Lessons learned from the first 50 COVID-19 critical care transfer missions conducted by a civilian UK Helicopter Emergency Medical Service team

Background The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. Methods Retrospective review of air critical care transfer service set up and case review of first 50 transfers. Results We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29–83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149–440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31–158). The mean transfer transit time between referring and receiving units was 72 min (9–182). Conclusion Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.

Intracranial pilocytic astrocytoma with spinal drop metastasis: A case review, discussion of its current management and related literature

Pilocytic astrocytoma (PA) is a low grade benign tumor, commonly occurs in Cerebellum (42-60%), Optic & hypothalamic region (9-30%), Brain Stem (9%). They rarely spread. It rarely occurs within the ventricle. In this report, we described our experience with cranial pilocytic astrocytoma in a 14-year-old child, who initially treated with near total decompression of tumor. Four and half years later, recurrence of primary tumor with obstructive hydrocephalus occurred for which he underwent ventriculo-peritoneal shunt followed by re-excision. As further treatment was being evaluated for radiotherapy in view of recurrence at the primary site, he got detected to have significant spinal drop metastasis seen on MRI Spine. Finally, he underwent craniospinal irradiation (CSI).

Case series demonstrating in vivo MR safety of stainless steel (Chinese/Ring) IUDs

Intrauterine devices (IUDs) are one of the most common forms of long-term contraception used by patients around the world. Many studies have been performed over the past few decades demonstrating the safety of many common hormonal and metallic intrauterine devices in Magnetic Resonance (MR) imaging; however, the stainless steel ring IUD (often termed the “Chinese” IUD) is still considered MR Unsafe. This device was used in the 1980s and 1990s in China, where as many as 60 million women in China were using an IUD by 1988, and approximately 90% of those were stainless steel ring IUDs. In a major metropolitan area hospital such as ours with a large immigrant population, we encounter females with this ring IUD several times a year. As this population ages, the need for medical care (and concomitantly, MR imaging) is projected to increase. The purpose of this case review is to examine the imaging and clinical course of patients with stainless-steel ring intrauterine devices who safely received 1.5T Brain MR scans at our institution for clinically necessary diagnostic imaging.

Collaborative Legacy Building to Alleviate Emotional Pain and Suffering in Pediatric Cancer Patients: A Case Review

Childhood cancer patients experience emotional hardship associated with their life-threatening diagnoses. Interdisciplinary team members working in pediatric cancer care can help alleviate physical pain and psychological suffering of children by facilitating collaborative legacy-building activities with patients and families. The contents of this article aim to support legacy building as a medium for emotional healing prior to the end of life. The authors use a case review to contextualize legacy-building projects and provide a comprehensive overview of methods and considerations for these initiatives.

Hypericum perforatum and Azadirachta indica (Neem) oil in the management of chronic leg ulcers: An uncontrolled retrospective observational case review

Chronic nonhealing leg ulcers are debilitating with high morbidity in a vulnerable patient population and pose a frequent clinical and socioeconomic problem. Numerous local treatment options exist, but clinical trials are rare and wound management still represents a big challenge. Recently a wound dressing based on the natural remedies Hypericum perforatum and Neem oil has been proposed for chronic wound management, but trials on nonhealing leg ulcers are missing. Uncontrolled retrospective observational case review on all patients under our supervision with chronic leg ulcers who underwent treatment with a plant-derived wound dressing based on Hypericum perforatum and Azadirachta indica (Neem) oil. It could be retrieved in a total 16 cases (11 female) with a median age of 71 years. All ulcers (7 ulcers on the leg and 9 ulcers on the feed) showed a complete healing after a median healing time of 82 days (Mean 85, range 14-180 days). No side effects occurred, medication was painless or even reduced pain. Wound dressings based on Hypericum perforatum and Neem oil are well tolerated and could be a potential additional simple treatment option in the management of non-healing leg ulcers. Prospective controlled trials are needed to confirm these observations.

Sztuczna inteligencja – wybór orzecznictwa

This article represents an overview of the jurisprudence case review of issues relatively connected with artificial intelligence technology. The collection of judgments chosen for the purposes of study which include concerns related to issues associated with forthcoming technological world. For example, the functionality of bot software automate human interaction easy with various online activities, the use of AI to analyse the car cost repairing according to model. AI used in forensic medical radiology, figure print scanning, security enhancement using facial biometrics recognition. AI in automate graphics and game design application. Also AI use to filter social networks to identify inciting terrorism. The main purpose of the study is to identify and assess the need of regulate artificial intelligence technology according to standardize policy, as well as to assess the level of threats associated with privacy of data analysis functions of the AI technology in the context of the presented jurisprudence.

