WorldWideScience

Sample records for redufix ambulant sicherheit

  1. Business-Intelligence-Systeme im Spannungsfeld zwischen Usability und Sicherheit

    OpenAIRE

    Hinck, Thorsten

    2010-01-01

    Business-Intelligence-Systeme stehen im Spannungsfeld zwischen Usability und Sicherheit. Die Gefahren und Sicherheitsmaßnahmen für Informationssysteme werden ermittelt und ökonomisch in Bezug zur Gebrauchstauglichkeit gesetzt. Es entsteht ein Sicherheitsprofil für Business-Intelligence-Systeme. Business-Intelligence-Systems are in tension between Usability and IT-Security. Risks and safety measures of informationsystems are defined and set in (economic) regard to Usability. A security prof...

  2. Contribution to increase coach safety; Die Sicherheit von Omnibussen

    Energy Technology Data Exchange (ETDEWEB)

    Grandel, J.; Mueller, C.F.

    1996-09-01

    The risk of injuries for coach passengers is comparatively low. Nevertheless some periodical occurring serious accidents cause discussions about the coach safety. To objectivize this discussion and to find measures to increase coach safety the Dekra accident research team has started to analyse the real accident events. The basic instrument for this work is the Dekra accident database. The analysis of about 200 real coach accidents shows that single accidents and rollover accidents cause a high risk of serious injuries for the coach occupants. The ejection of unbelted passengers and the collapse of the roof structure are often cause of death and severe injury. To get more detailed information about the kinematic processes during the impact it was necessary to design crash tests based on the results of the real accident investigations. To realize these crash tests Dekra used its own crash centre in Neumuenster. The present study shoes that an integral passenger safety-system consisting of seat, restraint system and body structure is able to increase coach safety. The effectiveness of this system assumes an optimised interacting between every part of the system. (orig.) [Deutsch] Einzelne schwere Busunfaelle sorgen immer wieder fuer negative Schlagzeilen und fuehren zu Diskussionen ueber die Sicherheit von Omnibussen. Fehlendes Grundlagenwissen fuehrt dabei haeufig zu falschen Schlussfolgerungen. Wichtigste Basis fuer eine sachliche Diskussion und die Ableitung von Verbesserungsmassnahmen bildet eine sorgfaeltige und tiefgehende Analyse der realen Omnibusunfaelle. Das Defizit in der grundlegenden Erforschung von Busunfaellen wurde durch eine umfassende Unfallanalyse der Dekra-Unfallforschung beseitigt. Aus dem Realunfallgeschehen abgeleitete und im Dekra-Crash-Zentrum durchgefuehrte Versuche vervollstaendigen das Gesamtbild und geben detaillierte Erkenntnisse bezueglich der Kinematik von Omnibus und Businsassen. Ausgehend von einem bereits hohen Sicherheitsniveau

  3. Loopbaanbeleid bij brandweer en ambulance

    NARCIS (Netherlands)

    Nauta, A.; Winthagen,T.; Stark, K.

    2005-01-01

    TNO onderzocht in opdracht van de sociale partners in de gemeentelijke CAO-onderhandelingen hoe loopbaanbeleid bij Brandweer en Ambulance vorm kan krijgen. Er is gekeken naar herplaatsingsmogelijkheden, loopbaanmaatregelen, succesvol en minder-succesvol loopbaanbeleid en randvoorwaarden waaraan

  4. Safety - thanks to the freedom to decide; Sicherheit durch Entscheidungsfreiheit

    Energy Technology Data Exchange (ETDEWEB)

    Brandes, B. [Brandes GmbH, Eutin (Germany)

    1994-12-01

    Vorstoss mehr Vor- als Nachteile bringt, muessen daher die entscheiden, die als Auftraggeber Nutzen aus der Fernheizleitung und Sicherheit fuer das investierte Geld aus dem Sicherheitssystem ziehen wollen. Eine Fehlentscheidung waere endgueltig und kritisch fuer die Fernwaerme. (orig./KO)

  5. The carbon footprint of Australian ambulance operations.

    Science.gov (United States)

    Brown, Lawrence H; Canyon, Deon V; Buettner, Petra G; Crawford, J Mac; Judd, Jenni

    2012-12-01

    To determine the greenhouse gas emissions associated with the energy consumption of Australian ambulance operations, and to identify the predominant energy sources that contribute to those emissions. A two-phase study of operational and financial data from a convenience sample of Australian ambulance operations to inventory their energy consumption and greenhouse gas emissions for 1 year. State- and territory-based ambulance systems serving 58% of Australia's population and performing 59% of Australia's ambulance responses provided data for the study. Emissions for the participating systems totalled 67 390 metric tons of carbon dioxide equivalents. For ground ambulance operations, emissions averaged 22 kg of carbon dioxide equivalents per ambulance response, 30 kg of carbon dioxide equivalents per patient transport and 3 kg of carbon dioxide equivalents per capita. Vehicle fuels accounted for 58% of the emissions from ground ambulance operations, with the remainder primarily attributable to electricity consumption. Emissions from air ambulance transport were nearly 200 times those for ground ambulance transport. On a national level, emissions from Australian ambulance operations are estimated to be between 110 000 and 120 000 tons of carbon dioxide equivalents each year. Vehicle fuels are the primary source of emissions for ground ambulance operations. Emissions from air ambulance transport are substantially higher than those for ground ambulance transport. © 2012 The Authors. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  6. [Ambulant treatment of alcohol withdrawal].

    Science.gov (United States)

    Nüstedt, Volker

    2016-07-01

    Most of the patients addicted to alcohol are socially well integrated. The offer of a low threshold ambulant withdrawal therapy opens an opportunity to build a sustainable therapeutic relationship. The so started empathic addiction therapy will be well accepted and will lead to a satisfying outcome. Using Clomethiazole or Oxazepam in a daily reduced dose and with daily personal contacts, the ambulant withdrawal in patients without seizures or delir in medical history is a secure and successful therapeutic option. © Georg Thieme Verlag KG Stuttgart · New York.

  7. Ambulation in persons with myelomeningocele

    OpenAIRE

    Bartonek, Åsa

    2001-01-01

    The aim was to study ambulatory function in persons with myelomeningocele. Different systems used to classify the extent of motor paresis were compared. The classification according to five commonly used systems showed a lack of congruence in classes L3 level and downward. In relation to functional ambulation groups of Hoffer, none of the patients could be classified in the same categories by all classification systems. The patient's orthopedic and neurologic status with res...

  8. Hourly associations between heat and ambulance calls.

    Science.gov (United States)

    Guo, Yuming

    2017-01-01

    The response speed of ambulance calls is very crucial to rescue patients suffering immediately life threatening conditions. The serious health outcomes might be caused by exposing to extreme heat only several hours before. However, limited evidence is available on this topic. This study aims to examine the hourly association between heat and ambulance calls, to improve the ambulance services and to better protect health. Hourly data on ambulance calls for non-accidental causes, temperature and air pollutants (PM10, NO2, and O3) were collected from Brisbane, Australia, during 2001 and 2007. A time-stratified case-crossover design was used to examine the associations between hourly ambulance calls and temperature during warm season (Nov, Dec, Jan, Feb, and Mar), while adjusting for potential confounders. Stratified analyses were performed for sex and age groups. Ambulance calls peaked at 10am for all groups, except those aged 27 °C) increase the demands of ambulance. This information is helpful to increase the efficiency of ambulance service then save lives, for example, preparing more ambulance before appearance of extremely hot temperature in combination with weather forecast. Also, people should better arrange their time for outdoor activities to avoid exposing to extreme hot temperatures. Copyright © 2016 Elsevier Ltd. All rights reserved.

  9. Riding Third: Social Work in Ambulance Work

    Science.gov (United States)

    Campbell, Hilary; Rasmussen, Brian

    2012-01-01

    This research explored the possible role of social work alongside emergency ambulance services. An ethnographic study included semistructured interviews and direct observations collected over 300 hours while riding in ambulances in an urban setting. The data suggest that social work could play a role by providing needed psychosocial care during…

  10. Metagenomic characterization of ambulances across the USA.

    Science.gov (United States)

    O'Hara, Niamh B; Reed, Harry J; Afshinnekoo, Ebrahim; Harvin, Donell; Caplan, Nora; Rosen, Gail; Frye, Brook; Woloszynek, Stephen; Ounit, Rachid; Levy, Shawn; Butler, Erin; Mason, Christopher E

    2017-09-22

    Microbial communities in our built environments have great influence on human health and disease. A variety of built environments have been characterized using a metagenomics-based approach, including some healthcare settings. However, there has been no study to date that has used this approach in pre-hospital settings, such as ambulances, an important first point-of-contact between patients and hospitals. We sequenced 398 samples from 137 ambulances across the USA using shotgun sequencing. We analyzed these data to explore the microbial ecology of ambulances including characterizing microbial community composition, nosocomial pathogens, patterns of diversity, presence of functional pathways and antimicrobial resistance, and potential spatial and environmental factors that may contribute to community composition. We found that the top 10 most abundant species are either common built environment microbes, microbes associated with the human microbiome (e.g., skin), or are species associated with nosocomial infections. We also found widespread evidence of antimicrobial resistance markers (hits ~ 90% samples). We identified six factors that may influence the microbial ecology of ambulances including ambulance surfaces, geographical-related factors (including region, longitude, and latitude), and weather-related factors (including temperature and precipitation). While the vast majority of microbial species classified were beneficial, we also found widespread evidence of species associated with nosocomial infections and antimicrobial resistance markers. This study indicates that metagenomics may be useful to characterize the microbial ecology of pre-hospital ambulance settings and that more rigorous testing and cleaning of ambulances may be warranted.

  11. EMT knowledge of ambulance traffic laws.

    Science.gov (United States)

    Whiting, J D; Dunn, K; March, J A; Brown, L H

    1998-01-01

    The safe operation of ambulances using warning lights and siren requires both the public and emergency medical technician (EMT) drivers to understand and obey relevant traffic laws. However, EMTs may be unfamiliar with these laws. The purpose of this study was to evaluate EMTs' knowledge of traffic laws related to the operation of ambulances with warning lights and sirens. North Carolina EMTs participating in a statewide EMS conference October 6-8, 1995, completed a five-question survey. Knowledge of ambulance speed limits, yielding at intersections, yielding in roadways, and following distances was assessed using a multiple-choice format. Demographic data pertaining to EMT age, years of experience, paid vs volunteer status, driver's education courses, and past accident involvement were also obtained. Proportions were compared using chi-square analysis, alpha = 0.05. Two-hundred ninety-three of 308 (95%) EMTs attending the conference completed questionnaires. The median number of correct responses to the five knowledge questions was 1 (range 0-4). Thirty-three percent of the EMTs knew that other vehicles are required by law to yield while either approaching or being overtaken by an ambulance with warning lights and sirens; 2% knew that due regard for safety is the only requirement of an ambulance approaching a red light at an intersection; 14% knew that the minimum following distance behind an ambulance is one city block; and 28% knew that there is no speed limit on ambulances with warning lights and sirens. Respondents were more likely to score above the median if they had taken one or more emergency driver's education courses or had nine years or more of EMS experience. In this sample, EMT knowledge of basic traffic laws pertaining to ambulance operation is poor. Emergency driver's education courses and increased experience appear to be related to increased knowledge scores. Increased training for EMTs about traffic laws may improve the safe operation of

  12. Air ambulance medical transport advertising and marketing.

    Science.gov (United States)

    2011-01-01

    The National Association of EMS Physicians (NAEMSP), the American College of Emergency Physicians (ACEP), the Air Medical Physician Association (AMPA), the Association of Air Medical Services (AAMS), and the National Association of State EMS Officials (NASEMSO) believe that patient care and outcomes are optimized by using air medical transport services that are licensed air ambulance providers with robust physician medical director oversight and ongoing quality assessment and review. Only air ambulance medical transport services with these credentials should advertise/market themselves as air ambulance services.

  13. Occupational hazards in a public ambulance service.

    Science.gov (United States)

    Constantin, Brânduşa; Morariu, S; Duma, Olga Odetta

    2013-01-01

    To identify the occupational risks in an ambulance service and to assess their impact on the health of employees. Two marched groups (number, sex, age, length of exposure) from two different work sectors were selected. A 60 item questionnaire was used. The 60 items were grouped into four categories related to work organization, work environment, neuropsychosensorial risk factors and health system and occupational safety-related risk factors and hazards. The data were statistically processed, significant correlations between the risk factors and the associated symptoms being found. Compared to the control group, significantly higher values (p<0.001) for work complexity, work environment factors, and organizational risk factors (walking on uneven ground, carrying weight, vicious postures) were found in ambulance service staff; cervical and lumbar spine problems were the most common complaints of ambulance service staff. The specific risk factors for ambulance service employees directly related to musculoskeletal disorders have been established.

  14. [Customer orientation in ambulant medicine].

    Science.gov (United States)

    Heinrich, M

    2014-07-01

    Due to developments of the health market, economic aspects of the health system are more relevant. In this upcoming market the patient is regarded as customer and the doctor as provider of medical services. Studies on customer orientation in the ambulant medicine lag behind this dynamic. An aim of the study is to comprehend the attitudes of the doctors referring to the customer orientation. In a second step the findings are discussed according to statements of health-care paticipants. Developments in role comprehension of doctor and patient are focused to gain results in scientific and practical applications. Guideline-supported, partly narrative interviews with n=9 gynaecologists and n=11 general practitioners in Freiburg/Germany are recorded, transcribed and reviewed in a qualitative analysis. The statements of the doctors show patient satisfaction has an incremental meaning sspecially regarding the sequence of patient relationship and economic management of the doctor's workplace. The doctor's role comprehension meets with a refusal of the role of salesman and the patient as customer. The method of interviews is suitable to gather empirical impressions of the doctors. The control sample is adequate, however a bias due to inhomogeneous thematic affinitiy and local social-demographics might be possible. The customer orientation has become an important factor in doctor-patient relationtships. The relevance of the doctor-patient conversation and the risk of misuse of the patient confidence are mentioned by the doctors. The doctor as paternalistic care provider gives way to the customer-focused service provider. The doctor's necessity of autonomyssss and dependency on patient satisfaction have potential for conflict. Intensive mention of customer orientation in medicine in the media emphasises its importance. Rational handling with the possibilities of individual health markets is a prospective challange. Further research could be established in all aspects of

  15. Active safety of industrial vehicles - status report 2003; Stand der aktiven Sicherheit von Nutzfahrzeugen - Statusreport 2003

    Energy Technology Data Exchange (ETDEWEB)

    Glasner, E.C. von [DaimlerChrysler AG, Stuttgart (Germany)

    2003-07-01

    Systematic improvement of the safety of industrial vehicles will require the enhanced use of intelligent mechatronic systems, especially those that ensure higher directional stability. Further, improved tyres are required for making full use of these systems. Research on tyre improvements should focus on directional stability without neglecting classic parameters like wear, grip, and comfort. Last but not least, all systems should be available at reasonable cost. [German] Der systematische Weg, um die aktive Sicherheit von Nutzfahrzeugen weiter zu verbessern, wird mehr und mehr den Einsatz von intelligenten mechatronischen Systemen erfordern, besonders bei Systemen fuer die Verbesserung von Fahrstabilitaet von Einzelfahrzeugen und Lastzuegen. Hier spielt in kritischen fahrdynamischen Situationen aber auch die Leistungsfaehigkeit des Reifens eine grosse Rolle. Die Vorteile solcher Sicherheitssysteme koennen deshalb nur genutzt werden, wenn die Leistungsfaehigkeit der Reifen weiter gesteigert werden kann, d.h. die Betonung bei der Reifenentwicklung fuer Nutzfahrzeuge muss auf der Erhoehung der uebertragbaren Seiten- und Laengskraefte unter Beibehaltung des heutigen Schraegwinkel - und Schlupfniveaus liegen. Selbstverstaendlich darf eine solche Weiterentwicklung nicht die ueblichen Reifenparameter, wie z.B. Verschleiss, Rollwiderstand und Komfort negativ beeinflussen. Ein abschliessender Aspekt in diesem Prozess, den man nicht ignorieren kann, ist der Einsatz aller sicherheitsbezogenen Systeme zu einem vernuenftigen und akzeptablen Preis, wobei gleichzeitig die ganzheitliche Oekonomie des Nutzfahrzeugs positiv beeinflusst werden sollte. (orig.)

  16. Safety through organizational learning; Sicherheit durch organisationales Lernen. Das Lernen aus Ereignissen und Beinahe-Ereignissen

    Energy Technology Data Exchange (ETDEWEB)

    Fahlbruch, B.; Miller, R.; Wilpert, B. [Technische Univ. Berlin, Fachbereich 11 Maschinenbau und Produktionstechnik (Germany)]|[Technische Univ. Berlin, Inst. fuer Psychologie (Germany)

    1998-11-01

    Systems safety is a characteristic of a system enabling it to function under the required operating conditions with a minimum of losses and unforeseen damage to the system and its environment and without any systems breakdowns. The system is influenced by human factors as those factors which, in a general way, influence people in working with a technical system, i.e., people, technology, and organization. Different approaches to learning from events, and processes of event analysis in nuclear technology are presented. The theoretical basis of the `Safety through Organizational Learning` event analysis technique is the sociotechnical event creation model, which postulates that events can be described as a chain of individual events arising from the joint action of factors contributing directly and indirectly. (orig.) [Deutsch] Systemsicherheit ist die Eigenschaft eines Systems, die es diesem ermoeglicht, ohne Systemzusammenbrueche unter erforderlichen Betriebszustaenden mit einem Minimum an Verlusten und unvorhergesehenen Schaeden fuer das System und seine Umwelt zu funktionieren. Einfluss auf das System haben als Human Factors diejenigen Faktoren, die generell den Menschen beim Umgang mit einer technischen Anlage beeinflussen: Mensch, Technik und Organisation. Es werden unterschiedliche Ansaetze zum Lernen aus Ereignissen und Verfahren zur Ereignisanalyse in der Kerntechnik vorgestellt. Theoretische Grundlage des Ereignisanalyseverfahrens `Sicherheit durch Organisationales Lernen` ist das soziotechnische Ereignisentstehungsmodell, in dem postuliert wird, dass Ereignisse als eine Kette von Einzelereignissen beschrieben werden koennen, die aus dem Zusammenwirken direkt und indirekt kontribuierender Faktoren entstehen. (orig.)

  17. Cost-efficient evaluation of ambulance services for community ...

    African Journals Online (AJOL)

    Objectives: To determine the cost-efficient ambulance services appropriate for community critical care transport needs in Machakos County. Design: Descriptive cross sectional study. Setting: Machakos County (Emergencies Services Department) Subjects: Publically financed ambulances. Results: Machakos has seventy ...

  18. CERN'S Fire and Rescue Group Gets New Ambulance

    CERN Multimedia

    2000-01-01

    The ambulance is to replace another based on the off-road vehicle design which was originally acquired for the civil engineering phase of LEP construction. Just one figure, in 1999, the CERN ambulance was called out 195 times.

  19. User reflection on actions in ambulance telemedicine systems

    DEFF Research Database (Denmark)

    Hansen, Magnus

    2010-01-01

    Much information is shared, interpreted and recreated between caller, emergency dispatch personnel and ambulance crew during an emergency call. This paper studies the use of reflection in the ambulance control center based on the information an ambulance crew produces during patient treatment in ...... to understand and use the feedback delivered through the system. The paper argues for broadening the scope of telemedicine use outside the boundaries of communication between ambulance and emergency department....

  20. Status quo and development of passive safety for passenger cars; Stand und Entwicklung der passiven Pkw-Sicherheit

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, C.F.; Grandel, J.

    1999-05-01

    The constant improvement of passive safety for modern passenger cars is obvious from the drop in fatal traffic accidents. The restraint systems `seat belt` and `airbag` play an important part in this. Other protective systems will be introduced in the future - but the costs will rise out of all proportion to the benefits. (orig.) [Deutsch] Die stetige Verbesserung der passiven Sicherheit moderner Personenwagen ist deutlich zu spueren: am Rueckgang der Verkehrsunfaelle mit Todesfolge. Die Rueckhaltesysteme Gurt und Airbag haben daran grossen Anteil. Auch kuenftig werden weitere Schutzsysteme eingefuehrt - der Aufwand steigt allerdings staerker als der Nutzen. (orig.)

  1. Higher safety and lower environmental stress in mining; Verbesserung der Sicherheit bei gleichzeitiger Minderung der Umweltbelastung in der Gewinnungstechnik

    Energy Technology Data Exchange (ETDEWEB)

    Wolter, N.; Myszkowski, M.

    2000-07-01

    Highly mechanised mines have safety problems, owing to the fact that high productivity and a high degree of automation result in concentration of different working stages, workers and machines in cramped space. Dangerous workplaces must be moved to other parts of the mine. Maintenance and repair times must be reduced and co-ordinated as far as possible, especially in longwall mining. In the first development stage, the projecting and dimensioning of coal plough and drum shearer loader systems will be improved on the basis of coal seam data. This regards machine design, load share distribution, and mine boundary conditions. In the second stage, investigations will be carried out on how to avoid cutting of bedrock, unless absolutely necessary, by means of automatic control. The third series of investigations will go into preventive measures for those parts of the seam where bedrock cutting is unavoidable, e.g. when working through faults. The fourth section will attempt to improve safety by means of improved environmental conditions, especially optimized water control at the drum shearer loader. [German] Die Sicherheit der Belegschaft in den hochmechanisierten Abbaubetriebspunkten ist nicht immer voll befriedigend. Die Ursachen hierfuer liegen darin, dass bei stark gestiegener Betriebspunktfoerdermenge und wachsendem Mechanisierungsgrad insbesondere im Strebbereich zeitweise unterschiedlichste Arbeitsvorgaenge, Menschen und Maschinen, auf engstem Raum konzentriert werden. Hier sind Massnahmen und Techniken zur Verbesserung der Sicherheit in den Abbaubetriebspunkten zu entwickeln. Insbesondere Arbeitsplaetze mit einem hohen Gefaehrdungspotential sollen durch Weiterentwicklung und Verbesserung der Betriebsmittel in weniger gefaehrdete Bereiche verlegt werden. Der Wartungs- und Reparaturaufwand soll gesenkt und durch Ertuechtigung der Betriebsmittel und Verfahrensweisen eine planmaessige Wartung und Reparatur in sicheren Bereichen ermoeglicht werden. Das gilt besonders

  2. Leg Spasticity and Ambulation in Multiple Sclerosis

    Directory of Open Access Journals (Sweden)

    Swathi Balantrapu

    2014-01-01

    Full Text Available Background. Spasticity of the legs is common in multiple sclerosis (MS, but there has been limited research examining its association with ambulatory outcomes. Objective. This study examined spasticity of the legs and its association with multiple measures of ambulation in persons with MS. Methods. The sample included 84 patients with MS. Spasticity of the legs was measured using a 5-point rating scale ranging between 0 (normal and 4 (contracted. Patients completed the 6-minute walk (6 MW, timed 25 foot walk (T25FW, and timed up-and-go (TUG, and O2 cost of walking was measured during the 6 MW. The patients undertook two walking trials on a GAITRite (CIR systems, Inc. for measuring spatial and temporal parameters of gait. The patients completed the Multiple Sclerosis Walking Scale-12 (MSWS-12 and wore an accelerometer over a seven-day period. Results. 52% (n=44 of the sample presented with spasticity of the legs. Those with leg spasticity had significantly worse ambulation as measured by 6 MW (P=0.0001, d=-0.86, T25FW (P=0.003,d=0.72, TUG (P=0.001, d=0.84, MSWS-12 (P=0.0001,d=1.09, O2 cost of walking (P=0.001, d=0.75, average steps/day (P<0.05, d=-0.45, and walking velocity (P<0.05, d=-0.53 and cadence (P<0.05, d=-0.46. Conclusion. Leg spasticity was associated with impairments in ambulation, including alterations in spatiotemporal parameters and free-living walking.

  3. Shoes versus sneakers in toddler ambulation.

    Science.gov (United States)

    Gould, N

    1985-10-01

    The purpose of this study was to determine the relative values and differences between shoes and sneakers for young children just learning to walk. In phase 1 of the study, 79 toddlers (47 females and 32 males), ranging in age from 11 months to 3 years, were carefully measured for footwear. Only 15 toddlers (19%) could be properly fitted in the medium-width sneakers that are currently available on the market. The majority of the measured toddlers required widths greater than D, and to accommodate these wider feet, it was necessary to fit them with longer sneakers than they actually needed otherwise, thus making ambulation a bit more difficult and clumsy. In phase 2, eight toddlers, randomly selected except for sex (four male and four female), ranging in age from 11 to 16 months who had been ambulating 2 weeks to 5 months, were tagged with an identifying letter and videotaped in four walking situations: sneakers on tile, shoes on tile, sneakers on rugging, and shoes on rugging. Four hours of video taping was edited down to one-half hour. Twenty-three observers (orthopaedic surgeons, pediatricians, and shoe fitters) carefully reviewed the tape on multiple occasions and came to the following conclusions: better fit, stance, gait, cadence, and stability were noted with shoes in all the toddlers and in all situations. Falls were three times more frequent in sneakers as compared to shoes on tile surfaces and five times more frequent on rugging. It was concluded that the slight economic advantage of sneakers over shoes was not that great to warrant jeopardizing the capabilities of the toddler in the earliest stages of ambulation.

  4. BURNOUT SYNDROM AMONG PUBLIC AMBULANCE STAFF.

    Science.gov (United States)

    Iorga, Magdalena; Dascalu, Neonila; Soponaru, Camelia; Ioan, Beatrice

    2015-01-01

    Healthcare professionals are frequently confronted with urgent situations and a high-risk human intervention. They are usually exposed to what is called burnout syndrome. To identify the effects of burnout syndrome on the professional conduct and attitudes of doctors and nurses who work in the Romanian public ambulance service. Secondary, the causal relationships between burnout and various socio-demographic variables were analyzed. The 20-item Toronto Alexithymia Scale (TAS- 20), Maslach Burnout Inventory and Job Satisfaction Questionnaire were administered to 122 ambulance doctors, nurses and drivers (62 females and 60 males). The degree of job satisfaction is the most important indicator of burnout syndrome. Significant differences were found between low and high alexithymic subjects. Women are more susceptible to experience higher levels of burnout than men. The level of burnout is influenced by the combined effect of job satisfaction and alexithymia. Burnout syndrome is a common problem among people working in the emergency medical system. The causes of job-related burnout have to be identified in order to apply an appropriate level of burnout intervention program and to increase the efficiency of coping strategies.

  5. Evaluating public ambulance service levels by applying a GIS based ...

    African Journals Online (AJOL)

    Ambulance vehicles are required to respond rapidly to medical emergencies. A number of factors may affect response times, most importantly the location of emergency services stations, the number of ambulance vehicles available at each station, road conditions and traffic volumes. To support spatial planning and provide ...

  6. Offload zone patient selection criteria to reduce ambulance offload delay

    NARCIS (Netherlands)

    Laan, Corine Maartje; Vanberkel, Peter T.; Boucherie, Richardus J.; Carter, Alix J.E.

    2016-01-01

    Emergency department overcrowding is a widespread problem and often leads to ambulance offload delay. If no bed is available when a patient arrives, the patient has to wait with the ambulance crew. A recent Canadian innovation is the offload zone—an area where multiple patients can wait with a

  7. Sinnvolle Lebensführung im Spannungsfeld von Risiko und Sicherheit Die Ethik der Risikominimierung im Lichte von Kierkegaards und Nietzsches Kritik der Moderne

    Directory of Open Access Journals (Sweden)

    Hüsch Sebastian

    2016-07-01

    Full Text Available Der Beitrag betrachtet die für die Gegenwartsgesellschaft charakteristische Orientierung an Sicherheit und Risikovermeidung vor dem Hintergrund der Reflexionen Søren Kierkegaards und Friedrich Nietzsches bezüglich der Abgründigkeit der menschlichen Existenz. Die Untersuchung wirft die Frage auf, ob die Suche nach einem im alltäglichen Sinne verstandenen „guten Leben“ letzten Endes zu Lasten der Möglichkeiten einer als sinnhaft erlebten Existenz geht.

  8. Reducing ambulance response times using discrete event simulation.

    Science.gov (United States)

    Wei Lam, Sean Shao; Zhang, Zhong Cheng; Oh, Hong Choon; Ng, Yih Ying; Wah, Win; Hock Ong, Marcus Eng

    2014-01-01

    The objectives of this study are to develop a discrete-event simulation (DES) model for the Singapore Emergency Medical Services (EMS), and to demonstrate the utility of this DES model for the evaluation of different policy alternatives to improve ambulance response times. A DES model was developed based on retrospective emergency call data over a continuous 6-month period in Singapore. The main outcome measure is the distribution of response times. The secondary outcome measure is ambulance utilization levels based on unit hour utilization (UHU) ratios. The DES model was used to evaluate different policy options in order to improve the response times, while maintaining reasonable fleet utilization. Three policy alternatives looking at the reallocation of ambulances, the addition of new ambulances, and alternative dispatch policies were evaluated. Modifications of dispatch policy combined with the reallocation of existing ambulances were able to achieve response time performance equivalent to that of adding 10 ambulances. The median (90th percentile) response time was 7.08 minutes (12.69 minutes). Overall, this combined strategy managed to narrow the gap between the ideal and existing response time distribution by 11-13%. Furthermore, the median UHU under this combined strategy was 0.324 with an interquartile range (IQR) of 0.047 versus a median utilization of 0.285 (IQR of 0.051) resulting from the introduction of additional ambulances. Response times were shown to be improved via a more effective reallocation of ambulances and dispatch policy. More importantly, the response time improvements were achieved without a reduction in the utilization levels and additional costs associated with the addition of ambulances. We demonstrated the effective use of DES as a versatile platform to model the dynamic system complexities of Singapore's national EMS systems for the evaluation of operational strategies to improve ambulance response times.

  9. Factors associated with community ambulation in chronic stroke.

    Science.gov (United States)

    Durcan, Sarah; Flavin, Evelyn; Horgan, Frances

    2016-01-01

    Loss of independent community ambulation is one of the most disabling consequences of stroke. The aim of this study was to investigate the association of multiple personal and post-stroke factors with community ambulation in persons between 1- and 3-year post-stroke. This was a cross-sectional study of 40 community-dwelling stroke patients, >18 years, between 1- and 3-year post-stroke. The main outcome measures used were self-report community ambulation questionnaire, demographic information, 10-M Walk Test, Timed Up and Go test, Activities-Specific Balance Confidence Scale, Fatigue Severity Scale, Hospital Anxiety and Depression Scale, Trail-Making Test-Part B, Single Letter Cancellation Test. Age, number of medications and use of a walking aid were found to be significantly associated with community ambulation (p ≤ 0.05). Gait speed, walking balance and balance self-efficacy were also found to be significantly associated with community ambulation (p ≤ 0.05). Balance self-efficacy was the only factor independently associated with community ambulation post-stroke (p ≤ 0.05). Balance self-efficacy may be a significant determinant in the attainment of independent community ambulation post-stroke. This suggests that physical aspects such as gait speed and walking balance should not be considered in isolation when addressing community ambulation post-stroke. Balance self-efficacy may play a significant role in the attainment of independent community ambulation in a chronic stroke population. Physiotherapy interventions addressing community ambulation post-stroke should consider methods for improving balance self-efficacy in chronic stroke, such as self management programmes.

  10. Factors influencing ambulance nurses' adherence to a national protocol ambulance care: an implementation study in the Netherlands

    NARCIS (Netherlands)

    Ebben, R.H.; Vloet, L.C.M.; Grunsven, P.M. van; Breeman, W.; Goosselink, B.; Lichtveld, R.A.; Groot, J. de; Achterberg, T. van

    2015-01-01

    OBJECTIVES: Adherence to prehospital guidelines and protocols is suboptimal. Insight into influencing factors is necessary to improve adherence. The aim of this study was to identify factors that influence ambulance nurses' adherence to a National Protocol Ambulance Care (NPAC). METHODS: A

  11. Driver assistance - Firstly a contribution to primary safety or rather to comfort?; Fahrerassistenz primaer zum Komfort oder fuer die Sicherheit?

    Energy Technology Data Exchange (ETDEWEB)

    Bubb, H. [TU Muenchen, Garching (Germany). Lehrstuhl fuer Ergonomie

    2003-07-01

    Doubtless assistance systems should contribute to the safety of car driving. They support simultaneously a comfortable use of the car. Especially the operation comfort is characterised by clarity, self explaining, robustness against errors, and so on. Operation comfort doesn't give an inessential contribution to a reliable and appropriate interaction between driver and vehicle that means also a contribution to a reliable function of the total system and thereby to safety. Therefore the subjective experience of assistance systems is of excellent importance with view on the subjective and public confidence in new assistance systems. Are they seen rather as a gain of comfort, as it is preferred by the producer by reasons of production related liability, or as an easing of the driver's behaviour providing safety? Consists in the last called tendency a new kind of danger? In this connection juristic problems may not be unmentioned. The driver may not or not completely be called to account for procedures on which he has no influence or thinks to have no influence. In this case the account for the not compensated damage is contributed to the producer of the system. Therefore, by considering human characteristics and abilities of the driver during the development of assistance systems unwanted juristic consequences should be prevented. (orig.) [German] Assitenzsysteme sollen zweifellos einen Beitrag fuer die Sicherheit des Autofahrers liefern. Zugleich dienen sie aber auch fuer eine komfortable Nutzung des Fahrzeugs. Speziell der Bedienkomfort ist durch leichte Verstaendlichkeit, Selbsterklaerbarkeit, Fehlerrobustheit u.ae. charakterisiert. Durch ihn wird ein nicht unwesentlicher Beitrag zur sicheren und zweckdienlichen Interaktion zwischen Fahrer und Fahrzeug geleistet, also auch ein Beitrag fuer die zuverlaessige Funktion des Systems und damit fuer die Sicherheit. Von herausragender Bedeutung insbesondere im Hinblick auf das subjektive und das oeffentliche

  12. Ambulation of patients who are mechanically ventilated: Nurses' views

    OpenAIRE

    Curtis, Lee; Irwin, Julie

    2017-01-01

    Aims Equipment and skills in intensive care have advanced dramatically, and early rehabilitation and ambulation for patients in intensive care units (ICUs) is part of their journey to recovery. The aim of this study is to increase understanding of nurses’ perspectives on ambulating mechanically ventilated patients, and to determine why this is not a routine part of ICU patient care.\\ud Method An interpretative phenomenological analysis method was used to extract data from semi- structured int...

  13. [Prehospital treatment. The Odense ambulance project. A prospective study].

    Science.gov (United States)

    Larsen, C F; Jørgensen, H R; Nielsen, J R; Skov, O; Lybecker, H; Hole, P; Nielsen, H; Haghfelt, T

    1990-06-25

    No legislation exists about ambulance services in Denmark. The present Danish prehospital treatment is undertaken by Falcks Redningskorps A/S and the municipal fire services. During a period of 12 months (1.2.1988-31.1.1989) a prospective investigation was carried out in Odense concerning the effect of medical support to the ambulance service, partly in the form of a medically staffed ambulance, partly in the form of an arrangement in which an independent doctor's car (rendez-vous arrangement) was sent together with the nearest ambulance. In addition, the heart ambulance model as recommended by the Danish National Board of Health was also tested. Experience from abroad and recent Danish trial arrangements demonstrate the positive effect of extended professional prehospital treatment. The authors consider, therefore, that an ambulance law is required as this would ensure better and more uniform prehospital treatment in Denmark. Planning of the future prehospital treatment of acute and injured patients including the extent of the training, equipment and treatment must be established on the basis of a healtheconomical assessment of the Danish arrangements.

  14. Technical safety management district heating; Technisches Sicherheitsmanagement (TSM) Fernwaerme. Ueberpruefung der Aufbau- und Ablauforganisation sowie der technischen Sicherheit von FVU

    Energy Technology Data Exchange (ETDEWEB)

    Brunn, H. von [Vereinigung Deutscher Elektrizitaetswerke e.V. (VDEW), Frankfurt am Main (Germany); Herbst, A. [DREWAG Stadtwerke Dresden GmbH (Germany); Hoffer, A. [EVH GmbH, Halle (Germany); Meigen, M. [Stadtwerke Leipzig (Germany); Siedler, W. [Stadtwerke Hannover AG (Germany)

    2003-08-01

    Anyone creating sources of danger in a public place must take proper precautions to prevent a hazard from actually arising. Work such as the construction or renovation of generating plants, pipe networks or district heat substations, the operation of heating installations and plants and the use of heating water and steam as media for the supply or district heating are potential sources of danger which may lead to accidents. The utility is liable for material damage and bodily harm. The only possible way of precluding liability is to prove that it has taken all possible measures for precluding risk at the outset within the organization itself, to the greatest possible extent. Not only must administration and line management be properly structured for this purpose, but administrative efficiency must also be demonstrated by a working system of delegation of tasks and responsibilities and the optimum organisation of processes and interfaces. (orig.) [German] Im AGFW-Arbeitsblatt FW 1000 'Anforderungen an die Qualifikation und die Organisation des technischen Bereichs von Fernwaermeversorgungsunternehmen' werden organisatorische, personelle sowie sicherheits- und betriebstechnische Mindestanforderungen fuer die Planung den Bau und den Betrieb von Nah- und Fernwaermeversorgungsanlagen beschrieben. Zur Bestaetigung der Anforderungserfuellung ist entweder eine Selbsteinschaetzung durch das Unternehmen oder die Ueberpruefung durch die AGFW vorgesehen. Hierfuer wurde ein Zertifizierungsverfahren entwickelt, das ab sofort von der gesamten Branche genutzt werden kann. (orig.)

  15. THESEUS - achieving maximum possible road transport tanker safety by means of experimental accident simulation; THESEUS - Tankfahrzeuge mit hoechsterreichbarer Sicherheit durch experimentelle Unfallsimulation

    Energy Technology Data Exchange (ETDEWEB)

    Rompe, K.; Heuser, G.

    1996-03-01

    In spring 1990, the Federal German Minister for Education, Science, Research and Technology (BMBF) commissioned the team from the Federal Institute for Materials Research and Testing (BAM), DEKRA, Daimler-Benz, the Federal Road Research Institute (BASt) with the University of Cologne, Ellinghaus and TUeV Rheinland (project leader) to perform the research project `THESEUS` (the acronym THESEUS comes from the German `Tankfahrzeuge mit hoechst erreichbarer Sicherheit durch experimentelle Unfallsimulation`, which translates as `achieving maximum possible road transport tanker safety by means of experimental accident simulation`). Arting from an analysis of road transport tanker accidents, crash tests and overturn tests were performed and supplemented by investigations of road transport tanker components and accompanying complex calculations of the failure processes. Parallel to this, the static side-tilt stability of road transport tankers was determined on a tilting test platform. The causes of and constructive possibilities for avoiding overturning, which is the most common cause of accidents in which hazardous materials escape, wewre analysed in dynamic driving tests with supplementary computer simulation. Various measures for improving the safety of road transport tankers were determined and subjected to a cost-benefit analysis. (orig.) [Deutsch] Das Bundesministerium fuer Bildung, Wissenschaft, Forschung und Technologie hat seit 1990 das Forschungsproject `THESEUS` (Tankfahrzeuge mit hoechst erreichbarer Sicherheit durch experimentelle Unfallsimulation) der Arbeitsgemeinschaft aus TUeV Rheinland (Federfuehrung), Bundesanstalt fuer Materialforschung und -pruefung (BAM), DEKRA, Daimler Benz, Bundesanstalt fuer Strassenwesen (BASt), Universitaet Koeln und Ellinghaus gefoerdert. Ausgehend von der detaillierten Analyse von 231 Tankfahrzeugunfaellen wurden Tankfahrzeug-Crashversuche und Tankfahrzeug-Umsturzversuche durchgefuehrt. Diese Messungen an kompletten Fahrzeugen

  16. Neighborhood Poverty and 9-1-1 Ambulance Contacts.

    Science.gov (United States)

    Seim, Josh; English, Joshua; Sporer, Karl

    2017-01-01

    Neighborhood poverty is positively associated with frequency of 9-1-1 ambulance utilization, but it is unclear whether this association remains significant when accounting for variations in the severities and types of ambulance contacts. We merged EMS ambulance contact records in a single California county (n = 88,027) with data from the American Community Survey at the census tract level (n = 300). Using tract as a proxy for neighborhood and negative binomial regression as an analytical tool, we predicted 16 outcomes: any ambulance contacts, ambulance contacts stratified by three intervention severities, and ambulance contacts varied by 12 primary impression categories. For each model, we estimated the incident rate ratios for 10 percentage point increases in tract-level poverty while controlling for geographic patterns in race, citizenship, gender, age, emergency department proximity, population density, and population size. Our study produced three major findings. First, tract-level poverty was positively associated with ambulance contacts (incident rate ratio [IRR] 1.45; 95% confidence interval [CI] 1.34 to 1.57). Second, poverty was positively associated with low severity contacts (IRR 1.48; 95% CI 1.35 to 1.61), medium severity contacts (IRR 1.38; 95% CI 1.28 to 1.49), and high severity contacts (IRR 1.40; 95% CI 1.30 to 1.51). Third, poverty was positively associated with 12 primary impression categories: abdominal (IRR 1.48; 95% CI 1.36 to 1.61), altered level of consciousness (IRR 1.37; 95% CI 1.25 to 1.50), cardiac (IRR 1.28; 95% CI 1.14 to 1.42), overdose/intoxication (IRR 1.59; 95% CI 1.40 to 1.81), pain (IRR 1.56; 95% CI 1.41 to 1.73), psych/behavioral (IRR 1.50; 95% CI 1.34 to 1.67), respiratory (IRR 1.42; 95% CI 1.29 to 1.56) seizure (IRR 1.52; 95% CI 1.38 to 1.68), stroke (IRR 1.14; 95% CI 1.01 to 1.28), syncope/near syncope (IRR 1.23; 95% CI 1.12 to 1.36), trauma (IRR 1.44; 95% CI 1.31 to 1.58), and general weakness (IRR 1.31; 95% CI 1.20 to 1

  17. CERN'S Fire and Rescue Group Gets New Ambulance

    CERN Multimedia

    2000-01-01

    The arrival of a new vehicle is always an important moment in the life of a fire station. So when a new ambulance was delivered to the CERN Fire Brigade on Wednesday 16 September 2000, it was given a warm welcome, attended by staff of the different divisions involved in its purchase. It took a year from the first administrative moves to the day of acquisition. On the one hand there were the calls for tender needed for such a purchase and on the other the development of this custom-designed ambulance with its unique features. Three visits to the manufacturer had to be made, including two to the head office of the Miesen factory at Bonn to study and incorporate in the ambulance the special requirements called for by its future users. These requirements, born from the past experience of CERN’s ambulance crews, concerned not only interior arrangements but also included a new side panel, opening up a stowage compartment where everything will be put that gets dirty during ambulance operations. This will minimize ...

  18. Community-acquired pneumonia; Ambulant erworbene Pneumonien

    Energy Technology Data Exchange (ETDEWEB)

    Poetter-Lang, S.; Herold, C.J. [Medizinische Universitaet Wien, Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Wien (Austria)

    2017-01-15

    The diagnosis of community-acquired pneumonia (CAP) is often not possible based only on the clinical symptoms and biochemical parameters. For every patient with the suspicion of CAP, a chest radiograph in two planes should be carried out. Additionally, a risk stratification for the decision between outpatient therapy or hospitalization is recommended. Based on the evaluation of the different radiological patterns as well as their extent and distribution, a rough allocation to so-called pathogen groups as well as a differentiation between viral and bacterial infections are possible; however, because different pathogens cause different patterns an accurate correlation is not feasible by relying purely on imaging. The radiological findings serve as proof or exclusion of pneumonia and can also be used to evaluate the extent of the disease (e.g. monolobular, multilobular, unilateral or bilateral). In cases of prolonged disease, suspicion of complications (e.g. pleural effusion or empyema, necrotizing pneumonia or abscess) or comorbid conditions (e.g. underlying pulmonary or mediastinal diseases) computed tomography is an important diagnostic tool in addition to chest radiography. Ultrasound is often used to diagnose pleural processes (e.g. parapneumonic effusion or pleural empyema). (orig.) [German] Anhand der klinischen Symptome und laborchemischen Befundkonstellation alleine ist es oft nicht moeglich, die Diagnose einer ambulant erworbenen Pneumonie (''community-acquired pneumonia'', CAP) zu stellen. Bei jedem Patienten mit Verdacht auf CAP sollte eine Roentgenthoraxaufnahme in 2 Ebenen angefertigt werden. Weiter muss eine Risikostratifizierung im Sinne der Entscheidung ambulante Therapie vs. Hospitalisierung erfolgen. Anhand der Analyse radiologischer Muster sowie deren Verteilung und Ausdehnung koennen eine grobe Zuordnung zu sogenannten Erregergruppen sowie eine Differenzierung zwischen viralen und bakteriellen Infektionen gelingen. Da

  19. [Examination of work-related stress and coping strategies among ambulance- and air-ambulance workers].

    Science.gov (United States)

    Schiszler, Bence; Karamánné Pakai, Annamária; Szabó, Zoltán; Raposa, László Bence; Pónusz, Róbert; Radnai, Balázs; Endrei, Dóra

    2016-11-01

    Among Hungary's health sector workers the presence of a high level of stress is known, which can affect the individual. The aim of the authors was to uncover major risk factors causing work-related stress, as well as its extent, and positive and negative coping strategies among ground and aerial rescue workers. From June until October 2015, a national survey was conducted among Hungarian rescue workers. An own questionnaire and Rahe Stress and coping validated short questionnaire online form were used. A total of 141 persons took part in the survey. As compared to air-ambulance workers, ground rescue workers were exposed to higher work-related stress effects (pStress and Coping Index effective coping mechanisms were observed among air rescue workers (pstress reduction. Orv. Hetil., 2016, 157(45), 1802-1808.

  20. Efficacy and safety of intravenous fentanyl administered by ambulance personnel

    DEFF Research Database (Denmark)

    Friesgaard, Kristian Dahl; Nikolajsen, Lone; Giebner, Matthias

    2016-01-01

    BACKGROUND: Management of pain in the pre-hospital setting is often inadequate. In 2011, ambulance personnel were authorized to administer intravenous fentanyl in the Central Denmark Region. The aim of this study was to evaluate the efficacy and safety of intravenous fentanyl administered...... by ambulance personnel. METHODS: Pre-hospital medical charts from 2348 adults treated with intravenous fentanyl by ambulance personnel during a 6-month period were reviewed. The primary outcome was the change in pain intensity on a numeric rating scale (NRS) from before fentanyl treatment to hospital arrival....... Secondary outcomes included the number of patients with reduction in pain intensity during transport (NRS ≥ 2), the number of patients with NRS > 3 at hospital arrival, and potential fentanyl-related side effects. RESULTS: Fentanyl reduced pain from before treatment (8, IQR 7-9) to hospital arrival (4, IQR...

  1. A framework for the design of ambulance sirens.

    Science.gov (United States)

    Catchpole, K; McKeown, D

    2007-08-01

    Ambulance sirens are essential for assisting the safe and rapid arrival of an ambulance at the scene of an emergency. In this study, the parameters upon which sirens may be designed were examined and a framework for emergency vehicle siren design was proposed. Validity for the framework was supported through acoustic measurements and the evaluation of ambulance transit times over 240 emergency runs using two different siren systems. Modifying existing siren sounds to add high frequency content would improve vehicle penetration, detectability and sound localization cues, and mounting the siren behind the radiator grill, rather than on the light bar or under the wheel arch, would provide less unwanted noise while maintaining or improving the effective distance in front of the vehicle. Ultimately, these considerations will benefit any new attempt to design auditory warnings for the emergency services.

  2. Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy: a systematic review.

    Science.gov (United States)

    Clutterbuck, Georgina; Auld, Megan; Johnston, Leanne

    2018-01-05

    Evaluate effectiveness of active exercise interventions for improving gross motor activity/participation of school-aged, ambulant/semi-ambulant children with cerebral palsy (CP). A systematic review was conducted following PRISMA guidelines. Five databases were searched for papers including school-aged children with CP, participating in active, exercise interventions with gross motor outcomes measured at the Activity/Participation level. Interventions with previous systematic reviews were excluded (e.g. hippotherapy). Evidence Level and conduct were examined by two raters. Seven interventions (34 studies) met criteria. All studies reported on gross motor function, however, a limited number investigated participation outcomes. Strong positive evidence was available for Gross Motor Activity Training (n= 6, Evidence Level II-IV), and Gross Motor Activity Training with progressive resistance exercise plus additional physiotherapy (n = 3, all Evidence Level II). Moderate positive evidence exists for Gross Motor Activity Training plus additional physiotherapy (n = 2, all Evidence Level II) and Physical Fitness Training (n = 4, Evidence Level II-V). Weak positive evidence was available for Modified Sport (n = 3, Evidence Level IV-V) and Non-Immersive Virtual Reality (n = 12, Evidence Level II-V). There was strong evidence against Gross Motor Activity Training plus progressive resistance exercise without additional physiotherapy (n = 4, all Evidence Level II). Active, performance-focused exercise with variable practice opportunities improves gross motor function in ambulant/semi-ambulant children with CP. Implications for rehabilitation Active exercise interventions improve gross motor function of ambulant/semi-ambulant children with cerebral palsy. Gross Motor Activity Training is the most common and effective intervention. Practice variability is essential to improve gross motor function. Participation was rarely measured and requires further

  3. Evaluating public ambulance service levels by applying a GIS based accessibility analysis approach

    CSIR Research Space (South Africa)

    Baloyi, Ethel

    2017-08-01

    Full Text Available Ambulance vehicles are required to respond rapidly to medical emergencies. A number of factors may affect response times, most importantly the location of emergency services stations, the number of ambulance vehicles available at each station, road...

  4. Stress and organization change in the ambulance service

    NARCIS (Netherlands)

    Wastell, D.; Newman, M.

    1996-01-01

    The development of information systems (IS) is a problematic process that all too often ends in failure. This paper reports a comparative analysis of two projects involving the computerisation of ambulance control-room operations in London and Manchester. The outcomes were strikingly different. In

  5. The accuracy of Johannesburg-based ambulance personnel in ...

    African Journals Online (AJOL)

    Background. Stroke is a potentially life-threatening, time-dependent event that requires urgent management to reduce morbidity and mortality. It has been suggested that earlier recognition by ambulance personnel and transport to stroke centres may significantly reduce treatment delays. For this reason it is vitally important ...

  6. Perioperative transfusion threshold and ambulation after hip revision surgery

    DEFF Research Database (Denmark)

    Nielsen, Kamilla; Johansson, Pär I; Dahl, Benny

    2014-01-01

    BACKGROUND: Transfusion with red blood cells (RBC) may be needed during hip revision surgery but the appropriate haemoglobin concentration (Hb) threshold for transfusion has not been well established. We hypothesized that a higher transfusion threshold would improve ambulation after hip revision ...

  7. Comparison of rural and urban ambulance crashes in Pennsylvania.

    Science.gov (United States)

    Ray, Adam M; Kupas, Douglas F

    2007-01-01

    To describe and compare the characteristics of, and associated injuries caused by, ambulance crashes that occur in rural versus urban areas. Crash data collected by the Pennsylvania Department of Transportation were obtained for ambulance crashes from 1997 to 2001. Crash demographics (e.g., location of crash, road conditions, and intersection type) and injuries reported by police were analyzed to determine differences, if any, between crashes occurring in rural and urban areas. 311 rural and 1,434 urban ambulance crashes were identified. Day and time of crash, light conditions, and road type were similar. Rural crashes were more likely to occur on snowy roads (13% vs. 5%) and at nighttime without street lighting (25% vs. 4%). Operator error was the most common cause of crashes (75% for rural; 93% for urban), whereas vehicle or environmental conditions more frequently affected rural drivers (25% vs. 7%). Urban crashes were more likely to involve angled collisions with other vehicles (54% vs. 19%), intersections (67% vs. 26%), and occur at a stop sign or signal (53% vs, 14%). Rural crashes often involved striking a fixed object (33% vs. 7%). Urban crashes more often involved more than one vehicle (88% vs. 56%) and more than four people total (35% vs. 23%). Pedestrian involvement was rare in both groups (traffic signals. Although more people and vehicles are often involved in urban ambulance crashes, the severity of injuries sustained are similar.

  8. The accuracy of Johannesburg-based ambulance personnel in ...

    African Journals Online (AJOL)

    It has been suggested that earlier recognition by ambulance personnel and transport to stroke centres may significantly reduce treatment ... 5% of BLS and 18.34% of ILS utilised validated stroke screening tools. ..... Thomas C, Mackey E. Influence of a clinical simulation elective on Baccalaureate nursing student clinical.

  9. ambulation during labor with combined spinal-epidural analgesia

    African Journals Online (AJOL)

    Adele

    tractions while preserving motor function, has led to the devel- opment of the ambulatory ... KM Kuczkowski. Assistant Clinical Professor of Anesthesiology and Reproductive Medicine director of Obstetric Anesthesia, Departments of Anesthesiology and .... If the patient is receiving an oxytocin infusion ambulation in close ...

  10. Ambulant disabled persons using buses: experiments with entrances and seats.

    Science.gov (United States)

    Petzäll, J

    1993-10-01

    This paper describes research work carried out in Sweden to adapt buses to the requirements of ambulant disabled people. It contains an experimental study where subjects tried different entrances and seats. For the experiments a bus was rebuilt and equipped with new entrance and seating arrangements. Three categories of subjects participated: seriously ambulant disabled, representing people having severe ambulatory difficulties in their daily life; less seriously ambulant disabled, representing people that normally travel with the special transportation service; and slightly ambulant disabled, representing ordinary elderly people. The evaluation was based on observations, photographs, interviews and in some cases timing with a stopwatch. The results show that low similar steps and well-designed handrails in the bus entrance made boarding and alighting easier. The seat trials showed the importance of having suitable grab rails to allow people to pull or heave themselves up. Design requirements are presented in the paper. The Swedish Board of Transport have used the results when working out regulations to adapt public transport vehicles for use by disabled people.

  11. Predictors of workplace violence among ambulance personnel : A longitudinal study.

    NARCIS (Netherlands)

    van der Velden, Peter; Bosmans, Mark; van der Meulen, Erik

    Abstract Aim To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed

  12. Evaluating public ambulance service levels by applying a GIS based ...

    African Journals Online (AJOL)

    Hunadi Mokgalaka

    distribution of demand (population), supply (station locations and ambulance numbers) and emergency road ... To do this it was necessary to audit the current supply and distribution of stations to identify areas ... that used digital road network data within a GIS system to model the transportation times from patient locations to ...

  13. Are bicycle ambulances and community transport plans effective in

    African Journals Online (AJOL)

    Results. Approximately 90 minutes of travel time was required with all forms transportation studied. Important cultural beliefs deterred most pregnant women from using the bicycle ambulances. People believe that publicisin g the onset of labour summons evil spirits resulting in obstructed labour. This explains why general.

  14. Risk of Transmission of MRSA on Contact Surfaces in Ambulance

    NARCIS (Netherlands)

    Lukas, R. -P.; Keppler, P. -A.; Brinkrolf, P.; Friedrich, A. W.; Van Aken, H.; Bohn, A.

    2015-01-01

    The gram-positive bacterium methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent causes of treatment-associated nosocomial infections. The incidence of MRSA among the population and in hospitalised patients is growing worldwide. Ambulance service is an interface between the

  15. Ambulance or taxi? High acuity prehospital transports in the Ashanti region of Ghana

    Directory of Open Access Journals (Sweden)

    C. Nee-Kofi Mould-Millman

    2014-03-01

    Conclusion: Although a minority of patients were transported by ambulance, they represented the most acute patients arriving at the KATH EC. Given the limited availability of EMS resources and ambulances in Ashanti, selective ambulance use appears warranted and should inform prehospital care planning.

  16. Neighborhood Poverty and 9-1-1 Ambulance Response Time.

    Science.gov (United States)

    Seim, Josh; Glenn, Melody J; English, Joshua; Sporer, Karl

    2018-01-30

    Are 9-1-1 ambulances relatively late to poorer neighborhoods? Studies suggesting so often rely on weak measures of neighborhood (e.g., postal zip code), limit the analysis to particular ambulance encounters (e.g., cardiac arrest responses), and do little to account for variations in dispatch priority or intervention severity. We merged EMS ambulance contact records in a single California county (n = 87,554) with tract-level data from the American Community Survey (n = 300). After calculating tract-level median ambulance response time (MART), we used ordinary least squares (OLS) regression to estimate a conditional average relationship between neighborhood poverty and MART and quantile regression to condition this relationship on 25th, 50th, and 75th percentiles of MART. We also specified each of these outcomes by five dispatch priorities and by three intervention severities. For each model, we estimated the associated changes in MART per 10 percentage point increase in tract-level poverty while adjusting for emergency department proximity, population density, and population size. Our study produced three major findings. First, most of our tests suggested tract-level poverty was negatively associated with MART. Our baseline OLS model estimates that a 10 percentage point increase in tract-level poverty is associated with almost a 24 s decrease in MART (-23.55 s, 95% confidence interval [CI] -33.13 to -13.98). Results from our quantile regression models provided further evidence for this association. Second, we did not find evidence that ambulances are relatively late to poorer neighborhoods when specifying MART by dispatch priority. Third, we were also unable to identify a positive association between tract-level poverty and MART when we specified our outcomes by three intervention severities. Across each of our 36 models, tract-level poverty was either not significantly associated with MART or was negatively associated with MART by a magnitude smaller than a full

  17. Transbrachial selective carotid DSA in outpatients: safety and efficacy; Diagnostische Sicherheit und Effizienz ambulanter transbrachialer selektiver Karotisangiographien

    Energy Technology Data Exchange (ETDEWEB)

    Rosen, T.; Poretti, F.; Vorwerk, D. [Klinikum Ingolstadt (Germany). Inst. fuer Diagnostische und Interventionelle Radiologie; Krawczynski, H. [Klinikum Ingolstadt (Germany). Chirurgische Klinik, Gefaesschirurgie

    2003-02-01

    Purpose: To describe safety and efficacy of transbrachial selective carotid digital subtraction angiography (DSA) in outpatients. Materials and Methods: From July 1999 to November 2001, selective carotid angiography was performed in 141 outpatients preferably using a left brachial arterial approach. The average age of the patients was 68 years (range: 39-89 years). After flush aortography through a 4F-pigtail catheter, bilateral selective common carotid artery (CCA) catheterization was performed with 4F-Sidewinder-1 or Sidewinder-2 catheters. In 49 patients, Doppler-sonography was performed before or after arteriography. A total of 41 patients underwent carotid surgery. Results: Selective catheterization of the CCA was successful in 96% of the cases. The diagnostic quality of the opacified aortra and CCA images was good to excellent. The overall complication rate did not exceed 2.1%, and severe complications were not observed. One patient showed transient neurological symptoms and another mild nausea and agitation, probably as toxic reaction to the contrast medium. A single local hematoma developed after unsuccessful puncture of the brachial artery. Conclusion: Transbrachial selective carotid DSA is safe, reliable and well-tolerated in outpatients and achieves a superimposition-free CCA visualization. (orig.) [German] Zielsetzung: Ziel der Arbeit ist, die Technik der transbrachialen selektiven Karotis-DSA zu beschreiben, und die Sicherheit und Effizienz der Methode bei ambulanten Patienten zu evaluieren. Material und Methodik: Von Juli 1999 bis November 2001 wurden bei insgesamt 141 ambulanten Patienten selektive Karotisangiographien in digitaler Subtraktionstechnik (DSA) durchgefuehrt. Das durchschnittliche Patientenalter betrug 68 Jahre (39-89 Jahre). Vorzugsweise wurde ein transbrachialer Zugangsweg von links gewaehlt und nach Darstellung des Aortenbogens mittels 4F-Pigtailkatheter die A.carotis communis (ACC) beidseits selektiv mit einem 4F-Sidewinder-1- oder

  18. Is the Ability to Ambulate Associated with Better Employment Outcomes in Participants with Traumatic Spinal Cord Injury?

    Science.gov (United States)

    Krause, James S.

    2010-01-01

    The author compares current employment status after spinal cord injury between participants who were independent in ambulation (required no assistance from others) and those who were dependent in ambulation (required assistance from at least one other person to ambulate). Those who were independent of assistance from others in ambulation were…

  19. Long-range transported Asian Dust and emergency ambulance dispatches.

    Science.gov (United States)

    Ueda, Kayo; Shimizu, Atsushi; Nitta, Hiroshi; Inoue, Kenichiro

    2012-10-01

    Asian Dust (AD) particles transported from source areas contribute to sharp increases in coarse particles in Japan. We examined the association of exposure to AD events with emergency ambulance dispatches in Nagasaki city. We also examined whether AD transported at different altitude routes from source areas influenced dispatch rates. Using lidar (light detection and ranging), we determined moderate AD days (0.066/km dust extinction coefficient ≤0.105/km) and heavy AD days (0.105/km dust extinction coefficient). We applied a time-stratified case-crossover analysis to estimate the association between AD days and emergency ambulance dispatches. There were 9,070 dispatches from March to May during 2003-2007. The heavy AD events at cumulative lag0-3 were associated with an increase in emergency dispatches due to all causes by 12.1% (95% confidence interval (CI), 2.3, 22.9) and an increase for those due to cardiovascular diseases by 20.8% (95% CI: 3.5, 40.9). We categorized 31 AD days based on backward trajectory analyses into AD days with lower altitude routes and those with higher altitude routes. We observed a greater increase in emergency ambulance dispatches on AD days with lower altitude routes compared with those on AD days with higher altitude routes although the difference was not significant (p for interaction 0.49). These results have shown that exposure to high AD particle levels could increase emergency ambulance dispatches due to illnesses such as cardiovascular stress, and that AD traveling through different routes may have different health effects.

  20. REGIONAL FACTORS RELATED WITH THE NUMBER OF AMBULANCE USERS

    Directory of Open Access Journals (Sweden)

    Kazuya Ikenishi

    2016-01-01

    Full Text Available Introduction: Ambulance use was increasing along with growth population of aged in Japan. The purpose of study paper is to clarify the relationship between the state of healthcare service use as well as regional characteristics and ambulance use on regions. The regions that were focused on in this study were 16 wards in Nagoya city, and those data for the past 10 years was analyzed. Methods: Analyzed variables in this study were those in previous studies reported had statistical significant with the number of ambulance use, as well as dummy variables represented year. These variables involved population and the number of household, the proportion of population aged 65 or over, the population of foreigners, proportion of livelihood protection recipients, regional health promotion measures, the proportion of health-checkups user, the number of retained motor vehicles. Spearman's rank correlation coefficient and multiple regression analysis were used. Results: This study included 160 data on 16wards in Nagoya city from 2004 to 2013. Results of multiple regression analysis showed that 6 variables were statistically significant: the number of households, population of foreigners, proportion of livelihood protection recipients, Colon cancer examinee rate, the number of participants in regional health promotion measures, the number of beds per 100,000 populations. Conclusion: This study founded that the variables related with the number of ambulance user were the number of households, population of foreigners, proportion of livelihood protection recipients, Colon cancer examinee rate, the number of participants in regional health promotion measures, number of beds per 100,000 populations.

  1. The Barbados Emergency Ambulance Service: High Frequency of Nontransported Calls

    Directory of Open Access Journals (Sweden)

    Sherwin E. Phillips

    2012-01-01

    Full Text Available Objectives. There are no published studies on the Barbados Emergency Ambulance Service and no assessment of the calls that end in nontransported individuals. We describe reasons for the nontransport of potential clients. Methods. We used the Emergency Medical Dispatch (Medical Priority Dispatch System instrument, augmented with five local call types, to collect information on types of calls. The calls were categorised under 7 headings. Correlations between call types and response time were calculated. Results. Most calls were from the category medical (54%. Nineteen (19% percent of calls were in the non-transported category. Calls from call type Cancelled accounted for most of these and this was related to response time, while Refused service was inversely related (. Conclusions. The Barbados Ambulance Service is mostly used by people with a known illness and for trauma cases. One-fifth of calls fall into a category where the ambulance is not used often due to cancellation which is related to response time. Other factors such as the use of alternative transport are also important. Further study to identify factors that contribute to the non-transported category of calls is necessary if improvements in service quality are to be made.

  2. Trends in diagnostic patterns and mortality in emergency ambulance service patients in 2007-2014

    DEFF Research Database (Denmark)

    Christensen, Erika Frischknecht; Bendtsen, Mette Dahl; Larsen, Thomas Mulvad

    : Population-based cohort study with linkage of Danish national registries. SETTING: The North Denmark Region in 2007-2014. PARTICIPANTS: Cohort of 148 757 patients transported to hospital by ambulance after calling emergency services. MAIN OUTCOME MEASURES: The number of emergency ambulance service patients......OBJECTIVE: Demand for ambulances is growing. Nevertheless, knowledge is limited regarding diagnoses and outcomes in patients receiving emergency ambulances. This study aims to examine time trends in diagnoses and mortality among patients transported with emergency ambulance to hospital. DESIGN......) to allow comparison by year, with 2007 as reference year. RESULTS: The annual number of emergency ambulance service patients increased from 24.3 in 2007 to 40.2 in 2014 per 1000 inhabitants. The proportions of women increased from 43.1% to 46.4% and of patients aged 60+ years from 39.9% to 48...

  3. Cross-sectional survey on self-reported health of ambulance personnel

    OpenAIRE

    Pek, Emese; Fuge, Kata; Marton, Jozsef; Banfai, Balint; Gombos, Gabriella Csaszarne; Betlehem, Jozsef

    2015-01-01

    Background The high job stress among ambulance personnel is a widely known phenomenon. Purpose: to asses the self reported health status of ambulance workers. Methods An anonym self-fill-in questionnaire applying SF-36 was used among workers from the northern and western regions of Hungarian National Ambulance Service. Results Based on the dimensions of the SF-36 questionnaire the respondents considered their ?Physical Functioning? the best, while ?Vitality? was regarded the worst. The more t...

  4. Lower air temperature is associated with ambulance transports and death in Takamatsu area, Japan.

    Science.gov (United States)

    Mochimasu, Kazumi Dokai; Miyatake, Nobuyuki; Tanaka, Naoko; Kinoshita, Hiroshi

    2014-07-01

    The aim of this study was to investigate the linkage among ambulance transports, the number of death and air temperature in Takamatsu area, Japan. Monthly data of ambulance transports (total and acute disease) and the number of death from 2004 to 2012 were obtained from Fire Department Service in Takamatsu and Takamatsu city official website, Japan. Climate parameters for required period were also obtained from Japan Meteorological Agency. Population data in Takamatsu area were also used to adjust ambulance transports and the number of death. The linkage among ambulance transports, the number of death and climate parameters was evaluated by ecological analysis. Total ambulance transports (/a hundred thousand people/day) and ambulance transports due to acute disease (/a hundred thousand people/day) were 12.3 ± 0.9 and 6.8 ± 0.7, respectively. The number of death (/a hundred thousand people/day) was 2.5 ± 0.4. By quadratic curve, ambulance transports due to acute disease and the number of death were significantly correlated with the parameters of air temperature. However, the number of death was the highest in January and the lowest in August. Although higher air temperature was only associated with higher ambulance transports, lower air temperature was associated with both higher ambulance transports and the number death in Takamatsu area, Japan.

  5. Occupational stressors and its organizational and individual correlates: a nationwide study of Norwegian ambulance personnel

    National Research Council Canada - National Science Library

    Sterud, Tom; Hem, Erlend; Ekeberg, Oivind; Lau, Bjørn

    2008-01-01

    .... We compared the severity and frequency level of organizational and ambulance-specific stressors, and studied their relationship to organizational conditions and individual differences A comprehensive...

  6. Masculinity and Lifting Accidents among Danish Ambulance Personnel

    DEFF Research Database (Denmark)

    Hansen, Claus D.; Nielsen, Kent J

    Background Work injuries related to lifting are the most prevalent among ambulance personnel (AP) despite the introduction of ‘assistive technologies’ (AT) that help reduce situations of manual lifting. One third of the AP report using AT only ‘sometimes’ and 10% report having lifted a patient...... measuring traditional male role norms (MRNI), safety attitudes and safety behavior will be linked to company register information on work injuries categorized as lifting accidents. Logistic regression is used to analyse associations between masculinity, lifting behavior, and lifting accidents. Results...... prevention strategies for AP’s and other male-dominated occupations....

  7. Optimizing the location of ambulances in Tijuana, Mexico.

    Science.gov (United States)

    Dibene, Juan Carlos; Maldonado, Yazmin; Vera, Carlos; de Oliveira, Mauricio; Trujillo, Leonardo; Schütze, Oliver

    2017-01-01

    In this work we report on modeling the demand for Emergency Medical Services (EMS) in Tijuana, Baja California, Mexico, followed by the optimization of the location of the ambulances for the Red Cross of Tijuana (RCT), which is by far the largest provider of EMS services in the region. We used data from more than 10,000 emergency calls surveyed during the year 2013 to model and classify the demand for EMS in different scenarios that provide different perspectives on the demand throughout the city, considering such factors as the time of day, work and off-days. A modification of the Double Standard Model (DSM) is proposed and solved to determine a common robust solution to the ambulance location problem that simultaneously satisfies all specified constraints in all demand scenarios selecting from a set of almost 1000 possible base locations. The resulting optimization problems are solved using integer linear programming and the solutions are compared with the locations currently used by the Red Cross. Results show that demand coverage and response times can be substantially improved by relocating the current bases without the need for additional resources. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Early Ambulation After Microsurgical Reconstruction of the Lower Extremity.

    Science.gov (United States)

    Orseck, Michael J; Smith, Christopher Robert; Kirby, Sean; Trujillo, Manuel

    2018-02-02

    Successful outcomes after microsurgical reconstruction of the lower extremity include timely return to ambulation. Some combination of physical examination, ViOptix tissue oxygen saturation monitoring, and the implantable venous Doppler have shown promise in increasing sensitivity of current flap monitoring. We have incorporated this system into our postoperative monitoring protocol in an effort to initiate earlier dependency protocols. A prospective analysis of 36 anterolateral thigh free flap and radial forearm flaps for lower extremity reconstruction was performed. Indications for reconstruction were acute and chronic wounds, as well as oncologic resection. Twenty-three patients were able to ambulate and 3 were able to dangle their leg on the first postoperative day. One flap showed early mottling that improved immediately after elevation. After reelevation and return to baseline, the dependency protocol was successfully implemented on postoperative day 3. All flaps went on to successful healing. Physical examination, implantable venous Doppler, and ViOptix can be used reliably as an adjunct to increase the sensitivity of detecting poorly performing flaps during the postoperative progression of dependency.

  9. The risk ogf high-risk jobs : psychological health consequences in forensic physicians and ambulance workers

    NARCIS (Netherlands)

    Ploeg, E. van der

    2003-01-01

    The risk of high-risk jobs: Psychological health consequences in forensic doctors and ambulance workers This thesis has shown that forensic physicians and ambulance personnel frequently suffer from psychological complaints as a result of dramatic events and sources of chronic work stress. A

  10. Resilience of urban ambulance services under future climate, meteorology and air pollution scenarios

    Science.gov (United States)

    Pope, Francis; Chapman, Lee; Fisher, Paul; Mahmood, Marliyyah; Sangkharat, Kamolrat; Thomas, Neil; Thornes, John

    2017-04-01

    Ambulances are an integral part of a country's infrastructure ensuring its citizens and visitors are kept healthy. The impact of weather, climate and climate change on ambulance services around the world has received increasing attention in recent years but most studies have been area specific and there is a need to establish basic relationships between ambulance data (both response and illness data) and meteorological parameters. In this presentation, the effects of temperature, other meteorological and air pollution variables on ambulance call out rates for different medical categories will be investigated. We use ambulance call out obtained from various ambulance services worldwide which have significantly different meteorologies, climatologies and pollution conditions. A time-series analysis is utilized to understand the relation between meteorological conditions, air pollutants and different call out categories. We will present findings that support the opinion that ambulance attendance call outs records are an effective and well-timed source of data and can be used for health early warning systems. Furthermore the presented results can much improve our understanding of the relationships between meteorology, climate, air pollution and human health thereby allowing for better prediction of ambulance use through the application of long and short-term weather, climate and pollution forecasts.

  11. The Effect of Ambulance Staffing Models in a Metropolitan, Fire-Based EMS System.

    Science.gov (United States)

    Cortez, Eric J; Panchal, Ashish R; Davis, James E; Keseg, David P

    2017-04-01

    Introduction The staffing of ambulances with different levels of Emergency Medical Service (EMS) providers is a difficult decision with evidence being mixed on the benefit of each model. Hypothesis/Problem The objective of this study was to describe a pilot program evaluating alternative staffing on two ambulances utilizing the paramedic-basic (PB) model (staffed with one paramedic and one emergency medical technician[EMT]). This was a retrospective study conducted from September 17, 2013 through December 31, 2013. The PB ambulances were compared to geographically matched ambulances staffed with paramedic-paramedic (PP ambulances). One PP and one PB ambulance were based at Station A; one PP and one PB ambulance were based at Station B. The primary outcome was total on-scene time. Secondary outcomes included time-to-electrocardiogram (EKG), time-to-intravenous (IV) line insertion, IV-line success rate, and percentage of protocol violations. Inclusion criteria were all patients requesting prehospital services that were attended to by these teams. Patients were excluded if they were not attended to by the study ambulance vehicles. Descriptive statistics were reported as medians and interquartile ranges (IQR). Proportions were reported with 95% confidence intervals (CI). The Mann-Whitley U test was used for significance testing (Pfire-based EMS system. Prehosp Disaster Med. 2017;32(2):175-179.

  12. Basic life support and automated external defibrillator skills among ambulance personnel

    DEFF Research Database (Denmark)

    Nielsen, Anne Møller; Isbye, Dan Lou; Lippert, Freddy Knudsen

    2012-01-01

    Ambulance personnel play an essential role in the 'Chain of Survival'. The prognosis after out-of-hospital cardiac arrest was dismal on a rural Danish island and in this study we assessed the cardiopulmonary resuscitation performance of ambulance personnel on that island....

  13. Acute and chronic job stressors among ambulance personnel: predictors of health symptoms

    NARCIS (Netherlands)

    Ploeg, E. van der; Kleber, R.J.

