scholarly journals Helicopter EMS: Research Endpoints and Potential Benefits

2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
Stephen H. Thomas ◽  
Annette O. Arthur
Keyword(s):  
Case Reports ◽  
Rural Setting ◽  
Level Of Care ◽  
Advanced Level ◽  
Level Ii ◽  
Timely Access ◽  
Hospital Systems ◽  
Potential Benefits ◽  
Level I ◽  
Interfacility Transport

Patients, EMS systems, and healthcare regions benefit from Helicopter EMS (HEMS) utilization. This article discusses these benefits in terms of specific endpoints utilized in research projects. The endpoint of interest, be it primary, secondary, or surrogate, is important to understand in the deployment of HEMS resources or in planning further HEMS outcomes research. The most important outcomes are those which show potential benefits to the patients, such as functional survival, pain relief, and earlier ALS care. Case reports are also important “outcomes” publications. The benefits of HEMS in the rural setting is the ability to provide timely access to Level I or Level II trauma centers and in nontrauma, interfacility transport of cardiac, stroke, and even sepsis patients. Many HEMS crews have pharmacologic and procedural capabilities that bring a different level of care to a trauma scene or small referring hospital, especially in the rural setting. Regional healthcare and EMS system's benefit from HEMS by their capability to extend the advanced level of care throughout a region, provide a “backup” for areas with limited ALS coverage, minimize transport times, make available direct transport to specialized centers, and offer flexibility of transport in overloaded hospital systems.

ICT-supported social work interventions with youth: A critical review

2016 ◽  
Vol 18 (4) ◽  
pp. 468-488 ◽  
Author(s):  
Chitat Chan
Keyword(s):  
Social Work ◽  
Case Reports ◽  
Internal Validity ◽  
Indirect Evidence ◽  
Level Of Evidence ◽  
Level Ii ◽  
Information And Communication ◽  
Level I ◽  
Social Work Interventions

Summary In youth social work, the trend of using various forms of information and communication technology (ICT) is increasing. However, evidence showing in what ways ICT has enhanced intervention effectiveness is loosely organized. This study conducted a systematic review of ICT-supported social work interventions with youth, targeting peer-reviewed articles in 64 social work journals published between 2000 and 2014. The included studies ( N = 13) were analysed with particular reference to their level of evidence, internal validity and approach to evaluating the role of ICT. Findings All the included studies presented positive outcomes: 54% of them provided level-I evidence (RCTs), 15% provided level-II evidence (case–control trials without randomization) and 31% provided level-III evidence (case reports). All of them were of ‘good’ or ‘fair’ quality in terms of their internal validity. However, there were only three studies which could provide direct evidence indicating that interventions using ICT were more effective than interventions without using ICT. Most of the remainder provided indirect evidence suggesting that the use of ICT might be associated with positive intervention outcomes. Applications These studies provide useful insights that help advance social work knowledge. Yet there is room for improvement in the conceptualization of ICT, and in research designs for evaluating the role of ICT.

Asphyxiated Neonates Treated with Hypothermia: Birth Place Matters

2020 ◽  
Author(s):  
Bayane Sabsabi ◽  
Cloe Huet ◽  
Emmanouil Rampakakis ◽  
Marc Beltempo ◽  
Richard Brown ◽  
...  
Keyword(s):  
Brain Injury ◽  
Adverse Outcome ◽  
Multivariable Analysis ◽  
Level Of Care ◽  
Cesarean Sections ◽  
Hospital Level ◽  
Live Births ◽  
Level Ii ◽  
Initial Ph ◽  
Level I

