PP28 Volunteer emergency responder response to the COVID-19 pandemic surge

2021 ◽  
Vol 38 (9) ◽  
pp. A12.2-A12
Author(s):  
Shadman Aziz ◽  
Aditi Nijhawan ◽  
Samantha Palfreyman-Jones ◽  
Chris Hartley-Sharpe
Keyword(s):  
Retrospective Review ◽  
Statistical Significance ◽  
Skill Training ◽  
Absolute Number ◽  
Ambulance Service ◽  
Valuable Resource ◽  
Front Line ◽  
Emergency Responder ◽  
Time Period ◽  
Life Threatening

BackgroundThe London Ambulance Service (LAS) runs an Emergency Responder (ER) scheme, where trained volunteers respond to 999 calls in blue-light rapid response vehicles (RRVs), alongside the statutory ambulance service response.The COVID-19 pandemic caused an unprecedented surge in call volume which, combined with reduced staffing of double-crewed ambulances (DCAs) due to illness, severely impaired the service’s ability to respond to calls.In response to this, as well as increasing volunteer RRV shifts, ERs were given additional up-skill training to work with regular ambulance service clinicians on DCAs, thus increasing the number of DCAs available to attend calls.This study aims to review the response to the COVID-19 pandemic provided by ERs.MethodA retrospective review was conducted of all ER shifts on volunteer RRVs and the service’s front-line DCAs. Data from the same time period (March 1 – April 30) was compared between 2019 (pre-pandemic period) and 2020 (pandemic period). The statistical significance of proportions was calculated using the χ2 test.ResultsThe absolute number of RRV hours volunteered by ERs increased by 34.2% (2,017 to 2,707), resulting in a 21.2% increase in RRV shifts (227 to 275) during the pandemic period. Furthermore, the proportion of C1 (life-threatening) incidents attended by ER RRVs doubled (32.4% vs 61.1%, p < 0.0001). In addition to RRV shifts, ERs volunteered 1,222 hours on DCAs during the pandemic, resulting in 125 additional DCA resources available. The combined total hours provided by ERs (RRV/DCA) increased by 94.8% (2,017 to 3,929).DiscussionVolunteer responders are a valuable resource during times of surge. In addition to volunteer RRV shifts, they have to the potential to assist ambulance service clinicians on DCAs. Future pandemic or winter-pressure plans should incorporate volunteer responders. This study predominantly looked at volunteer capacity, and further work is required to investigate patient-centred outcomes.

scholarly journals Reduction in ERCP volume for Acute Cholangitis and other Indications during COVID-19 Pandemic

2021 ◽  
pp. 01-04
Author(s):  
Swathi Paleti ◽  
Zain A. Sobani ◽  
Tarun Rustagi
Keyword(s):  
Seasonal Variation ◽  
Retrospective Review ◽  
Acute Cholangitis ◽  
Absolute Number ◽  
Similar Time ◽  
Endoscopic Procedures ◽  
Time Period

Introduction: The COVID-19 pandemic continues to significantly impact healthcare with Joint Gastrointestinal Societies recommending rescheduling elective and non-urgent endoscopic procedures. The aim of our study was to evaluate the trend of acute cholangitis requiring emergent ERCP and overall ERCP practice in the setting of the COVID 19 pandemic. Methods: A retrospective review of all ERCPs performed at our institution was performed during the study period (3/16/2020 to 4/15/2020) along with the preceding 2 months (1/1/2020 to 2/29/2020) and similar time period from the last 2 years (3/16/2019 to 4/15/2019 and 3/16/2018 to 4/15/2018) for comparison to account for any seasonal variation. Results: A reduction was noted in absolute number and proportion of ERCPs performed for acute cholangitis during the study period compared to preceding months (2 [6.45%] vs. average 10.5 [15.05%] cases/month; 81% reduction). We also found reduction in overall number of both inpatient and outpatient ERCPs during the study period (31 ERCPs/month to average 70 ERCPs/month; 55% reduction in ERCP volume). Conclusions: There was a reduction in the overall ERCP volume and number of ERCPs performed for acute cholangitis during the COVID-19 pandemic. Further larger studies are needed to validate this data and investigate its causes. Keywords: ERCP; COVID-19; SARS-2-Cov; Pandemic; Acute cholangitis; Trend; Biliary

OPERATIONS FOR ANEURISM OF THE ABDOMINAL AORTIC DEPARTMENT - RESECTION WITH THE FOLLOWING PROSTHETICS AND ENDOPROSTHETICS: A COMPARATIVE ANALYSIS OF COMPLICATIONS

