Implementation of a Teledentistry Platform for Dental Emergencies for the Elderly in the Context of the COVID-19 Pandemic in Chile.

Objectives: To develop and implement a "semi-presential" technology platform to support urgent and priority dental care for the elderly in the context of the COVID-19 pandemic among the Chilean population. Methods: A dental mobile clinic was implemented along with the development of a technological platform designed to support emergency and priority dental procedures, including teleconsultation with specialists. Under strict biosafety protocols, dental care was provided in five Chilean regions between February and May 2021. Sociodemographic, medical, and dental data were recorded. Results: A total of 135 patients over sixty years old, with a mean age of 72 years, were treated, 48 males and 87 females were attended between February and May 2021 in five different regions of Chile. 53.3% required immediate or urgent treatment, and 24.4% were derived to specialists from whom 60.6% needed immediate or urgent treatment. 74.3% of teleconsultations were derived to an oral pathology specialist. Conclusion: It was shown that a "semi-presential" technology platform implemented in a mobile dental clinic can help elderly people who are impeded to look for traditional dental assistance during a pandemic.

Comparison of lung image quality between CT Ark and Brilliance 64 CT during COVID-19.

AIM: This study is to compare the lung image quality between shelter hospital CT (CT Ark) and ordinary CT scans (Brilliance 64) scans. METHODS: The patients who received scans with CT Ark or Brilliance 64 CT were enrolled. Their lung images were divided into two groups according to the scanner. The objective evaluation methods of signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were used. The subjective evaluation methods including the evaluation of the fine structure under the lung window and the evaluation of the general structure under the mediastinum window were compared. Kappa method was used to assess the reliability of the subjective evaluation. The subjective evaluation results were analyzed using the Wilcoxon rank sum test. SNR and CNR were tested using independent sample t tests. RESULTS: There was no statistical difference in somatotype of enrolled subjects. The Kappa value between the two observers was between 0.68 and 0.81, indicating good consistency. For subjective evaluation results, the rank sum test P value of fine structure evaluation and general structure evaluation by the two observers was ≥ 0.05. For objective evaluation results, SNR and CNR between the two CT scanners were significantly different (P<0.05). Notably, the absolute values ​​of SNR and CNR of the CT Ark were larger than Brilliance 64 CT scanner. CONCLUSION: CT Ark is fully capable of scanning the lungs of the COVID-19 patients during the epidemic in the shelter hospital.

Taking therapeutic apheresis services to patients in South Africa: An eight year review of SANBS mobile therapeutic apheresis service, 2013-2020.

INTRODUCTION: A 20 year review of health and health care presents the multiple challenges faced by South Africans. Health and poverty is highlighted with 45% of population living on approximately US$ 2 per day and 10 million living on less than US$ 1 per day. Widening disparities in health care provision between public and private sector hospital services exist. The South African population includes the largest number of people living with HIV infection/AIDS of any country in the world, with a 70% estimate of 7.5 million people living with HIV on antiretroviral therapy. The South African National Blood Service provides a mixed model therapeutic apheresis service including mobile service and fixed-site therapeutic apheresis and an apheresis collection of hematopoietic stem cell (HPC-A) service. Therapeutic apheresis modalities offered by SANBS include plasmapheresis, red cell exchange, leukocyte and platelet reduction. In addition, collection of plasma, thrombocytes, mononuclear cells including CD34+ cells (HPCs) and granulocytes by apheresis for plasma and cellular therapies, and customised apheresis products for research purposes is offered. An operational database for the period 2013 to 2020 was reviewed to characterise the SANBS's mixed therapeutic apheresis service and HPC-A service from 2013 to 2020 in terms of patient numbers, patient demographics, patient procedures, therapeutic apheresis indication or diagnosis, therapeutic apheresis modality, hospital service type, and the American Society for Apheresis (ASFA) category of diagnosis. METHODS: A retrospective review of therapeutic apheresis patients referred to SANBS characterising patient numbers, patient demographics, patient procedures, therapeutic apheresis indication or diagnosis, therapeutic apheresis modality (Linz, 2017), hospital service type, and the ASFA category of diagnosis (Padmanabhan et al., 2019) for the period 01 January 2013 to 31 December 2020 was completed. Data is obtained from a SANBS operational routinely utilised to record patient procedure data. Patient procedure data is manually recorded by apheresis nurses and indexed on to the operational database, with both processes audited. The review period is a convenience sample. Storage of the database and access of the operational database is in compliance with the Protection of Personal Information Act (Government Gazette, 2013). Therapeutic apheresis modalities analysed include Plasmapheresis, Red Cell Exchange, Leukopheresis, Thrombocytapheresis, Lymphocyte collection, Granulocyte collection, Haematopoietic stem cell collection by apheresis and customised apheresis products for research purposes. Customised apheresis products for research purposes is excluded from this review. Descriptive statistics is used. RESULTS: For the review period, 2,485 unique patients with 120 unique indications as recorded by referring clinicians received 13,518 procedures involving 7 therapeutic apheresis modalities at 78 hospitals (21 public sector and 57 private sector) and at 3 SANBS blood donor centres in 7 provinces of South Africa. The age range of patients serviced is 4 months to 90 years (median = 39.5 years) (figure 1), 91% by procedure count was for patients 21 years of age or older, 62% were female, with 10,783 (79.6%) procedures performed in public sector hospitals. In all patients, the most common indications was plasmapheresis for thrombotic thromobocytopaenic purpura (52.5% of cumulative procedures), HPC-A for multiple myeloma (7.86%) and Antibody-mediated kidney transplant rejection (4.90%). Plasmapheresis was the most common therapeutic apheresis modality used (82.5% of cumulative procedures) followed by HPC-A (13.7%) and leukoreduction (3.39%). A range of indications for plasmapheresis (n = 65) and HPC-A (n = 41) were observed. Red cell exchange procedures was performed for patients with severe malaria and sickle cell disease indications. For leukoreduction indications, all patients were adults managed in public sector facilities and all were symptomatic. The most common indications were Chronic Myelogenous Leukemia, Chronic Lymphocytic Leukaemia and Multiple Myeloma. A pooled, total white cell count average of 457 × 109/L (range 141-689 × 109/L) prior to first procedure. Despite complex challenges for a national mixed model service, successful patient outcomes in emergent indications such as TTP (Louw et al., 2018; Swart et al., 2019) and engraftment post HPC-A in HSCT in multiple centres (Glatt, personal communication) are reported. CONCLUSION: The review confirms that apheresis medicine is increasingly used in South Africa in patients in both public and private sector, with the most common modalities being plasmapheresis, HPC-A and leukoreduction. Patients with HIV-associated TTP is the most commonly referred patient in both paediatric and adult patients and this is anticipated to continue. A growing HSCT transplant network capacity in South Africa is augmented through the mixed model mobile and fixed-site therapeutic apheresis services, including a mobile HPC-A service. The increasing number of HPC-A is a trend towards increasing numbers of patients support to HSCT for both adults and paediatric patients in private and public sector hospitals.