Objective This study aimed to assess whether the hospital level of care where asphyxiated neonates treated with hypothermia were originally born influences their outcome. Study Design We conducted a retrospective cohort study of all asphyxiated neonates treated with hypothermia in a large metropolitan area. Birth hospitals were categorized based on provincially predefined levels of care. Primary outcome was defined as death and/or brain injury on brain magnetic resonance imaging (adverse outcome) and was compared according to the hospital level of care. Results The overall incidence of asphyxiated neonates treated with hypothermia significantly decreased as hospital level of care increased: 1 per 1,000 live births (109/114,627) in level I units; 0.9 per 1,000 live births (73/84,890) in level II units; and 0.7 per 1,000 live births (51/71,093) in level III units (p < 0.001). The rate of emergent cesarean sections and the initial pH within the first hour of life were significantly lower in level I and level II units compared with level III units (respectively, p < 0.001 and p = 0.002). In a multivariable analysis adjusting for the rates of emergent cesarean sections and initial pH within the first hour of life, being born in level I units was confirmed as an independent predictor of adverse outcome (adjusted odds ratio [OR] level I vs. level III 95% confidence interval [CI]: 2.13 [1.02–4.43], p = 0.04) and brain injury (adjusted OR level I vs. level III 95% CI: 2.41 [1.12–5.22], p = 0.02). Conclusion Asphyxiated neonates born in level I units and transferred for hypothermia treatment were less often born by emergent cesarean sections, had worse pH values within the first hour of life, and had a higher incidence of adverse outcome and brain injury compared with neonates born in level III units. Further work is needed to optimize the initial management of these neonates to improve outcomes, regardless of the location of their hospital of birth. Key Points

Resuscitation and Evacuation from Low Earth Orbit: A Systematic Review

2019 ◽  
Vol 34 (05) ◽  
pp. 521-531
Author(s):  
Craig D. Nowadly ◽  
Brandon D. Trapp ◽  
Stephen K. Robinson ◽  
John R. Richards
Keyword(s):  
Critical Care ◽  
Case Reports ◽  
Case Series ◽  
Technical Information ◽  
Low Earth Orbit ◽  
Earth Orbit ◽  
Medical Evacuation ◽  
Level Ii ◽  
Level I ◽  
Based Medicine

AbstractIntroduction:Provision of critical care and resuscitation was not practical during early missions into space. Given likely advancements in commercial spaceflight and increased human presence in low Earth orbit (LEO) in the coming decades, development of these capabilities should be considered as the likelihood of emergent medical evacuation increases.Methods:PubMed, Web of Science, Google Scholar, National Aeronautics and Space Administration (NASA) Technical Server, and Defense Technical Information Center were searched from inception to December 2018. Articles specifically addressing critical care and resuscitation during emergency medical evacuation from LEO were selected. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines.Results:The search resulted in 109 articles included in the review with a total of 2,177 subjects. There were two Level I systematic reviews, 33 Level II prospective studies with 647 subjects, seven Level III retrospective studies with 1,455 subjects, and two Level IV case series with four subjects. There were two Level V case reports and 63 pertinent review articles.Discussion:The development of a medical evacuation capability is an important consideration for future missions. This review revealed potential hurdles in the design of a dedicated LEO evacuation spacecraft. The ability to provide critical care and resuscitation during transport is likely to be limited by mass, volume, cost, and re-entry forces. Stabilization and treatment of the patient should be performed prior to departure, if possible, and emphasis should be on a rapid and safe return to Earth for definitive care.

scholarly journals Perinatal Regionalization and Implications for Long-Term Health Outcomes in Cerebral Palsy

2016 ◽  
Vol 43 (2) ◽  
pp. 248-253 ◽  
Author(s):  
Corneliu Bolbocean ◽  
Pia Wintermark ◽  
Michael I. Shevell ◽  
Maryam Oskoui
Keyword(s):  
Cerebral Palsy ◽  
Propensity Score ◽  
Neonatal Care ◽  
Outcome Variable ◽  
Level Of Care ◽  
Level Ii ◽  
Versus Level ◽  
Perinatal Regionalization ◽  
Level I

AbstractBackground: Perinatal regionalization is linked to improved neonatal outcomes; however, the effects on long-term outcomes in cerebral palsy (CP) are not known. We estimate the effect of highest levels of neonatal care available at delivery on the risk of developing a nonambulatory CP status. Methods: Children with CP born in Quebec from the Canadian CP Registry excluding postneonatal causes were included (N=360). We estimate the effect of level of care available at delivery on risk of nonambulatory status among children with CP using propensity score matching and instrumental variables methods to adjust for differences in case mix among the three groups of hospitals. The outcome variable is an indicator for CP nonambulation assigned according to Gross Motor Function Classification System (levels IV and V). This study used data that predated therapeutic hypothermia in Quebec. Results: Propensity score estimates of change in the adjusted risk of having a nonambulatory CP status because of birth at level II versus level I is −0.081, 95% confidence interval (CI; −0.2182 to 0.0562); level III versus level I is −0.072 95% CI (−0.225 to 0.08), and level III versus level II is 0.157 95% CI (0.027 to 0.286). Conclusions: Differences in levels of neonatal care available at hospital where the delivery was carried out are not associated with the risk of a nonambulatory CP phenotype. This suggests that level of care and associated medical technology within the Quebec regionalized neonatal-perinatal system is used efficiently because it does not offer any further marginal benefit in the reduction of severe CP outcomes. The system works well as it is, which is supportive of the perinatal regionalization. The success of the neonatal resuscitation program and referral of high-risk births to regional hospitals with sufficient obstetric and perinatal competence and resources may contribute to this lack of variability.

