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BACKGROUND: Road traffic accidents (RTAs) are an emerging public health issue of global concern causing 1.35 million deaths per year. They are the leading cause of death among 5-29 years who contribute to the future and current productive population of the country. The outcome of mortality and permanent disability are public health concerns. We determined the factors associated with RTAs among medical undergraduates and assessed their knowledge of road traffic rules. MATERIALS AND METHODS: This study had 500 medical undergraduates from a tertiary hospital located in Chengalpattu district, Tamil Nadu. Data were collected using questions from "Road safety question bank" issued by Ministry of Road Transport and Highways, Government of India, sent as Google forms to students. Descriptive statistics were used and multivariate analysis was performed to identify risk factors associated with RTAs. RESULTS: The mean age of the students was 21.4 (standard deviation = 1.7) years. About 30.4% of students suffered from RTAs in the past 2 years. Practice of drunken driving and mobile phone usage showed significant association with RTA occurrence (P < 0.001). Multiple logistic regression revealed that students crossing speed limits and jumping signals had 3.19 and 2.04 times more risk of sustaining RTAs. Seventy-five percent of students had good knowledge on road traffic rules. CONCLUSION: Nearly half the subjects have suffered RTA in the past 2 years. Students who over speed, jumped signals and used mobile phones while driving sustained more RTAs. Overall, road traffic rules knowledge was satisfactory. Students need education on risky driving behaviors and aftermath of crashes.
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Donor kidney volume (KV) is an increasingly important parameter evaluated before living kidney donation; however, KV measurements on computed tomographic (CT) scanning requires a manually intensive process of manual or semiautomatic segmentation of kidneys with interobserver variation. Renal artery diameter (RAD) is an easier marker to measure, and this study aims to investigate the relationship between donor RAD and KV. METHODS: A retrospective review of 77 patients who underwent living donor nephrectomy was conducted. Bilateral KVs were measured based on contrast-enhanced CT scan imaging, and renal artery maximum diameter was measured by direct visualization on the arterial phase of transverse CT sections. RESULTS: On regression analysis, there was a significant association between the right and left RADs and their ipsilateral KVs with a regression coefficient of 7.9 (95% CI, 1.3-14.5; P = .02) and 9.8 (95% CI, 3.3-16.3; P = .004), respectively. Mean total RAD correlated with total KV with a regression coefficient of 9.3 (95% CI, 3.8-14.7; P = .001) and weakly correlated with estimated glomerular filtration rate with a Pearson coefficient of .10. CONCLUSIONS: This study demonstrates that renal artery size is positively associated with KV and may be used as an easily measured surrogate marker for kidney size with its attended implications in living donor transplantation.
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Trasplante de Riñón/métodos , Donadores Vivos , Arteria Renal/diagnóstico por imagen , Adulto , Femenino , Humanos , Riñón/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
INTRODUCTION: The aim of the study is to investigate the effect of using Automated External Defibrillator (AED) audiovisual feedback on the quality of cardiopulmonary resuscitation (CPR) in a manikin training setting. MATERIALS AND METHODS: Five cycles of 30 chest compressions were performed on a manikin without CPR prompts. After an interval of at least 5 minutes, the participants performed another 5 cycles with the use of real time audiovisual feedback via the ZOLL E-Series defibrillator. Performance data were obtained and analysed. RESULTS: A total of 209 dialysis centre staff participated in the study. Using a feedback system resulted in a statistically significant improvement from 39.57% to 46.94% (P=0.009) of the participants being within the target compression depth of 4 cm to 5 cm and a reduction in those below target from 16.45% to 11.05% (P=0.004). The use of feedback also produced a significant improvement in achieving the target for rate of chest compression (90 to 110 compressions per minute) from 41.27% to 53.49%; (P<0.001). The mean depth of chest compressions was 4.85 cm (SD=0.79) without audiovisual feedback and 4.91 (SD=0.69) with feedback. For rate of chest compressions, it was 104.89 (SD=13.74) vs 101.65 (SD=10.21) respectively. The mean depth of chest compression was less in males than in females (4.61 cm vs 4.93 cm, P=0.011), and this trend was reversed with the use of feedback. CONCLUSION: In conclusion, the use of feedback devices helps to improve the quality of CPR during training. However more studies involving cardiac arrest patients requiring CPR need to be done to determine if these devices improve survival.
