Lessons identified from the 2017 Manchester and London terrorism incidents. Part two: the reception and definitive care (hospital) phases

2018 ◽  
Vol 166 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Paul Hunt
Keyword(s):  
Multidisciplinary Approach ◽  
Large City ◽  
Care Hospital ◽  
Effective Response ◽  
Severe Burns ◽  
Clinical Support ◽  
Specialist Services ◽  
Serious Injuries ◽  
To Receive ◽  
Network Organisation

The provision of medical care during the reception and definitive care phases of a terrorist incident will likely take place in designated receiving hospitals such as Major Trauma Centres. There is a need for an enhanced capability in such units to receive, initially manage and hold casualties with more serious injuries. Also, even less severely injured casualties may require significant time and clinical input such as risk management in potential bloodborne viruses.The distribution of casualties from the incident scene requires advance consideration of the injury pattern and regional network organisation of specialist services, such as maxillofacial, neurosurgery or severe burns care. Paediatric centres are also more sparsely distributed and often only in large city networks which represents a significant challenge for planners and responders in other regions. An effective response relies on a coordinated multidisciplinary approach including emergency and front-of-house teams, surgical, medical and clinical support services.

Investigating the Degree of Reliable Change Among Persons Assigned to Receive Mental Health Peer Specialist Services

2018 ◽  
Vol 69 (12) ◽  
pp. 1238-1244 ◽  
Author(s):  
Matthew Chinman ◽  
Sharon McCarthy ◽  
Rachel L. Bachrach ◽  
Chantele Mitchell-Miland ◽  
Russell K. Schutt ◽  
...  
Keyword(s):  
Mental Health ◽  
Reliable Change ◽  
Specialist Services ◽  
Peer Specialist ◽  
To Receive

scholarly journals Major Trauma and Severe Burn: A Synergistic Mortality. Case Report and Literature Review

2020 ◽  
Vol 61 (01) ◽  
pp. 023-027
Author(s):  
Oriol Pujol ◽  
Jordi Selga ◽  
Jordi Serracanta ◽  
Juan Antonio Porcel ◽  
José Vicente Andrés-Peiró
Keyword(s):  
Synergistic Effect ◽  
Multidisciplinary Approach ◽  
Open Fracture ◽  
Major Trauma ◽  
Soft Tissues ◽  
Total Body Surface Area ◽  
High Energy ◽  
Complex Case ◽  
Severe Burns ◽  
The Right

Abstract Case Presentation A 42-year-old man was transferred to our institution after a high-energy accident (an explosion). He presented second-degree burns on 20% of the total body surface area (TBSA), affecting the lower hemiabdomen and the lower right limb. He also presented a supraintercondylar open fracture of the right femur (Gustilo I). The burns were treated with debridement and coverage with mesh graft, while the fracture required an early transitory transarticular external fixation with delayed definitive osteosynthesis. Our patient presented good local and systemic evolution. We can offer a eleven-month follow-up. Discussion The literature supports that the combination of trauma and burn injuries is a relatively rare pattern, which may explain the lack of knowledge and studies on this subject. This double injury has demonstrated a synergistic effect on mortality. The management of soft tissues in the coexistence of an open fracture and a burn in the same limb is a challenge. The method and timing of the treatment of the fracture directly impacts the treatment of the burn (and vice versa), and most authors tend to treat the fracture first. All of the studies reviewed emphasized the importance of the multidisciplinary approach. Conclusions We have presented a complex case combining major trauma and severe burns. Although there is a lack of studies in the literature on this subject, the papers state that this is an unusual pattern with a synergistic effect on mortality. In our experience, the management of soft tissues and the multidisciplinary approach play a central role, as it is also stated in the literature. The management of these patients is still controversial, and more studies are needed.

Use of a Clostridium difficile clinical prediction rule to facilitate antimicrobial stewardship

2019 ◽  
Vol 20 (5) ◽  
pp. 250-253 ◽  
Author(s):  
Davin Kamiyama ◽  
Bruce H Weng ◽  
Monica A Donnelley ◽  
Elizabeth Zhu ◽  
Jennifer Brown
Keyword(s):  
Clostridium Difficile ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospital ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Care Hospital ◽  
Clinical Prediction ◽  
Complex Patients ◽  
Novel Method ◽  
To Receive

In this study, we assessed whether a Clostridium difficile clinical prediction rule could be used to facilitate antimicrobial stewardship in an acute care hospital. We found that patients with higher scores were more likely to receive unnecessary antimicrobials and had the greatest potential for antimicrobial stewardship interventions. This novel method has the potential to expedite antimicrobial stewardship efforts, particularly for complex patients, in health care institutions.