2020 ◽  
pp. 43-49
Author(s):  
Андрей Анатольевич Иванов ◽  
Александр Иванович Жданов ◽  
Максим Сергеевич Шевелин ◽  
Александр Сергеевич Брежнев
Keyword(s):  
Comparative Analysis ◽  
Postoperative Complications ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Surgical Interventions ◽  
Vein Thrombosis ◽  
Scientific Hypothesis ◽  
Abdominal Aortic ◽  
Life Threatening ◽  
High Level

В статье представлены данные оригинального исследования по улучшению хирургического лечения аневризм брюшного отдела аорты. С этой целью произведен сравнительный анализ двух альтернативных друг другу операций: 1) резекции аневризмы с последующим протезированием аорты; 2) эндопротезирования аорты. Сформулировано научное предположение о том, что замена «классических» операций резекции аневризмы на «альтернативные» операции эндопротезирования приведет к принципиальному снижению уровня послеоперационных осложнений. В независимых группах пациентов с использованием сравниваемых хирургических вмешательств произведена точная качественная и количественная оценка послеоперационных осложнений: нетромботических - кардиальных, пульмональных, ренальных и тромботических - тромбозов глубоких вен и тромбозов браншей протеза. После реализации исследования было установлено, что замена «классических» операций на «альтернативные» достоверно приводит к принципиальному снижению уровня наиболее жизнеопасных осложнений - кардиальных (острых форм ишемической болезни сердца, нарушений сердечного ритма), пульмональных (пневмоний, тромбоэмболии легочной артерии, респираторного дистресс-синдрома взрослых) и ренальных (острой почечной недостаточности). Некоторое исключение составили менее жизнеопасные тромботические осложнения. Полученные результаты имеют высокий уровень статистической значимости, что позволяет рекомендовать их к рассмотрению к использованию в практике сосудистой хирургии The article presents data from an original study to improve the surgical treatment of abdominal aortic aneurysms. For this purpose, a comparative analysis of two alternate operations was performed: 1) aneurysm resection followed by aortic prosthetics; 2) aortic endoprosthetics. The scientific hypothesis is formulated that the replacement of the «classical» operations of resection of the aneurysm with «alternative» operations of endoprosthetics will lead to a fundamental decrease in the level of postoperative complications. In independent groups of patients using the compared surgical interventions, an accurate qualitative and quantitative assessment of postoperative complications was made: non-thrombotic - cardiac, pulmonary, renal and thrombotic - deep vein thrombosis and prosthetic jaw thrombosis. After the study was completed, it was found that the fundamental replacement of «classical» operations with «alternative» reliably leads to a fundamental decrease in the level of the most life-threatening complications - cardiac (acute forms of coronary heart disease, cardiac arrhythmias), pulmonary (pneumonia, pulmonary thromboembolism, respiratory distress syndrome of adults) and renal (acute renal failure). Some exceptions were less life-threatening thrombotic complications. The results obtained have a high level of statistical significance, which allows us to recommend them for consideration in the practice of vascular surgery

CD34 immunostain increases sensitivity of the diagnosis of fetal vascular malperfusion in placentas from ex-utero intrapartum treatment

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Jerzy Stanek
Keyword(s):  
Statistical Significance ◽  
Treatment Procedure ◽  
Fetal Survival ◽  
Ex Utero Intrapartum Treatment ◽  
Life Threatening ◽  
Group 2 ◽  
Cd34 Immunostain ◽  
The Impact ◽  
Diaphragmatic Hernias ◽  
Group 1

AbstractShort CommunicationsEXIT (ex-utero intrapartum treatment) procedure is a fetal survival-increasing modification of cesarean section. Previously we found an increase incidence of fetal vascular malperfusion (FVM) in placentas from EXIT procedures which indicates the underlying stasis of fetal blood flow in such cases. This retrospective analysis analyzes the impact of the recently introduced CD34 immunostain for the FVM diagnosis in placentas from EXIT procedures.Objectives and MethodsA total of 105 placentas from EXIT procedures (48 to airway, 43 to ECMO and 14 to resection) were studied. In 73 older cases, the placental histological diagnosis of segmental FVM was made on H&E stained placental sections only (segmental villous avascularity) (Group 1), while in 32 most recent cases, the CD34 component of a double E-cadherin/CD34 immunostain slides was also routinely used to detect the early FVM (endothelial fragmentation, villous hypovascularity) (Group 2). 23 clinical and 47 independent placental phenotypes were compared by χ2 or ANOVA, where appropriate.ResultsThere was no statistical significance between the groups in rates of segmental villous avascularity (29 vs. 34%), but performing CD34 immunostain resulted in adding and/or upgrading 12 more cases of segmental FVM in Group 2, thus increasing the sensitivity of placental examination for FVM by 37%. There were no other statistically significantly differences in clinical (except for congenital diaphragmatic hernias statistically significantly more common in Group 2, 34 vs 56%, p=0.03) and placental phenotypes, proving the otherwise comparability of the groups.ConclusionsThe use of CD34 immunostain increases the sensitivity of placental examination for FVM by 1/3, which may improve the neonatal management by revealing the increased likelihood of the potentially life-threatening neonatal complications.