Reliability of Field Assessment Stroke Triage for Emergency Destination Scale Use by Paramedics: Mobile Stroke Unit First-Year Experience.

Background and Purpose: Field Assessment Stroke Triage for Emergency Destination (FAST-ED) scale is a helpful tool to triage patients with stroke in the field. However, data on its reliability in the prehospital setting are lacking. We aim to test the reliability of FAST-ED scale when used by paramedics in a mobile stroke unit covering a metropolitan area. Methods: As part of standard operating mobile stroke unit procedures, paramedics initially evaluated patients. If the event characterized a stroke alert, the FAST-ED score was determined by the paramedic upon patient contact (in-person) and then independently by a vascular neurologist (VN) immediately after paramedic evaluation (remotely/telemedicine). This allowed testing of the interrater agreement of the FAST-ED scoring performance between on-site prehospital providers and remotely located VN. Results: Of a total of 238 patients transported in the first 15 months of the mobile stroke unit's activity, 173 were included in this study. Median age was 63 (interquartile range, 55.5­75) years and 52.6% were females. A final diagnosis of ischemic stroke was made in 71 (41%), transient ischemic attack in 26 (15%), intracranial hemorrhage in 15 (9%), whereas 61 (35%) patients were stroke mimics. The FAST-ED scores matched perfectly among paramedics and VN in 97 (56%) instances, while there was 0 to 1-point difference in 158 (91.3%), 0 to 2-point difference in 171 (98.8%), and 3 or more point difference in 2 (1.1%) patients. The intraclass correlation between VN and paramedic FAST-ED scores showed excellent reliability, intraclass correlation coefficient 0.94 (95% CI, 0.92­0.96; P<0.001). When VN recorded FAST-ED score ≥3, paramedics also scored FAST-ED≥3 in majority of instances (63/71 patients; 87.5%). A large vessel occlusion was identified in 16 (9.2%) patients; 13 occlusions were identified with a FAST-ED≥3 while 3 were missed. All of the latter patients had National Institutes of Health Stroke Scale score ≤5. Conclusions: We demonstrate excellent reliability of FAST-ED scale performed by paramedics when compared with VN, indicating that it can be accurately performed by paramedics in the prehospital setting.

Effect of thrombolysis in a mobile stroke unit versus in hospital for patients with ischemic stroke: A protocol for systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Ischemic stroke caused by arterial occlusion is the cause of most strokes. The focus of treatment is rapid reperfusion through intravenous thrombolysis and intravascular thrombectomy. Two acute stroke management including prehospital thrombolysis and in hospital have been widely used clinically to treat ischemic stroke with satisfied efficacy. However, there is no systematic review comparing the effectiveness of these 2 therapies. The aim of this study is to compare the effect of prehospital thrombolysis versus in hospital for patients with ischemic stroke. METHODS AND ANALYSIS: The following electronic databases will be searched: Web of Science, PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), Wanfang Database, and Chinese Scientific Journal Database.The randomized controlled trials of prehospital thrombolysis versus in hospital for ischemic stroke will be searched in the databases from their inception to December 2020 by 2 researchers independently. