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https://www.readbyqxmd.com/read/27913657/cost-benefit-analysis-of-telehealth-in-pre-hospital-care
#1
James R Langabeer, Tiffany Champagne-Langabeer, Diaa Alqusairi, Junghyun Kim, Adria Jackson, David Persse, Michael Gonzalez
OBJECTIVE: There has been very little use of telehealth in pre-hospital emergency medical services (EMS), yet the potential exists for this technology to transform the current delivery model. In this study, we explore the costs and benefits of one large telehealth EMS initiative. METHODS: Using a case-control study design and both micro- and gross-costing data from the Houston Fire Department EMS electronic patient care record system, we conducted a cost-benefit analysis (CBA) comparing costs with potential savings associated with patients treated through a telehealth-enabled intervention...
December 2, 2016: Journal of Telemedicine and Telecare
https://www.readbyqxmd.com/read/27912248/mean-arterial-blood-pressure-management-of-acute-spinal-cord-injured-patients-during-the-pre-hospital-and-early-admission-period
#2
Jin Wee Tee, Farhaan Altaf, Lise M Belanger, Tamir Ailon, John Street, Scott J Paquette, Michael C Boyd, Charles G Fisher, Marcel F Dvorak, Brian K Kwon
The optimization and maintenance of mean arterial blood pressure (MAP) and the general avoidance of systemic hypotension for the first 5 to 7 days following acute traumatic SCI is considered to be important for minimizing secondary spinal cord ischemic damage. The characterization of hemodynamic parameters in the immediate post-injury stage prior to admission to a specialized spine unit has not been previously reported. Here we describe the blood pressure management of 40 acute tSCI patients in the early post-injury phases of care prior to their arrival in a specialized spinal injury high dependency unit (HDU), intensive care unit (ICU) or operating room (OR)...
December 2, 2016: Journal of Neurotrauma
https://www.readbyqxmd.com/read/27907128/fasa-registry-on-acute-myocardial-infarction-farmi-feasibility-study-and-pilot-phase-results
#3
Ehsan Bahramali, Alireza Askari, Habib Zakeri, Mojtaba Farjam, Azizallah Dehghan, Kazem Zendehdel
BACKGROUND: Myocardial infarction (MI) is the leading cause of death in Iran. Every attempt to improve treatment patterns and patient outcomes needs a surveillance system to both consider the efficacy and safety measures. Fasa Registry on Myocardial Infarction (FaRMI) is the first population-based registry for acute MI in Iran targeted to provide meticulous description of patients' characteristics, to explore the management patterns of these patients, to discover the degree of adherence to the practice guidelines, and to investigate the determinants of poor in-hospital and later outcomes...
2016: PloS One
https://www.readbyqxmd.com/read/27894465/is-denial-a-maladaptive-coping-mechanism-which-prolongs-pre-hospital-delay-in-patients-with-st-segment-elevation-myocardial-infarction
#4
X Y Fang, L Albarqouni, A F von Eisenhart Rothe, S Hoschar, J Ronel, K-H Ladwig
OBJECTIVE: During an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse. METHODS: This cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside...
December 2016: Journal of Psychosomatic Research
https://www.readbyqxmd.com/read/27891574/termination-of-pre-hospital-resuscitation-by-anaesthesiologists-causes-and-consequences-a-retrospective-study
#5
S Mikkelsen, H M Lossius, L G Binderup, C Schaffalitzky de Muckadell, P Toft, A T Lassen
AIM: Differentiating between a newly deceased patient and the lifeless patient in whom immediate resuscitation is required may be facilitated by a pre-hospital anaesthesiologist. The purpose of our study was to investigate to what extent and why the pre-hospital anaesthesiologist pronounced life extinct in situations where an emergency medical technician (EMT) would have been required to resuscitate. METHODS: All lifeless patients seen pre-hospitally by the anaesthesiologist-manned Mobile Emergency Care Unit in Odense, Denmark, from 2010 to 2014 were retrospectively studied...
