scholarly journals After the Haiti 2021 Earthquake: Triage and treatment data for a cohort of patients transported for higher level of care

2021 ◽  
Author(s):  
Kelly Edwards ◽  
David Ellis ◽  
Cory Oaks ◽  
Clayton Mann ◽  
VINCENT DEGENNARO
Keyword(s):  
Task Force ◽  
Tertiary Care ◽  
Scale Up ◽  
The South ◽  
Wound Debridement ◽  
Interagency Coordination ◽  
Pelvis Fracture ◽  
Treatment Data ◽  
Ground Ambulance ◽  
Orthopedic Injuries

Intro: On August 14, a magnitude 7.2 earthquake occurred in the South of Haiti, killing over 2,200 people and leaving at least 12,000 injured. On August 17th, a joint task force coordinated the triage, treatment, and transport for patients arriving at the Port-au-Prince airport from the South. Methods: From August 17th-27th, approximately 243 patients were encountered at the Port-au-Prince airport. For the first three days of operations, written notes, reports, and various chat logs from WhatsApp were used to compile this data. Results: 243 patents were encountered at the airport Triage and Treatment from August 17 to August 27. Orthopedic injuries were the most common presenting injury with 20% of patients having a pelvis fracture (the most prevalent injury). Of the 174 with known transfer destinations, 118 (68%) were transported to one of three tertiary care hospitals, with 99 going via ground ambulance to the two in Port au Prince, and 19 going via HAA helicopter to Mirebalais, 32 miles away. Once treatment operations were initiated, 106 patients received some form of treatment at the airport while awaiting transport. Discussion: Interagency coordination was the key to rapid scale up. To address the most prevalent patient issues, a treatment bundle was conceptualized a few days into operations that consisted of IV fluids, analgesia, IV antibiotics, wound debridement and cleaning, and tetanus prophylaxis.

Expression of p63 Differs in Peritoneal Endometriosis, Endometriomas, Adenomyosis, Rectovaginal Septum Endometriosis, and Abdominal Wall Endometriosis

2007 ◽  
Vol 131 (7) ◽  
pp. 1099-1102
Author(s):  
Omero B. Poli Neto ◽  
Hebert M. Ferreira; ◽  
Leandra N. Z. Ramalho ◽  
Júlio C. Rosa e Silva ◽  
Francisco J. Candido dos Reis ◽  
...  
Keyword(s):  
Abdominal Wall ◽  
Task Force ◽  
Tertiary Care ◽  
Female Genital Tract ◽  
University Hospital ◽  
Rectovaginal Septum ◽  
Tissue Samples ◽  
Abdominal Wall Endometriosis ◽  
Peritoneal Endometriosis ◽  
Accompanying Symptoms

Abstract Context.—Although there is evidence that endometriosis results from basal endometrium dislocation, the underlying biology is not fully understood. One protein that plays an important role in regulating epithelial proliferation and differentiation is the 63-kDa membrane protein (p63), which is also a marker of basal and reserve cells in the female genital tract. Objective.—To determine whether p63 is expressed differently in peritoneal endometriosis, endometriomas, and adenomyosis, as well as in deep endometriotic nodules of the rectovaginal septum and abdominal wall. Design.—This study includes a prospective series of consecutive patients (Canadian Task Force classification II-2) from a tertiary care university hospital. Specimens collected from 83 patients (15 peritoneal endometriosis specimens, 22 endometrioma specimens, 36 adenomyosis specimens, and 10 rectovaginal septum/abdominal wall specimens) were evaluated. Diagnostic and operative laparoscopies or laparotomies were performed, and tissue samples were obtained. Immunohistochemistry was used to evaluate p63 expression. Results.—Positivity for p63 was detected in 93.3% of the peritoneal endometriosis specimens, 81.8% of the endometrioma specimens, 36.1% of the adenomyosis specimens, and none of the rectovaginal/abdominal wall endometriosis specimens (P < .001). Distribution of p63 immunostaining in the positive specimens was homogeneous. Conclusions.—Endometriotic lesions express p63 differently, and some retain the basal/reserve cell immunophenotype. Nevertheless, it remains unclear whether the lack of p63 expression in some lesions is related to the extent of the disease, to its clinical behavior, or to exacerbation of the accompanying symptoms.

