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Pre-hospital emergency care

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https://www.readbyqxmd.com/read/29455380/clinical-features-and-peripartum-outcomes-in-pregnant-women-with-cardiac-disease-a-nationwide-retrospective-cohort-study-in-japan
#1
Toshiaki Isogai, Hiroki Matsui, Hiroyuki Tanaka, Akira Kohyama, Kiyohide Fushimi, Hideo Yasunaga
Although the number of pregnancies in women with cardiac disease is increasing worldwide, there are few data concerning their clinical characteristics and peripartum outcomes. Using the Diagnosis Procedure Combination database between 2008 and 2014 in Japan, we retrospectively identified pregnant women who underwent high-risk delivery due to obstetric or non-obstetric comorbidities. We classified eligible women into those with pre-existing cardiac disease (cardiac disease group) and those with non-cardiac comorbidities (non-cardiac disease group) and compared their characteristics and peripartum outcomes...
February 17, 2018: Heart and Vessels
https://www.readbyqxmd.com/read/29454508/the-has-choice-study-utilizing-the-heart-score-an-adp-and-shared-decision-making-to-decrease-admissions-in-chest-pain-patients
#2
Gregory Gafni-Pappas, Susanne D DeMeester, Michael A Boyd, Arun Ganti, Adam M Nicholson, Jeremy Albright, Juan Wu
OBJECTIVE: The HAS-Choice pathway utilizes the HEART Score, an accelerated diagnostic protocol (ADP), and shared decision-making using a visual aid in the evaluation of chest pain patients. We seek to determine if our intervention can improve resource utilization in a community emergency department (ED) setting while maintaining safe patient care. METHODS: This was a single-center prospective cohort study with historical that included ED patients ≥21years old presenting with a primary complaint of chest pain in two time periods...
February 8, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/29447352/improvement-of-emergency-department-patient-flow-using-lean-thinking
#3
Miquel Sánchez, Montse Suárez, María Asenjo, Ernest Bragulat
Objective: To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. Design: A prospective interventional study. Setting: An ED of a tertiary care hospital. Participants: Triage acuity level-3 patients. Intervention(s): To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff...
February 13, 2018: International Journal for Quality in Health Care
https://www.readbyqxmd.com/read/29444787/randomised-controlled-pragmatic-clinical-trial-evaluating-the-effectiveness-of-a-discharge-follow-up-phone-call-on-30-day-hospital-readmissions-balancing-pragmatic-and-explanatory-design-considerations
#4
Maame Yaa A B Yiadom, Henry Domenico, Daniel Byrne, Michele Marie Hasselblad, Cheryl L Gatto, Sunil Kripalani, Neesha Choma, Sarah Tucker, Li Wang, Monisha C Bhatia, Johnston Morrison, Frank E Harrell, Tina Hartert, Gordon Bernard
INTRODUCTION: Hospital readmissions within 30 days are a healthcare quality problem associated with increased costs and poor health outcomes. Identifying interventions to improve patients' successful transition from inpatient to outpatient care is a continued challenge. METHODS AND ANALYSIS: This is a single-centre pragmatic randomised and controlled clinical trial examining the effectiveness of a discharge follow-up phone call to reduce 30-day inpatient readmissions...
February 14, 2018: BMJ Open
https://www.readbyqxmd.com/read/29441123/circulation-first-the-time-has-come-to-question-the-sequencing-of-care-in-the-abcs-of-trauma-an-american-association-for-the-surgery-of-trauma-multicenter-trial
#5
Paula Ferrada, Rachael A Callcut, David J Skarupa, Therese M Duane, Alberto Garcia, Kenji Inaba, Desmond Khor, Vincent Anto, Jason Sperry, David Turay, Rachel M Nygaard, Martin A Schreiber, Toby Enniss, Michelle McNutt, Herb Phelan, Kira Smith, Forrest O Moore, Irene Tabas, Joseph Dubose
Background: The traditional sequence of trauma care: Airway, Breathing, Circulation (ABC) has been practiced for many years. It became the standard of care despite the lack of scientific evidence. We hypothesized that patients in hypovolemic shock would have comparable outcomes with initiation of bleeding treatment (transfusion) prior to intubation (CAB), compared to those patients treated with the traditional ABC sequence. Methods: This study was sponsored by the American Association for the Surgery of Trauma multicenter trials committee...
