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Air Medical Journal 2024This observational study provides an overview of the implementation and impact of the helipad at the Bucharest Emergency University Hospital, Romania. The helipad,... (Observational Study)
Observational Study
Flight to Recovery: Impact of a Rooftop Helipad Air Ambulance Service at the Emergency University Hospital of Bucharest-A Caseload Analysis of the First 3 Years After Its Implementation.
OBJECTIVE
This observational study provides an overview of the implementation and impact of the helipad at the Bucharest Emergency University Hospital, Romania. The helipad, established in April 2019, is the only rooftop medical helipad in Bucharest authorized for day and night flights. Its influence extends beyond the local region, enabling the hospital to receive patients from various cities across Romania. The helipad has particularly strengthened the hospital's capabilities in cardiology, neurovascular emergencies, and neonatal care. Patients with acute myocardial infarctions or strokes can now be swiftly transported to the hospital for immediate intervention, whereas critically ill newborns can receive specialized care at the earliest stages of their lives. The objective of this article was to present a comprehensive timeline of the helipad's implementation and to demonstrate its transformative role in improving patient transportation, enhancing medical interventions, and elevating the overall efficiency of the health care facility.
METHODS
The study is a retrospective regional caseload analysis based on data gathered from the Emergency Department of the University Emergency Hospital of Bucharest database. We included all 215 air transfer missions registered between December 2019 and December 2022, exactly 3 years apart from the beginning of the program.
RESULTS
The findings provide valuable insights into patient demographics, case distribution, and trends, highlighting the importance of specialized medical interventions at the University Emergency Hospital of Bucharest. In particular, the mean age of patients treated at the hospital was 55.9 years, with a higher representation of males (156) than females (59). The average duration of hospitalization was 10.68 days. The study also examined transportation statistics, showing a decrease in the average number of transports per month over the years. Cardiologic cases accounted for the highest frequency (62.8%) among the analyzed categories followed by neurosurgery (8.8%) and neurologic cases (8.4%).
CONCLUSION
The analysis provides important insights into patient demographics, case distribution, and trends. The findings highlight the significance of specialized medical interventions, particularly in cardiology and neurosurgery, which accounted for the majority of the cases. The implementation of the helipad has greatly improved patient transportation and facilitated timely medical assistance.
Topics: Air Ambulances; Humans; Hospitals, University; Retrospective Studies; Female; Male; Emergency Service, Hospital; Middle Aged; Adult; Aged; Transportation of Patients; Infant, Newborn
PubMed: 38897695
DOI: 10.1016/j.amj.2024.03.002 -
Journal of Clinical Medicine May 2024: Catecholamines are among those agents that are indispensable in modern intensive care medicine. The rapid availability of hygienically impeccable and correctly...
: Catecholamines are among those agents that are indispensable in modern intensive care medicine. The rapid availability of hygienically impeccable and correctly concentrated injectable solutions, e.g., for syringe pumps, is becoming more and more important. However, little research has been conducted regarding how the use of catecholamines is distributed in different wards and what options can be used to achieve optimal availability. : In a retrospective monocentric study from 2019 to 2022, all continuously applied catecholamines in intensive care units (ICU) and intermediate care units (IMC) were investigated. The focus was on potential optimization by utilizing manufactured ready-to-administer solutions in the context of the economization of patient care. Norepinephrine syringes represented 81% of all syringes administered, appearing to be the most frequently used on all wards. Production by the in-house pharmacy showed both financial advantages and an increase in patient safety compared to syringes produced at the bedside. Increasing numbers of critically ill patients coupled with growing staff shortages and an increased awareness of safety requirements are driving the move towards ready-to-use and ready-to-administer solutions in critical care medicine. In-house manufacturing by hospital pharmacies can be a promising option to optimize processes and improve the economics of patient care. Individual calculations of the required catecholamine preparations with regard to possible economic advantages should be carried out in hospitals. In particular, in-house production of ready-to-use and ready-to-administer preparations could significantly increase patient safety and seems to be economically viable.
PubMed: 38892781
DOI: 10.3390/jcm13113070 -
Journal of Clinical Medicine May 2024: Cadaveric models have traditionally been a mainstay of dental and medical education worldwide since their inception. In Australia, educators at dental schools were...