617 Who Benefits the Most from Burn Camps?

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S162-S163
Author(s):  
Jennifer B Radics-Johnson ◽  
Daniel W Chacon ◽  
Li Zhang
Keyword(s):  
Retrospective Review ◽  
Burn Injury ◽  
Statistical Significance ◽  
Categorical Variables ◽  
P Value ◽  
Continuous Variables ◽  
Self Evaluation ◽  
Significant Difference ◽  
Return Home ◽  
The Impact

Abstract Introduction Burn camps provide a unique environment and activities for children that have experienced a burn-injury. Positive outcomes from attending burn camp include increased self-esteem, decreased feelings of isolation and a greater sense of self-confidence. In a 3-year retrospective review of camper evaluations from one of the largest and longest running week-long burn camps in the nation for ages 5–17, we aimed to assess if a child’s gender, age, TBSA or ethnicity affected the impact that burn camp had on a child. Methods A 3-year retrospective review of a Burn Camp’s camper evaluation forms was conducted for campers that attended burn camp between 2017–2019. Camp rosters were reviewed to determine the camper gender, age, TBSA and ethnicity. Camper self-evaluation forms completed at the end of each camp session were reviewed to record camper responses to questions regarding their opinions on the impact camp had on them as well as how camp will impact their lives once they return home. Categorical variables were summarized as frequency and percentage, and continuous variables were described as median and range. To check the relationship between two categorical variables, Chi-square test was used. To compare the continuous variable among groups, Kruskal-Wallis ANOVA was used. Statistical significance was declared based on a p value&lt; 0.5. Results Within 2017–2019, there were 413 camper records. Participants’ demographic characteristics are summarized in Table 1. There were 208 males (50.3%) and 205 females (49.6%). The median age of campers were 11.86, 12.44 and 12.45 for 2017–2019, with the range from 5.16 years to 17.96 years. The median TBSA were 20, 20 and 18 for 2017–2019, with the range from 0.08 to 90. Collectively there were 47.7% Hispanic (n= 197); 24.2% Whites (n=100); 13.1% Black (n= 54); 4.6% Asian (n=19) and 7.7% Other (n=32). There were 395 camper self-evaluation forms submitted. Results of three questions there we were interested in are summarized collectively in Table 2. 57% of campers responded, “Yes, Definitely” to the question “After going to this event, will you feel more comfortable being around your classmates or friends?” 54% responded, “ Yes, Definitely” to the question “Do you feel more confidents in sharing your burn story with others when returning home?” and 51% responded “Yes, Definitely” to “Did you learn anything that will help you when you return home?” Conclusions In analyzing the camper responses, there was no statistically significant difference in responses comparing gender, age, TBSA or ethnicity.

Human renal response to meat meal

1986 ◽  
Vol 250 (4) ◽  
pp. F613-F618 ◽  
Author(s):  
T. H. Hostetter
Keyword(s):  
Blood Flow ◽  
Renal Blood Flow ◽  
Renal Plasma Flow ◽  
Statistical Significance ◽  
Prostaglandin E ◽  
Base Line ◽  
Meat Meal ◽  
Time Period ◽  
Beef Steak ◽  
Renal Vascular