2018: World Journal of Emergency Surgery: WJES
https://www.readbyqxmd.com/read/29437308/presenteeism-among-emergency-health-care-staff
#6
Marta Sánchez-Zaballos, María Baldonedo-Mosteiro, Mª Pilar Mosteiro-Díaz
OBJECTIVES: To estimate the prevalence of presenteeism among different categories of hospital and pre-hospital emergency health care professionals in the Principality of Asturias, Spain, and to define the sociodemographic characteristics and workplace factors associated with presenteeism in all categories. MATERIAL AND METHODS: Cross-sectional descriptive study carried out during the last half of 2014 and first half of 2015. A self-administered questionnaire was used to collecta data on sociodemographic and work-related variables and perception of work as stressful...
February 2018: Emergencias: Revista de la Sociedad Española de Medicina de Emergencias
https://www.readbyqxmd.com/read/29429847/the-impact-of-geriatric-focused-nurse-assessment-and-intervention-in-the-emergency-department-a-systematic-review
#7
REVIEW
M Malik, Z Moore, D Patton, T O'Connor, L E Nugent
BACKGROUND: Nursing assessment of elderly patients is imperative in Emergency Departments (ED) while providing interventions that increase independence facilitating discharge to primary healthcare. AIMS: To systematically review the impact of geriatric focused nurse assessment and intervention in the ED on hospital utilisation in terms of admission rate, ED revisits and length of hospital stay (LOHS). METHODS: Search strategy used following databases; Cochrane, Medline, CINAHL, Embase, Scopus and Web of Knowledge; And terms; geriatric nurse assessment, nurse discharge planning, geriatric nurse specialist, nurse intervention, emergency department, accident and emergency, patient outcomes, discharge, admissions, readmissions, hospital utilization, hospitalization, length of stay/hospital stay...
February 8, 2018: International Emergency Nursing
https://www.readbyqxmd.com/read/29421694/resuscitative-endovascular-balloon-occlusion-of-the-aorta-and-resuscitative-thoracotomy-in-select-patients-with-hemorrhagic-shock-early-results-from-the-american-association-for-the-surgery-of-trauma-aortic-occlusion-in-resuscitation-for-trauma-and-acute-care
#8
Megan Brenner, Kenji Inaba, Alberto Aiolfi, Joseph DuBose, Timothy Fabian, Tiffany Bee, John B Holcomb, Laura Moore, David Skarupa, Thomas M Scalea
BACKGROUND: Aortic occlusion (AO) is a potentially valuable tool for early resuscitation in patients nearing extremis or in arrest from severe hemorrhage. STUDY DESIGN: AAST AORTA registry identified trauma patients without penetrating thoracic injury undergoing AO at the level of the descending thoracic aorta (RT or Zone 1 REBOA) in the Emergency Department (ED). Survival outcomes relative to the timing of CPR need and admission hemodynamic status were examined...
February 5, 2018: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/29420761/chinese-military-evaluation-of-a-portable-near-infrared-detector-of-traumatic-intracranial-hematomas
#9
Chun-Yang Liang, Yang Yang, Chun-Sen Shen, Hai-Jiang Wang, Nai-Ming Liu, Zhi-Wen Wang, Feng-Lei Zhu, Ru-Xiang Xu
Introduction: Secondary brain injury is the main cause of mortality from traumatic brain injury (TBI). One hallmark of TBI is intracranial hemorrhage, which occurs in 40-50% of severe TBI cases. Early identification of intracranial hematomas in TBI patients allows early surgical evacuation and can reduce the case fatality rate of TBI. As pre-hospital care is the weakest part of Chinese emergency care, there is an urgent need for a capability to detect brain hematomas early. In China, in addition to preventing injuries and diseases in military staff and in enhancing the military armed forces during war, military medicine participates in actions such as emergency public health crises, natural disasters, emerging conflicts, and anti-terrorist campaigns during peacetime...
