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Henry Zhao, Lauren Pesavento, Skye Coote, Edrich Rodrigues, Patrick Salvaris, Karen Smith, Stephen Bernard, Michael Stephenson, Leonid Churilov, Nawaf Yassi, Stephen M Davis, Bruce C V Campbell
BACKGROUND AND PURPOSE: Clinical triage scales for prehospital recognition of large vessel occlusion (LVO) are limited by low specificity when applied by paramedics. We created the 3-step ambulance clinical triage for acute stroke treatment (ACT-FAST) as the first algorithmic LVO identification tool, designed to improve specificity by recognizing only severe clinical syndromes and optimizing paramedic usability and reliability. METHODS: The ACT-FAST algorithm consists of (1) unilateral arm drift to stretcher <10 seconds, (2) severe language deficit (if right arm is weak) or gaze deviation/hemineglect assessed by simple shoulder tap test (if left arm is weak), and (3) eligibility and stroke mimic screen...
March 14, 2018: Stroke; a Journal of Cerebral Circulation
Patricia G Rosenstein, Brett S Tennent-Brown, Dez Hughes
OBJECTIVE: To review the current literature pertaining to the use of lactate as a prognostic indicator and therapeutic guide, the utility of measuring lactate concentrations in body fluids other than blood or plasma, and the clinical management of hyperlactatemia in dogs, cats, and horses. DATA SOURCES: Articles were retrieved without date restrictions primarily via PubMed, Scopus, and CAB Abstracts as well as by manual selection. HUMAN AND VETERINARY DATA SYNTHESIS: Increased plasma lactate concentrations are associated with increased morbidity and mortality...
March 2018: Journal of Veterinary Emergency and Critical Care
Samuel Mullinax, Christen E Chalmers, Jesse Brennan, Gary M Vilke, Kimberly Nordstrom, Michael P Wilson
BACKGROUND: Suicide screening scales have been advocated for use in the ED setting. However, it is currently unknown whether patients classified as low-risk on these scales can be safely discharged from the emergency department. This study evaluated the utility of three commonly-used suicide screening tools in the emergency department to predict ED disposition, with special interest in discharge among low-risk patients. METHODS: This prospective observational study enrolled a convenience sample of patients who answered "yes" to a triage suicidal ideation question in an urban academic emergency department...
January 31, 2018: American Journal of Emergency Medicine
Julia M Lappin, Muhammad H Ayub, David Rogers, Madeleine Morgan, Jean-Yves Kanyamibwa, Anthony Shakeshaft
OBJECTIVE: To evaluate the effectiveness of a routine screening and triage tool for alcohol withdrawal syndrome (AWS) in improving clinical care delivery in an ED setting. METHODS: In a regional ED in Australia, a screening and triage tool for AWS was introduced to routine ED assessment for a 13 week period. Subjects were all presentations to ED aged 16 and above with relevant presenting problems during the pre-intervention phase (1 January 2015-31 December 2016) and the post-intervention phase (8 August 2016-4 November 2016)...
March 12, 2018: Emergency Medicine Australasia: EMA
Ravit Bassal, Yoav Guilburd, Hagit Shapira, Joseph Azuri, Judith Zandbank, Eduardo Schejter
BACKGROUND: The human papillomavirus (HPV) test has proven to be efficient in triaging women with abnormal Pap findings in women with low cytological atypia, but there is no data about the accuracy for large loop excision of transformation zone in cases of recurrent atypia. OBJECTIVES: To assess the clinical correlation between results of HPV typing and conization histology in women who had recurrent abnormal Pap test results with no colposcopy findings. METHODS: Our retrospective cohort study included 138 women enrolled in the Maccabi Healthcare Services who had consecutive atypical Pap test results for 2 years in which no abnormal colposcopic findings were detected...
March 2018: Israel Medical Association Journal: IMAJ
Kathryn A Taylor, David N Durrheim, Tony Merritt, Peter Massey, John Ferguson, Nick Ryan, Carolyn Hullick
Background: System factors in a regional Australian health district contributed to avoidable care deviations from invasive meningococcal disease (IMD) management guidelines. Traditional root cause analysis (RCA) is not well-suited to IMD, focusing on individual cases rather than system improvements. As IMD requires complex care across healthcare silos, it presents an opportunity to explore and address system-based patient safety issues. Context: Baseline assessment of IMD cases (2005-2006) identified inadequate triage, lack of senior clinician review, inconsistent vital sign recording and laboratory delays as common issues, resulting in antibiotic administration delays and inappropriate or premature discharge...