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Reanimación Cardiopulmonar/instrumentación , Desfibriladores , Retroalimentación , Adulto , Recursos Audiovisuales , Reanimación Cardiopulmonar/métodos , Femenino , Humanos , Masculino , Maniquíes , Persona de Mediana Edad , Presión , Estudios Prospectivos , Tórax , Adulto JovenRESUMEN
The implementation of guidelines released by the National Resuscitation Council in 2006 involved all the main areas of resuscitation, especially basic life support and defibrillation. The emphasis was on community training, creation of simplified programmes, combining cardiopulmonary resuscitation (CPR) and defibrillation, and using simpler training devices. As a result, public access defibrillation programmes have been increasingly implemented together with the CPR + automated external defibrillator programmes. A large number of instructors have also been trained.
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Reanimación Cardiopulmonar/educación , Reanimación Cardiopulmonar/métodos , Servicios de Salud Comunitaria/métodos , Paro Cardíaco/terapia , Reanimación Cardiopulmonar/normas , Desfibriladores , Educación en Salud/métodos , Humanos , Guías de Práctica Clínica como Asunto , Desarrollo de Programa , Singapur , Sociedades MédicasRESUMEN
The main emphasis in the Advanced Cardiac Life Support (ACLS) guidelines are in the areas of good quality chest compressions, ensuring normoventilation, removal of atropine from the cardiac arrest algorithm, removal of the use of the endotracheal route for drug administration, and renewed focus on the care provided after return of spontaneous circulation. In addition, the need for monitoring of quality of the various care procedures is emphasised. While the various ACLS procedures are being carried out, there is a need to minimise interruptions to chest compressions for maintenance of coronary perfusion pressures. In addition, the resuscitation team needs to continually look out for reversible causes of the cardiac arrest.
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Arritmias Cardíacas/terapia , Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/normas , Paro Cardíaco/terapia , Guías de Práctica Clínica como Asunto , Antiarrítmicos/uso terapéutico , Competencia Clínica , Desfibriladores/normas , Servicios Médicos de Urgencia/métodos , Humanos , Intubación/métodos , Singapur , SobrevidaRESUMEN
There is debate as to whether chest compression-only cardiopulmonary resuscitation (CC-CPR) or standard 30:2 CPR should be taught to laypersons. Equivalence in outcomes between standard CPR and CC-CPR has been amply demonstrated in communities with short ambulance response times of about five minutes. Depriving oxygen from a collapsed patient beyond six minutes results in poorer outcomes. Communities with prolonged ambulance travel times have seen improved outcomes with CPR than CC-CPR. While healthcare workers demonstrate a reluctance to perform mouth-to-mouth ventilation, laypersons generally show a willingness to do so. Rescuer fatigue also argues against the use of CC-CPR for more than a few minutes. For communities with relatively long ambulance transport times, the best approach appears to be standard CPR, with emphasis on good quality compression. For dispatcher-assisted CPR, communication issues suggest that CC-CPR is advisable. Public CPR training should include teaching of mouth-to-mouth ventilation alternating with chest compressions.
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Reanimación Cardiopulmonar/métodos , Reanimación Cardiopulmonar/psicología , Conocimientos, Actitudes y Práctica en Salud , Paro Cardíaco Extrahospitalario/terapia , Guías de Práctica Clínica como Asunto , Ambulancias , American Heart Association , Animales , Reanimación Cardiopulmonar/normas , Servicios Médicos de Urgencia/métodos , Fatiga , Humanos , Singapur , Sobrevida , Estados UnidosRESUMEN
Following restoration of pulse after the institution of cardiopulmonary resuscitation, defibrillation and perhaps, the initial resuscitative drugs, there is a greater challenge of maintaining that heartbeat for at least the next 24 hours, which can better ensure a high likelihood of the patient being discharged alive from the hospital. A bundle of procedures, which may need to be administered simultaneously, is required. These include prompt identification and treatment of the cause of cardiac arrest, with early consideration for procedures such as percutaneous coronary interventions and fibrinolytics, and treatment of electrolyte abnormalities. In addition, a definitive airway and normocapnoeic ventilation without causing hyperoxaemia, together with rational management of haemodynamics with intra-arterial and central venous lines and vasoactive agents will be crucial. Additional benefit is possible with appropriate forms of early goal-directed therapy and achieving therapeutic hypothermia within the first few hours, followed by gradual rewarming and ensuring glycaemic control by maintaining blood sugars within a range of 6-10 mmol /L. All these would be important and need to be continued for at least 24 hours, together with a series of measures to control neurological reactions and monitor neurological responses for best effect. Creation of a bundle that incorporates these various aspects of care would more likely ensure that most patients who achieve return of spontaneous circulation may be discharged alive from the hospital with optimal neurological function.