Effect of pharmacist-led task force to reduce opioid prescribing in the emergency department

2019 ◽  
Vol 76 (22) ◽  
pp. 1853-1861
Author(s):  
Nicole M Acquisto ◽  
Rachel F Schult ◽  
Sandra Sarnoski-Roberts ◽  
Jaclyn Wilmarth ◽  
Courtney M C Jones ◽  
...  
Keyword(s):  
Emergency Department ◽  
Task Force ◽  
Care Center ◽  
Linear Regression Analysis ◽  
Tertiary Care ◽  
Interrupted Time Series Analysis ◽  
Opioid Use ◽  
Entire Study ◽  
Opioid Prescribing ◽  
Reduction Program

Abstract Purpose Results of a study to determine the effect of a pharmacist-led opioid task force on emergency department (ED) opioid use and discharge prescriptions are presented. Methods An observational evaluation was conducted at a large tertiary care center (ED volume of 115,000 visits per year) to evaluate selected opioid use outcomes before and after implementation of an ED opioid reduction program by interdisciplinary task force of pharmacists, physicians, and nurses. Volumes of ED opioid orders and discharge prescriptions were evaluated over the entire 25-month study period and during designated 1-month preimplementation and postimplementation periods (January 2017 and January 2018). Opioid order trends were evaluated using linear regression analysis and further investigated with an interrupted time series analysis to determine the immediate and sustained effects of the program. Results From January 2017 to January 2018, ED opioid orders were reduced by 63.5% and discharge prescriptions by 55.8% from preimplementation levels: from 246.8 to 90.1 orders and from 85.3 to 37.7 prescriptions per 1,000 patient visits, respectively. Over the entire study period, there were significant decreases in both opioid orders (β, –78.4; 95% confidence interval [CI], –88.0 to –68.9; R2, 0.93; p < 0.0001) and ED discharge prescriptions (β, –24.4; 95% CI, –27.9 to –20.9; R2, 0.90; p < 0.001). The efforts of the task force had an immediate effect on opioid prescribing practices; results for effect sustainability were mixed. Conclusion A clinical pharmacist–led opioid reduction program in the ED was demonstrated to have positive results, with a more than 50% reduction in both ED opioid orders and discharge prescriptions.

Abstract 9395: The Clinical Role of Atrial Fibrillation in Patients with Arrhythmogenic Right Ventricular Dysplasia

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ardan M Saguner ◽  
Samuel Baldinger ◽  
Argelia Medeiros-Domingo ◽  
Sabrina Ganahl ◽  
Felix C Tanner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Right Ventricular ◽  
Cardiac Death ◽  
Task Force ◽  
Tertiary Care ◽  
Arrhythmogenic Right Ventricular Dysplasia ◽  
Right Atrial ◽  
Clinical Role ◽  
Right Ventricular Dysplasia ◽  
Increased Risk