2018: BMJ Open Quality
Liz Floyd, Fiona Bryce, Rohit Ramaswamy, Adeyemi Olufolabi, Emmanuel Srofenyoh, David Goodman, Nancy Pearson, Kerry Morgan, Cecilia Tetteh, Victoria Ahwireng, Medge Owen
OBJECTIVE: to introduce and embed a midwife-led obstetric triage system in a busy labour ward in Accra, Ghana to improve the quality of care and to reduce delay. DESIGN: the study utilized a participatory action research design. Local staff participated in baseline data collection, the triage training course design and delivery, and post-training monitoring and evaluation. SETTING: a regional referral hospital in Accra, Ghana undertaking 11,032 deliveries in 2012...
February 12, 2018: Midwifery
Magnolia Cardona, Ebony T Lewis, Robin M Turner, Hatem Alkhouri, Stephen Asha, John Mackenzie, Margaret Perkins, Sam Suri, Anna Holdgate, Luis Winoto, Chan-Wei Chang, Blanca Gallego-Luxan, Sally McCarthy, Mette R Kristensen, Michael O'Sullivan, Helene Skjøt-Arkil, Anette A Ekmann, Hanne H Nygaard, Jonas J Jensen, Rune O Jensen, Jonas L Pedersen, Dorothy Breen, John A Petersen, Birgitte N Jensen, Christian Backer Mogensen, Ken Hillman, Mikkel Brabrand
BACKGROUND: Prognostic uncertainty inhibits clinicians from initiating timely end-of-life discussions and advance care planning. This study evaluates the efficacy of the CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) checklist in emergency departments. METHODS: Prospective cohort study of patients aged ≥65 years with any diagnosis admitted via emergency departments in ten hospitals in Australia, Denmark and Ireland. Electronic and paper clinical records will be used to extract risk factors such as nursing home residency, physiological deterioration warranting a rapid response call, personal history of active chronic disease, history of hospitalisations or intensive care unit admission in the past year, evidence of proteinuria or ECG abnormalities, and evidence of frailty to be concurrently measured with Fried Score and Clinical Frailty Scale...
March 6, 2018: Archives of Gerontology and Geriatrics
Olivia Sonneborn, Charne Miller, Leon Head, Rachel Cross
BACKGROUND: Operating theatre services can be heavily relied upon during mass casualty disaster events, which require nurses to have adequate training and education of hospital disaster management plans to respond appropriately. The evidence-base of disaster preparedness in the acute setting is limited, particularly with regard to operating theatre nurses. OBJECTIVES: Explore operating theatre nurse's disaster knowledge of their role in a mass casualty event, and identify the preferred mode of disaster education and training to improve disaster preparedness...
February 21, 2018: Nurse Education Today
Lulu Yu, Mingyue Jiang, Pengpeng Qu, Zeni Wu, Peisong Sun, Mingrong Xi, Yu Qin, Xin Liu, Guangdong Liao, Xiaoqin Lei, Lixin Sun, Yongzhen Zhang, Zhifang Li, Wen Chen, You-Lin Qiao
HPV-16 and -18 account for about 80% of cervical cancers. We evaluated the performance of HPV-16/18 oncoprotein to predict precancer and cancer in corresponding tissue biopsy specimens. 1008 women attending cervical cancer screening program and 638 women referred to colposcopy with biopsy-confirmed cervical intraepithelial neoplasia grade 2 or worse (CIN2+) from 4 hospitals were recruited (1646 in total). All women were tested OncoE6 (AVC), Liquid Based Cytology (Hologic) and cobas HPV test (Roche). Colposcopy was performed on women with any abnormal results...
March 9, 2018: International Journal of Cancer. Journal International du Cancer
Teddy Léguillier, Romain Jouffroy, Marie Boisson, Agathe Boussaroque, Camille Chenevier-Gobeaux, Tarek Chaabouni, Benoît Vivien, Valérie Nivet-Antoine, Jean-Louis Beaudeux
AIM OF THE STUDY: We evaluated if the StatStrip Xpress Meter, a Lactate point of care testing (POCT) handled device, could be a valuable tool in the mobile intensive care units (MICU) to assess the severity of septic patients. METHODS: We first investigated POCT analytical performance, then, using samples collected from 50 identified septic patients admitted to the intensive care unit (ICU), we compared lactate values obtained with the device to those obtained with four central laboratory analysers: one whole blood and three plasma-based methods...
March 6, 2018: Clinical Biochemistry
Chong Sherry Cheever, Celestina Barbosa-Leiker
OBJECTIVE: The aims of this study were to determine the prevalence and describe the importance of alcohol screening for all patients with traumatic brain injury (TBI) and examine the relationship between gender, age, Abbreviated Injury Scale (AIS), emergent decompressive craniectomy, Glasgow Coma Scale (GCS) from the emergency department (ED), and the length of stay with alcohol screening. METHOD: This is a retrospective analysis of de-identified data from the 2012 TBI registry of a level 1 trauma center in the Pacific Northwest...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Anna Ver Hage, Mohamed Teleb, Evelyn Smith
BACKGROUND: Nurses play an integral role in triaging stroke patients. The purpose of this quality improvement initiative was to determine the efficacy of using an emergent large vessel occlusion (ELVO) screening protocol in the emergency department by nursing staff to improve identification of eligible patients as compared with current practice, improving time to endovascular treatment. METHODS: Retrospective chart review was used to identify 76 patients admitted to a large urban stroke center...