February 6, 2018: Military Medicine
https://www.readbyqxmd.com/read/29412043/acute-crisis-care-for-patients-with-mental-health-crises-initial-assessment-of-an-innovative-prehospital-alternative-destination-program-in-north-carolina
#10
Jamie O Creed, Julianne M Cyr, Hillary Owino, Shannen E Box, Mia Ives-Rublee, Brian B Sheitman, Beat D Steiner, Jefferson G Williams, Michael W Bachman, Jose G Cabanas, J Brent Myers, Seth W Glickman
OBJECTIVE: Emergency Departments (ED) are overburdened with patients experiencing acute mental health crises. Pre-hospital transport by Emergency Medical Services (EMS) to community mental health and substance abuse treatment facilities could reduce ED utilization and costs. Our objective was to describe characteristics, treatment, and outcomes of acute mental health crises patients who were transported by EMS to an acute crisis unit at WakeBrook, a North Carolina community mental health center...
February 7, 2018: Prehospital Emergency Care
https://www.readbyqxmd.com/read/29408777/streamlined-triage-and-transfer-protocols-improve-door-to-puncture-time-for-endovascular-thrombectomy-in-acute-ischemic-stroke
#11
Akash P Kansagra, Adam N Wallace, David R Curfman, James D McEachern, Christopher J Moran, DeWitte T Cross, Jin-Moo Lee, Andria L Ford, S Goyal Manu, Peter D Panagos, Colin P Derdeyn
OBJECTIVE: Shorter time from symptom onset to treatment is associated with improved outcomes in patients who undergo mechanical thrombectomy for treatment of acute ischemic stroke due to emergent large vessel occlusion. In this work, we detail pre-thrombectomy process improvements in a multi-hospital network and report the effect on door-to-puncture time in patients undergoing mechanical thrombectomy. PATIENTS AND METHODS: A streamlined workflow was adopted to minimize door-to-puncture time...
January 30, 2018: Clinical Neurology and Neurosurgery
https://www.readbyqxmd.com/read/29406182/guidelines-for-the-management-of-tracheal-intubation-in-critically-ill-adults
#12
A Higgs, B A McGrath, C Goddard, J Rangasami, G Suntharalingam, R Gale, T M Cook
These guidelines describe a comprehensive strategy to optimize oxygenation, airway management, and tracheal intubation in critically ill patients, in all hospital locations. They are a direct response to the 4 th National Audit Project of the Royal College of Anaesthetists and Difficult Airway Society, which highlighted deficient management of these extremely vulnerable patients leading to major complications and avoidable deaths. They are founded on robust evidence where available, supplemented by expert consensus opinion where it is not...
February 2018: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29402334/developing-prehospital-clinical-practice-guidelines-for-resource-limited-settings-why-re-invent-the-wheel
#13
Michael McCaul, Ben de Waal, Peter Hodkinson, Jennifer L Pigoga, Taryn Young, Lee A Wallis
OBJECTIVES: Methods on developing new (de novo) clinical practice guidelines (CPGs) have received substantial attention. However, the volume of literature is not matched by research into alternative methods of CPG development using existing CPG documents-a specific issue for guideline development groups in low- and middle-income countries. We report on how we developed a context specific prehospital CPG using an alternative guideline development method. Difficulties experienced and lessons learnt in applying existing global guidelines' recommendations to a national context are highlighted...
February 5, 2018: BMC Research Notes
https://www.readbyqxmd.com/read/29396756/pre-hospital-management-of-pediatric-polytrauma-during-modern-conflict-experience-and-limits-of-the-french-military-health-service
#14
Victor Laville, Christophe Lebleu, Christophe Desterke, Pierre Mornand, Luc Aigle, Emmanuel Hornez
BACKGROUND: French military physicians serving in deployment are confronted with pediatric polytrauma patients (PPP) during the provision of medical aid to civilian populations. The objectives of this study were to describe the current care of PPPs during these missions, to report difficulties encountered and to evaluate the training of doctors for management of PPPs in the field. METHODS: A descriptive epidemiological study based on a questionnaire sent to physicians who had been deployed overseas...
February 2, 2018: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/29395429/current-trauma-care-system-and-trauma-care-training-in-china
#15
REVIEW
Lian-Yang Zhang, Xiu-Zhu Zhang, Xiang-Jun Bai, Mao Zhang, Xiao-Gang Zhao, Yong-An Xu, Hao Tan, Yang Li
Trauma is a life-threatening "modern disease". The outcomes only could be optimized by cost-efficient and prompt trauma care, which embarks on the improvement of essential capacities and conceptual revolution in addition to the disruptive innovation of the trauma care system. The experiences from the developed countries, the systematic trauma care training are the cornerstone of the generalization and the improvement on the trauma care, such as the Advance Trauma Life Support (ATLS). Currently, the pre-hospital EMS (emergency medical services) has been one of the essential elements of infrastructure of health services in China, which is also fundamental to the trauma care system...
