bluuebunny/crossref_metadata_2025 huggingface dataset:
(P2-11) Teletransmission of 12-Lead ECG in Warsaw Ambulance Service — Analysis of the First Months of the Operation
Authors: Michalak G. , Zając D. , Pilip S.
Published: May 2011

Background

Since September 2009, the Warsaw Ambulance Service (WAS) has enabled 23 ambulances to carry out a 12-lead electrocardiograph (ECG) transmission to the specialist in the ECG transmission center, and in return received an interpretation of sent data along with guidelines concerning further treatment and transportation. This would allow patients with myocardial infarction (MI) eligible for PCI to be transported directly to the catheterization laboratory. The aim of this study was to present the results of the first four months of operation of the ECG transmission system in WAS, and assess the frequency of its use and the amount of MI it covered. Furthermore this study, attended to the main issues that might have had a negative impact on the surveyed system.

Methods

Since September 2009, each attempt of transmission was described by a number of factors by the staff attending to ECG transmission center. Documentation created from September to December 2009 was subjected to a thorough analysis.

Results

From September to December 2009, there was a total of 1,650 attempts of transmission, 292 (18%) of them were unsuccessful. Of 1,358 successfully transmitted ECGs, 39 (3%) suggested a ST-Segment Elevation Myocardial Infarction (STEMI) and 149 (11%) suggested a Non-ST-Elevation Myocardial Infarction (NSTEMI). The number of attempted ECG transmission carried out by individual ambulance teams per intervention was significantly different (p < 0.001) and showed a relation with a place of stationing. The proportion of unsuccessful attempts was significantly different for individual ambulance teams (p < 0.001) and was higher for ambulance teams with lower amount of attempts (p < 0.0001).

Conclusions

Prehospital 12-Lead ECGs help to reduce emergency medical services-to-Balloon times. It often was used as a support in case of patients without symptoms typical for MI. Motivation and personal opinion of individual ambulance teams about the system affected frequency of its use. More frequent use of the system by ambulance teams resulted in a lower percentage of unsuccessful attempts of ECG transmission.
(P2-13) Pitfalls for Upper Limb Injuries in Emergency
Authors: Abrassart S. , Hoffmeyer P.
Published: May 2011

Sternoclavicular dislocation usually requires a Computed Tomography (CT) scan and surgery. This injury is rare because costoclavicular ligaments are strong. They appear in motorcycle accidents and sports collisions. Compression of the neurovascular structures or trachea involving the vital prognosis is not rare. Practitioners must be aware of symptoms such as dysphagia, dyspnea, hoarseness, or neurologic disorders. On the printing of thoracic standards, the medial clavicle appears misplaced superiorly in previous dislocations and posterior inferior dislocations. Fracture of the scapula (less than 1% of all fractures) rarely requires surgery, but should not be ignored because they signal a very high-energy trauma. The posterior shoulder dislocation is 2–4% of all delayed dislocations. Diagnosis is most often attributed to inadequate x-ray photographs. The main causes of this dislocation are epilepsy and electrocution. Radiography in front and profile observed a duplication of the humeral head. Joint space is not completely in view, and the CT scan can confirm the diagnostic if there is any doubt. Fracture of the clavicle is common in young patients. Fractures with lesions of the clavicular vessels and nerves are common. Practitioners also must be wary of intermediate fragments, which can puncture skin. Pneumothorax should always be excluded by a complete chest auscultation. The stump of the shoulder must be minimized in young patients, or an active patient operative indication can have negative functional and aesthetic consequences. Neurovascular examination must be complete, and circonflex nerve damage should not be confused with injury of the rotator cuff. These two injuries reduce abduction. The elbow is complex and a number of lesions could be missed, including: (1) the tip of the coronoid process; (2) epitrochlea and epicondyle; (3) radial head fractures; or (4) pullout capitelum.
(P2-14) Support System for Medical Command and Control at Major Incidents
Authors: Nilsson H. , Lundin R. , Bengtsson E. , Gustafsson L. , Jonsson C. , Vikström T.
Published: May 2011

Introduction

Communication and information are cornerstones of management during major incidents and disasters. To support medical command and control, the Web-based support system called Paratus Major Incident can be used. The Paratus Major Incident system can provide management staff with online information from the incident area, and support management and patient handling at both single and mass-casualty incidents. The purpose of the Web-based information technology (IT) system is to ensure communication and information between the medical management at the scene, hospital management, and regional medical command and control (gold level).

Experiences

In the region of Östergötland, Sweden, Paratus Major Incident system is used in operating topics such as: (1) information dissemination from the incident area; (2) communication between prehospital, regional, and hospital management; (3) continuous updates between the dispatch centre and medical commanders at all levels; (4) digital log-files for medical management and patient records; (4) database used for follow-up studies and quality control.

Results

During 2,161 incidents, 746 “first incident reports” from ambulance on scene were sent to regional medical command and control within 2 minutes. Four hundred and fifty-six “verification reports” were sent within 10 minutes. During 15 incidents, the designated duty officer on regional level confirmed “major incident” directly via the digital system, thereby notifying all arriving ambulance resources and involved medical managements.

Conclusion

This Web-based IT system successfully has been used daily within prehospital management since 2005. The system includes medical command and control at the regional level and all involved hospitals in a major incident.
(P2-16) Study to Assess the Cost Effectiveness of Re- Use of Expensive Disposable Items in a Neurosurgery Intensive Care Unit
Authors: Cj M. , Agarwal D.
Published: May 2011

Background

Certain disposable items such as Percutaneous Tracheostomy (PT) sets and intracranial pressure (ICP) monitoring sets are expensive and a major drain on resources of public funded hospitals.

Aims

To assess the use and cost-effectiveness of reusing expensive disposables (PT& ICP sensor) in a neurosurgery intensive care unit (ICU). Another objective was to assess the importance of bedside Tracheostomy and ICP insertion in an ICU rather than in OT.

Methods

An observational, retro-prospective study was done from January 2008 to November 2010 in the neurosurgical department of JPN Apex Trauma Center. Retrospective data on surgeries performed in Neurosurgery OT were taken for the year 2008 and following introduction of PT and bedside ICP monitoring sets in ICU, prospective data were collected from November 2009 in the neurosurgery ICU. Each set was tagged according to number of times used. A procedure book was maintained, in which each case along with the set used was mentioned.

Results

Of the 1209 surgeries performed in the neurosurgical OT in 2008–2009, 257 were minor procedures (238 open tracheostomy and 19 ICP transducer placements). In 2009–10, 236 percutaneous tracheostomies were performed in the ICU. Of these, 79 (33.4%) were new and 157 (66.5%) were re-used sets. The cost of a new PT set is Rs 15,000. With re-use, the average price per set came down to Rs 5,033. In the same period, 231 disposable ICP transducers were placed with an average of 19 cases per month (range 5–28). Of these, 142 (61%) were new ICP sets and 97 (42%) were ethylene oxide (ETO) sterilized. The cost of new ICP set is Rs 35,000. With re-use, the average price per set came down to Rs 21,515.

Conclusion

Nearly 40% of minor procedures are now excluded from the Neurosurgery OT statistics, as they are being performed in the ICU. This study shows that expensive disposable items can be re-used effectively, bringing immense cost savings to hospitals.
(P2-28) Collaboration Between Nurses and Physicians in the Emergency Department: An Indonesian Study
Authors: Suryanto S.
Published: May 2011

Background

Positive collaboration between nurses and physicians is essential in all areas of care especially in emergency practice. This is because it has a significant relationship with the quality, safety, accountability, and responsibility of care. Three areas are positively related to collaborative interaction between nurses and physicians: provider outcomes, patient outcomes, and organizational outcomes.

Aim

To examine nurses' and physicians' attitudes towards nurse-physician collaboration in the Emergency Department of Dr Saiful Anwar General Hospital, Malang, Indonesia.

Methods

The study was a comparative descriptive quantitative study using a modified Jefferson Scale of Attitude towards Physician-Nurse Collaboration. Data were collected from 47 nurses and 24 physicians who participated in the study. Descriptive statistics, parametric and non-parametric inferential statistics were used to determine group scores and to examine differences between groups, as well as to determine the relationship between demographic characteristics and participants attitudes.

Results

Emergency nurses had significantly more positive attitudes toward collaboration than emergency physicians (p < 0.001). Emergency nurses had significantly higher scores in three of four underlying factors of the instrument: “physician dominance”, “nurse autonomy”, and “caring as opposed to curing”. The effects of gender, age, education, and experience in other hospitals on nurses' and physicians' attitude towards collaboration were not statistically significant. However, experience in the Emergency Department of Dr Saiful Anwar General Hospital was significantly related to participants' attitudes towards collaboration (p = 0.023).

Conclusions

The findings of this study indicate that both organizational and individual strategies should be developed to enhance the nurse-physician collaborative relationship. Inter-professional education may enhance health care professionals' attitudes towards collaboration. A larger and more representative sample is needed for future research, especially examining relationships such as between collaboration of these health professionals and patient outcomes and work place satisfaction.
(P2-30) Development of Disaster and Emergency Medicine in Nepal
Authors: Maharjan R.K.
Published: May 2011

Nepal, a landlocked country between China and India, is developing disaster and emergency medicine. In 2007, the Nepal Disaster and Emergency Medicine (NADEM) Center was formed with the aim of developing this specialty in Nepal. The first hospital was built in July 1889. It wasn't until 1988 that a Disaster Response Team was organized following a stampede incident in the national stadium in Kathmandu. The country often experiences disaster and emergency situations due to geographic and natural hazards and political tensions.

In 1984, the Institute of Medicine, Tribhuvan University Teaching Hospital created emergency services with general practitioners (GPs) directing and providing services. Since then, almost all emergency services of different hospitals are run by GPs with house officers, nurses, and paramedics. There still is a lack of training and proper management, and limited equipment and infrastructure to provide needed disaster and emergency services to the people. The NADEM Center is developing coordination objectives between different emergency service providers to organize ways of service providing. This will be done through NADEM's continuing medical education and publication of Journal of Nepal Disaster and Emergency Medicine (J-NADEM) and NewsHealth; coordination among emergency medical services (prehospital), in-hospital services, and disaster and critical care medicine; and planning and implementation of different research, training, workshops, seminars, and conferences in disaster and emergency medicine with cooperation from the world. The NADEM Center will develop International Institute of Disaster and Emergency Medicine.
(P2-42) Mass-Gathering Risks in the Beijing Subway System
Authors: Du W. , Fitzgerald G.
Published: May 2011

Introduction

Mass gatherings pose a significant risk on health and safety. The mass gathering in the subway systems in Beijing represents a daily risk. An average of 4.52 million passengers rode the subway each day between 15 November and 30 November 2010, with the highest daily passenger number totaling 5.14 million. The purpose of this study is to identify the health and safety aspects of mass gatherings in Beijing subways, and proposes strategies that may mitigate these risks.

Methods

The methods included a literature review, field visitation of the subway systems, and interviews of 20 passengers and 10 management personnel from the subway system.

Results

Many safety and health measures has been taken by the Beijing Subway System, including emergency exit signs and other safety signs, prohibition of smoking, firefighting equipment and explosion-proof tanks, safety inspection of bags, and safety education in the subways. However, additional key health and safety aspects were indentified, including: (1) lack of strict flow control of passengers in interchange subway stations; (2) lack of platform safety gates in Line 1, Line 2, Line 13; (3) lack of passenger control during peak hours; (4) lack of biomedical monitoring systems in the subways; and (5) lack of health facilities and rescue equipments in the subways.

Conclusions

Mass gatherings pose great risks on subway passengers in Beijing, including psychosocial risks, biomedical risks, and environmental risks. Additional safety measures need to be taken to ensure the safety and health of passengers in subways in Beijing.
(P2-47) Emergency Response to a Mass Gathering Involving Hazardous Materials
Authors: Soh A.L. , Lim M.S. , Soh K.K.
Published: May 2011

Mass gatherings involving hazardous materials (HAZMAT) poses unique challenges to the operations of any emergency department. A screening station is essential for risk stratification and identification of HAZMAT casualties. Existing patients and relatives in the emergency department must be restricted and controlled. Prompt segregation and decontamination of casualties is crucial in a HAZMAT incident. Identification of such a facility with planning of inflow and outflow routes must not be undermined. Crowd control should be performed by securing all entrances and exits, minimizing cross-contamination The topography of the emergency department must be examined with the objectives of minimizing acquaintance and cross-contagion in mind. Directional leadership is crucial during chaotic situations. Clarity of thought and decisiveness is critical. Good communication channels must be established with internal and external agencies in all phases of emergency department response. Apart from the acute response mechanism, training is an important factor in enhancing staff preparedness. Regular continuity of education is essential to keep staff up-to-date with the latest procedures and legislation. Drills and audits are useful for assessing staff competency levels. Familiarity and easy accessibility to overall response plans and detailed individual action cards also are important. The availability and adequacy of operationally ready equipments and consumables must not be underestimated. All equipment and consumables must be easily accessible and clearly labeled. Bimonthly audits are recommended to ensure defect-free equipment and validity of consumables. In conclusion, regardless of these difficulties, emergency departments continue to be the main provider of care to contaminated individuals. Thus, it is imperative that all emergency departments in Singapore be vigilant during peace time.
(P2-48) Improve Nursing Disaster Preparedness by Education and Maneuver
Authors: Khankeh H.R. , Masoomi G.R. , Jallali A.R. , Ghanbari V. , Madah S. , Nakhaee M. , Ranjbar M.
Published: May 2011

Introduction

Nurses have pivotal roles before, during, and after disasters. Enhancing their professional skills to help the injured is one the basic principles in health management in disasters. The aim of this study is to investigate the effectiveness of training disaster nursing preparedness on improving the preparedness of nurses.

Method

Using a quasi-experimental method, 113 nurses were selected randomly. The preparedness program, which consisted of a one-day workshop on disaster management, a tabletop exercise, and an operational maneuver, was executed for the participants. The preparedness of all participating nurses was measured by disaster preparedness questionnaire, one week and also one month after the program. Data analysis was performed by using the ANOVA test.

Results

The mean scores of knowledge, attitude, and performance improved from 5.55 to 19.88, from 66.18 to 72.41, and from 3.36 to 12.48, respectively (p < 0.001). In addition, the mean of total preparedness score was increased from 75.14 in pretest to 104.77 in the follow up (p < 0.001).

