Evaluating the utility of Rapid Response EEG in emergency care

2021 ◽  
pp. emermed-2020-210903
Author(s):  
Norah M K Wright ◽  
Evan S Madill ◽  
Derek Isenberg ◽  
Kapil Gururangan ◽  
Hannah McClellen ◽  
...  
Keyword(s):  
Pilot Project ◽  
Rapid Response ◽  
Convulsive Status Epilepticus ◽  
Emergency Physicians ◽  
Patient Disposition ◽  
Perceived Impact ◽  
The One ◽  
Treatment Escalation ◽  
Community Site ◽  
Rule Out

BackgroundTimely management of non-convulsive status epilepticus (NCSE) is critical to improving patient outcomes. However, NCSE can only be confirmed using electroencephalography (EEG), which is either significantly delayed or entirely unavailable in emergency departments (EDs). We piloted the use of a new bedside EEG device, Rapid Response EEG (Rapid-EEG, Ceribell), in the ED and evaluated its impact on seizure management when used by emergency physicians.MethodsPatients who underwent Rapid-EEG to rule out NCSE were prospectively enrolled in a pilot project conducted at two ED sites (an academic hospital and a community hospital). Physicians were surveyed on the perceived impact of the device on seizure treatment and patient disposition, and we calculated physicians’ sensitivity and specificity (with 95% CI) for diagnosing NCSE using Rapid-EEG’s Brain Stethoscope function.ResultsOf the 38 patients enrolled, the one patient with NCSE was successfully diagnosed and treated within minutes of evaluation. Physicians reported that Rapid-EEG changed clinical management for 20 patients (53%, 95% CI 37% to 68%), primarily by ruling out seizures and avoiding antiseizure treatment escalation, and expedited disposition for 8 patients (21%, 95% CI 11% to 36%). At the community site, physicians diagnosed seizures by their sound using Brain Stethoscope with 100% sensitivity (95% CI 5% to 100%) and 92% specificity (95% CI 62% to 100%).ConclusionRapid-EEG was successfully deployed by emergency physicians at academic and community hospitals, and the device changed management in a majority of cases. Widespread adoption of Rapid-EEG may lead to earlier diagnosis of NCSE, reduced unnecessary treatment and expedited disposition of seizure mimics.

OP457 A Collaborative Horizon Scanning Alert For Disinvestment And Early Awareness

2020 ◽  
Vol 36 (S1) ◽  
pp. 10-10
Author(s):  
Vigdis Lauvrak ◽  
Kelly Farrah ◽  
Rosmin Esmail ◽  
Anna Lien Espeland ◽  
Elisabet Hafstad ◽  
...  
Keyword(s):  
Information Retrieval ◽  
Interest Group ◽  
Pilot Project ◽  
Relevant Information ◽  
Horizon Scanning ◽  
Google Alerts ◽  
One Year ◽  
The One ◽  
New Research ◽  
Google Search

IntroductionIn 2019, the Norwegian Institute for Public Health and Canadian Agency for Drugs and Technologies in Health (CADTH) received support from HTAi to produce a quarterly current awareness alert for the HTAi Disinvestment and Early Awareness Interest Group in collaboration with the HTAi Information Retrieval Interest Group. The alert focuses on methods and topical issues, and broader forecasts of potentially disruptive technologies that may be of interest to those involved in horizon scanning and disinvestment initiatives in health technology assessment (HTA).MethodsInformation specialists at both agencies developed search strategies for disinvestment and for horizon scanning in PubMed and Google. The template for the alert was based on an e-newsletter developed by the Information Retrieval Interest Group. Information specialists and researchers reviewed the monthly (PubMed) and weekly (Google) search results and selected potentially relevant publications. Additional sources were also identified through regular HTA and horizon scanning work.ResultsAlerts are posted quarterly on the HTAi Interest Group website; members receive an email notice when new alerts are available. While the revised PubMed searches are identifying relevant information, Google alerts have been disappointing, and this search may need to be revised further or dropped. When the one-year pilot project ends, in Fall 2020, interest group members will be surveyed to see if the alerts were useful, and whether they have suggestions for improving them.ConclusionsCollaborating on this alert service reduces duplication of effort between agencies, and makes new research in horizon scanning and disinvestment more accessible to colleagues in other agencies working in these areas.

scholarly journals Can emergency physicians accurately rule out clinically important cervical spine injuries by using computed tomography?