CLINICAL FEATURES, INDICATIONS AND RESULT OF TRACHEOTOMY

2017 ◽  
pp. 50-55
Author(s):  
Duc Luu Ngo ◽  
Tu The Nguyen ◽  
Manh Hung Ho ◽  
Thanh Thai Le
Keyword(s):  
Clinical Features ◽  
University Hospital ◽  
Female Ratio ◽  
Tube Obstruction ◽  
Level Ii ◽  
Study Results ◽  
Male Female Ratio ◽  
Hospital Patients ◽  
Level I

Background: This study aims to survey some clinical features, indications and results of tracheotomy at Hue Central Hospital and Hue University Hospital. Patients and method: Studying on 77 patients who underwent tracheotomy at all of departments and designed as an prospective, descriptive and interventional study. Results: Male-female ratio was 4/1. Mean age was 49 years. Career: farmer 44.2%, worker 27.2%, officials 14.3%, student 7.8%, other jobs 6.5%. Respiratory condition before tracheotomy: underwent intubation 62.3%, didn’t undergo intubation 37.7%. Period of stay of endotracheal tube: 1-5 days 29.2%, 6-14 days 52.1%, >14 days 18.7%. Levels of dyspnea before tracheotomy: level I 41.4%, level II 48.3%, level III 0%, 10.3% of cases didn’t have dyspnea. Twenty cases (26%) were performed as an emergency while fifty seven (74%) as elective produces. Classic indications (37.7%) and modern indications (62.3%). On the bases of the site, we divided tracheostomy into three groups: high (0%), mid (25.3%) and low (74.7%). During follow-up, 44 complications occurred in 29 patients (37.7%). Tracheobronchitis 14.3%, tube obstruction 13%, subcutaneous empysema 10.4%, hemorrhage 5%, diffcult decannulation 5.2%, tube displacement 3.9%, canule watery past 2.6%, wound infection 1.3%. The final result after tracheotomy 3 months: there are 33 patients (42.9%) were successfully decannulated. In the 33 patients who were successfully decannulated: the duration of tracheotomy ranged from 1 day to 90 days, beautiful scar (51.5%), medium scar (36.4%), bad scar (12.1%). Conclusions: In tracheotomy male were more than female, adult were more than children. The main indication was morden indication. Tracheobronchitis and tube obstruction were more common than other complications. Key words: Tracheotomy

scholarly journals Secondary prevention medication persistence and prognosis of acute ischaemic stroke or transient ischaemic attack

2021 ◽  
pp. svn-2020-000471
Author(s):  
Lei Zhang ◽  
Junfeng Shi ◽  
Yuesong Pan ◽  
Zixiao Li ◽  
Hongyi Yan ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Transient Ischaemic Attack ◽  
Recurrent Stroke ◽  
Medication Persistence ◽  
Level Ii ◽  
Composite Events ◽  
Ischaemic Attack ◽  
Level I