Conclusions

Preparedness plan training improves participants' preparedness for responding disasters, because preparedness and reliability for responding to disasters is influenced directly by the training courses and previous experiments. Therefore, based on the results obtained in this project, in order to improve the preparedness of nursing staff, including a disaster preparedness plan in academic, educational curriculum and as a continuing educational program is recommended.
(P2-56) Nurses' Knowledge, Skills and Perception Towards Disaster Response and Emergency Preparedness
Authors: Wee F.C.
Published: May 2011

Background

Disaster response and emergency preparedness has taken a bigger role in our daily operations since the advent of events of September 11 2001. It is essential that nurses be prepared and trained to respond to disaster incidents. Nonetheless, we are largely unaware of how our nurses feel about their readiness to respond to these disaster incidents. This study aims to understand our nurses' knowledge, skills and perception towards disaster response and emergency preparedness.

Method

A self administered structured questionnaire survey was conducted for the nurses in our hospital. Using a 5 point Likert scale, the questionnaire covered knowledge, skills and perception of institutional and individual preparedness towards a disaster incident. The data was analyzed using SPSS 17.

Results

A convenient sample of 1143 nurses (response rate 95.5%) was studied over a 2-month period from 1st August to 30th September 2010. 55.7% of the surveyed nurses have not attended any training in disaster response. Despite that, more than 50% of them scored correctly in term of their knowledge in different types of disaster incidents. 75.3% of them have not been trained to don the HAZMET suite within the last 2 years. 72.9% do not know where to get the HAZMET suit in the event of a chemical incident. While 80.2% felt that the institution is able to respond to any disaster incident, only 41.3% felt that they were ready. In addition, 83.6% were willing to participate in future disaster incident response training. 77.1% agreed that being able to respond to a disaster incident should be part of their professional competency.

Conclusions

There is a need for the hospital to incorporate disaster preparedness into nursing education curriculum as a clinical core skill to ensure that nurses are ready to respond to disaster incidents.
(P2-57) When a Glue Sniffer Turns Weak
Authors: Poh J.
Published: May 2011

Introduction and Discussion

Inhalant abuse has become less common in Singapore. Awareness of glue sniffing and its complications has decreased among local physicians. Prolonged toluene exposure can result in renal tubular acidosis, with electrolyte and acid-base derangements, and should be considered in the differential diagnosis of any young patient with unexplained hypokalaemic periodic paralysis and normal anion gap metabolic acidosis. We present a typical case to illustrate the abnormalities and to heighten awareness among emergency physicians who may not have laboratory results on hand when evaluating causes of limb weakness.
(P2-60) Thyroid Storm in the Emergency Department
Authors: Van veelen M.J. , Yurtsever L. , Baggen M. , Dubois E.A.
Published: May 2011

Case

A 20-year-old woman was referred to the emergency department with rapid acceleration of complaints of palpitations, fever, diarrhea, and agitation that had been present for several weeks. During physical examination, the patient was uncomfortable and restless with a tachycardia of 170/minute, and a fever of 38.5 °C. Palpation of the neck revealed a small ventral, painless, solid elastic mass, more prominent on the right side, clinically suspicious for goiter. An electrocardiograph showed an atrial flutter of 150/min. Initial laboratory results showed an erythrocyte sedimentation rate of 35 mm/hour (0–20 mm/hour) and urine analysis tested positive for ketones.

Outcome and Treatment

The patient was presumed to be suffering from a thyroid storm. She was treated promptly with Propranolol 160 mg and Thiamazole 30 mg twice daily at the emergency department. She was admitted to the Cardiac Care Unit for observation of the heart rhythm, which slowed down to 110/minute the same day and her condition improved clinically. The following day her laboratory result confirmed the diagnosis with a thyroid-stimulating hormone of < 0.01 mIU/L (0.4–4.0 mIU/L) and a free thyroxine (T4) of > 75 pmol/l (10–22 pmol/l). Eventually, she was diagnosed with Graves Disease.

Discussion

Thyroid storm is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones. The adult mortality rate is high (90%) if early diagnosis is not made and the patient is left untreated. Therefore, in case of clinical suspicion for thyroid storm, it is critical to start prompt treatment with Beta blockade and Thiamazole before the diagnosis can be confirmed biochemically.
(P2-68) Mental State of Healthcare Workers in a Designated H1N1 Screening Center
Authors: Seow E. , Hsin kai G. , Vasu A.
Published: May 2011

Introduction

In Singapore, the H1N1 outbreak lasted 108 days. The study emergency department (ED) was designated as Singapore's H1N1 screening centre for the borders and the country's primary care centers. Our aim was to determine the psychological morbidity among ED physicians, nurses, administrative and ancillary staff during the H1N1 outbreak.

Methods

We conducted a survey on all ED healthcare worker (n = 305) using the 12-item General Health Questionnaire (GHQ-12). The bimodal scoring of GHQ-12 was dichotomised into non-cases (score 0 – 2) and potential cases (score ≥ 3). Participation was strictly voluntary.