CJEM ◽  
2014 ◽  
Vol 16 (02) ◽  
pp. 131-135 ◽  
Author(s):  
Hendrik P. Van Zyl ◽  
James Bilbey ◽  
Alan Vukusic ◽  
Todd Ring ◽  
Jennifer Oakes ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Spine Injury ◽  
Clinical Skills ◽  
Ct Scans ◽  
Spine Injury ◽  
Emergency Physicians ◽  
Cervical Spine Injuries ◽  
Spine Ct ◽  
Spine Injuries ◽  
Rule Out

ABSTRACT Objective: Emergency physicians are expected to rule out clinically important cervical spine injuries using clinical skills and imaging. Our objective was to determine whether emergency physicians could accurately rule out clinically important cervical spine injuries using computed tomographic (CT) imaging of the cervical spine. Method: Fifteen emergency physicians were enrolled to interpret a sample of 50 cervical spine CT scans in a nonclinical setting. The sample contained a 30% incidence of cervical spine injury. After a 2-hour review session, the participants interpreted the CT scans and categorized them into either a suspected cervical spine injury or no cervical spine injury. Participants were asked to specify the location and type of injury. The gold standard interpretation was the combined opinion of two staff radiologists. Results: Emergency physicians correctly identified 182 of the 210 abnormal cases with cervical spine injury. The sensitivity of emergency physicians was 87% (95% confidence interval [CI] 82–91), and the specificity was 76% (95% CI 74–77). The negative likelihood ratio was 0.18 (95% CI 0.12–0.25). Conclusion: Experienced emergency physicians successfully identified a large proportion of cervical spine injuries on CT; however, they were not sufficiently sensitive to accurately exclude clinically important injuries. Emergency physicians should rely on a radiologist review of cervical spine CT scans prior to discontinuing cervical spine precautions.

Kinetics and mechanism of oxidation of N,N′-dimethyl-9,9′-biacridanyl by some π acceptors and a one-electron oxidant

1985 ◽  
Vol 63 (2) ◽  
pp. 445-451 ◽  
Author(s):  
Allan K. Colter ◽  
Charles C. Lai ◽  
A. Gregg Parsons ◽  
N. Bruce Ramsey ◽  
Gunzi Saito
Keyword(s):  
Electron Transfer ◽  
Reduction Potential ◽  
Isotope Effects ◽  
Substituent Effects ◽  
Kinetic Isotope Effects ◽  
Spin Trapping ◽  
Single Electron Transfer ◽  
Kinetic Isotope ◽  
The One ◽  
Rule Out

Oxidation of N,N′-dimethyl-9,9′-biacridanyl (DD) has been investigated as a model for single electron transfer (SET)-initiated oxidation of NADH coenzyme models such as N-methylacridan (DH). Oxidants investigated cover a 1010-fold range of reactivity in acetonitrile and include the π acceptors 1,4-benzoquinone (BQ), 2,6-dichloro-1,4-benzoquinone (DCIBQ), p-chloranil (CA), 2,3-dicyanobenzoquinone (DCBQ), 2,3-dicyano-1,4-naphthoquinone (DCNQ), 2,3-dicyano-5-nitro-1,4-naphthoquinone (DCNNQ), 9-dicyanomethylene-2,4,7-trinitrofluorene (DCMTNF), 9-dicyanomethylene-2,4,5,7-tetranitrofluorene (DCMTENF), 7,7,8,8-tetracyanoquinodimethane (TCNQ), and tetracyanoethylene (TCNE), and the one-electron oxidant tris(2,2′-bipyridyl)cobalt(III), [Formula: see text] The oxidation product is, in every case, N-methylacridinium ion (D+). A mechanism involving a rate-determining electron transfer with simultaneous fragmentation to D+ and N-methyl-9-acridanyl radical (D•) is proposed. This mechanism is supported by the observed dependence of the rate on oxidant reduction potential, by spin-trapping experiments, by kinetic isotope effects in oxidation of 9,9′-dideuterio-DD, and by substituent effects in oxidation of 2,2′- and 3,3′-dimethoxy-DD. The rate of oxidation of DD relative to that of DH is 3.4 × 102 with [Formula: see text] and with the π acceptors varies from ea. 0.3 (BQ) to 8.1 × 104 (DCMTENF). The results rule out a SET-initiated mechanism for oxidation of DH by all of the oxidants studied except TCNQ and DCMTENF.

