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Journal of Neuroendovascular Therapy 2022Time to recanalization is directly linked to cerebral infarction prognosis. However, patients transferred from another hospital take longer to arrive than those...
OBJECTIVE
Time to recanalization is directly linked to cerebral infarction prognosis. However, patients transferred from another hospital take longer to arrive than those transported directly. To minimize time to recanalization, the emergency room (ER) skip strategy for hospital transfers was executed and reviewed.
METHODS
From April 2019, patients transferred from another hospital for mechanical thrombectomy were carried into the angio-suite using emergency service stretchers. Results for these patients (ER skip group) were compared with those for patients transported directly to our hospital (Direct group).
RESULTS
Among 108 cases in 32 months, 99 patients (91.7%) had major cerebral artery occlusion and underwent endovascular treatment. No differences in age, baseline National Institutes of Health Stroke Scale score, effective recanalization rate, or proportion of posterior circulation cases were seen between groups. The ER skip group (26 patients) showed significantly longer median time from onset to arrival (240 vs. 120 min; p = 0.0001) and significantly shorter median time from arrival to groin puncture (11 vs. 69 min; p = 0.0000). No significant differences were evident in time from groin puncture to recanalization (39 vs. 45 min), time from onset to recanalization (298 vs. 244 min), or rate of modified Rankin Scale score 0-2 after 90 days (42.3% vs. 32.9%). Median time from alarm to recanalization (266 vs. 176 min; p = 0.0001) was significantly longer in the ER skip group. Door-to-puncture (DTP) time for the Direct group gradually fell as the number of cases increased, reaching 40 min by the end of study period. In contrast, DTP time for the ER skip group remained extremely short and did not change further. The proportion of patients who underwent both CT and MRI before endovascular treatment was significantly lower in the Direct group (30.1%) than in the ER skip group (57.7%). In the ER skip group, median length of stay in the primary hospital was 119 min, and the median duration of interhospital transfer was 16 min.
CONCLUSION
The ER skip strategy for patients transferred with large vessel occlusion achieved favorable outcomes comparable to that for direct transport cases. Direct transport to a thrombectomy-capable stroke center remains ideal, however, because the time to intervention is improving for direct transport cases each year.
PubMed: 37501738
DOI: 10.5797/jnet.oa.2022-0047 -
Materials Advances Aug 2022Stretching individual living cells with light is a standard method to assess their mechanical properties. Yet, heat introduced by the laser light of optical stretchers...
Stretching individual living cells with light is a standard method to assess their mechanical properties. Yet, heat introduced by the laser light of optical stretchers may unwittingly change the mechanical properties of cells therein. To estimate the temperature induced by an optical trap, we introduce cell-sized, elastic poly(-isopropylacrylamide) (PNIPAAm) microgels that relate temperature changes to hydrogel swelling. For their usage as a standardized calibration tool, we analyze the effect of free-radical chain-growth gelation (FCG) and polymer-analogous photogelation (PAG) on hydrogel network heterogeneity, micromechanics, and temperature response by Brillouin microscopy and optical diffraction tomography. Using a combination of tailor-made PNIPAAm macromers, PAG, and microfluidic processing, we obtain microgels with homogeneous network architecture. With that, we expand the capability of standardized microgels in calibrating and validating cell mechanics analysis, not only considering cell and microgel elasticity but also providing stimuli-responsiveness to consider dynamic changes that cells may undergo during characterization.
PubMed: 35979502
DOI: 10.1039/d2ma00296e -
Scandinavian Journal of Trauma,... May 2018In response to the review "Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review." by...
In response to the review "Advanced airway management in hoist and longline operations in mountain HEMS - considerations in austere environments: a narrative review." by Pietsch et al. we refer to recently published original research describing manual versus automatic ventilation of intubated patients during helicopter hoisting operations.
Topics: Air Ambulances; Aircraft; Airway Management; Emergency Medicine; Humans; Iron-Dextran Complex
PubMed: 29751816
DOI: 10.1186/s13049-018-0508-z -
Optics Express Jun 2023Optical quantum information processing requires low loss interference of quantum light. Also, when the interferometer is composed of optical fibers, degradation of...
Optical quantum information processing requires low loss interference of quantum light. Also, when the interferometer is composed of optical fibers, degradation of interference visibility due to the finite polarization extinction ratio becomes a problem. Here we propose a low loss method to optimize interference visibility by controlling the polarizations to a crosspoint of two circular trajectories on the Poincaré sphere. Our method maximizes visibility with low optical loss by using fiber stretchers as polarization controllers on both paths of the interferometer. We also experimentally demonstrate our method, where the visibility was maintained basically above 99.9% for three hours using fiber stretchers with an optical loss of 0.02 dB (0.5%). Our method makes fiber systems promising for practical fault-tolerant optical quantum computers.