April 2018: Journal of Neuroscience Nursing: Journal of the American Association of Neuroscience Nurses
Nam Ju Lee, Harold Litt
PURPOSE OF REVIEW: To compare outcomes between registries and randomized controlled trials of coronary computed tomographic angiography (CCTA)-based versus standard of care approaches to the initial evaluation of patients with acute chest pain. RECENT FINDINGS: Randomized trials have demonstrated CCTA to be a safe and efficient tool for triage of low- to intermediate-risk patients presenting to the emergency department with chest pain. Recent studies demonstrate heterogeneous result using different standard of care approaches for evaluation of hard endpoints in comparison with standard evaluation...
March 8, 2018: Current Cardiology Reports
Olivier Yavari-Sartakhti, Frédérique Briche, Daniel Jost, Nicolas Michaud, Michel Bignand, Jean-Pierre Tourtier
Deafness frequently observed in explosion victims, currently following terrorist attack, is a barrier to communication between victims and first responders. This may result in a delay in the initial triage and evacuation. In such situations, Paris Fire Brigade (Paris, France) proposes the use of assistance cards to help conscious, but deafened patients at the site of an attack where there may be numerous victims. Yavari-Sartakhti O , Briche F , Jost D , Michaud N , Bignand M , Tourtier JP . A new triage support tool in case of explosion...
March 8, 2018: Prehospital and Disaster Medicine
Christopher P Kellner, Eric Sauvageau, Kenneth V Snyder, Kyle M Fargen, Adam S Arthur, Raymond D Turner, Andrei V Alexandrov
INTRODUCTION: Effective triage of patients with emergent large vessel occlusion (ELVO) to endovascular therapy capable centers may decrease time to treatment and improve outcome for these patients. Here we performed a derivation study to evaluate the accuracy of a portable, non-invasive, and easy to use severe stroke detector. METHODS: The volumetric impedance phase shift spectroscopy (VIPS) device was used to assign a bioimpedance asymmetry score to 248 subjects across three cohorts, including 41 subjects presenting as acute stroke codes at a major comprehensive stroke center (CSC), 79 healthy volunteers, and 128 patients presenting to CSCs with a wide variety of brain pathology including additional stroke codes...
March 6, 2018: Journal of Neurointerventional Surgery
Sandhya Reddy, Pariseema S Pancholy, Kaveet P Pandya, Anvit Rai, Aman T Patel, Siddharth Chauhan, Ian C Gilchrist
OBJECTIVES: Evaluation of plethysmography as a reliable triage tool to access collateral circulation in the hand prior to transradial access. BACKGROUND: Hand plethysmographic testing has been used for access site triage prior to cardiac catheterization despite a lack of data supporting its result's stability. METHODS: Cohort of consecutive outpatients presenting for evaluation prior to cardiac catheterization underwent hand plethysmographic testing at the beginning of the office visit and before discharge...
March 2, 2018: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Lisa A Wolf, Cydne Perhats, Altair M Delao, Paul R Clark, Michael D Moon, Kathleen Evanovich Zavotsky
INTRODUCTION: Screening for suicidality is a critical nursing function at the initial ED encounter. Suicide is the tenth leading cause of death in the United States, and a substantial percentage of people who die by suicide present for health care in the year before their deaths. The emergency department provides health care professionals with a critical opportunity to identify patients at risk for suicide and intervene appropriately. METHODS: Qualitative exploratory study using focus-group data...
March 1, 2018: Journal of Emergency Nursing: JEN: Official Publication of the Emergency Department Nurses Association
James T Dant, Glen Reeves, Daniela Stricklin
OBJECTIVE: A radiological disaster could result in a large number of patients potentially exposed to harmful levels of radiation. Currently, early triage of patients for radiation exposure relies heavily on a clinical evaluation of signs and symptoms. However, detailed clinical assessment takes significant time and requires specialized training to accurately interpret the results. METHODS: During planning of a recent exercise, SMEs estimated that it would take up to 15 minutes per patient...
March 4, 2018: Disaster Medicine and Public Health Preparedness
Naser Kalid, A A Zaidan, B B Zaidan, Omar H Salman, M Hashim, O S Albahri, A S Albahri
This paper presents a new approach to prioritize "Large-scale Data" of patients with chronic heart diseases by using body sensors and communication technology during disasters and peak seasons. An evaluation matrix is used for emergency evaluation and large-scale data scoring of patients with chronic heart diseases in telemedicine environment. However, one major problem in the emergency evaluation of these patients is establishing a reasonable threshold for patients with the most and least critical conditions...
March 2, 2018: Journal of Medical Systems
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