November 27, 2016: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/27890837/association-between-pre-hospital-time-and-mortality-following-blunt-thoracic-aortic-injuries
#6
Biniam Kidane, Vaibhav Gupta, Mostafa El-Beheiry, Kelly Vogt, Neil G Parry, Richard Malthaner, Thomas L Forbes
OBJECTIVE: Blunt traumatic thoracic aortic injuries (BTAI) can be lethal, but advances in trauma systems and in surgical care have helped reduce mortality. The purpose of this study was to investigate whether time from injury to presentation is associated with mortality following BTAI. METHODS: Using the Ontario Trauma Registry, all patients were identified who were hospitalized with BTAI between 1999 & 2009. Variables including age, sex, Injury Severity Score, Charlson comorbidity index, systolic blood pressure on admission, operative intervention, and time from injury to presentation were analysed using multivariate logistic regression to determine independent predictors of mortality...
November 24, 2016: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/27889057/algorithm-for-the-automatic-computation-of-the-modified-anderson-wilkins-acuteness-score-of-ischemia-from-the-pre-hospital-ecg-in-st-segment-elevation-myocardial-infarction
#7
Yama Fakhri, Maria Sejersten, Mikkel Malby Schoos, Jacob Melgaard, Claus Graff, Galen S Wagner, Peter Clemmensen, Jens Kastrup
BACKGROUND: The acuteness score (based on the modified Anderson-Wilkins score) estimates the acuteness of ischemia based on ST-segment, Q-wave and T-wave measurements obtained from the electrocardiogram (ECG) in patients with ST Elevation Myocardial Infarction (STEMI). The score (range 1 (least acute) to 4 (most acute)) identifies patients with substantial myocardial salvage potential regardless of patient reported symptom duration. However, due to the complexity of the score, it is not used in clinical practice...
November 10, 2016: Journal of Electrocardiology
https://www.readbyqxmd.com/read/27888608/efficacy-and-safety-of-combined-intraventricular-fibrinolysis-with-lumbar-drainage-for-prevention-of-permanent-shunt-dependency-after-intracerebral-hemorrhage-with-severe-ventricular-involvement-a-randomized-trial-and-individual-patient-data-meta-analysis
#8
Dimitre Staykov, Joji B Kuramatsu, Jürgen Bardutzky, Bastian Volbers, Stefan T Gerner, Stephan P Kloska, Arnd Doerfler, Stefan Schwab, Hagen B Huttner
Objective Intraventricular hemorrhage (IVH) is a negative prognostic factor in intracerebral hemorrhage (ICH) and is associated with permanent shunt dependency in a substantial proportion of patients after ICH. IVH treatment by intraventricular fibrinolysis (IVF) was recently linked to reduced mortality rates in the CLEAR III study and IVF represents a safe and effective strategy to hasten clot resolution that may reduce shunt rates. Additionally, promising results from observational studies reported reductions in shunt dependency for a combined treatment approach of IVF plus lumbar drains (LD)...
November 26, 2016: Annals of Neurology
https://www.readbyqxmd.com/read/27875857/retrospective-review-of-prothrombinex-use-by-saas-medstar
#9
Roy Fischer, Simon Brettig, Andrew Pearce
OBJECTIVE: The aim of this study was to review and describe the use of Prothrombinex by a physician-led retrieval service based remote from a hospital blood bank. METHODS: This is a retrospective observational study. Patients to whom Prothrombinex was administered by the retrieval team were identified from the retrieval service patient database. The paper case cards of the identified patients were then manually reviewed and the data matched to patients in the state-wide electronic laboratory record...