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Reanimación Cardiopulmonar/métodos , Cuidados Críticos/métodos , Paro Cardíaco/terapia , Glucemia , Lesiones Encefálicas/prevención & control , Enfermedades Cardiovasculares/complicaciones , Paro Cardíaco/complicaciones , Humanos , Hiperglucemia/prevención & control , Hipoglucemia/prevención & control , Hipotermia Inducida , Sobrevida , Resultado del TratamientoRESUMEN
Survival rates for in-hospital cardiac arrests are disappointing. Even though such arrests are often witnessed by a nurse, inadequate training may cause these first responders to have to wait for Advanced Cardiac Life Support trained personnel to arrive to perform defibrillation. The introduction of automated external defibrillator (AED) use by nurses was designed to address this problem, but studies have revealed that AED use is associated with a lower rate of survival after in-hospital cardiac arrest compared with no AED use. Interruption to cardiopulmonary resuscitation during the AED advisory mode is the likely reason for these unexpected results. Hence, courses like the Life Support Course for Nurses, which trains nurses to recognise collapse rhythms and to institute manual defibrillation, are extremely important. Barriers to the practice of advanced life support by nurses and recommendations for the prevention and management of in-hospital cardiac arrest are discussed.
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Apoyo Vital Cardíaco Avanzado/educación , Competencia Clínica , Educación en Enfermería/métodos , Paro Cardíaco/terapia , Apoyo Vital Cardíaco Avanzado/métodos , Arritmias Cardíacas/complicaciones , Desfibriladores , Paro Cardíaco/complicaciones , Hospitales , Humanos , Singapur , SobrevidaRESUMEN
Singapore has a long way to go to becoming a 'heartsafe' society. Given our small size and culture of hard work in our country, we can achieve a state of good first response by our community citizens through public cardiopulmonary resuscitation and automated external defibrillators training programmes at various key sectors and through the implementation of public access defibrillation in a committed manner. For our second-line responders, investing in technology to improve response times and quality of chest compressions with earlier interventions will go a long way toward strengthening the chain of survival in the community. Building on this strong foundation and having a strong hospital-based cardiac arrest management system will ensure that those who achieve return of spontaneous circulation will more likely remain alive and be discharged from hospital in a neurologically optimal state.
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Reanimación Cardiopulmonar/educación , Servicios Médicos de Urgencia/métodos , Paro Cardíaco/terapia , Resucitación/educación , Reanimación Cardiopulmonar/métodos , Servicios de Salud Comunitaria/métodos , Desfibriladores , Humanos , Desarrollo de Programa , Resucitación/métodos , Instituciones Académicas , SingapurRESUMEN
This review of 2,586 renal biopsies over the past 3 decades in Singapore documents the changing pattern of glomerulonephritis (GN) from that of a third world country to that of a developed nation. In the 1st decade, mesangial proliferative glomerulonephritis was the most common form of primary GN, just as it was in the surrounding Asian countries. In the 2nd decade, the prevalence of mesangial proliferative GN decreased with a rise in membranous, GN which is also seen in China and Thailand. In the 3rd decade, there was a dramatic increase in focal sclerosing glomerulosclerosis. This increase reflects aging and obesity in keeping with more developed countries like Australia, India, Thailand and the United States of America. IgA nephritis remains the most common GN. Apart from the geographical influence, other socioeconomic factors play a significant role in the evolution of the renal biopsy pattern. Mesangial proliferative GN remains prevalent in many Asian countries, but in Singapore the prevalence is decreasing just as it is in Japan, Korea and Malaysia. Worldwide, the prevalence of focal sclerosing glomerulosclerosis continues to increase in many countries.
