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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 -
Scientific Reports May 2021Early recognition and rapid initiation of high-quality cardiopulmonary resuscitation (CPR) are key to maximising chances of achieving successful return of spontaneous...
Early recognition and rapid initiation of high-quality cardiopulmonary resuscitation (CPR) are key to maximising chances of achieving successful return of spontaneous circulation in patients with out-of-hospital cardiac arrests (OHCAs), as well as improving patient outcomes both inside and outside hospital. Mechanical chest compression devices such as the LUCAS-2 have been developed to assist rescuers in providing consistent, high-quality compressions, even during transportation. However, providing uninterrupted and effective compressions with LUCAS-2 during transportation down stairwells and in tight spaces in a non-supine position is relatively impossible. In this study, we proposed adaptations to the LUCAS-2 to allow its use during transportation down stairwells and examined its effectiveness in providing high-quality CPR to simulated OHCA patients. 20 volunteer emergency medical technicians were randomised into 10 pairs, each undergoing 2 simulation runs per experimental arm (LUCAS-2 versus control) with a loaded Resusci Anne First Aid full body manikin weighing 60 kg. Quality of CPR compressions performed was measured using the CPRmeter placed on the sternum of the manikin. The respective times taken for each phase of the simulation protocol were recorded. Fisher's exact tests were used to analyse categorical variables and median test to analyse continuous variables. The LUCAS-2 group required a longer time (~ 35 s) to prepare the patient prior to transport (p < 0.0001) and arrive at the ambulance (p < 0.0001) compared to the control group. The CPR quality in terms of depth and rate for the overall resuscitation period did not differ significantly between the LUCAS-2 group and control group, though there was a reduction in both parameters when evaluating the device's automated compressions during transport. Nevertheless, the application of the LUCAS-2 device yielded a significantly higher chest compression fraction of 0.76 (p < 0.0001). Our novel adaptations to the LUCAS-2 device allow for uninterrupted compressions in patients being transported down stairwells, thus yielding better chest compression fractions for the overall resuscitation period. Whether potentially improved post-OHCA survival rates may be achieved requires confirmation in a real-world scenario study.
Topics: Cardiopulmonary Resuscitation; Emergency Medical Technicians; Female; Humans; Male; Manikins; Out-of-Hospital Cardiac Arrest; Shoulder; Simulation Training; Stretchers; Transportation of Patients; Treatment Outcome
PubMed: 33972647
DOI: 10.1038/s41598-021-89291-4 -
Methods in Molecular Biology (Clifton,... 2021With the realization that mechanical forces mediate many biological processes and contribute to disease progression, researchers are focusing on developing new methods...
With the realization that mechanical forces mediate many biological processes and contribute to disease progression, researchers are focusing on developing new methods to understand the role of mechanotransduction in biological systems. Despite recent advances in stretching devices that analyze the effects of mechanical strain in vitro, there are still possibilities to develop new equipment. For example, many of these devices tend be expensive, whereas few have been designed to assess the effects of mechanical strain driven by the extracellular matrix (ECM) to epithelial cell monolayers and to cell-cell adhesion. In this chapter, we introduce a cost-efficient, user-friendly, 3D-printed stretching device that can be used to test the effects of mechanical strain on cultured epithelial cells. Evaluation of the device using speckle-tracking shows homogeneous strain distribution along the horizontal plane of membranes at 2.5% and 5% strains, supporting the reliability of the device. Since cell-cell junctions are mechanosensitive protein complexes, we hereby used this device to examine effects on cell-cell adhesion. For this, we used colon epithelial Caco2 cell monolayers that well-differentiate in culture and form mature adherens junctions. Subjecting Caco2 cells to 2.5% and 5% strain using our device resulted in significant reduction in the localization of the core adherens junction component E-cadherin at areas of cell-cell contact and its increased translocation to the cytoplasm, which in agreement with other methodologies showing that increased ECM-driven strain negatively affects cell-cell adhesion. In summary, we here present a new, cost-effective, homemade device that can be reliably used to examine effects of mechanical strain on epithelial cell monolayers and cell-cell adhesion, in vitro.
Topics: Adherens Junctions; Caco-2 Cells; Cadherins; Cell Adhesion; Epithelial Cells; Humans; Mechanotransduction, Cellular; Printing, Three-Dimensional; Reproducibility of Results; Stretchers
PubMed: 32789778
DOI: 10.1007/7651_2020_314 -
Optics Express Dec 2016We derived a formula for calculation of the spectral phase of ultrashort pulses propagating through aberrated stretchers. Our approach is based on Seidel aberration...