    Objectives: To predict symptomatology (post-traumatic distress, fatigue, and burnout) due to acute and chronic work related stressors among ambulance personnel. Methods: Data were gathered from 123 ambulance workers in The Netherlands in a longitudinal design. At two measurements they completed

  14. An exploration of factors influencing ambulance and emergency nurses protocol adherence in the Netherlands

    NARCIS (Netherlands)

    Remco Ebben; Lilian Vloet; Theo van Achterberg; Joke Mintjes

    2012-01-01

    Adherence to ambulance and ED protocols is often suboptimal. Insight into factors influencing adherence is a requisite for improvement of adherence. This study aims to gain an in-depth understanding of factors that influence ambulance and emergency nurses’ adherence to protocols.

  15. An exploration of factors influencing ambulance and emergency nurses' protocol adherence in the Netherlands

    NARCIS (Netherlands)

    Ebben, R.H.A.; Vloet, L.C.M.; Schalk, D.M.; Mintjes-de Groot, J.; Achterberg, T. van

    2014-01-01

    INTRODUCTION: Adherence to ambulance and ED protocols is often suboptimal. Insight into factors influencing adherence is a requisite for improvement of adherence. This study aims to gain an in-depth understanding of factors that influence ambulance and emergency nurses' adherence to protocols.

  16. Telemedicine-based physician consultation results in more patients treated and released by ambulance personnel

    DEFF Research Database (Denmark)

    Raaber, Nikolaj; Bøtker, Morten T; Riddervold, Ingunn S

    2016-01-01

    . In the intervention period, the EMCC was manned 24/7 with physicians experienced in emergency care. Eligible participants included all patients with nonurgent conditions receiving an ambulance after a medical emergency call. Ambulance personnel assessed patients and subsequently performed a telephone consultation...

  17. Comparison of different intubation techniques performed inside a moving ambulance: a manikin study.

    Science.gov (United States)

    Wong, K B; Lui, C T; Chan, William Y W; Lau, T L; Tang, Simon Y H; Tsui, K L

    2014-08-01

    OBJECTIVE. Airway management and endotracheal intubation may be required urgently when a patient deteriorates in an ambulance or aircraft during interhospital transfer or in a prehospital setting. The objectives of this study were: (1) to compare the effectiveness of conventional intubation by Macintosh laryngoscope in a moving ambulance versus that in a static ambulance; and (2) to compare the effectiveness of inverse intubation and GlideScope laryngoscopy with conventional intubation inside a moving ambulance. DESIGN. Comparative experimental study. SETTING. The experiment was conducted in an ambulance provided by the Auxiliary Medical Service in Hong Kong. PARTICIPANTS. A group of 22 doctors performed endotracheal intubation on manikins with Macintosh laryngoscope in a static and moving ambulance. In addition, they performed conventional Macintosh intubation, inverse intubation with Macintosh laryngoscope, and GlideScope intubation in a moving ambulance in both normal and simulated difficult airways. MAIN OUTCOME MEASURES. The primary outcome was the rate of successful intubation. The secondary outcomes were time taken for intubation, subjective glottis visualisation grading, and eventful intubation (oesophageal intubation, intubation time >60 seconds, and incisor breakage) with different techniques or devices. RESULTS. In normal airways, conventional Macintosh intubation in a static ambulance (95.5%), conventional intubation in a moving ambulance (95.5%), as well as GlideScope intubation in a moving ambulance (95.5%) were associated with high success rates; the success rate of inverse intubation was comparatively low (54.5%; P=0.004). In difficult airways, conventional Macintosh intubation in a static ambulance (86.4%), conventional intubation in a moving ambulance (90.9%), and GlideScope intubation in a moving ambulance (100%) were associated with high success rates; the success rate of inverse intubation was comparatively lower (40.9%; P=0.034). CONCLUSIONS

  18. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel

    DEFF Research Database (Denmark)

    Hansen, Claus D.; Rasmussen, Kurt; Kyed, Morten

    2012-01-01

    Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance...... personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel. Methods Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1......,691) and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self...

  19. Designing Service Coverage and Measuring Accessibility and Serviceability of Rural and Small Urban Ambulance Systems

    Directory of Open Access Journals (Sweden)

    EunSu Lee

    2014-03-01

    Full Text Available This paper proposes a novel approach to analyze potential accessibility to ambulance services by combining the demand-covered-ratio and potential serviceability with the ambulance-covering-ratio. A Geographic Information System (GIS-based spatial analysis will assist ambulance service planners and designers to assess and provide rational service coverage based on simulated random incidents. The proposed analytical model is compared to the gravity-based two-step floating catchment area method. The study found that the proposed model could efficiently identify under-covered and overlapped ambulance service coverage to improve service quality, timeliness, and efficiency. The spatial accessibility and serviceability identified with geospatial random events show that the model is able to plan rational ambulance service coverage in consideration of households and travel time. The model can be applied to both regional and statewide coverage plans to aid the interpretation of those plans.

  20. Stylistic analysis of the poem "Ambulance" by Philip Larkin

    Directory of Open Access Journals (Sweden)

    Muhammad Yasir Khan

    2016-09-01

    Full Text Available Philip Larkin is known as a movement poet, because there are many poems which were published in the book of poetic movement, New Lines. This movement was started in 1950, against the unreasonable, inflated and extortionate romanticism of 1930's and 1940's. The common features of movement poetry are; the use of irony and wit, an element of satire, the loneliness of modern man, pessimistic outlook on life, realism, use of ordinary diction, use of symbols, and loss of religious faith. Robert Conquest is known as the representative poet of this movement. The poets of this movement believed that the language of poetry should be simple, lucid and intelligible. The poem Ambulance deals with the important features of movement poetry. Through the stylistics study of this poem the researchers will show the loneliness and concept of death in modern man.

  1. Noise exposure during ambulance flights and repatriation operations.

    Science.gov (United States)

    Küpper, Thomas E; Zimmer, Bernd; Conrad, Gerson; Jansing, Paul; Hardt, Aline

    2010-01-01

    Although ambulance flights are routine work and thousands of employees work in repatriation organizations, there is no data on noise exposure which may be used for preventive advice. We investigated the noise exposure of crews working in ambulance flight organizations for international patient repatriation to get the data for specific guidelines concerning noise protection. Noise levels inside Learjet 35A, the aircraft type which is most often used for repatriation operations, were collected from locations where flight crews typically spend their time. A sound level meter class 1 meeting the DIN IEC 651 requirements was used for noise measurements, but several factors during the real flight situations caused a measurement error of ~3%. Therefore, the results fulfill the specifications for class 2. The data was collected during several real repatriation operations and was combined with the flight data (hours per day) regarding the personnel to evaluate the occupationally encountered equivalent noise level according to DIN 45645-2. The measured noise levels were safely just below the 85 dB(A) threshold and should not induce permanent threshold shifts, provided that additional high noise exposure by non-occupational or private activities was avoided. As the levels of the noise produced by the engines outside the cabin are significantly above the 85 dB(A) threshold, the doors of the aircraft must be kept closed while the engines are running, and any activity performed outside the aircraft - or with the doors opened while the engines are running - must be done with adequate noise protection. The new EU noise directive (2003/10/EG) states that protective equipment must be made available to the aircrew to protect their hearing, though its use is not mandatory.

  2. Targeted response? An exploration of why ambulance services find government targets particularly challenging.

    Science.gov (United States)

    Durham, Mark; Faulkner, Mark; Deakin, Charles

    2016-12-01

    Ambulance services have historically found their targets particularly challenging. This article explores some areas of this multifaceted problem. Research articles, government publications and published audit data. Demand is increasing in many areas of healthcare, but whilst hospitals saw a 7% increase in demand in recent times, ambulance services saw nearly double that. The services ambulance trusts provide have evolved from that of a transport service to that of a mobile health provider, and they have become victims of their own success. Ambulance targets have never evolved to match evolving care. Ambulance personnel strive to avoid hospital attendance where appropriate, but this can be difficult for a 24-hour service, when not all referral pathways have 24-hour referral systems. We discuss why demand might be growing disproportionately for ambulance services, and challenge the appropriateness of the targets themselves. Possible formats for revised ambulance targets are discussed. © The Author 2016. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  3. Fatigue and mental health in Australian rural and regional ambulance personnel.

    Science.gov (United States)

    Pyper, Zoe; Paterson, Jessica L

    2016-02-01

    Australian ambulance personnel experience stress, fatigue and exposure to traumatic events. These risks have been extensively researched in metropolitan paramedics. However, there has been limited research in rural and regional personnel. Rural and regional ambulance personnel make up a significant proportion of the Australian ambulance workforce and may be exposed to unique stressors. The aim of the current study was to investigate levels of fatigue, stress, and emotional trauma in rural and regional ambulance personnel. A sample of 134 (103 male, 31 female) rural and regional ambulance personnel completed a mixed methods survey assessing fatigue, stress and emotional trauma. Data were analysed using a combination of descriptive analysis and qualitative, deductive analysis that involved data immersion, coding, and categorisation. Participants reported high levels of fatigue and emotional trauma. Qualitative data revealed stressors including community expectations and 'office politics'. Participants also reported negative effects of fatigue including errors in drug administration and falling asleep while driving. The majority of participants reported normal levels of stress. It may be the case that working with known individuals in a community offers some degree of 'protective' impact for stress in rural and regional ambulance personnel. This is one of the first studies to investigate fatigue, stress, and emotional trauma in a rural and regional ambulance population. Results indicate a complex and unique profile of risks and challenges for this critical and understudied community resource. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. The relationship with the ambulance clinicians as experienced by significant others.

    Science.gov (United States)

    Holmberg, Mats; Forslund, Kerstin; Wahlberg, Anna Carin; Fagerberg, Ingegerd

    2016-07-01

    Interpersonal relationships between clinicians and patients are important aspects of the ambulance care, requiring a balance between objectified acute medical treatment and a holistic care. Being a significant other (SO) in the ambulance care setting is described as being caught between hope and dread. Little research has focused on SOs' experiences of the relationship with the ambulance clinicians. To elucidate meanings of the relationship with the clinicians in the ambulance care setting as experienced by the patients' SOs. Qualitative lifeworld design. Data was collected using open-ended interviews with nine SOs. The verbatim transcribed interviews were analysed with a phenomenological hermeneutic method. The structural analysis resulted in one main theme: 'Being lonely together'. The main theme comprises three themes: 'Being in a shared struggle', 'To hand over the affected person in trust' and 'Being the second person in focus' and six subthemes. The main theme is for the SOs to share the struggles of the affected person with the ambulance clinicians and to be comforted while handing over the responsibility for the affected person. Hence the SO is excluded and lonely and on his/her own, while not the primary focus of the ambulance clinicians. The relationship with the ambulance clinicians from the perspective of the SOs can be understood as complex, involving both being lonely and together at the same time. The findings support a holistic approach towards the ambulance care involving SOs. This study outlines the importance of an emergency ambulance care involving SOs as affected persons and supports a balance between emergency medical treatment to the patient and a holistic care, involving the SOs' suffering. © 2015 British Association of Critical Care Nurses.

  5. How public ambulance arrivals impact on Emergency Department workload and resource use

    Directory of Open Access Journals (Sweden)

    Enrico Ferri

    2010-03-01

    Full Text Available Objectives: To examine patient’s characteristics associated with ED arrival mode, and to determine EMS impact on ED clinical resource use, workload and crowding. Methods: This is a retrospective study of patients seen at Sant’Andrea Hospital ED. Comparison focused on visit characteristics, and on resource use. Results: The use of EMS ambulance confirms association to older age, higher rate of hospital admission, longer length of stay, and severity of injury. Moreover our data show that ambulance referred patients are triaged into a higher acuity category and have a greater intensive care unit admission. Conclusion: Ambulance arrivals have a significant impact on ED resource use, workload and crowding.

  6. Toward Electoral Security: Experiences from KwaZulu-Natal Höhere Sicherheit bei Wahlen: Erfahrungen aus KwaZulu-Natal

    Directory of Open Access Journals (Sweden)

    Kristine Höglund

    2011-01-01

    Full Text Available There is a growing recognition of the dangers of electoral violence. Yet, the theoretical foundation for systematic research and for adequate policy is still underdeveloped. This article aims to develop the theoretical understandings of strategies to manage and prevent electoral violence. This is accomplished by integrating research conducted within the two academic discourses on democratization and conflict management and also by drawing on the experiences from the conflict-ridden province KwaZulu-Natal in South Africa. The five strategies identified are monitoring, mediation, legal measures, law enforcement and self-regulating practices. In the article, the functions and mechanisms of the strategies are discussed. In addition, we analyse the limitations and usefulness of each of the strategies in turn and also provide suggestions on how to improve electoral security.Gewaltsame Auseinandersetzungen bei Wahlen werden zunehmend als Gefahr erkannt. Dennoch sind die theoretischen Grundlagen systematischer Forschungen zu diesem Phänomen, die zu angemessenen politischen Handlungsweisen beitragen könnten, immer noch ungenügend entwickelt. Dieser Beitrag zielt darauf ab, einen theoretischen Hintergrund für Strategien zum Umgang mit Gewalt bei Wahlen und zur Prävention zu entwickeln. Zu diesem Zweck kombinieren die Autorinnen Ergebnisse zweier Forschungsbereiche – der Demokratisierungsforschung und der Forschung zum Konfliktmanagement – und ziehen außerdem Erfahrungen aus der konfliktbeladenen südafrikanischen Provinz KwaZulu-Natal heran. Sie identifizieren fünf Strategien: Monitoring, Mediation, gesetzliche Maßnahmen, Sanktionierung und Selbsthilfepraktiken. Die Autorinnen diskutieren die Wirkungsweisen und Erfolgsaussichten, aber auch die Grenzen dieser Strategien und machen einige konkrete Vorschläge zur Erhöhung der Sicherheit bei Wahlen.

  7. Assessment of stress and autonomic nervous activity in Japanese female ambulance paramedics working 24-hour shifts

    National Research Council Canada - National Science Library

    Ayako Suzuki; Koichi Yoshioka; Susumu Ito; Yuko Naito

    2016-01-01

      Objectives: We studied the physical and mental conditions of 8 healthy young female ambulance paramedics working 24-hour shifts during their menstrual cycle, including assessment of cardiac autonomic nervous...

  8. The Fire Brigade acquires a new ambulance with all the bells and whistles!

    CERN Document Server

    Anaïs Schaeffer

    2012-01-01

    On 19 April the Fire Brigade unveiled its latest acquisition: a brand-new ambulance specially designed for CERN.   One of the Fire Brigade's two ambulances has just been replaced by a state-of-the-art vehicle tailor-made to meet CERN's unique requirements. At 4.6 metres long it's much more spacious than its predecessors, providing plenty of room for patient, doctor and paramedic. The ambulance's design and manufacture are the result of a successful collaboration between the Fire Brigade and the technicians from Profile Vehicles, the Finnish company that won the contract following a call for tenders launched in June 2011. "It took us six months to finalise the specification for our new ambulance," explains Patrick Berlinghi, who is responsible for the Fire Brigade's logistics. "We wanted it to be spacious enough for us to be able to work comfortably and to have the latest safety and patient care equipment.  We also reques...

  9. Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model.

    Science.gov (United States)

    Valenzuela Espinoza, Alexis; Devos, Stefanie; van Hooff, Robbert-Jan; Fobelets, Maaike; Dupont, Alain; Moens, Maarten; Hubloue, Ives; Lauwaert, Door; Cornu, Pieter; Brouns, Raf; Putman, Koen

    2017-11-24

    Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambulance telemedicine. We aim to develop a first cost effectiveness model for in-ambulance telemedicine and use this model to estimate the time savings needed before in-ambulance telemedicine becomes cost effective. Current standard stroke care is compared with current standard stroke care supplemented with in-ambulance telemedicine using a cost-utility model measuring costs and quality-adjusted life-years (QALYs) from a health care perspective. We combine a decision tree with a Markov model. Data from the UZ Brussel Stroke Registry (2282 stroke patients) and linked hospital claims data at individual level are combined with literature data to populate the model. A 2-way sensitivity analysis varying both implementation costs and time gain is performed to map the different cost-effective combinations and identify the time gain needed for cost effectiveness and dominance. For several modeled time gains, the cost-effectiveness acceptability curve is calculated and mapped in 1 figure. Under the base-case scenario (implementation cost of US $159,425) and taking a lifetime horizon into account, in-ambulance telemedicine is a cost-effective strategy compared to standard stroke care alone starting from a time gain of 6 minutes. After 12 minutes, in-ambulance telemedicine becomes dominant, and this results in a mean decrease of costs by US -$30 (95% CI -$32 to -$29) per patient with 0.00456 (95% CI 0.00448 to 0.00463) QALYs on average gained per patient. In over 82% of all probabilistic simulations

  10. Characteristics of fatal ambulance crashes during emergency and non-emergency operation.

    Science.gov (United States)

    Pirrallo, R G; Swor, R A

    1994-01-01

    To analyze the characteristics of fatal ambulance crashes to assist emergency medical services (EMS) directors in objectively developing their EMS system's policy governing ambulance operations. No difference exists between the characteristics of fatal ambulance crashes during emergency and nonemergency use. Retrospective, cross-sectional, comparative analysis of ambulance crashes resulting in fatalities reported to the Fatal Accident Reporting System (FARS) from 1987 to 1990. Twenty variables, representing characteristics of fatal ambulance crashes, were selected from the National Highway Traffic Administration FARS Codebook and were evaluated using tests of significance for categorical data grouped by emergency use and nonemergency use. Crash variable categories examined included demographics, accident configuration, accident severity, vehicle description, and ambulance operator action. During the four-year study period, 109 fatal ambulance crashes occurred producing 126 deaths. Four states, New York, Michigan, California, and North Carolina, accounted for 37.5% of all fatal crashes. Seventy-five fatal crashes (69%) occurred during emergency use (EU) and 34 fatal crashes (31%) occurred during nonemergency use (NEU). The total number of fatal crashes varied in a downward trend (1987:32; 1988:24; 1989:28; 1990:25). The number of fatal EU crashes also varied in a downward trend (1987:28; 1988:16; 1989:19; 1990:12), while the number of fatal NEU crashes increased each year [1987:4; 1988:8; 1989:9; 1990:13](p = .016). Most EU fatal crashes occurred between 1200 h and 1800 h (p = .009). Most NEU fatal crashes occurred during times when light conditions were poor (p = .003). When a violation was charged to the ambulance driver (17 cited), the vehicle was more likely to be in EU (p = .056). No statistically significant differences between EU and NEU were identified by: 1) day of week; 2) season; 3) atmospheric conditions; 4) roadway surface type; 5) roadway surface

  11. Demand Forecast Using Data Analytics for the Preallocation of Ambulances.

    Science.gov (United States)

    Chen, Albert Y; Lu, Tsung-Yu; Ma, Matthew Huei-Ming; Sun, Wei-Zen

    2016-07-01

    The objective of prehospital emergency medical services (EMSs) is to have a short response time. By increasing the operational efficiency, the survival rate of patients could potentially be increased. The geographic information system (GIS) is introduced in this study to manage and visualize the spatial distribution of demand data and forecasting results. A flexible model is implemented in GIS, through which training data are prepared with user-desired sizes for the spatial grid and discretized temporal steps. We applied moving average, artificial neural network, sinusoidal regression, and support vector regression for the forecasting of prehospital emergency medical demand. The results from these approaches, as a reference, could be used for the preallocation of ambulances. A case study is conducted for the EMS in New Taipei City, where prehospital EMS data have been collected for three years. The model selection process has chosen different models with different input features for the forecast of different areas. The best daily mean absolute percentage error during testing of the EMS demand forecast is 23.01%, which is a reasonable forecast based on Lewis' definition. With the acceptable prediction performance, the proposed approach has its potential to be applied to the current practice.

  12. Predictors of workplace violence among ambulance personnel: a longitudinal study.

    Science.gov (United States)

    van der Velden, Peter G; Bosmans, Mark W G; van der Meulen, Erik

    2016-04-01

    To examine predictors of repeated confrontations with workplace violence among ambulance personnel, the proportion of exposure to potentially traumatic events that are aggression-related and to what extent personnel was able to prevent escalations. Although previous research assessed the prevalences among this group, little is known about predictors, to what extent PTE's are WPV-related and their abilities to prevent escalations. A longitudinal study with a 6 months' time interval (N = 103). At T1 demographics, workplace violence and potentially traumatic events in the past year, mental health, personality, handling of rules, coping and social organizational stressors were assessed. Confrontations with aggression were also examined at T2. Multivariate logistic regression analyses showed that only problems with superiors independently predicted repeated verbal aggression and that only the (absence of the) ability to compromise very easily predicted repeatedly being on guard and repeatedly confronted with any form of aggression. Due to very low prevalences, we could not examine predictors of repeated confrontations with physical aggression (N = 5) and serious threat (N = 7). A large majority reported that in most workplace violence cases they could prevent further escalations. About 2% reported a potentially traumatic event in the year before T1 that was WPV related and perceived as very stressful.

  13. Time Gain Needed for In-Ambulance Telemedicine: Cost-Utility Model

    OpenAIRE

    Valenzuela Espinoza, Alexis; Devos, Stefanie; van Hooff, Robbert-Jan; Fobelets, Maaike; Dupont, Alain; Moens, Maarten; Hubloue, Ives; Lauwaert, Door; Cornu, Pieter; Brouns, Raf; Putman, Koen

    2017-01-01

    Background Stroke is a very time-sensitive pathology, and many new solutions target the optimization of prehospital stroke care to improve the stroke management process. In-ambulance telemedicine, defined by live bidirectional audio-video between a patient and a neurologist in a moving ambulance and the automated transfer of vital parameters, is a promising new approach to speed up and improve the quality of acute stroke care. Currently, no evidence exists on the cost effectiveness of in-ambu...

  14. Complexity, fractal dynamics and determinism in treadmill ambulation: Implications for clinical biomechanists.

    Science.gov (United States)

    Hollman, John H; Watkins, Molly K; Imhoff, Angela C; Braun, Carly E; Akervik, Kristen A; Ness, Debra K

    2016-08-01

    Reduced inter-stride complexity during ambulation may represent a pathologic state. Evidence is emerging that treadmill training for rehabilitative purposes may constrain the locomotor system and alter gait dynamics in a way that mimics pathological states. The purpose of this study was to examine the dynamical system components of gait complexity, fractal dynamics and determinism during treadmill ambulation. Twenty healthy participants aged 23.8 (1.2) years walked at preferred walking speeds for 6min on a motorized treadmill and overground while wearing APDM 6 Opal inertial monitors. Stride times, stride lengths and peak sagittal plane trunk velocities were measured. Mean values and estimates of complexity, fractal dynamics and determinism were calculated for each parameter. Data were compared between overground and treadmill walking conditions. Mean values for each gait parameter were statistically equivalent between overground and treadmill ambulation (P>0.05). Through nonlinear analyses, however, we found that complexity in stride time signals (P<0.001), and long-range correlations in stride time and stride length signals (P=0.005 and P=0.024, respectively), were reduced on the treadmill. Treadmill ambulation induces more predictable inter-stride time dynamics and constrains fluctuations in stride times and stride lengths, which may alter feedback from destabilizing perturbations normally experienced by the locomotor control system during overground ambulation. Treadmill ambulation, therefore, may provide less opportunity for experiencing the adaptability necessary to successfully ambulate overground. Investigators and clinicians should be aware that treadmill ambulation will alter dynamic gait characteristics. Copyright © 2016 Elsevier Ltd. All rights reserved.

  15. Venous Gas Emboli and Ambulation at 4.3 PSIA (Preliminary)

    Science.gov (United States)

    Conkin, J.; Pollock, N. W.; Natoli, M. J.; Martina, S. D.; Wessel, J. H., III; Gernhardt, M. L.

    2016-01-01

    Ambulation imparts compressive and decompressive forces into the lower body, potentially creating quasi-stable micronuclei that influence the outcome of hypobaric depressurizations. Hypotheses: ambulation before the conclusion of a denitrogenation (prebreathe) protocol at 14.7 pounds per square inch absolute is not sufficient to increase the incidence of venous gas emboli (VGE) at 4.3 pounds per square inch absolute but is sufficient if performed after tissues become supersaturated with nitrogen at 4.3 pounds per square inch absolute.

  16. Improving community ambulation after hip fracture: protocol for a randomised, controlled trial

    Directory of Open Access Journals (Sweden)

    D Orwig

    2017-01-01

    Discussion: This multicentre randomised study will be the first to test whether a home-based multi-component physiotherapy intervention targeting specific precursors of community ambulation (PUSH is more likely to lead to community ambulation than a home-based non-specific multi-component physiotherapy intervention (PULSE in older adults after hip fracture. The study will also estimate the potential economic value of the interventions.

  17. Weather factors in the short-term forecasting of daily ambulance calls.

    Science.gov (United States)

    Wong, Ho-Ting; Lai, Poh-Chin

    2014-07-01

    The daily ambulance demand for Hong Kong is rising, and it has been shown that weather factors (temperature and humidity) play a role in the demand for ambulance services. This study aimed at developing short-term forecasting models of daily ambulance calls using the 7-day weather forecast data as predictors. We employed the autoregressive integrated moving average (ARIMA) method to analyze over 1.3 million cases of emergency attendance in May 2006 through April 2009 and the 7-day weather forecast data for the same period. Our results showed that the ARIMA model could offer reasonably accurate forecasts of daily ambulance calls at 1-7 days ahead of time and with improved accuracy by including weather factors. Specifically, the inclusion of average temperature alone in our ARIMA model improved the predictability of the 1-day forecast when compared to that of a simple ARIMA model (8.8% decrease in the root mean square error, RMSE=53 vs 58). The improvement in the 7-day forecast with average temperature as a predictor was more pronounced, with a 10% drop in prediction error (RMSE=62 vs 69). These findings suggested that weather forecast data can improve the 1- to 7-day forecasts of daily ambulance demand. As weather forecast data are readily accessible from Hong Kong Observatory's official website, there is virtually no cost to including them in the ARIMA models, which yield better prediction for forward planning and deployment of ambulance manpower.

  18. The aging population and future demand for emergency ambulances in Japan.

    Science.gov (United States)

    Hagihara, Akihito; Hasegawa, Manabu; Hinohara, Yukako; Abe, Takeru; Motoi, Midori

    2013-08-01

    Demand for emergency ambulances has been increasing in developmentally advanced countries, and in Japan demand has been increasing due to the aging population since 2008, when the total population began to decrease. However, we do not know how acceleration of the aging population relates to the demand for emergency ambulances. Thus, we estimated future demand for emergency ambulances in Japan. A regression with autocorrelated errors model was used to estimate future demand for emergency ambulance dispatches and emergency transports. In the estimation, data on emergency ambulance dispatches, emergency transports, and population data from 1963 to 2011, and an estimate of the population of Japan from 2012 to 2025 were used. The number of emergency ambulance dispatches has increased since 2008, and it is expected to continue to increase until around 2023 or 2024, when it will reach a peak of ~6.2 million per year. Similarly, the number of emergency transports is expected to continue to increase until 2022 or 2023, when it will reach a peak of ~5.3 million per year. Although we need to be careful when evaluating numbers predicted for the remote future due to methodological limitations, the findings might be useful for updating emergency medical care systems to prepare for future increases in demand.

  19. Impact of Air Temperature on London Ambulance Call-Out Incidents and Response Times

    Directory of Open Access Journals (Sweden)

    Marliyyah A. Mahmood

    2017-08-01

    Full Text Available Ambulance services are in operation around the world and yet, until recently, ambulance data has only been used for operational purposes rather than for assessing public health. Ambulance call-out data offers new and valuable (near real-time information that can be used to assess the impact of environmental conditions, such as temperature, upon human health. A detailed analysis of London ambulance data at a selection of dates between 2003 and 2015 is presented and compared to London temperature data. In London, the speed of ambulance response begins to suffer when the mean daily air temperature drops below 2 °C or rises above 20 °C. This is explained largely by the increased number of calls past these threshold temperatures. The baseline relationships established in this work will inform the prediction of likely changes in ambulance demand (and illness types that may be caused by seasonal temperature changes and the increased frequency and intensity of extreme/severe weather events, exacerbated by climate change, in the future.

  20. Patients' perception of the ambulance services at Hospital Universiti Sains Malaysia.

    Science.gov (United States)

    Anisah, A; Chew, K S; Mohd Shaharuddin Shah, C H; Nik Hisamuddin, N A R

    2008-08-01

    Little is known regarding public opinion of prehospital care in Malaysia. This study was conducted to find out the public's perception and expectations of the ambulance services in one of the university hospitals in Malaysia. A six-month prospective cross-sectional study to look at patients' perception of Hospital Universiti Sains Malaysia's (HUSM) ambulance service was conducted from February 2006 to July 2006. Upon arrival at the hospital, patients or their relatives (who used our hospital's ambulances) were interviewed with a set of questions regarding their perception of the ambulance services and were asked to rate the perception on a Likert Scale from 1 to 10. A convenient sampling method was applied. A total of 87 samples were obtained. Despite the many problems faced by the ambulance service in HUSM, the mean score for each of the questions on patient's perception ranged from 9.33 to 9.70 out of 10. The questions with the highest mean score, which were both 9.70 each, were related to staff attentiveness and staff gentleness. Patients' perceptions can be very subjective, but until further similar studies could be carried out in other parts of Malaysia, this set of data merely represents a numerical measure of public perception of the ambulance services from HUSM.

  1. Microswitch-aided programs to support physical exercise or adequate ambulation in persons with multiple disabilities.

    Science.gov (United States)

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Perilli, Viviana; Oliva, Doretta; Buono, Serafino

    2014-09-01

    Three microswitch-aided programs were assessed in three single-case studies to enhance physical exercise or ambulation in participants with multiple disabilities. Study I was aimed at helping a woman who tended to have the head bending forward and the arms down to exercise a combination of appropriate head and arms movements. Study II was aimed at promoting ambulation continuity with a man who tended to have ambulation breaks. Study III was aimed at promoting ambulation with appropriate foot position in a girl who usually showed toe walking. The experimental designs of the studies consisted of a multiple probe across responses (Study I), an ABAB sequence (Study II), and an ABABB(1) sequence (Study III). The last phase of each study was followed by a post-intervention check. The microswitches monitored the target responses selected for the participants and triggered a computer system to provide preferred stimuli contingent on those responses during the intervention phases of the studies. Data showed that the programs were effective with each of the participants who learned to exercise head and arms movements, increased ambulation continuity, and acquired high levels of appropriate foot position during ambulation, respectively. The positive performance levels were retained during the post-intervention checks. The discussion focused on (a) the potential of technology-aided programs for persons with multiple disabilities and (b) the need of replication studies to extend the evidence available in the area. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Bringing humanity into view: action research with Qatar's ambulance service.

    Science.gov (United States)

    Coleman, Gill; Wiggins, Liz

    2017-08-21

    Purpose The purpose of this paper is to argue for the widening of attention in healthcare improvement efforts, to include an awareness of the humanity of people who work in the sector and an appreciation of the part human connection plays in engagement around good quality work. Theoretical frameworks and research approaches which draw on action-based, interpretive and systemic thinking are proposed, as a complement to current practices. Design/methodology/approach The paper describes the early stages of an action research (AR) project, which used the appreciative inquiry "4D" framework to conduct participative inquiry in Hamad Medical Corporation's ambulance service in Qatar, in which staff became co-researchers. Findings The co-researchers were highly motivated to work with improvement goals as a result of their participation in the AR. They, and their managers, saw each other and the work in new ways and discovered that they had much to offer. Research limitations/implications This was a small-scale pilot project, from which findings must be considered tentative. The challenges of establishing good collaboration across language, culture and organisational divides are considerable. Practical implications Appreciative and action-oriented inquiry methods can serve not only to find things out, but also to highlight and give value to aspects of humanity in the workplace that are routinely left invisible in formal processes. This, in turn, can help with quality improvement. Originality/value This paper is a challenge to the orthodox way of viewing healthcare organisations, and improvement processes within them, as reliant on control rather than empowerment. An alternative is to actively include the agency, sense-making capacity and humanity of those involved.

  3. EFFECTIVENESS OF SCHEDULED AMBULATION ON EARLY POSTOPERATIVE OUTCOME AMONG PATIENTS WHO HAVE UNDERGONE ABDOMINAL HYSTERECTOMY

    Directory of Open Access Journals (Sweden)

    Rinku Girija

    2017-01-01

    Full Text Available BACKGROUND Abdominal hysterectomy is one of the most frequently performed surgical procedures in women. The non-ambulatory postoperative period is a high risk period for the development of various complications like wound infection, venous stasis, lower respiratory infection, secondary haemorrhage, deep vein thrombosis, pulmonary embolism, paralytic ileus etc. Prolonged surgery, delayed ambulation and not feeding the patient within 48 hours of surgery are often associated with post-operative morbidity and mortality. This study aims to assess the effectiveness of Scheduled Ambulation on early post-operative outcome among patients undergone abdominal hysterectomy by introduction of Scheduled Ambulation from second day of surgery. MATERIALS AND METHODS Method used is quantitative and quasi experimental post-test control method. Scheduled ambulation technique and pattern were taught pre operatively to 35 patients consecutively selected from general and post-operative ward who formed the experimental group. They were given scheduled ambulation from second to fifth post-operative days and results analysed. Another 35 patients taken as control were given the routine post-operative care. Data Analysis- was performed using SPSS version 17.0. Between group comparisons, quantitative variables analysed by Chisquare test p value >0, 05 considered significant. RESULTS The indication of hysterectomy was fibroid uterus in 80% of the control group and 88, 6% of the experimental group. 51.4% of the hysterectomies were encountered in the age group 40-49 years. There was a statistically significant reduction in the severity of pain, fatigue, postural hypotension and risk for developing Deep vein thrombosis in the experimental group on practicing Scheduled Ambulation from second to fifth post-operative days. CONCLUSION Scheduled ambulation helped the abdominal hysterectomy patients to recover from fatigue, pain, postural hypotension and risk for Deep vein thrombosis

  4. A comparison of actual versus predicted emergency ambulance journey times using generic Geographic Information System software.

    Science.gov (United States)

    McMeekin, Peter; Gray, Jo; Ford, Gary A; Duckett, Jay; Price, Christopher I

    2014-09-01

    The planning of regional emergency medical services is aided by accurate prediction of urgent ambulance journey times, but it is unclear whether it is appropriate to use Geographical Information System (GIS) products designed for general traffic. We examined the accuracy of a commercially available generic GIS package when predicting emergency ambulance journey times under different population and temporal conditions. We undertook a retrospective cohort study of emergency ambulance admissions to three emergency departments (ED) serving differing population distributions in northeast England (urban/suburban/rural). The transport time from scene to ED for all the highest priority dispatches between 1 October 2009 and 30 September 2010 was compared with predictions made by generic GIS software. For 10,156 emergency ambulance journeys, the mean prediction discrepancy between actual and predicted journey times across all EDs was an underprediction of 1.6 min (SD 4.9). Underprediction was statistically significant at all population densities, but unlikely to be of clinical significance. Ambulances in urban areas were able to exceed general traffic speed, whereas, the opposite effect was seen in suburban and rural road networks. There were minor effects due to travel outside the busiest traffic times (mean overprediction 0.8 min) and during winter months (mean underprediction 0.4 min). It is reasonable to estimate emergency ambulance journey times using generic GIS software, but in order to avoid insufficient regional ambulance provision it would be necessary to make small adjustments because of the tendency towards systematic underprediction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Ambulance attendances resulting from self-harm after release from prison: a prospective data linkage study.

    Science.gov (United States)

    Borschmann, Rohan; Young, Jesse T; Moran, Paul; Spittal, Matthew J; Heffernan, Ed; Mok, Katherine; Kinner, Stuart A

    2017-10-01

    Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances. Baseline surveys with 1309 adults within 6 weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression. During 4691 person-years of follow-up (median 3.86 years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14-3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44-4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11-4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31-7.61)] were associated with self-harm attendances. Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population.

  6. Simulation-based decision support framework for dynamic ambulance redeployment in Singapore.

    Science.gov (United States)

    Lam, Sean Shao Wei; Ng, Clarence Boon Liang; Nguyen, Francis Ngoc Hoang Long; Ng, Yih Yng; Ong, Marcus Eng Hock

    2017-10-01

    Dynamic ambulance redeployment policies tend to introduce much more flexibilities in improving ambulance resource allocation by capitalizing on the definite geospatial-temporal variations in ambulance demand patterns over the time-of-the-day and day-of-the-week effects. A novel modelling framework based on the Approximate Dynamic Programming (ADP) approach leveraging on a Discrete Events Simulation (DES) model for dynamic ambulance redeployment in Singapore is proposed in this paper. The study was based on the Singapore's national Emergency Medical Services (EMS) system. Based on a dataset comprising 216,973 valid incidents over a continuous two-years study period from 1 January 2011-31 December 2012, a DES model for the EMS system was developed. An ADP model based on linear value function approximations was then evaluated using the DES model via the temporal difference (TD) learning family of algorithms. The objective of the ADP model is to derive approximate optimal dynamic redeployment policies based on the primary outcome of ambulance coverage. Considering an 8min response time threshold, an estimated 5% reduction in the proportion of calls that cannot be reached within the threshold (equivalent to approximately 8000 dispatches) was observed from the computational experiments. The study also revealed that the redeployment policies which are restricted within the same operational division could potentially result in a more promising response time performance. Furthermore, the best policy involved the combination of redeploying ambulances whenever they are released from service and that of relocating ambulances that are idle in bases. This study demonstrated the successful application of an approximate modelling framework based on ADP that leverages upon a detailed DES model of the Singapore's EMS system to generate approximate optimal dynamic redeployment plans. Various policies and scenarios relevant to the Singapore EMS system were evaluated. Copyright © 2017

  7. Study on advanced life support devices in the ambulances for emergency cases in Klang Valley, Malaysia.

    Science.gov (United States)

    Ismail, M S; Hasinah, A B; Syaiful, M N; Murshidah, H B; Thong, T J; Zairi, Z; Idzwan, Z; Herbosa, T J; Johar, M J; Ho, S E; Das, S

    2012-01-01

    In an effort to improve pre-hospital care, the authors assessed the availability and utility of ambulance devices. The study aimed to identify commonly used devices for managing emergency cases in Klang Valley of Malaysia. This was a prospective study comprising of 1075 emergency ambulances running on 30 days. The study analyzed the availability and utilization of life support equipment in nine ambulance providers of Klang Valley in Malaysia. The devices were classified into: (a) airway and ventilation, (b) immobilization and haemorrhage control and (c) communication. The percentage of device utilization was analysed using computerised software. Results showed only one ambulance service had complete equipment in accordance to international standards. In term of utilisation of life support equipment, oxygen delivery devices were used in 493 (45.86%) runs. The most used devices in immobilisation and haemorrhage control were:- (a) scoop stretcher in 321 (29.86%) runs, (b) wound dressings in 250 (23.26%) runs and (c) rigid spinal board in 206 (19.16%) runs. Two-way radios were used in 745 (69.30%) runs while mobile phones were used in 429 (39.91%) runs. In conclusion, ambulances in Klang Valley had a large variation in the availability of life support devices. This emphasizes a need for standardization of equipment.

  8. Effects of 24-hour shift work with nighttime napping on circadian rhythm characteristics in ambulance personnel.

    Science.gov (United States)

    Motohashi, Y; Takano, T

    1993-12-01

    Forty-two ambulance personnel engaged in a 24-h shift system participated in a chronobiological field study to study the effects of 24-h shift work on circadian rhythm characteristics. Autorhythmometry of circadian rhythms of oral temperature, right and left grip strengths, and heart rate plus subjective assessment of drowsiness, fatigue, and attention was performed every approximately 4 h except during sleep for 7 days. Cosinor and power spectral analyses were applied to the longitudinal data of each individual. Changes in circadian period different from 24 h of oral temperature, grip strengths, and heart rate plus subjective drowsiness, fatigue, and attention were observed in ambulance personnel. The incidence of circadian periodicity different from 24 h in oral temperature and right and left grip strength was 28.6%, 35.7%, and 47.6%, respectively. The incidence was relatively lower than that of shift workers engaged in a discontinuous 8-h shift system we reported on previously. Working conditions allowing ambulance personnel to nap when not called for emergency (for > 4 h) might contribute to a stabilization of circadian rhythms. Furthermore, long nighttime ambulance service amounting to > 100 min was significantly associated with a high incidence of at least one prominent circadian period among oral temperature and right and left grip strength rhythms different from 24 h. In conclusion, 24-h shift work altered the characteristics of circadian rhythms of ambulance personnel; nighttime naps seemed to have a favorable effect on averting changes in circadian rhythms.

  9. R.I.P. squad bench. European ambulances designed around the patient, not the vehicle.

    Science.gov (United States)

    Heightman, A J

    2013-07-01

    You can see and hear more about my journey throughout Germany and England in a special, archived, free Webcast on jems.com. And in future articles, videos and Web presentations, you'll see and learn about the different EMS delivery models I saw, the men and women whom I met and rode with on calls, and, most importantly, their impressive attitude about patient care, customer service and safety. Progressive American and Canadian ambulance manufacturers now agree with safety experts and forward-thinking ambulance operators that the squad bench is dead. These manufacturers now offer innovative seats that are much safer and functional than those coffin-like obstructions that gobbled up so much space in our rigs for the past three decades. Design your next ambulance around the needs and safety of your crews and their patients, and spec a patient compartment that is laid out logiclaly and efficient.

  10. 24 month longitudinal data in ambulant boys with Duchenne muscular dystrophy.

    Directory of Open Access Journals (Sweden)

    Elena Stacy Mazzone

    Full Text Available The aim of the study was i to assess the spectrum of changes over 24 months in ambulant boys affected by Duchenne muscular dystrophy, ii to establish the difference between the first and the second year results and iii to identify possible early markers of loss of ambulation.One hundred and thirteen patients (age range 4.1-17, mean 8.2 fulfilled the inclusion criteria, 67 of the 113 were on daily and 40 on intermittent steroids, while 6 were not on steroids. All were assessed using the 6 Minute Walk Test (6MWT, the North Star Ambulatory Assessment (NSAA and timed test.On the 6MWT there was an average overall decline of -22.7 (SD 81.0 in the first year and of -64.7 (SD 123.1 in the second year. On the NSAA the average overall decline was of -1.86 (SD 4.21 in the first year and of -2.98 (SD 5.19 in the second year. Fourteen children lost ambulation, one in the first year and the other 13 in the second year of the study. A distance of at least 330 meters on the 6MWT, or a NSAA score of 18 at baseline reduced significantly the risk of losing ambulation within 2 years.These results can be of help at the time of using inclusion criteria for a study in ambulant patients in order to minimize the risk of patients who may lose ambulation within the time of the trial.

  11. 24 Month Longitudinal Data in Ambulant Boys with Duchenne Muscular Dystrophy

    Science.gov (United States)

    Sormani, Maria Pia; Scalise, Roberta; Berardinelli, Angela; Messina, Sonia; Torrente, Yvan; D’Amico, Adele; Doglio, Luca; Viggiano, Emanuela; D’Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Bello, Luca; Bonfiglio, Serena; De Sanctis, Roberto; Rolle, Enrica; Bianco, Flaviana; Magri, Francesca; Rossi, Francesca; Vasco, Gessica; Vita, GianLuca; Motta, Maria Chiara; Donati, Maria Alice; Sacchini, Michele; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Napolitano, Sara; Bruno, Claudio; Politano, Luisa; Comi, Giacomo Pietro; Bertini, Enrico; Mercuri, Eugenio

    2013-01-01

    Objectives The aim of the study was i) to assess the spectrum of changes over 24 months in ambulant boys affected by Duchenne muscular dystrophy, ii) to establish the difference between the first and the second year results and iii) to identify possible early markers of loss of ambulation. Methods One hundred and thirteen patients (age range 4.1–17, mean 8.2) fulfilled the inclusion criteria, 67 of the 113 were on daily and 40 on intermittent steroids, while 6 were not on steroids. All were assessed using the 6 Minute Walk Test (6MWT), the North Star Ambulatory Assessment (NSAA) and timed test. Results On the 6MWT there was an average overall decline of −22.7 (SD 81.0) in the first year and of −64.7 (SD 123.1) in the second year. On the NSAA the average overall decline was of −1.86 (SD 4.21) in the first year and of −2.98 (SD 5.19) in the second year. Fourteen children lost ambulation, one in the first year and the other 13 in the second year of the study. A distance of at least 330 meters on the 6MWT, or a NSAA score of 18 at baseline reduced significantly the risk of losing ambulation within 2 years. Conclusions These results can be of help at the time of using inclusion criteria for a study in ambulant patients in order to minimize the risk of patients who may lose ambulation within the time of the trial. PMID:23326337

  12. The effect of heat waves on ambulance attendances in Brisbane, Australia.

    Science.gov (United States)

    Turner, Lyle R; Connell, Des; Tong, Shilu

    2013-10-01

    Introduction Heat waves have significant impacts on mortality and morbidity. However, little is known regarding effects on pre-admission health outcomes such as ambulance attendances, particularly in subtropical regions. Problem This study investigated both main temperature effects and the added effects of heat waves on ambulance attendances in Brisbane, a subtropical city in Australia. Daily data relating to 783,935 ambulance attendances, along with data on meteorological variables and air pollutants, were collected for the period 2000-2007. Ambient temperature (main) effects were assessed using a distributed lag nonlinear approach that accounted for delayed effects of temperature, while added heat wave effects were incorporated separately using a local heat wave definition. Effect estimates were obtained for total, cardiovascular and respiratory attendances, and different age groups. Main effects of temperature were found for total attendances, which increased by 50.6% (95% CI, 32.3%-71.4%) for a 9.5°C increase above a reference temperature of 29°C. An added heat wave effect on total attendances was observed (18.8%; 95% CI, 6.5%-32.5%). Significant effects were found for both respiratory and cardiovascular attendances, particularly for those aged 65 and above. Ambulance attendances can be significantly impacted by sustained periods of high temperatures, and are a valid source of early detection of the effects of extreme temperatures on the population. The planning of ambulance services may need to be adapted as a consequence of increasing numbers of heat waves in the future. Ambulance attendance data also should be utilized in the development of heat warning systems and climate change adaptation strategies.

  13. A geographic information system-based analysis of ambulance station coverage area in Samsun, Turkey.

    Science.gov (United States)

    Terzi, Ozlem; Sisman, Aziz; Canbaz, Sevgi; Dündar, Cihad; Peksen, Yıldız

    2013-11-01

    The location of ambulance stations are of great importance, as location is a determining factor of whether ambulances are able to respond to emergency calls within the critical period. The aim of the present study was to determine whether the ambulance stations in the provincial centre of Samsun, Turkey, were able to cover their entire operational area within 10 mins of receiving an emergency call. This study was based on emergency calls received by the emergency medical services of the study area. Detailed address data from the calls was used to produce thematic maps using the geographic information system (GIS). Buffer analysis was used to determine the adequacy of the stations' locations in relation to the time taken to respond to the emergency calls. In the study area, there were a total of 11,506 emergency ambulance calls made in 2009, which revealed a call density of 0.7 calls per ha and 23.8 calls per 1,000 population. A total of 75.8% of the calls were made due to medical reasons, while 11.6% were related to traffic accidents. The GIS-based investigation revealed that the 10-min coverage areas for the four ambulance stations in the provincial centre of Samsun served 76.9% of the area and 97.9% of its population. Of the 10,380 calls for which detailed address data were available, 99.2% were within the stations' 10-min coverage areas. According to the buffer analysis, the ambulance stations in the provincial centre of Samsun are able to reach 97.9% of the population within the critical 10-min response time. This study demonstrates that GIS is an indispensable tool for processing and analysing spatial data, which can in turn aid decision-making in the field of geographical epidemiology and public health.

  14. Why the closest ambulance cannot be dispatched in an urban emergency medical services system.

    Science.gov (United States)

    Dean, Stephen F

    2008-01-01

    Response time performance is related to increased survival for a relatively small group of patients with critical emergencies. Effectively utilizing current resources is a challenge for all emergency medical services (EMS) systems for reasons of cost-effectiveness and safety. The objective of this study was to identify opportunities for improving ambulance response-time performance in an urban EMS system using fixed deployment. This was a qualitative and quantitative case study which consisted of structured interviews with policy makers, managers, and workers in a fire department EMS division, as well as analysis of dispatch data and observation of dispatch operations. The current computer-aided dispatch (CAD) system does not identify the closest ambulance to the emergency, and therefore, dispatchers must guess which unit is closer when units are not within their stations or "first due" areas. There is no means to track how often dispatchers guess correctly or how often the closest ambulance actually is dispatched to the emergency. Temporal and geographic patterns were identified. Opportunities also were identified to improve response time performance through the use of dynamic deployment and peak-load staffing. The results suggest that there were opportunities for improving ambulance response times by implementing strategies such as peak-load staffing and dynamic deployment. However, the most important improvement would be the implementation of a policy to send the closest ambulance to the emergency. More research is needed to identify how prevalent the failure to send the closest ambulance is within EMS systems that use fixed-deployment response strategies and computer-aided dispatch systems that are incapable of tracking unit locations outside of their stations.

  15. Assessment of prehospital medical care for the patients transported to emergency department by ambulance

    Directory of Open Access Journals (Sweden)

    Sehnaz Akın Paker

    2015-09-01

    Full Text Available Objectives: In our study we aimed to investigate the quality and quantity of medical management inside ambulances for 14 and over 14 years old patients transported to a level three emergency department (ED. Material and methods: Our study was conducted prospectively at a level three ED. 14 and over 14 years old patients who were transported to the ED by ambulance were included in the study consecutively. “Lack of vital rate” was described as missing of one or more of five vital rates during ambulance transportation. Both of two attending emergency physicians evaluated the medical procedures and management of patients at the ambulance simultaneously and this was recorded on the study forms. Results: Four hundred and fifty six patients were included in the study. Missing vital signs were identified for 90.1% (n = 322 of the patients that were transported by physicians and 92.4% (n = 73 of the patients that were transported by paramedics. For five patients with cardiac arrest two (33.3% had cardiopulmonary resuscitation (CPR, one (20% was intubated, one (20% received adrenaline. Out of 120 patients, needed spinal immobilization, 69 (57.5% had spinal board. Cervical collar usage was 65.1% (n = 69 We have revealed that 316 (69.3% patients did not receive at least one of the necessary medical intervention or treatment. Conclusion: During ambulance transportation, life-saving procedures like cardiopulmonary resuscitation, vital sign measurement, crucial treatment administration, endotracheal intubation, defibrillation, fracture immobilization were not performed adequately. Increasing the training on the deficient interventions and performing administrative inspections may improve quality of patient care. Keywords: Emergency department, Ambulance, Prehospital emergency care

  16. Assessment of salivary cortisol as stress marker in ambulance service personnel: comparison between shifts working on mobile intensive care unit and patient transport ambulance.

    Science.gov (United States)

    Backé, Eva M; Kaul, Gerlinde; Klussmann, André; Liebers, Falk; Thim, Carmen; Massbeck, Peter; Steinberg, Ulf

    2009-10-01

    The aim of this study was to describe and compare salivary cortisol of ambulance personnel on days with different work demands as well as to correlate the individual perception of demands to the physiological outcome cortisol. Diurnal cortisol profiles on a day in emergency service and on a day in patient transport were monitored for 24 subjects working in an urban ambulance station. Changes of cortisol were also observed during 42 operations in emergency service and 24 operations in patient transport and were compared to the individual perception of physical and emotional demands. Rise of cortisol in the morning on days in emergency service was significantly higher than in patient transport suggesting adjustment to forthcoming demanding tasks. There were only few situations with strong endocrine reaction in emergency service as well as in patient transport. The magnitude of this reaction was not related to the individual perception of demand. Ambulance service personnel seem to be used to critical situations. There was few awareness of the "physiological" stress response indicating that stress is probably not perceived in work situations characterised by routines.

  17. Ambulance Transfer in Case of Postpartum Hemorrhage after Birth in Primary Midwifery Care in The Netherlands: A Prospective Cohort Study

    NARCIS (Netherlands)

    Stolp, Ineke; Smit, Marrit; Luxemburg, Sanne; van den Akker, Thomas; de Waard, Jan; van Roosmalen, Jos; de Vos, Rien

    2015-01-01

    The objective of this prospective cohort study was to assess whether the 45-minute prehospital limit for ambulance transfer is met in case of postpartum hemorrhage (PPH) after midwifery-supervised home birth in The Netherlands and evaluate the process of ambulance transfer, maternal condition during

  18. Delayed onset of ambulation in boys with Duchenne muscular dystrophy : Potential use as an endpoint in clinical trials

    NARCIS (Netherlands)

    Gissy, Jacob J.; Johnson, Teresa; Fox, Deborah J.; Kumar, Anil; Ciafaloni, Emma; van Essen, Anthonie J.; Peay, Holly L.; Martin, Ann; Lucas, Ann; Finkel, Richard S.

    2017-01-01

    Individuals with Duchenne muscular dystrophy (DMD) often exhibit delayed motor and cognitive development, including delayed onset of ambulation. Data on age when loss of independent ambulation occurs are well established for DMD; however, age at onset of walking has not been well described. We

  19. Are emergency department staffs' perceptions about the inappropriate use of ambulances, alcohol intoxication, verbal abuse and violence accurate?

    Science.gov (United States)

    Vardy, J; Mansbridge, C; Ireland, A

    2009-03-01

    To examine three opinions voiced by nightshift emergency department (ED) staff. First, that a significant proportion of adult patients arriving by emergency ambulance lack a clear indication for emergency transport. Second, that at night a high proportion of ambulance arrivals are drunk, abusive or leave without treatment. Third, that at night a high proportion of ambulance arrivals have been assaulted or have deliberately harmed themselves. A retrospective audit of all 5421 new patient attendances to Glasgow Royal Infirmary ED in February 2007, including 1743 arriving by ambulance. 19.5% of ambulance arrivals lacked a clear indication for emergency transport. Between midnight and 05:00 hours: 52.5% of ambulance arrivals were intoxicated; 6.2% were abusive to staff; 14.0% left before treatment was completed; 21.4% had been assaulted and 7.4% had deliberately harmed themselves. The majority of ambulances were called appropriately; however, there remains a significant proportion who could travel by other means. A high proportion of ambulance arrivals between midnight and 05:00 hours were intoxicated, abusive or victims of assault. This supported staff's perception that such patients form a substantial proportion of departmental workload at night.

  20. Using Behavioral Skills Training to Promote Safe and Correct Staff Guarding and Ambulation Distance of Students with Multiple Physical Disabilities

    Science.gov (United States)

    Nabeyama, Bobby; Sturmey, Peter

    2010-01-01

    The study analyzed the effects of self-recording and behavioral skills training on guarding responses of 3 staff members while they assisted 3 students with multiple disabilities to ambulate. The intervention increased the percentage of correct posture and guarding responses and the distance that students ambulated. These effects generalized when…

  1. Safety and tolerance of the ReWalk™ exoskeleton suit for ambulation by people with complete spinal cord injury: a pilot study

    National Research Council Canada - National Science Library

    Zeilig, Gabi; Weingarden, Harold; Zwecker, Manuel; Dudkiewicz, Israel; Bloch, Ayala; Esquenazi, Alberto

    2012-01-01

    ...™ exoskeleton ambulation system in people with spinal cord injury. Measures of functional ambulation were also assessed and correlated to neurological spinal cord level, age, and duration since injury...

  2. Ambulance services as part of the district health system in low-income countries: a feasibility study from Cambodia.

    Science.gov (United States)

    Jacobs, Bart; Men, Cheanrithy; Sam, Oeun Sam; Postma, Sjoerd

    2016-10-01

    Emergency referral care is considered an essential component of the district health system. Nevertheless, the establishment of effective and durable transport arrangements of such referral care by use of an ambulance is considered controversial in low-income countries. We aim to assess the extent to which an ambulance service as part of the district health system is feasible in rural Cambodia. In a rural health district, we assessed the population's perception of the ambulance service, its recurrent costs requirements, government financial contribution to its operations, profile and medical conditions of ambulance (non)users, reasons for (non)use of the ambulance and contextual factors required for the ambulance services to operate. This observation was obtained through nine key informant interviews, five focus group discussions, structured interviews with 225 caretakers of admitted patients, a 1-month census of admitted emergency cases and assessment of annual recurrent costs for the ambulance services. The ambulance services were well received by the population and authorities and appeared to reinforce an appreciation of the hospital. Ambulance services were mainly used by the poor and by women, especially for emergency obstetric care. Less than half the number of transported patients, 44%, was considered a medical emergency. The direct cost to the hospital per collected emergency case was $34.4. When certain conditions are met, effective ambulance services can be an integral part of the district health system and positively contribute to the population's appreciation of the hospital services and respective district health system. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

  3. Effects of a Public Education Campaign on the Association Between Knowledge of Early Stroke Symptoms and Intention to Call an Ambulance at Stroke Onset: The Acquisition of Stroke Knowledge (ASK) Study

    National Research Council Canada - National Science Library

    Nishikawa, Tomofumi; Okamura, Tomonori; Nakayama, Hirofumi; Miyamatsu, Naomi; Morimoto, Akiko; Toyoda, Kazunori; Suzuki, Kazuo; Toyota, Akihiro; Hata, Takashi; Yamaguchi, Takenori

    2016-01-01

    .... Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public...

  4. Sicherheit, Funktionalität und Wertschöpfung - die Schlüssel zur fokussierten Risikoanalyse: Vortrag gehalten auf dem 11. Osnabrücker FMEA-Forum, FMEA 2020 - Quo vadis?, 9.-10. März 2016, Osnabrück

    OpenAIRE

    Schloske, Alexander

    2016-01-01

    Der Vortrag beschreibt für die verschiedenen FMEA-Arten (System-FMEA, Konstruktions-FMEA und Prozess-FMEA) wie eine Systemstrukturierung, Funktions- und Merkmalszuordnung zu erfolgen hat, um eine effiziente und effektive Risikoanalyse durchzuführen. Die Empfehlungen werden zusätzlich anhand von Beispielen erläutert. Des Weiteren wird ein kurzer Exkurs in die Funktionale Sicherheit und die Gefahrenanalyse und Risikobewertung sowie deren Zusammenhänge zur FMEA durchgeführt.

  5. The role of the ambulance service as part of the health profession

    African Journals Online (AJOL)

    1990-09-15

    Sep 15, 1990 ... Mobile Army Surgical Hospitals (MASH), close to the battle- front, minimised the time spent getting the injured to special- ised facilities. I The Vietnam War gave birth to the paramedic concept and fIrmly established the use of the helicopter as an ambulance. The impact of the time lapse prior to commence-.

  6. Ambulance Services of Lagos State, Nigeria: A Six-Year (2001 ...

    African Journals Online (AJOL)

    system in Nigeria in 2001. OBJECTIVE: This was to review the activities of the Lagos State Emergency Ambulance Services (LASAMBUS) within the stated period with the hope that our findings can be used to audit the system and make recommendations for further improvement. SUBJECTS, MATERIALS AND METHODS: ...

  7. The role of the ambulance service as part of the health profession

    African Journals Online (AJOL)

    1990-09-15

    Sep 15, 1990 ... venous fluid administration. This was a sought-after qualllica- tion in the combined services. . At the same time a young Cape Town doctor pioneered the concept of the ambulance service as an independent health service under medical supervision in the RSA. Emergency Medical Services; Transvaal ...

  8. The 6 Minute Walk Test and Performance of Upper Limb in Ambulant Duchenne Muscular Dystrophy Boys

    Science.gov (United States)

    Pane, Marika; Mazzone, Elena Stacy; Sivo, Serena; Fanelli, Lavinia; De Sanctis, Roberto; D’Amico, Adele; Messina, Sonia; Battini, Roberta; Bianco, Flaviana; Scutifero, Marianna; Petillo, Roberta; Frosini, Silvia; Scalise, Roberta; Vita, Gian Luca; Bruno, Claudio; Pedemonte, Marina; Mongini, Tiziana; Pegoraro, Elena; Brustia, Francesca; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Busato, Fabio; Bonfiglio, Serena; Rolle, Enrica; Colia, Giulia; Bonetti, Annamaria; Palermo, Concetta; Graziano, Alessandra; D’Angelo, Grazia; Pini, Antonella; Corlatti, Alice; Gorni, Ksenija; Baranello, Giovanni; Antonaci, Laura; Bertini, Enrico; Politano, Luisa; Mercuri, Eugenio

    2014-01-01

    The Performance of Upper Limb (PUL) test was specifically developed for the assessment of upper limbs in Duchenne muscular dystrophy (DMD). The first published data have shown that early signs of involvement can also be found in ambulant DMD boys. The aim of this longitudinal Italian multicentric study was to evaluate the correlation between the 6 Minute Walk Test (6MWT) and the PUL in ambulant DMD boys. Both 6MWT and PUL were administered to 164 ambulant DMD boys of age between 5.0 and 16.17 years (mean 8.82). The 6 minute walk distance (6MWD) ranged between 118 and 557 (mean: 376.38, SD: 90.59). The PUL total scores ranged between 52 and 74 (mean: 70.74, SD: 4.66). The correlation between the two measures was 0.499. The scores on the PUL largely reflect the overall impairment observed on the 6MWT but the correlation was not linear. The use of the PUL appeared to be less relevant in the very strong patients with 6MWD above 400 meters, who, with few exceptions had near full scores. In patients with lower 6MWD the severity of upper limb involvement was more variable and could not always be predicted by the 6MWD value or by the use of steroids. Our results confirm that upper limb involvement can already be found in DMD boys even in the ambulant phase. PMID:25642376

  9. Epidemiology of ambulance responses to older people who have fallen in New South Wales, Australia.

    Science.gov (United States)

    Simpson, Paul M; Bendall, Jason C; Patterson, Jillian; Tiedemann, Anne; Middleton, Paul M; Close, Jacqueline Ct

    2013-09-01

    To quantify the size and scope of the operational burden for a large ambulance service arising from older people who have fallen and to describe this population. Retrospective analysis of ambulance records from New South Wales, Australia for emergency calls classified as 'falls' in the period 1 July 2008 to 30 June 2009. There were 42 331 responses to people aged 65 years or older, constituting 5.1% of total emergency workload. The median age of patients was 83 (interquartile range 76-87) and 62% were women. The transport rate was 76%. Transport to hospital was more likely during the day (odds ratio (OR) 1.8, 95% confidence interval (CI) 1.7-1.9) and on weekends (OR 1.06, 95%CI 1.0-1.1). Falls by older people constitute approximately 5% of all emergency responses, of which one quarter are not transported to emergency department (ED) after paramedic assessment. Increasing the sophistication of ambulance dispatch processes to older people who have fallen, and continuing with the development of new models of care aimed at decreasing unnecessary transports to the EDs, should be a priority when planning ambulance service delivery for older people who have fallen. © 2012 The Authors. Australasian Journal on Ageing © 2012 ACOTA.

  10. Dyspnea in the ambulance - etiology, mortality, and point-of-care diagnostics

    DEFF Research Database (Denmark)

    Bøtker, Morten Thingemann

    2016-01-01

    in the ambulance. Electrocardiographic assessment leading to suspicion of ST-elevation myocardial infarction or bundle branch block myocardial infarction was useful for identification of a small group of patients with very high risk of death, emphasizing the importance of obtaining an electrocardiogram in patients...

  11. Nursing students' perceptions of learning nursing skills in the ambulance service.

    Science.gov (United States)

    Nilsson, Tomas; Lindström, Veronica

    2017-05-01

    Several previous studies have explored nursing students' perceptions of clinical learning at hospitals and in other health care facilities, but there are few studies exploring nursing students' perceptions of the clinical learning in the ambulance service. Therefore, the aim of this study was to explore nursing students' perceptions of learning nursing skills in the ambulance service. An inductive qualitative study design with two focus group interviews and content analysis was used. Two themes were identified. The first theme, professional skills, included: Assessment, Prioritizing and initiating care, and Medical treatment and evaluation of interventions. The second theme, a holistic approach to the care included: Cultural, social, and ethical aspects of caring, Decision-making in collaboration with patients, and Care provided in the patients' home. The ambulance service provides a learning environment where the students face a multifaceted picture of health and illness. This learning environment helps nursing students to learn independently how to use professional nursing skills and how to care by employing a holistic approach. However, further research is needed to explore if and how this knowledge about nursing and caring in the ambulance service is useful when working as a Registered Nurse in other health care settings. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Symbolic and systemic violence in media representations of aggression towards ambulance personnel in the Netherlands

    NARCIS (Netherlands)

    Cuijpers, N.; Brown, P.R.

    2016-01-01

    Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the

  13. METABOLIC SYNDROME AND DAILY AMBULATION IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS

    Science.gov (United States)

    Gardner, Andrew W.; Parker, Donald E.; Krishnan, Sowmya; Chalmers, Laura J.

    2012-01-01

    Purposes To compare daily ambulatory measures in children, adolescents, and young adults with and without metabolic syndrome, and to assess which metabolic syndrome components, demographic measures, and body composition measures are associated with daily ambulatory measures. Methods Two-hundred fifty subjects between the ages of 10 and 30 years were assessed on metabolic syndrome components, demographic and clinical measures, body fat percentage, and daily ambulatory strides, durations, and cadences during seven consecutive days. Forty-five of the 250 subjects had metabolic syndrome, as defined by the International Diabetes Federation. Results Subjects with metabolic syndrome ambulated at a slower daily average cadence than those without metabolic syndrome (13.6 ± 2.2 strides/min vs. 14.9 ± 3.2 strides/min; p=0.012), and they had slower cadences for continuous durations of 60 minutes (p=0.006), 30 minutes (p=0.005), 20 minutes (p=0.003), 5 minutes (p=0.002), and 1 minute (p=0.001). However, the total amount of time spent ambulating each day was not different (p=0.077). After adjustment for metabolic syndrome status, average cadence is linearly associated with body fat percentage (pmetabolic syndrome ambulate more slowly and take fewer strides throughout the day than those without metabolic syndrome, even though the total amount of time spent ambulating is not different. Furthermore, the detrimental influence of metabolic syndrome on ambulatory cadence is primarily a function of body fatness. PMID:22811038

  14. Design and methods of European Ambulance Acute Coronary Syndrome Angiography Trial (EUROMAX)

    DEFF Research Database (Denmark)

    Steg, Philippe Gabriel; van 't Hof, Arnoud; Clemmensen, Peter

    2013-01-01

    In patients with ST-segment elevation myocardial infarction (STEMI) triaged to primary percutaneous coronary intervention (PCI), anticoagulation often is initiated in the ambulance during transfer to a PCI site. In this prehospital setting, bivalirudin has not been compared with standard-of-care ...

  15. [The correlation between personality characteristics and burnout syndrome in emergency ambulance workers].

    Science.gov (United States)

    Bergmueller, A; Zavgorodnii, I; Zavgorodnia, N; Kapustnik, W; Boeckelmann, I

    The work in Emergency Medical Ambulance Service is one of the professions, which is accompanied by high psychological and emotional stress. The aim was to determine the risk of professional burnout syndrome of Emergency Medical Ambulance Service staff and the relationship between burnout syndrome and personality. Ninety-seven doctors (57 women and 40 men, aged 37.0±12.21) of Emergency Medical Ambulance Service were interviewed using the MBI-GS questionnaire and the Freiburg personality questionnaire (FPI). Correlation and regression analysis were used. Nine (11.5%) of respondents had a risk of burnout syndrome and 28 (35.9%) had some symptoms. In the group, aged 45 years and older, the risk of burnout syndrome was not identified. The staff of Emergency Medical Ambulance Service is characterized by stable personality features. It is necessary to identify the prevalence of burnout syndrome and also to identity the causes for its prevention and development of measures on the increase of personal stress resilience.

  16. Disarticulation of the knee : Analysis of an extended database on survival, wound healing, and ambulation

    NARCIS (Netherlands)

    Nijmeijer, Rachelle; Voesten, Henricus G. J. M.; Geertzen, Joannes H. B.; Dijkstra, Pieter U.

    OBJECTIVE: This study analyzed survival of the amputee patients, wound healing, and ambulation after knee disarticulation (KD). METHODS: Between July 1989 and October 2015, 153 KDs in 138 patients were performed at Nij Smellinghe Hospital, Drachten. Data were retrieved from hospital medical records.

  17. Iterative optimization algorithm with parameter estimation for the ambulance location problem.

    Science.gov (United States)

    Kim, Sun Hoon; Lee, Young Hoon

    2016-12-01

    The emergency vehicle location problem to determine the number of ambulance vehicles and their locations satisfying a required reliability level is investigated in this study. This is a complex nonlinear issue involving critical decision making that has inherent stochastic characteristics. This paper studies an iterative optimization algorithm with parameter estimation to solve the emergency vehicle location problem. In the suggested algorithm, a linear model determines the locations of ambulances, while a hypercube simulation is used to estimate and provide parameters regarding ambulance locations. First, we suggest an iterative hypercube optimization algorithm in which interaction parameters and rules for the hypercube and optimization are identified. The interaction rules employed in this study enable our algorithm to always find the locations of ambulances satisfying the reliability requirement. We also propose an iterative simulation optimization algorithm in which the hypercube method is replaced by a simulation, to achieve computational efficiency. The computational experiments show that the iterative simulation optimization algorithm performs equivalently to the iterative hypercube optimization. The suggested algorithms are found to outperform existing algorithms suggested in the literature.

  18. Osteogenesis imperfecta in childhood: effects of spondylodesis on functional ability, ambulation and perceived competence

    NARCIS (Netherlands)

    Tolboom, N.; Cats, E. A.; Helders, P. J. M.; Pruijs, J. E. H.; Engelbert, R. H. H.

    2004-01-01

    We studied the effects of spondylodesis on spinal curvature, functional outcome, level of ambulation and perceived competence in 11 children with osteogenesis imperfecta (OI). Mean age at surgical intervention was 13.1 years (SD 2.5 years) and follow-up amounted to 3.4 years (SD 2.3 years). Spinal

  19. Ambulation with the reciprocating-gait orthosis - Experience in 15 children with myelomeningocele or paraplegia

    NARCIS (Netherlands)

    GerritsmaBleeker, CLE; Heeg, M; VosNiel, H

    1997-01-01

    We reviewed 15 children with spina bifida or paraplegia who have used a reciprocating-gait orthosis between 1985 and 1995. All were nonfunctional ambulators. The level of the spinal lesions ranged from Th10 to L3. The mean age of fitting the orthosis was 5 years. 8 children have stopped using it at

  20. Factors associated with utilization of motorcycle ambulances by pregnant women in rural eastern Uganda: a cross-sectional study.

    Science.gov (United States)

    Ssebunya, Rogers; Matovu, Joseph K B

    2016-03-03

    Evidence suggests that use of motorcycle ambulances can help to improve health facility deliveries; however, few studies have explored the motivators for and barriers to their usage. We explored the factors associated with utilization of motorcycle ambulances by pregnant women in eastern Uganda. This was a cross-sectional, mixed-methods study conducted among 391 women who delivered at four health facilities supplied with motorcycle ambulances in Mbale district, eastern Uganda, between April and May 2014. Quantitative data were collected on socio-demographic and economic characteristics, pregnancy and delivery history, and community and health facility factors associated with utilization of motorcycle ambulances using semi-structured questionnaires. Qualitative data were collected on the knowledge and attitudes towards using motorcycle ambulances by pregnant women through six focus group discussions. Using STATA v.12, we computed the characteristics of women using motorcycle ambulances and used a logistic regression model to assess the correlates of utilization of motorcycle ambulances. Qualitative data were analyzed manually using a master sheet analysis tool. Of the 391 women, 189 (48.3%) reported that they had ever utilized motorcycle ambulances. Of these, 94.7% were currently married or living together with a partner while 50.8% earned less than 50,000 Uganda shillings (US $20) per month. Factors independently associated with use of motorcycle ambulances were: older age of the mother (≥35 years vs ≤24 years; adjusted Odds Ratio (aOR) = 4.3, 95% CI: 2.03, 9.13), sharing a birth plan with the husband (aOR = 2.5, 95% CI: 1.19, 5.26), husband participating in the decision to use the ambulance (aOR =3.22, 95% CI: 1.92, 5.38), and having discussed the use of the ambulance with a traditional birth attendant (TBA) before using it (aOR =3.12, 95% CI: 1.88, 5.19). Qualitative findings indicated that community members were aware of what motorcycle ambulances

  1. Army Air Ambulance Blood Product Program in the Combat Zone and Challenges to Best Practices.

    Science.gov (United States)

    Powell-Dunford, Nicole; Quesada, Jose F; Gross, Kirby R; Shackelford, Stacy A

    2016-08-01

    Identify challenges and best practices in the development of an austere air ambulance transfusion program. A search of PubMed using combinations of the key terms 'prehospital,' 'blood product,' 'red blood cells,' 'damage control resuscitation,' 'transfusion,' 'air ambulance,' 'medical evacuation,' and 'medevac' yielded 196 articles for further analysis, with 14 articles suitable for addressing the background of prehospital transfusion within a helicopter. Retrospective analysis of unclassified briefs, after action reports, and procedures was also undertaken along with interview of subject matter experts. The initial series of 15 transfusions were discussed telephonically among flight crew, trauma surgeons, and lab specialists. Review of Joint Theater System data was readily available for 84 U.S. Army air ambulance transfusions between May-December 2012, with December marking the redeployment of the 25(th) Combat Aviation Brigade. Standardized implementation enabled safe blood product administration for 84 causalities from May-December 2012 without blood product shortage, expiration, or transfusion reaction. Challenges included developing transfusion competency, achieving high quality blood support, countering the potential for anti-U.S. sentiment, and diversity in coalition transfusion practices. Blood product administration aboard the air ambulance is logistically complex, requiring blood bank integration. Repetitive training enabled emergency medical technicians (EMTs) with basic medical training to safely perform transfusion in accordance with clinical operating guidelines. In the austere environment, logistic factors are significant challenges and political sensitivities are important considerations. Best practices may facilitate new en route transfusion programs. Powell-Dunford N, Quesada JF, Gross KR, Shackelford SA. Army air ambulance blood product program in the combat zone and challenges to best practices. Aerosp Med Hum Perform. 2016; 87(8):728-734.

