Examining outcomes in cases of elderly patients who fell from ground level at home with normal vital signs at the scene

2019 ◽  
Vol 87 (3) ◽  
pp. 672-677 ◽  
Author(s):  
Nasim Ahmed ◽  
Patricia Greenberg
BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e041553
Author(s):  
Enrico de Koning ◽  
Tom E Biersteker ◽  
Saskia Beeres ◽  
Jan Bosch ◽  
Barbra E Backus ◽  
...  

IntroductionEmergency department (ED) overcrowding is a major healthcare problem associated with worse patient outcomes and increased costs. Attempts to reduce ED overcrowding of patients with cardiac complaints have so far focused on in-hospital triage and rapid risk stratification of patients with chest pain at the ED. The Hollands-Midden Acute Regional Triage—Cardiology (HART-c) study aimed to assess the amount of patients left at home in usual ambulance care as compared with the new prehospital triage method. This method combines paramedic assessment and expert cardiologist consultation using live monitoring, hospital data and real-time admission capacity.Methods and analysisPatients visited by the emergency medical services (EMS) for cardiac complaints are included. EMS consultation consists of medical history, physical examination and vital signs, and ECG measurements. All data are transferred to a newly developed platform for the triage cardiologist. Prehospital data, in-hospital medical records and real-time admission capacity are evaluated. Then a shared decision is made whether admission is necessary and, if so, which hospital is most appropriate. To evaluate safety, all patients left at home and their general practitioners (GPs) are contacted for 30-day adverse events.Ethics and disseminationThe study is approved by the LUMC’s Medical Ethics Committee. Patients are asked for consent for contacting their GPs. The main results of this trial will be disseminated in one paper.DiscussionThe HART-c study evaluates the efficacy and feasibility of a prehospital triage method that combines prehospital patient assessment and direct consultation of a cardiologist who has access to live-monitored data, hospital data and real-time hospital admission capacity. We expect this triage method to substantially reduce unnecessary ED visits.


2006 ◽  
Vol 6 (2) ◽  
pp. 60-67 ◽  
Author(s):  
Yoshihisa HIRAKAWA ◽  
Yuichiro MASUDA ◽  
Masafumi KUZUYA ◽  
Takaya KIMATA ◽  
Akihisa IGUCHI ◽  
...  

2013 ◽  
Vol 43 (3) ◽  
pp. 389 ◽  
Author(s):  
Mi Ra Sung ◽  
Myungsun Yi ◽  
Dong Young Lee ◽  
Hye Young Jang

Nutrients ◽  
2021 ◽  
Vol 13 (6) ◽  
pp. 2066
Author(s):  
Oliver Chen ◽  
Traci M. Blonquist ◽  
Eunice Mah ◽  
Kristen Sanoshy ◽  
Dawn Beckman ◽  
...  

Nutritional ketosis is a state of mildly elevated blood ketone concentrations resulting from dietary changes (e.g., fasting or reduced carbohydrate intake) or exogenous ketone consumption. In this study, we determined the tolerability and safety of a novel exogenous ketone diester, bis-hexanoyl-(R)-1,3-butanediol (BH-BD), in a 28-day, randomized, double-blind, placebo-controlled, parallel trial (NCT04707989). Healthy adults (n = 59, mean (SD), age: 42.8 (13.4) y, body mass index: 27.8 (3.9) kg/m2) were randomized to consume a beverage containing 12.5 g (Days 0–7) and 25 g (Days 7–28) of BH-BD or a taste-matched placebo daily with breakfast. Tolerability, stimulation, and sedation were assessed daily by standardized questionnaires, and blood and urine samples were collected at Days 0, 7, 14, and 28 for safety assessment. There were no differences in at-home composite systemic and gastrointestinal tolerability scores between BH-BD and placebo at any time in the study, or in acute tolerability measured 1-h post-consumption in-clinic. Weekly at-home composite tolerability scores did not change when BH-BD servings were doubled. At-home scores for stimulation and sedation did not differ between groups. BH-BD significantly increased blood ketone concentrations 1-h post-consumption. No clinically meaningful changes in safety measures including vital signs and clinical laboratory measurements were detected within or between groups. These results support the overall tolerability and safety of consumption of up to 25 g/day BH-BD.


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