Results

The overall response rate was 273 (89.5%). Most respondents were females (73.3%); the mean age was 33 (SD 10.6) years. The mean GHQ score was found to be 1.9 (SD 2.7) with no gender-related differences. A comparison of the dichotomised GHQ-12 scores, found psychological morbidity to be more common in administrative staff (40%) and physicians (38.1%) than ancillary (24.2%) and nurses (19%) (p = 0.011). The average prevalence of psychological morbidity among ED staff was 25.3%. When we considered the 12 items of the GHQ separately and analyzed them by occupational group, we found physicians scoring the worst on item 6 - “Could not overcome difficulties” - than nurses, administrative and ancillary staff (p < 0.001). Physicians and administrative staff alike felt constantly under strain and were unable to concentrate compared to nurses and ancillary staff (p = 0.001).

Conclusion

Healthcare workers in an emergency setting unlike those in the rest of the hospital, face a wide range of risks on the job and this has a substantial effect on their mental well-being and job satisfaction.
(P2-70) A Systematic Search and Narrative Review of Existing Literature on the Medium and Long-Term Impact of Injuries
Authors: Turner J. , Chanakira E.
Published: May 2011

Background

A systematic search and narrative review of existing literature on the medium- and long-term impacts of injuries was conducted to provide context for a primary research study.

Methods

Searches were undertaken in MEDLINE, CINHAL and Science Citation Index using a combination of free text and Medical Subject Heading (MeSH) terms. Studies were included if they assessed outcomes following injury at least six months post-injury and reported morbidity-related outcomes. A standardized data extraction form was developed, and studies were assessed for quality using standard quality assessment criteria. The main characteristics of included studies were presented in structured tables and synthesized using a narrative summary.

Results

The search strategy identified 4,969 abstracts and/or titles, of which 125 appeared relevant. Following a detailed reading of the material, 32 studies met the inclusion criteria of this review. Summarizing the results of the studies was difficult, as they were of moderate quality and used many different methods. The main findings were that at 12 months post-injury a proportion of injured patients continue to suffer from physical, psychological, and social problems and this proportion doesn't decline over the next few years. In the medium term (12 months–5 years) about 10–25% of casualties continue to report a variety of health problems associated with their injuries.

Conclusions

It is difficult to synthesize injury outcome studies because of the varying methodological approaches, study populations, follow-up periods, and outcome measures used. The evidence that exists suggests that many casualties demonstrate good early recovery but a significant proportion still show significant social, physical, and psychological sequelae one to five years post-injury.
(P2-71) Topometric Agent-Based System for Disaster and Emergency Medicine
Authors: Trufanov A. , Rossodivita A. , Tikhomirov A. , Caruso A. , Dmitrienko N. , Gursky E. , Laporte R. , Linkov F. , Shunbikov E.
Published: May 2011

Introduction

A variety of models, methods, and computer-aided systems have been used to predict and analyze disasters and emergencies, and manage a pertinent medical response effectively. The list of these instruments traditionally comprises: computerized databases, geographic information systems (GISs), graph theory, complex networks, mathematical programming, simulation, and agent-based modeling. As a rule, each type of those is applied asunder. It makes sense to put in one silo diverse instruments to get multidisciplinary solution with its synergy effect for problems of disaster and emergency medicine.

Methods

Within this study, an original, agent-based model was developed. The model combines the advantages of the principal computer-aided instruments and considers all the types of information: semantic, topographical, metric, and topological. The model is severely dynamic, fits to real actors and principally covers all the disaster situation.

Results

In line with the model, a so called Topometric Agent-Based System (TABS) with its key visualization component has been designed. A TABS-specific simulation to investigate behavior of the attacked network of vulnerable actors has been conducted leading to critical findings. It has been shown a severe significance of order within combination of threats: man-made + natural or those of natural + man-made. A well-balanced financial distribution to protect actors of diverse status also has been found.

Conclusions

A TABS similar to GIS focuses on mapping. Topometric Agent-Based System mapping brings an efficient and clear language for information sharing not only within national emergency medical services but between experts from different fields and countries.
(P2-72) Diagnostic Accuracy of Bedside Ultrasound for Identifying Fractures in Patients with Orthopedic Trauma Presenting to the Emergency Department of a Level-1 Trauma Center - Aims Ultrasound Fracture Study
Authors: Sinha T.P. , Bhoi S. , Bhasin A. , Rodha M. , Kumar S.
Published: May 2011

Background

Radiography is the standard observation tool for examining orthopedic injuries. Bedside Ultrasound (BUS) may be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures.

Methods

Prospective observation study with convenience sampling was conducted in ED in patients > 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were performed by a emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopedic specialist. Statistical analysis was done by SPSS.

Results

A total of 133 patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI = 0.95–1.00. The positive predictive value (PPV) of USG was 100% with a CI = 0.86–1.00 and negative predictive value (NPV) of 93.8% with a CI = 0.86–0.97. There were six additional fractures which were recognized on x-ray and were not picked up by ultrasound.

Conclusions

BUS can be utilized by EP after brief training to accurately identify long-bone fractures. It may gain a more prominent role in pregnant and pediatric population as well as in mass-casualty scenarios.
(P2-79) Retrospective Review of Mortality in Patients with Traumatic Brain Injury from Rural India
Authors: Baisakhiya N. , Agrawal A. , Kakani A. , Galwankar S. , Dwivedi S.
Published: May 2011

Objective

Trauma is one of the leading causes of morbidity and mortality across the world with traumatic brain injury (TBI) being an important cause of trauma related deaths. The aim of our study was to review the medical charts of patients who died within 24 hours of presentation to our Hospital after head injury.