  2. Self-paced brain-computer interface control of ambulation in a virtual reality environment

    Science.gov (United States)

    Wang, Po T.; King, Christine E.; Chui, Luis A.; Do, An H.; Nenadic, Zoran

    2012-10-01

    Objective. Spinal cord injury (SCI) often leaves affected individuals unable to ambulate. Electroencephalogram (EEG) based brain-computer interface (BCI) controlled lower extremity prostheses may restore intuitive and able-body-like ambulation after SCI. To test its feasibility, the authors developed and tested a novel EEG-based, data-driven BCI system for intuitive and self-paced control of the ambulation of an avatar within a virtual reality environment (VRE). Approach. Eight able-bodied subjects and one with SCI underwent the following 10-min training session: subjects alternated between idling and walking kinaesthetic motor imageries (KMI) while their EEG were recorded and analysed to generate subject-specific decoding models. Subjects then performed a goal-oriented online task, repeated over five sessions, in which they utilized the KMI to control the linear ambulation of an avatar and make ten sequential stops at designated points within the VRE. Main results. The average offline training performance across subjects was 77.2±11.0%, ranging from 64.3% (p = 0.001 76) to 94.5% (p = 6.26×10-23), with chance performance being 50%. The average online performance was 8.5±1.1 (out of 10) successful stops and 303±53 s completion time (perfect = 211 s). All subjects achieved performances significantly different than those of random walk (p online sessions. Significance. By using a data-driven machine learning approach to decode users’ KMI, this BCI-VRE system enabled intuitive and purposeful self-paced control of ambulation after only 10 minutes training. The ability to achieve such BCI control with minimal training indicates that the implementation of future BCI-lower extremity prosthesis systems may be feasible.

  3. Exposure to hot and cold temperatures and ambulance attendances in Brisbane, Australia: a time-series study.

    Science.gov (United States)

    Turner, Lyle R; Connell, Des; Tong, Shilu

    2012-01-01

    To investigate the effect of hot and cold temperatures on ambulance attendances. An ecological time-series study. The study was conducted in Brisbane, Australia. The authors collected information on 783 935 daily ambulance attendances, along with data of associated meteorological variables and air pollutants, for the period of 2000-2007. The total number of ambulance attendances was examined, along with those related to cardiovascular, respiratory and other non-traumatic conditions. Generalised additive models were used to assess the relationship between daily mean temperature and the number of ambulance attendances. There were statistically significant relationships between mean temperature and ambulance attendances for all categories. Acute heat effects were found with a 1.17% (95% CI 0.86% to 1.48%) increase in total attendances for 1°C increase above threshold (0-1 days lag). Cold effects were delayed and longer lasting with a 1.30% (0.87% to 1.73%) increase in total attendances for a 1°C decrease below the threshold (2-15 days lag). Harvesting was observed following initial acute periods of heat effects but not for cold effects. This study shows that both hot and cold temperatures led to increases in ambulance attendances for different medical conditions. Our findings support the notion that ambulance attendance records are a valid and timely source of data for use in the development of local weather/health early warning systems.

  4. Association Between Remoteness to a Health Care Facility and Incidence of Ambulance Calls in Rural Areas of Japan.

    Science.gov (United States)

    Kashima, Saori; Inoue, Kazuo; Matsumoto, Masatoshi; Eboshida, Akira; Takeuchi, Keisuke

    2015-01-01

    Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan. We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers). We estimated the incidence rate and the incidence rate ratio (IRR) of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season. During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49]), and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility. This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.

  5. Ambulance call-outs and response times in Birmingham and the impact of extreme weather and climate change.

    Science.gov (United States)

    Thornes, John Edward; Fisher, Paul Anthony; Rayment-Bishop, Tracy; Smith, Christopher

    2014-03-01

    Although there has been some research on the impact of extreme weather on the number of ambulance call-out incidents, especially heat waves, there has been very little research on the impact of cold weather on ambulance call-outs and response times. In the UK, there is a target response rate of 75% of life threatening incidents (Category A) that must be responded to within 8 min. This paper compares daily air temperature data with ambulance call-out data for Birmingham over a 5-year period (2007-2011). A significant relationship between extreme weather and increased ambulance call-out and response times can clearly be shown. Both hot and cold weather have a negative impact on response times. During the heat wave of August 2003, the number of ambulance call-outs increased by up to a third. In December 2010 (the coldest December for more than 100 years), the response rate fell below 50% for 3 days in a row (18 December-20 December 2010) with a mean response time of 15 min. For every reduction of air temperature by 1°C there was a reduction of 1.3% in performance. Improved weather forecasting and the take up of adaptation measures, such as the use of winter tyres, are suggested for consideration as management tools to improve ambulance response resilience during extreme weather. Also it is suggested that ambulance response times could be used as part of the syndromic surveillance system at the Health Protection Agency.

  6. Communicative management in ambulance services: a study of interaction between station managers and paramedics working in frontline units.

    Science.gov (United States)

    Nordby, Halvor

    2015-01-01

    This article, the second in a series of three, presents a study of professional communication between ambulance station managers and paramedics. The study used observation and field memos from 20 ambulance stations as a basis for understanding real-life communication in this area of medical practice. The results showed that the unpredictable nature of ambulance work made it difficult for managers and employees to find time for extensive communication, and that the lack of face-to-face contact often led to misunderstanding and poor dialogue. Furthermore, the paramedics expressed health perspectives and norms of patient treatment that conflicted with economic-administrative frameworks expressed on management levels.

  7. Population-level Spatial Access to Prehospital Care by the National Ambulance Service in Ghana.

    Science.gov (United States)

    Tansley, Gavin; Stewart, Barclay; Zakariah, Ahmed; Boateng, Edmund; Achena, Christiana; Lewis, Daniel; Mock, Charles

    2016-01-01

    Conditions requiring emergency treatment disproportionately affect low- and middle-income countries (LMICs), where there is often insufficient prehospital care capacity. To inform targeted prehospital care development in Ghana, we aimed to describe spatial access to formal prehospital care services and identify ambulance stations for capacity expansion. Cost distance methods were used to evaluate areal and population-level access to prehospital care within 30 and 60 minutes of each of the 128 ambulance stations in Ghana. With network analysis methods, a two-step floating catchment area model was created to identify district-level variability in access. Districts without NAS stations within their catchment areas were identified as candidates for an additional NAS station. Additionally, five candidate stations for capacity expansion (e.g., addition of an ambulance) were then identified through iterative simulations that were designed to identify the stations that had the greatest influence on the access scores of the ten lowest access districts. Following NAS inception, the proportion of Ghana's landmass serviceable within 60 minutes of a station increased from 8.7 to 59.4% from 2004 to 2014, respectively. Over the same time period, the proportion of the population with access to the NAS within 60-minutes increased from 48% to 79%. The two-step floating catchment area model identified considerable variation in district-level access scores, which ranged from 0.05 to 2.43 ambulances per 100,000 persons (median 0.45; interquartile range 0.23-0.63). Seven candidate districts for NAS station addition and five candidate NAS stations for capacity expansion were identified. The addition of one ambulance to each of the five candidate stations improved access scores in the ten lowest access districts by a total 0.22 ambulances per 100,000 persons. The NAS in Ghana has expanded its population-level spatial access to the majority of the population; however, access inequality

  8. Aspects of neutrality: two Dutch ambulances at the eastern front in the First World War.

    Science.gov (United States)

    van Bergen, Leo

    2010-01-01

    The paper looks at two First World War ambulance teams which distinctly differed from each other, both in the way they perceived the war and the places at the front where they worked. The first was working on the Serbian side and the second on the Austrian-Hungarian. The questions raised are: how was medical neutrality defined (was it defined at all)? Was neutrality maintained, and if so how? The writings of several protagonists are closely examined, and placed in context, to show that total neutrality was not adhered to by the physicians and nurses of these ambulances. Apparently neutrality in wartime is difficult, even for men and women coming from a neutral country with an occupation seen as essentially neutral.

  9. Pre-Hospital Fast Positive Cases Identified by DFB Ambulance Paramedics – Final Clinical Diagnosis

    LENUS (Irish Health Repository)

    Feeney, A

    2016-04-01

    Ischaemic stroke clinical outcomes are improved by earlier treatment with intravenous thrombolysis. An existing pathway at the Mater University Hospital for assessment of suspected acute stroke in the Emergency Department was updated, aiming to shorten ‘door to needle time’. This study examines the final clinical diagnosis of Dublin Fire Brigade Ambulance Paramedic identified Face Arm Speech Test (FAST) positive patients presenting to the Emergency Department over a 7 month period. A retrospective analysis was carried out of 177 consecutive FAST positive patients presenting between March and November 2014. The final clinical diagnosis was acute stroke in 57.1% (n=101) of patients. Of these, 76 were ischaemic strokes of whom 56.5% (n=43) were thrombolysed. In the pre-hospital setting Ambulance Paramedics can identify, with reasonable accuracy, acute stroke using the FAST test. Over half of the ischaemic stroke patients presenting via this pathway can be treated with intravenous thrombolysis

  10. [To Russia with love: ambulances and medical equipment from Eretz Israel to the Red Army].

    Science.gov (United States)

    Levy, Nissim

    2007-12-01

    During the autumn of 1942 the attention of the entire world was concentrated on the decisive struggle at the Eastern Front between the Wehrmacht and the Red Army. The profound sympathies of the "Yishuv" towards Russia derived not only from the common cause--the defeat of Germany but also from the Eastern European mentality, similar socialistic ideology and culture of a significant part of the immigrants. Dr. Avigdor Mandelberg, a known pulmonologist and fervent socialist was instrumental in the formation of "League V" ("Victory") which volunteered to send vital medical equipment to the Soviets. Five locally manufactured ambulances and one mobile hospital were properly decorated with Stars of David and inscriptions in Hebrew, Yiddish and Russian indicating their origin. They were delivered to the Red Army in Teheran. Finally, now more than six decades later, and in spite of the Soviet anti-Zionist policy, we have some proof that at least one ambulance reached its destination with the original Zionist insignia.

  11. 10-year experience of CO2-laser application in ambulance gynecology

    Science.gov (United States)

    Stachanov, Michael L.; Masychev, Victor I.; Velsher, Leonid Z.; Kirkin, Vladimir V.; Zhashkov, Roman V.; Kocharian, Emilia A.

    2000-10-01

    CO2-laser surgical systems have come to stay in everyday practice of modern physicians and are successfully used in colposcopic and laparoscopic surgery. Results, obtained in ambulance gynecology are especially impressing. CO2- laser provides high medical- and cost-effective treatment. Presented work describes many-years experience of CO2- laser application. 439 patients with various vulvaric and cervix diseases were operated within this period. Laser beam parameters were selected according to requirements ((tau) =4 J/cm2) treatment without carbonization. Analyses of the results showed that the laser successfully destructs uterine cervix erosion, endocervicosis, dysplasia, leukoplakia, eritoplakia of uterine cervix, various benignant pathologies and focus degenerative process in ambulate conditions.

  12. Ambulance personnel and critical incidents: impact of accident and emergency work on mental health and emotional well-being.

    Science.gov (United States)

    Alexander, D A; Klein, S

    2001-01-01

    The association between mental health and occupational factors among ambulance personnel has not been thoroughly investigated in the UK. To identify the prevalence of psychopathology among ambulance personnel and its relationship to personality and exposure to critical incidents. Data were gathered from ambulance personnel by means of an anonymous questionnaire and standardised measures. Approximately a third of the sample reported high levels of general psychopathology, burnout and posttraumatic symptoms. Burnout was associated with less job satisfaction, longer time in service, less recovery time between incidents, and more frequent exposure to incidents. Burnout and GHQ-28 caseness were more likely in those who had experienced a particularly disturbing incident in the previous 6 months. Concerns about confidentiality and career prospects deter staff from seeking personal help. The mental health and emotional well-being of ambulance personnel appear to be compromised by accident and emergency work.

  13. Symbolic and systemic violence in media representations of aggression towards ambulance personnel in the Netherlands

    OpenAIRE

    Cuijpers, Nicole; Brown, Patrick R

    2016-01-01

    Violence towards public sector employees is perceived as a growing problem in a number of societies, attracting the attention of mass media, politicians and social scientists alike. In this article we discuss how national newspapers have reported aggression towards ambulance workers in the Netherlands. Our analysis is informed by Žižek’s conceptualisations of less visible yet fundamental formats of violence, which he posits as vital for analysing narratives of subjective experiences of aggres...

  14. Risk Management Analysis of Air Ambulance Blood Product Administration in Combat Operations

    Science.gov (United States)

    2014-11-01

    vac has only recently evolved to require paramedic -level training for fl ight medics ( 12 , 16 ) and, at the time of im- plementation of the Army...In many locations, a single Army fl ight medic manages casualties independently, with only the assistance of a nonmedical crew chief. By...medics are highly trained paramedics and operate in teams of two ( 9 ). Un- like other military air ambulances in Afghanistan, the U.S. Army medevac

  15. Reducing Ambulance Diversion at Hospital and Regional Levels: A Systematic Review of Insights from Simulation Models

    OpenAIRE

    Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.

    2013-01-01

    Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec,...

  16. Stability of adrenaline in ambulance and drug storage room Narenthorn Center, Rajavithi Hospital.

    Science.gov (United States)

    Tantivesruangdet, Nopmanee

    2013-03-01

    The stability and quality of Adrenaline medications were advocated 2 to be stored in temperature labeled at 2 degrees C to 8 degrees C at drug storage room. Thailand is located in a tropical area with the average room temperature within 25 degrees C. There was no previous study of adrenaline medication stability and quality in Thailand. To assess the stability and quality of Adrenaline stored at room temperature in Ambulance and drug storage room of Narenthorn center, Rajavithi Hospital. Forty vials of Adrenaline Bitartrade were stored at the temperature in each season for a period of 4 weeks. Half were stored in one Ambulance and the other half in a drug storage room. Samples were then analyzed for their appearance, pH and using stability indicating High Performance Liquid Chromatography (HPLC). The average temperature in the drug storage rooms were 30 degrees C, 28 degrees C and 27 degrees C in hot, rainy and cool seasons respectively; and 34 degrees C, 32 degrees C and 31 degrees C in Narenthorn Ambulance. The appearance of adrenaline was not changed as it was still clear. The average pH is 3.18 to 3.36. Adrenaline was found to be stable when storage in both ambulance and drug storage room. The percent drug remaining was 90 Ia% to 115 Ia%. There was no significant difference in between drug quality the two storage places (p = 0.792). No significant difference was found in the percent drug remaining between the hot and cool season. There was significant difference in the percent drug remaining between the rainy season from other seasons (p adrenaline stability and quality were not changed when testing by HPLC.

  17. Minnesota Heart Safe Communities: Are community-based initiatives increasing pre-ambulance CPR and AED use?

    Science.gov (United States)

    Boland, Lori L; Formanek, Michelle B; Harkins, Kim K; Frazee, Carol L; Kamrud, Jonathan W; Stevens, Andrew C; Lick, Charles J; Yannopoulos, Demetris

    2017-10-01

    Implementation research that describes how successfully resuscitation guidelines are translated into practice are lacking. We examined whether recent community-based initiatives being conducted as part of the Minnesota Heart Safe (HS) Communities program increase the delivery of CPR and use of automated external defibrillators (AED) by bystanders and first responders prior to ambulance arrival. Non-EMS witnessed out-of-hospital cardiac arrests (OHCA) with presumed cardiac etiology treated by a single ambulance service in 2013-2015 were studied. Data were obtained from the Minnesota HS program and the Cardiac Arrest Registry to Enhance Survival (CARES) Surveillance Registry. Pre-ambulance CPR and AED use within HS communities before and after completion of the program were compared. As of July 2016, 17 Minnesota communities within the ambulance service area had achieved HS designation and 294 OHCAs that occurred in these communities met inclusion criteria for analysis (120 before HS designation, 174 after). CPR was initiated by bystanders or first responders prior to ambulance arrival in 83% of OHCA events that occurred before HS designation and in 95% of events that occurred after designation (OR=4.23 [1.80-9.98]). Pre-ambulance AED use increased from 63% to 77% after the community intervention (OR=1.94 [1.16-3.24]). Overall unadjusted survival to hospital discharge increased slightly after HS designation, but this difference was not statistically significant (17% vs 20%, p=0.32). Implementation of the Heart Safe program in communities within our ambulance service area in Minnesota has increased use of CPR and AEDs by bystanders and first responders prior to ambulance arrival. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. Experience of critical incident stress among ambulance service staff and relationship to psychological symptoms.

    Science.gov (United States)

    Gallagher, Sharon; McGilloway, Sinéad

    2009-01-01

    This two-stage study was undertaken to assess the extent and nature of Critical Incident Stress (CIS) amongst frontline staff in a large ambulance service in Ireland. In Stage One, 63% (112/180) of participants completed a Screening Questionnaire and the GHQ-12. In Stage Two, 27 participants, who had experienced a critical incident (CI) during the previous year completed several measures to assess PTSD symptomatology, burnout, health-related Quality of Life, and dispositional optimism. Eighty-one per cent (80/94) of the Stage One group reported that their health had been affected by a CI; 42% (44/106) were identified as 'cases' on the GHQ-12. Stage Two results indicated that 12 participants had PTSD symptoms while this entire group showed moderate levels of emotional exhaustion and depersonalization, despite experiencing high levels of personal accomplishment and optimism. The findings suggest a high prevalence of CIS among ambulance personnel in Ireland and a significant impact on overall health and wellbeing. This has important implications for the effective management of CIS and suggests an important role for occupational health and organizational psychologists in providing routine support to ambulance service staff andpossibly other emergency services personnel.

  19. Reducing Time to First on Scene: An Ambulance-Community First Responder Scheme.

    Science.gov (United States)

    Campbell, Alan; Ellington, Matt

    2016-01-01

    The importance of early access to prehospital care has been demonstrated in many medical emergencies. This work aims to describe the potential time benefit of implementing a student Community First Responder scheme to support ambulance services in an inner-city setting in the United Kingdom. Twenty final and penultimate year medical students in the UK were trained in the "First Person on Scene" Business and Technology Education Council (BTEC) qualification. Over 12 months, they attended 89 emergency calls in an inner-city setting as Community First Responders (CFRs), alongside the West Midlands Ambulance Service, UK. At the end of this period, a qualitative survey investigated the perceived educational value of the scheme. The mean CFR response time across all calls was an average of 3 minutes and 8 seconds less than ambulance crew response times. The largest difference was to calls relating to falls (12 min). The difference varied throughout the day, peaking between 16:00 and 18:00. All questionnaire respondents stated that they felt more prepared in assessing and treating acutely unwell patients. In this paper, the authors present a symbiotic solution which has both reduced time to first on scene and provided training and experience in medical emergencies for senior medical students.

  20. Understanding physical factors associated with participation in community ambulation following stroke.

    Science.gov (United States)

    Robinson, Cynthia A; Shumway-Cook, Anne; Matsuda, Patricia Noritake; Ciol, Marcia A

    2011-01-01

    This study examined the association between impaired physical function and participation in community ambulation following stroke. We hypothesised that participation would be significantly less following stroke, and that physical impairments would be associated with participation. Using a case-control design 30 survivors of stroke aged 45 and older and 30 controls provided health status information and a self-report of participation in community ambulation (number of trips and walking-related activities (WRA) reported prospectively over a 12-day period). The association of physical impairments (strength, range of motion, sensation, muscle tone, vision, and activity limitations (gait speed and performance on complex walking tasks)) with level of participation was analysed using negative binomial regression and goodness of fit. Participants included 30 individuals with and 30 without stroke, average age 68 years, majority were Caucasian women. Average time since stroke was 40 months. Participation in survivors of stroke was characterised by fewer trips and WRA and lower satisfaction (p trips and WRA (p < 0.05). However, these factors explained less than very little of the variance in participation. While individual factors were associated with level of participation, results failed to accurately predict participation in community ambulation following stroke. Other factors, such as depression, cognition and self-efficacy may be stronger determinants of participation.

  1. Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures of Japan.

    Science.gov (United States)

    Murakami, Shoko; Miyatake, Nobuyuki; Sakano, Noriko

    2012-09-01

    Changes in air temperature and its relation to ambulance transports due to heat stroke in all 47 prefectures, in Japan were evaluated. Data on air temperature were obtained from the Japanese Meteorological Agency. Data on ambulance transports due to heat stroke was directly obtained from the Fire and Disaster Management Agency, Japan. We also used the number of deaths due to heat stroke from the Ministry of Health, Labour and Welfare, Japan, and population data from the Ministry of Internal Affairs and Communications. Chronological changes in parameters of air temperature were analyzed. In addition, the relation between air temperature and ambulance transports due to heat stroke in August 2010 was also evaluated by using an ecological study. Positive and significant changes in the parameters of air temperature that is, the mean air temperature, mean of the highest air temperature, and mean of the lowest air temperature were noted in all 47 prefectures. In addition, changes in air temperature were accelerated when adjusted for observation years. Ambulance transports due to heat stroke was significantly correlated with air temperature in the ecological study. The highest air temperature was significantly linked to ambulance transports due to heat stroke, especially in elderly subjects. Global warming was demonstrated in all 47 prefectures in Japan. In addition, the higher air temperature was closely associated with higher ambulance transports due to heat stroke in Japan.

  2. Feasibility, Reliability and Predictive Value Of In-Ambulance Heart Rate Variability Registration.

    Directory of Open Access Journals (Sweden)

    Laetitia Yperzeele

    Full Text Available Heart rate variability (HRV is a parameter of autonomic nervous system function. A decrease of HRV has been associated with disease severity, risk of complications and prognosis in several conditions.We aim to investigate the feasibility and the reliability of in-ambulance HRV registration during emergency interventions, and to evaluate the association between prehospital HRV parameters, patient characteristics, vital parameters and short-term outcome.We conducted a prospective study using a non-invasive 2-lead ECG registration device in 55 patients transported by the paramedic intervention team of the Universitair Ziekenhuis Brussel. HRV assessment included time domain parameters, frequency domain parameters, nonlinear analysis, and time-frequency analysis. The correlation between HRV parameters and patient and outcome characteristics was analyzed and compared to controls.Artifact and ectopic detection rates were higher in patients during ambulance transportation compared to controls in resting conditions, yet technical reasons precluding in-ambulance HRV analysis occurred in only 9.6% of cases. HRV acquisition was possible without safety issues or interference with routine emergency care. Reliability of the results was considered sufficient for Sample entropy (SampEn, good for the ratio of low frequency and high frequency components (LF/HF ratio in the frequency and the time frequency domain, and excellent for the triangular interpolation of the NN interval histogram (TINN, and for the short-term scaling exponent of the detrended fluctuation analysis (DFA α1. HRV indices were significantly reduced inpatients with unfavorable outcome compared to patients with favorable outcome and controls. Multivariate analysis identified lower DFA α1 as an independent predictor of unfavorable outcome (OR, 0.155; 95% CI 0.024-0.966; p = 0.049.In-ambulance HRV registration is technically and operationally feasible and produces reliable results for parameters

  3. Identification and characteristics of biological agents in work environment of medical emergency services in selected ambulances

    Directory of Open Access Journals (Sweden)

    Agata Bielawska-Drózd

    2017-08-01

    Full Text Available Objectives: Assessment of microbial air quality and surface contamination in ambulances and administration offices as a control place without occupational exposure to biological agents; based on quantitative and qualitative analysis of bacteria, yeasts and filamentous fungi found in collected samples. Material and Methods: The sampling was done by wet cyclone technology using the Coriolis recon apparatus, imprint and swab methods, respectively. In total, 280 samples from 28 ambulances and 10 offices in Warszawa were tested. Data was analyzed using Shapiro-Wilk normality test, Kruskal-Wallis test with α = 0.05. P value ≤ 0.05 was considered as significant. Results: The levels of air contamination were from 0 to 2.3×101 colony-forming unit (CFU/m3 for bacteria and for yeast and filamentous fungi were from 0 to 1.8×101 CFU/m3. The assessment of office space air samples has shown the following numbers of microorganisms: bacteria from 3.0×101 to 4.2×101 CFU/m3 and yeast and filamentous fungi from 0 to 1.9×101 CFU/m3. For surface contamination the mean bacterial count in ambulances has been between 1.0×101 and 1.3×102 CFU/25 cm2 and in offices – between 1.1×101 and 8.5×101 CFU/25 cm2. Mean fungal count has reached the level from 2.8×100 to 4.2×101 CFU/25 cm2 in ambulances and 1.3×101 to 5.8×101 CFU/25 cm2 in offices. The qualitative analysis has revealed the presence of Acinetobacter spp. (surfaces, coagulase – negative Staphylococci (air and surfaces, Aspergillus and Penicillium genera (air and surfaces. Conclusions: The study has revealed a satisfactory microbiological quantity of analyzed air and surface samples in both study and control environments. However, the presence of potentially pathogenic microorganisms in the air and on surfaces in ambulances may endanger the medical emergency staff and patients with infection. Disinfection and cleaning techniques therefore should be constantly developed and implemented. Int J Occup

  4. Patients who call emergency ambulances for primary care problems: a qualitative study of the decision-making process.

    Science.gov (United States)

    Booker, Matthew J; Simmonds, Rosemary L; Purdy, Sarah

    2014-06-01

    Telephone calls for emergency ambulances are rising annually, increasing the pressure on ambulance resources for clinical problems that could often be appropriately managed in primary care. To explore and understand patient and carer decision making around calling an ambulance for primary care-appropriate health problems. Semistructured interviews were conducted with patients and carers who had called an ambulance for a primary care-appropriate problem. Participants were identified using a purposive sampling method by a non-participating research clinician attending '999' ambulance calls. A thematic analysis of interview transcripts was undertaken. A superordinate theme, patient and carer anxiety in urgent-care decision making, and four subthemes were explored: perceptions of ambulance-based urgent care; contrasting perceptions of community-based urgent care; influence of previous urgent care experiences in decision making; and interpersonal factors in lay assessment and management of medical risk and subsequent decision making. Many calls are based on fundamental misconceptions about the types of treatment other urgent-care avenues can provide, which may be amenable to educational intervention. This is particularly relevant for patients with chronic conditions with frequent exacerbations. Callers who have care responsibilities often default to the most immediate response available, with decision making driven by a lower tolerance of perceived risk. There may be a greater role for more detailed triage in these cases, and closer working between ambulance responses and urgent primary care, as a perceived or actual distance between these two service sectors may be influencing patient decision making on urgent care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  5. Spatial analysis of ambulance response times related to prehospital cardiac arrests in the city-state of Singapore.

    Science.gov (United States)

    Earnest, Arul; Hock Ong, Marcus Eng; Shahidah, Nur; Min Ng, Wen; Foo, Chuanyang; Nott, David John

    2012-01-01

    The main objective of this study was to establish the spatial variation in ambulance response times for out-of-hospital cardiac arrests (OHCAs) in the city-state of Singapore. The secondary objective involved studying the relationships between various covariates, such as traffic condition and time and day of collapse, and ambulance response times. The study design was observational and ecological in nature. Data on OHCAs were collected from a nationally representative database for the period October 2001 to October 2004. We used the conditional autoregressive (CAR) model to analyze the data. Within the Bayesian framework of analysis, we used a Weibull regression model that took into account spatial random effects. The regression model was used to study the independent effects of each covariate. Our results showed that there was spatial heterogeneity in the ambulance response times in Singapore. Generally, areas in the far outskirts (suburbs), such as Boon Lay (in the west) and Sembawang (in the north), fared badly in terms of ambulance response times. This improved when adjusted for key covariates, including distance from the nearest fire station. Ambulance response time was also associated with better traffic conditions, weekend OHCAs, distance from the nearest fire station, and OHCAs occurring during nonpeak driving hours. For instance, the hazard ratio for good ambulance response time was 2.35 (95% credible interval [CI] 1.97-2.81) when traffic conditions were light and 1.72 (95% CI 1.51-1.97) when traffic conditions were moderate, as compared with heavy traffic. We found a clear spatial gradient for ambulance response times, with far-outlying areas' exhibiting poorer response times. Our study highlights the utility of this novel approach, which may be helpful for planning emergency medical services and public emergency responses.

  6. Association Between Remoteness to a Health Care Facility and Incidence of Ambulance Calls in Rural Areas of Japan

    Directory of Open Access Journals (Sweden)

    Saori Kashima

    2015-07-01

    Full Text Available Objectives: Whether traffic remoteness from health care service in rural areas influences usage of ambulance service has not been well investigated. This study aimed to evaluate the relation between remoteness to health care facilities and incidence of ambulance calls in rural areas of Japan. Methods: We analyzed 155 rural communities of Hiroshima. Data were obtained on all ambulance dispatches from 2010 to 2012. Driving time was calculated from each community to the closest primary/secondary and tertiary health care facility (equivalent to tertiary emergency care centers. We estimated the incidence rate and the incidence rate ratio (IRR of ambulance calls for each 10-minute increase in the driving time, using generalized log-linear regression models, and evaluated the effect among each specific subgroup of emergency level and season. Results: During the study period, the median incidence rate was 436 per 10 000 people in targeted communities. When driving time to the closest primary/secondary facility increased by an increment of 10 minutes, there was a significant increase in the IRR of ambulance calls, especially during colder seasons (IRR: 1.29 [95% confidence interval: 1.11-1.49], and this relation was also obtained for most emergency levels. In comparison, there was no such increase in IRRs observed for driving time to a tertiary facility. Conclusion: This study indicated a positive association between remoteness to primary/secondary medical facilities and the frequency of ambulance calls. The remoteness to a primary/secondary health care may induce an increase in ambulance calls, particularly during cold seasons.

  7. Bed rest versus early ambulation with standard anticoagulation in the management of deep vein thrombosis: a meta-analysis.

    Directory of Open Access Journals (Sweden)

    Zhenlei Liu

    Full Text Available Bed rest has been considered as the cornerstone of management of deep vein thrombosis (DVT for a long time, though it is not evidence-base, and there is growing evidence favoring early ambulation.Electronic databases including Medline, PubMed, Cochrane Library and three Chinese databases were searched with key words of "deep vein thrombosis", "pulmonary embolism", "venous thrombosis", "bed rest", "immobilization", "mobilization" and "ambulation". We considered randomized controlled trials, prospective or retrospective cohort studies that compared the outcomes of acute DVT patients managed with early ambulation versus bed rest, in addition to standard anticoagulation. Meta-analysis pertaining to the incidence of new pulmonary embolism (PE, progression of DVT, and DVT related deaths were conducted, as well as the extent of remission of pain and edema.13 studies were included with a total of 3269 patients. Compared to bed rest, early ambulation was not associated with a higher incidence of new PE, progression of DVT, or DVT related deaths (RD -0.03, 95% CI -0.05∼ -0.02; Z = 1.24, p = 0.22; random effect model, Tau2 = 0.01. Moreover, if the patients suffered moderate or severe pain initially, early ambulation was related to a better outcome, with respect to remission of acute pain in the affected limb (SMD 0.42, 95%CI 0.09∼0.74; Z = 2.52, p = 0.01; random effect model, Tau2 = 0.04. Meta-analysis of alleviation of edema cannot elicit a solid conclusion because of significant heterogeneity among the few studies.Compared to bed rest, early ambulation of acute DVT patients with anticoagulation was not associated with a higher incidence of new PE, progression of DVT, and DVT related deaths. Furthermore, for the patients suffered moderate or severe pain initially, a better outcome can be seen in early ambulation group, regarding to the remission of acute pain in the affected limb.

  8. Disaster metrics: quantitative estimation of the number of ambulances required in trauma-related multiple casualty events.

    Science.gov (United States)

    Bayram, Jamil D; Zuabi, Shawki; El Sayed, Mazen J

    2012-10-01

    Estimating the number of ambulances needed in trauma-related Multiple Casualty Events (MCEs) is a challenging task. Emergency medical services (EMS) regions in the United States have varying "best practices" for the required number of ambulances in MCE, none of which is based on metric criteria. The objective of this study was to estimate the number of ambulances required to respond to the scene of trauma-related MCE in order to initiate treatment and complete the transport of critical (T1) and moderate (T2) patients. The proposed model takes into consideration the different transport times and capacities of receiving hospitals, the time interval from injury occurrence, the number of patients per ambulance, and the pre-designated time frame allowed from injury until the transfer care of T1 and T2 patients. The main theoretical framework for this model was based on prehospital time intervals described in the literature and used by EMS systems to evaluate operational and patient care issues. The North Atlantic Treaty Organization (NATO) triage categories (T1-T4) were used for simplicity. The minimum number of ambulances required to respond to the scene of an MCE was modeled as being primarily dependent on the number of critical patients (T1) present at the scene any particular time. A robust quantitative model was also proposed to dynamically estimate the number of ambulances needed at any time during an MCE to treat, transport and transfer the care of T1 and T2 patients. A new quantitative model for estimation of the number of ambulances needed during the prehospital response in trauma-related multiple casualty events has been proposed. Prospective studies of this model are needed to examine its validity and applicability.

  9. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

    OpenAIRE

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena

    2015-01-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC na?ve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 a...

  10. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes.

    Science.gov (United States)

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature (T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

  11. Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

    Science.gov (United States)

    Asselin, Pierre K.; Avedissian, Manuel; Knezevic, Steven; Kornfeld, Stephen; Spungen, Ann M.

    2016-01-01

    Powered exoskeletons have become available for overground ambulation in persons with paralyses due to spinal cord injury (SCI) who have intact upper extremity function and are able to maintain upright balance using forearm crutches. To ambulate in an exoskeleton, the user must acquire the ability to maintain balance while standing, sitting and appropriate weight shifting with each step. This can be a challenging task for those with deficits in sensation and proprioception in their lower extremities. This manuscript describes screening criteria and a training program developed at the James J. Peters VA Medical Center, Bronx, NY to teach users the skills needed to utilize these devices in institutional, home or community environments. Before training can begin, potential users are screened for appropriate range of motion of the hip, knee and ankle joints. Persons with SCI are at an increased risk of sustaining lower extremity fractures, even with minimal strain or trauma, therefore a bone mineral density assessment is performed to reduce the risk of fracture. Also, as part of screening, a physical examination is performed in order to identify additional health-related contraindications. Once the person has successfully passed all screening requirements, they are cleared to begin the training program. The device is properly adjusted to fit the user. A series of static and dynamic balance tasks are taught and performed by the user before learning to walk. The person is taught to ambulate in various environments ranging from indoor level surfaces to outdoors over uneven or changing surfaces. Once skilled enough to be a candidate for home use with the exoskeleton, the user is then required to designate a companion-walker who will train alongside them. Together, the pair must demonstrate the ability to perform various advanced tasks in order to be permitted to use the exoskeleton in their home/community environment. PMID:27340808

  12. Appraisal of work ability in relation to job-specific health requirements in ambulance workers.

    Science.gov (United States)

    van Schaaijk, A; Boschman, J S; Frings-Dresen, M H W; Sluiter, J K

    2017-01-01

    To gain insight into which job-specific health requirements relate to work ability, the following two research questions were formulated: Which job-specific health requirements are associated with the appraisal of work ability in ambulance drivers and paramedics? How are appraisals of physical and mental work ability associated with the appraisal of overall work ability in ambulance drivers and paramedics? Workers Health Surveillance cross-sectional data of 506 ambulance workers (236 drivers and 270 paramedics) were used. The tests for specific job requirements were divided into six categories. Work ability was appraised as overall, physical and mental/emotional. Multiple linear stepwise regression analyses were used to model the associations. Outcomes in 'raised alertness and judgment ability' (R (2) = 0.09), 'job-specific physical abilities' (R (2) = 0.10) and 'emotional peak load' (R (2) = 0.07) significantly explained appraised overall, physical and mental/emotional work ability. Physical and mental/emotional work ability together explained 48.3% of the variance of overall work ability. The explained variance by physical and mental/emotional work ability was almost 4% higher in drivers than in paramedics. Overall work ability was significantly explained by outcomes in 'raised alertness and judgment ability' and 'emotional peak load.' Physical work ability was significantly explained by 'job-specific physical abilities' and 'raised alertness and judgment ability' outcomes, while 'emotional peak load' and 'raised alertness and judgment ability' outcomes significantly explained mental/emotional work ability. Physical and mental/emotional work ability explains the same proportion of variance in overall work ability.

  13. Postural asymmetry in non-ambulant adults with cerebral palsy: a scoping review.

    Science.gov (United States)

    Holmes, Carlee; Brock, Kim; Morgan, Prue

    2018-01-02

    Non-ambulant adults with cerebral palsy are vulnerable to development of postural asymmetry and associated complications. The primary aim of this scoping review was to identify postural deformities in non-ambulant adults with cerebral palsy. Comprehensive searches were undertaken in EMBASE, CINAHL, AMED, Cochrane, Psych INFO, and Joanna Briggs (1986-Jan 2017), supplemented by hand searching. Two reviewers independently extracted data using a customised tool focusing on study design, participant characteristics, postural descriptors, measurement tools, and interventions. From 2546 potential records, 17 studies were included. Variability in populations, reporting methodology, and measurement systems was evident. Data suggest more than 30% of this population have hip migration percentage in excess of 30%, more than 75% experience "scoliosis", and more than 40% demonstrate pelvic obliquity. Estimates ranged from 14% to 100% hip and 32% to 87% knee contracture incidence. Conservative interventions were infrequently and poorly described. Many non-ambulant adults with cerebral palsy experience postural asymmetry associated with windswept hips, scoliosis, pelvic obliquity, and limb contracture. Options for non-radiographic monitoring of postural asymmetry should be identified, and conservative interventions formally were evaluated in this population. Implications for rehabilitation The common postural asymmetries of windswept hips, scoliosis, pelvic obliquity, and limb contracture require standardised clinical measurement. Radiography is most commonly used to monitor postural asymmetry in this population, but standardised positioning is not applied and may not be feasible indicating a need for alternate methods and rigorous documentation. The Posture and Postural Ability Scale may be considered for use in the management of body shape in adults with CP.

  14. Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients

    Directory of Open Access Journals (Sweden)

    Beseler MR

    2014-11-01

    Full Text Available MR Beseler,1 C Rubio,1 E Duarte,1 D Hervás,2 MC Guevara,1 M Giner-Pascual,1 E Viosca1 1Physical Medicine and Rehabilitation, La Fe Hospital, Valencia, Spain; 2Statistical Unit, La Fe Hospital, Valencia, Spain Background: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old. Manual muscle test was used for checking strength of hip flexor muscles, hip abductor muscles and knee extensor muscles. Grip strength was assessed by hydraulic dynamometer. Walking ability was assessed by functional ambulation categories and Functional Classification of Sagunto Hospital Ambulation. Existence of cognitive impairment (Short Portable Mental Status of Pfeiffer and comorbidity (abbreviated Charlson index were considered to be confounding variables. Statistical analysis: Simple comparisons and mixed models of multiple ordinal regression. Results: The sample presented generalized weakness in scapular (mean 4.22 and pelvic (mean 3.82 muscle. Mean hand grip values were similar: 11.98 kg right hand; 11.70 kg left hand. The patients had lost walking ability. After treatment, there was a statistically significant for scapular waist strength (P=0.001, pelvic waist strength (P=0.005 and walking ability (P=0.001. A statistically significant relationship in the regression analysis was found between the grip (right and left hands and walking ability post-treatment (P=0.009; odds ratio 1.14 and P=0.0014 odds ratio 1.113 for each walking scale. The confounding variables showed no statistical significance in the results.Conclusion: Grip strength is associated with walking ability in hospitalized frail elderly. Grip strength assessment by hydraulic dynamometry is useful in patients with poor collaboration. Walking ability training in frail elderly inpatients is useful. Keywords: gait

  15. Effects of weather conditions on emergency ambulance calls for acute coronary syndromes

    Science.gov (United States)

    Vencloviene, Jone; Babarskiene, Ruta; Dobozinskas, Paulius; Siurkaite, Viktorija

    2015-08-01

    The aim of this study was to evaluate the relationship between weather conditions and daily emergency ambulance calls for acute coronary syndromes (ACS). The study included data on 3631 patients who called the ambulance for chest pain and were admitted to the department of cardiology as patients with ACS. We investigated the effect of daily air temperature ( T), barometric pressure (BP), relative humidity, and wind speed (WS) to detect the risk areas for low and high daily volume (DV) of emergency calls. We used the classification and regression tree method as well as cluster analysis. The clusters were created by applying the k-means cluster algorithm using the standardized daily weather variables. The analysis was performed separately during cold (October-April) and warm (May-September) seasons. During the cold period, the greatest DV was observed on days of low T during the 3-day sequence, on cold and windy days, and on days of low BP and high WS during the 3-day sequence; low DV was associated with high BP and decreased WS on the previous day. During June-September, a lower DV was associated with low BP, windless days, and high BP and low WS during the 3-day sequence. During the warm period, the greatest DV was associated with increased BP and changing WS during the 3-day sequence. These results suggest that daily T, BP, and WS on the day of the ambulance call and on the two previous days may be prognostic variables for the risk of ACS.

  16. EFFECT OF SHOE RAISE ALONG WITH MOTOR RELEARNING PROGRAMME (MRP ON AMBULATION IN CHRONIC STROKE

    Directory of Open Access Journals (Sweden)

    Gajanan Bhalerao

    2016-06-01

    Full Text Available Background: Stroke subjects face reduced tolerance to activity and sedentary lifestyle due to various impairments, such as muscle weakness, pain, spasticity, and poor balance. Thus, loss of independent ambulation especially outdoors is generally observed in them. Methods: Chronic stroke patients (> 6 months with Functional Ambulation Category score > 2 and able to walk at least 10 meters of distance with and without assistance from a tertiary healthcare centre were selected and treated. Subjects were randomly divided into 2 groups control group (n=14 and experimental group (n=13. Each group received Motor Relearning Programme for 60 minutes, 6 times a week for 4 weeks. The experimental group received an additional shoe-raise of 1 cm on the unaffected side along with while ambulating during therapy as well as at home. Pre and post treatment the patients were assessed for spatio-temporal parameters using foot print analysis method and Rivermead Visual Gait Assessment (RVGA Score using RVGA scale. Results: There was significant improvement seen in almost all the spatio-temporal gait parameters and RVGA score in within group analysis. Whereas on between group the results from between group comparison suggests that subjects in MRP with shoe-raise group showed better results in spatio-temporal parameters of gait than subjects receiving MRPalone. But there was no additional benefit of shoe-raise seen on RGVA score and angle of toe-out parameter. Conclusion: Additional use of shoe-raise helps to improve spatio-temporal gait parameters. However, there was no additional change seen in RVGA score.

  17. Age affects the attentional demands of stair ambulation: evidence from a dual-task approach.

    Science.gov (United States)

    Ojha, Heidi A; Kern, Rebecca W; Lin, Chien-Ho Janice; Winstein, Carolee J

    2009-10-01

    Approximately 75% of all injury-producing falls on steps for people of all ages occur in people 65 years of age and older. Diminished attentional capacity contributes to fall risk in older adults, particularly when task demands are high. The purpose of this study was to compare the attentional demands of ascending and descending a set of stairs (stair ambulation) in older adults and younger adults. This was a nonblinded, prospective, single-site, observational cohort study. Ten older (>65 years of age) and 10 younger (21-33 years of age) adults without disabilities were recruited. A dual-task approach was used for 2 task conditions: the first task was standing and responding verbally to an unanticipated auditory tone as quickly as possible (probe task), and the second task was ascending or descending a set of stairs with the same probe task. A 2-factor (group x task) analysis of variance with repeated measures on task (standing and stair ambulation) was performed for voice response time (VRT). Significance for the analysis was set at Ptask interaction was significant for VRT. Post hoc analyses indicated that during stair ambulation, the VRT for older adults was significantly longer than that for younger adults. For the standing task, the VRTs (X+/-SD) were similar for younger (322+/-65 milliseconds) and older (306+/-22 milliseconds) participants. For stair ascent and descent, the average VRTs were more than 100 milliseconds longer for older participants (493+/-113 and 470+/-127 milliseconds, respectively) than for younger participants (365+/-56 and 356+/-67 milliseconds, respectively). Because of the small sample size and generally fit older group, generalization of findings to older people at risk for falls is not recommended until further research is done. The results demonstrated that although both older and younger adults required similar attentional resources for the standing task, older adults required significantly more resources during stair ambulation. The

  18. Prediction of postoperative morbidity, mortality and rehabilitation in hip fracture patients: the cumulated ambulation score

    DEFF Research Database (Denmark)

    Foss, Nicolai Bang; Kristensen, Morten Tange; Kehlet, Henrik

    2006-01-01

    OBJECTIVE: To validate the cumulated ambulation score as an early postoperative predictor of short-term outcome in hip fracture patients. DESIGN: Prospective, descriptive study. SETTING: An orthopaedic hip fracture unit in a university hospital. PATIENTS: Four hundred and twenty-six consecutive hip...... of short-term postoperative outcome after hip fracture surgery....... fracture patients with an independent walking function admitted from their own home. Rehabilitation followed a well-defined multimodal rehabilitation regimen and discharge criteria. MAIN OUTCOME MEASURE: Admission tests with a new mobility score to assess prefracture functional mobility and a short mental...

  19. PreHospital Ambulance Stroke Test - pilot study of a novel stroke test.

    Science.gov (United States)

    Andsberg, Gunnar; Esbjörnsson, Magnus; Olofsson, Arne; Lindgren, Arne; Norrving, Bo; von Euler, Mia

    2017-04-11

    There is a need for a prehospital stroke test that in addition to high sensitivity for stroke, also is able to communicate stroke severity similar to the National Institute of Health Stroke Scale (NIHSS). The PreHospital Ambulance Stroke Test (PreHAST), an eight item test based on NIHSS, which scores stroke severity from 0-19 points, was designed and adapted for the ambulance services. In the pilot study the ambulance nurses used PreHAST to assess patients with suspected stroke in the prehospital setting. Regardless of the results after PreHAST testing the patients were triaged with a provisional stroke diagnosis. The PreHAST scores were compared with the final diagnosis and the ability to differentiate stroke and transient ischemic attacks (TIA) with ongoing symptoms at evaluation from non-stroke patients was analysed. 69 patients were included in the study, 26 had stroke/TIA and 43 other diagnoses. All stroke/TIA patients were identified by PreHAST (sensitivity 100% (95% CI; 87-100%)). The specificity increased with higher PreHAST scores and the discriminative capacity for PreHAST for different cut off values showed an area under the curve of 0.77 (95%CI; 0.66-0.88) in the receiver operating characteristic (ROC) analysis. PreHAST is designed for high sensitivity, screening for a broad range of stroke symptoms including most key components of NIHSS. The promising sensitivity between 87 and 100% in our study has to be confirmed in a larger study also including multiple centres. Higher PreHAST scores implied more typical patterns of stroke and accordingly the proportion of stroke mimics decrease with higher scores. However, also stroke mimics with epilepsy/seizure and patients with deficit after prior stroke could show higher PreHAST scores. Other prehospital stroke tests that evaluate stroke severity have been designed with the main purpose to screen for large vessel occlusion. The advantage of PreHAST is the dual purpose not only to evaluate stroke severity but

  20. Clinical effectiveness of grip strength in predicting ambulation of elderly inpatients

    OpenAIRE

    Beseler, MR; Rubio, C; Duarte, E; Hervás, D; Guevara, MC; Giner-Pascual, M; Viosca, E

    2014-01-01

    MR Beseler,1 C Rubio,1 E Duarte,1 D Hervás,2 MC Guevara,1 M Giner-Pascual,1 E Viosca1 1Physical Medicine and Rehabilitation, La Fe Hospital, Valencia, Spain; 2Statistical Unit, La Fe Hospital, Valencia, Spain Background: Assessing the clinical effectiveness of measuring grip strength as a prognostic tool in recovering ambulation in bed-confined frail elderly patients. Methods: A prospective study was carried out with 50 elderly inpatients (mean age: 81.6 years old). Manual muscle ...

  1. Early ambulation produces favorable outcome and nondemential state in aneurysmal subarachnoid hemorrhage patients older than 70 years of age.

    Science.gov (United States)

    Shimamura, Norihito; Matsuda, Naoya; Satou, Junko; Nakano, Takahiro; Ohkuma, Hiroki

    2014-02-01

    We analyzed consecutive subarachnoid hemorrhage (SAH) cases in patients older than 70 years of age who underwent aneurysm surgery. We report the influence of early ambulation on outcome in advanced-age SAH. From 2005 through 2010, 71 aneurysmal SAH cases whose Hunt-Hess grades ranged from 1 to 3 were included. All cases underwent clip ligation or coil embolization. Male to female ratio was 8/63; median age was 76 years (range, 70-87). We routinely have patients become ambulatory the day after surgery. The ambulation date was used to determine four groupings: 0-5 days, 6-10 days, 11-15 days, and 16 days and longer. We analyzed the relationship between ambulation date and the Glasgow Outcome Scale (GOS) or dementia at 30 days after the SAH. Favorable outcome was defined as good recovery and moderate disability according to the GOS. Dementia was screened by use of the revised-Hasegawa dementia scale. The chi-square test was used and a P Early ambulation positively correlated with favorable GOS and postoperative nondemential state. Elderly SAH patients with good Hunt-Hess grades should have a clip ligation or endovascular coiling. Early ambulation produces favorable outcome and a nondemential state in elderly SAH patients. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  2. Striving for balance - A qualitative study to explore the experiences of nurses new to the ambulance service in Sweden.

    Science.gov (United States)

    Hörberg, Anna; Lindström, Veronica; Kalén, Susanne; Scheja, Max; Vicente, Veronica

    2017-11-01

    New nurses and nurses new to a professional practice go through a transition where they adopt a new professional identity. This has been described as a challenging time where peer support and limited responsibility are considered necessary. Little is known about the experience of nurses being new to the ambulance service where support is limited and the nurse holds full responsibility of patient care. The aim of this study has therefore been to explore nurses' experiences during their first year of employment in the Swedish ambulance service. Data was generated from semi-structured interviews with 13 nurses having less than 12 months of experience of work in the ambulance service. The nurses represented nine different districts in Sweden. Analysis was a latent inductive qualitative content analysis. The analysis resulted in the main category, "Striving for balance during the transition process in the ambulance context". Transition in the ambulance service was experienced as a balance act between emotions, expectations and a strive for professional development. The balance was negatively affected by harsh, condescending attitudes among colleagues and the lack of structured support and feedback. In striving for balance in their new professional practice, the nurses described personal, unsupervised strategies for professional development. Copyright © 2017 Elsevier Ltd. All rights reserved.

  3. Characterizing demographics, injury severity, and intubation status for patients transported by air or ground ambulance to a rural burn center.

    Science.gov (United States)

    Ahmed, Azeemuddin; Van Heukelom, Paul; Harland, Karisa; Denning, Gerene; Liao, Junlin; Born, Janelle; Latenser, Barbara

    2014-01-01

    Our study was designed to characterize intubation status among patients transported by air or ground ambulance to a rural burn center. A retrospective chart review of patients arriving at our burn center from January 1, 2005 to December 31, 2009 was completed. Descriptive and multivariate analyses were performed. During the study period, 259 air and 590 ground ambulance patients met inclusion criteria. Air ambulance patients were older and had higher total body surface area burned, lower Glasgow Coma scores, longer lengths of stay, and more frequent inhalation injuries. Approximately 10% of patients arriving by air were intubated after burn center admission, and 49% of intubated patients were extubated within 24 hours of admission. These values were 2% and 40%, respectively, for patients transported by ground. Increasing age and air ambulance transport increased the overall likelihood of change in intubation status. The likelihood of intubation by burn center providers increased with age, with suspicion of inhalation injury, and for patients transported by air. The likelihood of extubation within 24 hours of burn center admission increased with age, decreased with suspected inhalation injury, and was independent of transport mode. Among our patient population, more severely injured patients were being transported by air ambulance. However, age, suspicion of inhalation injury, and mode of transport showed a complex pattern of associations with changes in intubation status, and illustrate the need to develop better prehospital guidelines for intubation in burn patients.

  4. Ambulant 24-h glucose rhythms mark calendar and biological age in apparently healthy individuals.

    Science.gov (United States)

    Wijsman, Carolien A; van Heemst, Diana; Hoogeveen, Evelien S; Slagboom, P Eline; Maier, Andrea B; de Craen, Anton J M; van der Ouderaa, Frans; Pijl, Hanno; Westendorp, Rudi G J; Mooijaart, Simon P

    2013-04-01

    Glucose metabolism marks health and disease and is causally inferred in the aging process. Ambulant continuous glucose monitoring provides 24-h glucose rhythms under daily life conditions. We aimed to describe ambulant 24-h glucose rhythms measured under daily life condition in relation to calendar and biological age in apparently healthy individuals. In the general population and families with propensity for longevity, we studied parameters from 24-h glucose rhythms; glucose levels; and its variability, obtained by continuous glucose monitoring. Participants were 21 young (aged 22-37 years), 37 middle-aged (aged 44-72 years) individuals from the general population, and 26 middle-aged (aged 52-74 years) individuals with propensity for longevity. All were free of diabetes. Compared with young individuals, middle-aged individuals from the general population had higher mean glucose levels (5.3 vs. 4.7 mmol L(-1) , P rhythms depending on calendar and biological age. © 2012 The Authors Aging Cell © 2012 Blackwell Publishing Ltd/Anatomical Society of Great Britain and Ireland.

  5. Assessment of stress and autonomic nervous activity in Japanese female ambulance paramedics working 24-hour shifts.

    Science.gov (United States)

    Suzuki, Ayako; Yoshioka, Koichi; Ito, Susumu; Naito, Yuko

    2016-01-01

    We studied the physical and mental conditions of 8 healthy young female ambulance paramedics working 24-hour shifts during their menstrual cycle, including assessment of cardiac autonomic nervous system activity by heart rate variability power spectral analysis. The autonomic activity during the awake period of on- and off-duty days in the follicular, late luteal, and menstruation phases was measured. Questionnaires regarding fatigue and menstrual distress were administered and correlated with the autonomic profile. While degrees of fatigue significantly increased after work, the changes in autonomic activity during the awake period on on-duty days were not significantly different from those on off-duty days (LF/HF, p=0.123; HF/(HF+LF), p=0.153). As for the sleeping period, there were no significant differences. Although the Menstrual Distress Questionnaire (MDQ) revealed the presence of mild menstrual discomfort in the late luteal and menstruation phases, no significant difference was observed in the autonomic profile of the three menstrual cycle phases. No significant correlation was observed between the degree of menstrual distress and autonomic profile, though there was a significant correlation in the late luteal phase between degree of menstrual distress and fatigue after work (pmenstrual discomfort and fatigue after work, their autonomic profile did not alter in the menstrual cycle. It is suggested that healthy young female ambulance paramedics may tolerate 24-hour shifts, though attention should be paid to subjective menstrual symptoms and fatigue.

  6. Referral to the Hospital And Emergency Ambulance Service Uses Patterns of the Inmates and Convicts

    Directory of Open Access Journals (Sweden)

    Emine Oncu

    2014-03-01

    Full Text Available Aim: The purpose of this study was to determine the reasons for referral to the hospital and 112 emergency ambulance service uses patterns of the inmates and convicts in an E type prison. Material and Method: In this descriptive study, it was evaluated the prison records associated with referral to the hospital and 112 emergency ambulance service uses for one year in 2010- 2011. Of the statistical analysis, descriptive statistics, chi-square test and Fisher%u2019s Exact Test were used. Results: All inmates and convicts were man, the median of age was 30,0 (min 18- max 68 years and substance use was 34,5%. The number of prisoners were referred to the hospital 815, total referrals were 1491; (referrals ranged from one to six and most common in January; and according to frequency, reasons of the referral were eyes problems, musculoskeletal disorders and psychological problems. Emergency medical service was used for in medical causes (78,3%, accident, trauma and injuries (16,4%, suicide (5,3%. Discussion: Findings from the study show that prisoners are more likely to have suffered physical and mental health problems that compared to the rest of society and have significantly high substance use rates.

  7. PTSD symptoms, response to intrusive memories and coping in ambulance service workers.

    Science.gov (United States)

    Clohessy, S; Ehlers, A

    1999-09-01

    To examine the relationship of coping strategies and responses to intrusive memories with post-traumatic stress disorder (PTSD) and other psychiatric symptoms in ambulance service workers. Fifty-six ambulance service workers describe the most distressing aspects of their work and completed questionnaires designed to measure their coping strategies in dealing with distressing incidents. They also described their intrusive memories of particularly distressing incidents and completed a questionnaire designed to measure their interpretation of these intrusions and their responses to them. In addition, they completed the Post-traumatic Stress Symptom Scale (PSS; Foa, Riggs, Dancu & Rothbaum, 1993) and the General Health Questionnaire (GHQ; Goldberg & Hiller, 1979). Of the participants, 21% met DSM-III-R criteria for PTSD, and 22% met GHQ screening criteria for psychiatric symptoms. Wishful thinking and mental disengagement when confronted with critical incidents at work, negative interpretations of intrusive memories, and maladaptive responses to these memories (rumination, suppression and dissociation) correlated with PTSD severity. The results are consistent with the hypothesis that coping strategies and responses to intrusive memories that prevent emotional processing of the distressing event maintain PTSD. They also support Ehlers & Steil's (1995) hypotheses about the role of negative interpretations of post-traumatic intrusions in PTSD. A substantial subgroup of emergency service personnel may need support in processing distressing incidents at work and may benefit from information that normalizes post-traumatic symptoms such as intrusions.

  8. Objectively measured work load, health status and sickness absence among Danish ambulance personnel. A longitudinal study

    DEFF Research Database (Denmark)

    Hansen, Claus D.

    2013-01-01

    Background: Reviews show that ambulance personnel (AP) have an increased risk of work-related health problems especially musculoskeletal disorders. Because of the unpredictable character of the AP’s work environment, standard measures of work environment exposures are imprecise. The aim of this p......Background: Reviews show that ambulance personnel (AP) have an increased risk of work-related health problems especially musculoskeletal disorders. Because of the unpredictable character of the AP’s work environment, standard measures of work environment exposures are imprecise. The aim...... of this presentation is to examine the associations between objectively measured work load taken from the company register, health and long-term sickness absence (LTSA) in 1-year follow up period. Methods: Data is taken from the first round of MARS – Men, accidents, risk and safety, a two wave panel study of AP...... workers in Denmark (n = 1606) collected in winter 2010/11. The response rate to the questionnaire was 62% in the baseline. The respondents were asked about health status, physical (DMQ) and psychosocial work environment factors (COPSOQ). Information from the company register about work load (e.g. mean...

  9. Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

    Science.gov (United States)

    Delgado, M. Kit; Meng, Lesley J.; Mercer, Mary P.; Pines, Jesse M.; Owens, Douglas K.; Zaric, Gregory S.

    2013-01-01

    Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED) crowding are unclear. We performed a systematic review of published simulation studies to identify: 1) the tradeoff between ambulance diversion and ED wait times; 2) the predicted impact of patient flow interventions on reducing diversion; and 3) the optimal regional strategy for reducing diversion. Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields. Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion. Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals are promising avenues for reducing diversion. PMID:24106548

  10. Humeral fracture in non-ambulant infants - a possible accidental mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Somers, John M.; Halliday, Katharine E. [Nottingham University Hospitals, Radiology Department, Nottingham (United Kingdom); Chapman, Stephen [Birmingham Children' s Hospital, Birmingham (United Kingdom)

    2014-10-15

    Humeral fracture in a non-ambulant infant younger than 1 year is suspicious for a non-accidental injury unless there is a credible accidental explanation. A previously unrecognised accidental mechanism was described in 1996 whereby a 5-month-old infant was rolled by a 3-year-old sibling from a prone to a supine position. To investigate the widely accepted view that an infant with limited mobility cannot sustain a fracture of the humerus by his or her own actions in the absence of the intervention of an external party. We present seven cases of non-ambulant infants between 4 and 7 months of age in whom an isolated humeral fracture was the only injury present. In each case the caregiver described the fracture occurring when the child rolled over, trapping the dependent arm, without the intervention of another party. There is no proof for this mechanism in the form of an independent witness or video recording. However, we propose that this mechanism is worthy of further consideration as a rare and unusual cause for the injury. Further study is required. (orig.)

  11. ANALYSIS OF EMERGENCY AMBULANCE RECALLS AMONG PATIENTS WITH HIGH BLOOD PRESSURE IN MOSCOW

    Directory of Open Access Journals (Sweden)

    N. F. Plavunov

    2017-01-01

    Full Text Available Over the last years the incidence of cardiovascular diseases had increased in Russian Federation. In a period of 2010-2014 y. the number of patients diagnosed hypertension increased by 16,8% (139,5 thousand patients. High prevalence of hypertension leads to different cardiac complications that could be responsible for death. Hypertension is a major risk factor for ischemic heart disease and stroke, increases the risk in 3-4 times, and therefore one of the most important causes of morality. The major cause that required emergency hospitalization in adult population was estimated to be cardiovascular diseases (23,9%, including ischemic heart disease (10,7%, cerebrovascular diseases (6%, and diseases attributable to high blood pressure (3,3%. We studied 1 605 374 (9,6% emergency ambulance calls to patients with high blood pressure during the period of 6 month (2015 y. . In 16,1% cases emergency service calls were related to hypertensive crisis and 1,45% of patients needed emergency evacuation. We determined that in 7,2% cases patients with high blood pressure called for emergency service again during 24 hours period. Among this group of patients the percent of hypertensive crisis and evacuation was higher — 19,4% and 4,1% respectively. Also we identified that in 59,5% cases the diagnosis was hypertensive disease. We determined that majority of frequent ambulance callers were elderly persons. 

  12. Paraplegia and transtibial amputation: successful ambulation after dual disability: a retrospective case report.

    Science.gov (United States)

    Senthilvelkumar, Thangavelu; Chandy, Bobeena R

    2017-01-01

    This is a single-subject case report. The objective is to describe the unique rehabilitation outcome of an individual with motor complete T12 paraplegia and a right transtibial amputation. This study was conducted at the Department of Physical Medicine and Rehabilitation of Christian Medical College in India. A 42-year-old policeman presented to our rehabilitation centre with motor complete T12 paraplegia and right transtibial amputation, 3 months following a road traffic accident. As the patient's goal was to walk, he was given a trial of independent ambulation with a customized prosthesis on the right side and a regular knee ankle foot orthosis (KAFO) on the left side. At the end of 12 weeks of rehabilitation, the patient was able to walk independently with the prosthesis/orthosis and bilateral elbow crutches. His Walking Index for Spinal Cord Injury (WISCI) score improved from 0/20 to 12/20 points. The scope of functional ambulation should not get restricted for a person with low thoracic spinal cord injury even when there is concurrent transtibial amputation.

  13. The Medical Duty Officer: An Attempt to Mitigate the Ambulance At-Hospital Interval

    Directory of Open Access Journals (Sweden)

    Megan H. Halliday

    2016-09-01

    Full Text Available Introduction: A lack of coordination between emergency medical services (EMS, emergency departments (ED and systemwide management has contributed to extended ambulance at-hospital times at local EDs. In an effort to improve communication within the local EMS system, the Baltimore City Fire Department (BCFD placed a medical duty officer (MDO in the fire communications bureau. It was hypothesized that any real-time intervention suggested by the MDO would be manifested in a decrease in the EMS at-hospital time. Methods: The MDO was implemented on November 11, 2013. A senior EMS paramedic was assigned to the position and was placed in the fire communication bureau from 9 a.m. to 9 p.m., seven days a week. We defined the pre-intervention period as August 2013 - October 2013 and the post-intervention period as December 2013 - February 2014. We also compared the post-intervention period to the “seasonal match control” one year earlier to adjust for seasonal variation in EMS volume. The MDO was tasked with the prospective management of city EMS resources through intensive monitoring of unit availability and hospital ED traffic. The MDO could suggest alternative transport destinations in the event of ED crowding. We collected and analyzed data from BCFD computer-aided dispatch (CAD system for the following: ambulance response times, ambulance at-hospital interval, hospital diversion and alert status, and “suppression wait time” (defined as the total time suppression units remained on scene until ambulance arrival. The data analysis used a pre/post intervention design to examine the MDO impact on the BCFD EMS system. Results: There were a total of 15,567 EMS calls during the pre-intervention period, 13,921 in the post-intervention period and 14,699 in the seasonal match control period one year earlier. The average at-hospital time decreased by 1.35 minutes from pre- to post-intervention periods and 4.53 minutes from the pre- to seasonal match

  14. High intertester reliability of the cumulated ambulation score for the evaluation of basic mobility in patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Andersen, Lene; Bech-Jensen, Rie

    2009-01-01

    OBJECTIVE: To examine the intertester reliability of the three activities of the Cumulated Ambulation Score (CAS) and the total CAS, and to define limits for the smallest change in basic mobility that indicates a real change in patients with hip fracture. DESIGN: An intertester reliability study....... independent ambulation. MAIN MEASURES: Reliability was evaluated using weighted kappa statistics, the standard error of measurement (SEM) and the smallest real difference (SRD). RESULTS: The kappa coefficient, the SEM and the SRD in the three activities and the total CAS were >or=0.92,...

  15. Respiratory, cardiovascular and metabolic responses during different modes of overground bionic ambulation in persons with motor-incomplete spinal cord injury: A case series

    Directory of Open Access Journals (Sweden)

    Jochen Kressler

    2017-09-01

    Full Text Available Objective: To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Design: Case series. Subjects: Four participants with chronic, motor-incomplete spinal cord injury. Methods: Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption and metabolic (caloric expenditure and substrate utilization measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Results: Cardiorespiratory responses ranged from low (24% VO2peak for the least impaired and fittest individual to supramaximal (124% VO2peak for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3–8% VO2peak differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Conclusion: Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.

  16. Respiratory, cardiovascular and metabolic responses during different modes of overground bionic ambulation in persons with motor-incomplete spinal cord injury: A case series.

    Science.gov (United States)

    Kressler, Jochen; Wymer, Tracie; Domingo, Antoinette

    2017-10-25

    To investigate the effects of overground bionic ambulation with variable assistance on cardiorespiratory and metabolic responses in persons with motor-incomplete spinal cord injury. Case series. Four participants with chronic, motor-incomplete spinal cord injury. Subjects completed a maximal graded exercise test on an arm-ergometer and 3 6-min bouts of overground bionic ambulation using different modes of assistance, i.e. Maximal, Adaptive, Fixed. Cardiorespiratory (oxygen consumption) and metabolic (caloric expenditure and substrate utilization) measures were taken using a mobile metabolic cart at each overground bionic ambulation assistance. Cardiorespiratory responses ranged from low (24% VO2peak) for the least impaired and fittest individual to supramaximal (124% VO2peak) for the participant with the largest impairments and the lowest level of fitness. Different overground bionic ambulation assistive modes elicited small (3-8% VO2peak) differences in cardiorespiratory responses for 3 participants. One participant had a large (28% VO2peak) difference in cardiorespiratory responses to different modes of overground bionic ambulation. Metabolic responses mostly tracked closely with cardiorespiratory responses. Total energy expenditure ranged from 1.39 to 7.17 kcal/min. Fat oxidation ranged from 0.00 to 0.17 g/min across participants and different overground bionic ambulation modes. Overground bionic ambulation with variable assistance can substantially increase cardiorespiratory and metabolic responses; however, these responses vary widely across participants and overground bionic ambulation modes.

  17. The Efficiency Evaluation Of The Training Activity Given To Ambulance Personnel

    Directory of Open Access Journals (Sweden)

    Huseyin Ulger

    2013-04-01

    Full Text Available Aim: It was aimed to evaluate the efficiency of the three days module given to the assistant health personnel working in 112 ambulances. Material and Methods: It was assumed that all the personnel working in the 112 ambulance systems under the health directory of Kirikkale city would be involved. Theoretic and practical first aid training was given to all the personnel attending to the course in 6 groups of 20-25 with duration of 3 days for each. A 50 itemed questionnaire was applied to all the groups before and after the training. Results: 132 people working in ambulance system in Kirikkale city were involved in training. 63,6% of the personnel involved in the study were male and 66% were married. When they were grouped according to age, it was determined that 44% of them were in 26-35 age group. When they were grouped according to branches, it was determined that 47 % of them were emergency medical technician (EMT and 40,2% were health officer. When their level of education was taken into consideration, it was determined that 53% of them were graduates of high school and 43,2% were graduates of associate degree. 50,8 of all the personnel had a job experience of 1-5 years. When all the groups were evaluated together, there was a statistical meaningful difference (p<0,001 between pretest success grade (29,58±6,74 and posttest success grade (39,81±4,68. When EMT, paramedics and the other groups were compared; there was a pr test grade difference(p=0,003 between EMT and paramedics group(31,55±6,52 and the others’ group(27,70±6,4. There wasn’t a grade difference between EMT, paramedics group and the others’ group in posttest (p=0,765. Conclusion: The occupational training module which was done in a limited time was determined to be effective in providing a meaningful positive difference in knowledge level and providing personnel knowledge level standardization. [TAF Prev Med Bull 2013; 12(2.000: 151-156

  18. Effect of Planned Early Recommended Ambulation Technique on Selected Post caesarean Biophysiological Health Parameters

    Directory of Open Access Journals (Sweden)

    Jyoti V. Dube

    2014-01-01

    Full Text Available Background: Caesarean section has been a part of human culture since ancient times. It has been used effectively throughout the 20th century and among the major abdominal surgeries, it is the most common, oldest worldwide surgery performed in obstetrics. Despite the life saving advantages, there are several adverse consequences of caesarean delivery for a woman and to her household. The rate and risk of these complications increases due to the increasing incidence mainly in countries like India. The role of nurse midwife is to act in the best interest of patient and newborn and make the patient independent in carrying out the activities of daily living as soon as possible. This can lead to a faster recovery and shorter hospital stay. Also it can indirectly help in reducing the complications associated with prolonged bed rest and can improve the maternal newborn bonding. Aim and Objectives: The present study was done to evaluate the effect of planned early ambulation on selected biophysiological health parameters of post caesarean patients. Material and Methods: The study included total 500 study subjects, 250 in experimental and 250 in control group. Quasi experimental approach with multiple time series design was adopted for the study. The experimental group was given an early planned recommended ambulation technique starting from the day of surgery. This consisted of deep breathing exercise, cough exercise, leg exercise and early mobilization. Over and above, the routine general health care was given by the doctors and nurses. The control group received only by routine general care by doctors and nurses and mobilization on third post operative day as per strategy adopted by the hospital. The deep breathing exercises, coughing exercises and leg exercises were not given routinely and hence were not given to the control group. Post caesarean biophysiological parameters chart was used to assess the selected parameters for first five post operative

  19. Ambulatorās aprūpes māsas profesionālā pilnveide

    OpenAIRE

    Pšenova, Jeļena

    2017-01-01

    Bakalaura darba tēma: Ambulatorās aprūpes māsas profesionālā pilnveide. Darba mērķis ir noskaidrot ambulatorās aprūpes māsas profesionālas pilnveides aktualitāti, kā arī to ietekmējošos faktorus. Bakalaura darba teorētiskajā daļā apskatīta informācija par ambulatorās aprūpes māsas praksi, profesionālo kompetenci, profesionālo izglītību, kā arī par profesionālās pilnveides iespējām un nozīmi ambulatorās aprūpes māsas praksē. Pētījuma pamatā pielietota P.Benneres māszinību teorija. Darba pētnie...

  20. Two hour ambulation after coronary angioplasty and stenting with 6 F guiding catheters and low dose heparin

    NARCIS (Netherlands)

    Koch, K. T.; Piek, J. J.; de Winter, R. J.; Mulder, K.; Schotborgh, C. E.; Tijssen, J. G.; Lie, K. I.

    1999-01-01

    OBJECTIVE: To evaluate the feasibility and safety of ambulation of patients two hours after elective coronary angioplasty or stenting, or both. METHODS: Coronary angioplasty and stenting were performed using 6 F guiding catheters by the femoral approach and a standard dose of heparin 5000 IU. There

  1. Body weight-supported bedside treadmill training facilitates ambulation in ICU patients: An interventional proof of concept study

    NARCIS (Netherlands)

    Sommers, Juultje; Wieferink, Denise C.; Dongelmans, Dave A.; Nollet, Frans; Engelbert, Raoul H. H.; van der Schaaf, Marike

    2017-01-01

    Purpose: Early mobilisation is advocated to improve recovery of intensive care unit (ICU) survivors. However, severe weakness in combination with tubes, lines and machinery are practical barriers for the implementation of ambulation with critically ill patients. The aim of this study was to explore

  2. Hippotherapy effects on trunk, pelvic, and hip motion during ambulation in children with neurological impairments.

    Science.gov (United States)

    Encheff, Jenna L; Armstrong, Charles; Masterson, Michelle; Fox, Christine; Gribble, Phillip

    2012-01-01

    This study investigated the effects of a 10-week hippotherapy program on trunk, pelvis, and hip joint positioning during the stance phase of gait. Eleven children (6 boys and 5 girls; 7.9 ± 2.7 years) with neurological disorders and impaired ambulation participated. Joint range of motion data were collected via 3-dimensional computerized gait analysis before and after the program. Paired t tests were performed on kinematic data for each joint. Significant improvements (P ≤ .008) and large effect sizes (ESs) for sagittal plane hip positions at initial contact and toe-off were found. No differences in pelvic or trunk positioning were determined, although sagittal plane pelvic positioning displayed a trend toward improvement with large ESs. Several trunk variables displayed moderate ESs with a trend toward more upright positioning. Improvements in pelvic and hip joint positioning and more normalized vertical trunk position may indicate increased postural control during gait after 10 sessions of hippotherapy.

  3. Nonoperative management of stable thoracolumbar burst fractures with early ambulation and bracing.

    Science.gov (United States)

    Cantor, J B; Lebwohl, N H; Garvey, T; Eismont, F J

    1993-06-15

    Eighteen neurologically intact patients with burst fractures at the thoracolumbar junction were treated with early ambulation in a total contact orthosis. No attempt was made to reduce the associated deformity. Selection criteria excluded patients with posterior column disruption. Hospital stay averaged 10 days. Follow-up averaged 19 months. Mean kyphosis was 19 at time of injury and 20 at follow-up. At follow-up, 15 patients rated their pain as little or none. Seventeen patients had little or no restriction of activity. Follow-up computed tomography (CT) scans obtained in eight patients showed significant resorption of retropulsed bone. No deterioration of neurologic function developed in any patient. In patients with intact posterior elements and thoracolumbar burst fractures, early mobilization in a total contact TLSO can lead to satisfactory functional results. Prolonged bed rest was not required in this series. The authors attribute the good results of nonoperative management to the exclusion of patients with posterior column disruption.