Glomerular filtration rate (GFR) increases after a meat meal in several species. The mechanism of this phenomenon is unknown and the excretory and metabolic responses largely unexplored. We examined in humans the nature of the hemodynamic response to a meat meal, the role of salt and water load in this response, and the associated renal excretory responses. Ten normal volunteers were studied after eating an average of 3.5 g/kg body wt of lean cooked beef steak and, on a separate day, after ingesting an amount of sodium and water equivalent to that in the steak. Average GFR increased by 28% for the entire 3 h after the meat meal compared with the same time period after the control salt solution (90 +/- 8 vs. 114 +/- 6 ml X min-1 X 1.73 M-2, mean +/- SE, P less than 0.05) and by 15% compared with the base-line periods, although this difference was not of statistical significance. However, not all subjects demonstrated an increase, and in those eight who did the degree was variable from 5 to 46% for the 3-h mean above the basal value. During the hour of peak GFR, the increment was associated with a nearly proportional increase in renal plasma flow and renal blood flow (all P less than 0.05). The increase in renal blood flow was entirely due to a significant fall in renal vascular resistance. The vasodilation was not accompanied by any change in prostaglandin E excretion.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Linear Atelectasis around the Hilum on Chest Radiography: A Novel Sign of Early Lung Cancer

2018 ◽  
Vol 8 ◽  
pp. 27
Author(s):  
Kerem Ozturk ◽  
Esra Soylu ◽  
Ugur Topal
Keyword(s):  
Lung Cancer ◽  
Significant Relationship ◽  
Retrospective Review ◽  
Statistical Significance ◽  
Primary Lung Cancer ◽  
Chest Radiographs ◽  
Bronchial Obstruction ◽  
Total Thickness ◽  
Patient Subgroup ◽  
Linear Shape

Background: Linear atelectasis is a focal area of subsegmental atelectasis with a linear shape. Linear atelectasis may occur as a consequence of subsegmental bronchial obstruction. Aims: We propose an early roentgen sign of obstructing lung tumors, namely perihilar linear atelectasis, and ascertain whether this phenomenon could be used as a sign to detect radiographically occult primary lung cancer. Materials and Methods: We performed a retrospective review of 45,000 posteroanterior chest radiographs to determine the frequency of appearance and characteristics of perihilar linear atelectasis. The perihilar region of chest radiographs was evaluated for the presence of linear atelectasis. When linear atelectasis was found, the total thickness was measured. Student's t-test was used to evaluate statistical significance, correlating the thickness of atelectasis and the presence of obstructing central primary lung cancer. Results: Perihilar linear atelectasis was demonstrated in 58 patients. Atelectasis was caused by an obstructing tumor in 21 (36%) cases and a variety of other conditions in 37 (64%) patients. A statistically significant relationship (P < 0.001) was observed between the dimension of perihilar linear atelectasis and primary lung cancer, with 16 of 19 patients with thick (>5.5 mm) perihilar linear atelectasis found to have primary lung cancer. Conclusion: Thick perihilar linear atelectasis is a new diagnostic roentgen sign that suggests subsegmental bronchial obstruction. In this patient subgroup, who are otherwise asymptomatic, a persistent linear atelectasis can be due to primary lung cancer.

The International Hypothermia Registry (IHR): Dieter's ESAO Winter Schools and Beat's International Hypothermia Registry

2017 ◽  
Vol 40 (1) ◽  
pp. 40-42 ◽  
Author(s):  
Beat H. Walpoth ◽  
Marie Meyer ◽  
Christophe Gaudet-Blavignac ◽  
Philippe Baumann ◽  
Pierre Gilquin ◽  
...  
Keyword(s):  
Mild Hypothermia ◽  
Statistical Significance ◽  
Orphan Disease ◽  
Accidental Hypothermia ◽  
Evidence Based ◽  
Outcome Predictors ◽  
Severe Hypothermia ◽  
Life Threatening

Accidental hypothermia could be listed as an ‘orphan disease,’ since mild hypothermia is common but has no severe medical consequences, whereas severe hypothermia is rare and life-threatening. In order to increase our knowledge, find new outcome predictors, and propose better guidelines for the treatment of deep accidental hypothermia victims, we created the International Hypothermia Registry (IHR: https://www.hypothermia-registry.org ), which will allow us to gather a large number of cases in order to achieve statistical significance and issue evidence-based recommendations.