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Glomerulonefritis/epidemiología , Riñón/patología , Adolescente , Adulto , Anciano , Biopsia , Distribución de Chi-Cuadrado , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Femenino , Mesangio Glomerular/patología , Glomerulonefritis/patología , Glomerulonefritis por IGA/epidemiología , Glomerulonefritis por IGA/patología , Glomerulonefritis Membranoproliferativa/epidemiología , Glomerulonefritis Membranoproliferativa/patología , Glomerulonefritis Membranosa/epidemiología , Glomerulonefritis Membranosa/patología , Glomeruloesclerosis Focal y Segmentaria/epidemiología , Glomeruloesclerosis Focal y Segmentaria/patología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Prevalencia , Medición de Riesgo , Factores de Riesgo , Singapur/epidemiología , Factores de Tiempo , Adulto JovenRESUMEN
OBJECTIVES: This study aimed to determine if a deployment strategy based on geospatial-time analysis is able to reduce ambulance response times for out-of-hospital cardiac arrests (OOHCA) in an urban emergency medical services (EMS) system. METHODS: An observational prospective study examining geographic locations of all OOHCA in Singapore was conducted. Locations of cardiac arrests were spot-mapped using a geographic information system (GIS). A progressive strategy of satellite ambulance deployment was implemented, increasing ambulance bases from 17 to 32 locations. Variation in ambulance deployment according to demand, based on time of day, was also implemented. The total number of ambulances and crews remained constant over the study period. The main outcome measure was ambulance response times. RESULTS: From October 1, 2001, to October 14, 2004, a total of 2,428 OOHCA patients were enrolled into the study. Mean ± SD age for arrests was 60.6 ± 19.3 years with 68.0% male. The overall return of spontaneous circulation (ROSC) rate was 17.2% and survival to discharge rate was 1.6%. Response time decreased significantly as the number of fire stations/fire posts increased (Pearson χ(2) = 108.70, df = 48, p < 0.001). Response times for OOHCA decreased from a monthly median of 10.1 minutes at the beginning to 7.1 minutes at the end of the study. Similarly, the proportion of cases with response times < 8 minutes increased from 22.3% to 47.3% and < 11 minutes from 57.6% to 77.5% at the end of the study. CONCLUSIONS: A simple, relatively low-cost ambulance deployment strategy was associated with significantly reduced response times for OOHCA. Geospatial-time analysis can be a useful tool for EMS providers.
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Ambulancias/estadística & datos numéricos , Paro Cardíaco Extrahospitalario/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Tratamiento de Urgencia/métodos , Femenino , Sistemas de Información Geográfica , Geografía , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Paro Cardíaco Extrahospitalario/terapia , Estudios Prospectivos , Características de la Residencia , Singapur/epidemiología , Tasa de Supervivencia , Factores de Tiempo , Servicios Urbanos de SaludRESUMEN
INTRODUCTION: Pre-hospital ambulance calls are not random events, but occur in patterns and trends that are related to movement patterns of people, as well as the geographical epidemiology of the population. This study describes the geographic-time epidemiology of ambulance calls in a large urban city and conducts a time demand analysis. This will facilitate a Systems Status Plan for the deployment of ambulances based on the most cost effective deployment strategy. MATERIALS AND METHODS: An observational prospective study looking at the geographic-time epidemiology of all ambulance calls in Singapore. Locations of ambulance calls were spot mapped using Geographic Information Systems (GIS) technology. Ambulance response times were mapped and a demand analysis conducted by postal districts. RESULTS: Between 1 January 2006 and 31 May 2006, 31,896 patients were enrolled into the study. Mean age of patients was 51.6 years (S.D. 23.0) with 60.0% male. Race distribution was 62.5% Chinese, 19.4% Malay, 12.9% Indian and 5.2% others. Trauma consisted 31.2% of calls and medical 68.8%. 9.7% of cases were priority 1 (most severe) and 70.1% priority 2 (moderate severity). Mean call receipt to arrival at scene was 8.0 min (S.D. 4.8). Call volumes in the day were almost twice those at night, with the most calls on Mondays. We found a definite geographical distribution pattern with heavier call volumes in the suburban town centres in the Eastern and Southern part of the country. We characterised the top 35 districts with the highest call volumes by time periods, which will form the basis for ambulance deployment plans. CONCLUSION: We found a definite geographical distribution pattern of ambulance calls. This study demonstrates the utility of GIS with despatch demand analysis and has implications for maximising the effectiveness of ambulance deployment.