  4. The effects of liberal versus restrictive transfusion thresholds on ambulation after hip fracture surgery

    DEFF Research Database (Denmark)

    Foss, Nicolai B; Kristensen, Morten Tange; Jensen, Pia Søe

    2009-01-01

    BACKGROUND: Perioperative anemia leads to increased morbidity and mortality and potentially inhibits rehabilitation after hip fracture surgery. As such, the optimum transfusion threshold after hip fracture surgery is unknown. PATIENTS AND METHODS: A total of 120 elderly, cognitively intact hip...... fracture patients admitted from their own home were randomly assigned to receive transfusion at a hemoglobin threshold of 10.0 g per dL (liberal) versus 8.0 g per dL (restrictive) in the entire perioperative period. Patients were treated according to a well-defined multimodal rehabilitation program....... Primary outcome was postoperative functional mobility measured with the cumulated ambulation score (CAS). RESULTS: Patients in the liberal group received transfusions more frequently than those in the restrictive group (44 patients vs. 22 patients; p transfusions during...

  5. Factors affecting the ambulance response times of trauma incidents in Singapore.

    Science.gov (United States)

    Lam, Sean Shao Wei; Nguyen, Francis Ngoc Hoang Long; Ng, Yih Yng; Lee, Vanessa Pei-Xuan; Wong, Ting Hway; Fook-Chong, Stephanie Man Chung; Ong, Marcus Eng Hock

    2015-09-01

    Time to definitive care is important for trauma outcomes, thus many emergency medical services (EMS) systems in the world adopt response times of ambulances as a key performance indicator. The objective of this study is to examine the underlying risk factors that can affect ambulance response times (ART) for trauma incidents, so as to derive interventional measures that can improve the ART. This was a retrospective study based on two years of trauma data obtained from the national EMS operations centre of Singapore. Trauma patients served by the national EMS provider over the period from 1 January 2011 till 31 December 2012 were included. ART was categorized into "Short" (8min) response times. A modelling framework which leveraged on both multinomial logistic (MNL) regression models and Bayesian networks was proposed for the identification of main and interaction effects. Amongst the process-related risk factors, weather, traffic and place of incident were found to be significant. The traffic conditions on the roads were found to have the largest effect-the odds ratio (OR) of "Long" ART in heavy traffic condition was 12.98 (95% CI: 10.66-15.79) times higher than that under light traffic conditions. In addition, the ORs of "Long ART" under "Heavy Rain" condition were significantly higher (OR 1.58, 95% CI: 1.26-1.97) than calls responded under "Fine" weather. After accounting for confounders, the ORs of "Long" ART for trauma incidents at "Home" or "Commercial" locations were also significantly higher than that for "Road" incidents. Traffic, weather and the place of incident were found to be significant in affecting the ART. The evaluation of factors affecting the ART enables the development of effective interventions for reducing the ART. Copyright © 2015 Elsevier Ltd. All rights reserved.

  6. Exploring optimal air ambulance base locations in Norway using advanced mathematical modelling.

    Science.gov (United States)

    Røislien, Jo; van den Berg, Pieter L; Lindner, Thomas; Zakariassen, Erik; Aardal, Karen; van Essen, J Theresia

    2017-02-01

    Helicopter emergency medical services are an important part of many healthcare systems. Norway has a nationwide physician staffed air ambulance service with 12 bases servicing a country with large geographical variations in population density. The aim of the study was to estimate optimal air ambulance base locations. We used high resolution population data for Norway from 2015, dividing Norway into >300 000 1 km×1 km cells. Inhabited cells had a median (5-95 percentile) of 13 (1-391) inhabitants. Optimal helicopter base locations were estimated using the maximal covering location problem facility location optimisation model, exploring the number of bases needed to cover various fractions of the population for time thresholds 30 and 45 min, both in green field scenarios and conditioning on the current base structure. We reanalysed on municipality level data to explore the potential information loss using coarser population data. For a 45 min threshold, 90% of the population could be covered using four bases, and 100% using nine bases. Given the existing bases, the calculations imply the need for two more bases to achieve full coverage. Decreasing the threshold to 30 min approximately doubles the number of bases needed. Results using municipality level data were remarkably similar to those using fine grid information. The whole population could be reached in 45 min or less using nine optimally placed bases. The current base structure could be improved by moving or adding one or two select bases. Municipality level data appears sufficient for proper analysis. 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/.

  7. Reducing Ambulance Diversion at Hospital and Regional Levels: Systemic Review of Insights from Simulation Models

    Directory of Open Access Journals (Sweden)

    M Kit Delgado

    2013-09-01

    Full Text Available Introduction: Optimal solutions for reducing diversion without worsening emergency department (ED crowding are unclear. We performed a systematic review of published simulation studies to identify: 1 the tradeoff between ambulance diversion and ED wait times; 2 the predicted impact of patient flow interventions on reducing diversion; and 3 the optimal regional strategy for reducing diversion.Methods: Data Sources: Systematic review of articles using MEDLINE, Inspec, Scopus. Additional studies identified through bibliography review, Google Scholar, and scientific conference proceedings. Study Selection: Only simulations modeling ambulance diversion as a result of ED crowding or inpatient capacity problems were included. Data extraction: Independent extraction by two authors using predefined data fields.Results: We identified 5,116 potentially relevant records; 10 studies met inclusion criteria. In models that quantified the relationship between ED throughput times and diversion, diversion was found to only minimally improve ED waiting room times. Adding holding units for inpatient boarders and ED-based fast tracks, improving lab turnaround times, and smoothing elective surgery caseloads were found to reduce diversion considerably. While two models found a cooperative agreement between hospitals is necessary to prevent defensive diversion behavior by a hospital when a nearby hospital goes on diversion, one model found there may be more optimal solutions for reducing region wide wait times than a regional ban on diversion.Conclusion: Smoothing elective surgery caseloads, adding ED fast tracks as well as holding units for inpatient boarders, improving ED lab turnaround times, and implementing regional cooperative agreements among hospitals. [West J Emerg Med. 2013;14(5:489-498.

  8. Effects of Weather and Heliophysical Conditions on Emergency Ambulance Calls for Elevated Arterial Blood Pressure

    Directory of Open Access Journals (Sweden)

    Jone Vencloviene

    2015-02-01

    Full Text Available We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009–2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs, in which the conditions for the emergency calls were made coded I.10–I.15. The Kaunas Weather Station provided daily records of air temperature (T, wind speed (WS, relative humidity, and barometric pressure (BP. We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS > 600 km/s increased the daily number of elevated arterial blood pressure (EABP by 12% (RR = 1.12; 95% confidence interval (CI 1.04–1.21; and WS ≥ 3.5 knots during days of T < 1.5 °C and T ≥ 12.5 °C by 8% (RR = 1.08; CI 1.04–1.12. An increase of T by 10 °C and an elevation of BP two days after by 10 hPa were associated with a decrease in RR by 3%. An additional effect of T was detected during days of T ≥ 17.5 °C only in females. Women and patients with grade III arterial hypertension at the time of the ambulance call were more sensitive to weather conditions. These results may help in the understanding of the population’s sensitivity to different weather conditions.

  9. Telehealth-Enabled Emergency Medical Services Program Reduces Ambulance Transport to Urban Emergency Departments

    Directory of Open Access Journals (Sweden)

    James Robert Langabeer

    2016-11-01

    Full Text Available Introduction Emergency medical services (EMS agencies transport a significant majority of patients with low acuity and non-emergent conditions to local emergency departments (ED, affecting the entire emergency care system’s capacity and performance. Opportunities exist for alternative models that integrate technology, telehealth, and more appropriately aligned patient navigation. While a limited number of programs have evolved recently, no empirical evidence exists for their efficacy. This research describes the development and comparative effectiveness of one large urban program. Methods The Houston Fire Department initiated the Emergency Telehealth and Navigation (ETHAN program in 2014. ETHAN combines telehealth, social services, and alternative transportation to navigate primary care-related patients away from the ED where possible. Using a case-control study design, we describe the program and compare differences in effectiveness measures relative to the control group. Results During the first 12 months, 5,570 patients participated in the telehealth-enabled program, which were compared against the same size control group. We found a 56% absolute reduction in ambulance transports to the ED with the intervention compared to the control group (18% vs. 74%, P<.001. EMS productivity (median time from EMS notification to unit back in service was 44 minutes faster for the ETHAN group (39 vs. 83 minutes, median. There were no statistically significant differences in mortality or patient satisfaction. Conclusion We found that mobile technology-driven delivery models are effective at reducing unnecessary ED ambulance transports and increasing EMS unit productivity. This provides support for broader EMS mobile integrated health programs in other regions.

  10. Longitudinal effect of eteplirsen versus historical control on ambulation in Duchenne muscular dystrophy

    Science.gov (United States)

    Goemans, Nathalie; Lowes, Linda P.; Alfano, Lindsay N.; Berry, Katherine; Shao, James; Kaye, Edward M.; Mercuri, Eugenio; Hamid, Hoda Abdel; Byrne, Barry J.; Connolly, Anne M.; Dracker, Robert A.; Matthew Frank, L.; Heydemann, Peter T.; O'Brien, Kevin C.; Sparks, Susan E.; Specht, Linda A.; Rodino‐Klapac, Louise; Sahenk, Zarife; Al‐Zaidy, Samiah; Cripe, Linda H.; Lewis, Sarah; M, Pane; E, Mazzone; S, Messina; GL, Vita; Bertini, D Amico A; Casimiro, Berardinelli A; Y, Torrente; F, Magri; GP, Comi; G, Baranello; T, Mongini; A, Pini; R, Battini; E, Pegoraro; C, Bruno; L, Politano; S, Previtali

    2016-01-01

    Objective To continue evaluation of the long‐term efficacy and safety of eteplirsen, a phosphorodiamidate morpholino oligomer designed to skip DMD exon 51 in patients with Duchenne muscular dystrophy (DMD). Three‐year progression of eteplirsen‐treated patients was compared to matched historical controls (HC). Methods Ambulatory DMD patients who were ≥7 years old and amenable to exon 51 skipping were randomized to eteplirsen (30/50mg/kg) or placebo for 24 weeks. Thereafter, all received eteplirsen on an open‐label basis. The primary functional assessment in this study was the 6‐Minute Walk Test (6MWT). Respiratory muscle function was assessed by pulmonary function testing (PFT). Longitudinal natural history data were used for comparative analysis of 6MWT performance at baseline and months 12, 24, and 36. Patients were matched to the eteplirsen group based on age, corticosteroid use, and genotype. Results At 36 months, eteplirsen‐treated patients (n = 12) demonstrated a statistically significant advantage of 151m (p < 0.01) on 6MWT and experienced a lower incidence of loss of ambulation in comparison to matched HC (n = 13) amenable to exon 51 skipping. PFT results remained relatively stable in eteplirsen‐treated patients. Eteplirsen was well tolerated. Analysis of HC confirmed the previously observed change in disease trajectory at age 7 years, and more severe progression was observed in patients with mutations amenable to exon skipping than in those not amenable. The subset of patients amenable to exon 51 skipping showed a more severe disease course than those amenable to any exon skipping. Interpretation Over 3 years of follow‐up, eteplirsen‐treated patients showed a slower rate of decline in ambulation assessed by 6MWT compared to untreated matched HC. Ann Neurol 2016;79:257–271 PMID:26573217

  11. Benefits of glucocorticoids in non-ambulant boys/men with Duchenne muscular dystrophy: A multicentric longitudinal study using the Performance of Upper Limb test

    Science.gov (United States)

    Pane, Marika; Fanelli, Lavinia; Mazzone, Elena Stacy; Olivieri, Giorgia; D'Amico, Adele; Messina, Sonia; Scutifero, Marianna; Battini, Roberta; Petillo, Roberta; Frosini, Silvia; Sivo, Serena; Vita, Gian Luca; Bruno, Claudio; Mongini, Tiziana; Pegoraro, Elena; De Sanctis, Roberto; Gardani, Alice; Berardinelli, Angela; Lanzillotta, Valentina; Carlesi, Adelina; Viggiano, Emanuela; Cavallaro, Filippo; Sframeli, Maria; Bello, Luca; Barp, Andrea; Bianco, Flaviana; Bonfiglio, Serena; Rolle, Enrica; Palermo, Concetta; D'Angelo, Grazia; Pini, Antonella; Iotti, Elena; Gorni, Ksenija; Baranello, Giovanni; Bertini, Enrico; Politano, Luisa; Sormani, Maria Pia; Mercuri, Eugenio

    2015-01-01

    The aim of this study was to establish the possible effect of glucocorticoid treatment on upper limb function in a cohort of 91 non-ambulant DMD boys and adults of age between 11 and 26 years. All 91 were assessed using the Performance of Upper Limb test. Forty-eight were still on glucocorticoid after loss of ambulation, 25 stopped steroids at the time they lost ambulation and 18 were GC naïve or had steroids while ambulant for less than a year. At baseline the total scores ranged between 0 and 74 (mean 41.20). The mean total scores were 47.92 in the glucocorticoid group, 36 in those who stopped at loss of ambulation and 30.5 in the naïve group (p < 0.001). The 12-month changes ranged between −20 and 4 (mean −4.4). The mean changes were −3.79 in the glucocorticoid group, −5.52 in those who stopped at loss of ambulation and −4.44 in the naïve group. This was more obvious in the patients between 12 and 18 years and at shoulder and elbow levels. Our findings suggest that continuing glucocorticoids throughout teenage years and adulthood after loss of ambulation appears to have a beneficial effect on upper limb function. PMID:26248957

  12. The relation between ambulance transports stratified by heat stroke and air temperature in all 47 prefectures of Japan in August, 2009: ecological study.

    Science.gov (United States)

    Miyatake, Nobuyuki; Sakano, Noriko; Murakami, Shoko

    2012-01-01

    Our aim was to investigate the link between ambulance transports stratified by heat stroke and air temperature in August 2009 in Japan. Monthly observations for ambulance transports stratified by heat stroke in August 2009, in all 47 prefectures of Japan were obtained from the Ministry of Internal Affairs and Communications. Daily air temperature data from the Japan Meteorological Agency in August 2009 for all 47 prefectures in Japan were also used. The effect of high air temperatures on ambulance transports stratified by heat stroke was analyzed in an ecological study. Various air temperature parameters , i.e., the mean of the mean air temperature, mean of the highest air temperature, mean of the lowest air temperature, the highest air temperature, and the lowest air temperature in August 2009 were significantly and positively correlated with ambulance transports stratified by heat stroke (per total number of ambulance transports and per 10,000 persons) in the 47 prefectures of Japan. The correlation coefficient between the mean of the highest air temperature in August 2009 and ambulance transports stratified by heat stroke (per 10 000 persons) was the highest among the examined parameters (r = 0.799, p < 0.0001). Higher air temperatures were closely associated with higher numbers of ambulance transports stratified by heat stroke in August 2009 in Japan.

  13. Seeking ambulance treatment for 'primary care' problems: a qualitative systematic review of patient, carer and professional perspectives.

    Science.gov (United States)

    Booker, Matthew J; Purdy, Sarah; Shaw, Alison R G

    2017-08-03

    To understand the reasons behind, and experience of, seeking and receiving emergency ambulance treatment for a 'primary care sensitive' condition. A comprehensive, qualitative systematic review. Medline, Embase, PsychInfo, Cumulative Index of Nursing and Allied Health, Health Management Information Systems, Healthcare Management Information Consortium, OpenSigle, EThOS and Digital Archive of Research Theses databases were systematically searched for studies exploring patient, carer or healthcare professional interactions with ambulance services for 'primary care sensitive' problems. Studies using wholly qualitative approaches or mixed-methods studies with substantial use of qualitative techniques in both the methods and analysis sections were included. An analytical thematic synthesis was undertaken, using a line-by-line qualitative coding method and a hierarchical inductive approach. Of 1458 initial results, 33 studies met the first level (relevance) inclusion criteria, and six studies met the second level (methodology and quality) criteria. The analysis suggests that patients define situations worthy of 'emergency' ambulance use according to complex socioemotional factors, as well as experienced physical symptoms. There can be a mismatch between how patients and professionals define 'emergency' situations. Deciding to call an ambulance is a process shaped by practical considerations and a strong emotional component, which can be influenced by the views of caregivers. Sometimes the value of a contact with the ambulance service is principally in managing this emotional component. Patients often wish to hand over responsibility for decisions when experiencing a perceived emergency. Feeling empowered to take control of a situation is a highly valued aspect of ambulance care. When responding to a request for 'emergency' help for a low-acuity condition, urgent-care services need to be sensitive to how the patient's emotional and practical perception of the situation

  14. Economic Outcomes of Extracorporeal Membrane Oxygenation With and Without Ambulation as a Bridge to Lung Transplantation.

    Science.gov (United States)

    Bain, Jesse C; Turner, David A; Rehder, Kyle J; Eisenstein, Eric L; Davis, R Duane; Cheifetz, Ira M; Zaas, David W

    2016-01-01

    An increasing number of centers are using active rehabilitation and ambulation for critically ill patients on extracorporeal membrane oxygenation (ECMO) as a bridge to lung transplantation. This investigation assessed the economic impact at a single center of ambulatory versus non-ambulatory ECMO strategies as a bridge to lung transplantation. We conducted a single-center retrospective cohort analysis of all subjects supported with ECMO as a bridge to lung transplantation (N = 9) from 2007 to 2012. Subjects who were rehabilitated while supported with ECMO before lung transplantation were compared with those who were not rehabilitated during ECMO. Hospital cost data for the month before transplantation through 12 months after the initial post-transplant hospital discharge were compared. The median cost (interquartile range [IQR]) in the 30 d before transplant for the ambulatory cohort was $88,137 (IQR $38,589-$122,111) compared with $52,124 (IQR $23,824-$69,929) for the non-ambulatory cohort (P = .08). The median post-transplant ICU cost for the ambulatory cohort was $38,468 (IQR $23,611-$64,126) compared with $143,407 (IQR $112,199-$168,993) for the non-ambulatory cohort (P = .01). The median total hospital cost for subjects supported with ambulatory ECMO was $213,086 (IQR $166,767-$264,536) compared with $273,291 (IQR $237,299-$374,175) for non-ambulatory ECMO subjects (P = .05). The median total cost for the ambulatory cohort was $268,194 (IQR $219,972-$517,320) compared with $300,307 (IQR $274,262-$394,913) for the non-ambulatory cohort (P = .14). Subjects supported with ambulatory ECMO had a 22% ($60,204) reduction in total hospital cost, 73% ($104,939) reduction in post-transplant ICU cost, and 11% ($32,133) reduction in total cost compared with non-ambulatory ECMO subjects. This analysis demonstrates the potential economic benefit of rehabilitation and ambulation during ECMO compared with a traditional strategy. Copyright © 2016 by Daedalus Enterprises.

  15. Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross-sectional survey.

    Science.gov (United States)

    Phung, Viet-Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne; Siriwardena, Aloysius N

    2016-02-01

    Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). We used a self-administered online questionnaire survey sent to front-line clinicians in all 12 English ambulance services. We conducted a cross-sectional analysis of quantitative data and qualitative analysis of free-text responses. There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre-hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large-scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. © 2016 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

  16. Differences in police, ambulance, and emergency department reporting of traffic injuries on Karachi-Hala road, Pakistan

    Directory of Open Access Journals (Sweden)

    Lagarde Emmanuel

    2011-03-01

    Full Text Available Abstract Background Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED datasets on an interurban road section in Pakistan. Methods The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS, and five hospital EDs in Karachi during 2008 (Jan to Dec were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants and outcome (died or injured. Further, records from these data were matched to assess ascertainment of traffic injuries and deaths by the three datasets. Results A total of 143 RTIs were reported to the police, 531 to EAS, and 661 to hospital EDs. Fatality per hundred traffic injuries was twice as high in police records (19 per 100 RTIs than in ambulance (10 per 100 RTIs and hospital ED records (9 per 100 RTIs. Pedestrian and motorcyclist involvement per hundred traffic injuries was lower in police records (8 per 100 RTIs than in ambulance (17 per 100 RTIs and hospital ED records (43 per 100 RTIs. Of the 119 deaths independently identified after matching, police recorded 22.6%, EAS 46.2%, and hospital ED 50.4%. Similarly, police data accounted for 10.6%, EAS 43.5%, and hospital ED 54.9% of the 1 095 independently identified injured patients. Conclusions Police reporting, particularly of non-fatal RTIs and those involving vulnerable road users, should be improved in Pakistan.

  17. Mobile Telestroke During Ambulance Transport Is Feasible in a Rural EMS Setting: The iTREAT Study.

    Science.gov (United States)

    Lippman, Jason M; Smith, Sherita N Chapman; McMurry, Timothy L; Sutton, Zachary G; Gunnell, Brian S; Cote, Jack; Perina, Debra G; Cattell-Gordon, David C; Rheuban, Karen S; Solenski, Nina J; Worrall, Bradford B; Southerland, Andrew M

    2016-06-01

    The use of telemedicine in the diagnosis and treatment of acute stroke, or telestroke, is a well-accepted method of practice improving geographic disparities in timely access to neurological expertise. We propose that mobile telestroke assessment during ambulance transport is feasible using low-cost, widely available technology. We designed a platform including a tablet-based end point, high-speed modem with commercial wireless access, external antennae, and portable mounting apparatus. Mobile connectivity testing was performed along six primary ambulance routes in a rural network. Audiovisual (AV) quality was assessed simultaneously by both an in-vehicle and an in-hospital rater using a standardized 6-point rating scale (≥4 indicating feasibility). We sought to achieve 9 min of continuous AV connectivity presumed sufficient to perform mobile telestroke assessments. Thirty test runs were completed: 93% achieved a minimum of 9 min of continuous video transmission with a mean mobile connectivity time of 18 min. Mean video and audio quality ratings were 4.51 (4.54 vehicle; 4.48 hospital) and 5.00 (5.13 in-vehicle; 4.87 hospital), respectively. Total initial cost of the system was $1,650 per ambulance. In this small, single-centered study we maintained high-quality continuous video transmission along primary ambulance corridors using a low-cost mobile telemedicine platform. The system is designed to be portable and adaptable, with generalizability for rapid assessment of emergency conditions in which direct observational exam may improve prehospital diagnosis and treatment. Thus mobile telestroke assessment is feasible using low-cost components and commercial wireless connectivity. More research is needed to demonstrate clinical reliability and efficacy in a live-patient setting.

  18. Multi-Agent Simulation of Allocating and Routing Ambulances Under Condition of Street Blockage after Natural Disaster

    Science.gov (United States)

    Azimi, S.; Delavar, M. R.; Rajabifard, A.

    2017-09-01

    In response to natural disasters, efficient planning for optimum allocation of the medical assistance to wounded as fast as possible and wayfinding of first responders immediately to minimize the risk of natural disasters are of prime importance. This paper aims to propose a multi-agent based modeling for optimum allocation of space to emergency centers according to the population, street network and number of ambulances in emergency centers by constraint network Voronoi diagrams, wayfinding of ambulances from emergency centers to the wounded locations and return based on the minimum ambulances travel time and path length implemented by NSGA and the use of smart city facilities to accelerate the rescue operation. Simulated annealing algorithm has been used for minimizing the difference between demands and supplies of the constrained network Voronoi diagrams. In the proposed multi-agent system, after delivering the location of the wounded and their symptoms, the constraint network Voronoi diagram for each emergency center is determined. This process was performed simultaneously for the multi-injuries in different Voronoi diagrams. In the proposed multi-agent system, the priority of the injuries for receiving medical assistance and facilities of the smart city for reporting the blocked streets was considered. Tehran Municipality District 5 was considered as the study area and during 3 minutes intervals, the volunteers reported the blocked street. The difference between the supply and the demand divided to the supply in each Voronoi diagram decreased to 0.1601. In the proposed multi-agent system, the response time of the ambulances is decreased about 36.7%.

  19. Exploration of contextual factors in a successful quality improvement collaborative in English ambulance services: cross‐sectional survey

    Science.gov (United States)

    Phung, Viet‐Hai; Essam, Nadya; Asghar, Zahid; Spaight, Anne

    2015-01-01

    Abstract Rationale, aims and objectives Clinical leadership and organizational culture are important contextual factors for quality improvement (QI) but the relationship between these and with organizational change is complex and poorly understood. We aimed to explore the relationship between clinical leadership, culture of innovation and clinical engagement in QI within a national ambulance QI Collaborative (QIC). Methods We used a self‐administered online questionnaire survey sent to front‐line clinicians in all 12 English ambulance services. We conducted a cross‐sectional analysis of quantitative data and qualitative analysis of free‐text responses. Results There were 2743 (12% of 22 117) responses from 11 of the 12 participating ambulance services. In the 3% of responders that were directly involved with the QIC, leadership behaviour was significantly higher than for those not directly involved. QIC involvement made no significant difference to responders' perceptions of the culture of innovation in their organization, which was generally considered poor. Although uptake of QI methods was low overall, QIC members were significantly more likely to use QI methods, which were also significantly associated with leadership behaviour. Conclusions Despite a limited organizational culture of innovation, clinical leadership and use of QI methods in ambulance services generally, the QIC achieved its aims to significantly improve pre‐hospital care for acute myocardial infarction and stroke. We postulate that this was mediated through an improvement subculture, linked to the QIC, which facilitated large‐scale improvement by stimulating leadership and QI methods. Further research is needed to understand success factors for QI in complex health care environments. PMID:26303398

  20. Cinéma Numérique Ambulant: Experiencia que reivindica la magia de la pantalla gigante

    Directory of Open Access Journals (Sweden)

    Marcos Velásquez

    2009-12-01

    Full Text Available Resalta la experiencia de comunicación que plantea Le Cinéma Numérique Ambulant CNA (África cuyo objetivo es difundir filmes de ficción, acompañados de documentos audiovisuales destinados a sensibilizar a los espectadores sobre los problemas de desarrollo de salud, o de convivencia en sociedad, en las regiones donde no existe el cine.

  1. Effects of weather and heliophysical conditions on emergency ambulance calls for elevated arterial blood pressure.

    Science.gov (United States)

    Vencloviene, Jone; Babarskiene, Ruta M; Dobozinskas, Paulius; Sakalyte, Gintare; Lopatiene, Kristina; Mikelionis, Nerijus

    2015-02-27

    We hypothesized that weather and space weather conditions were associated with the exacerbation of essential hypertension. The study was conducted during 2009-2010 in the city of Kaunas, Lithuania. We analyzed 13,475 cards from emergency ambulance calls (EACs), in which the conditions for the emergency calls were made coded I.10-I.15. The Kaunas Weather Station provided daily records of air temperature (T), wind speed (WS), relative humidity, and barometric pressure (BP). We evaluated the associations between daily weather variables and daily number of EACs by applying a multivariate Poisson regression. Unfavorable heliophysical conditions (two days after the active-stormy geomagnetic field or the days with solar WS>600 km/s) increased the daily number of elevated arterial blood pressure (EABP) by 12% (RR=1.12; 95% confidence interval (CI) 1.04-1.21); and WS≥3.5 knots during days of Tweather conditions. These results may help in the understanding of the population's sensitivity to different weather conditions.

  2. Modeling and simulation of paraplegic ambulation in a reciprocating gait orthosis.

    Science.gov (United States)

    Tashman, S; Zajac, F E; Perkash, I

    1995-08-01

    We developed a three dimensional, four segment, eight-degree-of-freedom model for the analysis of paraplegic ambulation in a reciprocating gait orthosis (RGO). Model development was guided by experimental analysis of a spinal cord injured individual walking in an RGO with the additional assistance of arm crutches. Body forces and torques required to produce a dynamic simulation of the RGO gait swing phase were found by solving an optimal control problem to track the recorded kinematics and ground reaction forces. We found that high upper body forces are required, not only during swing but probably also during double support to compensate for the deceleration of the body during swing, which is due to the pelvic thrust necessary to swing the leg forward. Other stimulations showed that upper body forces and body deceleration during swing can be reduced substantially by producing a ballistic swing. Functional neuromuscular stimulation of the hip musculature during double support would then be required, however, to establish the initial conditions needed in a ballistic swing.

  3. DMD genotypes and loss of ambulation in the CINRG Duchenne Natural History Study.

    Science.gov (United States)

    Bello, Luca; Morgenroth, Lauren P; Gordish-Dressman, Heather; Hoffman, Eric P; McDonald, Craig M; Cirak, Sebahattin

    2016-07-26

    To correlate time to loss of ambulation (LoA) and different truncating DMD gene mutations in a large, prospective natural history study of Duchenne muscular dystrophy (DMD), with particular attention to mutations amenable to emerging molecular treatments. We analyzed data from the Cooperative International Neuromuscular Research Group Duchenne Natural History Study for participants with DMD single- or multi-exon deletions or duplications with defined exon boundaries (n = 186), or small mutations identified by sequencing (n = 26, including 16 nonsense point mutations). We performed a time-to-event analysis of LoA, a strong indicator of overall disease severity, adjusting for glucocorticoid treatment and genetic modifiers. Participants with deletions amenable to skipping of exon 44 had later LoA (median 14.8 years, hazard ratio 0.31, 95% confidence interval 0.14-0.69, p = 0.004). Age at LoA did not differ significantly in participants with deletions amenable to exon 45, 51, and 53 skipping, duplications, and small rearrangements. Nonsense mutation DMD also showed a typical median age at LoA (11.1 years), with a few outliers (ambulatory around or after 16 years of age) carrying stop codons within in-frame exons, more often situated in the rod domain. As exon 44 skipping-amenable DMD has a later LoA, mutation-specific randomization and selection of placebo groups are essential for the success of clinical trials. © 2016 American Academy of Neurology.

  4. Rapid ambulation and range of motion after minimally invasive total knee arthroplasty.

    Science.gov (United States)

    Tanavalee, Aree; Thiengwittayaporn, Satit; Ngarmukos, Srihatach

    2004-09-01

    The authors evaluated the intraoperative data and early clinical results of 22 minimally invasive mini-incision total knee arthroplasties (mini-incision TKAs) performed between October 2002 and September 2003. Results were matched with 22 patients who underwent standard TKA in the same period. At a minimum 12-week follow up, results comparing the mini-incision TKA group and the standard TKA group were evaluated as follows: The average operative time was 137.1 vs 115.8min (p=0.02), the average wound length was 9.4 vs 13.7 cm, the average blood loss was 456 vs 512 ml (p=0.14) and the number of patients who could start to walk on postoperative day one was 17 vs 2. On postoperative day one, 82% of the mini-incision TKA group could do active knee extension meanwhile none of the standard group could. Postoperative pain score was not different at 24 hours or 48 hours. At 2 and6 weeks, the mini-incision TKA group had less pain with significant difference (p=0.002 and p=0.002). The postoperative range of motion in the mini-incision group was also significantly improved at 2 weeks (p=0.03). However, pain and range of motion were not different in both groups after 12 weeks. Early results of mini-incision TKA accelerated patient postoperative activity, ambulation and range of motion.

  5. [Helpful Factors of Ambulant Art Therapy in the Group and Changes of Experiences in Psychosomatic Patients].

    Science.gov (United States)

    Oster, Jörg; Moser, Anna Sophie; Danner-Weinberger, Alexandra; von Wietersheim, Jörn

    2016-02-01

    The aim of this study was to analyze the experiences of patients suffering from mostly chronic psychosomatic disorders in an ambulant art therapy in the group. Especially, the focus was on the experienced changes, helpful factors and specifics of the therapy as well as on the experienced benefit. For this, 30 patients were interviewed in a semi-standardized way. Additionally, the symptom-based strain was psychometrically recorded in a part of the patients (21) at the beginning of the therapy and after at least 6 months of participation. The evaluation of those interviews with the qualitative analysis of the therapy subjects surrendered an improvement of the health state in most of the participants. Especially group factors, art as a mean of communication, becoming aware of feelings but also diversion and fun were proved to be beneficial. The art therapy also serves for structuring the week as well as a contact point and a resource in the interpersonal communication of everyday life. Nearly all of the patients referred to some important turning point pictures. Mostly, the benefit was valued as being high. But, in contrast, the psychometric measure did not show any significant change. The results emphasize the stabilizing function of art therapy in the examined patients, whereat the classification of the psychometric result is complicated by the absence of a control group. © Georg Thieme Verlag KG Stuttgart · New York.

  6. 2-dimensional analysis of low limb taping methods on ambulation for stroke patients.

    Science.gov (United States)

    Lee, Jung-Ho

    2017-06-01

    [Purpose] The purpose of this study was to investigate the effect of treatment on the type of taping applied before proprioceptive neuromuscular facilitation treatment. [Subjects and Methods] This study was conducted on thirty patients diagnosed with stroke. The study subjects were divided into three groups: experimental group 1, experimental group 2, and control group 3. Experimental group 1 applied Kinesio taping to the lower limb before applying proprioceptive neuromuscular facilitation technique. Experimental group 2 applied McConnell taping to the lower limb before applying proprioceptive neuromuscular facilitation technique and control group applied only proprioceptive neuromuscular facilitation technique. In this study was used Dartfish to analyze the gait of the lower limbs. [Results] Experiment group 1 showed a significant difference of ankle angle compared to the control group, but a statistically significant difference of ankle angle was observed in week 8. Experiment group 1 and experiment group 2 showed a significantly longer stride length on the affected side than the control group. [Conclusion] Application of Kinesio taping has a more positive effect on the ambulation than McConnell taping.

  7. Impact of an implanted neuroprosthesis on community ambulation in incomplete SCI.

    Science.gov (United States)

    Lombardo, Lisa M; Kobetic, Rudolf; Pinault, Gilles; Foglyano, Kevin M; Bailey, Stephanie N; Selkirk, Stephen; Triolo, Ronald J

    2017-02-03

    Test the effect of a multi-joint control with implanted electrical stimulation on walking after spinal cord injury (SCI). Single subject research design with repeated measures Setting: Hospital-based biomechanics laboratory and user assessment of community use. Female with C6 AIS C SCI 30 years post injury. Lower extremity muscle activation with an implanted pulse generator and gait training. Walking speed, maximum distance, oxygen consumption, upper extremity (UE) forces, kinematics and self-assessment of technology. Short distance walking speed at one-year follow up with or without stimulation was not significantly different from baseline. However, average walking speed was significantly faster (0.22 m/s) with stimulation over longer distances than volitional walking (0.12 m/s). In addition, there was a 413% increase in walking distance from 95 m volitionally to 488 m with stimulation while oxygen consumption and maximum upper extremity forces decreased by 22 and 16%, respectively. Stimulation also produced significant (P ≤ 0.001) improvements in peak hip and knee flexion, ankle angle at foot off and at mid-swing. An implanted neuroprosthesis enabled a subject with incomplete SCI to walk longer distances with improved hip and knee flexion and ankle dorsiflexion resulting in decreased oxygen consumption and UE support. Further research is required to determine the robustness, generalizability and functional implications of implanted neuroprostheses for community ambulation after incomplete SCI.

  8. Issues in recruiting community-dwelling stroke survivors to clinical trials: the AMBULATE trial.

    Science.gov (United States)

    Lloyd, Gemma; Dean, Catherine M; Ada, Louise

    2010-07-01

    Recruitment to clinical trials is often slow and difficult, with a growing body of research examining this issue. However there is very little work related to stroke. The aim of this study was to examine the success and efficiency of recruitment of community-dwelling stroke survivors over the first two years of a clinical trial aiming to improve community ambulation. Recruitment strategies fell into 2 broad categories: (i) advertisement (such as newspaper advertising and media releases), and (ii) referral (via hospital and community physiotherapists, a stroke liaison officer and other researchers). Records were kept of the number of people who were screened, were eligible and were recruited for each strategy. The recruitment target of 60 in the first two years was not met. 111 stroke survivors were screened and 57 were recruited (i.e., a recruitment rate of 51%). The most successful strategy was referral via hospital-based physiotherapists (47% of recruited participants) and the least successful were media release and local newspaper advertising. The referral strategies were all more efficient than any of the advertisement strategies. In general, recruitment was inefficient and costly in terms of human resources. Given that stroke research is underfunded, it is important to find efficient ways of recruiting stroke survivors to clinical trials. An Australian national database similar to other disease-specific data bases (such as the National Cancer Database) is under development. In the interim, recruiting for several clinical trials at once may increase efficiency.

  9. Resource planning for ambulance services in mass casualty incidents: a DES-based policy model.

    Science.gov (United States)

    Rauner, Marion S; Schaffhauser-Linzatti, Michaela M; Niessner, Helmut

    2012-09-01

    Due to an increasing number of mass casualty incidents, which are generally complex and unique in nature, we suggest that decision makers consider operations research-based policy models to help prepare emergency staff for improved planning and scheduling at the emergency site. We thus develop a discrete-event simulation policy model, which is currently being applied by disaster-responsive ambulance services in Austria. By evaluating realistic scenarios, our policy model is shown to enhance the scheduling and outcomes at operative and online levels. The proposed scenarios range from small, simple, and urban to rather large, complex, remote mass casualty emergencies. Furthermore, the organization of an advanced medical post can be improved on a strategic level to increase rescue quality, including enhanced survival of injured victims. In particular, we consider a realistic mass casualty incident at a brewery relative to other exemplary disasters. Based on a variety of such situations, we derive general policy implications at both the macro (e.g., strategic rescue policy) and micro (e.g., operative and online scheduling strategies at the emergency site) levels.

  10. Emergency department visits, ambulance calls, and mortality associated with an exceptional heat wave in Sydney, Australia, 2011: a time-series analysis

    Directory of Open Access Journals (Sweden)

    Schaffer Andrea

    2012-01-01

    Full Text Available Abstract Background From January 30-February 6, 2011, New South Wales was affected by an exceptional heat wave, which broke numerous records. Near real-time Emergency Department (ED and ambulance surveillance allowed rapid detection of an increase in the number of heat-related ED visits and ambulance calls during this period. The purpose of this study was to quantify the excess heat-related and all-cause ED visits and ambulance calls, and excess all-cause mortality, associated with the heat wave. Methods ED and ambulance data were obtained from surveillance and administrative databases, while mortality data were obtained from the state death registry. The observed counts were compared with the average counts from the same period from 2006/07 through 2009/10, and a Poisson regression model was constructed to calculate the number of excess ED visits, ambulance and deaths after adjusting for calendar and lag effects. Results During the heat wave there were 104 and 236 ED visits for heat effects and dehydration respectively, and 116 ambulance calls for heat exposure. From the regression model, all-cause ED visits increased by 2% (95% CI 1.01-1.03, all-cause ambulance calls increased by 14% (95% CI 1.11-1.16, and all-cause mortality increased by 13% (95% CI 1.06-1.22. Those aged 75 years and older had the highest excess rates of all outcomes. Conclusions The 2011 heat wave resulted in an increase in the number of ED visits and ambulance calls, especially in older persons, as well as an increase in all-cause mortality. Rapid surveillance systems provide markers of heat wave impacts that have fatal outcomes.

  11. The nurse-patient relationship in pre-hospital emergency care--from the perspective of Swedish specialist ambulance nursing students.

    Science.gov (United States)

    Berntsson, Tommy; Hildingh, Cathrine

    2013-10-01

    The development of the Swedish ambulance service has resulted in three different competence levels in Swedish ambulance teams: specialist ambulance nurses, registered nurses and emergency medical technicians. A nursing scientific model developed by Peplau (Peplau, H., 1991. Interpersonal Relations in Nursing. Springer Publishing Company, New York.) breaks down the nurse-patient relationship into a number of phases: an orientation, an identification, an exploitation and a resolution phase. This model has then been adapted to the pre-hospital emergency care by Suserud (Dahlberg, K., Segesten, K., Nyström, M., Suserud, B.-O., Fagerberg, I., 2003. Att förstå vårdvetenskap [To Understand Caring Science]. Studentlitteratur, Lund.). The purpose of this study was to explore, by direct content analysis, how the phases of the pre-hospital nurse-patient relationship described by Suserud (Dahlberg et al., 2003), emerge in 17 specialist ambulance nursing students descriptions of ambulance missions. The results show that the four phases of the pre-hospital nurse-patient relationship could be identified and each phase includes several different parts. Furthermore, the results show that the parts of each phase can vary depending on the patient's condition and the environmental circumstances of the ambulance mission. This improved understanding of the four phases of the pre-hospital nurse-patient relationship, and their parts, could be used by ambulance team members as a support during the pre-hospital caring process in ambulance missions. This new knowledge could also be used in education. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Effect evaluation of a heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in prehospital emergency care – an intervention study

    Directory of Open Access Journals (Sweden)

    Jonas Aléx

    2015-09-01

    Full Text Available Background: The ambulance milieu does not offer good thermal comfort to patients during the cold Swedish winters. Patients’ exposure to cold temperatures combined with a cold ambulance mattress seems to be the major factor leading to an overall sensation of discomfort. There is little research on the effect of active heat delivered from underneath in ambulance care. Therefore, the aim of this study was to evaluate the effect of an electrically heated ambulance mattress-prototype on thermal comfort and patients’ temperatures in the prehospital emergency care. Methods: A quantitative intervention study on ambulance care was conducted in the north of Sweden. The ambulance used for the intervention group (n=30 was equipped with an electrically heated mattress on the regular ambulance stretcher whereas for the control group (n=30 no active heat was provided on the stretcher. Outcome variables were measured as thermal comfort on the Cold Discomfort Scale (CDS, subjective comments on cold experiences, and finger, ear and air temperatures. Results: Thermal comfort, measured by CDS, improved during the ambulance transport to the emergency department in the intervention group (p=0.001 but decreased in the control group (p=0.014. A significant higher proportion (57% of the control group rated the stretcher as cold to lie down compared to the intervention group (3%, p<0.001. At arrival, finger, ear and compartment air temperature showed no statistical significant difference between groups. Mean transport time was approximately 15 minutes. Conclusions: The use of active heat from underneath increases the patients’ thermal comfort and may prevent the negative consequences of cold stress.

  13. Physical and psychosocial work environment factors and their association with health outcomes in Danish ambulance personnel – a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Hansen Claus D

    2012-07-01

    Full Text Available Abstract Background Reviews of the literature on the health and work environment of ambulance personnel have indicated an increased risk of work-related health problems in this occupation. The aim of this study was to compare health status and exposure to different work environmental factors among ambulance personnel and the core work force in Denmark. In addition, to examine the association between physical and psychosocial work environment factors and different measures of health among ambulance personnel. Methods Data were taken from a nationwide sample of ambulance personnel and fire fighters (n = 1,691 and was compared to reference samples of the Danish work force. The questionnaire contained measures of physical and psychosocial work environment as well as measures of musculoskeletal pain, mental health, self-rated health and sleep quality. Results Ambulance personnel have half the prevalence of poor self-rated health compared to the core work force (5% vs. 10%. Levels of mental health were the same across the two samples whereas a substantially higher proportion of the ambulance personnel reported musculoskeletal pain (42% vs. 29%. The ambulance personnel had higher levels of emotional demands and meaningfulness of and commitment to work, and substantially lower levels of quantitative demands and influence at work. Only one out of ten aspects of physical work environment was consistently associated with higher levels of musculoskeletal pain. Emotional demands was the only psychosocial work factor that was associated with both poorer mental health and worse sleep quality. Conclusions Ambulance personnel have similar levels of mental health but substantially higher levels of musculoskeletal pain than the work force in general. They are more exposed to emotional demands and these demands are associated with higher levels of poor mental health and poor sleep quality. To improve work environment, attention should be paid to musculoskeletal

  14. The importance of job demands and work resources regarding the engagement, the commitment, burnout and the well-being of ambulance service personnel

    OpenAIRE

    Hering, Thomas

    2016-01-01

    Introduction. Research into the stress and demands of ambulance services is dominated by studies which mainly focus on psychologically highly stressful traumatizing emergencies and their pathological consequences such as posttraumatic stress disorder. Little research has been done on specific aspects of working conditions that the ambulance services are enduring and their importance for the characteristics of work-related health as well as for the indicators of commitment. So far, research ai...

  15. Quality of closed chest compression on a manikin in ambulance vehicles and flying helicopters with a real time automated feedback.

    Science.gov (United States)

    Havel, Christof; Schreiber, Wolfgang; Trimmel, Helmut; Malzer, Reinhard; Haugk, Moritz; Richling, Nina; Riedmüller, Eva; Sterz, Fritz; Herkner, Harald

    2010-01-01

    Automated verbal and visual feedback improves quality of resuscitation in out-of-hospital cardiac arrest and was proven to increase short-term survival. Quality of resuscitation may be hampered in more difficult situations like emergency transportation. Currently there is no evidence if feedback devices can improve resuscitation quality during different modes of transportation. To assess the effect of real time automated feedback on the quality of resuscitation in an emergency transportation setting. Randomised cross-over trial. Medical University of Vienna, Vienna Municipal Ambulance Service and Helicopter Emergency Medical Service Unit (Christophorus Flugrettungsverein) in September 2007. European Resuscitation Council (ERC) certified health care professionals performing CPR in a flying helicopter and in a moving ambulance vehicle on a manikin with human-like chest properties. CPR sessions, with real time automated feedback as the intervention and standard CPR without feedback as control. Quality of chest compression during resuscitation. Feedback resulted in less deviation from ideal compression rate 100 min(-1) (9+/-9 min(-1), pautomated feedback improves certain aspects of CPR quality in flying helicopters and moving ambulance vehicles. The effect of feedback guidance was most pronounced for chest compression rate. Copyright 2009 Elsevier Ireland Ltd. All rights reserved.

  16. Continuous adductor canal blocks are superior to continuous femoral nerve blocks in promoting early ambulation after TKA.

    Science.gov (United States)

    Mudumbai, Seshadri C; Kim, T Edward; Howard, Steven K; Workman, J Justin; Giori, Nicholas; Woolson, Steven; Ganaway, Toni; King, Robert; Mariano, Edward R

    2014-05-01

    Femoral continuous peripheral nerve blocks (CPNBs) provide effective analgesia after TKA but have been associated with quadriceps weakness and delayed ambulation. A promising alternative is adductor canal CPNB that delivers a primarily sensory blockade; however, the differential effects of these two techniques on functional outcomes after TKA are not well established. We determined whether, after TKA, patients with adductor canal CPNB versus patients with femoral CPNB demonstrated (1) greater total ambulation distance on Postoperative Day (POD) 1 and 2 and (2) decreased daily opioid consumption, pain scores, and hospital length of stay. Between October 2011 and October 2012, 180 patients underwent primary TKA at our practice site, of whom 93% (n = 168) had CPNBs. In this sequential series, the first 102 patients had femoral CPNBs, and the next 66 had adductor canal CPNBs. The change resulted from a modification to our clinical pathway, which involved only a change to the block. An evaluator not involved in the patients' care reviewed their medical records to record the parameters noted above. Ambulation distances were higher in the adductor canal group than in the femoral group on POD 1 (median [10(th)-90(th) percentiles]: 37 m [0-90 m] versus 6 m [0-51 m]; p randomized studies are needed to validate our major findings. Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

  17. Complexity of the decision-making process of ambulance staff for assessment and referral of older people who have fallen: a qualitative study.

    Science.gov (United States)

    Halter, Mary; Vernon, Susan; Snooks, Helen; Porter, Alison; Close, Jacqueline; Moore, Fionna; Porsz, Simon

    2011-01-01

    Older people who fall commonly present to the emergency ambulance service, and approximately 40% are not conveyed to the emergency department (ED), despite an historic lack of formal training for such decisions. This study aimed to understand the decision-making processes of emergency ambulance staff with older people who have fallen. During 2005 ambulance staff in London tested a clinical assessment tool for use with the older person who had fallen. Documented use of the tool was low. Following the trial, 12 staff participated in semistructured interviews. Interviews were recorded and transcribed. Thematic analysis was carried out. The interviews revealed a similar assessment and decision-making process among participants: Prearrival: forming an early opinion from information from the emergency call. Initial contact: assessing the need for any immediate action and establishing a rapport. Continuing assessment: gathering and assimilating medical and social information. Making a conveyance decision: negotiation, referral and professional defence, using professional experience and instinct. An assessment process was described that highlights the complexity of making decisions about whether or not to convey older people who fall and present to the emergency ambulance service, and a predominance of informal decision-making processes. The need for support for ambulance staff in this area was highlighted, generating a significant challenge to those with education roles in the ambulance service. Further research is needed to look at how new care pathways, which offer an alternative to the ED may influence decision making around non-conveyance.

  18. Stereotactic vacuum-assisted breast biopsy - success, histologic accuracy, patient acceptance and optimizing the BI-RADS{sup TM}-correlated indication; Stereotaktische Vakuumbiopsie mammographisch detektierter Laesionen - Erfolg, histologische Sicherheit, Patientenakzeptanz und BI-RADS{sup TM}-korrelierte Indikationsoptimierung

    Energy Technology Data Exchange (ETDEWEB)

    Siegmann, K.C.; Wersebe, A.; Fischmann, A.; Claussen, C.D.; Mueller-Schimpfle, M. [Abt. Radiologische Diagnostik, Universitaetsklinik Tuebingen (Germany); Fersis, N. [Abt. Geburtshilfe und Frauenheilkunde, Universitaetsklinik Tuebingen (Germany); Vogel, U. [Inst. fuer Pathologie, Universitaetsklinik Tuebingen (Germany)

    2003-01-01

    Purpose: To evaluate success, histologic accuracy, patient acceptance and BI-RADS{sup TM}-correlated malignancy rate of stereotactic vacuum-assisted breast biopsies in order to optimize the indication. Materials and Methods: In 132 patients with mammographically detected breast lesions 166 stereotactic vacuum-assisted 11 gauge core biopsies were performed. All lesions were classified according to the BI-RADS{sup TM} categories of the ACR. Removal of the lesion was radiographically assessed as complete, representative or not representative. Patient acceptance was evaluated. Results: Of the 166 lesions, 54 (32.5%) lesions were judged completely removed, 110 (66.3%) representatively removed and 2 (1.2%) not representatively removed. Malignancy was found in 38 (22.9%) lesions. The rate of malignancy increased from 6.3% (2/32) for BI-RADS{sup TM} category 3 to 16.7% (19/114) for BI-RADS{sup TM} category 4 and increased further to 85% (17/20) for BI-RADS{sup TM} category 5 (p<0.001). The histology of a sufficient vacuum-assisted biopsy was underestimated in 6 (15%) of the 40 lesions that were subsequently excised surgically. Most patients (98.5%; 130/132) stated they would undergo a vacuum-assisted biopsy again. Conclusion: Vacuum-assisted breast biopsy is accurate, has a justifiable rate of histologic underestimation and is well accepted by patients. Patients with BI-RADS{sup TM} category 4 microcalcification benefit the most. Lesions of BI-RADS{sup TM} category 3 and BI-RADS{sup TM} category 5 should be biopsied only under special circumstances (family risk of breast cancer; assessment of lesions extension). (orig.) [German] Ziel: Evaluierung der stereotaktischen Vakuumbiopsie hinsichtlich Biopsieerfolg, histologischer Sicherheit, Patientenakzeptanz und BI-RADS{sup TM}-korrelierter Malignitaetsrate zur Optimierung der Indikationsstellung. Methoden: Wir fuehrten bei 132 Patientinnen mit 166 mammografisch detektierten Laesionen eine stereotaktische 11 G

  19. Calls Forecast for the Moscow Ambulance Service. The Impact of Weather Forecast

    Science.gov (United States)

    Gordin, Vladimir; Bykov, Philipp

    2015-04-01

    We use the known statistics of the calls for the current and previous days to predict them for tomorrow and for the following days. We assume that this algorithm will work operatively, will cyclically update the available information and will move the horizon of the forecast. Sure, the accuracy of such forecasts depends on their lead time, and from a choice of some group of diagnoses. For comparison we used the error of the inertial forecast (tomorrow there will be the same number of calls as today). Our technology has demonstrated accuracy that is approximately two times better compared to the inertial forecast. We obtained the following result: the number of calls depends on the actual weather in the city as well as on its rate of change. We were interested in the accuracy of the forecast for 12-hour sum of the calls in real situations. We evaluate the impact of the meteorological errors [1] on the forecast errors of the number of Ambulance calls. The weather and the Ambulance calls number both have seasonal tendencies. Therefore, if we have medical information from one city only, we should separate the impacts of such predictors as "annual variations in the number of calls" and "weather". We need to consider the seasonal tendencies (associated, e. g. with the seasonal migration of the population) and the impact of the air temperature simultaneously, rather than sequentially. We forecasted separately the number of calls with diagnoses of cardiovascular group, where it was demonstrated the advantage of the forecasting method, when we use the maximum daily air temperature as a predictor. We have a chance to evaluate statistically the influence of meteorological factors on the dynamics of medical problems. In some cases it may be useful for understanding of the physiology of disease and possible treatment options. We can assimilate some personal archives of medical parameters for the individuals with concrete diseases and the relative meteorological archive. As a

  20. Inhaled methoxyflurane and intranasal fentanyl for prehospital management of visceral pain in an Australian ambulance service.

    Science.gov (United States)

    Johnston, Steven; Wilkes, Garry J; Thompson, Jennifer A; Ziman, Mel; Brightwell, Richard

    2011-01-01

    This study analysed the analgesic effect and changes in vital signs associated with administration of inhaled Methoxyflurane (MTX) and/or intranasal Fentanyl (INF) for prehospital management of visceral pain. A retrospective, observational study reviewing 1024 randomly selected records of patients with presumed visceral pain administered MTX (465), INF (397) or both (162) by the Western Australian Ambulance Service between January 2004 and February 2006. Clinical variables assessed included systolic blood pressure, pulse rate, respiration rate and Glasgow Coma Scale score. Pain was assessed utilising Visual/Verbal Analogue Scale pain scores. Overall effects on vital signs appeared favourable 5 min after use and at hospital arrival with either agent alone or in combination. As sole agents, MTX produced the greatest initial pain scores reduction (2.0 (1.7 to 2.2) vs 1.6 (1.4 to 1.8)) (mean (95% CI), and INF provided greater pain reduction by hospital arrival (3.2 (2.9 to 3.5) vs 2.5 (2.1 to 2.9)). While both agents were effective, INF provided a greater pain score reduction for cardiac (3.0 (2.6 to 3.4) vs 2.3 (1.8 to 2.8)), female (3.4 (2.9 to 4.0) v 2.5 (2.0 to 3.0)) and age 75+ patients (3.2 (2.5 to 3.8) vs 1.8 (1.0 to 2.5)). Combined use of agents was not advantageous. MTX and INF are effective agents for providing visceral pain analgesia in the prehospital setting. While MTX provided a more rapid onset of pain relief, INF provided superior analgesia after subsequent doses and in female, cardiac and older patients.

  1. Long Term Natural History Data in Ambulant Boys with Duchenne Muscular Dystrophy: 36-Month Changes

    Science.gov (United States)

    Sormani, Maria Pia; Messina, Sonia; D′Amico, Adele; Carlesi, Adelina; Vita, Gianluca; Fanelli, Lavinia; Berardinelli, Angela; Torrente, Yvan; Lanzillotta, Valentina; Viggiano, Emanuela; D′Ambrosio, Paola; Cavallaro, Filippo; Frosini, Silvia; Barp, Andrea; Bonfiglio, Serena; Scalise, Roberta; De Sanctis, Roberto; Rolle, Enrica; Graziano, Alessandra; Magri, Francesca; Palermo, Concetta; Rossi, Francesca; Donati, Maria Alice; Sacchini, Michele; Arnoldi, Maria Teresa; Baranello, Giovanni; Mongini, Tiziana; Pini, Antonella; Battini, Roberta; Pegoraro, Elena; Previtali, Stefano; Bruno, Claudio; Politano, Luisa; Comi, Giacomo P.; Bertini, Enrico; Mercuri, Eugenio

    2014-01-01

    The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3%) lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14%) and 11 between 24 and 36 months (12%). The 6 minute walk test showed an average overall decline of −15.8 (SD 77.3) m at 12 months, of −58.9 (SD 125.7) m at 24 months and −104.22 (SD 146.2) m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m) (p<0.001). The changes were also significantly different according to steroid treatment (p = 0.01). Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available. PMID:25271887

  2. Long term natural history data in ambulant boys with Duchenne muscular dystrophy: 36-month changes.

    Directory of Open Access Journals (Sweden)

    Marika Pane

    Full Text Available The 6 minute walk test has been recently chosen as the primary outcome measure in international multicenter clinical trials in Duchenne muscular dystrophy ambulant patients. The aim of the study was to assess the spectrum of changes at 3 years in the individual measures, their correlation with steroid treatment, age and 6 minute walk test values at baseline. Ninety-six patients from 11 centers were assessed at baseline and 12, 24 and 36 months after baseline using the 6 minute walk test and the North Star Ambulatory Assessment. Three boys (3% lost the ability to perform the 6 minute walk test within 12 months, another 13 between 12 and 24 months (14% and 11 between 24 and 36 months (12%. The 6 minute walk test showed an average overall decline of -15.8 (SD 77.3 m at 12 months, of -58.9 (SD 125.7 m at 24 months and -104.22 (SD 146.2 m at 36 months. The changes were significantly different in the two baseline age groups and according to the baseline 6 minute walk test values (below and above 350 m (p<0.001. The changes were also significantly different according to steroid treatment (p = 0.01. Similar findings were found for the North Star Ambulatory Assessment. These are the first 36 month longitudinal data using the 6 minute walk test and North Star Ambulatory Assessment in Duchenne muscular dystrophy. Our findings will help not only to have a better idea of the progression of the disorder but also provide reference data that can be used to compare with the results of the long term extension studies that are becoming available.

  3. Public access defibrillation—results from the Victorian Ambulance Cardiac Arrest Registry.

    Science.gov (United States)

    Lijovic, M; Bernard, S; Nehme, Z; Walker, T; Smith, K

    2014-12-01

    To assess the impact of automated external defibrillator (AED) use by bystanders in Victoria, Australia on survival of adults suffering an out-of-hospital cardiac arrest (OHCA) in a public place compared to those first defibrillated by emergency medical services (EMS). We analysed data from the Victorian Ambulance Cardiac Arrest Registry for individuals aged >15 years who were defibrillated in a public place between 1 July 2002 and 30 June 2013, excluding events due to trauma or witnessed by EMS. Of 2270 OHCA cases who arrested in a public place, 2117 (93.4%) were first defibrillated by EMS and 153 (6.7%) were first defibrillated by a bystander using a public AED. Use of public AEDs increased almost 11-fold between 2002/2003 and 2012/2013, from 1.7% to 18.5%, respectively (p defibrillation occurred sooner in bystander defibrillation (5.2 versus 10.0 min, p defibrillated patients was significantly higher than for those first defibrillated by EMS (45% versus 31%, p defibrillation by a bystander using an AED was associated with a 62% increase in the odds of survival to hospital discharge (adjusted odds ratio 1.62, 95% CI: 1.12–2.34, p = 0.010) compared to first defibrillation by EMS. Survival to hospital discharge is improved in patients first defibrillated using a public AED prior to EMS arrival in Victoria, Australia. Encouragingly, bystander AED use in Victoria has increased over time. More widespread availability of AEDs may further improve outcomes of OHCA in public places.

  4. Comparison of four different categories of prosthetic feet during ramp ambulation in unilateral transtibial amputees.

    Science.gov (United States)

    Agrawal, Vibhor; Gailey, Robert S; Gaunaurd, Ignacio A; O'Toole, Christopher; Finnieston, Adam; Tolchin, Ronald

    2015-10-01

    Comparative effectiveness of prosthetic feet during ramp ambulation in unilateral transtibial amputees, who function at different Medicare Functional Classification Levels, has not been published. To determine differences in symmetry in external work between four categories of prosthetic feet in K-Level-2 and K-Level-3 unilateral transtibial amputees during ramp ascent and descent. Randomized repeated-measures trial. Ten subjects completed six testing sessions during which symmetry in external work was calculated using F-scan in-sole sensors. Between testing sessions 1 and 2, subjects received standardized functional prosthetic training. In Sessions 3-6, subjects tested four feet--solid ankle cushion heel, stationary attachment flexible endoskeleton, Talux (categories K1, K2, and K3, respectively), and Proprio-Foot (microprocessor ankle)--using a study socket and had a 10- to 14-day accommodation period with each foot. During ramp descent, K-Level-2 subjects demonstrated higher symmetry in external work values with Talux and Proprio-Foot compared to the solid ankle cushion heel foot. K-Level-3 subjects also had higher symmetry in external work values with the Talux foot than the solid ankle cushion heel foot. Ramp ascent symmetry in external work values were not significantly different between feet. Prosthetic foot category appears to influence symmetry in external work more during decline walking than incline walking. K-Level-2 unilateral transtibial amputees achieve greater symmetry from K3 dynamic response prosthetic feet with J-shaped ankle and microprocessor ankles while descending ramps. The findings suggest that K-Level-2 unilateral transtibial amputees benefit from K3 dynamic response prosthetic feet with J-shaped ankle. These results support the prescription of K3 feet for K-Level-2 amputees who frequently negotiate ramps. © The International Society for Prosthetics and Orthotics 2014.

  5. Coupling the effect of mental practice and Pilates on ambulation of individuals with multiple sclerosis: Five case studies

    Directory of Open Access Journals (Sweden)

    Darshpreet Kaur

    2016-01-01

    Full Text Available Pilates, a popular form of exercise, greatly emphasizes on the strengthening of the core muscles; however, the efficacy of exercise program can be impaired in patients with cognitive impairments. To bridge this gap, mental practice of a desired task can help to mentally simulate a given action and retain many properties of the corresponding real action. This study tries to gain preliminary understanding on the effectiveness of the combination of mental practice and core-strengthening Pilates exercises. To explore the effectiveness of mental practice and Pilates-based training on core strength, balance and mobility in multiple sclerosis (MS patients. This study highlights a single center case series describing the outcomes in ambulant patients with MS treated with mental practice and Pilates. Five volunteer ambulant individuals with stable relapsing-remitting MS participated in 20 individualized sessions, spread over 10-week duration. Pilates with mental practice session was delivered by a physiotherapist. Each session comprised 20 min of mental practice followed by 40 min of core-strengthening Pilates exercises. All the included patients were screened with Movement Imagery Questionnaire-Revised Second Version to determine if they are were able to effectively engage in imagery practice. A range of outcomes were measured: Timed up and go, chair stand test, curl-ups, the abdominal angle through leg raises, and the Activities-specific Balance Confidence Scale before and after the intervention. Group data analysis indicated significant improvement between baseline and post-intervention phases for all the tested parameters. This study provides preliminary insight into this novel combination technique to improve balance and mobility in ambulant people with MS. Mental practice played an important role in keeping the patient's compliance, which was analyzed through structured interviews. Variations in response to the intervention are evident.

  6. Crew and patient safety in ambulances: results of a personnel survey and experimental side impact crash test.

    Science.gov (United States)

    Fournier, Marc; Chenaitia, Hichem; Masson, Catherine; Michelet, Pierre; Behr, Michel; Auffray, Jean-Pierre

    2013-08-01

    Ambulance drivers often travel under stressful conditions at high speed while using vehicles with poor high-speed maneuverability. The occupant safety of ambulance vehicles has not yet been addressed by the automotive safety paradigm; particularly for the rear patient compartment. This study had two objectives: (1) to assess by survey the French Emergency Medical Services (EMS) to determine the layout of the vehicle most often used and the EMS personnel's behavior during transport; and (2) to conduct a crash test to analyze the injuries which may affect EMS personnel and patients in the rear patient compartment. Firstly, a survey was distributed to the 50 largest metropolitan French EMS programs. Secondly, a crash test was performed with a Mobile Intensive Care Unit (MICU) in conditions closest to reality. Forty-nine of the 50 biggest metropolitan French EMS programs responded to the survey. This represents 108 French MICUs. During the last three years, 12 of 49 EMS programs (24%) identified at least one accident with an MICU, and six of these 12 (50%) suffered at least one death in those accidents. A crash test using a typical French EMS MICU showed that after impact of a collision, the ambulance was moved more than five meters with major consequences for all passengers. A study-approved human cadaver placed in the position of a potential patient was partially thrown from the stretcher with a head impact. The accelerometric reaction of the anthropomorphic manikin head was measured at 48G. The crash test demonstrated a lack of safety for EMS personnel and patients in the rear compartment. It would be preferable if each piece of medical equipment were provided with a quick release system resistant to three-dimensional 10G forces. The kinetic changes undergone by the "patient" substitute on the stretcher would probably have an effect of causing injury pathology. This study highlights the need for more research and development in this area.

  7. Characterization of Artifacts produced by gel displacement on non-invasive Brain-Machine Interfaces during ambulation

    Directory of Open Access Journals (Sweden)

    Alvaro eCosta

    2016-02-01

    Full Text Available So far, Brain-Machine Interfaces (BMIs have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals. To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training and one movement-free condition (BMI motor imagery task are compared to perform this study.Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions.

  8. Characterization of Artifacts Produced by Gel Displacement on Non-invasive Brain-Machine Interfaces during Ambulation

    Science.gov (United States)

    Costa, Álvaro; Salazar-Varas, Rocio; Úbeda, Andrés; Azorín, José M.

    2016-01-01

    So far, Brain-Machine Interfaces (BMIs) have been mainly used to study brain potentials during movement-free conditions. Recently, due to the emerging concern of improving rehabilitation therapies, these systems are also being used during gait experiments. Under this new condition, the evaluation of motion artifacts has become a critical point to assure the validity of the results obtained. Due to the high signal to noise ratio provided, the use of wet electrodes is a widely accepted technic to acquire electroencephalographic (EEG signals). To perform these recordings it is necessary to apply a conductive gel between the scalp and the electrodes. This work is focused on the study of gel displacements produced during ambulation and how they affect the amplitude of EEG signals. Data recorded during three ambulation conditions (gait training) and one movement-free condition (BMI motor imagery task) are compared to perform this study. Two phenomenons, manifested as unusual increases of the signals' amplitude, have been identified and characterized during this work. Results suggest that they are caused by abrupt changes on the conductivity between the electrode and the scalp due to gel displacement produced during ambulation and head movements. These artifacts significantly increase the Power Spectral Density (PSD) of EEG recordings at all frequencies from 5 to 90 Hz, corresponding to the main bandwidth of electrocortical potentials. They should be taken into consideration before performing EEG recordings in order to asses the correct gel allocation and to avoid the use of electrodes on certain scalp areas depending on the experimental conditions. PMID:26941601

  9. Factors associated with an immediate weight-bearing and early ambulation program for older adults after hip fracture repair.

    Science.gov (United States)

    Barone, Antonella; Giusti, Andrea; Pizzonia, Monica; Razzano, Monica; Oliveri, Mauro; Palummeri, Ernesto; Pioli, Giulio

    2009-09-01

    To evaluate baseline characteristics and in-hospital factors associated with nonadherence with an immediate weight-bearing and early ambulation (IWB-EA) program after hip fracture (HF) surgery. Prospective inception cohort study. Ortho-geriatric unit in an acute care hospital. Older adults (N=469) admitted with an osteoporotic HF who underwent surgery. Immediate weight-bearing and assisted ambulation training on the first postoperative day (all patients). Proportion of subjects who adhered to the IWB-EA protocol within 48 hours of surgery. A total of 366 patients (78%) bore weight and ambulated within 48 hours (weight-bearing [WB] group) while the others did not adhere to the protocol (nonweight-bearing [NWB] group). Subjects in the NWB group were significantly older, were more cognitively and functionally impaired, and presented a higher comorbidity at baseline. A higher proportion of subjects in the NWB group (42.7%) than the WB group (23.5%; PIWB-EA protocol (odds ratio=2.5; 95% confidence interval=1.6-4.0; PIWB-EA is feasible in a high proportion of patients after surgical stabilization of HF. Neither cognitive impairment nor high comorbidity influenced significantly the adherence to the protocol, indicating that IWB-EA may be offered to an unselected population of the elderly with HF. The day of surgery (eg, preholiday or not) was the only variable influencing the participation to the IWB-EA protocol, suggesting the importance of maintaining the same standard of daytime care every day of the week.

  10. Cumulated Ambulation Score to evaluate mobility is feasible in geriatric patients and in patients with hip fracture

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Jakobsen, Thomas Linding; Nielsen, Jesper Westphal

    2012-01-01

    Regaining basic mobility independence is considered important for elderly hospitalised patients. The Cumulated Ambulation Score (CAS) is a valid tool for evaluating these patients' basic mobility (getting in and out of bed, sit-to-stand from a chair and walking) in orthopaedic wards, and its use...... is recommended in Denmark for patients with hip fracture. The aims of the present study were to evaluate the feasibility of the CAS in a geriatric ward and to describe its use after hip fracture in Denmark....

  11. Model application for rapid detection of the exact location when calling an ambulance using OGC Open GeoSMS Standards

    Directory of Open Access Journals (Sweden)

    Sukic Enes

    2016-02-01

    Full Text Available The web has penetrated just about every sphere of human interest and using information from the web has become ubiquitous among different categories of users. Medicine has long being using the benefits of modern technologies and without them it cannot function. This paper offers a proposal of use and mutual collaboration of several modern technologies within facilitating the location and communication between persons in need of emergency medical assistance and the emergency head offices, i.e., the ambulance. The main advantage of the proposed model is the technical possibility of implementation and use of these technologies in developing countries and low implementation cost.

  12. A patient-safety and professional perspective on non-conveyance in ambulance care: a systematic review.

    Science.gov (United States)

    Ebben, Remco H A; Vloet, Lilian C M; Speijers, Renate F; Tönjes, Nico W; Loef, Jorik; Pelgrim, Thomas; Hoogeveen, Margreet; Berben, Sivera A A

    2017-07-17

    This systematic review aimed to describe non-conveyance in ambulance care from patient-safety and ambulance professional perspectives. The review specifically focussed at describing (1) ambulance non-conveyance rates, (2) characteristics of non-conveyed patients, (3) follow-up care after non-conveyance, (4) existing guidelines or protocols, and (5) influencing factors during the non-conveyance decision making process. We systematically searched MEDLINE, PubMed, CINAHL, EMBASE, and reference lists of included articles, in June 2016. We included all types of peer-reviewed designs on the five topics. Couples of two independent reviewers performed the selection process, the quality assessment, and data extraction. We included 67 studies with low to moderate quality. Non-conveyance rates for general patient populations ranged from 3.7%-93.7%. Non-conveyed patients have a variety of initial complaints, common initial complaints are related to trauma and neurology. Furthermore, vulnerable patients groups as children and elderly are more represented in the non-conveyance population. Within 24 h-48 h after non-conveyance, 2.5%-6.1% of the patients have EMS representations, and 4.6-19.0% present themselves at the ED. Mortality rates vary from 0.2%-3.5% after 24 h, up to 0.3%-6.1% after 72 h. Criteria to guide non-conveyance decisions are vital signs, ingestion of drugs/alcohol, and level of consciousness. A limited amount of non-conveyance guidelines or protocols is available for general and specific patient populations. Factors influencing the non-conveyance decision are related to the professional (competencies, experience, intuition), the patient (health status, refusal, wishes and best interest), the healthcare system (access to general practitioner/other healthcare facilities/patient information), and supportive tools (online medical control, high risk card). Non-conveyance rates for general and specific patient populations vary. Patients in the non

  13. Ambient particulate matter, landscape fire smoke, and emergency ambulance dispatches in Sydney, Australia.

    Science.gov (United States)

    Salimi, Farhad; Henderson, Sarah B; Morgan, Geoffrey G; Jalaludin, Bin; Johnston, Fay H

    2017-02-01

    Emergency ambulance dispatches (EAD) are a novel outcome for evaluating the public health impacts of air pollution. We assessed the relationships between ambient particulate matter (PM) from all sources, PM from landscape fire smoke (LFS), and EADs likely to be associated with cardiorespiratory problems in the Sydney greater metropolitan region for an 11-year period from 2004 to 2015. EAD codes are assigned at the time of the call to emergency services using standard computer assisted algorithms. We assessed EADs coded as: breathing problems, chest pain, stroke or cerebrovascular accident (stroke), cardiac or respiratory arrest and death (arrest), and heart or defibrillator problems (other heart problems). Using a daily times series study design with a generalized linear Poisson regression model we quantified the association between EAD and daily PM2.5 from all sources (PM2.5,all) and PM2.5 primarily due to LFS (PM2.5,LFS). Increases of 10μg·m-3 in PM2.5,all were positively associated with same day EAD for breathing problems (RR=1.03, 95% CI 1.02 to 1.04), arrest (RR=1.03, 95% CI 1.00 to 1.06), and chest pain (RR=1.01 CI 1.00 to 1.02) but not with other outcomes. Increases of 10μg·m-3 PM2.5,LFS were also positively associated with breathing problems on the same day (RR=1.04, 95% CI 1.02 to 1.05) and other heart problems at lag of two days (RR=1.05, 95% CI 1.01 to 1.09). Emergency dispatches for breathing problems are associated with PM2.5,all and PM2.5,LFS and provide a sensitive end point for continued research and surveillance activities investigating the impacts of daily fluctuations in ambient PM2.5. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Otimização da localização das bases de ambulâncias e do dimensionamento das suas regiões de cobertura em rodovias Optimizing the location of ambulance bases and the districting of their covering regions on highways

    Directory of Open Access Journals (Sweden)

    Ana Paula Iannoni

    2008-01-01

    Full Text Available Neste artigo combinamos extensões do modelo hipercubo de filas com algoritmos genéticos para otimizar a configuração e operação de sistemas médicos emergenciais em rodovias. Inicialmente apresentamos um método para localizar as bases de ambulâncias ao longo da rodovia, de forma a otimizar as principais medidas de desempenho do sistema. Em seguida estendemos a abordagem para apoiar duas decisões combinadas: a localização das bases de ambulâncias e o dimensionamento das regiões de cobertura de cada base na rodovia. Por exemplo, a abordagem permite determinar os locais para posicionar as bases de ambulâncias e dimensionar os tamanhos das suas áreas de atuação, tais que minimizem o tempo médio de resposta aos usuários e/ou o desbalanceamento das cargas de trabalho das ambulâncias do sistema. Para ilustrar a aplicação dos métodos propostos, analisamos os resultados de dois estudos de caso em rodovias brasileiras.In this paper we combine extensions of the hypercube queueing model with genetic algorithms to optimize the configuration and operation of emergency medical systems on highways. Initially we present a method to locate the ambulance bases along the highway so that the main system performance measures are optimized. Then we extend the approach to support combined decisions: the location of ambulance bases and the districting of the covering regions of each base on the highway. For instance, the approach can search for locals to place the ambulance bases and determine the sizes of their operation areas, such that the mean user response time and/or the ambulance workload imbalance are minimized. To illustrate the application of the proposed methods, we analyze the results of two case studies of Brazilian highways.