PubMed: 37381343
DOI: 10.1364/OE.489082 -
Physics in Medicine and Biology Jan 2024The goal of this work was to assess the potential use of non-contact scintillator imaging dosimetry for tracking delivery in total body irradiation (TBI).. Studies were...
The goal of this work was to assess the potential use of non-contact scintillator imaging dosimetry for tracking delivery in total body irradiation (TBI).. Studies were conducted to measure the time-gated light signals caused by radiation exposure to scintillators that were placed on tissue. The purpose was to assess efficacy in conditions common for TBI, such as the large source to surface distance (SSD) commonly used, the reduced dose rate, the inclusion of a plexiglass spoiler, angle of incidence and effects of peripheral patient support structures. Dose validation work was performed on phantoms that mimicked human tissue optical properties and body geometry. For this work, 1.5 cm diameter scintillating disks were developed and affixed to phantoms under various conditions. A time-gated camera synchronized to the linac pulses was used for imaging. Scintillation intensity was quantified in post processing and the values verified with simultaneous thermolumiescent dosimeter (TLD) measurements. Mean scintillation values in each region were compared to TLD measurements to produce dose response curves, and scatter effects from the spoiler and patient bed were quantified.The dose determined by scintillators placed in TBI conditions agreed with TLD dose determinations to within 2.7%, and did so repeatedly within 1.0% standard deviation variance. A linear fit between scintillator signal and TLD dose was achieved with an= 0.996 across several body sites. Scatter from the patient bed resulted in a maximum increase of 19% in dose.This work suggests that non-contact scintillator imaging dosimetry could be used to verify dose in real time to patients undergoing TBI at the prescribed long SSD and low dose rate. It also has shown that patient transport stretchers can significantly influence surface dose by increasing scatter.
Topics: Humans; Scintillation Counting; Whole-Body Irradiation; Radiometry; Radiotherapy Dosage; Phantoms, Imaging; Optical Imaging
PubMed: 38171002
DOI: 10.1088/1361-6560/ad1a23 -
Journal of Sports Sciences 2016Lumbar-pelvic kinematics change in response to increasing rowing stroke rates, but little is known about the effect of incremental stroke rates on changes in joint...
Lumbar-pelvic kinematics change in response to increasing rowing stroke rates, but little is known about the effect of incremental stroke rates on changes in joint kinetics and their implications for injury. The purpose of this study was to quantify the effects of incremental rowing intensities on lower limb and lumbar-pelvic kinetics. Twelve female rowers performed an incremental test on a rowing ergometer. Kinematic data of rowers' ankle, knee, hip and lumbar-pelvic joints, as well as external forces at the handle, seat and foot-stretchers of the rowing machine were recorded. Inter-segmental moments and forces were calculated using inverse dynamics and were compared across stroke rates using repeated measures ANOVA. Rowers exhibited increases in peak ankle and L5/S1 extensor moments, reductions in peak knee moments and no change in peak hip moments, with respect to stroke rate. Large shear and compressive forces were seen at L5/S1 and increased with stroke rate (P < 0.05). This coincided with increased levels of lumbar-pelvic flexion. High levels of lumbar-pelvic loading at higher stroke rates have implications with respect to injury and indicated that technique was declining, leading to increased lumbar-pelvic flexion. Such changes are not advantageous to performance and can potentially increase the risk of developing injuries.
Topics: Ankle; Biomechanical Phenomena; Female; Hip; Humans; Knee; Lower Extremity; Lumbosacral Region; Pelvis; Physical Education and Training; Sports
PubMed: 26090702
DOI: 10.1080/02640414.2015.1056821 -
Clinics (Sao Paulo, Brazil) 2019
Topics: Female; Hemodynamics; Humans; Patient Positioning; Pregnancy; Prenatal Care; Prone Position; Stretchers
PubMed: 31038647
DOI: 10.6061/clinics/2019/e958 -
Journal of Safety, Health and... 2016In a mine emergency where refuge is necessary, miners may sustain injuries that will render them unable to walk or crawl. In this situation, a miner may have to rely on...
In a mine emergency where refuge is necessary, miners may sustain injuries that will render them unable to walk or crawl. In this situation, a miner may have to rely on others for transportation into the mobile refuge alternative (RA) while on a stretcher. Since requirements for mine first-aid stations were developed before RAs, stretchers should be evaluated to determine whether they are usable in an RA and within the physical capabilities of miners in a refuge. The size of the RA airlock is a concern, as it has not been determined if current airlocks will accommodate a miner on a stretcher. This study evaluated the time required to move three types of stretchers into two commercially available RAs. The splint stretcher had the longest average time to move into each RA as compared to the backboard and soft stretcher. This increase was mostly due to the increased time requirements for getting the splint stretcher into the airlock. For all stretchers, it took approximately two to three times longer to enter the inflatable tent-type RA compared to the rigid steel RA. Mining companies should consider how well their current first-aid implements work with their RAs and manufacturers of inflatable RAs should maximize the size of the outer doors leading into the airlock to allow an easier entry for stretchers.