Introduction: Atrial fibrillation/flutter (Afib/Aflu) in general, and clinical variables predicting Afib/Aflu in particular, are not well defined in patients with arrhythmogenic right ventricular dysplasia (ARVD). Hypothesis: We hypothesized that transthoracic echocardiography (TTE) and ECG could be helpful to predict Afib/Aflu in these patients. Methods and Results: 12-lead ECGs and TTEs of 90 patients from three tertiary-care centers diagnosed with definite or borderline ARVD according to the 2010 Task Force Criteria were analyzed. Data were compared in two patient groups: (1) patients with Afib/Aflu and (2) all other patients. Eighteen (20%) patients experienced Afib/Aflu during a follow-up period of 5.8 years (interquartile range 2.0-10.4 years). Kaplan-Meier analysis (Figure) revealed reduced times to Afib/Aflu among patients with echocardiographic RV fractional area change <27% (p<0.001), left atrial diameter ≥24.4 mm/m2 (p=0.001), and right atrial short axis diameter ≥22.1 mm/m2 (p=0.05). From all ECG variables, P sinistroatriale conferred the highest hazard ratio (3.37, 95% CI 0.92-12.36, p=0.067). Five patients with Afib/Aflu experienced inappropriate ICD shocks compared to four patients without Afib/Aflu (36% vs. 9%, p=0.03). Presence of Afib/Aflu was more prevalent in heart transplanted patients and in those who succumbed to cardiac death compared to the remaining patients (56% vs. 16%, p=0.014). Conclusions: Afib/Aflu are associated with inappropriate ICD shocks, heart transplantation, and cardiac death in patients with ARVD. Echocardiographic evidence of reduced RV function and atrial dilation helps to identify those ARVD patients being at increased risk for Afib/Aflu, which may help to guide individual patient management.

Development of an Interfacility Transport Program for Critically Ill Cardiovascular Patients

1990 ◽  
Vol 1 (1) ◽  
pp. 3-12 ◽  
Author(s):  
Adrienne Greco
Keyword(s):  
Los Angeles ◽  
Critically Ill ◽  
Tertiary Care ◽  
Care Facility ◽  
Good Samaritan ◽  
Tertiary Care Facility ◽  
Cardiovascular Patients ◽  
Ground Ambulance ◽  
Tertiary Care Centers ◽  
Interfacility Transport

The expanding use of newer coronary artery intervention modalities in the treatment of critically ill cardiac patients has produced a profound change in the manner in which acute care is rendered to these patients. To meet the needs of community hospitals and to improve the safety of interfacility transport to tertiary care centers, a transport program was developed at The Hospital of the Good Samaritan, Los Angeles, California. Rapid transport by helicopter, fixed-wing aircraft or specialized ground ambulance services has been used to improve patient transit time and safety of transfer between the community hospital and tertiary care facility. Experience at The Hospital of the Good Samaritan (1,012 consecutive patients) compares favorably with other programs and proves to be safe and beneficial.

scholarly journals Use of the Fluoride Varnish Billing Code in a Tertiary Care Center Setting

2020 ◽  
Vol 11 ◽  
pp. 215013272091373
Author(s):  
Peter Kim ◽  
Jeanette M. Daly ◽  
Sharon Berkowitz ◽  
Barcey T. Levy
Keyword(s):  
Teaching Hospital ◽  
Task Force ◽  
Care Center ◽  
Tertiary Care ◽  
The United States ◽  
Fluoride Varnish ◽  
Successful Implementation ◽  
Clinical Notes ◽  
Tertiary Teaching ◽  
Tertiary Teaching Hospital

Introduction: Dental caries is the most common chronic disease in children from birth through 5 years of age. Application of fluoride varnish (FV) is recommended for children younger than 6 years every 3 to 6 months by the United States Preventive Services Task Force. The purposes of this study were to (1) assess use and reimbursement of Current Dental Terminology (CDT) D1206 and Current Procedural Terminology (CPT) 99188 codes, which are the billing codes for FV application; (2) determine when and by whom each FV code was used; and (3) summarize the associated clinical notes. Methods: Using the electronic medical record data warehouse from a single tertiary teaching hospital and its affiliated primary care clinics, the dates of service, departments, provider names, and patient identifiers associated with codes CDT D1206 and CPT 99188 were collected. The content of clinical notes was reviewed and summarized. The study period was from May 1, 2009 through May 17, 2019. Results: During the 10-year time period, CDT D1206 was used 5 times and CPT 99188 was used 35 times. FV was applied exclusively during well-child visits. Only pediatricians, and no family physicians, applied FV in this setting. Discussion: A single pediatrician championing for FV application increased both the completion of procedure and the appropriate billing in 2019. Conclusion: FV application has been likely underutilized in this Midwestern tertiary teaching hospital and its affiliated clinics. For both family medicine and pediatric offices, an advocate for caries prevention is likely needed for successful implementation of FV application at well-child visits.