November 22, 2016: Emergency Medicine Australasia: EMA
https://www.readbyqxmd.com/read/27873224/therapeutic-potential-of-transdermal-glyceryl-trinitrate-in-the-management-of-acute-stroke
#10
Jason P Appleton, Nikola Sprigg, Philip M Bath
The nitric oxide donor, glyceryl trinitrate (GTN), is a candidate treatment for the management of acute stroke with haemodynamic and potential reperfusion and neuroprotective effects. When administered as a transdermal patch during the acute and subacute phases after stroke, GTN was safe, lowered blood pressure, maintained cerebral blood flow, and did not induce cerebral steal or alter functional outcome. However, when given within 6 h of stroke onset, GTN reduced death and dependency (odds ratio 0.52; 95% confidence interval 0...
November 21, 2016: CNS Drugs
https://www.readbyqxmd.com/read/27871770/ptsd-in-those-who-care-for-the-injured
#11
Kevin Luftman, Jayson Aydelotte, Kevin Rix, Sadia Ali, Katherine Houck, Thomas B Coopwood, Pedro Teixeira, Alex Eastman, Brian Eastridge, Carlos V R Brown, Matthew Davis
BACKGROUND: Post Traumatic Stress Disorder (PTSD) has become a focus for the care of trauma victims, but the incidence of PTSD in those who care for injured patients has not been well studied. Our hypothesis was that a significant proportion of health care providers involved with trauma care are at risk of developing PTSD. METHODS: A system-wide survey was applied using a modified version of the Primary Care PTSD Screen [PC-PTSD], a validated PTSD screening tool currently being used by the VA to screen veterans for PTSD...
November 10, 2016: Injury
https://www.readbyqxmd.com/read/27865776/post-cardiac-arrest-shock-treated-with-veno-arterial-extracorporeal-membrane-oxygenation-an-observational-study-and-propensity-score-analysis
#12
Wulfran Bougouin, Nadia Aissaoui, Alain Combes, Nicolas Deye, Lionel Lamhaut, Daniel Jost, Carole Maupain, Frankie Beganton, Adrien Bouglé, Nicole Karam, Florence Dumas, Eloi Marijon, Xavier Jouven, Alain Cariou
PURPOSE: Cardiogenic shock due to post-resuscitation myocardial dysfunction is a major cause of mortality among patients hospitalized after cardiac arrest (CA). Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been proposed in the most severe cases but the level of evidence is very low. We assessed characteristics, outcome and prognostic factors of patients treated with VA-ECMO for post-CA shock. METHODS: Using a large regional registry, we focused on all CA admitted in ICU...
November 17, 2016: Resuscitation
https://www.readbyqxmd.com/read/27857907/clinical-outcome-of-acute-epidural-hematoma-in-korea-preliminary-report-of-285-cases-registered-in-the-korean-trauma-data-bank-system
#13
Young Ha Jeong, Ji Woong Oh, Sungmin Cho
OBJECTIVE: The aim of this preliminary collaborative study was to assess the clinical characteristics, management, and outcome of epidural hematoma (EDH) based on the data collected and registered in the Korean Trauma Data Bank System (KTDBS). METHODS: Of 2,698 patients registered in the KTDBS between September 2010 and March 2014, 285 patients with EDH were analyzed. Twenty-three trauma centers participated in the study voluntarily to collect data. We subcategorized the patients into two groups with good and poor outcomes...
October 2016: Korean Journal of Neurotrauma
https://www.readbyqxmd.com/read/27855964/interventions-to-reduce-emergency-department-utilisation-a-review-of-reviews
#14
Koen Van den Heede, Carine Van de Voorde
OBJECTIVE: To describe policy interventions that have the objective to reduce ED use and to estimate their effectiveness. METHODS: Narrative review by searching three electronic databases for scientific literature review papers published between 2010 and October 2015. The quality of the included studies was assessed with AMSTAR, and a narrative synthesis of the retrieved papers was applied. RESULTS: Twenty-three included publications described six types of interventions: (1) cost sharing; (2) strengthening primary care; (3) pre-hospital diversion (including telephone triage); (4) coordination; (5) education and self-management support; (6) barriers to access emergency departments...