Resilience of the Canterbury Hospital System to the 2011 Christchurch Earthquake

2014 ◽  
Vol 30 (1) ◽  
pp. 533-554 ◽  
Author(s):  
Caitlin C. Jacques ◽  
Jason McIntosh ◽  
Sonia Giovinazzi ◽  
Thomas D. Kirsch ◽  
Thomas Wilson ◽  
...  
Keyword(s):  
Multidisciplinary Approach ◽  
Fault Tree Analysis ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Contributing Factors ◽  
Hospital System ◽  
Nonstructural Components ◽  
Survey Tool ◽  
Future Performance ◽  
Hospital Safety

The paper analyzes the performance of a hospital system using a holistic and multidisciplinary approach. Data on impacts to the hospital system were collected using a standardized survey tool. A fault-tree analysis method is adopted to assess the functionality of critical hospital services based on three main contributing factors: staff, structure, and stuff. Damage to utility networks and to nonstructural components was found to have the most significant effect on hospital functionality. The functional curve is integrated over time to estimate the resilience of the regional acute-care hospital with and without the redistribution of its major services. The ability of the hospital network to offer redundancies in services after the earthquake increased the resilience of the Christchurch Hospital by 12%. The resilience method can be used to assess future performance of hospitals, and to quantify the effectiveness of seismic retrofits, hospital safety legislation, and new seismic preparedness strategies.

scholarly journals What are healthcare providers’ understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e019701 ◽  
Author(s):  
Shane Sinclair ◽  
Thomas F Hack ◽  
Shelley Raffin-Bouchal ◽  
Susan McClement ◽  
Kelli Stajduhar ◽  
...  
Keyword(s):  
Grounded Theory ◽  
Healthcare Provider ◽  
Healthcare Providers ◽  
Care Hospital ◽  
Care Services ◽  
Palliative Care Services ◽  
Patient Model ◽  
To Receive ◽  
Empirical Foundation ◽  
Insight Into

BackgroundHealthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed.ObjectivesThe aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model.DesignData were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory.Setting and participants57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada.ResultsFive categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as—a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action.ConclusionsAn empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.

scholarly journals Impact of Infectious Diseases Consultation on Mortality in Patients with Candidemia

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S52-S52 ◽  
Author(s):  
Carlos Mejia ◽  
Ryan Kronen ◽  
Charlotte Lin ◽  
Kevin Hsueh ◽  
William Powderly ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Cox Regression ◽  
Clinical Care ◽  
Tertiary Care ◽  
Central Line ◽  
Care Hospital ◽  
Consult Group ◽  
Infectious Diseases Consultation ◽  
To Receive ◽  
Research Grant

Abstract Background An infectious diseases (ID) consultation is often, but not always, obtained to help guide treatment of patients with candidemia. We examined if ID consultation affected patient outcome in patients with culture positive candidemia. Methods We assembled a retrospective cohort of 1,873 cases of candidemia in patients hospitalized in our academic tertiary care hospital from 2002 to 2015. We collected data on comorbidities, predisposing factors; antifungal therapy, survival and ID consult. Patients who died within 24 hours of diagnosis were excluded, under the presumption that they did not have an opportunity to receive an ID consult. Survival analysis was performed via univariate and multivariate Cox Regression with censoring at 90 days, as subsequent mortality was less likely to be related to candidemia. Results 913 (49%) of the candidemic patients received an ID consult; 960 (51%) did not. Underlying comorbidities were evenly distributed between patients with and without an ID consult, except that patients with an ID consult more frequently had a central line (39% vs. 26%, p < 0.001), were on mechanical ventilation (4% vs. 2%, P = 0.003) or were receiving extracorporeal membrane oxygenation (2.2% vs. 0.5%, p = 0.002). The ID consult group had lower 90-day mortality compared with patients without an ID consult (34% vs. 49%, P < 0.001), with an adjusted hazard ratio of mortality for those patients receiving an ID consult of 0.55 (95% CI: 0.48, 0.64, P < 0.001) (Fig 1). Patient management differed significantly: the ID consult group was more likely to receive an echinocandin (29% vs. 21%, P < 0.001) or amphotericin B (AmB) (3.4% vs. 1.4%, P = 0.006). Conclusion Candidemic patients who received an ID consult were significantly less likely to die, and were more likely to receive therapy with amphotericin or an echinocandin. These data suggest that an ID consult should be an integral part of clinical care of patients with candidemia. Disclosures W. Powderly, Merck: Grant Investigator and Scientific Advisor, Consulting fee and Research grant; Gilead: Scientific Advisor, Consulting fee; Astellas: Grant Investigator, Research grant; A. Spec, Astellas Pharma US, Inc.: Grant Investigator, Research grant