scholarly journals COVID-19: A Therapeutic Approach Based on Pathophysiological Staging

2020 ◽  
Vol 14 (1) ◽  
pp. 32-37
Author(s):  
Christian Domingo Ribas
Keyword(s):  
Respiratory Failure ◽  
Therapeutic Approach ◽  
Distress Syndrome ◽  
The Other ◽  
Present Evidence ◽  
Respiratory Events ◽  
Therapeutic Decisions ◽  
Disease Staging ◽  
The One ◽  
Rule Out

The COVID-19 pandemic is a recently emerging problem. This has caused that the knowledge of the disease has been progressive and, therefore, the therapeutic decisions have been conditioned by this lack of knowledge on the one hand and by the therapeutic limitations on the other. Many published studies are methodologically weak and their conclusions, of limited value, have contributed to creating confusion on the therapeutic approach of the disease. In the present paper, we propose a therapeutic approach based on a new disease staging. The therapeutic approach is divided into two big sections: the pharmacological treatment for the phase of viral replication, cytokine storm or late respiratory events (which includes the adult respiratory distress syndrome (ARDS)) and the treatment of the respiratory failure In every stage, we discuss the pathophysiology and comment (accept or rule out) the pharmacological options according to the present evidence. Moreover, we indicate how respiratory failure should be treated. Some characteristics are based on the evidence found in the literature. Others are the result of my experience in other situations.

scholarly journals Holistic and conceptual character of the mental in Donald Davidson’s work

2020 ◽  
Vol 63 (1) ◽  
pp. 123-142
Author(s):  
Milos Bogdanovic
Keyword(s):  
The Other ◽  
Ontological Category ◽  
Conceptual Category ◽  
Central Thesis ◽  
Other Hand ◽  
The One ◽  
Rule Out

In this paper we will try to confront Quine?s and Davidson?s holistic position through Davidson?s thesis of mental as a non-ontological category. In this regard, since Davidson came to this position through the thesis of mental as a decidedly conceptual category, we will try to show how this approach does not, nevertheless, rule out the possibility of its interpretation in ontological terms. However, in what follows we will draw attention to the fact that mental can be interpreted so that it proves to be immune to ontologization in Quine?s sense. This would be the evidence of different ways, which are not necessarily compatible, to argue for Davidson?s central thesis - the thesis about holistic character of mental - as well as, which is closely related, a certain difference that exists between Davidson?s view of mental as a conceptual category on the one hand, and a holistic category on the other hand.

Can Emergency Physicians Accurately Rule Out a Central Cause of Vertigo Using the HINTS Examination? A Systematic Review and Meta‐analysis

2020 ◽  
Vol 27 (9) ◽  
pp. 887-896 ◽  
Author(s):  
Robert Ohle ◽  
Renee‐Anne Montpellier ◽  
Virginie Marchadier ◽  
Aidan Wharton ◽  
Sarah McIsaac ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Emergency Physicians ◽  
Rule Out

scholarly journals Ahmedabad Regional Passport Office: Rapid Response Time by Process Redesign

2003 ◽  
Vol 28 (3) ◽  
pp. 101-112
Author(s):  
Doorva Bahuguna ◽  
N Ravichandran
Keyword(s):  
Response Time ◽  
Rapid Response ◽  
Process Redesign ◽  
The One

If all your documents are in order, you should get your fresh passport in five weeks. If you already hold a passport, then your passport should be re-issued in one week. In case of damaged or lost passports (except in case of habitual losers), provided you apply to the same office that issued your original passport, you should get your passport in about five weeks. If you have applied for a duplicate passport to an office other than the one that issued the passport you have lost or damaged, you should get your passport in six weeks. Remember – It is the applicant's right to obtain a passport within the prescribed timeframe and without harassment.