Methods

We received approval from the institutional review board to conduct a retrospective review of patient charts at Acharaya Vinoba Bhave Rural Hospital, in Sawangi (M), Maharashtra (India). All patients who died within 24 hours of the presentation to the emergency department (ED) and had been diagnosed with TBI were included in the study. We collected data from 113 charts between January 2007 and December 2009.

Results

During this three year period, 113 patients died within 24 Hours of admission to the hospital. Of these, 37% (42/113) were diagnosed with (TBI). We conducted a chart review of these 42 patients. All our patients were brought to the ED by relatives or bystanders in non-ambulance vehicles. At the time of presentation to the ED, nearly all patients were normotensive, with only one patient with hypotension The Majority of our patients had a Glasgow Coma Scale of less than 5.

Conclusion

Our study brings to light various deficiencies in rural India, trauma care which include immediate rescue and transportation. Although patients were provided the optimum care in the ED, however it was not associated with favorable outcome. This highlights the need of a Trauma Registry to record real-time data which will help to improve care and systems.
(P2-81) A Survey of the Health Effects of Bushfire Smoke on Patients Attending Two Sydney Emergency Departments
Authors: Watkins G.O.
Published: May 2011

The objective of this survey was to investigate the incidence of respiratory symptoms reported by emergency department patients during the Christmas 2001–2002 Sydney bushfire disaster. Two hundred and thirty patients attending two Sydney emergency departments for any reason completed questionnaires regarding respiratory symptoms. The symptoms investigated were cough, shortness of breath, chest tightness and wheeze. The same questionnaire was subsequently administered to a similar control group who were not exposed to bushfire smoke. 51% of those surveyed during the bushfires reported one or more of the respiratory symptoms investigated compared to 31% of the control group. This difference was statistically significant (p < 0.01). A significantly higher proportion of respiratory patients in the study group reported an exacerbation of their condition and increased medication use during the bushfires (p < 0.01). The results are consistent with other research on the subject and suggest that exposure to bushfire smoke causes an increased incidence of respiratory pathology.
(P2-84) Upper Gastrointestinal Tract Bleeding (UGIB) Management: Belgian Guidelines for Adults and Children
Authors: Dhondt E.L. , Penaloza A. , Colle I. , Wilmer A. , Laterre P. ,   Belgian interuniversity UGIB guidelines consensus group
Published: May 2011

Background

UGIB remains a common disease affecting 100 to 170 adults per year, with an associated mortality ranging from 5 to 14%, causing thereby an important burden to healthcare resources. UGIB in children is uncommon (1–2/10,000 per year) but potentially life threatening. Since various specialists (general practitioners, emergency physicians, gastroenterologists and hepatologists, pediatricians, intensivists, radiologists and surgeons) may be involved and given the absence of evidence-based medical (EBM) recommendations - for adults as well as for children - there is considerable variability in the management of UGIB. Moreover, as even RCTs on the management of UGIB in children are lacking, many treatment strategies are simply deducted from the management of adult UGIB.

Aim

To provide EBM guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture.

Method and Results

An interuniversity interdisciplinary team of Belgian experts was launched. Statements based on the published literature up to September 2010 were collected and proposed after expert opinions reconciliation and graded accordingly to the class of evidence. The current guidelines for the management of UGIB include recommendations for the diagnosis process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension induced bleeding. Specificities and differences in the approach to UGIB in children compared to adults are highlighted.

Conclusion

Interdisciplinary guidelines for the management of UGIB based on current standards for EBM will provide an opportunity for clinicians to improve the management of their patients. However, clinical guidelines are not mandatory tenets appropriate for all patients, but should constitute a canon or principle tailored to the individual patient. In addition, EBM might provide quality indicators for the assessment of care to bleeding patients at a local, national or international level.
(P2-94) How One Group of Physicians Helped a Busy Emergency Department
Authors: Hu J. , Xu J. , Botler J. , Haydar S.
Published: May 2011

A pilot admission leadership physician (ALP) program was experimented within a 693-bed, tertiary medical center with a 60-bed emergency department. This trial was intended to investigate whether having a physician triage potential patients would shorten patients' length-of-stay in the emergency department. After a emergency physician evaluated patients, ALP triaged them. The ALP ordered the appropriate bed for the patients if they qualified for the inpatient criteria, choosing among medical, medical telemetry, cardiac telemetry, intermediate care, or intensive care bed. The mean patient door-to-bed order time (time between patients reaching the emergency department to time to bed ordered by ALP) is 330.7 minutes (n = 234, SD = 151.68, 95% CI = 310.21–351.28) with ALP involvement. Compared with the mean door-to-bed order time of 337.8 minutes (n = 827, SD = 149.71, 95%CI = 326.98–348.57) without ALP, ALP shortened the waiting time by 7.09 minutes. During the same period, the door-to-physician time was 41.38 minutes (SD = 38.87 95%CI = 36.38–46.39), compared with 39.52 minutes (SD = 40.32, 95%CI = 36.77–42.27) before ALP. The time for patients waiting in the emergency department for other services such as surgery, psychiatry, and pediatrics also have decreased accordingly. Incorrect medical admissions such as scrambling to get the patient to the intensive care unit right after seeing patients has decreased (data not provided). Identifying physicians as physicians in the emergency department who triage potential admissions also has improved efficiencies within the hospital medicine group and bonding with ER physicians.
(P2-100) Prognosis of Unknown and Unattended Patients in the Neurosurgical Department
Authors: Mathew A.S.
Published: May 2011