Evaluation of feedback modalities and preferences regarding feedback on decision-making in a pediatric emergency department

Objectives To compare pediatric emergency clinicians’ attitudes toward three feedback modalities and assess clinicians’ case-based feedback preferences. Methods Electronic survey sent to pediatric emergency medicine (PEM) physicians and fellows; general pediatricians; and advanced practice providers (APPs) with nine questions exploring effectiveness and emotional impact of three feedback modalities: case-based feedback, bounce-back notifications, and biannual performance reports. Additional questions used a four-point ordinal agreement response scale and assessed clinicians’ attitudes toward case review notification, case-based feedback preferences, and emotional support. Survey responses were compared by feedback modality using Pearson’s chi-squared. Results Of 165 eligible providers, 93 (56%) responded. Respondents agreed that case-based feedback was timely (81%), actionable (75%), prompted reflection on decision-making (92%), prompted research on current clinical practice (53%), and encouraged practice change (58%). Pediatric Emergency Care Applied Research Network (PECARN) performance reports scored the lowest on all metrics except positive feedback. No more than 40% of providers indicated that any feedback modality provided emotional support. Regarding case-based feedback, 88% of respondents desired email notification before case review and 88% desired feedback after case review. Clinicians prefer receiving feedback from someone with similar or more experience/training. Clinicians receiving feedback desire succinctness, supporting evidence, consistency, and sensitive delivery. Conclusions Case-based feedback scored highest of the three modalities and is perceived to be the most likely to improve decision-making and promote practice change. Most providers did not perceive emotional support from any feedback modality. Emotional safety warrants purposeful attention in feedback delivery. Critical components of case-based feedback include succinctness, supporting evidence, consistency, and sensitive delivery.

Progress of Indian summer monsoon onset and convective episodes over Indo-Pacific region observed during 2009-2014

Summer monsoon onset progress from the oceanic region of Southeast Bay of Bengal / Andaman Sea (Oceanr) up to extreme southwestern part of India (Kerala) for the years 2009 to 2014 is investigated. Synoptic weather information, INSAT/KALPANA-1 as well as cloud imageries archived from Dundee Satellite Receiving Station for May and early June for these years are used in the analysis. Upper-air reanalyzed winds from NCEP/NCAR and OLR data archived through NOAA satellites are also used. During the study period, the dates of monsoon onset as well as the time required for the advancement of onset from Oceanr to Kerala have shown a large variation. An attempt is made to investigate the causes for such variations. The results indicate that intense disturbances which formed over north Indian Ocean in 2009, 2010, 2013 and 2014 and over west-north Pacific Oceanic region in 2011 and 2012 have contributed for the same. Analysis is carried out, limiting its focus to bring out the role of these convective events in the observed variation of onset timing and its progress by taking case to case review of these events and bringing out their influence through synoptic analysis. Utility of this information in prediction of the progress of Indian summer monsoon onset is also brought out.

Novel Program Offering Remote, Asynchronous Subspecialist Input in Thoracic Oncology: Early Experience and Insights Gained During the COVID-19 Pandemic

PURPOSE: AccessHope is a program developed initially by City of Hope to provide remote subspecialist input on cancer care for patients as a supplemental benefit for specific payers or employers. The leading platform for this work has been an asynchronous model of review of medical records followed by a detailed assessment of past and current management along with discussion of potential future options in a report sent to the local oncologist. This summary describes an early period of development and growth of this service, focusing on cases of lung cancer, particularly during the COVID-19 pandemic. METHODS: Cases were primarily identified by a trigger list of cancer diagnoses that included non–small-cell lung cancer and small-cell lung cancer. After medical records were obtained, a summary narrative was provided to a thoracic oncology specialist who wrote a case review sent to the local physician, followed by a direct discussion with the recipient. We focused on feasibility as measured by case volumes, the rates of concordance between the subspecialist reviewer with the local team, and cost savings from recommended changes, using descriptive statistics. RESULTS: From April 2019 to November 2020, 110 cases were reviewed: 55% male, median age 62.5 years (range, 33-92 years); 82% non–small-cell lung cancer (12% stage I or II, 16% stage III, and 57% stage IV), and 17% small-cell lung cancer (4% limited and 14% extensive). Median turnaround time for report send-out was 5.0 days. The review agreed with local management in 79 (72%) cases and disagreed in 31 (28%) cases; notably, specific additional recommendations were associated with evidence-based anticipated improvements in efficacy in 76 cases (69%) and improvement in potential for cure in 14 cases (13%). Recommendations leading to cost savings were identified in 14 cases (13%), translating to a projected cost savings of $19,062 (USD) per patient for the entire cohort of patient cases reviewed. CONCLUSION: We demonstrate the feasibility of completing a rapid turnaround of cases of lung cancer either patient-initiated for review or prospectively triggered by diagnosis and stage. This program of asynchronous second opinions identified evidence-based management changes affecting current treatment in 28% and potential improvements to improve care in 92% of patients, along with cost savings realized by eliminating low-value interventions.