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Ambulancias/estadística & datos numéricos , Sistemas de Información Geográfica , SingapurRESUMEN
INTRODUCTION: The emergency treatment of supraventricular tachycardia (SVT) has, over the last two decades, changed from verapamil to adenosine primarily owing to documented hypotensive episodes occurring with rapid bolus infusions of the calcium channel blocker. Slow infusions of calcium channel blockers have not previously demonstrated hypotension to any significant degree. The aim of this study was to compare the efficacy and safety of bolus intravenous adenosine and slow infusion of the calcium channel blockers verapamil and diltiazem in the emergency treatment of spontaneous SVT. METHODS: A prospective randomized controlled trial with one group receiving bolus intravenous adenosine 6 mg followed, if conversion was not achieved, by adenosine 12 mg; and the other group receiving a slow infusion of either verapamil at a rate of 1mg per minute up to a maximum dose of 20mg, or diltiazem at a rate of 2.5mg per minute up to a maximum dose of 50mg. These infusions would be stopped at time of conversion of the SVT or when the whole dose was administered. Heart rate and blood pressure was continuously monitored during drug infusion and for up to 2h post-conversion. RESULTS: A total of 206 patients with spontaneous SVT were analysed. Of these, 102 were administered calcium channel blockers (verapamil=48, diltiazem=54) and 104 were given adenosine. The conversion rates for the calcium channel blockers (98%) were statistically higher than the adenosine group (86.5%), p=0.002, RR 1.13, 95% CI 1.04-1.23. The initial mean change in blood pressure post-conversion in the calcium channel blocker group was -13.0/-8.1 mmHg (verapamil) and -7.0/-9.4 mmHg (diltiazem) and 2.6/-1.7 mmHg for adenosine. Only one patient in the calcium channel group (0.98%) (95% CI 0.025-5.3) developed hypotension, and none in the adenosine group. CONCLUSION: Slow infusion of calcium channel blockers is an alternative to adenosine in the emergency treatment of stable patients with SVT. Calcium channel blockers are safe and affordable for healthcare systems where the availability of adenosine is limited.
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Adenosina/administración & dosificación , Antiarrítmicos/administración & dosificación , Bloqueadores de los Canales de Calcio/administración & dosificación , Servicios Médicos de Urgencia/métodos , Taquicardia Supraventricular/tratamiento farmacológico , Adulto , Presión Sanguínea/efectos de los fármacos , Diltiazem/administración & dosificación , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Infusiones Intravenosas , Inyecciones Intravenosas , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Resultado del Tratamiento , Verapamilo/administración & dosificaciónRESUMEN
INTRODUCTION: There appears to be a circadian rhythm in the timing of cardiovascular and neurovascular events. The majority of studies have been conducted in western populations. This is the first study to look at the peaks and distribution of out-of-hospital cardiac arrest (OHCA) patients in Singapore. METHODS: The Cardiac Arrest and Resuscitation Epidemiology Studies I and II were prospective observation studies on OHCA in Singapore from October 1, 2001 to October 14, 2004. This study analysed data for patients older than 16 years. All data was collected and recorded as per the Utstein style template. Analysis was done for each of the quadrants of the 24-hour clock: 0001-0600, 0601-1200, 1201-1800 and 1801-2400 hours. RESULTS: Of the 2,428 cases, 2,167 OHCA patients qualified for the final analysis. Their mean ages were in the 60s for all the four quadrants, with a male predominance. The two peaks noted were at 0800 and 1900 hours for cardiac causes of death (n = 1,591), and at 0900 and 2000 hours for non-cardiac causes of death (n = 576). At all times of the day, the majority of OHCA occurred in residences and the bystander cardiopulmonary resuscitation rate ranged from 14.6 to 24.3 percent in the different quadrants of the day. CONCLUSION: OHCA has a bimodal distribution in our local cohort of patients. The information obtained will be utilised for fine-tuning emergency medical services strategies, as we strive to improve our current survival rates for OHCA.