  15. Case Studies of Technology-aided Interventions to Promote Hand Reaching and Standing or Basic Ambulation in Persons with Multiple Disabilities.

    Science.gov (United States)

    Lancioni, Giulio E; Singh, Nirbhay N; O'Reilly, Mark F; Sigafoos, Jeff; Alberti, Gloria; Campodonico, Francesca

    2016-02-01

    Motor impairments such as lack of standing and/or independent ambulation are common among persons with multiple disabilities. These two studies assessed technology-aided programs for persons with those impairments. Specifically, Study I assessed a program to teach two non-ambulatory adults to hand reach a stimulation-linked object by standing up. Study II assessed a program to teach a child and a man to ambulate while holding a rail or following a corridor wall. Standing increased from below 15% to about or over 80% of the session duration in Study I. The participants of Study II managed to complete brief ambulation trials independent of guidance. These performance achievements were discussed in relation to the technology-aided programs employed in the studies and the programs' applicability in daily contexts. © The Author(s) 2016.

  16. Delaying Ambulation Mode Transition Decisions Improves Accuracy of a Flexible Control System for Powered Knee-Ankle Prosthesis.

    Science.gov (United States)

    Simon, Ann M; Ingraham, Kimberly A; Spanias, John A; Young, Aaron J; Finucane, Suzanne B; Halsne, Elizabeth G; Hargrove, Levi J

    2017-08-01

    Powered lower limb prostheses can assist users in a variety of ambulation modes by providing knee and/or ankle joint power. This study's goal was to develop a flexible control system to allow users to perform a variety of tasks in a natural, accurate, and reliable way. Six transfemoral amputees used a powered knee-ankle prosthesis to ascend/descend a ramp, climb a 3- and 4-step staircase, perform walking and standing transitions to and from the staircase, and ambulate at various speeds. A mode-specific classification architecture was developed to allow seamless transitions at four discrete gait events. Prosthesis mode transitions (i.e., the prosthesis' mechanical response) were delayed by 90 ms. Overall, users were not affected by this small delay. Offline classification results demonstrate significantly reduced error rates with the delayed system compared to the non-delayed system (p system and 0.43% [0.23%] for the delayed system. The average error rate for all toe off decisions was 0.47% [0.16%] for the non-delayed system and 0.13% [0.05%] for the delayed system. The results are encouraging and provide another step towards a clinically viable intent recognition system for a powered knee-ankle prosthesis.

  17. Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center

    Directory of Open Access Journals (Sweden)

    Jorge Luis Alvarado-Socarras

    2016-06-01

    Full Text Available Abstract Objective: To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Methods: Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS, and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. Results: A total of 176 neonates were transported by ambulance (10.22% by air over six months. The transport distances were longer by air (median: 237.5 km than by ground (median: 11.3 km. Mortality was higher among neonates transported by air (33.33% than by ground (7.79%. No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Conclusions: Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation to obtain good clinical outcomes according type of ambulance.

  18. Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

    Science.gov (United States)

    Schwab, Joseph H.; Gasbarrini, Alessandro; Cappuccio, Michele; Boriani, Luca; De Iure, Federico; Colangeli, Simone; Boriani, Stefano

    2011-01-01

    Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29%) patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (P = 0.01). The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (P = 0.001). Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series. PMID:22312498

  19. Living in critical times: The impact of critical incidents on frontline ambulance personnel--a qualitative perspective.

    LENUS (Irish Health Repository)

    Gallagher, Sharon

    2007-01-01

    Little is known about the impact of Critical Incidents (CIs) on the lives of ambulance personnel. One-to-one interviews were conducted with 27 participants who had experienced CIs during the previous 12 months in order to: assess the nature and impact of CIs on health and well-being; examine attitudes toward support services; and explore barriers to service use. The results showed that incidents involving children, suicides, and grotesque mutilation were the most distressing. Participants reported a wide range of physical and mental health problems including sleep difficulties, angry outbursts, irrationality and feelings of alienation. Key themes included: low support service uptake due to fears relating to confidentiality and machismo; a perceived lack of concern and support from management; and a need for professional counselling and stress awareness training. Emergency Medical Controllers (EMCs) also reported a number of difficulties unique to their role. The findings suggest that exposure to CIs has a significant impact on health and well-being; this has important implications for recognizing and appropriately addressing the health and training needs of ambulance personnel, including the effective management of Critical Incident Stress.

  20. Reduction in Fatalities, Ambulance Calls, and Hospital Admissions for Road Trauma After Implementation of New Traffic Laws

    Science.gov (United States)

    Chan, Herbert; Brasher, Penelope; Erdelyi, Shannon; Desapriya, Edi; Asbridge, Mark; Purssell, Roy; Macdonald, Scott; Schuurman, Nadine; Pike, Ian

    2014-01-01

    Objectives. We evaluated the public health benefits of traffic laws targeting speeding and drunk drivers (British Columbia, Canada, September 2010). Methods. We studied fatal crashes and ambulance dispatches and hospital admissions for road trauma, using interrupted time series with multiple nonequivalent comparison series. We determined estimates of effect using linear regression models incorporating an autoregressive integrated moving average error term. We used neighboring jurisdictions (Alberta, Saskatchewan, Washington State) as external controls. Results. In the 2 years after implementation of the new laws, significant decreases occurred in fatal crashes (21.0%; 95% confidence interval [CI] = 15.3, 26.4) and in hospital admissions (8.0%; 95% CI = 0.6, 14.9) and ambulance calls (7.2%; 95% CI = 1.1, 13.0) for road trauma. We found a very large reduction in alcohol-related fatal crashes (52.0%; 95% CI = 34.5, 69.5), and the benefits of the new laws are likely primarily the result of a reduction in drinking and driving. Conclusions. These findings suggest that laws calling for immediate sanctions for dangerous drivers can reduce road trauma and should be supported. PMID:25121822

  1. Minimally Invasive Posterior Stabilization Improved Ambulation and Pain Scores in Patients with Plasmacytomas and/or Metastases of the Spine

    Directory of Open Access Journals (Sweden)

    Joseph H. Schwab

    2011-01-01

    Full Text Available Background. The incidence of spine metastasis is expected to increase as the population ages, and so is the number of palliative spinal procedures. Minimally invasive procedures are attractive options in that they offer the theoretical advantage of less morbidity. Purpose. The purpose of our study was to evaluate whether minimally invasive posterior spinal instrumentation provided significant pain relief and improved function. Study Design. We compared pre- and postoperative pain scores as well as ambulatory status in a population of patients suffering from oncologic conditions in the spine. Patient Sample. A consecutive series of patients with spine tumors treated minimally invasively with stabilization were reviewed. Outcome Measures. Visual analog pain scale as well as pre- and postoperative ambulatory status were used as outcome measures. Methods. Twenty-four patients who underwent minimally invasive posterior spinal instrumentation for metastasis were retrospectively reviewed. Results. Seven (29% patients were unable to ambulate secondary to pain and instability prior to surgery. All patients were ambulating within 2 to 3 days after having surgery (=0.01. The mean visual analog scale value for the preoperative patients was 2.8, and the mean postoperative value was 1.0 (=0.001. Conclusion. Minimally invasive posterior spinal instrumentation significantly improved pain and ambulatory status in this series.

  2. Time is money, but how much? The monetary value of response time for Thai ambulance emergency services.

    Science.gov (United States)

    Jaldell, Henrik; Lebnak, Prachaksvich; Amornpetchsathaporn, Anurak

    2014-07-01

    To calculate the monetary value of the time factor per minute and per year for emergency services. The monetary values for ambulance emergency services were calculated for two different time factors, response time, which is the time from when a call is received by the emergency medical service call-taking center until the response team arrives at the emergency scene, and operational time, which includes the time to the hospital. The study was performed in two steps. First, marginal effects of reduced fatalities and injuries for a 1-minute change in the time factors were calculated. Second, the marginal effects and the monetary values were put together to find a value per minute. The values were found to be 5.5 million Thai bath/min for fatality and 326,000 baht/min for severe injury. The total monetary value for a 1-minute improvement for each dispatch, summarized over 1 year, was 1.6 billion Thai baht using response time. The calculated values could be used in a cost-benefit analysis of an investment reducing the response time. The results from similar studies could for example be compared to the cost of moving an ambulance station or investing in a new alarm system. Copyright © 2014 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  3. Integration between the tele-cardiology unit and the central laboratory: methodological and clinical evaluation of point-of-care testing cardiac marker in the ambulance.

    Science.gov (United States)

    Di Serio, Francesca; Lovero, Roberto; Leone, Massimo; De Sario, Rosalia; Ruggieri, Vincenzo; Varraso, Lucia; Pansini, Nicola

    2006-01-01

    The aim of this study was to identify patients with myocardial necrosis in pre-hospital phase during transport by ambulance, without ST-segment elevation (NSTE) on the ambulance ECG. The analytical performance of the i-STAT troponin I (cTnI) method was assessed. A total of 53 NSTE ambulance ECG patients admitted to hospital were followed. The ambulance had experimental software able to receive data from the i-STAT device and transmit it to a protected address and server. cTnI mean values from 2.0 to 34 microg/L showed a total CV of 3.0-5.6%. The detection limit was 0.016 microg/L. A mean cTnI concentration of 0.09 microg/L was associated with a CV of 8.0% (decision limit). The i-STAT cTnI method was linear for concentrations from 0 to 35 microg/L. There was no effect (p0.09 microg/L in 20 AMI patients (91%). The median ambulance turnaround time (TAT) was 12 min and median hospital TAT was 40 min, a difference of 28 min. The high sensitivity of the i-STAT cTnI method integrated with tele-medicine procedures could play an important role in the management of acute coronary syndrome patients related to the pre-hospital phase (early diagnosis and treatment in the ambulance). These approaches may allow improvements in patient outcomes and continuous monitoring of the POCT network in the central laboratory, thus meeting quality requirements.

  4. The Use of Emergency Lights and Sirens by Ambulances and Their Effect on Patient Outcomes and Public Safety: A Comprehensive Review of the Literature.

    Science.gov (United States)

    Murray, Brett; Kue, Ricky

    2017-04-01

    The benefits of emergency lights and sirens (L&S) use as warning devices by ambulances continue to be a debated topic in Emergency Medical Services (EMS). While the most widely studied aspect of L&S use has been related to their effect on ambulance response and transport times, the literature suggests minimal time savings with more questionable impact on actual patient outcomes. As L&S use has been shown to increase the risk for vehicle crashes, the secondary concern of ambulance design and safety also becomes an important aspect on potential design recommendations that could mitigate the effects of a crash on patients, EMS providers, and the general public. The least studied aspect of L&S use (and probably the most important) is their effect on patient outcomes and quality of medical care during transport. The current evidence suggests no significant improvement on patient outcomes and potential worsening to certain aspects of patient care during transport. The purpose of this review was to examine the current literature regarding ambulance L&S use and the risks they pose to EMS providers, patients, and the general public. In doing so, it will provide sound background for EMS leaders to better develop policies governing the use of L&S by ambulances and promote better research in the patient outcomes effect associated with their use. This review offers some strategies in mitigating the risks associated with L&S use, such as ways to reduce their overall use and modifying other related factors to emergency medical vehicle collisions (EMVCs). Murray B , Kue R . The use of emergency lights and sirens by ambulances and their effect on patient outcomes and public safety: a comprehensive review of the literature. Prehosp Disaster Med. 2017;32(2):209-216.

  5. Transporte de crianças em ambulâncias terrestres: segurança e conhecimentos dos profissionais

    Directory of Open Access Journals (Sweden)

    Sílvia Faria

    2017-01-01

    Full Text Available Introdução: O transporte de crianças em ambulâncias terrestres é uma problemática ainda insuficientemente investigada em todo o mundo. Neste contexto pretende-se conhecer as medidas de segurança usadas no transporte de crianças em ambulâncias terrestres e identificar o conhecimento dos profissionais acerca das medidas a adotar para este tipo de transporte. Materiais e Métodos: Estudo quantitativo, exploratório descritivo. A análise das medidas de segurança usadas no transporte de crianças tem por base as recomendações da National Highway Traffic Safety Administration. Aplicado um questionário a 135 enfermeiros e bombeiros/tripulantes de ambulâncias portuguesas baseado em 4 possíveis situações de transporte e abrangendo 5 faixas etárias pediátricas. Resultados: Os profissionais adotam uma grande variedade de medidas de segurança na prática havendo uma diferença significativa entre a forma como transportam as crianças e o modo que consideram ser o ideal. Os resultados da avaliação do transporte situam-se mais próximos dos níveis de segurança aceitáveis do que dos níveis recomendados como ideais. Verifica-se que mulheres, profissionais graduados e enfermeiros de pediatria transportam as crianças em ambulâncias com mais segurança. Discussão e Conclusões: Muitos profissionais desconhecem as possibilidades de transporte seguro para as crianças nem conhecem recomendações para este tipo de transporte. A dispersão apurada na forma como o transporte é efetuado e os resultados obtidos sugerem a necessidade de regulamentação deste transporte, de investimento na formação dos profissionais e de sensibilização das instituições de saúde para a importância do uso de sistemas de retenção para crianças durante o seu transporte. Cómo citar este artículo: Faria S, Lomba L, Carvalhais M, Apóstolo J. Transporte de crianças em ambulâncias terrestres: segurança e conhecimentos dos profissionais. Rev Cuid

  6. Sagittal Subtalar and Talocrural Joint Assessment During Ambulation With Controlled Ankle Movement (CAM) Boots.

    Science.gov (United States)

    McHenry, Benjamin D; Exten, Emily L; Cross, Janelle A; Kruger, Karen M; Law, Brian; Fritz, Jessica M; Harris, Gerald

    2017-11-01

    The purpose of the current study was to determine sagittal plane talocrural and subtalar kinematic differences between barefoot and controlled ankle movement (CAM) boot walking. This study used fluoroscopic images to determine talar motion relative to tibia and calcaneal motion relative to talus. Fourteen male subjects (mean age 24.1 ± 3.5 years) screened for normal gait were tested. A fluoroscopy unit was used to collect images at 200 Hz during stance. Sagittal motion of the talocrural and subtalar joints were analyzed barefoot and within short and tall CAM boots. Barefoot talocrural mean maximum plantar and dorsiflexion were 9.2 ± 5.4 degrees and -7.5 ± 7.4 degrees, respectively; short CAM boot mean maximum plantar and dorsiflexion were 3.2 ± 4.0 degrees and -4.8 ± 10.2 degrees, respectively; and tall CAM boot mean maximum plantar and dorsiflexion were -0.2 ± 3.5 degrees and -2.4 ± 5.1 degrees, respectively. Talocrural mean range of motion (ROM) decreased from barefoot (16.7 ± 5.1 degrees) to short CAM boot (8.0 ± 4.9 degrees) to tall CAM boot (2.2 ± 2.5 degrees). Subtalar mean maximum plantarflexion angles were 5.3 ± 5.6 degrees for barefoot walking, 4.1 ± 5.9 degrees for short CAM boot walking, and 3.0 ± 4.7 degrees for tall CAM boot walking. Mean minimum subtalar plantarflexion angles were 0.7 ± 3.2 degrees for barefoot walking, 0.7 ± 2.9 degrees for short CAM boot walking, and 0.1 ± 4.8 degrees for tall CAM boot walking. Subtalar mean ROM decreased from barefoot (4.6 ± 3.9 degrees) to short CAM boot (3.4 ± 3.8 degrees) to tall CAM boot (2.9 ± 2.6 degrees). Tall and short CAM boot intervention was shown to limit both talocrural and subtalar motion in the sagittal plane during ambulation. The greatest reductions were seen with the tall CAM boot, which limited talocrural motion by 86.8% and subtalar motion by 37.0% compared to barefoot. Short CAM boot intervention reduced talocrural motion by 52.1% and subtalar motion by 26.1% compared to

  7. Air Ambulance Delivery and Administration of Four-factor Prothrombin Complex Concentrate Is Feasible and Decreases Time to Anticoagulation Reversal.

    Science.gov (United States)

    Vines, Claire; Tesseneer, Stephanie J; Cox, Robert D; Darsey, Damon A; Carbrey, Kristin; Puskarich, Michael A

    2017-10-27

    The objective was to evaluate the feasibility, safety, and preliminary efficacy of four-factor prothrombin complex concentrate (4-factor PCC) administration by an air ambulance service prior to or during transfer of patients with warfarin-associated major hemorrhage to a tertiary care center for definitive management (interventional arm) compared to patients receiving 4-factor PCC following transfer by air ambulance or ground without 4-factor PCC treatment (conventional arm). This was a retrospective chart review of patients presenting to a large academic medical center. All patients presenting to the emergency department (ED) treated with 4-factor PCC from April 1, 2014, through June 30, 2016, were identified. For this study, only transfer patients with an International Normalized Ratio (INR) > 1.5 actively treated with warfarin were included. The primary outcome was the proportion of patients with an INR ≤ 1.5 upon tertiary care hospital arrival, and the secondary efficacy outcome was difference in time to achievement of INR ≤ 1.5. Additional safety and efficacy objectives included difference in thromboembolic complications, length of stay, intensive care unit length of stay, and inpatient mortality between groups. Of the 72 included patients, a higher proportion of patients in the interventional group had an INR ≤ 1.5 on ED arrival (proportion difference = 0.82, 95% confidence interval = 0.64-0.92, p < 0.0001) and significantly reduced time to observed INR ≤ 1.5 (181 minutes vs. 541 minutes, p = 0.001). No differences were observed in thromboembolic complications or patient-centered outcomes with the exception of mortality, which was significantly higher in patients in the interventional group. This group was also observed to have lower Glasgow Coma Scale score and higher intubation rates prior to transfer and treatment. Dispatch of an air ambulance carrying 4-factor PCC with administration prior to transfer is feasible and leads to more rapid

  8. Long-term effect of selective dorsal rhizotomy on gross motor function in ambulant children with spastic bilateral cerebral palsy, compared with reference centiles

    NARCIS (Netherlands)

    Bolster, E.A.M.; van Schie, P.E.M.; Becher, J.G.; van Ouwerkerk, W.J.R.; Strijers, R.L.M.; Vermeulen, R.J.

    2013-01-01

    Aim: The aim of this study was to evaluate the long-term effect of selective dorsal rhizotomy (SDR) on the gross motor function of ambulant children with spastic bilateral cerebral palsy (CP), compared with reference centiles. Method: The study used a prospective cohort design and participants

  9. The Effect of Early Ambulation of Patients on Bleeding and Hematom Via the Femoral Artery in Post Angiography Ward in Ayatollah Moosavy Hospital(Zanjan 2011

    Directory of Open Access Journals (Sweden)

    J Naserian

    2012-05-01

    Full Text Available Introduction: Coronary angiography is frequently applied for diagnostic purposes in patient with coronary artery disease. There is no consensus about the optimal time for the ambulation on patients following femoral arterial puncture. This study intended to investigate the differences between 6 hours of complete bed rest and 2 hours of complete bed rest for the patients after angiography. Methods: This clinical trial study was performed in 100 patients candidated for coronary angiography. The patients were randomly divided in to experimental and control groups. Primarily, demographic data was filled, and then intervention was done for two groups. The arterial sheath was immediately removed after the procedure. Hemostasis was achieved by manual compression and maintained with sandbags. Early ambulation was performed after two hours of supine bed rest following sheath removal. The incidence of bleeding and hematoma was documented in 24 hours after the procedure. Results: Our findings were indicative of no significant differences between the two groups in terms of gender, age, body mass index, catheter size, total procedure duration, total hemostasis time, history of anticoagulant drag use and coagulation tests before angiography. Conclusion: Ambulation of 2 hours after angiography via the femoral artery is as feasible and safe as that of 6 hours of bed rest. Therefore, an early ambulation protocol can shorten hospital stay without significant vascular complication.

  10. Effects of Ambulant Myofeedback Training and Ergonomic Counselling in Female Computer Workers with Work-Related Neck-Shoulder Complaints: A Randomized Controlled Trial

    NARCIS (Netherlands)

    Voerman, Gerlienke; Sandsjö, Leif; Vollenbroek-Hutten, Miriam Marie Rosé; Larsman, Pernilla; Kadefors, Roland; Hermens, Hermanus J.

    Objective: To investigate the effects of ambulant myofeedback training including ergonomic counselling (Mfb) and ergonomic counselling alone (EC), on work-related neck-shoulder pain and disability. Methods: Seventy-nine female computer workers reporting neck-shoulder complaints were randomly

  11. Assessment of consent models as an ethical consideration in the conduct of prehospital ambulance randomised controlled clinical trials: a systematic review

    Directory of Open Access Journals (Sweden)

    Stephanie Armstrong

    2017-09-01

    Full Text Available Abstract Background We sought to understand the main ethical considerations when conducting clinical trials in the prehospital ambulance based setting. Methods A systematic review of the literature on randomised controlled trials in ambulance settings was undertaken. A search of eight databases identified published studies involving recruitment of ambulance service users. Four independent authors undertook abstract and full-text reviews to determine eligibility and extract relevant data. The data extraction concentrated on ethical considerations, with any discussion of ethics being included for further analysis. The resultant data were combined to form a narrative synthesis. Results In all, 56 papers were identified as meeting the inclusion criteria. Issues relating to consent were the most significant theme identified. Type of consent differed depending on the condition or intervention being studied. The country in which the research took place did not appear to influence the type of consent, apart from the USA where exception from consent appeared to be most commonly used. A wide range of terms were used to describe consent. Conclusions Consent was the main ethical consideration in published ambulance based research. A range of consent models were used ranging from informed consent to exception from consent (waiver of consent. Many studies cited international guidelines as informing their choice of consent model but diverse and sometimes confused terms were used to describe these models. This suggests that standardisation of consent models and the terminology used to describe them is warranted.

  12. A microswitch-based program for promoting initial ambulation responses: An evaluation with two girls with multiple disabilities.

    Science.gov (United States)

    Stasolla, Fabrizio; Caffò, Alessandro O; Perilli, Viviana; Boccasini, Adele; Stella, Anna; Damiani, Rita; Albano, Vincenza; Damato, Concetta

    2017-04-01

    We assessed the use of a microswitch-based program for promoting ambulation responses by two children with multiple disabilities. The goals of the study were to: (a) evaluate the importance of the contingency between the target behavior (forward step) and the programmed consequence (preferred stimuli), (b) measure effects of the intervention on indices of happiness, and (c) assess the social validation of the procedure using 20 physiotherapists as external raters. The intervention involved the automatic delivery of preferred stimuli contingent on forward steps. Results showed that both participants improved their performance (forward steps and indices of happiness) during contingent reinforcement phases compared to baseline and noncontingent reinforcement phases. Moreover, physiotherapists rated the intervention as socially valid. © 2017 Society for the Experimental Analysis of Behavior.

  13. Prognostic Factors Associated with Recovery of Ambulation and Urinary Continence in Dogs with Acute Lumbosacral Spinal Cord Injury.

    Science.gov (United States)

    Shaw, T A; De Risio, L; Laws, E J; Rose, J H; Harcourt-Brown, T R; Granger, N

    2017-05-01

    Limited information is available about prognostic factors for recovery after spinal cord injury (SCI) to the L4-S3 segments. Previous research suggests that L4-S3 SCI does not have a worse prognosis than T3-L3 SCI. To elucidate prognostic factors for regaining urinary continence and ambulation in dogs with L4-S3 SCI and compare prognosis to T3-L3 SCI. A retrospective study on 61 nonambulatory dogs with L4-S3 SCI, matched to dogs with T3-L3 SCI, compared 3 weeks after onset. Prognostic factors explored using logistic regression and used for matching: nonchondrodystrophic dogs >15 kg versus dogs that were chondrodystrophic or dogs regained continence compared to T3-L3 dogs (64 vs 85%, P = .0033), but no difference existed for regaining ambulation (66 vs 75%, P = .1306). In L4-S3 SCI dogs, fewer dogs regained continence with loss of CPP (P Dogs with L4-S3 SCI have a poorer short-term prognosis than do dogs with T3-L3 SCI. Dogs with L4-S3 SCI had a poor prognosis with loss of CPP, or noncompressive lesions combined with LMN incontinence. Small-breed or chondrodystrophic dogs with retained CPP, compressive lesions, and UMN incontinence had an excellent prognosis. These findings may help guide decision-making in L4-S3 SCI. Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

  14. A atividade de trabalho de motoristas de ambulância sob o ponto de vista ergológico

    Directory of Open Access Journals (Sweden)

    Francinaldo do Monte Pinto

    Full Text Available Objetivo: analisar a atividade dos motoristas de ambulância do Serviço Móvel de Urgência (SAMU. Métodos: foi empregada a perspectiva ergológica, que se opera a partir da concepção de vida-saúde-doença postulada por George Canguilhem, e a Ergonomia da Atividade. Foram realizadas onze entrevistas dialógicas com motoristas da Unidade de Terapia Intensiva Móvel, em 2010, no estado da Paraíba. Resultados: os motoristas atribuem as principais dificuldades para realizar o trabalho ao modo de organização prescrita do trabalho no SAMU, à gestão temporal da atividade, à atividade no trânsito, à relação com a população usuária e ao risco de contrair doenças. Em contraposição, os motoristas adquirem sentido no trabalho ao salvarem vidas, em uma conjunção de valores – solidariedade, confiança e cooperação – em relação aos socorridos e aos seus acompanhantes. Quando essa possibilidade não se concretiza, o coletivo de trabalho serve de apoio para que permaneçam na profissão, apesar das frustrações. Conclusão: evidenciou-se que, mesmo diante das variabilidades cotidianas da atividade de trabalho, os motoristas de ambulâncias produzem modos operatórios para dar conta das situações de trabalho, cooperando para solução dos problemas e/ou manejando as imprevisibilidades no trabalho em equipe.

  15. Mechanical CPR devices compared to manual CPR during out-of-hospital cardiac arrest and ambulance transport: a systematic review

    Science.gov (United States)

    2012-01-01

    Aims The aim of this paper was to conduct a systematic review of the published literature to address the question: “In pre-hospital adult cardiac arrest (asystole, pulseless electrical activity, pulseless Ventricular Tachycardia and Ventricular Fibrillation), does the use of mechanical Cardio-Pulmonary Resuscitation (CPR) devices compared to manual CPR during Out-of-Hospital Cardiac Arrest and ambulance transport, improve outcomes (e.g. Quality of CPR, Return Of Spontaneous Circulation, Survival)”. Methods Databases including PubMed, Cochrane Library (including Cochrane database for systematic reviews and Cochrane Central Register of Controlled Trials), Embase, and AHA EndNote Master Library were systematically searched. Further references were gathered from cross-references from articles and reviews as well as forward search using SCOPUS and Google scholar. The inclusion criteria for this review included manikin and human studies of adult cardiac arrest and anti-arrhythmic agents, peer-review. Excluded were review articles, case series and case reports. Results Out of 88 articles identified, only 10 studies met the inclusion criteria for further review. Of these 10 articles, 1 was Level of Evidence (LOE) 1, 4 LOE 2, 3 LOE 3, 0 LOE 4, 2 LOE 5. 4 studies evaluated the quality of CPR in terms of compression adequacy while the remaining six studies evaluated on clinical outcomes in terms of return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and Cerebral Performance Categories (CPC). 7 studies were supporting the clinical question, 1 neutral and 2 opposing. Conclusion In this review, we found insufficient evidence to support or refute the use of mechanical CPR devices in settings of out-of-hospital cardiac arrest and during ambulance transport. While there is some low quality evidence suggesting that mechanical CPR can improve consistency and reduce interruptions in chest compressions, there is no evidence that

  16. Combining afferent stimulation and mirror therapy for rehabilitating motor function, motor control, ambulation, and daily functions after stroke.

    Science.gov (United States)

    Lin, Keh-chung; Huang, Pai-chuan; Chen, Yu-ting; Wu, Ching-yi; Huang, Wen-ling

    2014-02-01

    Mirror therapy (MT) and mesh glove (MG) afferent stimulation may be effective in reducing motor impairment after stroke. A hybrid intervention of MT combined with MG (MT + MG) may broaden aspects of treatment benefits. To demonstrate the comparative effects of MG + MT, MT, and a control treatment (CT) on the outcomes of motor impairments, manual dexterity, ambulation function, motor control, and daily function. Forty-three chronic stroke patients with mild to moderate upper extremity impairment were randomly assigned to receive MT + MG, MT, or CT for 1.5 hours/day, 5 days/week for 4 weeks. Outcome measures were the Fugl-Meyer Assessment (FMA) and muscle tone measured by Myoton-3 for motor impairment and the Box and Block Test (BBT) and 10-Meter Walk Test (10 MWT) for motor function. Secondary outcomes included kinematic parameters for motor control and the Motor Activity Log and ABILHAND Questionnaire for daily function. FMA total scores were significantly higher and synergistic shoulder abduction during reach was less in the MT + MG and MT groups compared with the CT group. Performance on the BBT and the 10 MWT (velocity and stride length in self-paced task and velocity in as-quickly-as-possible task) were improved after MT + MG compared with MT. MT + MG improved manual dexterity and ambulation. MT + MG and MT reduced motor impairment and synergistic shoulder abduction more than CT. Future studies may integrate functional task practice into treatments to enhance functional outcomes in patients with various levels of motor severity. The long-term effects of MG + MT remain to be evaluated.

  17. Hospital survival upon discharge of ill-neonates transported by ground or air ambulance to a tertiary center.

    Science.gov (United States)

    Alvarado-Socarras, Jorge Luis; Idrovo, Alvaro Javier; Bermon, Anderson

    2016-01-01

    To evaluate the differences in hospital survival between modes of transport to a tertiary center in Colombia for critically ill neonates. Observational study of seriously ill neonates transported via air or ground, who required medical care at a center providing highly complex services. Data on sociodemographic, clinical, the Transport Risk Index of Physiologic Stability (TRIPS), and mode of transport were collected. Patients were described, followed by a bivariate analysis with condition (live or dead) at time of discharge as the dependent variable. A multiple Poisson regression with robust variance model was used to adjust associations. A total of 176 neonates were transported by ambulance (10.22% by air) over six months. The transport distances were longer by air (median: 237.5km) than by ground (median: 11.3km). Mortality was higher among neonates transported by air (33.33%) than by ground (7.79%). No differences in survival were found between the two groups when adjusted by the multiple model. An interaction between mode of transport and distance was observed. Live hospital discharge was found to be associated with clinical severity upon admittance, birth weight, hemorrhaging during the third trimester, and serum potassium levels when admitted. Mode of transport was not associated with the outcome. In Colombia, access to medical services through air transport is a good option for neonates in critical condition. Further studies would determine the optimum distance (time of transportation) to obtain good clinical outcomes according type of ambulance. Copyright © 2016 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. All rights reserved.

  18. The impact of fatigue on the non-technical skills performance of critical care air ambulance clinicians.

    Science.gov (United States)

    Myers, J A; Powell, D M C; Aldington, S; Sim, D; Psirides, A; Hathaway, K; Haney, M F

    2017-11-01

    The relationship between fatigue-related risk and impaired clinical performance is not entirely clear. Non-technical factors represent an important component of clinical performance and may be sensitive to the effects of fatigue. The hypothesis was that the sum score of overall non-technical performance is degraded by fatigue. Nineteen physicians undertook two different simulated air ambulance missions, once when rested, and once when fatigued (randomised crossover design). Trained assessors blinded to participants' fatigue status performed detailed structured assessments based on expected behaviours in four non-technical skills domains: teamwork, situational awareness, task management, and decision making. Participants also provided self-ratings of their performance. The primary endpoint was the sum score of overall non-technical performance. The main finding, the overall non-technical skills performance rating of the clinicians, was better in rested than fatigued states (mean difference with 95% CI, 2.8 [2.2-3.4]). The findings remained consistent across individual non-technical skills domains; also when controlling for an order effect and examining the impact of a number of possible covariates. There was no difference in self-ratings of clinical performance between rested and fatigued states. Non-technical performance of critical care air transfer clinicians is degraded when they are fatigued. Fatigued clinicians may fail to recognise the degree to which their performance is compromised. These findings represent risk to clinical care quality and patient safety in the dynamic and isolated environment of air ambulance transfer. © 2017 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd.

  19. Safety first. Yes, but which safety?; Primat der Sicherheit. Ja, aber welche Sicherheit ist gemeint?

    Energy Technology Data Exchange (ETDEWEB)

    Roehlig, Klaus-Juergen [Technische Univ. Clausthal, Clausthal-Zellerfeld (Germany). Inst. fuer Endlagerforschung; Eckhardt, Anne [risicare GmbH, Zollikerberg (Switzerland)

    2017-09-01

    The site selection law in Germany and the final report of the final repository commission state the central objective to find a repository site that will guarantee safety for the next million of years. Decision makers, concerned and interested people have obviously different opinions and acceptance criteria with respect to the tools for the demonstration of safety (safety case). Possible solutions for a broad acceptance of safety definitions are discussed.

  20. Effects of a Public Education Campaign on the Association Between Knowledge of Early Stroke Symptoms and Intention to Call an Ambulance at Stroke Onset: The Acquisition of Stroke Knowledge (ASK) Study.

    Science.gov (United States)

    Nishikawa, Tomofumi; Okamura, Tomonori; Nakayama, Hirofumi; Miyamatsu, Naomi; Morimoto, Akiko; Toyoda, Kazunori; Suzuki, Kazuo; Toyota, Akihiro; Hata, Takashi; Yamaguchi, Takenori

    2016-01-01

    An immediate ambulance call offers the greatest opportunity for acute stroke therapy. Effectively using ambulance services requires strengthening the association between knowledge of early stroke symptoms and intention to call an ambulance at stroke onset, and encouraging the public to use ambulance services. The present study utilized data from the Acquisition of Stroke Knowledge (ASK) study, which administered multiple-choice, mail-in surveys regarding awareness of early stroke symptoms and response to a stroke attack before and after a 2-year stroke education campaign in two areas subject to intensive and moderate intervention, as well as in a control area, in Japan. In these three areas, 3833 individuals (1680, 1088 and 1065 participants in intensive intervention, moderate intervention, and control areas, respectively), aged 40 to 74 years, who responded appropriately to each survey were included in the present study. After the intervention, the number of correctly identified symptoms significantly associated with intention to call an ambulance (P symptoms), without increasing choice of decoy symptoms in the intensive intervention area. Meanwhile, in other areas, rate of identification of not only correct symptoms but also decoy symptoms associated with intention to call an ambulance increased. Furthermore, the association between improvement in the knowledge of stroke symptoms and intention to call an ambulance was observed only in the intensive intervention area (P = 0.009). Our results indicate that intensive interventions are useful for strengthening the association between correct knowledge of early stroke symptoms and intention to call an ambulance, without strengthening the association between incorrect knowledge and intention to call an ambulance.

  1. Non-technical skills evaluation in the critical care air ambulance environment: introduction of an adapted rating instrument--an observational study.

    Science.gov (United States)

    Myers, Julia A; Powell, David M C; Psirides, Alex; Hathaway, Karyn; Aldington, Sarah; Haney, Michael F

    2016-03-08

    In the isolated and dynamic health-care setting of critical care air ambulance transport, the quality of clinical care is strongly influenced by non-technical skills such as anticipating, recognising and understanding, decision making, and teamwork. However there are no published reports identifying or applying a non-technical skills framework specific to an intensive care air ambulance setting. The objective of this study was to adapt and evaluate a non-technical skills rating framework for the air ambulance clinical environment. In the first phase of the project the anaesthetists' non-technical skills (ANTS) framework was adapted to the air ambulance setting, using data collected directly from clinician groups, published literature, and field observation. In the second phase experienced and inexperienced inter-hospital transport clinicians completed a simulated critical care air transport scenario, and their non-technical skills performance was independently rated by two blinded assessors. Observed and self-rated general clinical performance ratings were also collected. Rank-based statistical tests were used to examine differences in the performance of experienced and inexperienced clinicians, and relationships between different assessment approaches and assessors. The framework developed during phase one was referred to as an aeromedical non-technical skills framework, or AeroNOTS. During phase two 16 physicians from speciality training programmes in intensive care, emergency medicine and anaesthesia took part in the clinical simulation study. Clinicians with inter-hospital transport experience performed more highly than those without experience, according to both AeroNOTS non-technical skills ratings (p = 0.001) and general performance ratings (p = 0.003). Self-ratings did not distinguish experienced from inexperienced transport clinicians (p = 0.32) and were not strongly associated with either observed general performance (r(s) = 0.4, p = 0

  2. Solo emergency care by a physician assistant versus an ambulance nurse: a cross-sectional document study.

    Science.gov (United States)

    Bloemhoff, Anneke; Schoonhoven, Lisette; de Kreek, Arjan J L; van Grunsven, Pierre M; Laurant, Miranda G H; Berben, Sivera A A

    2016-06-29

    This study compares the assessment, treatment, referral, and follow up contact with the dispatch centre of emergency patients treated by two types of solo emergency care providers in ambulance emergency medical services (EMS) in the Netherlands: the physician assistant (PA), educated in the medical domain, and the ambulance registered nurse (RN), educated in the nursing domain. The hypothesis of this study was that there is no difference in outcome of care between the patients of PAs and RNs. In a cross-sectional document study in two EMS regions we included 991 patients, treated by two PAs (n = 493) and 23 RNs (n = 498). The inclusion period was October 2010-December 2012 for region 1 and January 2013-March 2014 for region 2. Emergency care data were drawn from predefined and free text fields in the electronic patient records. Data were analysed using descriptive statistics. We used χ (2) and Mann-Whitney U tests to analyse for differences in outcome of care. Statistical significance was assumed at a level of P <0.05. Patients treated by PAs and RNs were similar with respect to patient characteristics. In general, diagnostic measurements according to the national EMS standard were applied by RNs and by PAs. In line with the medical education, PAs used a medical diagnostic approach (16 %, n = 77) and a systematic physical exam of organ tract systems (31 %, n = 155). PAs and RNs provided similar interventions. Additionally, PAs consulted more often other medical specialists (33 %) than RNs (17 %) (χ (2)  = 35.5, P <0.0001). PAs referred less patients to the general practitioner or emergency department (50 %) compared to RNs (73 %) (χ (2)  = 52.9, P <0.0001). Patient follow up contact with the dispatch centre within 72 h after completion of the emergency care on scene showed no variation between PAs (5 %) and RNs (4 %). In line with their medical education, PAs seemed to operate from a more general medical perspective. They used a

  3. Asian dust and daily emergency ambulance calls among elderly people in Japan: an analysis of its double role as a direct cause and as an effect modifier.

    Science.gov (United States)

    Kashima, Saori; Yorifuji, Takashi; Suzuki, Etsuji

    2014-12-01

    To evaluate the direct health effects of Asian dust on ambulance calls and its role as an effect modifier on the effects of anthropogenic air pollution in Japan. The subjects were 51,945 elderly residents who visited hospital emergency departments from 2006 to 2010. We evaluated the impact of Asian dust by time-series analyses and the excess risk from suspended particulate matter (SPM) stratified by Asian-dust exposure. Asian dust was associated with daily ambulance calls due to all-cause, cardiovascular, and respiratory disease independently of SPM, for example, the relative risk per interquartile increase in Asian dust (3-day lag) was 1.021 (1.002 to 1.039) for cardiovascular disease. Furthermore, Asian dust modified the effects of SPM on cardiovascular and respiratory diseases. Asian dust had adverse effects and modified the effect of SPM.

  4. Fire and EMS Districts, Ambulance and first responder territories are combined to create emergency medical service boundaries for use in dispatching., Published in 2013, 1:2400 (1in=200ft) scale, Manitowoc County Government.

    Data.gov (United States)

    NSGIC Local Govt | GIS Inventory — Fire and EMS Districts dataset current as of 2013. Ambulance and first responder territories are combined to create emergency medical service boundaries for use in...

  5. Move to improve: the feasibility of using an early mobility protocol to increase ambulation in the intensive and intermediate care settings.

    Science.gov (United States)

    Drolet, Anne; DeJuilio, Patti; Harkless, Sherri; Henricks, Sherry; Kamin, Elizabeth; Leddy, Elizabeth A; Lloyd, Joanna M; Waters, Carissa; Williams, Sarah

    2013-02-01

    Prolonged bed rest in hospitalized patients leads to deconditioning, impaired mobility, and the potential for longer hospital stays. The purpose of this study was to determine the effectiveness of a nurse-driven mobility protocol to increase the percentage of patients ambulating during the first 72 hours of their hospital stay. A quasi-experimental design was used before and after intervention in a 16-bed adult medical/surgical intensive care unit (ICU) and a 26-bed adult intermediate care unit (IMCU) at a large community hospital. A multidisciplinary team developed and implemented a mobility order set with an embedded algorithm to guide nursing assessment of mobility potential. Based on the assessments, the protocol empowers the nurse to consult physical therapists or occupational therapists when appropriate. Daily ambulation status reports were reviewed each morning to determine each patient's activity level. Retrospective and prospective chart reviews were performed to evaluate the effectiveness of the protocol for patients 18 years of age and older who were hospitalized 72 hours or longer. In the 3 months prior to implementation of the Move to Improve project, 6.2% (12 of 193) of the ICU patients and 15.5% (54 of 349) of the IMCU patients ambulated during the first 72 hours of their hospitalization. During the 6 months following implementation, those rates rose to 20.2% (86 of 426) and 71.8% (257 of 358), respectively. The study was carried out at only one center. The initial experience with a nurse-driven mobility protocol suggests that the rate of patient ambulation in an adult ICU and IMCU during the first 72 hours of a hospital stay can be increased.

  6. Skylab IMSS checklist application study for emergency medical care. [emergency medical care operations involving the use and operation of the portable ambulance module

    Science.gov (United States)

    Carl, J. G.; Furukawa, S.

    1975-01-01

    A manual is presented that provides basic technical documentation to support the operation and utilization of the Portable Ambulance Module (PAM) in the field. The PAM is designed to be used for emergency resuscitation and victim monitoring. The functions of all the controls, displays, and stowed equipment of the unit are defined. Supportive medical and physiological data in those areas directly related to the uses of the PAM unit are presented.

  7. Smoking predicts posttraumatic stress symptoms among rescue workers: A prospective study of ambulance personnel involved in the Enschede Fireworks Disaster

    Science.gov (United States)

    van der Velden, Peter G.; Kleber, Rolf J.; Koenen, Karestan C.

    2009-01-01

    Background: Examining whether smoking is a risk factor for posttraumatic stress disorder (PTSD) symptoms among rescue workers affected by a disaster. Methods: Ambulance personnel (N=66) participated in surveys 2–3 weeks (T1) and 18 months after a fireworks disaster (T2). Hierarchical multiple regression analyses were conducted with cigarette consumption at T1 as a predictor of PTSD symptoms at T2. Demographic characteristics, disaster experiences, peritraumatic dissociation, intrusions and avoidance, psychological distress and alcohol consumption assessed at T1 were included as covariates. Results: Regression analyses showed that smoking at T1 independently predicted intrusions, avoidance, hostility, and depression symptoms at T2. Results were not affected by controlling for post-disaster critical incidents at work. Conclusions: This is the first prospective study among rescue workers demonstrating that smoking soon after a disaster predicts PTSD symptoms in the intermediate term. Findings substantiate results of previous studies indicating that smoking is a relevant risk factor. Future research on how changes in cigarettes consumption post-trauma affect risk of PTSD is required. PMID:18093750

  8. An art therapy intervention for cancer patients in the ambulant aftercare - results from a non-randomised controlled study.

    Science.gov (United States)

    Geue, K; Richter, R; Buttstädt, M; Brähler, E; Singer, S

    2013-05-01

    Art therapy in psycho-oncology is gaining increasing importance, but systematic evaluations of its effects are rare. The aim of this study is to investigate the effects of an art therapy intervention for cancer patients in ambulant aftercare on psychological distress and coping. The intervention consisted of 22 sessions. At three points of measurement (t1: before intervention, t2: following intervention, t3: 6 months after t2), participants responded to questionnaires (Freiburg Questionnaire on Coping with Illness, Perceived Adjustment to Chronic Illness Scale, Hospital Anxiety and Depression Scale). A group of haemato-oncological patients served as the comparison group (CG). Pre-post comparisons and analyses of variance were applied for statistical analysis. Relevant confounders were controlled. Fifty-four patients (intervention group, IG) with various cancer diagnoses completed the intervention. One hundred and twenty-nine data sets were available for the CG. Analyses of variance included group membership (IG vs. CG) and the following factors: gender, other psychosocial help and major life events. None of these variables was a predictor for changes in depression, anxiety and coping. Therefore, we could not prove intervention effects over time. Our results contradict those of preliminary studies and raise important questions. Further work on evaluating art therapy is necessary to explore which intervention concepts in which setting at which treatment stage show significant effects. Therefore, controlling for relevant confounders is needed. © 2013 Blackwell Publishing Ltd.

  9. Improvement in weight loss and ambulation outcomes after gastric sleeve surgery for a person with chronic motor-incomplete tetraplegia: clinical case report.

    Science.gov (United States)

    Perreault, J R; Geigle, P R; Gorman, P H; Scott, W H

    2016-09-01

    To measure body mass index (BMI) and ambulation changes for a morbidly obese, 47-year-old man with chronic motor-incomplete tetraplegia after gastric sleeve surgery. A morbidly obese man, BMI=44 kg m(-)(2), with chronic C5 AIS D tetraplegia underwent elective gastric sleeve surgery. Assessment of BMI and function via the 6-minute walk test (6MWT), 10-meter walk test (10MWT) and ambulation parameters (CIR Systems/GAITRite, Franklin, NJ, USA) was performed preoperatively and at 12, 24, 36 and 52 weeks postoperatively, and additionally after 3 weeks of both a prescribed coached (3 × /week facility based) and a non-coached (3 × /week home based) walking program initiated at 52 weeks. A step activity monitor assessed daily ambulation preoperatively, prior to and during the third and sixth week of the walking program. Results included a 34.3% peak BMI decrease at 52 weeks post surgery and a peak increase in 6MWT distance of 58% at 52 weeks post surgery, 10MWT preferred speed of 56% at 55 weeks and step activity monitor of 82% at 58 weeks post surgery. At 58 weeks, gait data demonstrated a decrease in double limb stance of 38% and decrease in base of support of 72%. This empirical case assessment of BMI and functional mobility before and after gastric sleeve surgery may encourage further investigation into mobility and general health effects post gastric procedures for people with chronic motor-incomplete spinal cord injury.

  10. Survival of resuscitated cardiac arrest patients with ST-elevation myocardial infarction (STEMI) conveyed directly to a Heart Attack Centre by ambulance clinicians.

    Science.gov (United States)

    Fothergill, Rachael T; Watson, Lynne R; Virdi, Gurkamal K; Moore, Fionna P; Whitbread, Mark

    2014-01-01

    This study reports survival outcomes for patients resuscitated from out-of-hospital cardiac arrest (OHCA) subsequent to ST-elevation myocardial infarction (STEMI), and who were conveyed directly by ambulance clinicians to a specialist Heart Attack Centre for expert cardiology assessment, angiography and possible percutaneous coronary intervention (PCI). This is a retrospective descriptive review of data sourced from the London Ambulance Service's OHCA registry over a one-year period. We observed excellent survival rates for our cohort of patients with 66% of patients surviving to be discharged from hospital, the majority of whom were still alive after one year. Those who survived tended to be younger, to have had a witnessed arrest in a public place with an initial cardiac rhythm of VF/VT, and to have been transported to the specialist centre more quickly than those who did not. A system allowing ambulance clinicians to autonomously convey OHCA STEMI patients who achieve a return of spontaneous circulation directly to a Heart Attack Centre is highly effective and yields excellent survival outcomes. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  11. Posicionamento de ambulâncias do SAMU através de Programação Inteira e Teoria de Filas

    Directory of Open Access Journals (Sweden)

    Bruno Barreto

    Full Text Available Resumo: A configuração de redes logísticas para serviços de emergência é questão estratégica de imensa importância, visto que pequenas variações no tempo de resposta podem implicar na morte do solicitante. Partindo dessa premissa, o trabalho propõe novas alternativas de posicionamento para as ambulâncias do sistema SAMU na cidade de Duque de Caxias, RJ, capazes de reduzir o tempo de resposta do serviço. Essas propostas de reposicionamento das ambulâncias foram construídas em duas etapas: na primeira, dois modelos de Programação Inteira foram aplicados para se obter soluções que provejam maior cobertura à população. Posteriormente, o Modelo do Hipercubo foi empregado para avaliar a disponibilidade dos servidores, dentre outros indicadores de desempenho relevantes, como o tempo médio de resposta e a taxa de ocupação das ambulâncias.

  12. Interfacility helicopter ambulance transport of neurosurgical patients: observations, utilization, and outcomes from a quaternary level care hospital.

    Directory of Open Access Journals (Sweden)

    Brian P Walcott

    Full Text Available The clinical benefit of helicopter transport over ground transportation for interfacility transport is unproven. We sought to determine actual practice patterns, utilization, and outcomes of patients undergoing interfacility transport for neurosurgical conditions.We retrospectively examined all interfacility helicopter transfers to a single trauma center during 2008. We restricted our analysis to those transfers leading either to admission to the neurosurgical service or to formal consultation upon arrival. Major exclusion criteria included transport from the scene, death during transport, and transport to any area of the hospital other than the emergency department. The primary outcome was time interval to invasive intervention. Secondary outcomes were estimated ground transportation times from the referring hospital, admitting disposition, and discharge disposition. Of 526 candidate interfacility helicopter transfers to our emergency department in 2008, we identified 167 meeting study criteria. Seventy-five (45% of these patients underwent neurosurgical intervention. The median time to neurosurgical intervention ranged from 1.0 to 117.8 hours, varying depending on the diagnosis. For 101 (60% of the patients, estimated driving time from the referring institution was less than one hour. Four patients (2% expired in the emergency department, and 34 patients (20% were admitted to a non-ICU setting. Six patients were discharged home within 24 hours. For those admitted, in-hospital mortality was 28%.Many patients undergoing interfacility transfer for neurosurgical evaluation are inappropriately triaged to helicopter transport, as evidenced by actual times to intervention at the accepting institution and estimated ground transportation times from the referring institution. In a time when there is growing interest in health care cost containment, practitioners must exercise discretion in the selection of patients for air ambulance transport

  13. Ability of independently ambulant children with cerebral palsy to ride a two-wheel bicycle: a case-control study.

    Science.gov (United States)

    Toovey, Rachel; Reid, Susan M; Rawicki, Barry; Harvey, Adrienne R; Watt, Kerrianne

    2017-04-01

    Limited information exists on the ability of children with cerebral palsy (CP) to ride a two-wheel bicycle, an activity that may improve health and participation. We aimed to describe bicycle-riding ability and variables associated with ability to ride in children with CP (Gross Motor Functional Classification System [GMFCS] levels I-II) compared with children with typical development. This case-control study surveyed parents of 114 children with CP and 87 children with typical development aged 6 to 15 years (115 males, mean age 9y 11mo, standard deviation [SD] 2y 10mo). Kaplan-Meier methods were used to compare proportions able to ride at any given age between the two groups. Logistic regression was used to assess variables associated with ability to ride for children with CP and typical development separately. The proportion of children with CP able to ride at each level of bicycle-riding ability was substantially lower at each age than peers with typical development (pchildren with typical development were able to ride independently by 10 years of age, 51% of children with CP classified as GMFCS level I and 3% of those classified as GMFCS level II had obtained independent riding in the community by 15 years of age. Variables associated with ability to ride for children classified as GMFCS level I were age and parent-rated importance of their child being able to ride. Some independently ambulant children with CP can learn to ride a bicycle, in particular if they are classified as GMFCS level I. Variables associated with ability to ride deserve consideration in shaping future efforts for the majority of this population who are not yet able to ride. © 2016 Mac Keith Press.

  14. Gait speed in ambulant older people in long term care: a systematic review and meta-analysis.

    Science.gov (United States)

    Kuys, Suzanne S; Peel, Nancye M; Klein, Kerenaftali; Slater, Alexandra; Hubbard, Ruth E

    2014-03-01

    Gait speed, recently proposed as the sixth vital sign of geriatric assessment, is a strong predictor of adverse outcomes. Walking faster than 1.0 m/s is associated with better survival in community-dwelling older adults, and a recent meta-analysis of older adults in clinical settings estimated usual gait speed to be 0.58 m/s. Here, we aimed to review gait speed values for long term care residents. Relevant databases were systematically searched for original research studies published prior to December 2012. Inclusion criteria were participants living in long term care, mean age >70 years, and gait speed measured over a short distance. Meta-analysis determined gait speed data adjusting for covariates including age, sex, and cognition. Final data included 2888 participants from 34 studies. The percentage of residents ineligible because of inability to mobilize was stated in only 1 study. Of the 34 studies, 22 reported cognitive status using the Mini-Mental State Examination. Usual pace and maximal pace gait speeds were determined separately using a random effects model. No association between gait speed and covariates was found. Usual pace gait speed was 0.475 m/s (95% confidence interval 0.396-0.554) and maximal pace was 0.672 m/s (95% confidence interval 0.532-0.811). In ambulant older people in long term care, gait speed is slow but remains functional. However, since many residents are likely to have been ineligible to participate in assessments, these results cannot be generalized to the long term care population as a whole. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

  15. How feasible is the attainment of community ambulation after stroke? A pilot randomized controlled trial to evaluate community-based physiotherapy in subacute stroke.

    Science.gov (United States)

    Lord, Susan; McPherson, Kathryn M; McNaughton, Harry K; Rochester, Lynn; Weatherall, Mark

    2008-03-01

    This pilot randomized controlled trial evaluated an assistant-led, community-based intervention to improve community mobility and participation after stroke, and examined the potential for independent community ambulation in people with subacute stroke who present with moderate gait deficit. A multicentre, pilot randomized controlled trial. Three hospitals and three community settings in New Zealand. Thirty post-acute, home-dwelling stroke survivors were randomly allocated to receive intervention in the community (n = 14) or as hospital outpatients (n = 16) twice a week for seven weeks. The community intervention involved practice of functional gait activities in community environments relevant to each participant. Hospital-based physiotherapy was based upon a Motor Relearning approach. The primary outcome measure was gait speed (m/min). Secondary outcomes included endurance (six-minute walk time), Activities-specific Confidence Balance Scale, and the Subjective Index of Physical and Social Outcomes measured at baseline, post intervention and six months. Large gains in gait speed were obtained for participants in both groups: community group mean (SD) 16 (16.1) m/min; physiotherapy group mean (SD) 15.9 (16.1) m/min, maintained at six months. There were no significant differences between groups for primary and secondary outcomes after treatment (P = 0.86 ANOVA) or at six months (P = 0.83 ANOVA). Only 11 participants reported independent community ambulation. Levels of social integration were low to moderate. A community-based gait recovery programme appears a practicable alternative to routine physiotherapy, however independent community ambulation is a challenging rehabilitation goal.

  16. Independent radiographic prognostic factors in patients with hospital-treated community-acquired pneumonia; Unabhaengige radiologische Prognosefaktoren fuer den letalen Ausgang stationaer behandlungsbeduerftiger ambulant erworbener Pneumonien

    Energy Technology Data Exchange (ETDEWEB)

    Wilhelm, K.; Textor, J.; Schild, H. [Bonn Univ. (Germany). Radiologische Klinik; Ewig, S.; Luederitz, B. [Bonn Univ. (Germany). Medizinische Poliklinik; Krollmann, G. 1

    1999-02-01

    Purpose: To evaluate the independent prognostic impact of the chest radiograph for mortality from community-acquired pneumonia requiring hospitalization. Methods: Chest radiographs of 67 patients with hospital-treated community-acquired pneumonia were analyzed with regard to the prognostic implications of radiographic patterns, extent and density of infiltrates, and its evolution during treatment. Results: Non-survivors had a significantly higher extent of infiltrates (p=0.008), density of infiltrates (p=0.05), and radiographic spread during follow-up within 48-72 hours (p=0.0001). In multivariate analysis, persistent or progressive infiltrates were associated with a 47fold increase, and persistent or progressive density of infiltrates with an 18fold increase in risk of mortality. The presence of both parameters could correctly predict 96% of survivors and 90% of non-survivors. Conclusions: The chest radiograph is an independent predictor of the severity of pneumonia. Both persistent or progressive infiltrates and persistent or progressive density of infiltrates are independently associated with mortality from community-acquired pneumonia. (orig.) [Deutsch] Ziel: Evaluierung der Thoraxuebersichtsaufnahme als unabhaengiger prognostischer Marker fuer den letalen Ausgang der ambulant erworbenen Pneumonie. Material und Methoden: Die Roentgenaufnahmen von 67 Patienten mit stationaer behandlungbeduerftiger ambulant erworbener Pneumonie wurden hinsichtlich der prognostischen Bedeutung von Infiltratmuster, Infiltratgroesse, Infiltratdichte sowie deren Veraenderungen im Krankheitsverlauf in uni- und multivariater Analyse untersucht. Ergebnisse: Fuer die Gruppe der Verstorbenen ergaben sich signifikant hoehere Mittelwerte bei der Infiltratgroesse (p=0,008), der Infiltratdichte (p=0,05) sowie der prozentualen Infiltrat-Groessenzunahme (p=0,0001) im Verlaufsroentgenbild (48-72 Stunden nach Erstaufnahme). In multivariater Analyse waren gleichbleibende oder zunehmende

  17. Physician presence in an ambulance car is associated with increased survival in out-of-hospital cardiac arrest: a prospective cohort analysis.

    Directory of Open Access Journals (Sweden)

    Akihito Hagihara

    Full Text Available The presence of a physician seems to be beneficial for pre-hospital cardiopulmonary resuscitation (CPR of patients with out-of-hospital cardiac arrest. However, the effectiveness of a physician's presence during CPR before hospital arrival has not been established. We conducted a prospective, non-randomized, observational study using national data from out-of-hospital cardiac arrests between 2005 and 2010 in Japan. We performed a propensity analysis and examined the association between a physician's presence during an ambulance car ride and short- and long-term survival from out-of-hospital cardiac arrest. Specifically, a full non-parsimonious logistic regression model was fitted with the physician presence in the ambulance as the dependent variable; the independent variables included all study variables except for endpoint variables plus dummy variables for the 47 prefectures in Japan (i.e., 46 variables. In total, 619,928 out-of-hospital cardiac arrest cases that met the inclusion criteria were analyzed. Among propensity-matched patients, a positive association was observed between a physician's presence during an ambulance car ride and return of spontaneous circulation (ROSC before hospital arrival, 1-month survival, and 1-month survival with minimal neurological or physical impairment (ROSC: OR = 1.84, 95% CI 1.63-2.07, p = 0.00 in adjusted for propensity and all covariates; 1-month survival: OR = 1.29, 95% CI 1.04-1.61, p = 0.02 in adjusted for propensity and all covariates; cerebral performance category (1 or 2: OR = 1.54, 95% CI 1.03-2.29, p = 0.04 in adjusted for propensity and all covariates; and overall performance category (1 or 2: OR = 1.50, 95% CI 1.01-2.24, p = 0.05 in adjusted for propensity and all covariates. A prospective observational study using national data from out-of-hospital cardiac arrests shows that a physician's presence during an ambulance car ride was independently associated with

  18. A Movement Monitor Based on Magneto-Inertial Sensors for Non-Ambulant Patients with Duchenne Muscular Dystrophy: A Pilot Study in Controlled Environment.

    Directory of Open Access Journals (Sweden)

    Anne-Gaëlle Le Moing

    Full Text Available Measurement of muscle strength and activity of upper limbs of non-ambulant patients with neuromuscular diseases is a major challenge. ActiMyo® is an innovative device that uses magneto-inertial sensors to record angular velocities and linear accelerations that can be used over long periods of time in the home environment. The device was designed to insure long-term stability and good signal to noise ratio, even for very weak movements. In order to determine relevant and pertinent clinical variables with potential for use as outcome measures in clinical trials or to guide therapy decisions, we performed a pilot study in non-ambulant neuromuscular patients. We report here data from seven Duchenne Muscular Dystrophy (DMD patients (mean age 18.5 ± 5.5 years collected in a clinical setting. Patients were assessed while wearing the device during performance of validated tasks (MoviPlate, Box and Block test and Minnesota test and tasks mimicking daily living. The ActiMyo® sensors were placed on the wrists during all the tests. Software designed for use with the device computed several variables to qualify and quantify muscular activity in the non-ambulant subjects. Four variables representative of upper limb activity were studied: the rotation rate, the ratio of the vertical component in the overall acceleration, the hand elevation rate, and an estimate of the power of the upper limb. The correlations between clinical data and physical activity and the ActiMyo® movement parameters were analyzed. The mean of the rotation rate and mean of the elevation rate appeared promising since these variables had the best reliability scores and correlations with task scores. Parameters could be computed even in a patient with a Brooke functional score of 6. The variables chosen are good candidates as potential outcome measures in non-ambulant patients with Duchenne Muscular Dystrophy and use of the ActiMyo® is currently being explored in home environment

  19. [In the footsteps of Dr. François Ribes, surgeon of the 1st division of the so-called ambulance of the battlefield].

    Science.gov (United States)

    Vesselle, Benoît; Vesselle, Guillaume

    2014-01-01

    François Ribes was a surgeon at Emperor Napoleon's so called ambulance of the battle field but he is not well known despite his high offices. On his record of service there are 20 battles, 17 fights and 3 sieges during the Revolution and Empire. Beside his numerous campaigns he was a surgeon at the parisian Invalides Hospital and was highly thought of as a good anatomist. He wrote 84 articles and 47 memoirs of which the best known is entitled History of the autopsy and embalming of Louis XVIII's corpse. However, as a health officer, he only wrote 40 pages about his military campaigns, published in 1845.

  20. Understanding therapeutic benefits of overground bionic ambulation: exploratory case series in persons with chronic, complete spinal cord injury.

    Science.gov (United States)

    Kressler, Jochen; Thomas, Christine K; Field-Fote, Edelle C; Sanchez, Justin; Widerström-Noga, Eva; Cilien, Deena C; Gant, Katie; Ginnety, Kelly; Gonzalez, Hernan; Martinez, Adriana; Anderson, Kimberley D; Nash, Mark S

    2014-10-01

    To explore responses to overground bionic ambulation (OBA) training from an interdisciplinary perspective including key components of neuromuscular activation, exercise conditioning, mobility capacity, and neuropathic pain. Case series. Academic research center. Persons (N=3; 2 men, 1 woman) aged 26 to 38 years with complete spinal cord injury (SCI) (American Spinal Injury Association Impairment Scale grade A) between the levels of T1 and T10 for ≥1 year. OBA 3d/wk for 6 weeks. To obtain a comprehensive understanding of responses to OBA, an array of measures were obtained while walking in the device, including walking speeds and distances, energy expenditure, exercise conditioning effects, and neuromuscular and cortical activity patterns. Changes in spasticity and pain severity related to OBA use were also assessed. With training, participants were able to achieve walking speeds and distances in the OBA device similar to those observed in persons with motor-incomplete SCI (10-m walk speed, .11-.33m/s; 2-min walk distance, 11-33m). The energy expenditure required for OBA was similar to walking in persons without disability (ie, 25%-41% of peak oxygen consumption). Subjects with lower soleus reflex excitability walked longer during training, but there was no change in the level or amount of muscle activity with training. There was no change in cortical activity patterns. Exercise conditioning effects were small or nonexistent. However, all participants reported an average reduction in pain severity over the study period ranging between -1.3 and 1.7 on a 0-to-6 numeric rating scale. OBA training improved mobility in the OBA device without significant changes in exercise conditioning or in neuromuscular or cortical activity. However, pain severity was reduced and no severe adverse events were encountered during training. OBA therefore opens the possibility to reduce the common consequences of chronic, complete SCI such as reduced functional mobility and neuropathic

  1. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial.

    Science.gov (United States)

    Freeman, Jennifer; Fox, Esther; Gear, Margaret; Hough, Alan

    2012-04-05

    People with Multiple Sclerosis (MS) frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK) provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect.This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training; 2 Comparing core stability training with standardised physiotherapy exercise; 3 Exploring underlying mechanisms of change associated with this intervention This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control). All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12), the Functional Reach (forwards and lateral), a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC) Scale. In addition, ultrasound imaging of the abdominal muscles will be performed before

  2. Pilates based core stability training in ambulant individuals with multiple sclerosis: protocol for a multi-centre randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Freeman Jennifer

    2012-04-01

    Full Text Available Abstract Background People with Multiple Sclerosis (MS frequently experience balance and mobility impairments, including reduced trunk stability. Pilates-based core stability training, which is aimed at improving control of the body's stabilising muscles, is popular as a form of exercise with people with MS and therapists. A replicated single case series study facilitated by the Therapists in MS Group in the United Kingdom (UK provides preliminary evidence that this approach can improve balance and mobility in ambulant people with MS; further evidence is needed to substantiate these findings to ensure that limited time, energy, finances and resources are used to best effect. This study builds upon the pilot work undertaken in the case series study by implementing a powered randomised controlled study, with the aims of: 1 Establishing the effectiveness of core stability training 2 Comparing core stability training with standardised physiotherapy exercise 3 Exploring underlying mechanisms of change associated with this intervention Methods This is a multi-centre, double blind, block randomised, controlled trial. Eligible participants will be recruited from 4 UK centres. Participants will be randomly allocated to one of three groups: Pilates based core stability training, standardised physiotherapy exercise or contract-relax relaxation sessions (placebo control. All will receive face to face training sessions over a 12 week period; together with a 15 minute daily home programme. All will be assessed by a blinded assessor before training, at the end of the 12 week programme and at 4 week follow-up. The primary outcome measure is the 10 metre timed walk. Secondary outcome measures are the MS walking Scale (MSWS-12, the Functional Reach (forwards and lateral, a 10 point Numerical Rating Scale to determine "Difficulty in carrying a drink when walking", and the Activities-specific Balance Confidence (ABC Scale. In addition, ultrasound imaging of the

  3. The Functional Ambulation: Standard Treatment versus Electrical Stimulation Therapy (FASTEST trial for stroke: study design and protocol

    Directory of Open Access Journals (Sweden)

    Dunning K

    2013-02-01

    Full Text Available Kari Dunning,1 Michael O'Dell,2 Patricia Kluding,3 Samuel S Wu,4 Jody Feld,5 Jivan Ginosian,6 Keith McBride61Department of Rehabilitation Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, 2Department of Rehabilitation Medicine, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, 3Department of Physical Therapy and Rehabilitation Sciences, University of Kansas Medical Center, Kansas City, KS, 4Department of Biostatistics, University of Florida, Gainesville, FL, 5Department of Community and Family Medicine, Duke University School of Medicine, Durham, NC, 6Bioness Inc, Valencia, CA, USABackground: Surface electrical stimulation for foot drop (foot drop stimulation [FDS] technology has greatly improved over the last decade, leading to increased use in the clinic environment and the community. Despite numerous studies suggesting the benefit of FDS among persons with stroke, there are no randomized controlled trials comparing FDS to standard of care (ankle foot orthosis [AFO]. The Functional Ambulation: Standard Treatment versus Electrical Stimulation Therapy (FASTEST study is a single-blinded randomized controlled trial with the primary purpose of comparing FDS and AFO among persons with stroke conducted at eleven sites throughout the USA.Methods: Persons ≥ 3 months poststroke are randomized to wear either FDS or AFO for 30 weeks. After 30 weeks, AFO participants crossover to wear an FDS. All participants are followed for 42 weeks with repeated measures at baseline and Weeks 6, 12, 30, 36, and 42. The primary analysis will compare gait speed between FDS and AFO at 30 weeks. Secondary outcomes span the International Classification of Functioning, Disability, and Health categories and include functional gait, balance, motor control, falls, and quality of life. Tertiary analyses will be performed using Weeks 36 and 42 time points.Conclusion: This pivotal trial is the first longitudinal

  4. The Groningen Ambulance Study

    NARCIS (Netherlands)

    Svilaas, T; Dijk, WA; Busman, JP; Dassen, WRM; de Vos, R; Zijlstra, F

    2005-01-01

    This paper describes the effects of a treatment protocol for patients with ST elevation myocardial infarction, which was introduced in 2004. The setup of the new approach is described. The principle goal is to minimize time between onset of symptoms associated with acute myocardial infarction and

  5. Ambulation and Parkinson disease.

    Science.gov (United States)

    Amano, Shinichi; Roemmich, Ryan T; Skinner, Jared W; Hass, Chris J

    2013-05-01

    Parkinson disease is a progressive neurodegenerative disorder characterized by a variety of motor and nonmotor features. This article reviews the problems of postural instability and gait disturbance in persons with Parkinson disease through the discussion of (1) the neuropathology of parkinsonian motor deficits, (2) behavioral manifestations of gait and postural abnormalities observed in persons with Parkinson disease, and (3) pharmacologic, surgical, and physical therapy-based interventions to combat postural instability and gait disturbance. This article advances the treatment of postural instability and gait disturbance by condensing up-to-date knowledge and making it available to clinicians and rehabilitation professionals. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. Préambule

    Directory of Open Access Journals (Sweden)

    Emmanuel Grimaud

    2011-06-01

    Full Text Available Courses à la virtuosité Nombreuses sont les pratiques qui ont généré, parfois en leur cœur et souvent en leurs marges, des programmes acrobatiques. Ces programmes ont généralement des finalités comparables. Il s’agit d’apprécier et d’évaluer l’excellence technique, d’explorer plus ou moins librement les possibilités d’un instrument ou de mettre à l’épreuve ses limites. De la musique à la jonglerie, de la prestidigitation à la voltige aérienne ou encore à la cascade à moto, rares sont les arts...

  7. Favourable cost-benefit in an early defibrillation programme using dual dispatch of ambulance and fire services in out-of-hospital cardiac arrest.

    Science.gov (United States)

    Sund, Björn; Svensson, Leif; Rosenqvist, Mårten; Hollenberg, Jacob

    2012-12-01

    Out-of-hospital cardiac arrest is fatal without treatment, and time to defibrillation is an extremely important factor in relation to survival. We performed a cost-benefit analysis of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm, Sweden. A cost-benefit analysis was performed to evaluate the effects of dual dispatch defibrillation. The increased survival rates were estimated from a real-world implemented intervention, and the monetary value of a life ( 2.2 million) was applied to this benefit by using results from a recent stated-preference study. The estimated costs include defibrillators (including expendables/maintenance), training, hospitalisation/health care, fire service call-outs, overhead resources and the dispatch centre. The estimated number of additional saved lives was 16 per year, yielding a benefit-cost ratio of 36. The cost per quality-adjusted life years (QALY) was estimated to be 13,000, and the cost per saved life was 60,000. The intervention of dual dispatch defibrillation by ambulance and fire services in the County of Stockholm had positive economic effects. For the cost-benefit analysis, the return on investment was high and the cost-effectiveness showed levels below the threshold value for economic efficiency used in Sweden. The cost-utility analysis categorises the cost per QALY as medium.

  8. Voluntary Ambulation by Upper Limb-Triggered HAL® in Patients with Complete Quadri/Paraplegia Due to Chronic Spinal Cord Injury

    Directory of Open Access Journals (Sweden)

    Yukiyo Shimizu

    2017-11-01

    Full Text Available Patients with complete paraplegia after spinal cord injury (SCI are unable to stand or walk on their own. Standing exercise decreases the risk of decubitus ulcers, osteoporosis, and joint deformities in patients with SCI. Conventional gait training for complete paraplegia requires excessive upper limb usage for weight bearing and is difficult in cases of complete quadriplegia. The purpose of this study was to describe voluntary ambulation triggered by upper limb activity using the Hybrid Assistive Limb® (HAL in patients with complete quadri/paraplegia after chronic SCI. Four patients (3 men, 1 woman were enrolled in this study. The mean patient age ± standard deviation was 37.2 ± 17.8 (range, 20–67 years. Clinical evaluation before intervention revealed the following findings: case 1, neurological level C6, American Spinal Cord Injury Association impairment scale (AIS grade B; case 2, T6, AIS A; case 3, T10 AIS A; and case 4, T11, AIS A. The HAL intervention consisted of 10 sessions. Each HAL session lasted 60–90 min. The HAL electrodes for hip and knee flexion-extension were placed on the anterior and posterior sides of the upper limbs contralaterally corresponding to each of the lower limbs. Surface electromyography (EMG was used to evaluate muscle activity of the tensor fascia lata and quadriceps femoris (Quad in synchronization with a Vicon motion capture system. The modified Ashworth scale (mAs score was also evaluated before and after each session. All participants completed all 10 sessions. Cases 1, 2, and 3 demonstrated significant decreases in mAs score after the sessions compared to pre-session measurements. In all cases, EMG before the intervention showed no apparent activation in either Quad. However, gait phase dependent activity of the lower limb muscles was seen during voluntarily triggered ambulation driven by upper limb muscle activities. In cases 3 and 4, active contraction in both Quads was observed after intervention

  9. Effects of A Thai Traditional Music Listening Program on Acute Pain Alleviation and Early Ambulation among Patients during the First 48 hours after Open Abdominal Surgery

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    Phanicha Phosida

    2016-09-01

    Full Text Available Background: To study the effects of listening to a Thai traditional music program on acute pain alleviation among patients during the first 48 hours after open abdominal surgery. Objective: A cross over research design in adult patients’ aged 18-60 years at Siriraj Hospital. Methods: The sample was selected by purposive sampling based on inclusion criteria and assigned into the following two groups by simple random sampling: the group receiving the Thai traditional music program (experimental group and the group receiving routine care (control group. This study employed a cross over design with 44 samples in a private surgical ward at Siriraj Hospital, Bangkok. Pain was assessed before and after the intervention. Data were collected by the following three sets of instruments: 1 the demographic and treatment background form; 2 the Thai Short - Form McGill Pain Questionnaire with the vital sign form and 3 the post abdominal surgery early ambulation form. Results: The patients in the experimental group had lower mean pain descriptor scores, mean present pain intensity scores and mean Visual Analog Scale scores after the Thai traditional music program than before the intervention at 48 hours after abdominal surgery with statistical significance (t = 14.11, t = 17.41 and t = 16.47 (p < .001, respectively. When compared between groups, the patients in the experimental group had lower mean pain descriptor scores, mean present pain intensity scores and mean Visual Analog Scale scores than the control group at 48 hours with statistical significance (F = 138.71, F = 170 and F = 298.97 (p < .001, respectively. Furthermore, on the first and second postoperative days as well as the sum of both days, the experimental group was also found to have better early ambulation mean scores than the control group with statistical significance (F = 10.67, p < .002, F = 41.36, p < .001, F = 44.47, p < .001, respectively. Conclusion: The findings suggest that a Thai

  10. Semi-Automated Analysis of Diaphragmatic Motion with Dynamic Magnetic Resonance Imaging in Healthy Controls and Non-Ambulant Subjects with Duchenne Muscular Dystrophy

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    Courtney A. Bishop

    2018-01-01

    Full Text Available Subjects with Duchenne Muscular Dystrophy (DMD suffer from progressive muscle damage leading to diaphragmatic weakness that ultimately requires ventilation. Emerging treatments have generated interest in better characterizing the natural history of respiratory impairment in DMD and responses to therapy. Dynamic (cine Magnetic Resonance Imaging (MRI may provide a more sensitive measure of diaphragm function in DMD than the commonly used spirometry. This study presents an analysis pipeline for measuring parameters of diaphragmatic motion from dynamic MRI and its application to investigate MRI measures of respiratory function in both healthy controls and non-ambulant DMD boys. We scanned 13 non-ambulant DMD boys and 10 age-matched healthy male volunteers at baseline, with a subset (n = 10, 10, 8 of the DMD subjects also assessed 3, 6, and 12 months later. Spirometry-derived metrics including forced vital capacity were recorded. The MRI-derived measures included the lung cross-sectional area (CSA, the anterior, central, and posterior lung lengths in the sagittal imaging plane, and the diaphragm length over the time-course of the dynamic MRI. Regression analyses demonstrated strong linear correlations between lung CSA and the length measures over the respiratory cycle, with a reduction of these correlations in DMD, and diaphragmatic motions that contribute less efficiently to changing lung capacity in DMD. MRI measures of pulmonary function were reduced in DMD, controlling for height differences between the groups: at maximal inhalation, the maximum CSA and the total distance of motion of the diaphragm were 45% and 37% smaller. MRI measures of pulmonary function were correlated with spirometry data and showed relationships with disease progression surrogates of age and months non-ambulatory, suggesting that they provide clinically meaningful information. Changes in the MRI measures over 12 months were consistent with weakening of

  11. Medicare program; revisions to payment policies under the physician fee schedule, and other Part B payment policies for CY 2008; revisions to the payment policies of ambulance services under the ambulance fee schedule for CY 2008; and the amendment of the e-prescribing exemption for computer generated facsimile transmissions. Final rule with comment period.