Addition of Acute Care Nurse Practitioners to Medical and Surgical Rapid Response Teams: A Pilot Project

2014 ◽  
Vol 34 (1) ◽  
pp. 51-59 ◽  
Author(s):  
April N. Kapu ◽  
Arthur P. Wheeler ◽  
Byron Lee
Keyword(s):  
Acute Care ◽  
Nurse Practitioners ◽  
Rapid Response Team ◽  
Pilot Project ◽  
Rapid Response ◽  
Therapeutic Interventions ◽  
Rapid Response Teams ◽  
Care Nurse ◽  
Response Team ◽  
The Impact

BackgroundVanderbilt University Hospital’s original rapid response team included a critical care charge nurse and a respiratory therapist. A frequently identified barrier to care was the time delay between arrival of the rapid response team and arrival of the primary health care team.ObjectiveTo assess the impact of adding an acute care nurse practitioner to the rapid response team.MethodsAcute care nurse practitioners were added to surgical and medical rapid response teams in January 2011 to diagnose and order treatments on rapid response calls.ResultsIn 2011, the new teams responded to 898 calls, averaging 31.8 minutes per call. The most frequent diagnoses were respiratory distress (18%), postoperative pain (13%), hypotension (12%), and tachyarrhythmia (10%). The teams facilitated 360 transfers to intensive care and provided 3056 diagnostic and therapeutic interventions. Communication with the primary team was documented on 97% of the calls. Opportunities for process improvement were identified on 18% of the calls. After implementation, charge nurses were surveyed, with 96% expressing high satisfaction associated with enhanced service and quality.ConclusionsTeams led by nurse practitioners provide diagnostic expertise and treatment, facilitation of transfers, team communication, and education.

Coast Guard and Epa: One Area Contingency Plan

1999 ◽  
Vol 1999 (1) ◽  
pp. 967-969
Author(s):  
David Westerholm ◽  
David Anderson ◽  
James Augustyn ◽  
Thomas Rayburn
Keyword(s):  
Environmental Protection Agency ◽  
Oil Pollution ◽  
Pilot Project ◽  
Coast Guard ◽  
Contingency Planning ◽  
Physical Size ◽  
Western Lake ◽  
Federal Response ◽  
The One ◽  
Western Lake Erie

ABSTRACT The U.S. Coast Guard (USCG) and U.S. Environmental Protection Agency (EPA) have developed a pilot project to address federal Oil Pollution Act of 1990 (OPA) requirements for Area Contingency planning in the Captain of the Port (COTP) Zone and the corresponding U.S. EPA inland area in a portion of the Western Lake Erie Basin. The project, known as the “One County In” approach, encompasses contingency planning for the entire county, not just the COTP Zone. Local and state planners and responders as well as industry representatives fully support the effort. The one plan eliminates the multi-plan issues associated with divided federal response jurisdictions. While the geographic scope of the Plan expanded, the physical size of the document decreased significantly due to a detailed review by the Area Committee. Initiated in fall 1997, the combined Plan was completed in September 1998.

Plutarch’s Lives

2017 ◽  
Author(s):  
Paolo Desideri
Keyword(s):  
Special Interest ◽  
Dominant Role ◽  
The Other ◽  
The Political ◽  
Political World ◽  
History Of ◽  
The One ◽  
Of Greece ◽  
Rule Out

This chapter discusses first the general cosmological principles which lie behind Plutarch’s historiographical work, such as can be recovered through significant passages of his Delphic Dialogues. Second, it investigates the reasons why Plutarch wrote biographies, and more specifically parallel biographies, instead of outright histories: in this way, Plutarch aimed to emphasize, on the one hand, the dominant role of individual personalities in the political world of his own time, and, on the other hand, the mutual and exclusive relevance of Greece and Rome in the history of human culture. Third, the chapter seeks to connect the rise-and-fall pattern, typical of biography, with the general rise-and-fall pattern which Plutarch recognizes both in the Greek and in the Roman civilizations; through that connection one can rule out the idea that Plutarch had any providential view of history. Finally, some reflections are offered on Nietzsche’s special interest in Plutarch’s biographies.

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