: Cadaveric models have traditionally been a mainstay of dental and medical education worldwide since their inception. In Australia, educators at dental schools were among the first to use cadaveric porcine heads in formal teaching in oral surgery. This practice has since fallen out of favour in most modern dental curricula. The aim of this pilot study was to determine the utility of cadaveric porcine models for oral surgery training from a student perspective (Griffith University, Gold Coast, Australia). : Thirty participants who were all third-year dental students attended a two-hour session comprising a 30 min lecture followed by a 90 min practical workshop. The lecture outlined the steps and supervision of students during the practical and was provided by a consultant maxillofacial surgeon. At the conclusion of the workshop, participants were asked to anonymously complete a printed questionnaire with eight questions related to their experience. : Prior to the workshop, two-thirds (61%) of participants felt that they had been taught the surgical procedure for raising mucoperiosteal flaps adequately in their dental school curriculum during their third year, although only 43% of students had assisted specialty residents in raising a mucoperiosteal flap and 14% reported having performed the procedure themselves. Almost all students (96%) agreed that the porcine model was useful for their dental education and that they would practice the exercise using the model again if provided with the opportunity. The questionnaire had a 93.33% completion rate. : This pilot study indicates that porcine heads present a useful, low-cost adjunct in the learning of basic oral surgical procedures.
PubMed: 38892742
DOI: 10.3390/jcm13113032 -
Healthcare (Basel, Switzerland) Jun 2024Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists... (Review)
Review
Tuberculosis (TB) is the top infectious killer in the world despite efforts to eliminate it. Pharmaceutical care roles are pillars of pharmacy practice, and pharmacists are well equipped to serve a unique role in the pathway to provide education about TB. Previous systematic reviews emphasize pharmacists' role in treating TB; however, pharmacists can and do play much broader roles in overall TB elimination efforts. Five researchers searched five electronic databases (PubMed, PsychInfo, CINAHL, Academic Search Premier, and Embase). Search terms included pharmacy, pharmacist, tuberculosis, antitubercular agents, supply, distribution, and drug therapy. Inclusion criteria were studies published from 2010 through March 2023, in English or Spanish, addressed a specific TB-related role for pharmacists/pharmacies, and were peer-reviewed. Exclusion criteria included pharmacology, pharmacokinetics, clinical trials on drug efficacy, and editorials. Two researchers conducted each level of review; for discordance, a third researcher reviewed, and a decision was reached by consensus. Roles were extracted and cross-referenced with traditional pharmaceutical care steps. Of the initial 682 hits, 133 were duplicates. After further review, we excluded 514 records, leaving 37 articles for full extraction. We found nine roles for pharmacists in TB prevention and classified them as implemented, not implemented, or recommended. These roles were: (1) TB symptom screening; (2) Referring to TB care systems; (3) TB testing; (4) Dispensing TB medication correctly and/or directly observed therapy; (5) Counseling; (6) Looking to reduce socioeconomic barriers; (7) Procurement of TB medications; (8) Quality assurance of TB medications; (9) Maintaining and using pharmacy data systems. Pharmacists are well situated to play a vital role in the global fight against TB. Findings suggested pharmacists in many settings have already expanded their roles related to TB elimination beyond traditional pharmaceutical care. Still others need to increase the understanding of TB procurement and treatment, their power to improve TB care, and their contributions to data systems that serve population health. Pharmacy curricula should increase TB-related training to better equip future pharmacists to contribute to TB elimination.
PubMed: 38891212
DOI: 10.3390/healthcare12111137 -
Healthcare (Basel, Switzerland) May 2024A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of...
BACKGROUND AND OBJECTIVES
A sustainability-oriented hospital governance has the potential to increase the efficiency of healthcare services and reduce the volume of expenses. The objective of this research is to develop a new complex tool for evaluating healthcare facility governance as a component of social responsibility, integrated into sustainability.
MATERIALS AND METHODS
We designed the research to develop the domains of a new reference framework for evaluating healthcare facility governance. The methodology for designing the indicators that make up the new reference framework consists of collecting and processing the most recent and relevant practices regarding the governance of healthcare facilities that have been reported by representative hospitals around the world.
RESULTS
We designed eight indicators that are brought together in the healthcare facility governance indicators matrix. They have descriptions and qualitative and quantitative rating scales with values from 0 to 5 that allow the degree of fulfillment to be quantified. The importance of the indicators is evaluated on a specific scale described qualitatively and quantitatively by values from 0 to 5. The values of the degree of achievement-importance couples of the indicators allow the development of improvement measures with priority according to the results revealed by the Eisenhower-type assessment diagram.