PubMed: 27942423
DOI: No ID Found -
Academic Emergency Medicine : Official... Apr 2014Emergency department (ED) crowding negatively affects quality of care and disproportionately affects medium-acuity (Emergency Severity Index [ESI] level 3) patients. The...
BACKGROUND
Emergency department (ED) crowding negatively affects quality of care and disproportionately affects medium-acuity (Emergency Severity Index [ESI] level 3) patients. The effect of a dedicated area in the ED focused on these patients has not been well studied.
OBJECTIVES
The objective was to find out the operational effect of a midtrack area dedicated to the evaluation and safe disposition of uncomplicated medium-acuity (ESI 3) patients.
METHODS
This was a 24-month pre-/postintervention study to evaluate the effect of implementation of a dedicated midtrack area at an urban tertiary academic adult ED. The midtrack had three examination rooms and three hallway stretchers for ongoing treatment staffed by an attending physician and two registered nurses (RNs). Besides the two additional RNs representing a 3.4% increase in total daily nursing hours, the intervention required no additional ED resources. The midtrack area was open from 1 p.m. to 9 p.m. on weekdays, corresponding to peak ED arrival rates. All patients presenting during weekdays were included, excluding patients triaged directly to the trauma bay or psychiatric unit or who expired in the ED. The main outcomes were left without being seen (LWBS) rates and ED length of stay (LOS), adjusting for patient volume, daily total patient hours (a proxy for ED crowding), and acuity.
RESULTS
A total of 91,903 patients were included for analysis during the study period including 261 pre- and 256 postintervention days. Comparing the pre- and postintervention periods, mean ED daily visits (173 vs. 182) and mean total daily patient hours (889 vs. 942) were all significantly higher in the postintervention period (p<0.0001). There was no significant change in percentage of patients with high triage acuity levels. Despite this increase in volume and crowding, the unadjusted and adjusted LWBS rates decreased from 6.85% to 4.46% (p<0.0001) and from 7.33% to 3.97% (p<0.0001), respectively. The mean LOS for medium-acuity patients also decreased by 39.2 minutes (p<0.0001). For high-acuity patients, there was no significant change in the mean time to room (14.69 minutes vs. 15.21 minutes, p=0.07); however, their mean LOS increased by 24 minutes (331 minutes vs. 355 minutes, p<0.0001).
CONCLUSIONS
Implementation of a midtrack area dedicated to caring for uncomplicated medium-acuity (ESI 3) patients was associated with a decrease in overall ED LWBS rates and ED LOS for medium-acuity patients.
Topics: Adult; Crowding; Emergency Service, Hospital; Female; Humans; Length of Stay; Male; Middle Aged; Outcome and Process Assessment, Health Care; Patient Acuity; Patients' Rooms; Retrospective Studies; Time Factors; Triage
PubMed: 24730406
DOI: 10.1111/acem.12345 -
Indian Journal of Palliative Care 2018In the last decades, patients with chronic terminal diseases have had more frequent visits to emergency services.
CONTEXT
In the last decades, patients with chronic terminal diseases have had more frequent visits to emergency services.
AIMS
This study aims to determine the proportion of terminal illness in patients readmitted to emergency room, to evaluate the use of this service and rate of death.
SETTINGS AND DESIGN
A cross-sectional study in a tertiary hospital with 120 stretchers which annually reports 160 thousand attentions and 22 thousand admissions.
SUBJECTS AND METHODS
Included 18-year-old patients or older who were readmitted to emergency room. Patient and/or caregiver were interviewed; medical record was reviewed and made 1-year follow-up. Terminal cancer was determined by histologically confirmation in Stage IV and nononcologic terminal disease by total functional dependence (Katz index) or severe cognitive impairment (Pfeiffer questionnaire) in addition of advanced organ failure.
STATISTICAL ANALYSIS USED
Fisher's exact and U of Mann-Whitney tests for two independent samples.
RESULTS
Ninety-two (26%) of 349 were readmissions; 29 (36.7%) of 79 evaluated patients were identifying with terminal disease. Eleven (38%) of them had cancer (genitourinary in 64%). Nononcologic terminal disease was identified in 18 cases (62%) (Neurodegenerative involvement in 50%). More frequent symptoms were dyspnea 41%, mental confusion 24%, and pain 21%. Terminal patients had 6.2 (standard deviation 8.2) emergency visits at last year, being admitted 48,6% of these visits. Six-month mortality rate was 73 and 61% in oncologic and nononcolgic patients, respectively ( < 0.05).
CONCLUSIONS
End-stage disease is frequent in readmitted patients to emergency, more of nononcologic kind. These patients use frequently emergency service, with high mortality (more elevated in oncologic).
PubMed: 29440802
DOI: 10.4103/IJPC.IJPC_108_17