History and experience of a volunteer ambulance first responder scheme in London

2021 ◽  
Vol 13 (8) ◽  
pp. 344-348
Author(s):  
Saman Al-Sahab ◽  
Aditi Nijhawan ◽  
Tim Kirkby ◽  
Shadman Aziz
Keyword(s):  
Cardiac Arrest ◽  
Blue Light ◽  
Response Times ◽  
Ambulance Service ◽  
First Responder ◽  
Emergency Responders ◽  
Life Saving ◽  
Wide Range ◽  
Life Threatening ◽  
Set Up

Emergency responders (ERs) are volunteers who attend category 1 (immediately life-threatening) and category 2 (emergency) 999 calls on behalf of the London Ambulance Service NHS Trust (LAS). ERs aim to arrive first on scene to these incidents to provide essential life-saving interventions prior to the arrival of further ambulance resources. ERs come from a wide range of backgrounds and undergo a thorough selection, training and mentorship process before advancing to working in a two-person ER crew. Compared to most traditional volunteer first responder schemes, the LAS ER scheme, which was set up in 2008, involves an enhanced skillset, dispatch to medical and traumatic emergencies in addition to cardiac arrest, and the use of blue-light vehicles to reduce response times. Over a period of 13 years, the scheme has grown in scope and size, and now operates with more than 120 volunteers based at seven ambulance stations across London.

scholarly journals Benign versus life-threatening causes of pneumatosis intestinalis: differentiating CT features

2018 ◽  
Vol 64 (6) ◽  
pp. 543-548 ◽  
Author(s):  
Sujin Ko ◽  
Seong Sook Hong ◽  
Jiyoung Hwang ◽  
Hyun-joo Kim ◽  
Yun-Woo Chang ◽  
...  
Keyword(s):  
Bowel Wall ◽  
Statistical Significance ◽  
Pneumatosis Intestinalis ◽  
Bowel Distension ◽  
Wall Defect ◽  
Ct Findings ◽  
Free Air ◽  
Appropriate Treatment ◽  
Life Threatening ◽  
Ct Features

SUMMARY OBJECTIVE: To assess the diagnostic performance of CT findings in differentiating causes of pneumatosis intestinalis (PI), including benign and life-threatening causes. METHODS: All CT reports containing the word “pneumatosis” were queried from June 1st, 2006 to May 31st, 2015. A total of 42 patients with PI were enrolled (mean age, 63.4 years; 23 males and 19 females) and divided into two groups on based on electronic medical records: a benign group (n=24) and a life-threatening group (n=18). Two radiologists reviewed CT images and evaluated CT findings including bowel distension, the pattern of bowel wall enhancement, bowel wall defect, portal venous gas (PVG), mesenteric venous gas (MVG), extraluminal free air, and ascites. RESULTS: CT findings including bowel distension, decreased bowel wall enhancement, PVG, and ascites were more commonly identified in the life-threatening group (all p<0.05). All cases with PVG were included in the life-threatening group (8/18 patients, 44.4%). Bowel wall defect, extraluminal free air, and mesenteric venous gas showed no statistical significance between both groups. CONCLUSION: PI and concurrent PVG, bowel distension, decreased bowel wall enhancement, or ascites were significantly associated with life-threatening causes and unfavorable prognosis. Thus, evaluating ancillary CT features when we encountered PI would help us characterize the causes of PI and determine the appropriate treatment option.

scholarly journals The effectiveness of latex wound model on wound dressing skill of the nursing students

2020 ◽  
Vol 10 (10) ◽  
pp. 68
Author(s):  
Benyaporn Bannaasan
Keyword(s):  
Nursing Students ◽  
Wound Dressing ◽  
Statistical Significance ◽  
Skill Training ◽  
Control Group ◽  
Evaluation Form ◽  
Wound Model ◽  
The Mean ◽  
Skill Evaluation ◽  
Experimental Group

Wound dressing is a skill which must be able to be performed by all nurses. If the practical ability of a nurse is weak, it will affect the quality of patient care. The objective of this research is to study the effectiveness of the latex wound model for wound dressing training on wound dressing skills of the nursing student. The latex wound model is a device used in practice which is made from rubber. The samples are the 60 second-year nursing students. Simple random sampling was applied in the selection of samples to be an experimental group and a control group for 30 persons per group. The latex wound model was provided to the experimental group for wound dressing skill training at the dormitory for a seven day period. A personal data questionnaire, wet dressing skill evaluation form, and dry dressing skill evaluation form were used for data collection. The data were analyzed using descriptive statistics, Wilcoxon Signed Ranks Test and Mann-Whitney U Test. The results indicated that: 1) the mean score of wet dressing skill and dry dressing skill after the intervention were significantly higher than before the intervention (p < .05); 2) the mean score of wet dressing skill and dry dressing skill of the experimental group were higher than that of the control group, who was given the explanation of research procedures and the use of latex wound model, at statistical significance (p < .05). The findings imply that the use of the latex wound model for wound dressing training could enhance the wound dressing practical skill of the nursing students.

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