Accuracy of Assignment of Orthopedic Inpatients to Receive Weekend Physical Therapy Services in an Acute Care Hospital

2006 ◽  
Vol 58 (3) ◽  
pp. 221-232
Author(s):  
Lisa Taylor ◽  
Kristen Goodman ◽  
Daniela Soares ◽  
Heather Carr ◽  
Gina Peixoto ◽  
...  
Keyword(s):  
Physical Therapy ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Care Hospital ◽  
Therapy Services ◽  
To Receive ◽  
Physical Therapy Services

Using the Telephone in the delivery of early intervention programs in Rural Victoria

1993 ◽  
Vol 17 (2) ◽  
pp. 27-32
Author(s):  
Renae L. Moore ◽  
Stana H. Sargood
Keyword(s):  
Early Intervention ◽  
Young Child ◽  
Developmental Disability ◽  
Rural Areas ◽  
Intervention Programs ◽  
Geographical Isolation ◽  
Early Intervention Services ◽  
Specialist Services ◽  
Intervention Services ◽  
To Receive

Families living in rural areas who have a young child with a developmental disability often face difficulties in accessing early intervention services due to geographical isolation and restricted options to specialist services. Lack of services has been reported in a number of surveys of early intervention programs across Australia (Watt, Elkins, Conrad, Andrews, Apelt, Hayes, Calder, Coulston, & Willis, 1982; Barrie & Tomlinson, 1985). Watt et al found only five programs operating in rural areas with populations of 10,000 or less across Australia with a further 15 in towns of 10,000 to 30,000. Hayes and Livingstone (1986) found only rudimentary services in country areas often necessitating the placement of child in an urban facility to receive services.

scholarly journals A comparative study of azelastine, cromolyn and olopatadine ophthalmic solution in vernal keratoconjunctivitis in a tertiary care hospital-open label parallel group study design

2021 ◽  
Vol 10 (7) ◽  
pp. 785
Author(s):  
Gaurav Sharma ◽  
Kulbhushan P. Chaudhary ◽  
Sushma Sawaraj
Keyword(s):  
Tertiary Care ◽  
Ophthalmic Solution ◽  
Cromolyn Sodium ◽  
The Other ◽  
Vernal Keratoconjunctivitis ◽  
Care Hospital ◽  
Open Label ◽  
Parallel Group ◽  
Dry Climates ◽  
To Receive

Background: Vernal keratoconjunctivitis (VKC) is a chronic, bilateral, external ocular inflammatory disease primarily affecting young boys living in warm, dry climates with seasonal variations. The disease causes lot of discomfort to the patient and sometimes can predispose to serious problems like shield ulceration and keratoconus. A number of drugs are used in the management of the condition, with variable results. The aims and objectives of this study was to compare the efficacy and safety of the drugs, cromolyn sodium, azelastine and olopatadine ophthalmic solutions in the treatment of VKC.Methods: Sixty patients of VKC were studied over a period of 6 weeks. They were divided into 3 groups randomly to receive one of the drugs under study. Symptoms and signs were recorded after detailed questioning and examination according to modified criterion of Tabbara and Arafat.Results: There was significant reduction in the mean itching scores with olopatadine as compared to cromolyn sodium and azelastine (p<0.05). Olopatadine significantly decreased mean lacrimation scores as compared to cromolyn sodium and azelastine (p<0.005). Olopatadine, cromolyn and azelastine showed significant reduction of corneal stippling, but no drug was significantly better than the other. Both cromolyn and olopatadine showed reduction of limbal edema equally (p<0.05), olopatadine reduced limbal edema more significantly as compared to azelastine (p<0.05).Conclusions: All the three drugs were found to be safe in the treatment of VKC. Olopatadine may be preferred over the other two drugs since it reduced both itching and discharge most significantly.

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