CONCLUSIONS
Validation in practice of the system of indicators at an emergency hospital in an orthopedic profile highlighted the fact that they can be integrated into other national and international reference frameworks implemented in the hospital. The added value of the implementation consists of the facilitation of sustainable development and the orientation of health personnel, patients, and interested parties toward sustainability.
PubMed: 38891155
DOI: 10.3390/healthcare12111080 -
Trials Jun 2024In Kenya, 65% of sexually active unmarried women use modern contraceptives, a population at increased risk of HIV acquisition compared to other populations. Anchoring...
Enhancing HIV pre-exposure prophylaxis outcomes among Kenyan adolescent girls and young women with a novel pharmacy-based PrEP delivery platform: protocol for a cluster-randomized controlled trial.
BACKGROUND
In Kenya, 65% of sexually active unmarried women use modern contraceptives, a population at increased risk of HIV acquisition compared to other populations. Anchoring HIV prevention services, including pre-exposure prophylaxis (PrEP), to trusted contraceptive delivery settings offers opportunities to efficiently reach this important population. In Kenya, almost half (40%) of women accessing contraception services do so outside traditional healthcare facilities, such as retail pharmacies. Thus, integrating PrEP services into retail pharmacies may increase options for reaching adolescent girls and young women (AGYW) who could benefit from PrEP. Efforts are underway to define care pathways for pharmacy-delivered PrEP services in Kenya, including unsupported and supported models with nurse navigators.
METHODS
The AGYW Pharmacy PrEP study is an unblinded 2-arm cluster-randomized controlled trial in Kisumu, Kenya. The objective is to determine the effect that unsupported versus supported pharmacy-delivered PrEP services has on PrEP initiation, persistence, and adherence among AGYW seeking contraception. Twenty retail pharmacies offering pharmacy provider-led PrEP delivery will be randomized 1:1 to either receive or not receive a nurse navigator to support PrEP delivery. Eligible AGYW (n = 1900 total, n = 950/arm) will be ≥ 15 years old, purchasing a method of contraception at the pharmacy. Trained pharmacy provider will offer eligible AGYW either daily oral PrEP or the monthly DPV vaginal ring. The primary trial outcomes are PrEP initiation (use of PrEP at 1 month), persistence (use of PrEP at 10 months), and adherence (quantified by levels of TFV or DPV in hair samples). Additionally, several secondary (STI incidence, PrEP method selection, predictors of PrEP adherence) and exploratory outcomes (HIV incidence, quality of care, contraceptive method mix) will be explored.
DISCUSSION
We hypothesize pharmacy-delivered PrEP services supported with nurse navigator, versus delivered by pharmacy providers alone, will improve PrEP outcomes among AGYW seeking contraception. Our results will help policy makers better understand how to potentially implement this novel differentiated service model for PrEP and prime pharmacies for the delivery of new PrEP agents in the pipeline (e.g., long-acting injectables and multi-purpose technologies). The study was initiated on May 13, 2023, and is expected to be completed by February 2025.
TRIAL REGISTRATION
ClinicalTrials.gov (NCT05467306), with registration on July 20, 2022.
Topics: Humans; Female; Adolescent; HIV Infections; Pre-Exposure Prophylaxis; Kenya; Young Adult; Anti-HIV Agents; Randomized Controlled Trials as Topic; Medication Adherence; Treatment Outcome; Time Factors; Multicenter Studies as Topic; Community Pharmacy Services
PubMed: 38890744
DOI: 10.1186/s13063-024-08206-6 -
International Breastfeeding Journal Jun 2024Early initiation of breastfeeding is the initiation of breastfeeding within one hour of birth, which plays a significant role in a born baby's growth and...
BACKGROUND
Early initiation of breastfeeding is the initiation of breastfeeding within one hour of birth, which plays a significant role in a born baby's growth and survival, however its prevalence and predictors among urban full-time readymade garments (RMG) working mothers are not investigated. The purpose of this study is to determine the prevalence and factors affecting early initiation of breastfeeding among urban RMG working mothers.
METHODS
A sequential explanatory mixed-methods study was conducted between March 2023 and December 2023 in Dhaka, Bangladesh. A total of 452 full-time female RMG workers were included for the quantitative study. Qualitative study was carried out among 30 full-time female RMG workers, four female physicians who were employed in the RMGs, four RMG factory managers, and four local pediatricians.