December 8, 2017: Chinese Journal of Traumatology, Zhonghua Chuang Shang za Zhi
https://www.readbyqxmd.com/read/29394480/interprofessional-huddle-one-children%C3%A2-s-hospital%C3%A2-s-approach-to-improving-patient-flow
#16
Cheryl L McBeth, Blythe Durbin-Johnson, Elena O Siegel
Admitting pediatric patients promptly to the appropriate unit where they can receive specialty care is of critical importance to safe, quality care. A daily morning huddle was implemented at one children’s hospital as a quality improvement project. The aim of this project was to improve patient flow throughout the children’s hospital by improving interprofessional and interdepartmental communication and collaboration. This article reports on changes in patient flow before and after implementation of the daily huddle, as measured by pediatric emergency department (ED) boarding times...
March 2017: Pediatric Nursing
https://www.readbyqxmd.com/read/29389252/risk-factors-and-predictive-model-development-of-thirty-day-post-operative-surgical-site-infection-in-the-veterans-administration-surgical-population
#17
Xinli Li, William Nylander, Tracy Smith, Soonhee Han, William Gunnar
BACKGROUND: Surgical site infection (SSI) complicates approximately 2% of surgeries in the Veterans Affairs (VA) hospitals. Surgical site infections are responsible for increased morbidity, length of hospital stay, cost, and mortality. Surgical site infection can be minimized by modifying risk factors. In this study, we identified risk factors and developed accurate predictive surgical specialty-specific SSI risk prediction models for the Veterans Health Administration (VHA) surgery population...
February 1, 2018: Surgical Infections
https://www.readbyqxmd.com/read/29386714/forward-surgical-care-emerging-issues-and-challenges
#18
Bipin Puri
War strategies have been evolving with time and battlefield casualty care services have been trying to keep pace with the changing demands. Technological advances in the field of trauma care have revolutionised the way in which erstwhile 'non-salvageable' lives and limbs are managed with more favourable outcome. The quality of Pre-Hospital Trauma Care Services will largely determine the survival statistics of battle casualties. The surgeon has to acknowledge the various resource constraints imposed upon him in the course of delivery of expert trauma care in the battlefield...
October 2017: Medical Journal, Armed Forces India
https://www.readbyqxmd.com/read/29386154/assesment-of-predictor-variables-and-clinical-consequences-associated-with-surgical-site-infection-in-tertiary-care-setting-karachi-pakistan
#19
Anum Tariq, Huma Ali, Farya Zafar, Ali Akbar Sial, Kamran Hameed, Mehwish Rizvi, Rabia Bushra, Saima Salim, Zeb-Un Nisa, Ghazala R Naqvi, Saba Zubair
Among the well-known Health care-associated infections (HAIs), surgical site infections (SSIs) contribute to considerable high mortality and morbidity rate, substantial prolongation in hospitalization period and extra expenses in terms of treatment cost. This study was aimed to evaluate the predictive variables associated with surgical site infections, and their clinical consequences. This was a prospective, cross sectional study conducted in the surgical department of tertiary care setting in Karachi, Pakistan...
January 2018: Pakistan Journal of Pharmaceutical Sciences
https://www.readbyqxmd.com/read/29385778/patient-satisfaction-with-pre-hospital-emergency-services-a-qualitative-study-comparing-professionals-and-patients-views
#20
Fernando García-Alfranca, Anna Puig, Carles Galup, Hortensia Aguado, Ismael Cerdá, Mercedes Guilabert, Virtudes Pérez-Jover, Irene Carrillo, José Joaquín Mira
Objective: To describe patient satisfaction with pre-hospital emergency knowledge and determine if patients and professionals share a common vision on the satisfaction predictors. Methods: A qualitative study was conducted in two phases. First, a systematic review following the PRISMA protocol was carried out searching publications between January 2000 and July 2016 in Medline, Scopus, and Cochrane. Second, three focus groups involving professionals (advisers and healthcare providers) and a total of 79 semi-structured interviews involving patients were conducted to obtain information about what dimensions of care were a priority for patients...
January 30, 2018: International Journal of Environmental Research and Public Health
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