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Ritmo Circadiano , Paro Cardíaco/diagnóstico , Paro Cardíaco/mortalidad , Adolescente , Adulto , Anciano , Reanimación Cardiopulmonar , Muerte Súbita Cardíaca , Cardioversión Eléctrica , Femenino , Paro Cardíaco/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Singapur , Factores de TiempoRESUMEN
OBJECTIVE: Chest compression only cardiopulmonary resuscitation (CC-CPR) without ventilation has been proposed as an alternative to standard cardiopulmonary resuscitation (CPR) for bystanders. However, there has been controversy regarding the relative effectiveness of both of these techniques. We aim to compare the outcomes of cardiac arrest patients in the cardiac arrest and resuscitation epidemiology study who either received CC-CPR, standard CPR or no bystander CPR. METHODS: This prospective cohort study involved all out-of-hospital cardiac arrest (OHCA) patients attended to by emergency medical service (EMS) providers in a large urban centre. The data analyses were conducted secondarily on these collected data. The technique of bystander CPR was reported by paramedics who arrived at the scene. RESULTS: From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Of these, 255 were EMS-witnessed arrests and were excluded. 1695 cases did not receive any bystander CPR, 287 had standard CPR and 154 CC-CPR. Patient characteristics were similar in both the standard and CC-CPR groups except for a higher incidence of residential arrests and previous heart disease sufferers in the CC-CPR group. Patients who received standard CPR (odds ratio (OR) 5.4, 95% confidence interval (CI) 2.1-14.0) or CC-CPR (OR 5.0, 95% CI 1.5-16.4) were more likely to survive to discharge than those who had no bystander CPR. There was no significant difference in survival to discharge between those who received CC-CPR and standard CPR (OR 0.9, 95% CI 0.3-3.1). CONCLUSION: We found that patients were more likely to survive with any form of bystander CPR than without. This emphasises the importance of chest compressions for OHCA patients, whether with or without ventilation.
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Reanimación Cardiopulmonar/métodos , Paro Cardíaco/terapia , Masaje Cardíaco , Servicios Médicos de Urgencia , Femenino , Paro Cardíaco/mortalidad , Humanos , Incidencia , Modelos Logísticos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Singapur/epidemiología , Análisis de Supervivencia , Resultado del Tratamiento , Población UrbanaRESUMEN
INTRODUCTION: Public access defibrillation (PAD) has shown potential to increase cardiac arrest survival rates. OBJECTIVES: To describe the geographic epidemiology of prehospital cardiac arrest in Singapore using geographic information systems (GIS) technology and assess the potential for deployment of a PAD program. METHODS: We conducted an observational prospective study looking at the geographic location of pre-hospital cardiac arrests in Singapore. Included were all patients with out-of-hospital cardiac arrest (OHCA) presented to emergency departments. Patient characteristics, cardiac arrest circumstances, emergency medical service (EMS) response and outcomes were recorded according to the Utstein style. Location of cardiac arrests was spot-mapped using GIS. RESULTS: From 1 October 2001 to 14 October 2004, 2428 patients were enrolled into the study. Mean age for arrests was 60.6 years with 68.0% male. 67.8% of arrests occurred in residences, with 54.5% bystander witnessed and another 10.5% EMS witnessed. Mean EMS response time was 9.6 min with 21.7% receiving prehospital defibrillation. Cardiac arrest occurrence was highest in the suburban town centers in the Eastern and Southern part of the country. We also identified communities with the highest arrest rates. About twice as many arrests occurred during the day (07:00-18:59 h) compared to night (19:00-06:59 h). The categories with the highest frequencies of occurrence included residential areas, in vehicles, healthcare facilities, along roads, shopping areas and offices/industrial areas. CONCLUSION: We found a definite geographical distribution pattern of cardiac arrest. This study demonstrates the utility of GIS with a national cardiac arrest database and has implications for implementing a PAD program, targeted CPR training, AED placement and ambulance deployment.