RESULTS
The prevalence of early initiation of breastfeeding was 40% among the women. It was significantly associated with various factors, including socio-cultural barriers, the advanced age of the mother (AOR 3.93, 95%CI 1.18, 13.04), lack of education (AOR 6.86, 95%CI 1.11, 42.49), lack of awareness, and cultural practices such as initiating goat milk and honey instead of breast milk. The absence of colostrum feeding (AOR 8.96, 95%CI 4.30, 18.70) and pre-lacteal feeding (AOR 0.06, 95%CI 0.03, 0.11) were significant baby feeding practice-related barriers to early initiation of breastfeeding. Maternal health factors, notably post-delivery sickness, cesarean delivery, and lack of breastmilk production, were revealed as a significant hindrance to the early initiation of breastfeeding explored from qualitative analysis. In addition, RMG factory-related factors that significantly affect early initiation of breastfeeding include a strong focus on production, a busy schedule, and a lack of initiative regarding the early initiation of breastfeeding.
CONCLUSIONS
The prevalence of early initiation of breastfeeding among RMG working women is poor. This study emphasizes the need for interventions that address specific challenges of early initiation of breastfeeding faced by working mothers in RMG sectors, including improved lactation education, increased awareness to mitigate cultural barriers, RMG factory-based initiatives to empower female workers early initiation of breastfeeding, and preparing early initiation of breastfeeding -friendly post-cesarean unit at the health care facility.
Topics: Humans; Breast Feeding; Bangladesh; Female; Adult; Mothers; Prevalence; Urban Population; Young Adult; Women, Working; Clothing; Infant, Newborn; Poverty
PubMed: 38890634
DOI: 10.1186/s13006-024-00645-w -
The Journal of Medicine Access 2024Community pharmacies play a vital role in promoting the rational use of medicines by providing medication counseling to their clients to ensure the safe and appropriate...
BACKGROUND
Community pharmacies play a vital role in promoting the rational use of medicines by providing medication counseling to their clients to ensure the safe and appropriate use of medicines. Thus, this study aimed to assess awareness of the rational use of medicines and the medication counseling practice in community pharmacies.
METHODS
A descriptive cross-sectional study was conducted from June to July 2021. The study was carried out in community pharmacies in Nyamagana district, Mwanza, Tanzania. Data were collected using a self-administered, semi-structured questionnaire. The data for descriptive statistics were entered in Microsoft Excel and analyzed using STATA version 15.
RESULTS
A total of 68 pharmaceutical personnel participated in this study. Thirty-eight participants, that is, 55.9%, were aware of the rational use of medicines. The awareness was significantly influenced by the participant's age and profession. The majority of the dispensers practiced rational use of medicines by telling their clients the dose of the medicine ( = 63, 92.6%), frequency of administration ( = 61, 89.7%), and route of administration ( = 60, 88.2%). However, only 21 (30.9%) told clients about the need to comply with their medications. The information that was not regularly provided by dispensers to clients was the side effects of medicines ( = 6, 8.8%). Less than a quarter of participants frequently told their clients information regarding why the medicine is prescribed, drug interactions, storage conditions, and contraindications.
CONCLUSION
This study has shown that almost half of the participants were aware of the rational use of medicines. There was a low frequency at which information was given regarding medication compliance, side effects, storage conditions, drug interactions, and contraindications. These findings underscore the need for targeted interventions to enhance pharmaceutical personnel's understanding of rational use of medicine principles and improve their practice of patient medication counseling.
PubMed: 38887665
DOI: 10.1177/27550834241261852 -
Diabetology & Metabolic Syndrome Jun 2024Elevations in the gut metabolite trimethylamine-N-oxide (TMAO) have been linked to cardiovascular and metabolic diseases. Whether elevated TMAO levels reflect early...
BACKGROUND
Elevations in the gut metabolite trimethylamine-N-oxide (TMAO) have been linked to cardiovascular and metabolic diseases. Whether elevated TMAO levels reflect early mechanistic involvement or a sequela of evolving disease awaits elucidation. The purpose of this study was to further explore these potential associations.