October 13, 2016: Health Policy
https://www.readbyqxmd.com/read/27855275/epidemiology-and-aetiology-of-traumatic-cardiac-arrest-in-england-and-wales-a-retrospective-database-analysis
#15
Ed Barnard, David Yates, Antoinette Edwards, Marisol Fragoso-Iñiguez, Tom Jenks, Jason E Smith
BACKGROUND: Historically, reported survival from traumatic cardiac arrest (TCA) was extremely low. More recent publications have recorded survival to discharge of up to 8%. This improvement is likely to be multi-factorial; however, there are currently no published data describing the epidemiology or aetiology of TCA in England and Wales to guide future practice improvement. METHODS: Population-based analysis of 2009-2015 Trauma Audit and Research Network (TARN) data...
November 14, 2016: Resuscitation
https://www.readbyqxmd.com/read/27849481/brief-report-systemic-vascular-access-and-resuscitation-via-corpus-cavernosum
#16
Melville Bradley
BACKGROUND: Pre-hospital systemic vascular access with early resuscitation in the hypovolemic trauma patient can be problematic and is attempted through venous cut-downs, peripheral IV lines, and/or interosseous routes. This brief report examines an alternative for males via the corpus cavernosum (CC). METHODS: A systematic literature review using certain inclusion criteria including, but not limited to, corpus cavernosum access and resuscitation was conducted and a summary table created...
November 2016: Military Medicine
https://www.readbyqxmd.com/read/27846459/simplifying-electrocardiographic-assessment-in-stemi-reperfusion-management-pros-and-cons
#17
REVIEW
Cheuk-Kit Wong
Current guidelines on STEMI reperfusion management do not incorporate further electrocardiographic details over the presence of significant ST elevation. Fibrinolysis is considered an alternative therapy to primary PCI if there is a long PCI-related delay, but the 2 therapies should not be combined. Meanwhile, reperfusion for ischemic stroke has evolved on mechanistic understanding - reperfusion benefit being greatest in the patient with small "core" infarct and large ischemic "penumbra". Fibrinolysis is not regarded as an alternative to mechanical thrombectomy, and the 2 therapies can be combined...
November 11, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27842564/heel-pressure-ulcer-prevention-and-predictors-during-the-care-delivery-chain-when-and-where-to-take-action-a-descriptive-and-explorative-study
#18
Åsa Muntlin Athlin, Maria Engström, Lena Gunningberg, Carina Bååth
BACKGROUND: Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes...
November 14, 2016: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/27836253/bi-manual-proximal-external-aortic-compression-after-major-abdominal-pelvic-trauma-and-during-ambulance-transfer-a-simulation-study
#19
M J Douma, D O'Dochartaigh, P G Brindley
BACKGROUND: Applying manual pressure after hemorrhage is intuitive, cost-free, and logistically-simple. When direct abdominal-pelvic compression fails, clinicians can attempt indirect proximal-external-aortic-compression (PEAC), while expediting transfer and definitive rescue. This study quantifies the sustainability of simulated bi-manual PEAC both immediately on scene and during subsequent ambulance transfer. The goal is to understand when bi-manual PEAC might be clinically-useful, and when to prioritize compression-devices or endovascular-occlusion...
November 5, 2016: Injury
https://www.readbyqxmd.com/read/27834561/relative-contribution-of-lower-body-work-as-a-biomechanical-determinant-of-spine-sparing-technique-during-common-paramedic-lifting-tasks
#20
Paul J Makhoul, Kathryn E Sinden, Renée S MacPhee, Steven L Fischer
Paramedics represent a unique occupational group where the nature of their work providing pre-hospital emergency care makes workplace modifications to manage and control injury risks, difficult. Therefore, the provision of workplace education and training to support safe lifting remains a viable and important approach. There is, however, a lack of evidence describing movement strategies that may be optimal for paramedic work. The purpose of this study was to determine if a strategy leveraging a greater contribution of work from the lower body relative to the torso was associated with lower biomechanical exposures on the spine...
November 11, 2016: Journal of Applied Biomechanics
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