    Science.gov (United States)

    2007-11-27

    This final rule with comment period addresses certain provisions of the Tax Relief and Health Care Act of 2006, as well as making other proposed changes to Medicare Part B payment policy. We are making these changes to ensure that our payment systems are updated to reflect changes in medical practice and the relative value of services. This final rule with comment period also discusses refinements to resource-based practice expense (PE) relative value units (RVUs); geographic practice cost indices (GPCI) changes; malpractice RVUs; requests for additions to the list of telehealth services; several coding issues including additional codes from the 5-Year Review; payment for covered outpatient drugs and biologicals; the competitive acquisition program (CAP); clinical lab fee schedule issues; payment for renal dialysis services; performance standards for independent diagnostic testing facilities; expiration of the physician scarcity area (PSA) bonus payment; conforming and clarifying changes for comprehensive outpatient rehabilitation facilities (CORFs); a process for updating the drug compendia; physician self referral issues; beneficiary signature for ambulance transport services; durable medical equipment (DME) update; the chiropractic services demonstration; a Medicare economic index (MEI) data change; technical corrections; standards and requirements related to therapy services under Medicare Parts A and B; revisions to the ambulance fee schedule; the ambulance inflation factor for CY 2008; and amending the e-prescribing exemption for computer-generated facsimile transmissions. We are also finalizing the calendar year (CY) 2007 interim RVUs and are issuing interim RVUs for new and revised procedure codes for CY 2008. As required by the statute, we are announcing that the physician fee schedule update for CY 2008 is -10.1 percent, the initial estimate for the sustainable growth rate for CY 2008 is -0.1 percent, and the conversion factor (CF) for CY 2008 is $34.0682.

  12. Weakness and the Inability to Ambulate in a 14-Month-Old Female: A Case Report and Concise Review of Guillain-Barre Syndrome

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    Scott A. Bloch

    2013-01-01

    Full Text Available Guillain-Barre syndrome (GBS is an acquired disease of the peripheral nervous system which causes demyelination and leads to weakness, ataxia, and areflexia. There are a variety of forms of the syndrome, and although it is found in all age groups, it is rare in children less than two years of age. The present complaint of weakness, ataxia, or lower extremity pain in the pediatric population should cause the practitioner to consider GBS in the differential. We describe a case of a 14-month-old girl presenting with weakness and the inability to ambulate who was diagnosed with GBS. The purpose of this paper is to review the emergency medicine diagnosis and management of Guillain-Barre syndrome in children.

  13. The feasibility of using a portable xenon delivery device to permit earlier xenon ventilation with therapeutic cooling of neonates during ambulance retrieval.

    Science.gov (United States)

    Dingley, John; Liu, Xun; Gill, Hannah; Smit, Elisa; Sabir, Hemmen; Tooley, James; Chakkarapani, Ela; Windsor, David; Thoresen, Marianne

    2015-06-01

    Therapeutic hypothermia is the standard of care after perinatal asphyxia. Preclinical studies show 50% xenon improves outcome, if started early. During a 32-patient study randomized between hypothermia only and hypothermia with xenon, 5 neonates were given xenon during retrieval using a closed-circuit incubator-mounted system. Without xenon availability during retrieval, 50% of eligible infants exceeded the 5-hour treatment window. With the transportable system, 100% were recruited. Xenon delivery lasted 55 to 120 minutes, using 174 mL/h (117.5-193.2) (median [interquartile range]), after circuit priming (1300 mL). Xenon delivery during ambulance retrieval was feasible, reduced starting delays, and used very little gas.

  14. The effect of core stability training on balance and mobility in ambulant individuals with multiple sclerosis: a multi-centre series of single case studies.

    Science.gov (United States)

    Freeman, J A; Gear, M; Pauli, A; Cowan, P; Finnigan, C; Hunter, H; Mobberley, C; Nock, A; Sims, R; Thain, J

    2010-11-01

    Core stability training is popular in the management of people with multiple sclerosis (MS); however, scientific evidence to support its effectiveness is scarce. To explore the effectiveness of core stability training on balance and mobility. A multi-centre series of eight single case studies was undertaken. Eight ambulant individuals with stable MS participated in 16 face-to-face core stability training sessions, delivered by a neurophysiotherapist, plus a daily home exercise programme. A range of outcomes were measured: 10-m timed walk, 12-item MS walking scale, timed get up and go, functional reach tests, timed single leg stance, visual analogue scales of two activities, and the Activities-specific Balance Confidence Scale. Visual analysis of trend, level and slope demonstrated improvement in five subjects (62%) in seven measures. This was confirmed by the two standard deviation band method of analysis for six measures. Analysis of group data (repeated measures within subjects analysis of variance) indicated significant improvement between baseline and intervention phases for timed walk (p = 0.019), MSWS-12 Scale (p = 0.041), forward (p = 0.015) and lateral reach (p = 0.012). In general, no further improvements were made following withdrawal of the intervention. This study provides preliminary evidence of the effectiveness of an 8-week core stability training programme in improving balance and mobility in ambulant people with MS. Variations in response to intervention are evident. Assessor-blinded randomized controlled studies are required to confirm these findings and determine patient characteristics which identify those who benefit most from this intervention.

  15. An artificial neural network to safely reduce the number of ambulance ECGs transmitted for physician assessment in a system with prehospital detection of ST elevation myocardial infarction

    Directory of Open Access Journals (Sweden)

    Forberg Jakob L

    2012-02-01

    Full Text Available Abstract Background Pre-hospital electrocardiogram (ECG transmission to an expert for interpretation and triage reduces time to acute percutaneous coronary intervention (PCI in patients with ST elevation Myocardial Infarction (STEMI. In order to detect all STEMI patients, the ECG should be transmitted in all cases of suspected acute cardiac ischemia. The aim of this study was to examine the ability of an artificial neural network (ANN to safely reduce the number of ECGs transmitted by identifying patients without STEMI and patients not needing acute PCI. Methods Five hundred and sixty ambulance ECGs transmitted to the coronary care unit (CCU in routine care were prospectively collected. The ECG interpretation by the ANN was compared with the diagnosis (STEMI or not and the need for an acute PCI (or not as determined from the Swedish coronary angiography and angioplasty register. The CCU physician's real time ECG interpretation (STEMI or not and triage decision (acute PCI or not were registered for comparison. Results The ANN sensitivity, specificity, positive and negative predictive values for STEMI was 95%, 68%, 18% and 99%, respectively, and for a need of acute PCI it was 97%, 68%, 17% and 100%. The area under the ANN's receiver operating characteristics curve for STEMI detection was 0.93 (95% CI 0.89-0.96 and for predicting the need of acute PCI 0.94 (95% CI 0.90-0.97. If ECGs where the ANN did not identify a STEMI or a need of acute PCI were theoretically to be withheld from transmission, the number of ECGs sent to the CCU could have been reduced by 64% without missing any case with STEMI or a need of immediate PCI. Conclusions Our ANN had an excellent ability to predict STEMI and the need of acute PCI in ambulance ECGs, and has a potential to safely reduce the number of ECG transmitted to the CCU by almost two thirds.

  16. Circadian variation of cardiac autonomic nervous profile is affected in Japanese ambulance men with a working system of 24-h shifts.

    Science.gov (United States)

    Mitani, Satoko; Fujita, Masatoshi; Shirakawa, Taro

    2006-01-01

    The purpose of this study was to compare the stress levels of Japanese ambulance men between on-duty and off-duty days, by using the physiological indices of heart rate variability (HRV) and cortisol in urine, measured over each 24-h period. Measurements were made during one on-duty and one off-duty day for each subject. The participants were monitored for 24 h with a Holter recording system and a parameter reflecting overall stress levels was obtained by measuring the cortisol level in urine collected over 24 h. The circadian variation of cardiac autonomic nervous system activity was affected when the subjects were on duty. The low-frequency/high-frequency power ratio (=low-frequency power/high-frequency power: LF/HF), which is a useful parameter that reflects the balance of cardiac autonomic nervous activity, differed significantly between the waking and sleeping times on the off-duty day (P=0.03), while it did not differ between these two states on the on-duty day (P=0.56). Similarly, the normalized high-frequency power [=high-frequency/(high-frequency+low-frequency) power: HF/(HF+LF)] ratio, which is a useful measure of the activity of the parasympathetic nervous system, differed significantly between these two states on the off-duty day (P=0.04), while there was no significant difference in the ratio between the two states on the on-duty day (P=0.13). These results show that the diurnal balance of the cardiac autonomic nervous system is affected on the on-duty day, even though it is possible for ambulance men to sleep regular hours.

  17. Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan.

    Science.gov (United States)

    Hanaki, Nao; Yamashita, Kazuto; Kunisawa, Susumu; Imanaka, Yuichi

    2016-12-09

    In Japan, ambulance staff sometimes must make request calls to find hospitals that can accept patients because of an inadequate information sharing system. This study aimed to quantify effects of the number of request calls on the time interval between an emergency call and hospital arrival. A cross-sectional study of an ambulance records database in Nara prefecture, Japan. A total of 43 663 patients (50% women; 31.2% aged 80 years and over): (1) transported by ambulance from April 2013 to March 2014, (2) aged 15 years and over, and (3) with suspected major illness. The time from call to hospital arrival, defined as the time interval from receipt of an emergency call to ambulance arrival at a hospital. The mean time interval from emergency call to hospital arrival was 44.5 min, and the mean number of requests was 1.8. Multilevel linear regression analysis showed that ∼43.8% of variations in transportation times were explained by patient age, sex, season, day of the week, time, category of suspected illness, person calling for the ambulance, emergency status at request call, area and number of request calls. A higher number of request calls was associated with longer time intervals to hospital arrival (addition of 6.3 min per request call; ptime for diseases needing cardiologists, neurologists, neurosurgeons and orthopaedists. The study revealed 6.3 additional minutes needed in transportation time for every refusal of a request call, and also revealed disease-specific delays among specific areas. An effective system should be collaboratively established by policymakers and physicians to ensure the rapid identification of an available hospital for patient transportation in order to reduce the time from the initial emergency call to hospital arrival. 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/.

  18. Validation of computer codes and modelling methods for giving proof of nuclear safety of transport and storage of spent VVER-type nuclear fuels. Pt. 2. Criticality safety during transport and storage of spent VVER fuel elements. Final report; Einschaetzung von Rechenprogrammen und Methoden zum Nachweis der nuklearen Sicherheit bei Transport und Lagerung von WWER-Kernbrennstoffen. T. 2. Kritikalitaetssicherheit bei Transport und Lagerung von WWER-Brennelementen. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Buechse, H.; Langowski, A.; Lein, M.; Nagel, R.; Schmidt, H.; Stammel, M.

    1995-03-15

    The report gives the results of investigations on the validation of computer codes used to prove nuclear safety during transport and storage of spent VVER - fuel of NPP Greifswald and Rheinsberg. Characteristics of typical spent fuel (nuclide concentration, neutron source strength, gamma spectrum, decay heat) - calculated with several codes - and dose rates (e.g. in the surrounding of a loaded spent fuel cask) - based on the different source terms - are presented. Differences and their possible reasons are discussed. The results show that despite the differences in the source terms all relevant health physics requirements are met for all cases of source term. The validation of the criticality code OMEGA was established by calculation of appr. 200 critical experiments of LWR fuel, including VVER fuel rod arrangements. The mean error of the effective multiplication factor k{sub eff} is -0,01 compared to the experiment for this area of applicability. Thus, the OMEGA error of 2% assumed in earlier works has turned out to be sufficiently conservative. (orig.) [Deutsch] Der Bericht enthaelt die Ergebnisse von Untersuchungen zur Validierung von Rechenprogrammen, welche zum Nachweis der nukelaren Sicherheit bei Transport und Lagerung von WWER-Kernbrennstoff der KKW Greifswald und Rheinsberg eingesetzt wurden. Es werden eine Charakteristik des abgebrannten Brennstoffs (Nuklidkonzentrationen, Neutronenquellstaerke, Gammaspektrum, Nachzerfallsleistung) - berechnet mit verschiedenen Programmen - und Ortsdosisleistungen (z.B. in der Umgebung eines Transportbehaelters) - basierend auf den verschiedenen Quelltermen - angegeben. Differenzen und Ursachen werden diskutiert. Die Ergebnisse zeigen, dass trotz der Differenzen in den Quelltermen alle strahlenschutztechnisch relevanten Aussagen unbeeinflusst bleiben. Fuer die Einschaetzung des Gueltigkeitsbereiches des Monte-Carlo-Programms OMEGA wurden ca. 200 kritische Experimente mit LWR-Brennstoff unter besonderer Beruecksichtigung

  19. Systems for uninterrupted power supply; USV - ein starkes Stueck Sicherheit

    Energy Technology Data Exchange (ETDEWEB)

    Schneider, D.; Soelter, W. [AEG SVS GmbH, Warstein-Belecke (Germany)

    1999-09-01

    The millennium bug is only one of the many potential hazards in information technology. Systems for uninterrupted power supply offer a solution. [German] Alle Welt spricht vom Jahr-2000-Problem (Y2K). Die Meinungen dazu reichen von Horror-Szenarien bis hin zum Ignorieren dieses Problems. Dabei steht fest: Das Jahr-2000-Problem ist nur eines unter vielen Gefahrenpotentialen fuer die Informationstechnik. Dabei lassen sich alle Stoerfaktoren, die aus der Energieversorgung resultieren mit einer USV beseitigen. USV sichern Geschaeftsablaeufe und Fertigungsprozesse. (orig.)

  20. CyLaw-Report V : "Sicherheit von ec-Karten"

    OpenAIRE

    Schmid, Viola

    2008-01-01

    Entscheidung des BGH vom 05.10.2004 - XI ZR 210/03 Die vorliegende Entscheidung des Bundesgerichtshof (BGH) bringt - nach jahrelanger juristischer Diskussion und divergierender Rechtsprechung verschiedener Gerichte - weiteren Aufschluss bei beweis- und haftungsrechtlichen Fragen von ec-Karten. Die besondere Bedeutung bargeldloser Zahlungsverfahren im Bereich von eCommerce, eGovernment etc. machen das Urteil des BGH zu einer für das Cyberlaw interessanten Entscheidung.

  1. Safety is paramount; Sicherheit ist das oberste Gebot

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-11-15

    Since 20 years nuclear power plants provider a contribution to the power supply in Germany. In this long period the safety concept has been approved and was completed ever more. Aim of the safety concept is the operational personnel and the population from ionizing (radioactive) radiation, which arises in the nuclear fission itself or is emitted by the radionuclides produced in the nuclear fission. Base of the safety concept is the concerted action of facility safety, safety management, qualification of co-workers, and living safety culture. German nuclear power plants belong concidedly to the worldwide safest. They were and are currently fitted to the progressing status of technology and offer the guarantee that they also during the remaining operational time are operated on the highest safety level.

  2. Timed function tests, motor function measure, and quantitative thigh muscle MRI in ambulant children with Duchenne muscular dystrophy: A cross-sectional analysis.

    Science.gov (United States)

    Schmidt, Simone; Hafner, Patricia; Klein, Andrea; Rubino-Nacht, Daniela; Gocheva, Vanya; Schroeder, Jonas; Naduvilekoot Devasia, Arjith; Zuesli, Stephanie; Bernert, Guenther; Laugel, Vincent; Bloetzer, Clemens; Steinlin, Maja; Capone, Andrea; Gloor, Monika; Tobler, Patrick; Haas, Tanja; Bieri, Oliver; Zumbrunn, Thomas; Fischer, Dirk; Bonati, Ulrike

    2018-01-01

    The development of new therapeutic agents for the treatment of Duchenne muscular dystrophy has put a focus on defining outcome measures most sensitive to capture treatment effects. This cross-sectional analysis investigates the relation between validated clinical assessments such as the 6-minute walk test, motor function measure and quantitative muscle MRI of thigh muscles in ambulant Duchenne muscular dystrophy patients, aged 6.5 to 10.8 years (mean 8.2, SD 1.1). Quantitative muscle MRI included the mean fat fraction using a 2-point Dixon technique, and transverse relaxation time (T2) measurements. All clinical assessments were highly significantly inter-correlated with p quantitative muscle MRI values significantly correlated with all clinical assessments with the extensors showing the strongest correlation. In contrast to the clinical assessments, quantitative muscle MRI values were highly significantly correlated with age. In conclusion, the motor function measure and timed function tests measure disease severity in a highly comparable fashion and all tests correlated with quantitative muscle MRI values quantifying fatty muscle degeneration. Copyright © 2017 Elsevier B.V. All rights reserved.

  3. Systematic review of non-transportation rates and outcomes for older people who have fallen after ambulance service call-out.

    Science.gov (United States)

    Mikolaizak, A Stefanie; Simpson, Paul M; Tiedemann, Anne; Lord, Stephen R; Close, Jacqueline C T

    2013-09-01

    To review the evidence regarding non-transported older people who have fallen in relation to non-transportation rates, outcomes and impact of alternate care pathways. Electronic databases and reference lists of included studies (up to December 2011) were systematically searched. Studies were eligible if they included data on non-transportation rates, information on outcomes or alternate care pathways for older people who have fallen. Twelve studies were included. Non-transportation rates following a fall ranged from 11% to 56%. Up to 49% of non-transported people who have fallen had unplanned health-care contact within 28 days of the initial incident. Attendance by specially trained paramedics and individualised multifactorial interventions significantly reduced adverse events including subsequent falls, emergency ambulance calls, emergency department attendance and hospital admission. Limited but promising evidence shows that appropriate interventions can improve health outcomes of non-transported older people who have fallen. Further studies are needed to explore alternate care pathways and promote more efficient use of health services. © 2013 The Authors. Australasian Journal on Ageing © 2013 ACOTA.

  4. The effect of presenting symptoms and patient characteristics on prehospital delay in MI patients presenting to emergency department by ambulance: a cohort study.

    Science.gov (United States)

    Coventry, Linda L; Bremner, Alexandra P; Williams, Teresa A; Celenza, Antonio

    2015-10-01

    There is little recent information about prehospital delay time for Australian patients with myocardial infarction (MI). This study: (1) describes prehospital delay time for patients with MI; (2) identifies variables and presenting symptoms which contribute to the delay. This retrospective cohort study identified patients with an Emergency Department (ED) discharge diagnosis of MI, transported by ambulance to one of the seven Perth metropolitan EDs, between January 2008 and October 2009. Prehospital delay times were analysed using linear regression models. Non-numeric (word descriptions) of delay time were categorised. Of 1,633 patients, symptom onset-time was available for 1,003. For 829 patients with a numeric onset-time, median delay was 2.2hours; decreased delay was associated with age prehospital delay times remain longer than is optimal, public awareness of MI symptoms should be enhanced in order to decrease prehospital delay. Copyright © 2015 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

  5. The effects of dynamic ankle-foot orthoses on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait.

    Science.gov (United States)

    Suat, Erel; Fatma, Uygur; Nilgün, Bek

    2011-01-01

    To investigate the effects of dynamic ankle-foot orthoses (DAFOs) on functional ambulation activities, weight bearing and spatio-temporal characteristics of hemiparetic gait and to inquire whether wearing a DAFO for 3 months has a carryover effect. Fourteen chronic hemiparetic patients who could walk independently with or without a cane were the subjects of the study. Patients were assessed initially with tennis shoes and were given custom fabricated DAFOs which they wore for three months and were retested under two conditions: with tennis shoes only and with DAFOs worn in these shoes. All patients were assessed for weight bearing percentage of the affected side, cadence, step length of the involved and uninvolved sides, step width, functional reach, timed up and go, timed down stairs, timed up stairs, physiologic cost index and velocity. Comparison of initial and third month assessments with shoes only condition showed that there was no significant improvement for the measured parameters. When comparison was made at the third month while patients were wearing tennis shoes only and when they were wearing DAFO's in their shoes there was a significant difference in favour of the condition where patients were wearing DAFOs. The benefits of using DAFOs in chronic hemiparetic patients are lost when the patients are not wearing their orthoses.

  6. Immediate Return to Ambulation and Improved Functional Capacity for Rehabilitation in Complex Regional Pain Syndrome following Early Implantation of a Spinal Cord Stimulation System

    Directory of Open Access Journals (Sweden)

    Brandon Jesse Goff

    2014-01-01

    Full Text Available Complex regional pain syndrome (CRPS is a neuropathic pain condition that is characterized by vasomotor, sensory, sudomotor, and motor symptoms. Spinal cord stimulation (SCS has been successfully utilized for the treatment of pain refractory to conventional therapies. We present a case of a previously highly functioning 54-year-old female who developed a rarely reported case of idiopathic CRPS of the right ankle which spontaneously occurred four months after an uncomplicated anterior cervical disc fusion. This condition resulted in severe pain and functional impairment that was unresponsive to pharmacological management. The patient’s rehabilitation was severely stymied by her excruciating pain. However, with the initiation of spinal cord stimulation, her pain was adequately controlled allowing for progression to full unassisted ambulation, advancing functional capacity, and improving quality of life. This case report supports the concept that rapid progression to neuromodulation, rather than delays that occur due to attempts at serial sympathetic blocks, may better control symptoms leading allowing for a more meaningful recovery.

  7. Integrated Suit Test 1 - A Study to Evaluate Effects of Suit Weight, Pressure, and Kinematics on Human Performance during Lunar Ambulation

    Science.gov (United States)

    Gernhardt, Michael L.; Norcross, Jason; Vos, Jessica R.

    2008-01-01

    In an effort to design the next generation Lunar suit, NASA has initiated a series of tests aimed at understanding the human physiological and biomechanical affects of space suits under a variety of conditions. The first of these tests was the EVA Walkback Test (ICES 2007-01-3133). NASA-JSC assembled a multi-disciplinary team to conduct the second test of the series, titled Integrated Suit Test 1 (IST-1), from March 6 through July 24, 2007. Similar to the Walkback Test, this study was performed with the Mark III (MKIII) EVA Technology Demonstrator suit, a treadmill, and the Partial Gravity Simulator in the Space Vehicle Mock-Up Facility at Johnson Space Center. The data collected for IST-1 included metabolic rates, ground reaction forces, biomechanics, and subjective workload and controllability feedback on both suited and unsuited (shirt-sleeve) astronaut subjects. For IST-1 the center of gravity was controlled to a nearly perfect position while the weight, pressure and biomechanics (waist locked vs. unlocked) were varied individually to evaluate the effects of each on the ability to perform level (0 degree incline) ambulation in simulated Lunar gravity. The detailed test methodology and preliminary key findings of IST-1 are summarized in this report.

  8. Monitoring the effect of air pollution episodes on health care consultations and ambulance call-outs in England during March/April 2014: A retrospective observational analysis.

    Science.gov (United States)

    Elliot, Alex J; Smith, Sue; Dobney, Alec; Thornes, John; Smith, Gillian E; Vardoulakis, Sotiris

    2016-07-01

    There is an increasing body of evidence illustrating the negative health effects of air pollution including increased risk of respiratory, cardiac and other morbid conditions. During March and April 2014 there were two air pollution episodes in England that occurred in close succession. We used national real-time syndromic surveillance systems, including general practitioner (GP) consultations, emergency department attendances, telehealth calls and ambulance dispatch calls to further understand the impact of these short term acute air pollution periods on the health seeking behaviour of the general public. Each air pollution period was comparable with respect to particulate matter concentrations (PM10 and PM2.5), however, the second period was longer in duration (6 days vs 3 days) and meteorologically driven 'Sahara dust' contributed to the pollution. Health surveillance data revealed a greater impact during the second period, with GP consultations, emergency department attendances and telehealth (NHS 111) calls increasing for asthma, wheeze and difficulty breathing indicators, particularly in patients aged 15-64 years. Across regions of England there was good agreement between air quality levels and health care seeking behaviour. The results further demonstrate the acute impact of short term air pollution episodes on public health and also illustrate the potential role of mass media reporting in escalating health care seeking behaviour. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  9. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care.

    Science.gov (United States)

    Snooks, Helen; Anthony, Rebecca; Chatters, Robin; Cheung, Wai-Yee; Dale, Jeremy; Donohoe, Rachael; Gaze, Sarah; Halter, Mary; Koniotou, Marina; Logan, Phillippa; Lyons, Ronan; Mason, Suzanne; Nicholl, Jon; Phillips, Ceri; Phillips, Judith; Russell, Ian; Siriwardena, A Niroshan; Wani, Mushtaq; Watkins, Alan; Whitfield, Richard; Wilson, Lynsey

    2012-01-01

    Emergency calls to ambulance services are frequent for older people who have fallen, but ambulance crews often leave patients at the scene without ongoing care. Evidence shows that when left at home with no further support older people often experience subsequent falls which result in injury and emergency-department attendances. SAFER 2 is an evaluation of a new clinical protocol which allows paramedics to assess and refer older people who have fallen, and do not need hospital care, to community-based falls services. In this protocol paper, we report methods and progress during trial implementation. SAFER 2 is recruiting patients through three ambulance services. A successful trial will provide robust evidence about the value of this new model of care, and enable ambulance services to use resources efficiently. Pragmatic cluster randomised trial. We randomly allocated 25 participating ambulance stations (clusters) in three services to intervention or control group. Intervention paramedics received training and clinical protocols for assessing and referring older people who have fallen to community-based falls services when appropriate, while control paramedics deliver care as usual. Patients are eligible for the trial if they are aged 65 or over; resident in a participating falls service catchment area; and attended by a trial paramedic following an emergency call coded as a fall without priority symptoms. The principal outcome is the rate of further emergency contacts (or death), for any cause and for falls. Secondary outcomes include further falls, health-related quality of life, 'fear of falling', patient satisfaction reported by participants through postal questionnaires at 1 and 6 months, and quality and pathways of care at the index incident. We shall compare National Health Service (NHS) and patient/carer costs between intervention and control groups and estimate quality-adjusted life years (QALYs) gained from the intervention and thus incremental cost per

  10. Effects of neuromuscular electrical stimulation of muscles of ambulation in patients with chronic heart failure or COPD: a systematic review of the English-language literature.

    Science.gov (United States)

    Sillen, Maurice J H; Speksnijder, Caroline M; Eterman, Rose-Miek A; Janssen, Paul P; Wagers, Scott S; Wouters, Emiel F M; Uszko-Lencer, Nicole H M K; Spruit, Martijn A

    2009-07-01

    Despite optimal drug treatment, many patients with congestive heart failure (CHF) or COPD still experience disabling dyspnea, fatigue, and exercise intolerance. They also exhibit significant changes in body composition. Attempts to rehabilitate these patients are often futile because conventional exercise-training modalities are limited by the severity of exertional dyspnea. Therefore, there is substantial interest in new training modalities that do not evoke dyspnea, such as transcutaneous neuromuscular electrical stimulation (NMES). In this article, we systematically review the literature that addresses the effects of NMES applied to the muscles of ambulation. We focused on the effects of NMES on strength, exercise capacity, and disease-specific health status in patients with CHF or COPD. We also address the methodological quality of the reported studies as well as the safety of NMES. Manuscripts published prior to December 2007 were identified by searching the Medline/PubMed, Embase, Cochrane Controlled Trials Register, CINAHL, and Physiotherapy Evidence Database (PEDro) databases. Fourteen trials were identified (nine trials that examined NMES in CHF patients, and five in COPD patients). PEDro scores for methodological quality of the trials were generally moderate to good. Many of the studies reported significant improvements in muscle strength, exercise capacity, and/or health status. Nonetheless, the limited number of studies, the disparity in patient populations, and the variability in NMES methodology prohibit the use of metaanalysis. Yet, from the viewpoint of a systematic review, NMES looks promising as a means of rehabilitating patients with CHF and COPD. There is at least sufficient evidence to warrant more large prospective, randomized, controlled trials.

  11. An outpatient, ambulant-design, controlled human infection model using escalating doses of Salmonella Typhi challenge delivered in sodium bicarbonate solution.

    Science.gov (United States)

    Waddington, Claire S; Darton, Thomas C; Jones, Claire; Haworth, Kathryn; Peters, Anna; John, Tessa; Thompson, Ben A V; Kerridge, Simon A; Kingsley, Robert A; Zhou, Liqing; Holt, Kathryn E; Yu, Ly-Mee; Lockhart, Stephen; Farrar, Jeremy J; Sztein, Marcelo B; Dougan, Gordon; Angus, Brian; Levine, Myron M; Pollard, Andrew J

    2014-05-01

    Typhoid fever is a major global health problem, the control of which is hindered by lack of a suitable animal model in which to study Salmonella Typhi infection. Until 1974, a human challenge model advanced understanding of typhoid and was used in vaccine development. We set out to establish a new human challenge model and ascertain the S. Typhi (Quailes strain) inoculum required for an attack rate of 60%-75% in typhoid-naive volunteers when ingested with sodium bicarbonate solution. Groups of healthy consenting adults ingested escalating dose levels of S. Typhi and were closely monitored in an outpatient setting for 2 weeks. Antibiotic treatment was initiated if typhoid diagnosis occurred (temperature ≥38°C sustained ≥12 hours or bacteremia) or at day 14 in those remaining untreated. Two dose levels (10(3) or 10(4) colony-forming units) were required to achieve the primary objective, resulting in attack rates of 55% (11/20) or 65% (13/20), respectively. Challenge was well tolerated; 4 of 40 participants fulfilled prespecified criteria for severe infection. Most diagnoses (87.5%) were confirmed by blood culture, and asymptomatic bacteremia and stool shedding of S. Typhi was also observed. Participants who developed typhoid infection demonstrated serological responses to flagellin and lipopolysaccharide antigens by day 14; however, no anti-Vi antibody responses were detected. Human challenge with a small inoculum of virulent S. Typhi administered in bicarbonate solution can be performed safely using an ambulant-model design to advance understanding of host-pathogen interactions and immunity. This model should expedite development of diagnostics, vaccines, and therapeutics for typhoid control.

  12. An Outpatient, Ambulant-Design, Controlled Human Infection Model Using Escalating Doses of Salmonella Typhi Challenge Delivered in Sodium Bicarbonate Solution

    Science.gov (United States)

    Waddington, Claire S.; Darton, Thomas C.; Jones, Claire; Haworth, Kathryn; Peters, Anna; John, Tessa; Thompson, Ben A. V.; Kerridge, Simon A.; Kingsley, Robert A.; Zhou, Liqing; Holt, Kathryn E.; Yu, Ly-Mee; Lockhart, Stephen; Farrar, Jeremy J.; Sztein, Marcelo B.; Dougan, Gordon; Angus, Brian; Levine, Myron M.; Pollard, Andrew J.

    2014-01-01

    Background. Typhoid fever is a major global health problem, the control of which is hindered by lack of a suitable animal model in which to study Salmonella Typhi infection. Until 1974, a human challenge model advanced understanding of typhoid and was used in vaccine development. We set out to establish a new human challenge model and ascertain the S. Typhi (Quailes strain) inoculum required for an attack rate of 60%–75% in typhoid-naive volunteers when ingested with sodium bicarbonate solution. Methods. Groups of healthy consenting adults ingested escalating dose levels of S. Typhi and were closely monitored in an outpatient setting for 2 weeks. Antibiotic treatment was initiated if typhoid diagnosis occurred (temperature ≥38°C sustained ≥12 hours or bacteremia) or at day 14 in those remaining untreated. Results. Two dose levels (103 or 104 colony-forming units) were required to achieve the primary objective, resulting in attack rates of 55% (11/20) or 65% (13/20), respectively. Challenge was well tolerated; 4 of 40 participants fulfilled prespecified criteria for severe infection. Most diagnoses (87.5%) were confirmed by blood culture, and asymptomatic bacteremia and stool shedding of S. Typhi was also observed. Participants who developed typhoid infection demonstrated serological responses to flagellin and lipopolysaccharide antigens by day 14; however, no anti-Vi antibody responses were detected. Conclusions. Human challenge with a small inoculum of virulent S. Typhi administered in bicarbonate solution can be performed safely using an ambulant-model design to advance understanding of host–pathogen interactions and immunity. This model should expedite development of diagnostics, vaccines, and therapeutics for typhoid control. PMID:24519873

  13. Associations of short-term exposure to ambient air pollutants with emergency ambulance calls for the exacerbation of essential arterial hypertension.

    Science.gov (United States)

    Vencloviene, Jone; Braziene, Agne; Dedele, Audrius; Lopatiene, Kristina; Dobozinskas, Paulius

    2017-12-01

    We investigated the association between daily emergency ambulance calls (EAC) for elevated blood pressure that occurred during the time intervals of 8:00-13:59, 14:00-21:59, and 22:00-7:59, and exposure to CO, PM10, and ozone. We used Poisson regression to explore the association between the risk of EAC and short-term variation of pollutants, adjusting for seasonality and weather variables. Before noon, the risk was associated with an interquartile range (IQR) (7.9 μg/m3) increase in PM10 at lag 2-4 days below the median (RR = 1.08, p = 0.031) and with an IQR (0.146 mg/m3) increase in CO at lag 6-7 below the median (RR = 1.05, p = 0.028). During 14:00-21:59, the risk was associated with an IQR (18.8 μg/m3) increase in PM10 on the previous day below the median (RR = 1.04, p = 0.031). At night, EAC were negatively affected by lower O3 (lag 0-2) below the median (per IQR decrease RR = 1.10, p = 0.018) and a higher PM10 at lag 0-1 above the median for the elderly (RR = 1.07, p = 0.030).

  14. Robot-assisted gait training improves brachial-ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation: Randomized controlled trial.

    Science.gov (United States)

    Han, Eun Young; Im, Sang Hee; Kim, Bo Ryun; Seo, Min Ji; Kim, Myeong Ok

    2016-10-01

    Brachial-ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone. The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention. Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group. Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke.

  15. Robot-assisted gait training improves brachial–ankle pulse wave velocity and peak aerobic capacity in subacute stroke patients with totally dependent ambulation

    Science.gov (United States)

    Han, Eun Young; Im, Sang Hee; Kim, Bo Ryun; Seo, Min Ji; Kim, Myeong Ok

    2016-01-01

    Abstract Objective: Brachial–ankle pulse wave velocity (baPWV) evaluates arterial stiffness and also predicts early outcome in stroke patients. The objectives of this study were to investigate arterial stiffness of subacute nonfunctional ambulatory stroke patients and to compare the effects of robot-assisted gait therapy (RAGT) combined with rehabilitation therapy (RT) on arterial stiffness and functional recovery with those of RT alone. Method: The RAGT group (N = 30) received 30 minutes of robot-assisted gait therapy and 30 minutes of conventional RT, and the control group (N = 26) received 60 minutes of RT, 5 times a week for 4 weeks. baPWV was measured and calculated using an automated device. The patients also performed a symptom-limited graded exercise stress test using a bicycle ergometer, and parameters of cardiopulmonary fitness were recorded. Clinical outcome measures were categorized into 4 categories: activities of daily living, balance, ambulatory function, and paretic leg motor function and were evaluated before and after the 4-week intervention. Results: Both groups exhibited significant functional recovery in all clinical outcome measures after the 4-week intervention. However, peak aerobic capacity, peak heart rate, exercise tolerance test duration, and baPWV improved only in the RAGT group, and the improvements in baPWV and peak aerobic capacity were more noticeable in the RAGT group than in the control group. Conclusion: Robot-assisted gait therapy combined with conventional rehabilitation therapy represents an effective method for reversing arterial stiffness and improving peak aerobic capacity in subacute stroke patients with totally dependent ambulation. However, further large-scale studies with longer term follow-up periods are warranted to measure the effects of RAGT on secondary prevention after stroke. PMID:27741123

  16. Violence-related ambulance call-outs in the North West of England: a cross-sectional analysis of nature, extent and relationships to temporal, celebratory and sporting events.

    Science.gov (United States)

    Quigg, Zara; McGee, Ciara; Hughes, Karen; Russell, Simon; Bellis, Mark A

    2017-06-01

    The aim of this study was to explore the potential of ambulance call-out data in understanding violence to inform about prevention activity. This cross-sectional (2013-2015) study examined the nature, extent and characteristics of violence-related ambulance call-outs (n=15 687) across North West England and relationships with temporal, celebratory and sporting events. The majority of call-outs were for men, with a mean age of 33 years. Most call-outs were to deprived (64.4%) and urban (65.4%) areas and occurred at night (18:00-5:59; 75.2%). Three-quarters (77.3%) were recorded as assault/sexual assault and 22.7% stab/gunshot/penetrating trauma. Significant differences in call-out characteristics were identified between the two violence types. Generalised linear modelling found that call-outs significantly increased on weekends, New Year's Eve and weekday bank holiday eves (except for stab/gunshot/penetrating trauma). No significant associations between all violence call-outs, the two violence categories and sporting or celebration events were identified. Two-thirds (66.1%) of the call-outs were transferred to another health service for further assessment and/or treatment. The odds of being transferred were significantly higher among men (adjusted OR (AOR) 1.5, 95%CI 1.4 to 1.6), those aged 13-24 years (AOR 1.2, 95%CI 1.0 to 1.4), call-outs for stab/gunshot/penetrating trauma (AOR 1.4, 95%CI 1.3 to 1.5) and call-outs on Fridays/Saturdays (AOR 1.1, 95%CI 1.0 to 1.2) and lower for call-outs on New Year's Eve (AOR 0.6, 95%CI 0.4 to 0.9). Ambulance call-out data can provide a wealth of information to understand violence and subsequently inform about violence prevention and response activity. Ambulance services and staff could play a key role in preventing violence through sharing data and identifying and supporting victims. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is

  17. Assessment of Mobility in Older People Hospitalized for Medical Illness Using de Morton Mobility Index and Cumulated Ambulation Score-Validity and Minimal Clinical Important Difference.

    Science.gov (United States)

    Trøstrup, Jeanette; Andersen, Helle; Kam, Charlotte Agger Meiner; Magnusson, S Peter; Beyer, Nina

    2017-12-15

    Older adults acutely hospitalized for medical illness typically have comorbidity and disability, and inhospital physical inactivity greatly increases the likelihood of developing new disability. Thus, assessment of the patients' mobility status is crucial for planning and carrying out targeted interventions that ensure mobilization during hospital admission. The aim of this study was to determine convergent validity, known group validity, floor and ceiling effects, and anchor-based minimal clinically important difference (MCID) of the more time-consuming de Morton Mobility Index (DEMMI) and the less time-consuming Cumulated Ambulation Score (CAS) in older adults acutely hospitalized for medical illness. In this multicenter cohort study, 235 older hospitalized adults, with a mean (standard deviation) age of 84.8 (7.1) years, were consecutively included. Assessments of mobility using the DEMMI (score range 0-100), the CAS (score range 0-6), and the Barthel Index (BI, score range 0-100) were performed by physical or occupational therapists at hospital admission and discharge. In addition, at discharge patients and therapists were independently asked to assess the patients' current mobility status compared with their mobility status at hospital admission using the Global Rating of Change scale. Complete data sets were obtained for 155 patients. Baseline characteristics of those with complete data sets did not differ from those with incomplete data sets, except for the number of secondary diagnoses, which was lower in the latter. Significant and moderate relationships existed both at admission and at discharge between scores in the DEMMI and the BI (rs = 0.68, P mobility and can be considered to have the required properties for measuring mobility in older adults who are hospitalized in medical and geriatric wards. In contrast, the CAS appears to be appropriate to identify whether a patient is independently mobile or needs assistance, while the measure is less suitable

  18. Proportion recovery and times to ambulation for non-ambulatory dogs with thoracolumbar disc extrusions treated with hemilaminectomy or conservative treatment: A systematic review and meta-analysis of case-series studies.

    Science.gov (United States)

    Langerhuus, L; Miles, J

    2017-02-01

    Thoracolumbar intervertebral disc extrusion is a common cause of spinal cord dysfunction in dogs. Peer-reviewed studies reporting treatment of predominantly chondrodystrophic dogs with disc extrusion with loss of ambulation with either hemilaminectomy or conservative treatment (rest, analgesics and anti-inflammatories) were evaluated in a systematic review of the literature. Generally, the level of evidence available was low with no controlled studies and only case series available. In the meta-analysis, there was a clear trend to a greater proportion of dogs recovering and returning faster to ambulation for dogs treated with hemilaminectomy than for conservatively treated dogs. The mean proportions that recovered for neurological grades 3, 4 and 5 were 93, 93 and 61% for those treated with hemilaminectomy, and 79, 62 and 10% for those treated conservatively (Grade 3 - non-ambulatory paraparetic dogs; grade 4 - paraplegic dogs with intact deep pain perception; grade 5 - paraplegic dogs without intact deep pain perception). Due to the use of case series, these results represent between-study comparisons, thereby increasing the risk of selection bias and other biases. Data presented in this review support the current recommendations for surgical management of non-ambulatory dogs with disc-extrusion, but controlled clinical studies comparing outcomes are necessary to confirm these findings. Copyright © 2016 Elsevier Ltd. All rights reserved.

  19. Occupational accidents among ambulance drivers in the emergency relief Accidentes del trabajo de conductores de ambulancia que brindan atención de urgencia Acidentes de trabalho com motoristas de ambulâncias que realizam socorro de urgência

    Directory of Open Access Journals (Sweden)

    Elisabete Takeda

    2007-06-01

    Full Text Available We analyzed the occurrence of occupational accidents (OA among ambulance drivers in Emergency Relief (ER, with a view to disclosing the types of events and their causes. A quantitative-qualitative study was carried out through the interview of 22 workers in a city in São Paulo, Brazil. The subjects were male, between 36 and 40 years old (40.9%, married (81.82%, with uncompleted primary education (40.9%, individual (90.9% and family (54.55% income between two and four Brazilian minimum wages, not performing any other paid occupation (45.45%. The majority of the OA were typical, due to an excess of exercises and vigorous and repeated movements (42.11% and aggression through body strength and other means (26.33%. The OA occurs mainly because drivers carry out tasks that do not suit their professional formation.Fue estudiada la frecuencia de accidentes del trabajo (AT con chóferes de ambulancia que brinda Atención de Urgencia (AU, buscando encontrar los tipos de accidentes y sus causas. La investigación fue cuanti-cualitativa, para lo cual fueron entrevistados 22 trabajadores de una ciudad en el Estado de São Paulo. Los sujetos eran de sexo masculino, con edades entre 36 y 40 años (40,9%, casados (81,82%, con educación primaria incompleta (40,9%, sueldo individual (90,9%, sueldo familiar (54,55% entre dos y cuatro sueldos mínimos y sin otra ocupación (45,45%. La gran mayoría de los AT fueron típicos, por exceso de ejercicios, movimientos enérgicos y repetidos (42,11% y daño por fuerza corporal y otras formas (26,33%. Los AT se dieron principalmente porque los chóferes realizaban actividades que no iban de acuerdo con su formación profesional.Estudou-se a ocorrência de acidentes de trabalho (AT com motoristas de ambulância que realizam Socorro de Urgência (SU, buscando evidenciar os tipos desses eventos e suas causas. A investigação foi quanti-qualitativa, entrevistando-se 22 trabalhadores que atuam em uma cidade paulista. Os

  20. Evaluation of the effects of botulinum toxin A injections when used to improve ease of care and comfort in children with cerebral palsy whom are non-ambulant: a double blind randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Thorley Megan

    2012-08-01

    Full Text Available Abstract Background Children with cerebral palsy (CP whom are non-ambulant are at risk of reduced quality of life and poor health status. Severe spasticity leads to discomfort and pain. Carer burden for families is significant. This study aims to determine whether intramuscular injections of botulinum toxin A (BoNT-A combined with a regime of standard therapy has a positive effect on care and comfort for children with CP whom are non-ambulant (GMFCS IV/V, compared with standard therapy alone (cycle I, and whether repeated injections with the same regime of adjunctive therapy results in greater benefits compared with a single injecting episode (cycle II. The regime of therapy will include serial casting, splinting and/or provision of orthoses, as indicated, combined with four sessions of goal directed occupational therapy or physiotherapy. Method/design This study is a double blind randomized controlled trial. Forty participants will be recruited. In cycle I, participants will be randomized to either a treatment group who will receive BoNT-A injections into selected upper and/or lower limb muscles, or a control group who will undergo sham injections. Both groups will receive occupational therapy and /or physiotherapy following injections. Groups will be assessed at baseline then compared at 4 and 16 weeks following injections or sham control. Parents, treating clinicians and assessors will be masked to group allocation. In cycle II, all participants will undergo intramuscular BoNT-A injections to selected upper and/or lower limb muscles, followed by therapy. The primary outcome measure will be change in parent ratings in identified areas of concern for their child’s care and comfort, using the Canadian Occupational Performance Measure (COPM. Secondary measures will include the Care and Comfort Hypertonicity Scale (ease of care, the Cerebral Palsy Quality of Life Questionnaire (CP QoL–Child (quality of life, the Caregiver Priorities and Child

  1. Chest Compression Fraction between Mechanical Compressions on a Reducible Stretcher and Manual Compressions on a Standard Stretcher during Transport in Out-of-Hospital Cardiac Arrests: The Ambulance Stretcher Innovation of Asian Cardiopulmonary Resuscitation (ASIA-CPR) Pilot Trial.

    Science.gov (United States)

    Kim, Tae Han; Shin, Sang Do; Song, Kyoung Jun; Hong, Ki Jeong; Ro, Young Sun; Song, Sung Wook; Kim, Chu Hyun

    2017-01-01

    Cardiopulmonary resuscitation (CPR) with the use of mechanical devices is recommended during ambulance transport. However, the CPR quality en route and while in transfer to the emergency department (ED) for out-of-hospital cardiac arrests (OHCAs) remains uncertain. We developed a mechanical CPR device outfitted on a reducible stretcher (M-CPR) and compared with standard manual CPR on a standard stretcher (S-CPR) to evaluate CPR quality. Adult OHCAs transported by five ambulances in a metropolitan area with a population of 3.5 million (many of whom lived in high-rise buildings) from September to October (before-phase) and November to December (after-phase) in 2015 were collected. The reducible stretcher was developed for use in a small elevator during the transfer from scene to ambulance, and the AutoPulse® (ZOLL Medical, Chelmsford, MA, USA) was used for M-CPR. Chest compression fraction (CCF) was measured by transthoracic impedance data using an X-series® cardiac monitor (ZOLL Medical) during time from attachment to patient to arrival to the ED. A comparison of CCF using a Wilcoxon signed-rank test evaluated the difference between the before- and after-phases. Of the eligible 49 OHCAs, 31 (21 in the before-phase and 10 in the after-phase) were analyzed, excluding patients for whom CCF was not measured, for whom M-CPR was not used, who had a return of spontaneous circulation in the field before transport, or who collapsed during transport. There were no differences in demographic data. Median total CCF (median, q1-q3) was significantly higher in the after-phase M-CPR group (85.2, 83.4-86.3) than in the before-phase S-CPR group (80.1, 68.0-85.2) (p = 0.03). Mechanical CPR on the reducible stretcher during the transport of OHCAs to the ED showed a much higher chest compression fraction than standard manual CPR.

  2. GRIN: “GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial”: study protocol

    Science.gov (United States)

    2014-01-01

    Background Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. Methods/Design An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child’s occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. Discussion This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised

  3. GRIN: "GRoup versus INdividual physiotherapy following lower limb intra-muscular Botulinum Toxin-A injections for ambulant children with cerebral palsy: an assessor-masked randomised comparison trial": study protocol.

    Science.gov (United States)

    Thomas, Rachel E; Johnston, Leanne M; Boyd, Roslyn N; Sakzewski, Leanne; Kentish, Megan J

    2014-02-07

    Cerebral palsy is the most common cause of physical disability in childhood. Spasticity is a significant contributor to the secondary impairments impacting functional performance and participation. The most common lower limb spasticity management is focal intramuscular injections of Botulinum Toxin-Type A accompanied by individually-delivered (one on one) physiotherapy rehabilitation. With increasing emphasis on improving goal-directed functional activity and participation within a family-centred framework, it is timely to explore whether physiotherapy provided in a group could achieve comparable outcomes, encouraging providers to offer flexible models of physiotherapy delivery. This study aims to compare individual to group-based physiotherapy following intramuscular Botulinum Toxin-A injections to the lower limbs for ambulant children with cerebral palsy aged four to fourteen years. An assessor-masked, block randomised comparison trial will be conducted with random allocation to either group-based or individual physiotherapy. A sample size of 30 (15 in each study arm) will be recruited. Both groups will receive six hours of direct therapy following Botulinum Toxin-A injections in either an individual or group format with additional home programme activities (three exercises to be performed three times a week). Study groups will be compared at baseline (T1), then at 10 weeks (T2, efficacy) and 26 weeks (T3, retention) post Botulinum Toxin-A injections. Primary outcomes will be caregiver/s perception of and satisfaction with their child's occupational performance goals (Canadian Occupational Performance Measure) and quality of gait (Edinburgh Visual Gait Score) with a range of secondary outcomes across domains of the International Classification of Disability, Functioning and Health. This paper outlines the study protocol including theoretical basis, study hypotheses and outcome measures for this assessor-masked, randomised comparison trial comparing group versus

  4. Enhancement of a prosthetic knee with a microprocessor-controlled gait phase switch reduces falls and improves balance confidence and gait speed in community ambulators with unilateral transfemoral amputation.

    Science.gov (United States)

    Fuenzalida Squella, Sara Agueda; Kannenberg, Andreas; Brandão Benetti, Ângelo

    2017-07-01

    Despite the evidence for improved safety and function of microprocessor stance and swing-controlled prosthetic knees, non-microprocessor-controlled prosthetic knees are still standard of care for persons with transfemoral amputations in most countries. Limited feature microprocessor-control enhancement of such knees could stand to significantly improve patient outcomes. To evaluate gait speed, balance, and fall reduction benefits of the new 3E80 default stance hydraulic knee compared to standard non-microprocessor-controlled prosthetic knees. Comparative within-subject clinical study. A total of 13 young, high-functioning community ambulators with a transfemoral amputation underwent assessment of performance-based (e.g. 2-min walk test, timed ramp/stair tests) and self-reported (e.g. falls, Activities-Specific Balance Confidence scale, Prosthesis Evaluation Questionnaire question #1, Satisfaction with the Prosthesis) outcome measures for their non-microprocessor-controlled prosthetic knees and again after 8 weeks of accommodation to the 3E80 microprocessor-enhanced knee. Self-reported falls significantly declined 77% ( p = .04), Activities-Specific Balance Confidence scores improved 12 points ( p = .005), 2-min walk test walking distance increased 20 m on level ( p = .01) and uneven ( p = .045) terrain, and patient satisfaction significantly improved ( p knee. Slope and stair ambulation performance did not differ between knee conditions. The 3E80 knee reduced self-reported fall incidents and improved balance confidence. Walking performance on both level and uneven terrains also improved compared to non-microprocessor-controlled prosthetic knees. Subjects' satisfaction was significantly higher than with their previous non-microprocessor-controlled prosthetic knees. The 3E80 may be considered a prosthetic option for improving gait performance, balance confidence, and safety in highly active amputees. Clinical relevance This study compared

  5. The Barthel Index and the Cumulated Ambulation Score are superior to the de Morton Mobility Index for the early assessment of outcome in patients with a hip fracture admitted to an acute geriatric ward.

    Science.gov (United States)

    Hulsbæk, Signe; Larsen, Rikke Faebo; Rosthøj, Susanne; Kristensen, Morten Tange

    2018-01-15

    To examine clinimetric properties of the de Morton Mobility Index (DEMMI) in patients with hip fracture in comparison with the modified Barthel Index (BI), Cumulated Ambulation Score (CAS), and 30-s Chair Stand Test (30-s CST). Two hundred and twenty two patients with a hip fracture admitted to a geriatric ward following surgery were assessed on day 1 and at discharge (mean of 9 [SD 5.1] post-surgery days). Ninety eight percent and 89% of patients were not able to perform the 30-s CST at baseline and at discharge (large floor effect), respectively. Corresponding floor effects were 39% and 31% for DEMMI, 12% and 5% for BI, and 22% and 6%, respectively, for CAS. Convergent validity was strong between DEMMI and CAS (r = 0.76, 95% CI: 0.69-0.81), and moderate between DEMMI and BI (r = 0.58, 95% CI: 0.48-0.66) and CAS and BI (r = 0.49, 95% CI: 0.39-0.59). Responsiveness, as indicated by the effect size was 0.76 for DEMMI, 1.78 for BI and 1.04 for CAS. Baseline scores of DEMMI, BI, and CAS showed similar properties in predicting discharge destination of patients from own home. The value of using DEMMI and 30-s CST in patients with hip fracture during the acute hospitalization seems limited in comparison with BI and CAS. DEMMI and CAS seem to assess similar constructs. Implications for Rehabilitation Outcome measures used for the evaluation of patients with hip fracture should be validated in the specific time-line and rehabilitation setting following surgery, before being implemented in daily clinical practice. We suggest the Cumulated Ambulation Score for monitoring basic mobility during the acute hospitalization for the entire group of patients recovering from a hip fracture, while DEMMI seems more feasible for the subgroup of patients with higher functional levels. The modified Barthel Index seems useful for the assessment of activities of daily living in the acute care setting of patients with hip fracture. We cannot recommend the original 30-s Chair

  6. Effect of High-Dose Vitamin D3 Intake on Ambulation, Muscular Pain and Bone Mineral Density in a Woman with Multiple Sclerosis: A 10-Year Longitudinal Case Report

    Directory of Open Access Journals (Sweden)

    François Feron

    2012-10-01

    Full Text Available Mounting evidence correlate vitamin D3 (cholecalciferol supplementation or higher serum levels of vitamin D (25(OHD with a lower risk of developing multiple sclerosis (MS, reduced relapse rate, slower progression or fewer new brain lesions. We present here the case of a woman who was diagnosed with MS in 1990. From 1980 to 2000, her ability to walk decreased from ~20 to 1 km per day. Since January 2001, a vitamin D3 supplement was ingested daily. The starting dose was 20 mcg (800 IU/day and escalated to 100 mcg (4000 IU/day in September 2004 and then to 150 mcg (6000 IU/day in December 2005. Vitamin D3 intake reduced muscular pain and improved ambulation from 1 (February 2000 to 14 km/day (February 2008. Vitamin D intake over 10 years caused no adverse effects: no hypercalcaemia, nephrolithiasis or hypercalciuria were observed. Bowel problems in MS may need to be addressed as they can cause malabsorption including calcium, which may increase serum PTH and 1,25(OH2D levels, as well as bone loss. We suggest that periodic assessment of vitamin D3, calcium and magnesium intake, bowel problems and the measurement of serum 25(OHD, PTH, Ca levels, UCa/Cr and bone health become part of the integral management of persons with MS.

  7. Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial.

    Science.gov (United States)

    Thomas, Rachel E; Johnston, Leanne M; Sakzewski, Leanne; Kentish, Megan J; Boyd, Roslyn N

    2016-01-01

    This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; pphysiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. [Palliative home care in Westfalia-Lippe--baseline study 12 and 36 months after coming into effect of the "agreement to the implementation of ambulant home palliative careforterminally ill patients"].

    Science.gov (United States)

    Lux, E A; Althaus, A; Classen, B; Hilscher, H; Hofmeister, U; Holtappels, P; Mansfeld-Nies, R; Weller, H U

    2013-07-25

    On 2009-04-01 the Association of Statutory Health Insurance Physicians Westfalia-Lippe and health insurance organizations made an agreement to implement palliative home care for terminally ill patients. Based on this agreement, family doctors and palliativecardoctorscooperate,supported by coordinators. 12 and 36 months after coming into effect of the agreement a questionnaire was sent to the regional palliative care networks to collect data about supply structure, number of patients and their place of death. In the year 2011 85,410 people died in Westfalia-Lippe, 9.0% of them were included in palliative care structures. 69.5% of the included patients died at home, 9.9% in hospital (in 2010: 68.7% at home, 14.7% in hospital). A correlation between the population density or the number of included patients per palliative networkcould not be detected. Low-threshold access to palliative care networks(bothfamilydoctorand patientcancontact the palliative care team at any time) improves ambulant palliative care. Non-bureaucratic change from general home palliative care (German abbreviation: AAPV) to specialized home palliative care (SAPV) has proven successful in Westfalia-Lippe. Well-trained and experienced coordinators guarantee multidisciplinary and multiprofessional working of palliative care teams. In order to enhance palliative care in Westfalia-Lippe, data for quality assurance should be defined, periodically collected and evaluated in the future.

  9. Motivācija tālākizglītības programmu apmeklējumiem ambulatorās māsas pamatspecialitātē

    OpenAIRE

    Daniele-Plandere, Lauma

    2017-01-01

    Bakalaura darba tēma „Motivācija tālālizglītības pasākumu apmeklējumiem ambulatorās māsas pamatspecialitātē.” Tēmas aktualitāti nosaka primārās veselības aprūpes kvalitātes atkarība no tālākizglītoties motivēta aprūpes personāla. Ir svarīgi noskaidrot, kāda ir ambulatoro māsu motivācija tālākizglītoties. Darba mērķis ir noskaidrot ambulatoro māsu motivāciju tālākizglītības kursu apmeklējumiem. Pētniecības jautājums: Kāda ir amulatoro māsu motivācija tālākizglītības pasāk...

  10. The European Union and nuclear safety; Die EU und die nukleare Sicherheit

    Energy Technology Data Exchange (ETDEWEB)

    Raetzke, Christian [CONLAR Consulting on Nuclear Law and Regulation, Leipzig (Germany)

    2014-02-15

    In recent years the EU Commission has developed a range of activities in the area of nuclear safety. Currently, the Commission has submitted a draft Directive revising the Nuclear Safety Directive 2009/71 to the Council. It seems that this draft text will undergo substantial changes in the course of Council deliberations and it is not clear yet whether any revision of the Directive will be adopted at all. The article shortly explains the background and the history of EU legislative activities in nuclear safety - a history which has been somewhat less than straightforward and has not yet reached its final chapter. The Commission's endeavours to introduce meaningful legislation have always met resistance from Member States determined to protect their sovereignty in this area. A decisive handicap for the Commission in this struggle certainly is the fact that it does not have a sufficient degree of in-house expertise in nuclear safety. Unless this is changed by upgrading and empowering the Commission to become a 'super-regulatory authority' - which seems to be very unlikely -, the Commission will have to resign itself to contribute to the further development of nuclear safety by closely cooperating with the Member States and their regulators. In any case, this can be a very effective and meaningful role. (orig.)

  11. Safety requirements to the operation of hydropower plants; Sicherheit beim Betrieb von Wasserkraftwerken

    Energy Technology Data Exchange (ETDEWEB)

    Lux, Reinhard [Berufsgenossenschaft Energie Textil Elektro Medienerzeugnisse (BG ETEM), Koeln (Germany)

    2011-07-01

    Employers have to take into account various safety and health requirements relating to the design, construction, operation and maintenance of hydropower plants. Especially the diversity of the hydropower plant components requires the consideration of different safety and health aspects. In 2011 the ''Fachausschuss Elektrotechnik'' (expert committee electro-technics) of the institution for statutory accident insurance and prevention presented a new ''BG-Information'' dealing with ''Safe methods operating hydropower plants''. The following article gives an introduction into the conception and the essential requirements of this new BG-Information. (orig.)

  12. Safety during diathermy and microwave application; Sicherheit bei Diathermie und Mikrowellenanwendung

    Energy Technology Data Exchange (ETDEWEB)

    Molla-Djafari, H. [Allgemeine Unfallversicherungsanstalt, Wien (Austria)

    2004-07-01

    Diathermy appliances are used for therapeutic purposes in physical medicine with the aim of warming up the deeper layers of the treated parts of the body. In this investigation, the electromagnetic fields of 34 diathermy devices in 12 medical institutions were examined, and the occupational radiation exposure of the medical staff was evaluated on the basis of the Austrian Standard OeNORM S1120. The whole body exposure in each measurement position was calculated. 17 short-wave diathermy appliances with a frequency of 27,12 MHz were tested. 15 of them showed exceeded electric and/or magnetic field intensity limits within the operating personnel's manipulation area near the appliances. The maximum whole body exposure value measured amounted to 41200% of the limit value (i.e. 412 times the limit value.). Furthermore, 13 decimetre diathermy appliances of a frequency of 433.92 MHz were tested. Only in one case, the whole body exposure limit was exceeded (1.1 time the limit value). At the 4 tested microwave diathermy appliances (frequency 2.450 GHz), the whole body exposure limits were not exceeded. (orig.)

  13. Safety in the stress field involving man and production. Sicherheit im Spannungsfeld von Mensch und Produktion

    Energy Technology Data Exchange (ETDEWEB)

    Mieles, K.

    1991-03-14

    Modern production systems are characterised by continuous innovative adaptations and improvements. They do not permit adequate preparation of vocational training in the phase between school and job. Only a basis extending to basic skills, basic knowledge and attitude to work can thus be secured in the training. However, knowledge of work and work experience should be added to the technical and social skills for the work input in order to achieve higher qualification by technical competence, system competence and social competence. It is essential to include safety as an integrated part of the training. Consequently safety and social skills, which in subsequent work input constitute the prerequisites to enable safety to compete with the other production aims, could be acquired in this way. The time taken to acquire a far higher qualification, viz. risk competence, is thus also inevitably shortened. Risk competence is understood to mean the ability to perceive risks and organise all behaviour in the sense of rational prevention of danger. However, human behaviour is determined by the readiness to accept risks and the assessment of risks. As no technology can be utilised without risks, either the readiness to accept risks or their assessment or preferably both must be changed to reduce the accident rate. The school records of the trainees offer good prerequisites for basic knowledge; the youthful age of the work force of 34 years on average suggests that the higher qualification has not yet been achieved in many sectors as a result of the change of generation. There is thus still imbalance between the force fields of the workplaces and the employees. However, a balanced condition can be achieved only if this development takes place gradually in stages in which the technical, organisational and personnel aspects are controllable. (orig.).

  14. Technique, driving dynamics and safety of modern motorcycles. Technik, Fahrdynamik und Sicherheit moderner Motorraeder

    Energy Technology Data Exchange (ETDEWEB)

    Weidele, A.; Breuer, B.

    1989-09-01

    Modern motorcycles demonstrate a fascinating variety of configurations and technical elements, which by continuous development (for example ABS) have led to significantly higher levels of driving stability and safety. There is still much room for further improvements and potentials on the side of the motorcycle itself (for example curve braking, airbag), the road surface, traffic facilities (guard rails) and other traffic participants (partnerprotection). The Automotive Engineering Department of Darmstadt University (FZD) is engaged in motorcycle research and reports on new motorcycle technique and research findings. (orig.).

  15. An evaluator-blinded randomized controlled trial evaluating therapy effects and prognostic factors for a general and an individually defined physical therapy program in ambulant children with bilateral spastic cerebral palsy.

    Science.gov (United States)

    Franki, I; Desloovere, K; De Cat, J; Tijhuis, W; Molenaers, G; Feys, H; Vanderstraeten, G; Van Den Broeck, C

    2015-12-01

    Cerebral palsy (CP) is characterized by a heterogeneous nature with a variety of problems. Therefore, individualized physical therapy might be more appropriate to address the needs for these children. The first aim was to compare the effectiveness of an individually-defined therapy program (IT) and a general therapy program (GT) on gait and gross motor function in children with CP. The second aim was to evaluate interaction-effects, time-effects, treatment with botulinum toxin A, age, gross Motor Function Classification Scale (GMFCS), treatment frequency and quality as factors influencing outcome. An evaluator-blinded, randomized controlled trial. Outpatient rehabilitation unit. Forty ambulant children with spastic bilateral CP (mean age 6 years 1 month). All children were randomly assigned to receive either IT or GT over a 10 week period. Nineteen of these children were enrolled into a second and/or third program, resulting in 60 interventions. Primary outcome was assessed with the Goal Attainment Scale (GAS) for gross motor function goals and z-scores for goals based on specific 3D gait parameters. Secondary outcome included the Gross Motor Function Measure-88 (GMFM-88) scores, time and distance gait parameters, Gait Profile Score, Movement Analysis Profiles and time needed to complete Timed-Up-and-Go and Five-Times-Sit-To-Stand tests. There were higher, but non-significant GAS and z-score changes following the IT program compared to the GT program (GAS: 46.2 for the IT versus 42.2 for the GT group, P=0.332, ES 0.15; z-score: 0.135 for the IT compared to 0.072 for the GT group, P=0.669, ES 0.05). Significant time-effects could be found on the GAS (P<0.001) and the GMFM-88 total score (P<0.001). Age was identified as a predictor for GAS and GMFM-88 improvement (P=0.023 and P=0.044). No significant differences could be registered between the effects of the IT and the GT. The favorable outcome after the IT program was only a trend and needs to be confirmed on larger

  16. Ambulant ST-segmentmonitorering efter akut myokardieinfarkt

    DEFF Research Database (Denmark)

    Mickley, H; Junker, A; Friis, E V

    1994-01-01

    Over the last decade the concept of silent myocardial ischaemia has received considerable attention. Without doubt, the increased use of ambulatory ST-segment monitoring is the most important reason for the growing interest in this field. The prevalence of ambulatory ischaemia after myocardial in...

  17. Ambulant cognitive assessment using a smartphone.

    Science.gov (United States)

    Timmers, Corrie; Maeghs, Anne; Vestjens, Michiel; Bonnemayer, Charlie; Hamers, Huub; Blokland, Arjan

    2014-01-01

    The focus of neuropsychology is to understand the relationship between assessment results and everyday cognitive abilities and disabilities. However, the generalizability of traditional neuropsychological tests to real-life behaviors, the ecological validity, is compromised by the test environment, among other things. Neuropsychological tests are often completed in a laboratory setting that is typically quiet with few distractions. This is very unlike most everyday environments. The aim of the present study was to investigate the possibility of using a smartphone in standardized cognitive assessment. A short-term memory task was obtained from young adults in either an everyday-life environment or a controlled test setting at four time points during a day. Results show no significant differences between the task performances in both conditions. There was no indication that fatigue, tension, or environmental noise had an effect on task performance. High correlations between subsequent time points were found in the everyday-life environment, suggesting a high test-retest reliability and commitment of the participants. The present study demonstrates that smartphones can be used to assess cognitive functions outside a laboratory setting.

  18. Upper extremity joint stresses during walkerassisted ambulation in post-surgical patients Estresse articular no membro superior durante marcha assistida por andador em pacientes pós-cirúrgicos

    Directory of Open Access Journals (Sweden)

    Kevin J. Mcquade

    2011-08-01

    Full Text Available BACKGROUND: A walker is a common device prescribed for ambulatory assistance for individuals with balance difficulties or to reduce lower extremity demands following injury or surgery. The long-term use of a walker imposes significant demands on the patient's upper extremities that may lead to increased risk for development of secondary conditions such as wrist, elbow or shoulder pain. OBJECTIVE: To describe the joint kinematics, forces and moments of the wrist, elbow and shoulder in a sample of twenty patients that were using a walker as a result of total joint surgery of the hips and knees. METHODS: Three-dimensional upper extremity kinematics were recorded using a motion capture system synchronized with forces and torques transmitted through a walker instrumented with force transducers in the handles. RESULTS: Compressive forces were found to be nearly 20% of the body weight at each of the upper extremity joints, both surgical and non-surgical sides, being the greatest force at the wrist and decreasing proximally. Compression forces were greater in the non-surgical side limb at the wrist and at the elbow. CONCLUSION: Our findings indicated that loads on upper extremity joints associated with the use of a walker for assisted ambulation are high and further studies are needed to address the cause-effect relationship between the actual joint loading and the development of secondary musculoskeletal upper extremity complaints in more frail patients.CONTEXTUALIZAÇÃO: Um andador é um dispositivo frequentemente prescrito para auxiliar a marcha de indivíduos com dificuldades de equilíbrio ou para reduzir demandas à extremidade inferior após cirurgia ou lesão. O uso prolongado de um andador impõe significante demanda para a extremidade superior do paciente, o que pode levar a um risco aumentado de desenvolver condições secundárias, como dor no punho, cotovelo e ombro. OBJETIVO: Descrever a cinemática articular, forças e momentos do punho

  19. Support and Assessment for Fall Emergency Referrals (SAFER 1) trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial.

    Science.gov (United States)

    Snooks, Helen; Cheung, Wai-Yee; Close, Jacqueline; Dale, Jeremy; Gaze, Sarah; Humphreys, Ioan; Lyons, Ronan; Mason, Suzanne; Merali, Yasmin; Peconi, Julie; Phillips, Ceri; Phillips, Judith; Roberts, Stephen; Russell, Ian; Sánchez, Antonio; Wani, Mushtaq; Wells, Bridget; Whitfield, Richard

    2010-01-26

    Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology--hand-held computers with computerised clinical decision support (CCDS) software--to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters') at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial.Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders.The primary outcome is the interval to the first subsequent reported fall (or death). We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services.In conclusion this complex emergency care trial will provide rigorous evidence on the clinical and cost

  20. Support and Assessment for Fall Emergency Referrals (SAFER 1 trial protocol. Computerised on-scene decision support for emergency ambulance staff to assess and plan care for older people who have fallen: evaluation of costs and benefits using a pragmatic cluster randomised trial

    Directory of Open Access Journals (Sweden)

    Roberts Stephen

    2010-01-01

    Full Text Available Abstract Background Many emergency ambulance calls are for older people who have fallen. As half of them are left at home, a community-based response may often be more appropriate than hospital attendance. The SAFER 1 trial will assess the costs and benefits of a new healthcare technology - hand-held computers with computerised clinical decision support (CCDS software - to help paramedics decide who needs hospital attendance, and who can be safely left at home with referral to community falls services. Methods/Design Pragmatic cluster randomised trial with a qualitative component. We shall allocate 72 paramedics ('clusters' at random between receiving the intervention and a control group delivering care as usual, of whom we expect 60 to complete the trial. Patients are eligible if they are aged 65 or older, live in the study area but not in residential care, and are attended by a study paramedic following an emergency call for a fall. Seven to 10 days after the index fall we shall offer patients the opportunity to opt out of further follow up. Continuing participants will receive questionnaires after one and 6 months, and we shall monitor their routine clinical data for 6 months. We shall interview 20 of these patients in depth. We shall conduct focus groups or semi-structured interviews with paramedics and other stakeholders. The primary outcome is the interval to the first subsequent reported fall (or death. We shall analyse this and other measures of outcome, process and cost by 'intention to treat'. We shall analyse qualitative data thematically. Discussion Since the SAFER 1 trial received funding in August 2006, implementation has come to terms with ambulance service reorganisation and a new national electronic patient record in England. In response to these hurdles the research team has adapted the research design, including aspects of the intervention, to meet the needs of the ambulance services. In conclusion this complex emergency care

  1. Perfil funcional de locomoção em um grupo de pacientes com lesão medular atendidos em um centro de reabilitação Perfil funcional de locomoción en un grupo de pacientes con lesión medular atendidos en un centro de rehabilitación Functional ambulation profile in a group of spinal cord injured patients attended at a rehabilitation center

    Directory of Open Access Journals (Sweden)

    Ana Cristina Franzoi

    2009-12-01

    Full Text Available OBJETIVO: descrever o perfil de locomoção de um grupo de pacientes com lesão medular (LM, correlacionando-o com as características da amostra. MÉTODOS: setenta pacientes (50 com LM traumática e 20 com LM não-traumática. Instrumentos: Classificação Funcional da Marcha Modificada (CFMM, WISCI-II, Escala de Ashworth Modificada (EAM, Classificação AIS, Lower Extremities Muscle Score (AIS-LEMS. Estatística: descritiva, comparação entre grupos, testes de correlação considerando pOBJETIVO: describir el perfil de locomoción de un grupo de pacientes con lesión medular (LM, correlacionándolo con las características de la muestra. MÉTODOS: setenta pacientes (50 con LM traumática y 20 con LM no traumática. Instrumentos: Clasificación Funcional de la Marcha Modificada (CFMM, WISCI-II, Escala de Ashworth Modificada (EAM, Clasificación AIS, AIS Lower Extremities Muscle Score (AIS-LEMS. Estadística: descriptiva, comparación entre grupos, testes de correlación considerando un pOBJECTIVE: to describe the locomotion profile of a group of spinal cord injured (SCI patients and its correlation with the sample features. METHODS: seventy patients (50 with traumatic SCI and 20 non-traumatic were assessed. Instruments: Modified Functional Ambulation Classification (MFAC, Walking Index for Spinal Cord Injury II (WISCI-II, Modified Ashworth Scale (MAS, American Spinal Injury Association Impairment Scale (AIS and AIS Lower Extremities Muscle Score (AIS-LEMS. Statistics: descriptive, comparison between groups, correlation tests (considering p<0,05. RESULTS: average values were: age: 36 years, 72.9% males, average time of lesion 4.7 years. AIS A, 38.6%; AIS B, 10%; AIS C, 22.8%; AIS D, 28.6%. Level of lesion: 32.8% cervical, 52.9% thoracic, 14.3% lumbar. More prevalent etiologies: gunshot wounds 30% and car accidents 18%. MFAC: Non-ambulation, 34.3%; Therapeutic ambulation 20%, Household ambulation 12.8%, community ambulation (32.9%; WISCI-II: 7

  2. Safety in the energy economy. In memoriam Peter J. Tettinger; Sicherheit in der Energiewirtschaft. In memoriam Peter J. Tettinger

    Energy Technology Data Exchange (ETDEWEB)

    Pielow, Johann-Christian (ed.)