SURFACE FACILITIES FOR OILFIELDS IN THE SOUTH AUSTRALIAN SECTOR OF THE COOPER BASIN

1986 ◽  
Vol 26 (1) ◽  
pp. 470
Author(s):  
R.J. Scanlan ◽  
C.J. White
Keyword(s):  
Net Present Value ◽  
Task Force ◽  
Development Project ◽  
Project Planning ◽  
Present Value ◽  
The South ◽  
Field Development ◽  
Variable Nature ◽  
Wide Range ◽  
Cooper Basin

Delhi Petroleum Pty Ltd, as operator, has been responsible for the development of eight oilfields in the South Australian sector of the Cooper Basin since 1982. Some of these field developments are economically marginal, hence the need to optimise those aspects of the facilities which impact on the ongoing cost of production and the overall profitability. A phased development approach has evolved over the past three years to reduce the external financing requirements and to improve the certainty of the data used to define the key elements of each project.For the successful completion of the project a task force approach to project management is utilised, supported by the use of computerised project planning and control systems. Further, it is important to define and agree on the design criteria and philosophy for the project at the commencement, this providing a base by which to measure scope changes, and so that all concerned are working to a common goal.The use of economic analysis as a decision-making tool during all phases of the project assists the project team to home in on the key objective which is to maximise the project net present value. Comparative economics and sensitivity analysis are used at the conceptual stage to select the preferred development option, e.g. pipeline versus trucking.The design of surface facilities is dictated by a wide range of criteria including the above development philosophy. The variable nature of these criteria demonstrates that each new field development must normally be engineered individually to ensure the target of maximum net present value can be achieved.The Gidgealpa Crude Oil Development Project demonstrates the effectiveness of the above methodology and philosophies. The field was discovered in August 1984, and early production and trucking of oil commenced in January 1985 with 374 000 bbls produced prior to commissioning of the pipeline to Moomba in September 1985.

Impact of the Current US Preventive Services Task Force Recommendations for Cervical Cancer Screening in Young Women 21 to 29 Years Old

2020 ◽  
Vol 153 (6) ◽  
pp. 734-742 ◽  
Author(s):  
C Paul Morris ◽  
Sayanan Chowsilpa ◽  
Sara Mustafa ◽  
Isaac Chan ◽  
Daniel Miller ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Cancer Screening ◽  
Cervical Cancer Screening ◽  
Task Force ◽  
Statistical Significance ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Preventive Services ◽  
High Grade ◽  
The Impact

Abstract Objectives In 2012, the US Preventive Services Task Force decreased the recommended frequency of cervical cytology screening to once every 3 years and recommended against testing women younger than 21 years regardless of sexual history. We evaluated the impact of this in 21 to 29-year-old women at a tertiary care academic medical center in 2011 and 2017. Methods We retrospectively analyzed Papanicolaou test results at two time points in 21- to 29-year-old women. Results There was a decrease in the number of high-grade lesions in 21- to 25-year-old women (odds ratio [OR], 0.36) from 2011 to 2017. Within the 26- to 29-year-old patient group, there was a trend toward a higher percentage of high-grade squamous intraepithelial lesion (HSIL) in 2017 compared to 2011 on cytology, which did not reach statistical significance (OR, 1.46). However, follow-up histologic specimens showed a higher percentage of HSIL in 2017 compared to 2011 in this age group (OR, 2.16). Conclusions Our findings suggest that the cervical cancer screening guidelines introduced in 2012 have not had a detrimental impact on the outcomes of cervical cancer screening for 21- to 25-year-old women. However, we need to continue monitoring the effects of decreased screening in 26- to 29-year-old women.

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