We derived a formula for calculation of the spectral phase of ultrashort pulses propagating through aberrated stretchers. Our approach is based on Seidel aberration theory. The dependence of spectral phase dispersion terms and residual angular dispersion on the individual Seidel aberration coefficients is found. As an example, the spectral phase deviation and the residual angular dispersion of an ultrashort pulse for the Martinez/Banks stretcher using spherical optics is calculated.
PubMed: 28059317
DOI: 10.1364/OE.24.030421 -
Journal of Veterinary Science 2015Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the...
Our objective was to evaluate the effectiveness of skin-stretching devices for closing defects on the extremities of dogs. Antebrachial skin defects were created on the limbs of 24 dogs randomly divided into three groups. Skin stretchers included staples and sutures passing through them (group A), sutures and hypodermic needles (group B), and Pavletic device (group C). Wounds on the left were further undermined in all groups. Tension and blood perfusion were assessed. After removing the stretchers on day 3, the defects were sutured and wound healing was clinically scored. Histological variables evaluated were cellular infiltration, edema, collagen orientation, and thickness of epidermis. Significant differences in tension were found among groups (p 0.0005) and between measurement times for undermined (p = 0.001) or non-undermined (p < 0.0005) wounds. In contrast, blood perfusion values did not differ significantly. Clinical scores for group B seemed to be better than those for groups A and C, but differences were not significant. Primary wound closure using the Pavletic device was not feasible. No significant differences in histological variables were found between groups. Skin stretching with staples or hypodermic needles resulted in successful wound management with minor side effects on skin histology and circulation.
Topics: Animals; Dogs; Female; Forelimb; Male; Skin; Stress, Mechanical; Tissue Expansion; Wound Closure Techniques; Wound Healing
PubMed: 25269717
DOI: 10.4142/jvs.2015.16.1.99 -
Scandinavian Journal of Trauma,... Mar 2021Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in...
BACKGROUND
Spinal stabilisation is recommended for prehospital trauma treatment. In Germany, vacuum mattresses are traditionally used for spinal stabilisation, whereas in anglo-american countries, long spine boards are preferred. While it is recommended that the on-scene time is as short as possible, even less than 10 minutes for unstable patients, spinal stabilisation is a time-consuming procedure. For this reason, the time needed for spinal stabilisation may prevent the on-scene time from being brief. The aim of this simulation study was to compare the time required for spinal stabilisation between a scoop stretcher in conjunction with a vacuum mattress and a long spine board.
METHODS
Medical personnel of different professions were asked to perform spinal immobilizations with both methods. A total of 172 volunteers were immobilized under ideal conditions as well as under realistic conditions. A vacuum mattress was used for 78 spinal stabilisations, and a long spinal board was used for 94. The duration of the procedures were measured by video analysis.
RESULTS
Under ideal conditions, spinal stabilisation on a vacuum mattress and a spine board required 254.4 s (95 % CI 235.6-273.2 s) and 83.4 s (95 % CI 77.5-89.3 s), respectively (p < 0.01). Under realistic conditions, the vacuum mattress and spine board required 358.3 s (95 % CI 316.0-400.6 s) and 112.6 s (95 % CI 102.6-122.6 s), respectively (p < 0.01).
CONCLUSIONS
Spinal stabilisation for trauma patients is significantly more time consuming on a vacuum mattress than on a long spine board. Considering that the prehospital time of EMS should not exceed 60 minutes and the on-scene time should not exceed 30 minutes or even 10 minutes if the patient is in extremis, based on our results, spinal stabilisation on a vacuum mattress may consume more than 20 % of the recommended on-scene time. In contrast, stabilisation on a spine board requires only one third of the time required for that on a vacuum mattress. We conclude that a long spine board may be feasible for spinal stabilisation for critical trauma patients with timesensitive life threatening ABCDE-problems to ensure the shortest possible on-scene time for prehospital trauma treatment, not least if a patient has to be rescued from an open or inaccessible terrain, especially that with uneven overgrown land.
Topics: Beds; Emergency Medical Services; Female; Germany; Humans; Immobilization; Male; Patient Simulation; Spinal Injuries; Stretchers; Vacuum
PubMed: 33706791
DOI: 10.1186/s13049-021-00854-w -
Saudi Medical Journal Jan 2021To compare the efficacies of various chest compression procedures performed on a stretcher during dynamic transport of patients with in-hospital cardiac...