METHODS
We investigated relationships between circulating levels of TMAO and its pre-cursor substrates, dietary factors, gut microbiome profiles and disease risk in individuals with a Healthy BMI (18.5 < BMI < 25, n = 41) or key precursor states for cardiometabolic disease: Overweight (25 < BMI < 30 kg/m, n = 33), Obese (BMI > 30, n = 27) and Metabolic Syndrome (MetS; ≥ 3 ATPIII report criteria, n = 39).
RESULTS
Unexpectedly, plasma [TMAO] did not vary substantially between groups (means of 3-4 µM; p > 0.05), although carnitine was elevated in participants with MetS. Gut microbial diversity and Firmicutes were also significantly reduced in the MetS group (p < 0.05). Exploratory analysis across diverse parameters reveals significant correlations between circulating [TMAO] and seafood intake (p = 0.007), gut microbial diversity (p = 0.017-0.048), and plasma [trimethylamine] (TMA; p = 0.001). No associations were evident with anthropometric parameters or cardiometabolic disease risk. Most variance in [TMAO] within and between groups remained unexplained.
CONCLUSIONS
Data indicate that circulating [TMAO] may be significantly linked to seafood intake, levels of TMA substrate and gut microbial diversity across healthy and early disease phenotypes. However, mean concentrations remain < 5 µM, with little evidence of links between TMAO and cardiometabolic disease risk. These observations suggest circulating TMAO may not participate mechanistically in cardiometabolic disease development, with later elevations likely a detrimental sequela of extant disease.
PubMed: 38886825
DOI: 10.1186/s13098-024-01368-y -
BMC Women's Health Jun 2024Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both...
Understanding maternal Ethnomedical Folklore in Central Uganda: a cross-sectional study of herbal remedies for managing Postpartum hemorrhage, inducing uterine contractions and abortion in Najjembe sub-county, Buikwe district.
UNLABELLED
Pregnant women in rural Uganda largely rely on medicinal plants for inducing labor, treating postpartum hemorrhage (PPH), and inducing abortion. 90% of the women in both rural and urban Uganda use plants to manage pregnancy symptoms like constipation, heartburn, morning sickness, body aches, nausea, and vomiting. After delivery women continue using plants to manage postpartum complications and for infant care especially herbal baths. This study documented how ethnomedical folklore has been used to aid childbirth, manage postpartum hemorrhage, and induce abortion.
METHODS
A cross-sectional ethnobotanical survey was conducted from May - December 2023 in Najjemebe sub-county, Buikwe district. 206 respondents from 12 villages were selected using snowball sampling. Key informants included Traditional Birth Attendants (TBAs) and herbalists. Data was collected using semi-structured questionnaires and focus group discussions. Voucher specimens of the plants were identified and authenticated at Makerere University Herbarium. Data were analyzed using descriptive statistics, Informant Consensus factor (ICF), Use Reports (URs), paired comparisons, and GraphPad Prism® version 9.0.0 software.
RESULTS
All respondents (N = 206, 100%), used plants to induce labour, treat PPH, and induce abortion. One hundred four plant species were documented: most cited or preferred were: Hoslundia opposita (N = 109, 53%), Phytolacca dodecandra (N = 72, 35%), and Commelina erecta (N = 47, 23%). The plants belonged to 49 families, Lamiaceae (16.3%) and Fabaceae (14.3%) having the majority of the species. Herbs were 42 (40%) and trees 23 (22%). Oral administration 95(72%) was the commonest, then topical 19 (14.4%) and vaginal 14(10.6%).
CONCLUSION
Health surveys revealed that about 27% of deliveries in Uganda take place outside a health facility. Due to the oxytocic effects of plant species reported in this study, they play a triple role of being uterotonics, abortifacients, and treating postpartum haemmorhage. The dilemma lies in the unknown dosages and toxicity levels that could endanger both the mother's and the unborn child's lives. Due to Uganda's high rates of population growth, overall fertility, maternal mortality, and morbidity, policies, and programmes on gendered health provision need to be reevaluated. Integrating herbal medicine into health care systems appears to be a feasible solution.
Topics: Humans; Female; Uganda; Cross-Sectional Studies; Adult; Pregnancy; Postpartum Hemorrhage; Medicine, African Traditional; Abortion, Induced; Phytotherapy; Plants, Medicinal; Middle Aged; Young Adult; Ethnobotany; Surveys and Questionnaires; Plant Preparations; Midwifery; Male
PubMed: 38886787
DOI: 10.1186/s12905-024-03205-w