Background

In 2009 in Delhi, 7,516 road traffic crash victims were admitted to hospitals as unknown or unattended.

Objective

The aim of this study was to assess the morbidity and mortality of unknown or unattended patients and problems they faced relative to the provision of nursing care.

Methods

This is a retrospective analysis from February 2010 to August 2010 wherein all unknown or unattended patients with head injuries (Glasgow Coma Scale (GCS) score = 1–15) admitted to the neurosurgery department were included. The duration of hospital stay, admission GCS, and outcome were assessed and an attempt also was made to analyze the problems faced by nursing personnel.

Observations

The total number of patients enrolled was 38. Of these, 22 were unknown, and 16 were unattended. The average hospital stay of unknown and unattended victims was 35 (1–151), and 21 (7–120) days, respectively. The mean GCS score of unknown patients upon admission was 9 (3–15), and during discharge, 8 (3–15). The mean GCS scores of unattended patients during admission and discharge was 12 (13–15) and 14 (3–15). respectively. Of the 22 unknown patients, 24% were identified during their stay, 33% were transferred to rehabilitation homes, and 43% died without being identified. Of the 16 unattended patients, 25% went home, 63% were transferred to rehabilitation homes, and 12% expired. The most common problems faced during nursing care were contractures (8%) and pressure sores (11%), due mainly to their long hospital stays.

Conclusions

Patients remaining unknown/unattended is a unique problem as far as developing countries are concerned. Managing these patients is difficult, as they occupy hospital beds for a longer duration, and require more nursing care, and have higher mortality and morbidity. It remains surprising that in spite of advancements in the field of mass communication, almost 76% of the unknown patients remain unidentified.
Diversity of seed storage proteins in common wheat (Triticum aestivum L.)
Authors: Šramková Zuzana , Gregová Edita , Šliková Svetlana , Šturdík Ernest
Published: May 2011

The objective of our study was to determine the composition of high-molecular weight-glutenin subunits (HMW-GS) in 120 cultivars of common wheat (Triticum aestivum L.). Fourteen alleles and 34 allelic compositions were detected using sodium dodecyl sulphate-polyacrylamide gel electrophoresis. The most frequent HMW-GS alleles at the Glu-A1, Glu-B1 and Glu-D1 loci were null (57.1%), 7+9 (43.3%) and 5+10 (61.9%), respectively. However, low-frequency HMW-GS alleles were also observed, such as 13+16, 20, 21, 7 and 18, encoded by the Glu-B1 locus, and 4+12, encoded by the Glu-D1 locus. The wheat–rye 1BL.1RS translocation was identified in 25 cultivars, using acid polyacrylamide gel electrophoresis. The Glu-score varied greatly, and some lines reached the maximum value of 10.
The Cochrane Collaboration as key player in the struggle for better and more relevant patients- and system-oriented research
Authors: Liberati A.
Published: May 2011

The Cochrane Collaboration represents a quite successful example of a grass roots international effort aimed at contributing the growing demand for valid and reliable information on the effects of health care intervention, eagerly sought by consumers, patients, doctors and policy makers worldwide. The Cochrane Collaboration is fully aware that part of its success is due to the originality of its founding principles and that the challenge ahead is to maintain its ‘Cochrane Collaboration brand’ while understanding how a mature organisation can cope with the expectations of the relevant stakeholders with whom it seeks to collaborate. In this editorial reference is made to the strategic reflections emerged from the internal review that the organisation has recently completed to guide its years ahead.
(U‐Th)/He dating of terrestrial impact structures: The Manicouagan example
Authors: van Soest Matthijs C. , Hodges Kip V. , Wartho Jo‐Anne , Biren Marc B. , Monteleone Brian D. , Ramezani Jahandar , Spray John G. , Thompson Lucy M.
Published: May 2011