IntroductionThe risk of disability and mortality is high among recurrent stroke, which highlights the importance of secondary prevention measures. We aim to evaluate medication persistence for secondary prevention and the prognosis of acute ischaemic stroke or transient ischaemic attack (TIA) in China.MethodsPatients with acute ischaemic stroke or TIA from the China National Stroke Registry II were divided into 3 groups based on the percentage of persistence in secondary prevention medication classes from discharge to 3 months after onset (level I: persistence=0%, level II: 0%<persistence<100%, level III: persistence=100%). The primary outcome was recurrent stroke. The secondary outcomes included composite events (stroke, myocardial infarction or death from cardiovascular cause), all-cause death and disability (modified Rankin Scale score=3–5) from 3 months to 1 year after onset. Recurrent stroke, composite events and all-cause death were performed using Cox regression model, and disability was identified through logistic regression model using the generalised estimating equation method.Results18 344 patients with acute ischaemic stroke or TIA were included, 315 (1.7%) of whom experienced recurrent strokes. Compared with level I, the adjusted HR of recurrent stroke for level II was 0.41 (95% CI 0.31 to 0.54) and level III 0.37 (0.28 to 0.48); composite events for level II 0.41 (0.32 to 0.53) and level III 0.38 (0.30 to 0.49); all-cause death for level II 0.28 (0.23 to 0.35) and level III 0.20 (0.16–0.24). Compared with level I, the adjusted OR of disability for level II was 0.89 (0.77 to 1.03) and level III 0.82 (0.72 to 0.93).ConclusionsPersistence in secondary prevention medications, especially in all classes of medications prescribed by the physician, was associated with lower hazard of recurrent stroke, composite events, all-cause death and lower odds of disability in patients with acute ischaemic stroke or TIA.

scholarly journals Adaptation of the AACN Synergy Model for Patient Care to Critical Care Transport

2014 ◽  
Vol 34 (1) ◽  
pp. 16-28 ◽  
Author(s):  
Scott Swickard ◽  
Wendy Swickard ◽  
Andrew Reimer ◽  
Deborah Lindell ◽  
Chris Winkelman
Keyword(s):  
Critical Care ◽  
Patient Care ◽  
Care Delivery ◽  
Health Care Delivery System ◽  
Level Of Care ◽  
Patient Centered ◽  
Levels Of Care ◽  
Interhospital Transfer ◽  
Mode Of Transport ◽  
Interfacility Transport

Today’s health care delivery system relies heavily on interhospital transfer of patients who require higher levels of care. Although numerous tools and algorithms have been used for the prehospital determination of mode of transport, no tool for the transfer of patients between hospitals has been widely accepted. Typically, the interfacility transport decision is left to the discretion of the referring provider, who may or may not be aware of the level of care provided or the means of transport available. A need exists to determine the appropriate level of care required to meet the needs of patients during transport. The American Association of Critical-Care Nurses (AACN) Synergy Model for Patient Care is a patient-centered model that focuses on optimizing patient care by matching the characteristics of the patient with the competencies of the nurse. This model shows significant promise in providing the theoretical backing to guide the decision on the level of care necessary to complete interfacility transfers safely and effectively. This article describes a new tool inspired by the AACN Synergy Model for Patient Care to determine the appropriate level of care required for interfacility transport.

Source depth estimation using multi-station waveform data

1984 ◽  
Vol 74 (5) ◽  
pp. 1623-1643
Author(s):  
Falguni Roy
Keyword(s):  
Depth Estimation ◽  
The United States ◽  
Digital Data ◽  
United States Geological Survey ◽  
Travel Times ◽  
Source Depth ◽  
Time Data ◽  
Waveform Data ◽  
Level Ii ◽  
Level I

Abstract A depth estimation procedure has been described which essentially attempts to identify depth phases by analyzing multi-station waveform data (hereafter called level II data) in various ways including deconvolution, prediction error filtering, and spectral analysis of the signals. In the absence of such observable phases, other methods based on S-P, ScS-P, and SKS-P travel times are tried to get an estimate of the source depth. The procedure was applied to waveform data collected from 31 globally distributed stations for the period between 1 and 15 October 1980. The digital data were analyzed at the temporary data center facilities of the National Defense Research Institute, Stockholm, Sweden. During this period, a total number of 162 events in the magnitude range 3.5 to 6.2 were defined by analyzing first arrival time data (hereafter called level I data) alone. For 120 of these events, it was possible to estimate depths using the present procedure. The applicability of the procedure was found to be 100 per cent for the events with mb &gt; 4.8 and 88 per cent for the events with mb &gt; 4. A comparison of level I depths and level II depths (the depths as obtained from level I and level II data, respectively) with that of the United States Geological Survey estimates indicated that it will be necessary to have at least one local station (Δ &lt; 10°) among the level I data to obtain reasonable depth estimates from such data alone. Further, it has been shown that S wave travel times could be successfully utilized for the estimation of source depth.

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