    2007-07-01

    The Bochum contributions to energy act and mining legislation 'Safety in the energy economy' is published by the Institute for Mining and Energy Law of the Ruhr-University Bochum (Bochum, Federal Republic of Germany) and contains the following contributions: (a) In memory of professor Dr. iur. Peter J. Tettinger, the many years' director of the Institute for Mining and Energy Law ({dagger} 23rd September,2005) (Klaus Stern); (b) Energy security in an uncertain world (Claude Mandil); (c) Energy charer treaty and its role in international energy (Andrei Konoplanik, Thomas Waelde); (d) Reduction of energy conflicts by protection of foreign investments (Helga Steeg); (e) 'e8' - An initiative of the power industry for sustainability and climate (Wolfgang Strassburg); (f) Gazprom and the European power supply - from the Russian-Ukrainian crisis in January, 2006, to G8 gummit in July, 2006 (Inigo del Guayo); (g) The timetable for a competition-orientated European power internal market (Peter Mombaur); (h) The guarantee for the grid access as a condition for effective competitive electricity market (Franz Juergen Saecker); (i) Security of supply - appearance forms and constellations of assessment (Gunther Kuehne); (j) Federal order of ensuring infrastructure in the area of energy (Joerg Ennuschat); (k) Legal fundaments for the coordination of power plants and grids in the electricity economy according to the Energy Law Reform of 2005 (Ulrich Buedenbender); (l) Reform of the Spanish law of electricity economy in the year 2006 (Antonio Jimenez-Blanco); (m) Liberalizing electricity markets: Does Europe challenge member states? (Estanislao Aarana Garcia, Leonor Moral Soriano, Maria Asuncion Torres L'opez); (n) Security of planning with the construction of power plants? Actual trends in the law of spatial and special planning (Ulrich Battis); (o) Security of planning for energy supply lines (Norbert Kaemper); (p) Security of supply due to legal safety for power plants (Christian Stenneken); (q) Legal problems of the guarantee in the supply of wind energy plants (Peter Salje); (r) Is a price or quantity supply of renewable energy to be preferred from environmentally political and energetically political view? (Helmut Karl); (s) Energy efficiency as a contribution of housing sector to the securing of energy - legal obstacles with the transition for commercial heat supply (Michael Lippert); (t) The legal regime of wind energy in Spain (Masao Javier Lopez Sako); (u) Securing of nuclear facilities in the Japanese law (Yoriaki Narito); (v) The conditions for the transmission of electricity according the atomic law (Tobias Leidinger); (w) The protection of nuclear facilities against attacks of terror considering the actual legislation (Gregor Franssen, Axel Pottschmidt); (x) The intrinsically securing obligation of the paragraph 7 sect. 2 no. 5 Atomic Energy Act (Wolfgang Otten); (y) Obligation of cooperation of persons concerned by mining and the consequences of non-compliance with this (Bettina Keienburg).

  3. Road.safety.forum - Integrated safety concepts and reliability. Proceedings; verkehrs.sicherheits.forum - Integrierte Sicherheitskonzepte und Zuverlaessigkeit. Tagungsband

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2005-07-01

    The proceedings volume of the two days Meeting titled:''road.safety.forum - Integrated Safety Concepts and Reliability'' which has been held on the 5th and 6th April 2005 in Leipzig, includes the ten contributions presented. The subjects were as follows: safety and reliability in modern vehicles; e-safty activities of European Commission; advanced safety technology for enhanced road safety; safety systems - sometimes less may be more - analysis related to markets with limited purchasing power like in Czech Republic; modern design of the truck driver's workplace and supporting technologies for road safety; risk management and car safety; concepts of driver assistance - state of affairs and outlook; to err (while driving) is human - which technical systems can help?; Safety Net: developing the European Road Safety Observatory; consumer safety ratings and their effect on car safety. The manuscripts are available in the form of reproduced overhead foils. (AKF)

  4. Regulatory oversight report 2012 concerning nuclear safety in Swiss nuclear installations; Aufsichtsbericht 2012 zur nuklearen Sicherheit in den schweizerischen Kernanlagen

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-04-15

    The Swiss Federal Nuclear Safety Inspectorate (ENSI) assesses and monitors nuclear facilities in Switzerland. These include the five nuclear power plants, the interim storage facilities based at each plant, the Central Interim Storage Facility (ZWILAG) and the nuclear facilities at the Paul Scherrer Institute (PSI), at the Federal Institute of Technology in Lausanne (EPFL) and at the University of Basel. Using a combination of inspections, regulatory meetings, examinations and analyses together with reports from the licensees of individual facilities, ENSI obtains the required overview of nuclear safety in the relevant facilities. It ensures that the facilities comply with the regulations and operate as required by law. Its regulatory responsibilities also include the transport of radioactive materials from and to nuclear facilities and the preparations for a deep geological repository for nuclear waste. ENSI maintains its own emergency organisation. It formulates and updates its own guidelines which stipulate the criteria for evaluating the current activities and future plans of the operators of nuclear facilities. ENSI produces regular reports on its regulatory activities and nuclear safety in Swiss nuclear facilities. It fulfils its statutory obligation to provide the public with information on particular events and findings in nuclear facilities. In 2012, the five nuclear power plants in Switzerland were all operated safely. 34 events were reported; on the international INES scale of 0 to 7, ENSI rated 33 events as Level 0 and 1 as Level 1. ENSI evaluates the safety of each nuclear power plant as part of a systematic safety evaluation taking account of both reportable events and other findings, in particular the results of more than 400 inspections conducted by ENSI during 2012. ZWILAG consists of several interim storage halls, a conditioning plant and an incineration/melting plant. At the end of 2012, the cask storage hall contained 40 transport/storage casks with spent fuel assemblies and vitrified residue packages as well as six casks with decommissioned waste from the experimental nuclear power plant at Lucens. Some 20% of the capacity of the HLW store was in use and about 24% of the ILW store. During the year, ZWILAG conducted two campaigns to incinerate and melt radioactive waste. ENSI is also responsible for the surveillance of the nuclear facilities at PSI: the research reactor PROTEUS, the hot laboratory, the collection point for radioactive waste from medicine, industry and research and the Federal Interim Storage Facility. During 2012, there were no further operational activities or radiation experiments at the PROTEUS research reactor. Two reportable events were recorded at the Paul Scherrer Institute (PSI), but no one at the research reactors at EPFL or the University of Basel. Last year, the amount of radioactive material released into the environment via waste water and exhaust air from the facilities under review was considerably less than the limits specified in the operating licenses. Analyses showed that the maximum doses were less than 1 % of the annual exposure to natural radiation. During 2012, spent fuel assemblies from Swiss nuclear power plants were reprocessed. The AREVA recycling facility in La Hague returned a consignment of high level waste. According to the Sectoral Plan for the deep geological repository, NAGRA proposed several different sites for surface facilities. ENSI provided information on the safety criteria for the selection process and on safety and geology, particularly in view of the Opalinus Clay Project. The geological research into the Opalinus clay continued during 2012. Every five years, the licensees of nuclear power plants are required by law to re-calculate the decommissioning and waste management costs. During 2012, ENSI evaluated the technical principles used in the 2011 cost study conducted by the licensees of nuclear power plants. ENSI is involved in its own projects and cooperation: one project is looking at the geo-mechanical behaviour of the Opalinus clay, two other projects are examining the behaviour of Opalinus clay tunnel walls on drying, and a third is evaluating a new method of measuring porosity. Participation in national and international working groups provides ENSI with an opportunity to pursue issues relating to the disposal of waste in deep geological repositories and to remain up-to-date with the current state of science and research.

  5. Safety cutting units - maximum security whole cutting cable under voltage; Sicherheitsschneidanlagen - optimale Sicherheit beim Kabelschneiden unter Spannung

    Energy Technology Data Exchange (ETDEWEB)

    Gaenslein, H.G. [Kabelkonfektionstechnik KKT GmbH, Sonneberg (Germany)

    1998-12-14

    If operations are carried out on electric installations, it is absolutely necessary to find out if these installations are off circuit in order to guarantee an effective protection against the risks caused by electric current. But sometimes it is difficult to identify if the installations is off circuit because in practice the isolated cable cannot always be pursued up to the place of work and voltage on the cable cannot clearly be ascertained respectively. In the last years in these cases a safety cutting unit has proved in practice successful. (orig.) [Deutsch] Sollen an elektrischen Anlagen Arbeiten durchgefuehrt werden, so ist zunaechst die Spannungsfreiheit festzustellen. Die Ermittlung der Spannungsfreiheit in Kabelanlagen bereitet jedoch nicht selten Schwierigkeiten, da in der Praxis das freigeschaltete Kabel nicht eindeutig bis zur Arbeitsstelle verfolgt bzw. die Spannung an einem Kabel nicht eindeutig festgestellt werden kann. In den letzten Jahren hat sich deshalb fuer derartige Faelle der Einsatz von Sicherheitsschneidanlagen bewaehrt. (orig.)

  6. Digital identities. Basis for IT security in smart grids; Digitale Identitaeten. Basis fuer IT Sicherheit im Smart Grid

    Energy Technology Data Exchange (ETDEWEB)

    Fiat, Roland; Stoertkuhl, Thomas [TUEV SUED AG Embedded Systems, Muenchen (Germany)

    2012-07-01

    An essential part of a given IT environment's cyber-security is the proper authentication of persons, systems and applications. Indeed, this is a fundamental requirement to secure communication. With the appearance of malware like Stuxnet and other cyber-attacks securing the communication in industrial infrastructures becomes increasingly important. To improve the authentication during device to device communication, this paper drafts a solution based on digital certificates which guarantee a sufficient level of authentication thanks to the use of established asymmetric cryptographic algorithms. A prerequisite for a widespread use of digital certificates, however, is an according infrastructure that allows for the secure generation and distribution of such certificates on the devices ideally in an automated way. The present paper outlines such a methodology as a starting point for further discussions. (orig.)

  7. Safety in coal and coal dust handling. Sicherheit beim Umgang mit Kohlen und Kohlenstaeuben sowie mit Koksen und Koksstaeuben

    Energy Technology Data Exchange (ETDEWEB)

    Kohlschmidt, J.; Hoeppner, K.; May, M.; Schmieder, L.

    1985-01-01

    The brochure intends to point out the necessity of protective measures. Training, dust control, and ignition prevention are necessary. The ignition characteristics of coals and coal dusts are presented, and regulations on industrial hygiene, industrial safety, and fire protection are mentioned. There is a leaflet with hints for coal and coke handling and coal storage. (HSCH).

  8. Sicherheit und Verträglichkeit einer inhalativen Heparinapplikation bei Patienten mit idiopathischer pulmonaler Fibrose (IPF) : eine Pilotstudie

    OpenAIRE

    Nass, Robert Josef

    2009-01-01

    Patienten mit fibrosierenden Lungenerkrankungen, einschließlich der idiopathischen pulmonalen Fibrose (IPF), weisen eine erhöhte „tissue factor“ (TF)-Faktor-VII-vermittelte prokoagulatorische Aktivität im alveolären Kompartiment auf. Veränderungen des alveolären hämostaseolytischen Gleichgewichtes tragen vermutlich über verschiedene Mechanismen zu der Pathogenese fibrosierender Lungenerkrankungen bei. Fibrin selbst scheint auch als Reservoir für profibrotische Wachstumsfaktoren und als Matrix...

  9. Handbook on criticality. Vol. 1. Criticality and nuclear safety; Handbuch zur Kritikalitaet. Bd. 1. Kritikalitaet und nukleare Sicherheit

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2015-04-15

    This handbook was prepared primarily with the aim to provide information to experts in industry, authorities or research facilities engaged in criticality-safety-related problems that will allow an adequate and rapid assessment of criticality safety issues already in the planning and preparation of nuclear facilities. However, it is not the intention of the authors of the handbook to offer ready solutions to complex problems of nuclear safety. Such questions have to remain subject to an in-depth analysis and assessment to be carried out by dedicated criticality safety experts. Compared with the previous edition dated December 1998, this handbook has been further revised and supplemented. The proven basic structure of the handbook remains unchanged. The handbook follows in some ways similar criticality handbooks or instructions published in the USA, UK, France, Japan and the former Soviet Union. The expedient use of the information given in this handbook requires a fundamental understanding of criticality and the terminology of nuclear safety. In Vol. 1, ''Criticality and Nuclear Safety'', therefore, first the most important terms and fundamentals are introduced and explained. Subsequently, experimental techniques and calculation methods for evaluating criticality problems are presented. The following chapters of Vol. 1 deal i. a. with the effect of neutron reflectors and absorbers, neutron interaction, measuring methods for criticality, and organisational safety measures and provide an overview of criticality-relevant operational experience and of criticality accidents and their potential hazardous impact. Vol. 2 parts 1 and 2 finally compile criticality parameters in graphical and tabular form. The individual graph sheets are provided with an initially explained set of identifiers, to allow the quick finding of the information of current interest. Part 1 includes criticality parameters for systems with {sup 235}U as fissile material, while part 2 deals with systems comprising {sup 233}U, plutonium and higher actinides.

  10. Safety of long-distance pipelines. Probabilistic and deterministic aspects; Sicherheit von Rohrfernleitungen. Probabilistik und Deterministik im Vergleich

    Energy Technology Data Exchange (ETDEWEB)

    Hollaender, Robert [Leipzig Univ. (Germany). Inst. fuer Infrastruktur und Ressourcenmanagement

    2013-03-15

    The Committee for Long-Distance Pipelines (Berlin, Federal Republic of Germany) reported on the relation between deterministic and probabilistic approaches in order to contribute to a better understanding of the safety management of long-distance pipelines. The respective strengths and weaknesses as well as the deterministic and probabilistic fundamentals of the safety management are described. The comparison includes fundamental aspects, but is essentially determined by the special character of the technical plant 'long-distance pipeline' as an infrastructure project in the area. This special feature results to special operation conditions and related responsibilities. However, our legal system 'long-distance pipeline' does not grant the same legal position in comparison to other infrastructural facilities such as streets and railways. Thus, the question whether and in what manner the impacts from the land-use in the environment of long-distance pipelines have to be considered is again and again the initial point for the discussion on probabilistic and deterministic approaches.

  11. Adaptação para a língua portuguesa do Questionário de Experiências Dissociativas Peritraumáticas (QEDP numa amostra de bombeiros Portuguese adaptation of the Peritraumatic Dissociation Experiences Questionnaire (PDEQ in a sample of ambulance personal

    Directory of Open Access Journals (Sweden)

    Ângela Costa Maia

    2009-01-01

    Full Text Available CONTEXTO: A dissociação peritraumática é uma resposta no momento da exposição a uma situação ameaçadora que tem se mostrado um preditor significativo de perturbação psicológica a longo prazo, nomeadamente perturbação pós-estresse traumático. OBJETIVOS: Fazer a adaptação para português do Peritraumatic Dissociation Experiences Questionnaire numa população altamente exposta a situações traumáticas, como é o caso dos bombeiros. MÉTODO: Após a tradução e o estudo dos itens, fizeram-se a aplicação e a análise psicométrica com uma amostra de 170 bombeiros, que relataram exposição traumática e que também preencheram uma escala de Perturbação de Pós-Estresse Traumático. RESULTADOS: Os dados indicam que se trata de um instrumento com uma boa consistência interna (alfa de Cronbach = 0,87 e cuja validade de construto o torna adequado para a avaliação das respostas dessa população no exercício da sua profissão. Para além disso, a correlação elevada com os sintomas de perturbação pós-estresse traumático sugere ainda uma boa validade convergente. DISCUSSÃO: Atendendo ao fato de que a dissociação peritraumática prevê PPST, o recurso a um instrumento que revela boas capacidades psicométricas pode ajudar a identificar as pessoas que desenvolverão perturbação após exposição a trauma.BACKGROUND: Peritraumatic dissociation is a reaction that occurs in the moment someone is exposed to a threatening situation and has shown to be an important predictor of long term psychological disorder, including post traumatic stress disorder. OBJECTIVES: To make the psychometric adaptation of Peritraumatic Dissociation Experiences Questionnaire in Portuguese ambulance personnel that report high exposure to trauma. The instrument has been widely used in research, and was initially designed to analyse peritraumatic dissociation in emergency personnel. METHODS: After items translation and study, 170 ambulance

  12. Richtlijn detoxificatie van psychoactieve middelen: Verantwoord ambulant of intramuraal detoxificeren

    NARCIS (Netherlands)

    Dijkstra, B.A.G.; Oort, M.M.H.J. van; Schellekens, A.F.A.; Haan, H.A. de; Jong, C.A.J. de

    2017-01-01

    Een keur aan experts geeft in deze richtlijn aan hoe op verantwoorde wijze het proces van detoxificatie van verslavende middelen kan worden doorlopen en begeleid. Daarbij ligt het accent van het complex van interventies op de biologische aspecten van de verslavingsproblemen, maar is er ook aandacht

  13. MobiHealth: Ambulant Patient Monitoring Over Public Wireless Networks

    NARCIS (Netherlands)

    Konstantas, D.; van Halteren, Aart; Bults, Richard G.A.; Wac, K.E.; Jones, Valerie M.; Widya, I.A.; Herzog, Rainer

    2004-01-01

    The use of health BANs together with advanced wireless communications enables remote management of chronic conditions and detection of health emergencies whilst maximising patient mobility. MobiHealth1,2 has developed a generic Body Area Network (BAN) for healthcare and an m-health service platform.

  14. Forebyggende ambulant behandling ved affektiv lidelse (depression og mani)

    DEFF Research Database (Denmark)

    Kessing, Lars Vedel; Hansen, Hanne Vibe; Hougaard, Esben

    2007-01-01

    The present article is based on a Health Technology Assessment Report (HTA, available with an English summary at www.cemtv.dk) on preventive out-patient treatment of affective disorders. The article briefly reviews the course of depressive disorder and bipolar affective disorder and reviews the b...... the best available treatment modalities including shared care models, prophylactic pharmacotherapy and prophylactic combination therapy involving pharmacotherapy and psychological treatment....

  15. Accuracy of Wristband Activity Monitors during Ambulation and Activities.

    Science.gov (United States)

    Chen, Ming-DE; Kuo, Chang-Chih; Pellegrini, Christine A; Hsu, Miao-Ju

    2016-10-01

    The main purpose of this study was to examine the accuracy of wristband activity monitors on measuring step counts at prescribed speeds on a treadmill and under short bouts of common daily activities. Thirty healthy young adults wore three wristband activity monitors on both wrists while walking or jogging on a treadmill at different speeds (54, 80, 107, and 134 m·min) and performing six different common daily activities for 5 min each. The monitors included the Fitbit Flex, the Garmin Vivofit, and the Jawbone UP. The common daily activity conditions included two sitting activities (playing a tablet computer game and folding laundry), two walking activities (pushing a stroller, carrying a bag), and two stair climbing activities (down and up). Absolute percentage error (APE) scores were computed to examine the accuracy between actual observed steps and monitor-detected steps. Under the treadmill condition, the APE ranged between 1.5% and 9.6%. Accuracy was improved at faster speeds (134 m·min) for all the monitors (APE 33%) when pushing a stroller. Higher APE was observed when worn on the dominant wrist under the common daily activity conditions. The wristband activity monitors examined were more accurate for measuring step counts between 80 and 134 m·min as compared with a slower speed. Accuracy under each common daily activity condition ranged widely between monitors and activity, with less error when worn on the nondominant wrist. These results will help to inform researchers on the use and accuracy of wristband activity monitors for future studies.

  16. Rationality, religion and refusal of treatment in an ambulance revisited.

    Science.gov (United States)

    McMahon-Parkes, Kate

    2013-09-01

    In their recent article, Erbay et al considered whether a seriously injured patient should be able to refuse treatment if the refusal was based on a (mis)interpretation of religious doctrine. They argued that in such a case 'what is important…is whether the teaching or philosophy used as a reference point has been in fact correctly perceived' (p 653). If it has not been, they asserted that this eroded the patient's capacity to make an autonomous decision and that therefore, in such cases, it is the role of the healthcare professional (HCP) to 'assist patients to think more clearly and rationally' (p 653). There are, however, a number of problems with the reasons why Erbay et al suggest we should help patients to rationalise their decisions and how HCPs should go about this. In this article, the author explores some of their main arguments regarding consent and rationality (particularly in relation to religious beliefs), as well as Erbay et al's normative claim that HCPs have an obligation to promote autonomy by helping patients to come to a 'rational' decision. Ultimately, the author agrees that the (temporary) solution to the dilemma presented in this scenario (which was to insert an intravenous cannula into the patient in order to allow an infusion of fluids in the event that he changed his mind) seemed both pragmatic and ethically permissible. However, it is suggested that the arguments which underpin this conclusion in Erbay et al's article are largely unsound.

  17. Feasibility of Suited 10-km Ambulation "Walkback" on the Moon

    Science.gov (United States)

    Norcross, Jason; Lee, Lesley; DeWitt, John K.; Klein, Jill; Wessell, James; Gernhardt, Michael L.

    2008-01-01

    This viewgraph presentation reviews a study that examined the feasibility of having astronauts walk about 10 kilometers to the base in the event of a breakdown of the lunar rover. This was done in part to examine the possibility of having a single rover on the lunar exploration missions. Other objectives of the study are to: (1) Understand specific biomedical and human performance limitations of the suit compared to matched shirt-sleeve controls; (2) Collect metabolic and ground-reaction force data to develop an EVA simulator for use on future prebr eathe protocol verification tests (3) Provide data to estimate consum ables usage for input to suit and portable life support system (PLSS) design (4) Assess the cardiovascular and resistance exercise associa ted with partialgravity EVA for planning appropriate exploration exer cise countermeasures

  18. Advances in obstetric anesthesia: ambulation during labor with ...

    African Journals Online (AJOL)

    However, epidural labor analgesia is not a generic procedure and many technical modifications have been invented over time. Continuous search for a balanced labor analgesia, which provides relief of pain of contractions while preserving motor function, has led to the development of the ambulatory labor analgesia.

  19. Reflexões sobre deambulação e posição materna no trabalho de parto e parto Reflexiones sobre deambulación y posición materna en el trabajo de parto y parto Reflection on ambulation and maternal position during labor and delivery

    Directory of Open Access Journals (Sweden)

    Fabiana Villela Mamede

    2007-06-01

    place to other ones that valued the technology, the medicalization and the intervention. Such changes didn't make possible a significant reduction in the mother mortality and neonatal, in other way, they promoted the lack of humanization in the assistance. A new look on the ambulation effect and the position during labor and delivery is been encouraged and giving opportunity to became evident a variety of vantages and benefits to the mother and child.

  20. A implantação do projeto de atendimento Móvel de Urgência em Salvador/BA: panorama e desafios La implantación del proyecto de Atención de Urgencia Móvil en Salvador/BAHIA: panorama y retos Implantation of the Emergency Ambulance Service in Salvador, Bahia: reality and challenges

    Directory of Open Access Journals (Sweden)

    Célia Maria Sales Vieira

    2008-12-01

    retos en la dinámica y calidad de la atención: educación comunitaria, capacitación profesional, evaluación de recursos humanos y materiales.The goal of this study was to describe the implementation of the emergency ambulance service of Salvador, Bahia (SAMU-192. The Ministry of Health provided the legal basis and regulations for its implementation. The main purpose of this service is the provision of free primary level healthcare to individuals, with clinical, surgical, traumatic and psychiatric aggravations that cause suffering, sequels or death and occur outside the hospital environment. The specific goals of SAMU-192 was to grant free healthcare to urgency and emergency situations, under the hierarchy and regulations of the Single Health System (SUS of the Brazilian government, assuring that public resources will be available and integrated to the complementary healthcare network. Investments for the installation of the service were agreed on in the city and with federal and state management commissions. To turn SAMU-192 into reality, several challenges need to be accomplished, including community education, professional qualification and evaluation of human and material resources so as to provide basic emergency care with the appropriate quality.

  1. Security of the electricity supply. The area of conflict between profitability and environmental compatibility; Sicherheit der Elektrizitaetsversorgung. Das Spannungsfeld von Wirtschaftlichkeit und Umweltvertraeglichkeit

    Energy Technology Data Exchange (ETDEWEB)

    Praktiknjo, Aaron

    2013-07-01

    The scope of the book is on the one hand support for the power industry defining investment and sales strategies that intend optimum supply security in the view of the customer and on the other hand the information for energy and environmental politicians demonstrating the conflict of objectives. The following issues are covered: technical and organizational aspects of electricity supply, theoretical background of the security of electricity supply, security of supply for economic sections, security of electricity supply for private households: theoretical microeconomic approach, security of electricity supply for private households: method of defined preferences, security of electricity supply in the context of climate protection and nuclear phase-out.

  2. Regulatory oversight report 2007 concerning nuclear safety in Swiss nuclear installations; Aufsichtsbericht 2007 ueber die nukleare Sicherheit in den schweizerischen Kernanlagen

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2008-04-15

    This annual report issued by the Swiss Federal Nuclear Inspectorate (HSK) reports on the work carried out by the Inspectorate in 2007. This report reviews the regulatory activities in the four Swiss nuclear power stations and in four further nuclear installations in various Swiss research facilities. It deals with topics such as operational details, technologies in use, radiation protection, radioactive wastes, emergency dispositions and personnel and provides an assessment of operations from the point of view of safety. Also, the transportation of nuclear materials - both nuclear fuels and nuclear wastes - is reported on. General topics discussed include probabilistic safety analyses and accident management. Finally, the disposal of nuclear wastes and work done in the rock laboratories in Switzerland is commented on.

  3. Regulatory oversight report 2008 concerning nuclear safety in Swiss nuclear installations; Aufsichtsbericht 2008 ueber die nukleare Sicherheit in den schweizerischen Kernanlagen

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2009-04-15

    This annual report issued by the Swiss Federal Nuclear Inspectorate (ENSI) reports on the work carried out by the Inspectorate in 2008. This report reviews the regulatory activities in the four Swiss nuclear power stations and in four further nuclear installations in various Swiss research facilities. It deals with topics such as operational details, technologies in use, radiation protection, radioactive wastes, emergency dispositions, personnel and provides an assessment of operations from the safety point of view. Also, the transportation of nuclear materials - both nuclear fuels and nuclear wastes - is reported on. General topics discussed include probabilistic safety analyses and accident management, earthquake damage analysis and agreements on nuclear safety. The underground disposal of highly-radioactive nuclear wastes and work done in the rock laboratories are discussed, as are proposals for additional nuclear power stations.

  4. Studies on the safety and transmutation behaviour of innovative fuels for light water reactors; Untersuchungen zum Sicherheits- und Transmutationsverhalten innovativer Brennstoffe fuer Leichtwasserreaktoren

    Energy Technology Data Exchange (ETDEWEB)

    Schitthelm, Oliver

    2012-07-01

    Nuclear power plants contribute a substantial part to the energy demand in industry. Today the most common fuel cycle uses enriched uranium which produces plutonium due to its {sup 238}U content. With respect to the long-term waste disposal Plutonium is an issue due to its heat production and radiotoxicity. This thesis consists of three main parts. In the first part the development and validation of a new code package MCBURN for spatial high resolution burnup simulations is presented. In the second part several innovative uranium-free and plutonium-burning fuels are evaluated on assembly level. Candidates for these fuels are a thorium/plutonium fuel and an inert matrix fuel consisting of plutonium dispersed in an enriched molybdenum matrix. The performance of these fuels is evaluated against existing MOX and enriched uranium fuels considering the safety and transmutation behaviour. The evaluation contains the boron efficiency, the void coefficient, the doppler coefficient and the net balances of every radionuclide. In the third part these innovative fuels are introduced into a German KONVOI reactor core. Considering todays approved usage of MOX fuels a partial loading of one third of innovative fuels and two third of classical uranium fuels was analysed. The efficiency of the plutonium depletion is determined by the ratio of the production of higher isotopes compared to the plutonium depletion. Todays MOX-fuels transmutate about 25% to 30% into higher actinides as Americium or Curium. In uranium-free fuels this ratio is about 10% due to the lack of additional plutonium production. The analyses of the reactor core have shown that one third of MOX fuel is not capable of a net reduction of plutonium. On the other hand a partial loading with thorium/plutonium fuel incinerates about half the amount of plutonium produced by an uranium only core. If IMF is used the ratio increases to about 75%. Considering the safety behavior all fuels have shown comparable results.

  5. DGMK guideline: safety of fired process heaters in refineries and petrochemical plants; DGMK-Leitfaden: Sicherheit von Prozessoefen in Raffinerien und Petrochemie

    Energy Technology Data Exchange (ETDEWEB)

    Mueller, H.; Ries, L.; Roith, W.; Stroebl, J.; Steiglecher, J.

    2002-08-01

    The DGMK guideline compares the requirements for the safely instrumentation of Fired Process Heaters in refineries and petrochemical plants based on the EN 746-2, published in 1997 with actual installations in the industry and other regulations i.e. the American NFPA 85 from 2001. Main focus is the safety related instrumentation for Multiburner Installations, mainly used in Refineries and Petrochemical Plants in combination with the relevant operating procedures (orig.)

  6. IT safety in production data networks (PDN). Tracking, evaluation and elimination of safety threats; IT-Sicherheit in Produktionsnetzen (PDN). Aufspueren, einschaetzen und beseitigen von Sicherheitsbedrohungen

    Energy Technology Data Exchange (ETDEWEB)

    Neider, Ulrich [DETACK GmbH, Ludwigsburg (Germany)

    2013-03-01

    This contribution reports on the threats of production data networks. Within the context of the IT security, the risks of production data networks are not only based on a possible contamination by computer viruses. The author of this contribution increases awareness of dangers to whose production systems are faced. The author also presents a phase model from his own consulting practice in order to increase the safety of production data systems by implementation of a safety control. This phase model consists of the six following steps: (a) Stock taking of the state of the art; (b) Determination of the target (development of a safety concept); (c) Creation of an IT safety policy; (d) Application of IT safety policy; (e) Audit of the results (IT safety audit); (f) Regular safety tests.

  7. Safety during handling of coal, coal dust, coke and coke dust. Sicherheit beim Umgang mit Kohlen und Kohlenstaeuben sowie mit Koksen und Koksstaeuben

    Energy Technology Data Exchange (ETDEWEB)

    Kohlschmidt, J.; Hoeppner, K.; May, M.; Schmieder, L.

    1985-01-01

    This paper reviews fire and explosion prevention measures for transport, storage and combustion of brown coal and black coal. The fire and explosion hazard of coal and coke dust is characterized; various examples of hazardous situations in handling coal and coke are presented. Safety requirements for the design of coal and coke handling equipment according to GDR standard TGL 30634/02 are further noted. Safe storage of bulk coal in open-air facilities as well as safe transportation and bunker storage of fuel dust are described. Safety requirements for manually operated coal combustion equipment and for pneumatic fuel-feeding systems of steam generators are also outlined. Fire fighting methods to be employed in case of fires or suspected smoldering fires are listed briefly. (11 refs.)

  8. Safety and risk, a comparison on an international scale with regard to society, law and economy. Sicherheit und Risiko im internationalen Vergleich - gesellschaftlich, rechtlich, wirtschaftlich

    Energy Technology Data Exchange (ETDEWEB)

    Compes, P.C. (ed.)

    1987-01-01

    More than 130 experts of different nations and different fields of science met to discuss the following subjects: Traffic and transport, labour and employment, products and commodities, energy and environment (safety concepts for fossil-fuel and nuclear power plants, international harmonisation of nuclear technical standards, harmonisation of environmental law in a European context). All contributions are presented in their original language, with abstracts in German, English, and French. (HP).

  9. Contribution of psychology to the safety of installations with a high hazard potential; Beitrag der Psychologie zur Sicherheit von Einrichtungen hohen Gefaehrdungspotentials

    Energy Technology Data Exchange (ETDEWEB)

    Wilpert, B. [ed.

    1996-12-31

    Installations with a high hazard potential are usually characterised by the dual attribute `low risk - high hazard`. Diverse strategies of safety management are employed in such installations in order to limit the great hazard potential of safety-relevant occurrences (faults, abnormal operating states, accidents) that can take place in them. These strategies include specific control principles. In nuclear engineering, for example, the feedforward principle has already been used for some time as a tool of analytic risk determination (e.g., in probabilistic Safety Analysis (PSA) or Human Reliability Analysis (HRA)). A further example of these strategies of safety management is the empirical determination of risks through evaluation of operating experience (feedback control, e.g., epemiological studies, accident analysis) and, derived from this, identification of the system`s weak points in terms of safety. Insights derived from the application of these control principles can serve to develop specific means of intervention. These will tend to be closely oriented to the results obtained with the control method and may consist in, e.g., trainings or measures of organisation development. Independent of this, it will also be possible to identify long-term measures for preventing safety-relevant occurrences (e.g., organisational learning, safety-mindedness). The above-named strategies of safety management (control, intervention, prevention) provide a fertile basis for psychological studies in fields such as the physiology and psychology of perception (information processing), cognitive, psychology (thought and action), social psychology (division of labour, norms), paedagogic psychology (training), or organisational and environmental psychology (safety-mindedness, leadership, environmental influences). (orig./DG) [Deutsch] Einrichtungen hohen Gefaehrdungspotentials sind in der Regel gekennzeichnet durch die Eigenschaft von `low risk - high hazard`. Das grosse Gefahrenpotential, das von sicherheitsrelevanten Ereignissen (Stoerungen, Stoerfaelle, Unfaelle) in diesen Einrichtungen ausgeht, versucht man durch diverse Strategien des Sicherheitsmanagements einzugrenzen. Hierzu gehoeren spezifische Kontrollprinzipien. So hat man in der Kerntechnik seit geraumer Zeit damit begonnen mit Hilfe der feedforward-Kontrolle Risiken vorab analytisch zu bestimmten (z.B. durch Probabilistische Sicherheitsanalysen - PSA und Human Reliability Analysis - HRA). Die empirische Bestimmung von Risiken durch Auswertung von Betriebserfahrung (feedback-Kontrolle, z.B. epidemiologische Studien, Unfallanalyse) und die damit verbundene Identifizierung von sicherheitsgefaehrdenden Schwachstellen des Systems gehoert ebenfalls zu diesen Strategien des Sicherheitsmanagements. Die aus diesen Kontrollprinzipien abgeleiteten Erkenntisse legen spezifische Interventionen nahe. Diese sind relativ eng an die Ergebnisse aus den verschiedenen Verfahren zur Kontrolle angelehnt (z.B. Trainings, Massnahmen der Organisationsentwicklung). Davon unabhaengig lassen sich langfristige Massanhmen zur Praevention von Ereignissen identifizieren (z.B. Organisationales Lernen, Sicherheitskultur). Die genannten Strategien des Sicherheitsmanagements (Kontrolle, Intervention, Praevention) liefern umfangreiche Ankuepfungspunkte fuer psychologische Fragestellungen. Sie reichen von der physiologischen und Wahrnehmungspsychologie (Informationsverarbeitung), der Kognitionspsychologie (Denken und Handeln) zur Sozialpsychologie (Arbeitsteilung, Normen) ueber die paedagogische Psychologie (Training) bis hin zur Organisations- und Umweltpsychologie (Sichherheitskultur, Fuehrung, Umwelteinfluesse). (orig./DG)

  10. Iran, the bomb and the pursuit of security. Structured conflict analyses; Iran, die Bombe und das Streben nach Sicherheit. Strukturierte Konfliktanalysen

    Energy Technology Data Exchange (ETDEWEB)

    Bock, Andreas M. [Akkon-Hochschule fuer Humanwissenschaften, Berlin (Germany); Henneberg, Ingo (ed.) [Freiburg Univ. (Germany). Professur fuer Governance in Mehrebenensystemen

    2014-07-01

    This volume introduces readers to the structured conflict analysis as a tool of social science research and uses this instrument exemplarily to analyze systematically and on a broad basis the various conflicts that are associated with Iran both domestically and in foreign policy - beyond popular stereotypes such as the ''bomb''. The 13 contributions draw a complex picture of the conflicts with and in Iran and reflect the various aspects of these conflicts from different perspectives and at a high methodological and theoretical level. The nuclear program is examined, inter alia through the eyes of four major theories of International Relations. In addition, the analyses are concerned with the regional security dimension, the relationship USA-Iran, the role of national preferences, and the effect of national processes to the Iranian foreign policy.

  11. Safety bey statistics? A critical view on statistical methods applied in health physics; Sicherheit durch Statistik? Ein kritischer Blick auf die Anwendung statistischer Methoden im Strahlenschutz

    Energy Technology Data Exchange (ETDEWEB)

    Kraut, W. [Duale Hochschule Baden-Wuerttemberg (DHBW), Karlsruhe (Germany). Studiengang Sicherheitswesen

    2016-07-01

    The only proper way to describe uncertainties in health physics is by statistical means. But statistics never can replace Your personal evaluation of effect, nor can statistics transmute randomness into certainty like an ''uncertainty laundry''. The paper discusses these problems in routine practical work.

  12. Study on the safety and on international developments of small modular reactors (SMR). Final report; Studie zur Sicherheit und zu internationalen Entwicklungen von Small Modular Reactors (SMR). Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Buchholz, Sebastian; Kruessenberg, Anne; Schaffrath, Andreas; Zipper, Reinhard

    2015-05-15

    This report documents the work and results of the project RS1521 Study of Safety and International Development of Small Modular Reactors (SMR). The aims of this study can be summarized as - setting-up of a sound overview on SMR, - identification of essential issues of reactor safety research and future R and D projects, - identification of needs for adaption of system codes of GRS used in reactor safety research. The sound overview consists of the descriptions of in total 69 SMR (Small and Medium Sized Rector) concepts (32 light water reactors (LWR), 22 liquid metal cooled reactors (LMR), 2 heavy water reactors, 9 gas cooled reactors (GCR) and 4 molten salt reactors (MSR)). It provides information about the core, the cooling circuits and the safety systems. The quality of the given specifications depends on their availability and public accessibility. Using the safety requirements for nuclear power plants and the fundamental safety functions, the safety relevant issues of the described SMR concepts were identified. The systems and measures used in the safety requirements were summarized in table form. Finally it was evaluated whether these systems and measures can be already simulated with the nuclear simulation chain of GRS and where further code development and validation is necessary. The results of this study can be summarized as follows: Many of the current SMR concepts are based on integral design. Here the main components like steam generators, intermediate heat exchangers or - in case of forced convection core cooling - main cooling pumps are located within the reactor pressure vessel. Most of the SMR fulfil highest safety standards and their safety concepts are mainly based on passive safety systems. The safety of theses reactors is achieved indefinitely without energy supply or additional measures of the operators. Since SMR's aim is not only to produce electricity but also couple them with chemical or physical process plants, the safety aspects of such a coupling were investigated, too. For simulation of the safety systems and the behaviour of the SMR in normal operation and in accident conditions the GRS codes for safety analyses e.g. ATHLET, COCOSYS, QUABOX/CUBBOX, etc. must be enhanced and validated. Specific examples for this are e.g. the implementation of material properties of cooling fluids (e.g. gases, liquid metals, molten salts, etc.), the simulation of highly compact steam generators (helical and plate heat exchanger), the simulation of the behaviour of large water pools with special treatment of thermal stratification and the behaviour and performance of passive safety systems. The work to be done depends strongly on the cooling fluid used. At GRS as well as worldwide, most experience has been gained for light water reactors and their behaviour both in operation and accident conditions but also for licensing issues. The compact and integral design of most SMR concepts requires extensive use of code coupling. It is advisable to perform the code development and validation described in this report within national and international research alliances.

  13. Information and dialogue process on the safety and environmental compatibility of the fracking technology; Informations- und Dialogprozess zur Sicherheit und Umweltvertraeglichkeit der Fracking-Technologie

    Energy Technology Data Exchange (ETDEWEB)

    Borchardt, Dietrich [Helmholtz-Zentrum fuer Umweltforschung - UFZ, Magdeburg (Germany); Ewen, Christoph [team ewen, Darmstadt (Germany); Richter, Sandra [sconas GbR, Ahnatal (Germany); Hammerbacher, Ruth [hammerbacher gmbh - beratung und projekte, Osnabrueck (Germany)

    2012-11-01

    Due to the reservations from the public among the production of natural gas from unconventional deposits (shale gas, coal gas) The ''Information and dialogue process on the safety and environmental compatibility of the fracking technology'' was initiated. The authors of the contribution report on the modus operandi and the summary recommendations of the neutral expert panel.

  14. Information and dialogue process on safety and environmental effects of the hydraulic fracturing technology; Der Informations- und Dialogprozess zur Sicherheit und Umweltvertraeglichkeit der Fracking-Technologie

    Energy Technology Data Exchange (ETDEWEB)

    Borchardt, Dietrich; Richter, Sandra [Helmholtz-Zentrum fuer Umweltforschung - UFZ, Magdeburg (Germany); Ewen, Christoph [team ewen, Darmstadt (Germany); Hammerbacher, Ruth [hammerbacher gmbh - beratung und projekte, Osnabrueck (Germany)

    2012-10-15

    After the big success of hydraulic fracturing in the USA, natural gas utilities are now planning natural gas production from nonconventional deposits (shale gas, coal seam gas) by hydraulic fracturing also in Germany. In order to calm public fears, an 'information and dialogue process on safety and environmental effects of the hydraulic fracturing technology' was initiated. A risk study carried out by a team of neutral experts gives recommendations for a well-founded, careful and realistic discussion of the environmental compatibility of hydraulic fracturing.

  15. Emergency response and nuclear risk governance. Nuclear safety at nuclear power plant accidents; Notfallschutz und Risk Governance. Zur nuklearen Sicherheit bei Kernkraftwerksunfaellen

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlen, Johannes

    2014-07-01

    The present study entitled ''Emergency Response and Nuclear Risk Governance: nuclear safety at nuclear power plant accidents'' deals with issues of the protection of the population and the environment against hazardous radiation (the hazards of nuclear energy) and the harmful effects of radioactivity during nuclear power plant accidents. The aim of this study is to contribute to both the identification and remediation of shortcomings and deficits in the management of severe nuclear accidents like those that occurred at Chernobyl in 1986 and at Fukushima in 2011 as well as to the improvement and harmonization of plans and measures taken on an international level in nuclear emergency management. This thesis is divided into a theoretical part and an empirical part. The theoretical part focuses on embedding the subject in a specifically global governance concept, which includes, as far as Nuclear Risk Governance is concerned, the global governance of nuclear risks. Due to their characteristic features the following governance concepts can be assigned to these risks: Nuclear Safety Governance is related to safety, Nuclear Security Governance to security and NonProliferation Governance to safeguards. The subject of investigation of the present study is as a special case of the Nuclear Safety Governance, the Nuclear Emergency governance, which refers to off-site emergency response. The global impact of nuclear accidents and the concepts of security, safety culture and residual risk are contemplated in this context. The findings (accident sequences, their consequences and implications) from the analyses of two reactor accidents prior to Fukushima (Three Mile Iceland in 1979, Chernobyl in 1986) are examined from a historical analytical perspective and the state of the Nuclear Emergency governance and international cooperation aimed at improving nuclear safety after Chernobyl is portrayed by discussing, among other topics, examples of ''best practice''(stakeholder projects, international harmonization projects) as well as existing deficiencies or challenges that came to light during-the emergency response after Fukushima. Subsequently, the nuclear power plant accident in Fukushima (March 2011) and its consequences are considered. The results of the analyses of the accidents, the accident sequence and their consequences show the need to improve national and international emergency response planning. The author then comes forward with several proposals on how to set up a pan-European emergency response scheme within the framework of a Nuclear Safety Regime, the obstacles (problems) which may interfere with the implementation of these suggestions are addressed and an interim solution for enhanced cross-border cooperation regarding emergency response is proposed. The empirical part of the thesis consists of two topics. Firstly, the national intervention levels for measures to protect the population in case of a nuclear power plant accident are examined by using comparative studies which show a considerable need for action in connection with a crossborder harmonization. One of the results is that the technical basis, e.g. regarding the different dose concepts and parameters for the intervention levels, is lacking. This information is listed in the appendix to this study. Secondly, the empirical part focuses on the collection and analysis of data that result from the answers to a couple of questions which cover all subject areas of emergency preparedness and which are related to intervention levels: With the help of an extensive questionnaire (''Questionnaire Regarding International Harmonization of Emergency Management''), the two politically or technically-oriented professional target groups in the field of Nuclear Emergency were interviewed worldwide during the time period from 23 November 2010 to 15 February 2011, that is, before the Fukushima reactor accident on 11 March 2011. They were asked to rate statements which were in fact the components of a document which the respondents did not know. This document is the result of a trans-border harmonization of emergency preparedness in case of nuclear power plant accidents which was developed and agreed upon by an international working group (EPAL) consisting of representatives of 13 European countries. An important result of the analysis of the questionnaire is that respondents neither have a common position nor a common professional approach to harmonization of emergency intervention levels. Since then, following the experiences of the accident at Fukushima, there has been an need for cross-border regulations. E.g. it has become evident, that it is necessary to negotiate an EU-wide uniform level of protection for the population in Europe in case of nuclear power plant accidents. The author makes it clear that we can no longer wait for the surveyed target groups surveyed to come an agreement, but we should rather sooner than later aim at a political agreement on an improved Nuclear Emergency regime (or Nuclear Safety regime). This may include the proposals made in the theoretical part of this thesis as well as the steps presented which would lead to EU wide emergency response arrangements for a Nuclear Safety Regime.

  16. Joint convention on the safety of spent fuel management and on the safety of radioactive waste management. Report of the Federal Republic of Germany for the fourth review meeting in may 2012; Gemeinsames Uebereinkommen ueber die Sicherheit der Behandlung abgebrannter Brennelemente und ueber die Sicherheit der Behandlung radioaktiver Abfaelle. Bericht der Bundesrepublik Deutschland fuer die vierte Ueberpruefungskonferenz im Mai 2012

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2011-08-15

    There are currently nine power reactors in operation in Germany. These are exclusively light-water reactors (seven pressurised water reactors and two boiling water reactors whose fuel assemblies are composed of low-enriched uranium oxide or uranium/plutonium mixed oxide (MOX)). With the 13{sup th} amendment to the Atomic Energy Act of 6 August 2011 as a consequence of the events in Japan, which led to a reassessment of the risks associated with the use of nuclear energy, the licences to operate the Biblis A and B, Neckarwestheim 1, Brunsbuettel, Isar 1, Unterweser, Philippsburg 1 and Kruemmel plants expired. For the remaining nine nuclear power plants, the operating licences will expire between 2015 and the end of 2022. Another 12 power reactors have already been or are in the process of being decommissioned. There were furthermore seven prototype and demonstration nuclear power plants operated in Germany, which have all been decommissioned. Two of these, the HDR Grosswelzheim, which was fully removed in 1998, and the VAK Kahl, which was also removed completely in 2010, were boiling water reactors using low-enriched uranium oxide pellets (in the VAK partly also MOX) as fuel. Two other reactors, the AVR at Juelich and the THTR at Hamm-Uentrop, were helium-cooled graphite-moderate high-temperature reactors in which the medium- and high-enriched fuel consisting of uranium/thorium oxide particles was enclosed in graphite spheres. The MZFR at Karlsruhe was a heavy-water reactor using very-low-enriched (0.85 %) uranium oxide fuel. The Compact Sodium-Cooled Nuclear Reactor (Kompakter Natriumgekuehlter Kernreaktor - KNK II) at Karlsruhe used high-enriched uranium oxide and uranium/plutonium mixed-oxide fuel. The Niederaichbach NPP (KKN) was in operation between 1972 and 1974 as a prototype plant with a heavy-water-moderated and CO{sub 2}-gas-cooled pressure tube reactor using natural uranium as fuel. Its complete removal was finished in 1995; the reactor was released from regulatory supervision. There are at present three research reactors (MTR facility BER-II at Berlin; high-flux reactor FRM II at Garching; TRIGA reactor at Mainz), three teaching reactors and one training reactor in operation in Germany. (orig.)

  17. Dual-energy X-ray absorptiometry, skinfold thickness and waist circumference for assessing body composition in ambulant and non-ambulant wheelchair games players

    Directory of Open Access Journals (Sweden)

    Annika eWillems

    2015-11-01

    Full Text Available Field-based assessments provide a cost–effective and accessible alternative to dual-energy X-ray absorptiometry (DXA for practitioners determining body composition in athletic populations. It remains unclear how the range of physical impairments classifiable in wheelchair sports may affect the utility of field-based body composition techniques. The present study assessed body composition using DXA in 14 wheelchair games players who were either wheelchair dependent (non-walkers; n =7 or relied on a wheelchair for sports participation only (walkers; n =7. Anthropometric measurements were used to predict body fat percentage with existing regression equations established for able-bodied persons by Sloan & Weir, Durnin & Womersley, Lean et al, Gallagher et al and Pongchaiyakul et al. In addition, linear regression analysis was performed to calculate the association between body fat percentage and BMI, waist circumference, sum of 6 skinfold thicknesses and sum of 8 skinfold thicknesses. Results showed that non-walkers had significantly lower total lean tissue mass (46.2±=6.6 kg vs. 59.4±8.2 kg, P =.006 and total body mass (65.8 ±4.2 kg vs. 79.4 ±14.9 kg; P =0.05 than walkers. Body fat percentage calculated from most existing regression equations was significantly lower than that from DXA, by 2 to 9% in walkers and 8 to14% in non-walkers. Of the anthropometric measurements, the sum of 8 skinfold thicknesses had the lowest standard error of estimation in predicting body fat content. In conclusion, existing anthropometric equations developed in able-bodied populations substantially underestimated body fat content in wheelchair athletes, particularly non-walkers. Impairment specific equations may be needed in wheelchair athletes.

  18. Physiological cost index in cerebral palsy: its role in evaluating the efficiency of ambulation.

    Science.gov (United States)

    Raja, Kavitha; Joseph, Benjamin; Benjamin, Susan; Minocha, Vineet; Rana, Binay

    2007-03-01

    The study was undertaken to evaluate whether the Physiological Cost Index (PCI) can be used as a reliable index of efficiency of gait and as an outcome measure in cerebral palsy (CP). Physiological Cost Index was calculated in normal subjects by recording the heart rate manually and with electrocardiograph recording, and the values compared. In another group of subjects, PCI was calculated after they walked 3 different distances (50, 100, and 150 m). The PCI of normal children and children with CP was then estimated by manual recording of the pulse, with the children walking 50 m indoors and 50 m on an uneven surface outdoors. The reproducibility of calculation of PCI was evaluated. The PCI value of each patient was compared to the corresponding Functional Mobility Score. In a group of children with CP, PCI was calculated before and after therapeutic intervention. The PCI values were comparable with either method of heart rate measurement and for the 3 distances walked. The reproducibility of measurement of PCI was satisfactory (Intraclass Correlation Coefficients, 0.80-0.88). The PCI of normal children was 0.1 beats per meter, whereas children with CP had 6 times higher values of PCI, with the highest values in children with a crouch gait. In normal children, 10% greater PCI values were noted when they walked outdoors compared to a 100% increase in children with CP. The higher the PCI values, the lower the Functional Mobility Scores. Therapeutic interventions altered PCI values, and interventions that effectively reduced energy consumption could be identified. We conclude that PCI may be used as a reliable outcome measure of gait efficiency in children with CP.

  19. Routing Ambulances to Designated Centers Increases Access to Stroke Center Care and Enrollment in Prehospital Research.

    Science.gov (United States)

    Sanossian, Nerses; Liebeskind, David S; Eckstein, Marc; Starkman, Sidney; Stratton, Samuel; Pratt, Franklin D; Koenig, William; Hamilton, Scott; Kim-Tenser, May; Conwit, Robin; Saver, Jeffrey L

    2015-10-01

    Emergency medical services routing of patients with acute stroke to designated centers may increase the proportion of patients receiving care at facilities meeting national standards and augment recruitment for prehospital stroke research. We analyzed consecutive patients enrolled within 2 hours of symptom onset in a prehospital stroke trial, before and after regional Los Angeles County Emergency Medical Services implementation of preferentially routing patients with acute stroke to approved stroke centers (ASCs). From January 2005 to mid-November 2009, patients were transported to the nearest emergency department, whereas from mid-November 2009 to December 2012, patients were preferentially transported to first 9, and eventually 29, ASCs. There were 863 subjects enrolled before and 764 after emergency medical service preferential routing, with implementation leading to an increase in the proportion cared for at an ASC from 10% to 91% (Prouting were immediate and included an increase in proportion of receiving ASC care (from 17% to 88%; P9 in 10, with no clinically significant increase in prehospital care times and enhanced recruitment of patients into a prehospital treatment trial. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00059332. © 2015 American Heart Association, Inc.

  20. A micro control valve with integrated capacitive sensing for ambulant blood pressure waveform monitoring

    NARCIS (Netherlands)

    Groen, Maarten; Brookhuis, Robert Anton; van Houwelingen, M.J.; Brouwer, Dannis Michel; Lötters, Joost Conrad; Wiegerink, Remco J.

    2013-01-01

    We have designed and fabricated the first single-wafer proportional micro control valve with built-in capacitive dis-placement sensing. The displacement sensor can facilitate high-speed active proportional control of gas flow through the valve. This is an essential requirement for non-invasive blood

  1. A piezoelectric micro control valve with integrated capacitive sensing for ambulant blood pressure waveform monitoring

    NARCIS (Netherlands)

    Groen, Maarten; Wu, Kai; Brookhuis, Robert Anton; van Houwelingen, Marc J.; Brouwer, Dannis Michel; Lötters, Joost Conrad; Wiegerink, Remco J.

    2014-01-01

    We have designed and characterized a MEMS microvalve with built-in capacitive displacement sensing and fitted it with a miniature piezoelectric actuator to achieve active valve control. The integrated displacement sensor enables high bandwidth proportional control of the gas flow through the valve.

  2. Motion noise cancellation in seismocardiogram of ambulant subjects with dual sensors.

    Science.gov (United States)

    Chenxi Yang; Tavassolian, Negar

    2016-08-01

    This paper presents a dual-sensor method of extracting seismocardiographic (SCG) data from moving adult subjects using chest-worn wireless MEMS accelerometers. A digital signal processing (DSP) system including a normalized least means square (NLMS) adaptive filter is designed and tested in MATLAB. Data results from 10 subjects indicate a detection rate of 98.72% which outperforms our previously-proposed single-sensor scheme. Various sensor positons and possible failure mechanisms are also investigated to further evaluate the system performance. The results reveal that the quality of the SCG signal from moving subjects could be improved by integrating information from multiple sensors at the cost of increasing system complexity.

  3. Limitations in Prehospital Communication Between Trauma Helicopter, Ambulance Services, and Dispatch Centers.

    Science.gov (United States)

    Harmsen, Annelieke Maria Karien; Giannakopoulos, Georgios; Franschman, Gaby; Christiaans, Herman; Bloemers, Frank

    2017-04-01

    Prehospital communication with Emergency Medical Services (EMS) is carried out in hectic situations. Proper communication among all medical personal is required to enhance collaboration, to provide the best care and enable shared situational awareness. The objective of this article was to give insight into current Dutch prehospital emergency care communication among all EMS and evaluate the usage of a new physician staffed helicopter EMS (P-HEMS) cancellation model. Trauma-related P-HEMS dispatches between November 1, 2014 and May 31, 2015 for the Lifeliner 1 were included; a random sample of 100 dispatches was generated. Tape recordings on all verbal prehospital communication between the dispatch center, EMS, and P-HEMS were transcribed and analyzed. Qualitative content analysis was performed, using open coding to code key messages. Ninety-two tape recordings were analyzed. The most frequent reason for P-HEMS dispatch was suspicion of brain injury (24%). The cancellation model was followed in 66%, overruled in 9%, and not applicable in 25%. The main reason for not adhering to the model was hemodynamic stability. In 5% of P-HEMS dispatches, a complete ABCD (airway, breathing, circulation, disability) methodology was used for handover, in 9% a complete Situation-Background-Assessment-Recommendation technique, in 2% a complete Mechanism-Injuries-Signs-Treatment method was used. The other handovers were incomplete. Prehospital handover between EMS on-scene and P-HEMS often entails insufficient information. The cancellation model for P-HEMS is frequently used and promotes adequate information transfer. To increase joined decision-making, more patient and situational information needs to be handed over. Standardization of prehospital trauma handovers will facilitate this and improve trauma patient's outcome. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Walking Exercise in Water Improving Practical Ambulation in a Patient with Chronic Cerebellar Ataxia

    OpenAIRE

    池永, 康規; 豊田, 多喜子; 八幡, 徹太郎; 染矢, 富士子; 立野, 勝彦

    2002-01-01

    The specific effect of general dynamic water exercise in 41 year-old woman with chronic cerebellar ataxia induced by meningitis was observed. She was conservatively treated and took bed rest for two weeks, and she suffered from severe dynamic and static ataxia. And exercise under weight-bearing and bandage pressure and Frenkel exercise was applied for nine months. However her disability was not improved. And then she took a 30-minute walking practice in water twice weekly. After that training...

  5. Energy expenditure estimation during normal ambulation using triaxial accelerometry and barometric pressure.

    Science.gov (United States)

    Wang, Jingjing; Redmond, Stephen J; Voleno, Matteo; Narayanan, Michael R; Wang, Ning; Cerutti, Sergio; Lovell, Nigel H

    2012-11-01

    Energy expenditure (EE) is an important parameter in the assessment of physical activity. Most reliable techniques for EE estimation are too impractical for deployment in unsupervised free-living environments; those which do prove practical for unsupervised use often poorly estimate EE when the subject is working to change their altitude by walking up or down stairs or inclines. This study evaluates the augmentation of a standard triaxial accelerometry waist-worn wearable sensor with a barometric pressure sensor (as a surrogate measure for altitude) to improve EE estimates, particularly when the subject is ascending or descending stairs. Using a number of features extracted from the accelerometry and barometric pressure signals, a state space model is trained for EE estimation. An activity classification algorithm is also presented, and this activity classification output is also investigated as a model input parameter when estimating EE. This EE estimation model is compared against a similar model which solely utilizes accelerometry-derived features. A protocol (comprising lying, sitting, standing, walking, walking up stairs, walking down stairs and transitioning between activities) was performed by 13 healthy volunteers (8 males and 5 females; age: 23.8 ± 3.7 years; weight: 70.5 ± 14.9 kg), whose instantaneous oxygen uptake was measured by means of an indirect calorimetry system (K4b(2), COSMED, Italy). Activity classification improves from 81.65% to 90.91% when including barometric pressure information; when analyzing walking activities alone the accuracy increases from 70.23% to 98.54%. Using features derived from both accelerometry and barometry signals, combined with features relating to the activity classification in a state space model, resulted in a VO(2) estimation bias of -0.00 095 and precision (1.96SD) of 3.54 ml min(-1) kg(-1). Using only accelerometry features gives a relatively worse performance, with a bias of -0.09 and precision (1.96SD) of 5.99 ml min(-1) kg(-1), with the largest errors due to an underestimation of VO(2) when walking up stairs.

  6. A validation of ground ambulance pre-hospital times modeled using geographic information systems

    Directory of Open Access Journals (Sweden)

    Patel Alka B

    2012-10-01

    Full Text Available Abstract Background Evaluating geographic access to health services often requires determining the patient travel time to a specified service. For urgent care, many research studies have modeled patient pre-hospital time by ground emergency medical services (EMS using geographic information systems (GIS. The purpose of this study was to determine if the modeling assumptions proposed through prior United States (US studies are valid in a non-US context, and to use the resulting information to provide revised recommendations for modeling travel time using GIS in the absence of actual EMS trip data. Methods The study sample contained all emergency adult patient trips within the Calgary area for 2006. Each record included four components of pre-hospital time (activation, response, on-scene and transport interval. The actual activation and on-scene intervals were compared with those used in published models. The transport interval was calculated within GIS using the Network Analyst extension of Esri ArcGIS 10.0 and the response interval was derived using previously established methods. These GIS derived transport and response intervals were compared with the actual times using descriptive methods. We used the information acquired through the analysis of the EMS trip data to create an updated model that could be used to estimate travel time in the absence of actual EMS trip records. Results There were 29,765 complete EMS records for scene locations inside the city and 529 outside. The actual median on-scene intervals were longer than the average previously reported by 7–8 minutes. Actual EMS pre-hospital times across our study area were significantly higher than the estimated times modeled using GIS and the original travel time assumptions. Our updated model, although still underestimating the total pre-hospital time, more accurately represents the true pre-hospital time in our study area. Conclusions The widespread use of generalized EMS pre-hospital time assumptions based on US data may not be appropriate in a non-US context. The preference for researchers should be to use actual EMS trip records from the proposed research study area. In the absence of EMS trip data researchers should determine which modeling assumptions more accurately reflect the EMS protocols across their study area.

  7. Ambulant neuropsykologisk opfølgning af patienter indlagt med aseptisk meningitis

    DEFF Research Database (Denmark)

    Damsgaard Gunst, Jesper; Klostergaard, Kirsten Rose; Leutscher, Peter Derek Christian

    2014-01-01

    Aseptic meningitis is considered to be a benign illness with mild symptoms, and the prognosis is usually good. However, retrospective studies have demonstrated that these patients may experience cognitive sequelae. A neuropsychologist was affiliated to the Department of Infectious Diseases......, and neuropsychological findings in patients with aseptic meningitis were assessed. In conclusion, at twelve months of follow-up cognitive dysfunction persist among the majority of patients; 75% had mental fatigue and 45% had changed their work status....

  8. Prävalenz psychiatrischer Diagnosen/Komorbidität von ambulant-medizinisch betreuten Patienten

    OpenAIRE

    Himmelberger, Stephan Josef

    2012-01-01

    Hintergrund und Fragestellung. Eine erste Motivation für diese Arbeit entsprang dem Interesse an den bio-psycho-sozialen Zusammenhängen bei den eigenen Patienten auf der medizinischen Poliklinik des Universitätsspitals Zürich. Auch das bei dieser Assistenzstelle nunmehr plötzlich verstärkte Gefühl der eigenen Unzulänglichkeit im Umgang mit verschiedenen Patienten und deren Problemen motivierten mich, die vorliegende Erhebung durchzuführen. Bestärkt durch Aussagen meiner Mitassistenten, welche...

  9. "Saving Lives; Living the Dream": Gender and Emotional Labor Among Ambulance-Based 911 Paramedics

    OpenAIRE

    McNamara, Megan Bethany

    2016-01-01

    This project examines intersections of work, gender, and emotional labor among paramedics in Emergency Medical Services (EMS). Ethnographic research on gender and work analyzes labor through pre-gendered lenses: occupations are either masculinized or feminized, and the people who work those jobs are either in gender-matched occupations, or they are crossing over into occupations that have not traditionally been associated with their gender. EMS is a unique case in which workers are required t...

  10. Svær dehydrering hos nyfødt efter ambulant fødsel

    DEFF Research Database (Denmark)

    Thøstesen, Lisbeth Marianne; Fenger-Grøn, Jesper

    2011-01-01

    A nine day-old girl was hospitalised because of breast-feeding problems and life-threatening hypernatremic dehydration; weight loss was 30% of birth weight and s-Na 187 mmol/l. The question is raised whether there could be an association to the current changes in the perinatal health care...... in Denmark. The case emphasizes the necessity of a sufficient safety net beneath the newborn children in order to minimise the risk of breast-feeding problems and re-hospitalizing. Neonatal problems such as marked weight loss, dehydration, hypernatremia and marked jaundice are potentially preventable....

  11. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review.

    Science.gov (United States)

    Ozaki, Hayao; Loenneke, Jeremy P; Thiebaud, Robert S; Stager, Joel M; Abe, Takashi

    2013-01-01

    It is known that ambulatory exercises such as brisk walking and jogging are potent stimuli for improving aerobic capacity, but it is less understood whether ambulatory exercise can increase leg muscle size and function. The purpose of this brief review is to discuss whether or not ambulatory exercise elicits leg muscle hypertrophy in older adults. Daily ambulatory activity with moderate (>3 metabolic equivalents [METs], which is defined as the ratio of the work metabolic rate to the resting metabolic rate) intensity estimated by accelerometer is positively correlated with lower body muscle size and function in older adults. Although there is conflicting data on the effects of short-term training, it is possible that relatively long periods of walking, jogging, or intermittent running for over half a year can increase leg muscle size among older adults. In addition, slow-walk training with a combination of leg muscle blood flow restriction elicits muscle hypertrophy only in the blood flow restricted leg muscles. Competitive marathon running and regular high intensity distance running in young and middle-aged adults may not produce leg muscle hypertrophy due to insufficient recovery from the damaging running bout, although there have been no studies that have investigated the effects of running on leg muscle morphology in older subjects. It is clear that skeletal muscle hypertrophy can occur independently of exercise mode and load.

  12. «Ambulant akutteam - Et sikkerhetsbelte for mennesker i psykisk krise?»

    Directory of Open Access Journals (Sweden)

    Monika Knudsen Gullslett

    2014-01-01

    Full Text Available The objective of this study is to contribute with in-depth knowledge based on persons’ subjective experiences within mental health crisis and support and help from a Crisis Resolution/Home Treatment (CR/HT team. The study has a qualitative, exploratory design and qualitative interviews were conducted with seven persons. They have experiences with both inpatient treatment in hospitals and support from a CR/HT teams. The informants revealed a variety of experiences as service users in the different helping contexts. The experiences of the CR/HT team’s accessibility, availability and flexibility, was highlighted as important.  The Service users felt they were taken more seriously and met as a fellow human being in the home setting as opposed to hospital ward. The informants also emphasized how the CR/HT team helped them to feel more safe and secure. This study offers some in-depth insights of being on the receiving end of mental health services. It is important to include experience based user knowledge in the evidence base of practice development.

  13. Influence of diabetes on ambulation and inflammation in men and women with symptomatic peripheral artery disease

    Directory of Open Access Journals (Sweden)

    Andrew W. Gardner

    2015-12-01

    Conclusions: In patients with PAD, diabetic men and women with CAD had more severe claudication than their non-diabetic counterparts, as measured by shorter PWT, and the men had further ambulatory impairment manifested by slower 4-meter gait speed. Furthermore, the diabetic patients with CAD had elevations in interleukin-8, leptin, and PEDF.

  14. The drone ambulance [A-UAS]: golden bullet or just a blank?

    Science.gov (United States)

    Van de Voorde, P; Gautama, S; Momont, A; Ionescu, C M; De Paepe, P; Fraeyman, N

    2017-07-01

    Defibrillation within the first minutes after sudden cardiac arrest can save many quality-adjusted life years. Yet, despite enormous investments, 'healthcare' is still unable to provide this for the majority of patients. Emergency Medical Services often have a too long mean response time and many issues surround Public Access Defibrillation programs. In this article we argument that AED-equipped drones could be the 'magic bullet'. They are easily deployed and fast, and have a relatively low operational cost. As such they could rapidly bring an AED next to the victim, irrespective of most geographical circumstances, give visual feedback and situational awareness to the EMS dispatcher and thus assist a bystander to provide better CPR. Although there are many real-life barriers to actual deployment, we argument these might all get solved once we have solved the described technological issues. Copyright © 2017 Elsevier B.V. All rights reserved.

  15. Muscle strength, aerobic capacity and physical activity in independent ambulating children with lumbosacral spina bifida

    NARCIS (Netherlands)

    P.J.M. Helders; T. Takken; J.F. de Groot; J.L.M. Hilleart; M.A.G.C. Schoenmakers; J.W. Gorter

    2009-01-01

    Purpose. This cross-sectional study investigates deficits and associations in muscle strength, 6-minute walking distance (6MWD), aerobic capacity (VO2peak), and physical activity (PA) in independent ambulatory children with lumbosacral spina bifida. Method. Twenty-tree children participated (13

  16. Elderly and Nonelderly Use of a Dedicated Ambulance Corps’ Emergency Medical Services in Taiwan

    Directory of Open Access Journals (Sweden)

    Chien-Chia Huang

    2016-01-01

    Full Text Available Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years and nonelderly (<65 years. Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05 fewer (28 (9.2% nontransport calls than did the nonelderly (136 (21.4%. In the transport calls, 276 (35.6% were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

  17. Walk-in ambulant lungefunktionsservice for rygere i Kobenhavn--etarsopgorelse

    DEFF Research Database (Denmark)

    Backer, V.; Bolton, S.; Ehlers, H.D.

    2008-01-01

    BACKGROUND: Early prevention of COPD and immediate consultation about tobacco cessation is a major issue in respiratory medicine. Aim: To evaluate if a community-based walk-in lung function service, either in a clinic or a shopping mall, could result in early detection of COPD. Early detection...... would facilitate prevention. MATERIALS AND METHODS: In an area with 1.5 mill inhabitants, a walk-in lung function service opened in 2005/06 once a month for 3 hours at a clinic and on two full days in a mall. The staff consisted of two respiratory nurses and one chest physician. The nurses informed all...... function service at the mall (38% versus 25%) (p mall and the clinic (32 (20) versus 23 (16), p

  18. New horizons for orthotic and prosthetic technology: artificial muscle for ambulation

    Science.gov (United States)

    Herr, Hugh M.; Kornbluh, Roy D.

    2004-07-01

    The rehabilitation community is at the threshold of a new age in which orthotic and prosthetic devices will no longer be separate, lifeless mechanisms, but intimate extensions of the human body-structurally, neurologically, and dynamically. In this paper we discuss scientific and technological advances that promise to accelerate the merging of body and machine, including the development of actuator technologies that behave like muscle and control methodologies that exploit principles of biological movement. We present a state-of-the-art device for leg rehabilitation: a powered ankle-foot orthosis for stroke, cerebral palsy, or multiple sclerosis patients. The device employs a forcecontrollable actuator and a biomimetic control scheme that automatically modulates ankle impedance and motive torque to satisfy patient-specific gait requirements. Although the device has some clinical benefits, problems still remain. The force-controllable actuator comprises an electric motor and a mechanical transmission, resulting in a heavy, bulky, and noisy mechanism. As a resolution of this difficulty, we argue that electroactive polymer-based artificial muscle technologies may offer considerable advantages to the physically challenged, allowing for joint impedance and motive force controllability, noise-free operation, and anthropomorphic device morphologies.

  19. Impaired ambulation and steroid therapy impact negatively on bone health in multiple sclerosis.

    Science.gov (United States)

    Tyblova, M; Kalincik, T; Zikan, V; Havrdova, E

    2015-04-01

    The prevalence of osteopenia and osteoporosis is higher amongst patients with multiple sclerosis in comparison with the general population. In addition to the general determinants of bone health, two factors may contribute to reduced bone mineral density in multiple sclerosis: physical disability and corticosteroid therapy. The aim of this study was to examine the effect of physical disability and steroid exposure on bone health in weight-bearing bones and spine and on the incidence of low-trauma fractures in multiple sclerosis. In this retrospective analysis of prospectively collected data, associations between bone mineral density (at the femoral neck, total femur and the lumbar spine) and its change with disability or cumulative steroid dose were evaluated with random-effect models adjusted for demographic and clinical determinants of bone health. The incidence of low-trauma fractures during the study follow-up was evaluated with Andersen-Gill models. Overall, 474 and 438 patients were included in cross-sectional and longitudinal analyses (follow-up 2347 patient-years), respectively. The effect of severely impaired gait was more apparent in weight-bearing bones (P ≤ 10(-15) ) than in spine (P = 0.007). The effect of cumulative steroid dose was relatively less pronounced but diffuse (P ≤ 10(-4) ). Risk of low-trauma fractures was associated with disability (P = 0.02) but not with cumulative steroid exposure and was greater amongst patients with severely impaired gait (annual risk 3.5% vs. 3.0%). Synergistic effects were found only between cumulative steroid dose in patients ambulatory without support (P = 0.02). Bone health and the incidence of low-trauma fractures in multiple sclerosis are more related to impaired gait than to extended corticosteroid therapy. © 2014 The Author(s) European Journal of Neurology © 2014 EAN.

  20. Using Shoulder Straps Decreases Heart Rate Variability and Salivary Cortisol Concentration in Swedish Ambulance Personnel

    Directory of Open Access Journals (Sweden)

    Kåre J. Karlsson

    2016-03-01

    Conclusion: The use of shoulder straps decreases measurable physical stress and should therefore be implemented when heavy equipment or a stretcher needs to be carried. An easy way to ensure that staff use these or similar lifting aids is to provide them with personalized, well-adapted shoulder straps. Another better option would be to routinely sewn these straps into the staff's personal alarm jackets so they are always in place and ready to be used.

  1. Design Considerations to Enhance the Safety of Patient Compartments in Ambulance Transporters

    National Research Council Canada - National Science Library

    Byran, Eyal; Gilad, Issachar

    2012-01-01

    .... The workplace ergonomics of the interior of the passenger cabin is lacking. This article discusses an improved ergonomic interior design based on study findings, observations and subjective perception...

  2. Predictive factors of cessation of ambulation in patients with Duchenne muscular dystrophy

    NARCIS (Netherlands)

    Bakker, Jan P. J.; de Groot, Imelda J. M.; Beelen, Anita; Lankhorst, Gustaaf J.