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Desfibriladores , Sistemas de Información Geográfica , Planificación en Salud/métodos , Accesibilidad a los Servicios de Salud , Paro Cardíaco/epidemiología , Cardioversión Eléctrica , Femenino , Paro Cardíaco/terapia , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Singapur/epidemiologíaRESUMEN
Auscultation, the act of listening to the sounds of internal organs, is a valuable medical diagnostic tool. Auscultation methods provide the information about a vast variety of internal body sounds originated by various organs such as heart, lungs, bowel, vascular disorders, etc. In this study, a cardiac sound registration system has been designed incorporating functions such as heart signals segmentation, classification and characterization for automated identification and ease of interpretation by the users. Considering a synergy with the domain of speech analysis, the authors introduced Mel-frequency cepstral coefficient (MFCC) to extract representative features and develop hidden Markov model (HMM) for signal classification. This system was applied to 1381 data sets of real and simulated, normal and abnormal domains. Classification rates for normal and abnormal heart sounds were found to be 95.7% for continuous murmurs, 96.25% for systolic murmurs and 90% for diastolic murmurs by a probabilistic comparison approach. This implies a high potential for the system as a diagnostic aid for primary health-care sectors.
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Auscultación Cardíaca/métodos , Soplos Cardíacos/diagnóstico , Cadenas de Markov , Procesamiento de Señales Asistido por Computador , Algoritmos , Cardiopatías/diagnóstico , Humanos , Fonocardiografía/métodos , Sensibilidad y Especificidad , Soplos Sistólicos/diagnósticoRESUMEN
BACKGROUND: Public emergency departments (EDs) in Singapore were facing increasing attendances (visits) with frequent overcrowding in the 10 years from 1975 to 1985. Over the next 12 years a series of social interventions were carried out to minimize "unnecessary" attendances at these EDs. AIMS: This paper reviews the various interventions carried out on ED utilization to determine their impact and usefulness. METHODS: Emergency and non-emergency attendances at the six main public EDs were analysed over the 32 years of the review and especially just before and soon after the application of four major interventions relating to use of EDs, including: (1) public education campaigns, (2) financial disincentives, (3) redirection to primary health care centres and (4) use of alternative clinics. RESULTS: The 12-year period of social interventions resulted in a fall in the proportion of non-emergency patients using the EDs from 57% to 18%. Public education campaigns each resulted in a fall in inappropriate attendances of 27% to 67%. Financial disincentives were able to demonstrate an impact if they were significant and resulted in a heavier fiscal cost to the patient than if available primary health clinics were used. Redirection of non-emergencies away from EDs resulted in significant public relations issues with only mild decreases in non-emergency attendances. Alternative clinics may provide some respite if actively promoted by ED staff, but are able to generate their own separate patient clientele. CONCLUSIONS: Public education and financial measures that seek to change the pattern of ED utilization in a community must go hand in hand with an easily accessible primary health care system for best effect. Co-ordination of such efforts requires active support from all levels of the health service and political leadership. An active feedback loop is needed for better outcomes management.
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More than 90% of the world population receives emergency medical care from different types of practitioners with little or no specific training in the field and with variable guidance and oversight. Emergency medical care is being recognized by actively practicing physicians around the world as an increasingly important domain in the overall health services package for a community. The know-do gap is well recognized as a major impediment to high-quality health care in much of the world. Knowledge translation principles for application in this highly varied young domain will require investigation of numerous aspects of the knowledge synthesis, exchange, and application domains in order to bring the greatest benefit of both explicit and tacit knowledge to increasing numbers of the world's population. This article reviews some of the issues particular to knowledge development and transfer in the international domain. The authors present a set of research proposals developed from a several-month online discussion among practitioners and teachers of emergency medical care in 16 countries from around the globe and from all economic strata, aimed at improving the flow of knowledge from developers and repositories of knowledge to the front lines of clinical care.