The accurate dating of meteorite impact structures on Earth has proven to be challenging. Melt sheets are amenable to high‐precision dating by the U‐Pb and 40Ar/39Ar methods, but many impact events do not produce them, or they are not preserved. In cases where high‐temperature shock metamorphism of the target materials has occurred without widespread melting, these isotopic chronometers may be partially reset and yield dates that are difficult to interpret unambiguously as the age of impact. However, the (U‐Th)/He chronometer is sensitive to thermal resetting and can provide a powerful new tool for dating impactites. We report (U‐Th)/He dates for accessory minerals from the Manicouagan impact structure in Quebec, Canada. Nine zircons from a melt sheet sample yield a weighted mean age of 213.2 ± 5.4 Ma (2SE), indistinguishable from the published 214 ± 1 Ma (2σ) U‐Pb zircon age for the impact. In contrast, five apatites from this sample yield dates between 205.9 ± 6.5 and 162.0 ± 5.3 Ma (2σ), indicating variable postimpact helium loss due to low‐temperature thermal disturbance. Preimpact titanite crystals from a shocked meta‐anorthosite sample yield two dates consistent with the impact age, at 212 ± 27 and 214 ± 13 Ma (2σ), and two younger dates of 189.6 ± 6.9 and 192.2 ± 9.8 Ma (2σ), suggestive of postimpact helium loss. These results indicate that (U‐Th)/He chronometry is a suitable method for dating impact events, although interpretation of the results requires recognition of possible 4He loss related to reheating subsequent to impact.
Fuzzy probabilistic design of water distribution networks
Authors: Fu Guangtao , Kapelan Zoran
Published: May 2011

The primary aim of this paper is to present a fuzzy probabilistic approach for optimal design and rehabilitation of water distribution systems, combining aleatoric and epistemic uncertainties in a unified framework. The randomness and imprecision in future water consumption are characterized using fuzzy random variables whose realizations are not real but fuzzy numbers, and the nodal head requirements are represented by fuzzy sets, reflecting the imprecision in customers' requirements. The optimal design problem is formulated as a two‐objective optimization problem, with minimization of total design cost and maximization of system performance as objectives. The system performance is measured by the fuzzy random reliability, defined as the probability that the fuzzy head requirements are satisfied across all network nodes. The satisfactory degree is represented by necessity measure or belief measure in the sense of the Dempster‐Shafer theory of evidence. An efficient algorithm is proposed, within a Monte Carlo procedure, to calculate the fuzzy random system reliability and is effectively combined with the nondominated sorting genetic algorithm II (NSGAII) to derive the Pareto optimal design solutions. The newly proposed methodology is demonstrated with two case studies: the New York tunnels network and Hanoi network. The results from both cases indicate that the new methodology can effectively accommodate and handle various aleatoric and epistemic uncertainty sources arising from the design process and can provide optimal design solutions that are not only cost‐effective but also have higher reliability to cope with severe future uncertainties.
Note: Radio frequency surface impedance characterization system for superconducting samples at 7.5 GHz
Authors: Xiao B. P. , Reece C. E. , Phillips H. L. , Geng R. L. , Wang H. , Marhauser F. , Kelley M. J.
Published: May 2011

A radio frequency (RF) surface impedance characterization (SIC) system that uses a novel sapphire-loaded niobium cavity operating at 7.5 GHz has been developed as a tool to measure the RF surface impedance of flat superconducting material samples. The SIC system can presently make direct calorimetric RF surface impedance measurements on the central 0.8 cm2 area of 5 cm diameter disk samples from 2 to 20 K exposed to RF magnetic fields up to 14 mT. To illustrate system utility, we present first measurement results for a bulk niobium sample.
Internal specular reflection from nanoparticle layers on the end face of optical fibers
Authors: Gouvêa Paula M. P. , Jang Hoon , Carvalho Isabel C. S. , Cremona M. , Braga Arthur M. B. , Fokine Michael
Published: May 2011

Metal nanoparticles deposited on a dielectric substrate exhibit an absorption peak due to localized surface plasmon resonance (LSPR). Changes in the refractive index of the surrounding medium cause the LSPR band to shift in wavelength. In this paper, gold nanoparticles were placed on the end face of an optical fiber spliced to a reflection setup. As expected in reflection geometries, the back-reflected signal exhibits a dip at wavelengths in the LSPR band when the fiber tip is surrounded by ambient air (n = 1). However, as the refractive index of the surrounding medium is increased, there is a gradual inversion from a dip (n = 1.0) to a peak (n = 2.0). To explain these results, a model based on absorption and interference between the specular reflections from the fiber/nanoparticle and nanoparticle/ambient interfaces is proposed, showing that our reflection configuration can be used in sensing applications.
Aluminum and tungsten X-pinch experiments on 100 kA, 100 ns linear transformer driver stage
Authors: Wu Jian , Sun Tie-Ping , Wu Gang , Wang Liang-Ping , Han Juan-Juan , Li Mo , Cong Pei-Tian , Qiu Ai-Ci , Lv Min
Published: May 2011

X-pinch experiments have been carried out on a 100 kA, 100 ns linear transformer driver stage recently built up. The X-pinches exhibited a source size of about 10 μm, a pulse duration of 3 ns, 3–5 keV radiation energy of 3.9 mJ, and a burst time jitter of tens of nanosecond with the 2-wire 8 μm W X-pinch load. The generator output current and the X-pinch characteristics depended on the X-pinch wire materials in the tests. X-ray backlighting images from the insects showed the significant phase-contrast effect.