    2002-01-01

    To identify baseline patient and treatment characteristics that can predict wheelchair dependency within 2 yr. This prospective cohort study included 44 subjects who met study inclusion criteria. The same investigator examined them at 6-mo intervals. Ambulatory status, anthropometric data, muscle

  3. Intramuscular fat in ambulant young adults with bilateral spastic cerebral palsy

    OpenAIRE

    Noble, Jonathan J; Charles-Edwards, Geoffrey D; Keevil, Stephen F.; Lewis, Andrew P.; Gough, Martin; Shortland, Adam P

    2014-01-01

    Background It is known that individuals with bilateral spastic cerebral palsy (BSCP) have small and weak muscles. However, no studies to date have investigated intramuscular fat infiltration in this group. The objective of this study is to determine whether adults with BSCP have greater adiposity in and around their skeletal muscles than their typically developing (TD) peers as this may have significant functional and cardio-metabolic implications for this patient group. Methods 10 young adul...

  4. The effects of a controlled energy storage and return prototype prosthetic foot on transtibial amputee ambulation.

    Science.gov (United States)

    Segal, Ava D; Zelik, Karl E; Klute, Glenn K; Morgenroth, David C; Hahn, Michael E; Orendurff, Michael S; Adamczyk, Peter G; Collins, Steven H; Kuo, Arthur D; Czerniecki, Joseph M

    2012-08-01

    The lack of functional ankle musculature in lower limb amputees contributes to the reduced prosthetic ankle push-off, compensations at other joints and more energetically costly gait commonly observed in comparison to non-amputees. A variety of energy storing and return prosthetic feet have been developed to address these issues but have not been shown to sufficiently improve amputee biomechanics and energetic cost, perhaps because the timing and magnitude of energy return is not controlled. The goal of this study was to examine how a prototype microprocessor-controlled prosthetic foot designed to store some of the energy during loading and return it during push-off affects amputee gait. Unilateral transtibial amputees wore the Controlled Energy Storage and Return prosthetic foot (CESR), a conventional foot (CONV), and their previously prescribed foot (PRES) in random order. Three-dimensional gait analysis and net oxygen consumption were collected as participants walked at constant speed. The CESR foot demonstrated increased energy storage during early stance, increased prosthetic foot peak push-off power and work, increased prosthetic limb center of mass (COM) push-off work and decreased intact limb COM collision work compared to CONV and PRES. The biological contribution of the positive COM work for CESR was reduced compared to CONV and PRES. However, the net metabolic cost for CESR did not change compared to CONV and increased compared to PRES, which may partially reflect the greater weight, lack of individualized size and stiffness and relatively less familiarity for CESR and CONV. Controlled energy storage and return enhanced prosthetic push-off, but requires further design modifications to improve amputee walking economy. Published by Elsevier B.V.

  5. 75 FR 62639 - Air Ambulance and Commercial Helicopter Operations, Part 91 Helicopter Operations, and Part 135...

    Science.gov (United States)

    2010-10-12

    .... Helicopter air medical transportation was first used prominently during the Korean War to move injured... Drug and Alcohol Testing Program, and would therefore not be required to undergo drug testing...

  6. A stair-climbing test for measuring mechanical efficiency of ambulation in adults with chronic stroke.

    Science.gov (United States)

    Harries, Netta; Loeppky, Jack A; Shaheen, Samira; Al-Jarrah, Muhammed; Molteni, Franco; Hutzler, Yeshayahu; Bar-Haim, Simona

    2015-01-01

    Mechanical efficiency can assess motor performance in individuals with physical disabilities. The purpose was to determine the utility of predicting it from heart rate (HR) during a self-paced stair-climbing test in adults with chronic hemiparesis after stroke and to determine the minimal detectable change of net mechanical efficiency (MEnet) measured by this exercise. First, 15 subjects with chronic hemiparesis participated in a validation study (A) and then 28 took part in a repeatability study (B). In study A the MEnet was calculated from external work and oxygen uptake above rest (dVO2), as directly measured and as predicted from body weight and increase in heart rate (dHR). In study B, predicted dVO2 was used to obtain MEnet for duplicate stair-climbing tests (T1, T2) with >30 min rest between. Measured MEnet was closely related to predicted MEnet (r = 0.97, p climbing test seem sufficiently meaningful to estimate ambulatory ability and its changes with interventions or walking aids in adults with hemiparesis. Ambulatory ability can be estimated from mechanical efficiency, obtained from a 5-min stair-climbing test utilizing a 4-step stair, to measure external work, and the change in heart rate above rest to estimate the metabolic cost of the task. A change of > 0.6% in mechanical efficiency by this stair-climbing test indicates a significant change in ambulatory ability of persons with hemiparesis.

  7. Cross-cultural validation of the Italian version of the Cumulated Ambulation Score

    DEFF Research Database (Denmark)

    Grana, Elisa; Verzellotti, Simone; Grassi, Federico A

    2016-01-01

    -cultural adapt, and validate the CAS in the Italian language (CAS-I). The translation was carried out according to recommended guidelines. The final version of the CAS-I was administered to 80 geriatric patients with hip fracture admitted to a Traumatology Unit, and allowed full weight-bearing after treatment...

  8. Musculoskeletal neck-shoulder pain : a new ambulant myofeedback intervention approach

    NARCIS (Netherlands)

    Voerman, Gerlienke

    2007-01-01

    Persisting musculoskeletal complaints in the neck-shoulder region are highly prevalent and associated with high health care and community costs in industrialized countries. The mechanisms underlying the development and perpetuation of these complaints have not fully been identified yet, but

  9. Fluid and salt supplementation effect on body hydration and electrolyte homeostasis during bed rest and ambulation

    Science.gov (United States)

    Zorbas, Yan G.; Kakurin, Vassily J.; Kuznetsov, Nikolai A.; Yarullin, Vladimir L.

    2002-06-01

    Bed rest (BR) induces significant urinary and blood electrolyte changes, but little is known about the effect of fluid and salt supplements (FSS) on catabolism, hydration and electrolytes. The aim was to measure the effect of FSS on catabolism, body hydration and electrolytes during BR. Studies were done during 7 days of a pre-bed rest period and during 30 days of a rigorous bed rest period. Thirty male athletes aged, 24.6±7.6 years were chosen as subjects. They were divided into three groups: unsupplemented ambulatory control subjects (UACS), unsupplemented bed rested subjects (UBRS) and supplemented bed rested subjects (SBRS). The UBRS and SBRS groups were kept under a rigorous bed rest regime for 30 days. The SBRS daily took 30 ml water per kg body weight and 0.1 sodium chloride per kg body weight. Plasma sodium (Na), potassium (K), calcium (Ca) and magnesium (Mg) levels, urinary Na, K, Ca and Mg excretion, plasma osmolality, plasma protein level, whole blood hemoglobin (Hb) and hematocrit (Hct) level increased significantly ( p≤0.05), while plasma volume (PV), body weight, body fat, peak oxygen uptake, food and fluid intake decreased significantly ( p≤0.05) in the UBRS group when compared with the SBRS and UACS groups. In contrast, plasma and urinary electrolytes, osmolality, protein level, whole blood Hct and Hb level decreased significantly ( p≤0.05), while PV, fluid intake, body weight and peak oxygen uptake increased significantly ( p≤0.05) in the SBRS group when compared with the UBRS group. The measured parameters did not change significantly in the UACS group when compared with their baseline control values. The data indicate that FSS stabilizes electrolytes and body hydration during BR, while BR alone induces significant changes in electrolytes and body hydration. We conclude that FSS may be used to prevent catabolism and normalize body hydration status and electrolyte values during BR.

  10. Possibility of leg muscle hypertrophy by ambulation in older adults: a brief review

    Directory of Open Access Journals (Sweden)

    Ozaki H

    2013-03-01

    Full Text Available Hayao Ozaki,1 Jeremy P Loenneke,2 Robert S Thiebaud,2 Joel M Stager,3 Takashi Abe31Juntendo University, Inzai, Chiba, Japan; 2Department of Health and Exercise Science, University of Oklahoma, Norman, OK, USA; 3Department of Kinesiology, Indiana University, Bloomington, IN, USAAbstract: It is known that ambulatory exercises such as brisk walking and jogging are potent stimuli for improving aerobic capacity, but it is less understood whether ambulatory exercise can increase leg muscle size and function. The purpose of this brief review is to discuss whether or not ambulatory exercise elicits leg muscle hypertrophy in older adults. Daily ambulatory activity with moderate (>3 metabolic equivalents [METs], which is defined as the ratio of the work metabolic rate to the resting metabolic rate intensity estimated by accelerometer is positively correlated with lower body muscle size and function in older adults. Although there is conflicting data on the effects of short-term training, it is possible that relatively long periods of walking, jogging, or intermittent running for over half a year can increase leg muscle size among older adults. In addition, slow-walk training with a combination of leg muscle blood flow restriction elicits muscle hypertrophy only in the blood flow restricted leg muscles. Competitive marathon running and regular high intensity distance running in young and middle-aged adults may not produce leg muscle hypertrophy due to insufficient recovery from the damaging running bout, although there have been no studies that have investigated the effects of running on leg muscle morphology in older subjects. It is clear that skeletal muscle hypertrophy can occur independently of exercise mode and load.Keywords: aerobic exercise, muscle mass, aging, strength, sarcopenia

  11. Functional ability and muscle force in healthy children and ambulant Duchenne muscular dystrophy patients

    NARCIS (Netherlands)

    Beenakker, EAC; Maurits, NM; Fock, JM; Brouwer, OF; van der Hoeven, JH

    2005-01-01

    Neuromuscular disorders are characterised by progressive muscle weakness, which in time causes functional impairment. To quantify the extent of disease progression, muscle force and functional ability can be measured. Which of these parameters changes most depends on the disease stage. In a previous

  12. Ambulant children with spastic cerebral palsy and their parents' perceptions and expectations prior to multilevel surgery.

    Science.gov (United States)

    Capjon, Hilde; Bjørk, Ida Torunn

    2010-01-01

    This study explores the pre-operative situation of children accepted for multilevel surgery for cerebral palsy (CP) and their parents. Eight ambulatory children with varied severity of spastic CP and their parents were included. Qualitative, semi-structured interviews were carried out separately with the children and parents. Everyday life of the children and their parents was vulnerable. The degree to which children strived for social acceptance and normality increased their pain. Deteriorating physical capacity resulted in pain and fatigue and was the parents' and children's main motivation for the operation. Although the parents were ambivalent to the operation they mediated hope and cautious optimism about a better life for their children. Parents' and children's experiences imply the need for improvements to ensure facilitation for disabled children in schools and all levels of the health service, equality of communication and awareness-raising in the pre-operative phase of multilevel surgery.

  13. The Role of Lower Extremity Joint Powers in Successful Stair Ambulation

    Science.gov (United States)

    2011-01-01

    written informed consent, all subjects participated in a biomechanical gait assessment during stair ascent walking. A total of 55 markers were used...power generation and vertical COM acceleration (COMA) during stair ascent. Twenty-two healthy individuals underwent a biomechanical gait assessment...limb mechanics during stair - climbing . J Bone Joint Surg Am 1980;62:749–57. [3] Costigan PA, Deluzio KJ, Wyss UP. Knee and hip kinetics during normal

  14. Home monitoring after ambulatory implanted primary cardiac implantable electronic devices: The home ambulance pilot study.

    Science.gov (United States)

    Parahuleva, Mariana S; Soydan, Nedim; Divchev, Dimitar; Lüsebrink, Ulrich; Schieffer, Bernhard; Erdogan, Ali

    2017-11-01

    The Home Monitoring (HM) system of cardiac implantable electronic devices (CIEDs) permits early detection of arrhythmias or device system failures. The aim of this pilot study was to examine how the safety and efficacy of the HM system in patients after ambulatory implanted primary CIEDs compare to patients with a standard procedure and hospitalization. We hypothesized that HM and their modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs. This retrospective analysis evaluates telemetric data obtained from 364 patients in an ambulatory single center over 6 years. Patients were assigned to an active group (n = 217), consisting of those who were discharged early on the day of implantation of the primary CIED, or to a control group (n = 147), consisting of those discharged and followed up with the HM system according to usual medical practices. The mean duration of hospitalization was 73.2% shorter in the active group than in the control group, corresponding to 20.5 ± 13 fewer hours (95% confidence interval [CI]: 6.3-29.5; P ambulatory implanted CIED when compared with standard management of these patients. Early discharge with the HM system after ambulatory CIED implantation was safe and not inferior to the classic medical procedure. Thus, together with lower costs, HM and its modifications would be a useful extension of the present concepts for ambulatory implanted CIEDs. © 2017 Wiley Periodicals, Inc.

  15. The Relationship between Manual Ability and Ambulation in Adolescents with Cerebral Palsy

    Science.gov (United States)

    Majnemer, Annette; Shikako-Thomas, Keiko; Shevell, Michael; Poulin, Chantal; Lach, Lucyna; Law, Mary; Schmitz, Norbert

    2013-01-01

    This study examined the relationship between gross motor function and manual ability in 120 adolescents with cerebral palsy (CP) (15.2, SD 2.1 years, 59.8% male). Adolescents were evaluated using the Gross Motor Function Classification System (GMFCS) and the Manual Ability Classification System (MACS). A neurologist classified CP subtype. Most…

  16. Safety and risk questions following the nuclear incidents and accidents in Japan. Summary final report; Sicherheits- und Risikofragen im Nachgang zu den nuklearen Stoer- und Unfaellen in Japan. Zusammenfassender Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Mildenberger, Oliver

    2015-03-15

    After the nuclear accidents in Japan, GRS has carried out in-depth investigations of the events. On the one hand, the accident sequences in the affected units have been analysed from various viewpoints. On the other hand, the transferability of the findings to German plants has been examined to possibly make recommendations for safety improvements. The accident sequences at Fukushima Daiichi have been traced with as much detail as possible based on all available information. Additional insights have been drawn from thermohydraulic analyses with the GRS code system ATHLET-CD/COCOSYS focusing on the events in units 2 and 3, e.g. with regard to core damage and the state of the containments in the first days of the accident sequence. In-depth investigations have also been carried out on topics such as natural external hazards, electrical power supply or organizational measures. In addition, methodological studies on further topics related with the accidents have been performed. Through a detailed analysis of the relevant data from the events in Japan, the basis for an in-depth examination of the transferability to German plants was created. It was found that an implementation of most of the insights gained from the investigations had already been initiated as part of the GRS information notice 2012/02. Further findings have been communicated to the federal government and introduced into other relevant bodies, e.g. the Nuclear Safety Standards Committee (KTA) or the Reactor Safety Commission (RSK).

  17. Study on the safety during transport of radioactive materials. Pt. 4. Events during transport. Final report work package 6; Untersuchungen zur Sicherheit bei der Befoerderung radioaktiver Stoffe. T. 4. Ereignisse bei der Befoerderung. Abschlussbericht zum Arbeitspaket 6

    Energy Technology Data Exchange (ETDEWEB)

    Sentuc, Florence-Nathalie

    2014-09-15

    This report presents the results from a data collection and an evaluation of the safety significance of events in the transportation of radioactive material by all modes on public routes in Germany. Systems for reporting and evaluation of the safety significance of events encountered in the transport of radioactive material are a central element in monitoring and judging the adequacy and effectiveness of the transport regulations and their underlying safety philosophy, this allows for revision by experience feedback (lessons learned). The nationwide survey performed covering the period from the mid 1990s through 2013 identified and analysed a total of 670 transport events varying in type and severity. The vast majority of recorded transport events relate to minor deviations from the provisions of the transport regulations (e.g. improper markings and error in transport documents) or inappropriate practices and operational procedures resulting in material damage of packages and equipment such as handling incidents. Severe traffic accidents and fires represented only a small fraction (ca. 3 percent) of the recorded transport events. Four transport events were identified in the reporting period to have given rise to environmental radioactive releases. Three transport events have reportedly resulted in minor radiation exposures to the transport personnel; in one case an exposure in excess of the statutory annual dose limit for the public seems possible. Based on the EVTRAM scale, with seven significance levels, the broad majority of transport events has been classified as ''non-incidents'' (Level 0) and ''events without affecting the safety functions of the package'' (Level 1). On the INES scale most transport events would be classified as events with ''no safety significance'' (Below Scale/Level 0). The survey results show no serious deficiencies in the transport of radioactive material, supporting the conclusion that a high level of safety and protection is ensured by the existing regulatory requirements. However, there is potential for improvement notably through avoiding common administrative deviations that could be rectified by training and qualification of the involved transport personnel. Otherwise, harmonising and consolidating of transport event reports would be a preferable future goal.

  18. Development of computational methods for the safety assessment of gas-cooled high-temperature and supercritical light-water reactors. Final report; Rechenmethoden zur Bewertung der Sicherheit von gasgekuehlten Hochtemperaturreaktoren und superkritischen Leichtwasserreaktoren. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Buchholz, S.; Cron, D. von der; Hristov, H.; Lerchl, G.; Papukchiev, A.; Seubert, A.; Sureda, A.; Weis, J.; Weyermann, F.

    2012-12-15

    This report documents developments and results in the frame of the project RS1191 ''Development of computational methods for the safety assessment of gas-cooled high temperature and supercritical light-water reactors''. The report is structured according to the five work packages: 1. Reactor physics modeling of gas-cooled high temperature reactors; 2. Coupling of reactor physics and 3-D thermal hydraulics for the core barrel; 3. Extension of ATHLET models for application to supercritical reactors (HPLWR); 4. Further development of ATHLET for application to HTR; 5. Further development and validation of ANSYS CFX for application to alternative reactor concepts. Chapter 4 describes the extensions made in TORT-TD related to the simulation of pebble-bed HTR, e.g. spectral zone buckling, Iodine-Xenon dynamics, nuclear decay heat calculation and extension of the cross section interpolation algorithms to higher dimensions. For fast running scoping calculations, a time-dependent 3-D diffusion solver has been implemented in TORT-TD. For the PBMR-268 and PBMR-400 as well as for the HTR-10 reactor, appropriate TORT-TD models have been developed. Few-group nuclear cross sections have been generated using the spectral codes MICROX- 2 and DRAGON4. For verification and validation of nuclear cross sections and deterministic reactor models, MCNP models of reactor core and control rod of the HTR-10 have been developed. Comparisons with experimental data have been performed for the HTR-10 first criticality and control rod worth. The development of the coupled 3-D neutron kinetics and thermal hydraulics code system TORT-TD/ATTICA3D is documented in chapter 5. Similar to the couplings with ATHLET and COBRA-TF, the ''internal'' coupling approach has been implemented. Regarding the review of experiments and benchmarks relevant to HTR for validation of the coupled code system, the PBMR-400 benchmarks and the HTR-10 test reactor have been selected. Performed test and validation calculations for short and long term transients like withdrawal and ejection of all or single control rods, cold helium ingress or depressurized loss of forced cooling (DLOFC) demonstrate the applicability of TORT-TD/ATTICA3D to 3-D analyses of pebble bed HTR. Chapter 6 documents the extension made in ATHLET regarding application to supercritical water reactors. This includes the implementation of supercritical water as a working fluid and extensions of the model equations for the physics of heat transfer and pressure drop at supercritical water pressure as well as the extension of the material properties package to pressures above the critical point and the modeling of supercritical discharge. The extensions in ATHLET to simulate pebble-bed HTR are described in chapter 7. In ATHLET, the coolant helium has been implemented both as gas component and a working fluid. The material properties package has been properly extended. For the thermal hydraulic modeling of the reactor pressure vessel, a generic parallel channel model including cross connections has been developed for the PBMR-400 design. The HECU model in ATHLET has been extended to spherical geometries in order to simulate the heat transfer processes in HTR fuel pebbles with detailed representation of the TRISO particle fuel. In addition, ATHLET models of gas turbine and compressor have been developed and tested. Finally, chapter 8 documents the development and validation of ANSYS CFX for application to alternative reactor concepts. This includes extensions and applications of the CFX code regarding HPLWR requirements. Accuracy demonstrations of ANSYS CFX models for heat transfer and wall interfaces of gas cooled systems have been performed for several turbulence models by comparing with experimental data. Finally, the development and validation of the coupled code system ATHLET/ANSYS CFX for alternative reactor concepts is described and first coupled steam and helium simulations are presented.

  19. Questions concerning safety and risk after the nuclear accidents in Japan. Deepened accident analysis for the Fukushima Daiichi power plant; Sicherheits- und Risikofragen im Nachgang zu den nuklearen Stoer- und Unfaellen in Japan. Vertiefte Ereignisanalyse zur Anlage Fukushima-Daini

    Energy Technology Data Exchange (ETDEWEB)

    Pistner, Christoph; Englert, Matthias [Oeko-Institut e.V. - Institut fuer Angewandte Oekologie, Darmstadt (Germany)

    2015-02-25

    The study questions concerning safety and risk in Japanese power plants following the disastrous nuclear accident covers the following issues: the nuclear facility Fukushima Daiichi, site characterization, important technical equipment, important electro-technical equipment, personal; description of the accident progression in the Fukushima nuclear power plant: impact of the earthquake, impact of the tsunami, short-term measures of the operating personnel, pressure and temperature situation in the containments, restoration of the after-heat cooling system in the units 1/2 and 4, fuel element storage pool, summarized parameters during the accident progress; comparative analysis of the accident progression at the Fukushima Daiichi site.

  20. 27. MPA-Seminar - Safety and reliability in energy technology. Vol. 2: Papers 27-45; 27. MPA-Seminar - Sicherheit und Verfuegbarkeit in der Energietechnik. Bd. 2: Vortraege 27-45

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2001-07-01

    The proceedings of the 27th MPA Seminar on 'Safety and Reliability in Energy Technology' were issued in two volumes. The main topics of the second volume are: 1. Material behaviour in the creep regime; 2. Fracture machanics; 3. Reliability analysis and 4. Failure analysis.

  1. Multicenter analysis of tolerance and clinical safety of the extracellular MR contrast agent gadobenate dimeglumine (MultiHance {sup registered}); Multizentrische Analyse der Vertraeglichkeit und klinischen Sicherheit des extrazellulaeren MR-Kontrastmittels Gadobenat-Dimeglumin (MultiHance {sup registered})

    Energy Technology Data Exchange (ETDEWEB)

    Herborn, Christoph U.; Jaeger-Booth, I.; Goyen, M. [Universitaetsklinikum Hamburg-Eppendorf, Medizinisches PraeventionsCentrum Hamburg (MPCH) (Germany); Lodemann, K.P. [R und D, Altana Pharma (Germany); Spinazzi, A. [Marketing, BRACCO Ltd (Italy)

    2009-07-15

    Purpose: Retrospective analysis of the occurrence of adverse events and the diagnostic efficacy of a paramagnetic contrast agent with weak intermittent protein binding and high relaxivity. Materials end methods: Postmarketing surveillance studies for gadobenate dimeglumine (MultiHance, BRACCO Altana Pharma, Constance) were conducted in Germany between 1998 and 2006 and then retrospectively analyzed. Demographic data, relevant comorbidities, and allergies were recorded. The safety and tolerability of MultiHance were logged on a standardized data sheet. Results: A total of 38568 patients were included in the study. 829 patients (2.1%) had a known intolerance against contrast media. The examined regions included the central nervous system, the liver, and the vascular bed. The injection rate with automated injectors (n = 10456) varied between 1.0 und 3.0 ml/sec in 86.5% of patients. Adverse events totaled 1.2%. 11 patients (0.03%) experienced serious adverse events. The most frequent findings were nausea, vomiting and a feeling of warmth. Conclusion: MultiHance is a safe and very well tolerated contrast agent for magnetic resonance imaging (MRI) with a profile and frequency of adverse events similar to other extracellular MR contrast materials. (orig.)

  2. The 15th German Atomic Energy Act Amendment to the implementation of the EURATOM nuclear safety directive; Die 15. AtG-Novelle zur Umsetzung der EURATOM-Sicherheits-Richtlinie

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Dehn, Christian [PreussenElektra GmbH, Hannover (Germany)

    2017-06-15

    The 15th German Atomic Energy Act Amendment has now passed the parliamentary legislative procedure with the decision of the Bundestag in the third reading of 30 March 2017. The publication in the Federal Law Gazette (Bundesgesetzblatt) is still pending. The background of the amendment is the addition to the Euratom safeguards directive adopted by the European Council in July 2014. This directive has to be implemented in the national regulations of the EURATOM Member States. However, since most of these supplements were already standard in German atomic law, the regulatory requirements for Germany were low. This is also explicitly stated in the statement to the act.

  3. The increase of safety of mounted camshafts through the introduction of press fitted joints with unorganic and compound stable conversion coatings; Erhoehung der Sicherheit gebauter Nockenwellen durch Einsatz beschichteter Pressverbindungen

    Energy Technology Data Exchange (ETDEWEB)

    Seim, K.; Gropp, H.; Tenberge, P.

    1996-05-01

    Introductory the current known joint methods for mounting of cams at thinwalled hollow shafts were shown. Afterwards a new generation of press fitted joints with unorganic and compound stable conversion coatings for highly stressed shaft-hub-joints were presented. The manufaction, the features and the advantages of these new press joints were discussed in comparison with conventional press joints, examples for successful industrial applications and possibilities for future utilization at mounted camshafts were given. (orig./HW) [Deutsch] Bei der Herstellung von Nockenwellen zeichnet sich in den letzten Jahren ein deutlicher Trend zum Uebergang von aus einem Stueck gegossenen Nockenwellen zu solchen, die aus mehreren Einzelteilen zusammengebaut werden, ab. Diese gebauten Nockenwellen bestehen im wesentlichen aus einem Rohr, auf dem mit unterschiedlichen Verfahren die Nocken sowie entsprechende Mitnehmer- und Lagerelemente befestigt werden. (orig./HW)

  4. The German atomic law on trial. The requirements of the EURATOM Nuclear Safety Directive; Deutsches Atomrecht auf dem Pruefstand. Die Anforderungen aus der EURATOM-Richtlinie zur nuklearen Sicherheit

    Energy Technology Data Exchange (ETDEWEB)

    Mueller-Dehn, Christian [E.ON Kernkraft GmbH, Hannover (Germany). Nuclear Regulation and Policy

    2016-05-15

    The EURATOM Directive on Nuclear Safety, dated 8 July 2014, is to be transposed into national law, not later than 15 August 2017. This raises the question of whether and to what extent by then the German atomic energy act is adapted to the respective requirements. On national level requirements have to be implemented now, that are already not effective. This includes the introduction of thematic peer reviews and, if necessary, regulations for the independence and effectiveness of the regulatory authorities. Here - but only here - is a need for implementation.

  5. The safety lie. Severe faults remain undetected for years, known deficiencies have no consequences - and the NPPs are in operation; Die Sicherheits-Luege. Gravierende Fehler bleiben jahrzehntelang unentdeckt, bekannte Defizite ohne Folgen - und die AKW am Netz

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2017-07-15

    The contribution deals with deficiencies of German nuclear power plants with respect to design, old safety standards - as in the case of resistance against aircraft crashes, not implemented safety requirements and undetected failures.

  6. The project ANSICHT. Safety and demonstration methodology for a final repository in clay formations in Germany; Projekt ANSICHT. Sicherheits- und Nachweismethodik fuer ein Endlager im Tongestein in Deutschland. Synthesebericht

    Energy Technology Data Exchange (ETDEWEB)

    Jobmann, Michael; Bebiolka, Anke; Jahn, Steffen; and others

    2017-03-30

    Based on the status of science and technology and under consideration of international repository concepts the fundamental methodology for safety demonstration for a high-level radioactive waste final repository in clay formations Germany was developed. Basic elements of the safety concept are the geological site description and the geo-scientific long-term prognosis on future performance. Another important section is the closure and sealing concept for the mine shafts. In the frame of the project the fundamental elements were developed and documented for model regions in northern and southern Germany. Three independent safety proofs have to be performed: the demonstration of the geological barrier integrity (clay), the demonstration of the geo-technical barrier system integrity - i.e. closure constructions and backfilling of the shafts, and the radiological demonstration that the radionuclide release in the area is lower than the respective limiting value.

  7. Estudo comparativo entre bupivacaína racêmica a 0,25% e bupivacaína com excesso enantiomérico de 50% (S75-R25 a 0,25%, associadas ao fentanil para analgesia de parto com deambulação da parturiente Estudio comparativo entre bupivacaína racémica a 0,25% y bupivacaína con exceso enantiomérico de 50% (S75-R25 a 0,25% asociadas con fentanil para analgesia de parto con deambulación de la gestante Racemic 0.25% bupivacaine and 50% enantiomeric excess (S75-R25 0.25% bupivacaine associated to fentanyl for labor analgesia with patient’s ambulation. Comparative study

    Directory of Open Access Journals (Sweden)

    Carlos Alberto Figueiredo Côrtes

    2006-02-01

    ógiros de los anestésicos locales demostraron mayor seguridad debido a la menor cardiotoxicidad. La deambulación de la gestante durante el trabajo de parto por lo que puede abreviar la duración del parto. Este estudio compara la calidad de la analgesia y las repercusiones materno fetales así como la capacidad de deambular y de orinar en forma espontánea de las gestantes, usando bupivacaína a 0,25% y bupivacaína con exceso enantiomérico de 50% (S75-R25 a 0,25% asociadas con fentanil por vía peridural continua durante el trabajo de parto. MÉTODO: Fueron evaluadas 40 gestantes, estado físico ASA I y II, con feto único y en trabajo de parto, que recibieron analgesia peridural continua, divididas en 2 grupos. En el grupo I recibieron 8 mL (20 mg de bupivacaína (S75-R25 a 0,25% con epinefrina asociados a 100 µg de fentanil. En el grupo II recibieron 8 ml (20 mg de bupivacaína racémica a 0,25% con epinefrina asociados a 100 µg de fentanil. Los siguientes parámetros fueron evaluados: tiempo de latencia, altura del bloqueo sensitivo, grado de bloqueo motor, examen de Romberg, capacidad de deambular y orinar en forma espontánea, duración del trabajo de parto y del período expulsivo, variables maternas respiratorias y hemodinámicas y la vitalidad de los neonatos. RESULTADOS: No hubo diferencia estadística entre los grupos en los parámetros evaluados. Todas las gestantes tenían fuerza muscular y capacidad para deambular, pero esto no ocurrió en un caso del grupo II por indicación de cesárea y en 4 casos del grupo I porque el parto ocurrió antes de iniciar la evaluación motora. CONCLUSIONES: Tanto la bupivacaína a 0,25% como la bupivacaína (S75-R25 a 0,25% asociadas con fentanil demostraron ser una buena opción para analgesia de parto.BACKGROUND AND OBJECTIVES: Clinical studies with levogyrous enantiomers of local anesthetics have shown better safety due to lower cardiotoxicity. Parturients ambulation during labor may be able to shorten it. This study

  8. Pain in amaXhosa women living with HIV/AIDS: a cross-sectional study of ambulant outpatients.

    Science.gov (United States)

    Parker, Romy; Jelsma, Jennifer; Stein, Dan J

    2017-04-13

    Pain is one of the most commonly reported symptoms in people living with HIV/AIDS, whether or not they are receiving anti-retroviral therapy. A recent systematic review identified a paucity of studies exploring pain in women in low and middle income countries. The prevalence and characteristics of pain in women living with HIV/AIDS may differ from that of men as many chronic pain conditions are more prevalent in women. The aims of this study were to establish pain prevalence, characteristics and management in amaXhosa women living with HIV/AIDS. In addition, we aimed to identify whether there were associations between pain in this population and the psychosocial factors of employment, education, self-efficacy, depression, post-traumatic stress disorder, health related quality of life and childhood trauma. A cross-sectional study of 229 women who had undergone HIV testing and were registered patients at a community health centre was conducted. Data were collected by interview with a demographic questionnaire, the Brief Pain Inventory-Xhosa, Childhood Trauma Questionnaire-Xhosa, Harvard Trauma Questionnaire-Xhosa for PTSD, Self-Efficacy for Managing Chronic Disease 6-Item Scale-Xhosa; the EQ-5D health related quality of life instrument, and the Beck Depression Inventory. 170 of the women had pain, a prevalence rate of 74.24% (95%CI 68.2 - 79.47%). The women reported significant pain with pain severity of 5.06 ± 1.57 and pain interference of 6.39 ± 1.96 out of 10. Only two women were receiving adequate pain management according to the pain management index. Participants reported a mean of 2.42 ± 1.21 different anatomical sites of pain. There were more unemployed participants in the group with pain and they had significantly fewer years of schooling. Those with pain had lower self-efficacy; health related quality of life and increased depression and PTSD symptom severity. This study highlights that pain is a common problem for amaXhosa women living with HIV/AIDS. These data emphasise the need to prioritise pain assessment and management in amaXhosa women living with HIV/AIDS. Routinely assessing for the presence of pain in women with HIV/AIDS has the potential to improve pain management and minimise the impact of pain on function.

  9. A systematic review of job-specific workers' health surveillance activities for fire-fighting, ambulance, police and military personnel

    NARCIS (Netherlands)

    Plat, M. J.; Frings-Dresen, M. H. W.; Sluiter, J. K.

    2011-01-01

    Some occupations have tasks and activities that require monitoring safety and health aspects of the job; examples of such occupations are emergency services personnel and military personnel. The two objectives of this systematic review were to describe (1) the existing job-specific workers' health

  10. [Childhood trauma and its relation to diagnoses and psychic complaints in patients of an psychosomatic university ambulance].

    Science.gov (United States)

    Subic-Wrana, Claudia; Tschan, Regine; Michal, Matthias; Zwerenz, Rüdiger; Beutel, Manfred; Wiltink, Jörg

    2011-02-01

    The Childhood Trauma Questionnaire (CTQ) was given to 1 439 patients of the outpatient- and consultation/liaison unit of the psychosomatic department of a university hospital. Self-reported emotional, sexual and physical abuse and emotional and physical neglect were related to the mental diagnoses and distress. Patients with childhood trauma (41,4%) reported higher levels of social anxiety, distress and physical complaints than patients without traumatizing childhood experiences. We found relations between emotional abuse and depression and personality disorders, physical abuse and somatoform disorders and sexual abuse and posttraumatic stress disorder. The observed relation between specific dimensions of childhood trauma and psychiatric diagnoses is consistent with reports on other clinical samples. © Georg Thieme Verlag KG Stuttgart · New York.

  11. Association of bystander cardiopulmonary resuscitation and survival according to ambulance response-times after out-of-hospital cardiac arrest

    DEFF Research Database (Denmark)

    Rajan, Shahzleen; Wissenberg, Mads; Folke, Fredrik

    2016-01-01

    Background: Bystander-initiated cardiopulmonary resuscitation (CPR) increases patient survival after out-of-hospital cardiac arrest, but it is unknown to what degree bystander CPR remains positively associated with survival with increasing time to potential defibrillation. The main objective...... was to examine the association of bystander CPR with survival as time to advanced treatment increases. Methods: We studied 7623 out-of-hospital cardiac arrest patients between 2005 and 2011, identified through the nationwide Danish Cardiac Arrest Registry. Multiple logistic regression analysis was used...... out-of-hospital cardiac arrest statistics, an additional 233 patients could potentially be saved annually if response time was reduced from 10 to 5 minutes and 119 patients if response time was reduced from 7 (the median response time in this study) to 5 minutes. Conclusions: The absolute survival...

  12. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial

    DEFF Research Database (Denmark)

    Dali, Christine í; Hansen, Flemming Juul; Pedersen, Søren Anker

    2002-01-01

    changes that might not be reflected in performance measurements. We also judged range of motion, degree of spasticity, and muscle growth measured by CT. Fifty seven of 82 outpatients who were able to walk at least with a walker, completed all 12 months of treatment (hemiplegia n=25, diplegia n=32...

  13. Primary retrieval of a shocked neonate with duct-dependent circulation to tertiary care by air ambulance.

    Science.gov (United States)

    Dias, Paul J; Plunkett, Adrian

    2010-08-24

    In the UK the incidence of congenital heart disease is approximately 7 per 1000 live births. The case of a neonate with shock due to an undiagnosed heart defect who was resuscitated in a rural GP surgery and transferred directly to a paediatric centre with specialist tertiary services is described. This case emphasises the importance of the recognition of the sick infant and demonstrates what can be achieved within the current framework for delivery of care. Helicopter emergency medical teams have training in many advanced practical skills, diagnostic skills and clinical experience, which facilitate transfer of the patient to a place of definitive treatment, reducing morbidity and mortality.

  14. Threshold electrical stimulation (TES) in ambulant children with CP: a randomized double-blind placebo-controlled clinical trial

    DEFF Research Database (Denmark)

    Dali, Christine í; Hansen, Flemming Juul; Pedersen, Søren Anker

    2002-01-01

    A randomized double-blind placebo-controlled clinical trial was carried out to determine whether a group of stable children with cerebral palsy (36 males, 21 females; mean age 10 years 11 months, range 5 to 18 years) would improve their motor skills after 12 months of threshold electrical...

  15. Psychosociální problematika infertility verbalizovaná pacienty ambulance pro léčbu neplodnosti.

    OpenAIRE

    DVOŘÁKOVÁ, Alena

    2007-01-01

    Infertility is the inability to naturally conceive a child or to carry a pregnancy to full term. There are many reasons why a couple may not be able to conceive, or may not be able to conceive without medical assistance. Infertility may have profound psychological effects. Partners may become more anxious to conceive. Marital discord often develops in infertile couples, especially when they are under pressure to make medical decisions. Women trying to conceive often have clinical depression. ...

  16. The Angio-Seal™ femoral closure device allows immediate ambulation after coronary angiography and percutaneous coronary intervention

    DEFF Research Database (Denmark)

    Hvelplund, Anders; Jeger, Raban; Osterwalder, Remo

    2011-01-01

    To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device.......To test the safety of immediate mobilisation of patients undergoing coronary angiography and percutaneous coronary intervention (PCI) closed with Angio-Seal™ -a femoral vascular closure device....

  17. Pilot Field Test: The Ability to Ambulate Following Landing as Assessed with Seat Egress, Walk and Obstacle Testing

    Science.gov (United States)

    Fisher, E. A.; Fomina, E. V; Reschke, M. F.; Cerisano, J. M.; Kofman, I. S.; Gadd, N. E.; Phillips, T. R.; Lee, S. M. C.; Laurie, S. S.; Stenger, M. B.; hide

    2016-01-01

    To date, changes in functional performance have been systematically studied after short-duration space flight. As important as the postflight functional changes have been, full functional recovery has never been investigated or established for long-duration flights. The Pilot Field Test (PFT) experiment, conducted with participation of ISS crewmembers traveling on Soyuz expeditions 34S - 41S, is comprised of several tasks designed to study the recovery of sensorimotor abilities of astronauts during the first 24 hours after landing and beyond. The objective of the Seat Egress - Walk and Obstacle Test, developed by NASA's Russian collaborators at the Institute for Biomedical Problems, is to address this gap in knowledge. This will allow us to characterize the ability of crewmembers to perform critical mission requirements that they will be expected to perform after an unassisted landing following 6 to 12 months in microgravity.

  18. Monitoring Ambulation of Patients in Geriatric Rehabilitation Wards: The Accuracy of Clinicians' Prediction of Patients' Walking Time

    Science.gov (United States)

    Cheung, Vivian H. Y.; Salih, Salih A.; Crouch, Alisa; Karunanithi, Mohanraj K.; Gray, Len

    2012-01-01

    The aim of this study is to determine whether clinicians' estimates of patients' walking time agree with those determined by accelerometer devices. The walking time was measured using a waist-mounted accelerometer device everyday during the patients' waking hours. At each weekly meeting, clinicians estimated the patients' average daily walking…

  19. Effect of impaired ambulation and anti-epileptic drug intake on vitamin D status of children with cerebral palsy.

    Science.gov (United States)

    Seth, Anju; Aneja, Satinder; Singh, Ritu; Majumdar, Ritu; Sharma, Neera; Gopinath, Muthuselvan

    2017-08-01

    Children with cerebral palsy (CP) are vulnerable to developing vitamin D deficiency. There is little information on the prevalence and severity of vitamin D deficiency in these patients. To study vitamin D status in children with CP with special reference to their intake of anti-epileptic drugs (AED) and ambulatory status. The relative effects of AED use and ambulatory status on the vitamin D status of 120 children with CP aged 2-10 years were examined in this observational study. The patients were classified into four groups (30 in each) on the basis of AED use and ambulatory status: ambulatory (CPA), ambulatory receiving AED (CPAD), non-ambulatory (CPNA) and non-ambulatory receiving AED (CPNAD). A control group of 30 age-matched healthy children was also included. Parameters assessed included dietary calcium intake, sun exposure, serum total and ionised calcium (tCa, iCa), inorganic phosphate (iP), alkaline phosphatase (ALP), parathormone (PTH), 25 hydroxy vitamin D [25(OH)D] levels and a wrist radiograph to detect rickets. Vitamin D status was defined on the basis of serum 25(OH)D levels as normal (>50 nmol/L), mild deficiency (25-50 nmol/L), moderate deficiency (12.5-25 nmol/L), severe deficiency (<12.5 nmol/L). Median (IQR) serum 25 (OH)D levels in patients with CP were 35.6 (26.75-64) nmol/L compared with 60 (37-69.25) nmol/L in controls (p = 0.04). Sixty per cent of children with CP and 36.7% of controls were vitamin D-deficient [25(OH)D < 50 nmol/L]. Children with CP had a significantly lower dietary calcium intake and sun exposure than controls (p < 0.0001 each). Serum tCa and iCa levels were significantly lower (p = 0.01 and p < 0.001, respectively) and PTH and ALP levels significantly higher (p = 0.04 and p = 0.001, respectively) in children with CP than in controls. Patients in the CPNAD group were the worst affected, 83.3% of them being vitamin D-deficient with median (IQR) 25(OH)D levels of 33.5 (12.5-45.25) nmol/L. Also, 53.3% of them had raised ALP and 17.2% raised PTH levels. Children with CP are highly vulnerable to vitamin D deficiency. In these patients, AED use and lack of sun exposure contribute towards poor vitamin D status, the effect being more pronounced when they co-exist.

  20. Controlled Hypotension in Patients Suspected of a Ruptured Abdominal Aortic Aneurysm: Feasibility during Transport by Ambulance Services and Possible Harm

    NARCIS (Netherlands)

    Reimerink, J. J.; Hoornweg, L. L.; Vahl, A. C.; Wisselink, W.; Balm, R.

    2010-01-01

    Objective: To evaluate a controlled hypotension protocol for patients suspected of a ruptured aneurysm of the abdominal aorta (RAAA) and to identify possible harm to patients with a final diagnosis other than RAAA. Design: Retrospective analysis of patients suspected of RAAA and transported by

  1. Austrian Security Strategy: Need For Reformulation Due To Security Developments

    Science.gov (United States)

    2016-02-14

    of tomorrow (multipolarity, inter polarity) and the comprehensive approach to security of the Copenhagen School (prismatic approach to security... interpret , translate) is a theory of the interpretation and understanding of texts. 4. Bundeskanzleramt, Sicherheits- und Verteidigungsdoktrin 2001

  2. GRS knowledge base ''Safety of pressure-bearing components'' - An example of knowledge management of a technical support organisation; GRS-Wissensbasis ''Sicherheit druckfuehrender Komponenten'' - Ein Beispiel zum Wissensmanagement einer Sachverstaendigenorganisation

    Energy Technology Data Exchange (ETDEWEB)

    Schulz, H.; Michel, F. [Gesellschaft fuer Anlagen- und Reaktorsicherheit mbH (GRS), Koeln (Germany)

    2005-07-01

    In long-lived technical systems, the main challenge is in preserving knowledge on all technical aspects throughout the plant life as several generations of engineers are involved from projecting to decommissioning. A technical support organisation has access to knowledge on safety requirements and their development with time, relevant damage cases both in Germany and abroad, research projects and analyses as well as expert documentations. A modern working environment enables fast access to, and combination of, distributed parts of knowledge provided that some prestructuring is ensured. The contribution presents an exemplary information system of GRS, whose elements may be of interest to other organisations as well. [German] Fuer technische Anlagen mit langen Lebenszeiten ist es eine besondere Herausforderung, das erforderliche Wissen zu allen technischen Sachverhalten jederzeit verfuegbar zu haben. Von der Projektierung bis zum Betriebsende einer Anlage sind mehrere Generationen von Ingenieuren mit den jeweiligen Sachverhalten befasst. Fuer eine Sachverstaendigenorganisation stehen Kenntnisse zu den sicherheitstechnischen Anforderungen und deren zeitlicher Entwicklung, relevanten Schadensereignissen im In- und Ausland, Erkenntnisse aus Forschungsvorhaben und Analysen sowie die Verfuegbarkeit des weiteren dokumentierten Fachwissens und technischer Experten im Vordergrund. Die moderne Arbeitsumgebung erlaubt heute ein schnelles Auffinden und Zusammenfuehren der vorhandenen Wissensbausteine. Eine sinnvolle Vorstrukturierung als Wegweiser im Dschungel der Informationen ist jedoch unerlaesslich. Ein auf die Beduerfnisse der GRS zugeschnittenes Beispiel wird im Einzelnen vorgestellt. Wesentliche Elemente der Struktur fuer ein praktikables Wissensmanagement sind auch fuer andere Organisationen nutzbar.

  3. 24. MPA-seminar: safety and reliability of plant technology with special emphasis on integrity and life management. Vol. 1. Papers 1-27; 24. MPA-Seminar: Sicherheit und Verfuegbarkeit in der Anlagentechnik mit dem Schwerpunkt Integritaet und Lebensdauermanagement. Bd. 1. Vortraege 1-27

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-08-01

    The first volume is dedicated to the safety and reliability of plant technology with special emphasis on the integrity and life management. The main topic in the volume is the contribution of nondestructive testing to the reactor safety from an international point of view. All 20 papers are separately analyzed for this database. (orig.)

  4. 30. MPA-Seminar 'Safety and reliability in energy technology' in conjunction with the 9th German-Japanese seminar. Vol. 2 (Papers 27-53); 30. MPA-Seminar 'Sicherheit und Verfuegbarkeit in der Energietechnik' in Verbindung mit dem 9. Deutsch-Japanischen Seminar. Bd. 2 (Vortraege 27-53)

    Energy Technology Data Exchange (ETDEWEB)

    Roos, E. (comp.)

    2004-07-01

    he 30th MPA-seminar on ''Safety and Availability in Energy Engineering'' was held in conjuction with the 9th German-Japanese Seminar. The 52 contributions were published in two volumes. Volume 1 contains the contributions to the following sessions: fracture mechanics, fatigue, welding, environmental impact and European research projects. Volume 2 contains contributions of sessions 6-9: high-temperature application, modelling-simulation, ageing management and non-destructive testing. (uke)

  5. 24. MPA-seminar: safety and reliability of plant technology with special emphasis on integrity and life management. Vol. 2. Papers 28-63; 24. MPA-Seminar: Sicherheit und Verfuegbarkeit in der Anlagentechnik mit dem Schwerpunk Integritaet und Lebensdauermanagement. Bd. 2. Vortraege 28-63

    Energy Technology Data Exchange (ETDEWEB)

    1999-09-01

    The second volume is dedicated to the safety and reliability of plant technology with special emphasis on the integrity and life management. The following topics are discussed: 1. Integrity of vessels, pipes and components. 2. Fracture mechanics. 3. Measures for the extension of service life, and 4. Online Monitoring. All 30 contributions are separately analyzed for this database. (orig.)

  6. Nuclear safety assessment of nuclear power plants and nuclear risk in Eastern Europe and other regions. Scientific-technical cooperation with nuclear regulatory authorities and technical support organizations (TSOs); Einschaetzung der nuklearen Sicherheit von Kernkraftwerken sowie nuklearer Risiken in Osteuropa und anderen Regionen. Wissenschaftlich-technische Zusammenarbeit mit atomrechtlichen Behoerden und deren Sachverstaendigenorganisationen (TSO)

    Energy Technology Data Exchange (ETDEWEB)

    Wolff, Holger

    2014-09-15

    The BMUB/BfS project 3611I01512 formed the frame of the GRS for the scientifictechnical cooperation with Technical Support Organisations and Nuclear Regulatory Authorities in the field of nuclear safety of NPPs and for the evaluation of nuclear risks in Eastern Europe and other regions for the period from September 2011 till June 2014. In the present final report main results of the project are described. The project comprised the following technical topics: - Record status of NPP modernisation programs, Monitoring and evaluation of modernisation programs; - Design basis and severe accident analyses for NPP with PWR (WWER-440, WWER-1000); - Cooperation with INSC partner countries on DBA, BDBA and severe accident analyses for WWER plants of generation 3+ and on building NRA and safety evaluation capacities; - Decommissioning of nuclear facilities and disposal of radioactive waste; - Evaluation of new reactor concepts and their safety design; Panels at regulatory level. The work results are preceded by a summary on the activities related to the project management and to the planning of the bilateral work.

  7. Study on the safety during transportion of radioactive materials. Pt. 3. Coverage of the inspection conditions for packages. Final report work package 3; Untersuchungen zur Sicherheit bei der Befoerderung radioaktiver Stoffe. T. 3. Abdeckungsgrad der Pruefbedingungen fuer Versandstuecke. Abschlussbericht zum Arbeitspaket 3

    Energy Technology Data Exchange (ETDEWEB)

    Eberhardt, Holger; Eich, Patrick; Sentuc, Florence-Nathalie

    2014-08-15

    The report summarizes the state of science and technology and the inspection request according to the transport regulations SSR-6. The studies concerning different transport modes are evaluated with respect to accident data: air transport, maritime transport, rail transport and road transport. It has been shown that not enough appropriate information is available to quantify the accident probability. The IAEA transport regulations are considered to cover the thermal and mechanical loads to a large extent.

  8. Studies on the safety of the transport of radioactive materials. Part 1.1: Calculation of the limiting activity values - Q-model. Final report on the working package 4; Untersuchungen zur Sicherheit bei der Befoerderung radioaktiver Stoffe. Teil 1.1. Berechnung von Aktivitaetsgrenzwerten - Q-Modell. Abschlussbericht zum Arbeitspaket 4

    Energy Technology Data Exchange (ETDEWEB)

    Buettner, Uwe

    2014-08-15

    One aim of this project 3611R03300 was the analysis of the methods used in the Q system to establish a program for calculation of Q and A{sub 1}/A{sub 2} values. With this program not only the already known nuclides listed in the IAEA Transport Regulations SSR-6 should be recalculated, but one should also be able to calculate new radionuclides. For this reason a program was developed, using Microsoft Excel sheets and Excel VBA programming language. This report is the documentation of the development of this program and the used models for calculating Q and A{sub 1}/A{sub 2} values. In comparison with the Transport Regulations SSR-6 the results of this program are in good agreement for most of the A{sub 1}/A{sub 2} values. Furthermore, it is possible not even to recalculate Q and A{sub 1}/A{sub 2} values on the up to now used older data basis of ICRP 38 but also by using re-cent nuclide data presented in ICRP 107. Within the development of the calculation program many lacks of the documentation and problematic issues of the used so called Q system where found and are discussed in this report. At the end some points for a possible improvement of the Q system are presented.

  9. Investigations on the safety of radioactive materials transport. Pt. 1.2. Calculation of activity limits - permitted limits. Final report on the working package 4; Untersuchungen zur Sicherheit bei der Befoerderung radioaktiver Stoffe. T. 1.2. Berechnung von Aktivitaetsgrenzwerten - Freigrenzen. Abschlussbericht zum Arbeitspaket 4

    Energy Technology Data Exchange (ETDEWEB)

    Richter, Cornelia; Eich, Patrick

    2014-09-15

    One aim of this project 3611R03300 was the analysis of the methods for the calculation of exemption values and the development of software for the calculation following the EU Principles and Methods of Radiation Protection 65 (RP 65). A program was devel-oped using Microsoft Excel-VBA. In this document, the development and underlying model is described. A comparison of the newly calculated values with the tabulated values of RP 65 shows a very good agreement. During the development a lot of deficiencies of the RP 65 documentation became evi-dent, precluding the expansion of the program for the calculation of new exemption values. Especially the methods for the calculation of nuclide specific parameters could not be reproduced partly.

  10. Convention on Nuclear Safety - CNS. Report by the government of the Federal Republic of Germany for the sixth review conference in March/April 2014; Uebereinkommen ueber nukleare Sicherheit. Bericht der Regierung der Bundesrepublik Deutschland fuer die Sechste Ueberpruefungstagung im Maerz/April 2014

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2013-08-01

    The report by the government of the Federal Republic of Germany for the sixth review conference (Convention on Nuclear Safety - CNS) in March/April 2014 covers the following issues: reappraisal of nuclear energy in the Federal Republic of Germany; measures as consequence of the reactor accident in the nuclear power plant Fukushima; safety regulations; execution of the IRRS follow-up mission in Germany; safety management and technical qualification of the occupational personnel; safety surveillance; radiation protection, overview on important safety topics; events and incidents larger INES 0. Assessment of the existing nuclear facilities; progress and changes since 2011; future activities.

  11. Convention on Nuclear Safety - CNS. Report by the government of the Federal Republic of Germany for the seventh review conference in March/April 2017; Uebereinkommen ueber nukleare Sicherheit. Bericht der Regierung der Bundesrepublik Deutschland fuer die Siebte Ueberpruefungstagung im Maerz/April 2017

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-22

    The CNS (Convention on Nuclear Safety) report by the government of the Federal Republic of Germany for the seventh review conference in March/April 2017 covers the following topics: Summary of the most important results since the sixth review conference: existing nuclear facilities, frame for legislation and execution, licensing system, regulatory authority, governmental organizations, responsibility of the licensee, priority of safety, financing and personnel, human factors, quality assurance, safety assessment, radiation protection, emergency preparedness, site selection for nuclear facilities, design and construction, operation.

  12. Rational criteria for the evaluation of defects in high-pressure gas pipelines improve the safety and enhance the economy of the gas supply; Objektive Beurteilungskriterien fuer Fehlstellen in Gas-Hochdruckleitungen heben die Sicherheit und steigern die Wirtschaftlichkeit der Gasversorgung

    Energy Technology Data Exchange (ETDEWEB)

    Hofbauer, M.; Bachhuber, F. [Technische Univ. Bergakademie Freiberg (Germany). Lehrstuhl fuer Gastechnik

    1999-07-01

    Pipelines for public gas supply are subject to a large number of damaging influences, primarily external interferences, which can adversely affect their integrity during the 50 to 100 years of their life span. The present paper investigates the remaining strength of high-pressure steel pipelines with areas of reduced wall thickness, which may be due to metal loss by corrosion, grinding of gouches during repair work or even to the production of the pipes. Based on extensive numerical simulations making use of the finite element program ABAQUS a simple dimensionless curve is deduced describing the burst pressure of a pipe with reduced wall thickness as a function of depth and diameter of the defect. This curve should enable the practitioner or planning engineer responsible for rehabilitation projects to assess pipe defects and to decide in an objective and documented manner, whether a defect needs repair or whether the pipeline can be safely operated without repair. (orig.) [German] Rohrleitungen der oeffentlichen Gasversorgung sind waehrend ihrer langen, durchschnittlich 50 bis 100 Jahre betragenden Lebensdauer zahlreichen schaedigenden, vor allem aeusseren Einfluessen ausgesetzt, die zu einer Minderung ihrer Standfestigkeit fuehren koennen. In der vorliegenden Arbeit wird die Rest-Standfestigkeit von Gas-Hochdruckleitungen aus Stahl untersucht, welche durch Wanddickenminderungen geschwaecht sind, wie sie beispielsweise durch Korrosionsabtrag, Ausschleifen von Riefen bei Reparaturen oder auch bereits im Herstellungsprozess beim Walzen der Bleche auftreten koennen. Aufgrund umfangreicher numerischer Simulationen mittels des Finite-Elemente-Programms ABAQUS wird eine einfache dimensionslose Kurve abgeleitet, die den Berstdruck einer geschwaechten Leitung in Abhaengigkeit vom Durchmesser und von der Tiefe der schadhaften Stelle beschreibt. Mit Hilfe dieser einfachen Kurve kann der Partikel vor Ort ebenso wie der Planer von Sanierungsprojekten, ohne selbst Berechnungen anstellen zu muessen, schadhafte Stellen beurteilen und in nachvollziehbarer Weise entscheiden, ob eine Reparatur erforderlich oder ein gefahrloser Weiterbetrieb moeglich ist. (orig.)

  13. 23. MPA-Seminar: Safety and reliability of plant technology with special emphasis on behaviour of pressurized components and systems at increased loading. Vol. 1. Papers 1-26; 23. MPA-Seminar: Sicherheit und Verfuegbarkeit in der Anlagentechnik mit dem Schwerpunkt Verhalten von druckfuehrenden Komponenten und Systemen bei erhoehten Belastungen. Bd. 1. Vortraege 1-26

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-11-01

    This book is dedicated to the components of nuclear and conventional power plants with special emphasis on the behaviour of pressurized components and systems. The following topics are discussed: 1. integrity of pipes, vessels, and components and 2. fracture mechanics

  14. Enhancing the safety and efficiency of the driving gear of coal mining machinery by using water as a hydraulic fluid and enhancing the reliability of scraper-chain conveyors; Erhoehung der Sicherheit und Leistungsfaehigkeit der Antriebstechnik von Arbeitsmaschinen durch Verwendung von Wasserhydraulik sowie Erhoehung der Zuverlaessigkeit der Kettenkratzerfoerderer

    Energy Technology Data Exchange (ETDEWEB)

    Reichel, J.; Boeing, R.; Graetz, A.; Loehning, H.D.; Plum, D.

    1997-12-31

    The objective pursued is to increasingly use water or high water-content fluids as a substitute for other hydraulic fluids in driving gear of mining machinery. The state of the art of the technology is represented only by individual solutions achieved for given purposes which are not suitable for other applications, let alone for coal mining machinery. The research project was to identify hydraulic components that will permit the use of water or watery substances as a hydraulic fluid in mining applications. The components have been found and further developed, and finally systems with linear and rotatory drives have been tested at various test facilities in order to derive information on the system behaviour of pressurized fluids and machinery components and their suitability for coal mining applications. (orig./CB) [Deutsch] In der untertaegigen Antriebstechnik sollen vermehrt Wasser und wasserhaltige Fluessigkeiten eingesetzt werden. Der Stand der Technik fuehrt bei der Anwendung von Wasserhydraulik immer wieder nur Einzelloesungen auf, die nicht allgemein und insbesondere im Steinkohlenbergbau angewendet werden koennen. Im Rahmen dieses Forschungsvorhabens wurden fuer die Wasserhydraulik geeignete Komponenten untersucht, weiterentwickelt und schliesslich Systeme mit linearen und rotatorischen Antrieben auf verschiedenen Pruefstaenden erprobt, um Aussagen ueber das Systemverhalten von Druckfluessigkeit und Bauelementen fuer Bergbauanwendungen zu bekommen. (orig./MSK)

  15. Further development and data basis for safety and accident analyses of nuclear front end and back end facilities and actualization and revision of calculation methods for nuclear safety analyses. Final report; Weiterentwicklung von Methoden und Datengrundlagen zu Sicherheits- und Stoerfallanalysen fuer Anlagen der nuklearen Ver- und Entsorgung sowie Aktualisierung und Ueberpruefung von Rechenmethoden zu nuklearen Sicherheitsanalysen. Abschlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Kilger, Robert; Peters, Elisabeth; Sommer, Fabian; Moser, Eberhard-Franz; Kessen, Sven; Stuke, Maik

    2016-07-15

    This report briefly describes the activities carried out under the project 3613R03350 on the GRS ''Handbook on Accident Analysis for Nuclear Front and Back End Facilities'', and in detail the continuing work on the revision and updating of the GRS ''Handbook on Criticality'', which here focused on fissile systems with plutonium and {sup 233}U. The in previous projects started and ongoing literature study on innovative fuel concepts is continued. Also described are the review and qualification of computational methods by research and active benchmark participation, and the results of tracking the state of science and technology in the field of computational methods for criticality safety analysis. Special in-depth analyzes of selected criticality-relevant occurrences in the past are also documented.

  16. 30. MPA-Seminar 'Safety and reliability in energy technology' in conjunction with the 9th German-Japanese seminar. Vol. 1 (Papers 1-26); 30. MPA-Seminar 'Sicherheit und Verfuegbarkeit in der Energietechnik' in Verbindung mit dem 9. Deutsch-Japanischen Seminar. Bd. 1 (Vortraege 1-26)

    Energy Technology Data Exchange (ETDEWEB)

    Roos, E. (comp.)

    2004-07-01

    The 30th MPA-seminar on ''Safety and Availability in Energy Engineering'' was held in conjuction with the 9th German-Japanese Seminar. The 52 contributions were published in two volumes. Volume 1 contains the contributions to the following sessions: fracture mechanics, fatigue, welding, environmental impact and European research projects. Volume 2 contains contributions of sessions 6-9: high-temperature application, modelling-simulation, ageing management and non-destructive testing. (uke)

  17. Project CHRISTA. Feasibility study on the development of a safety demonstration methodology for a final repository for heat generating radioactive wastes in crystalline rock formations in Germany; Projekt CHRISTA. Machbarkeitsuntersuchung zur Entwicklung einer Sicherheits- und Nachweismethodik fuer ein Endlager fuer Waerme entwickelnde radioaktive Abfaelle im Kristallingestein in Deutschland

    Energy Technology Data Exchange (ETDEWEB)

    Jobmann, Michael (ed.)

    2016-10-24

    In the frame of CHRISTA several options with different safety concepts for the final disposal of heat generating radioactive wastes were studied. The German safety requirements and the demonstration of the geological barrier integrity are based on an enclosure concept (ewG) that was developed primarily for salt and clay formations. The applicability of these requirements for crystalline host rocks had to be investigated. The enclosure functio0n is based on low hydraulic permeability of the host rock in combination with geotechnical barriers closing the access. With respect to the transferability of the Swedish/Finnish KBS-3 concept it has to be remarked, that the national standards in Sweden and Finland require the safety demonstration for 100.000 years (in Germany 1 million years). The Swedish/Finish container concept is based on a copper sheathed container with adjacent buffer; MOX fuel elements are not foreseen. The report concludes that the actual German safety concept based on geological barriers is to be preferred compared to technical barriers.

  18. Development and application of a NaNiCl{sub 2}-battery for industrial trucks regarding the requirements cycle life, safety and reliability. Final report; Entwicklung und Erprobung einer NaNiCl{sub 2}-Batterie fuer Flurfoerderzeuge unter besonderer Beruecksichtigung der Aspekte Lebensdauer, Sicherheit und Zuverlaessigkeit. Schlussbericht

    Energy Technology Data Exchange (ETDEWEB)

    Boehm, H.; Beyermann, G.; Bulling, M.

    1996-07-01

    Two NaNiCl{sub 2}-battery types including the battery controller and peripheral equipment have been developed for the application in fork lift trucks and driverless transportation. The batteries have been tested and evaluated on bench testing as well as in fork lift trucks and driverless trucks in practical application. The field tests have been performed by the subcontractors Still, Mercedes-Benz and Indumat. All test results have shown that the NaNiCl{sub 2}-battery (ZEBRA-battery) is well suited for the application in industrial traction. A series development together with a cost reduction programme have to be performed ahead of the introduction of the ZEBRA-battery into the market for industrial traction batteries. (orig.) [Deutsch] Im Rahmen des Vorhabens wurden zwei NaNiCl{sub 2}-Batterietypen, eine fuer die Anwendung in Gabelstaplern, die andere fuer den Einsatz in fahrerlosen Transportsystemen (FTS), einschliesslich des Batteriesteuergeraetes und der Batterieperipherie entwickelt. Die Batterien wurden auf Teststaenden im Labor sowie in Gabelstaplern und FTS unter Praxisbedingungen erprobt. Der praktische Einsatz erfolgte bei den Unterauftragnehmern Still, Mercedes-Benz und Indumat. Die Ergebnisse haben gezeigt, dass die NaNiCl{sub 2}-Batterie (ZEBRA-Batterie) fuer die Anwendung in Gabelstaplern und FTS geeignet ist. Insbesondere wurde nachgewiesen, dass die NaNiCl{sub 2}-Batterie im Gegensatz zu anderen Batteriesystemen einen Zweischichtbetrieb von Gabelstaplern ohne Batteriewechsel ermoeglicht. Vor Einfuehrung der ZEBRA-Batterie in den Flurfoerdermarkt muss die Serienentwicklung bei gleichzeitiger Senkung der Herstellkosten durchgefuehrt werden. (orig.)

  19. Scientific-technical study on reactor safety of nuclear power plants in Eastern Europe and EU partner countries (INSC) and risk assessment; Wissenschaftlich-technische Untersuchungen zur nuklearen Sicherheit von Kernkraftwerken in Osteuropa und in EU-Partnerstaaten (INSC) sowie Einschaetzung nuklearer Risiken

    Energy Technology Data Exchange (ETDEWEB)

    Tosch, Burkhard; Teske, Hartmuth; Dierschow, Frank; Ivenin, Vitaly; Kuechler, Lutz; Stransky, Sebastian

    2015-02-15

    Project 3611R0801503 of the BMUB/BfS was focused on coordination and implementation of generic technical and organisational activities for assessments of nuclear safety and effectiveness of regulatory systems in foreign countries (with focus to Eastern Europe and in INSC partner countries). To comply with the BMUB objectives and the GRS strategy, the tasks were structured taking into account the specificity of countries and nuclear design series whereas the technical knowledge and results of the analyses were provided to meet the requirements. This final documentation on the project describes the results of the activities from 04/01/2011 through 09/31/2014 on working packages ''Programme Coordination'', ''Project Management'', ''Networks and On-Site Assistance'', ''Project Documentation'', ''Knowledge Management'', ''Design Series Specific Activities'', ''Multilateral Activities'', ''Country Specific Activities'', ''International Institutions'', ''EU Panels'', ''G8 and EBRD Funds'' and ''Network Activities''. The project contributed significantly to a systematic extension and deepening of knowledge in GRS. Also, international cooperation with selected regulators and their TSOs as well as with the IAEA, the EU and representatives of multilateral bodies was intensified. As intended, this allowed to extend the information and knowledge basis for nuclear safety. The know-how gain for GRS is to be rated as high. This is true for the work in international bodies, but also for the creation, further development and usage of national and international information, knowledge and cooperation platforms. By the insights gained from the project, GRS completes and consolidates its knowledge and tools available. The status achieved in the knowledge management development and respective platforms can be estimated as exemplary.

  20. 23. MPA-Seminar: Safety and reliability of plant technology with special emphasis on behaviour of pressurized components and systems at increased loading. Vol. 2. Papers 27-50; 23. MPA-Seminar: Sicherheit und Verfuegbarkeit in der Anlagentechnik mit dem Schwerpunkt Verhalten von druckfuehrenden Komponenten und Systemen bei erhoehten Belastungen. Bd. 2. Vortraege 27-50

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1998-11-01

    This book is dedicated to the components of nuclear and conventional power plants with special emphasis on the behaviour of pressurized components and systems. The following topics are discussed: 1. structure and safety analysis, 2. aging phenomena, 3. nondestructive testing, and 4. optimization of in-service inspection.

  1. Air ambulance and hospital services for critically ill and injured in Greenland, Iceland and the Faroe Islands: how can we improve?

    Science.gov (United States)

    Gunnarsson, Björn; Jensen, Niels S Kieler; Garði, Tummas I; Harðardóttir, Helga; Stefánsdóttir, Lilja; Heimisdóttir, María

    2015-01-01

    The Nordic Atlantic Cooperation (NORA) is an intergovernmental organization under the auspices of the Nordic Council of Ministers. The NORA region comprises Greenland, Iceland, Faroe Islands and western coastal areas of Norway. Historical, cultural and institutional links bind these nations together in multiple ways, and regional co-operation has in recent years become a focus of interest. This commentary addresses air medical services (AMSs) and available advanced hospital services in the 3 smallest NORA countries challenged sparse populations, hereafter referred to as the region. It seems likely that strengthened regional co-operation can help these countries to address common challenges within health care by exchanging know-how and best practices, pooling resources and improving the efficiency of care delivery. The 4 largest hospitals in the region, Dronning Ingrids Hospital in Nuuk (Greenland), Landspítali in Reykjavík and Sjúkrahúsið á Akureyri, (both in Iceland) and Landssjúkrahúsið Tórshavn on the Faroe Islands, have therefore undertaken the project Network for patient transport in the North-West Atlantic (in Danish: Netværk for patienttransport i Vest-Norden). The goal of the project, and of this article, is to exchange information and provide an overview of current AMSs and access to acute hospital care for severely ill or injured patients in the 3 participating countries. Of equal importance is the intention to highlight the need for increased regional co-operation to optimize use of limited resources in the provision of health care services.

  2. Effects of Pilates-Based Core Stability Training in Ambulant People With Multiple Sclerosis: Multicenter, Assessor-Blinded, Randomized Controlled Trial.

    Science.gov (United States)

    Fox, Esther E; Hough, Alan D; Creanor, Siobhan; Gear, Margaret; Freeman, Jennifer A

    2016-08-01

    Pilates exercise is often undertaken by people with multiple sclerosis (MS) who have balance and mobility difficulties. The primary aim of the study was to compare the effects of 12 weeks of Pilates exercises with relaxation on balance and mobility. Secondary aims were: (1) to compare standardized exercises with relaxation and (2) to compare Pilates exercises with standardized exercises. A multicenter, assessor-blinded, randomized controlled trial was conducted. Participants with Expanded Disability Status Scale scores of 4.0 to 6.5 were randomly allocated to groups receiving 12 weeks of Pilates exercises, standardized exercises, or relaxation. Assessments were undertaken at baseline and weeks 12 and 16 (primary outcome measure: 10-Meter Timed Walk Test [10MTW]). One hundred participants (mean age=54 years, 74% female) were randomized to study groups. Six participants relapsed (withdrew from the study), leaving 94 participants for intention-to-treat analysis. There was no significant difference in mean 10MTW measurements between the Pilates and relaxation groups. At 12 weeks, there was a mean reduction of 4.2 seconds for the standardized exercise group compared with the relaxation group (95% confidence interval [relaxation group minus standardized exercise group measurements]=0.0, 8.4) and a mean reduction of 3.7 seconds for the Pilates group compared with the standardized exercise group (95% confidence interval [Pilates group minus standardized exercise group measurements]=-0.4 to 7.8). At 16 weeks, mean 10MTW times for the standardized exercise group remained quicker than those for the Pilates and relaxation groups, although the differences were nonsignificant. There were no significant differences between the Pilates and relaxation groups for any secondary outcome measure. In this study, therapists were limited to a standardized basket of exercises that may have affected the study outcomes. Furthermore, choosing measures such as posturography to assess balance, accelerometry to assess walking, or a specific trunk assessment scale might have been more responsive in detecting changes in outcome. Participants did not improve significantly, either in the short term or at the 4-week follow-up, on the 10MTW after 12 weeks of Pilates exercises compared with 12 weeks of relaxation. © 2016 American Physical Therapy Association.

  3. Assessment of Mobility in Older People Hospitalized for Medical Illness Using de Morton Mobility Index and Cumulated Ambulation Score-Validity and Minimal Clinical Important Difference

    DEFF Research Database (Denmark)

    Trøstrup, Jeanette; Andersen, Helle; Kam, Charlotte Agger Meiner

    2017-01-01

    BACKGROUND AND PURPOSE: Older adults acutely hospitalized for medical illness typically have comorbidity and disability, and inhospital physical inactivity greatly increases the likelihood of developing new disability. Thus, assessment of the patients' mobility status is crucial for planning and ...

  4. Expeditionair Geneeskundige Uitrustingen. De Conceptmethode Toegepast op de Mercedes Benz Ziekenauto (Expeditionary Medical Kits. The Concept Method Applied to the Mercedes Benz Ambulance)

    Science.gov (United States)

    2007-02-01

    8217 (V403). Doel van het project is het aanscherpen van de wetenschap van bet geneeskundig inpakken en assembleren. Wij onderzoeken de mogelijkheid om...primaire doel van de ZAU als; uitrusting. Het biedt niet de gelegenheid om een tas of koffer snel van het plateau af te nemen en bet hanteren van bet...tijdons hot primaire doel van de ZAU (PGU, VU) dionen zodanig opgeborgon te warden dlat ze niot in do weg liggon en geen kostbare ruimte en tijd in beslag

  5. Impact of elosulfase alfa in patients with morquio A syndrome who have limited ambulation: An open‐label, phase 2 study

    Science.gov (United States)

    Mengel, Eugen; Geberhiwot, Tarekegn; Muschol, Nicole; Hendriksz, Christian J.; Burton, Barbara K.; Jameson, Elisabeth; Berger, Kenneth I.; Jester, Andrea; Treadwell, Marsha; Sisic, Zlatko; Decker, Celeste

    2016-01-01

    Efficacy and safety of elosulfase alfa enzyme replacement therapy (ERT) were assessed in an open‐label, phase 2, multi‐national study in Morquio A patients aged ≥5 years unable to walk ≥30 meters in the 6‐min walk test. Patients received elosulfase alfa 2.0 mg/kg/week intravenously for 48 weeks. Efficacy measures were functional dexterity, pinch/grip strength, mobility in a modified timed 25‐foot walk, pain, quality of life, respiratory function, and urine keratan sulfate (KS). Safety/tolerability was also assessed. Fifteen patients received elosulfase alfa, three patients discontinued ERT due to adverse events (two were grade 3 drug‐related adverse events, the other was not drug‐related), and two patients missed >20% of planned infusions; 10 completed treatment through 48 weeks and received ≥80% of planned infusions (Modified Per Protocol [MPP] population). The study population had more advanced disease than that enrolled in other trials. From baseline to week 48, MPP data showed biochemical efficacy (urine KS decreased 52.4%). The remaining efficacy results were highly variable due to challenges in test execution because of severe skeletal and joint abnormalities, small sample sizes, and clinical heterogeneity among patients. Eight patients showed improvements in one or more outcome measures; several patients indicated improvements not captured by the study assessments (e.g., increased energy, functional ability). The nature of adverse events was similar to other elosulfase alfa studies. This study illustrates the considerable challenges in objectively measuring impact of ERT in very disabled Morquio A patients and highlights the need to examine results on an individual basis. © 2016 The Authors. American Journal of Medical Genetics Part A Published by Wiley Periodicals, Inc. PMID