OBJECTIVES
To compare the efficacies of various chest compression procedures performed on a stretcher during dynamic transport of patients with in-hospital cardiac arrest. Methods: This prospective and randomized cross-over study used manikins. Practitioners were asked to perform chest compressions on a manikin placed on a moving stretcher for 2 minutes. Cardiopulmonary resuscitation (CPR) procedures were included the following 3 types: i) CPR-walking (CPR-W) ii) CPR-straddling (CPR-S), and iii) CPR-mechanical chest compression device (CPR-MCCD). Demographic data of the participants, CPR quality indicators, the time between the start command and first compression, level of difficulty, and the distance covered by the stretcher for the duration of each application were recorded.
RESULTS
Thirty-two physicians (9 female, 23 male), participated in this study. The CPR-MCCD procedure was the most effective for all parameters, except the time between the start command and first compression. On the other hand, the compression rate at optimal depth, CPR success score, distance covered, and level of difficulty parameters were significantly favored in the CPR-S group, when compared to the CPR-W group (p less than 0.001, all comparisons).
CONCLUSIONS
It is possible to perform high-quality chest compressions during patient transport using the CPR-MCCD method. The CPR-S method allowed practitioners to perform higher-quality chest compressions compared to CPR-W.
Topics: Adult; Cardiopulmonary Resuscitation; Cross-Over Studies; Emergency Medical Services; Female; Heart Arrest; Hospitals; Humans; Male; Manikins; Prospective Studies; Stretchers
PubMed: 33399174
DOI: 10.15537/smj.2021.1.25607 -
Medicine Sep 2019The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our...
The aim of this study was to investigate the experiences of medical transportation of Korean travelers who suffered accidents abroad and then transferred home by our aeromedical team.We collected demographic and clinical data on patients injured while traveling abroad from January 2013 to July 2017. Descriptive analyses based on 4 different transportation methods and transport time since hospitalization were performed.A total of 33 patients were repatriated during the study period. Of these, 28 (84.8%) were trauma cases with pedestrian injuries being the most common (11 cases; 39.3%). Twenty patients were repatriated by flight-stretchers, 6 by flight-prestige, 2 by ship, and 5 by air ambulance. The air ambulance was the most expensive (average 61,124 US Dollars) mode of transportation (P = .001) and the ship took the longest time (14 hours) to transport patients back to Korea from regions with similar distance (P = .0023).We experienced medical repatriation of 33 seriously injured Korean travelers back to South Korea. Transfer time should be an important considering factor and directly contacting and communicating with the specialized staff of foreign hospitals could also be very important to reduce unnecessary overseas hospital stay and cost incidence.
Topics: Accidents; Adult; Air Ambulances; Female; Humans; Incidence; Insurance, Health; Internationality; Male; Republic of Korea; Stretchers; Transportation of Patients; Travel; Wounds and Injuries
PubMed: 31574869
DOI: 10.1097/MD.0000000000017330 -
The Canadian Journal of Infectious... 2022Bacterial contamination in intensive care units is an important risk factor associated with increasing incidences of nosocomial infections. This study was conducted to...
BACKGROUND
Bacterial contamination in intensive care units is an important risk factor associated with increasing incidences of nosocomial infections. This study was conducted to study the bacterial colonization on commonly touched objects of intensive care units and antibiotic resistance pattern of bacterial isolates.
METHODS
This study was conducted in different intensive care units of Manipal Teaching Hospital, Pokhara, Nepal. A total of 235 swabs were collected from surfaces of bed rails, monitors, door handles, IV stands, telephone sets, nursing stations, medicine trolleys, sphygmomanometers, wash basin taps, dressing drums, stethoscopes, pulse oximeters, ventilators, defibrillators, and stretchers. Isolation, identification, and antibiotic susceptibility tests of the bacteria were performed following standard microbiological techniques.
RESULTS
Of 235 samples, bacterial growth was observed in 152 samples. A total of 90 samples of were isolated from 235 samples. Most of the sampling sites included in this study were found contaminated with . . The highest number of . was cultured from the surface of bed rails. Of the total . isolates, 54.4% (49/90) were methicillin-resistant (MRSA). Vancomycin resistance was detected among 8.1% MRSA isolates (4/49). species were the commonest Gram-negative bacterial isolate.
CONCLUSION
Bacterial contamination of the objects/instruments of the ICU was recorded to be high. The most common contaminating bacteria were . with a high percentage of MRSA and emergence of VRSA. Periodic microbiological surveillance, detection of contaminated sites, and effective decontamination methods would minimize the colonization by potential pathogens and their transmission.
PubMed: 35637744
DOI: 10.1155/2022/1023241 -
Clinics (Sao Paulo, Brazil) Apr 2019
Topics: Female; Hemodynamics; Humans; Patient Positioning; Pregnancy; Prenatal Care; Prone Position; Stretchers
PubMed: 30994712
DOI: 10.6061/clinics/2019/e878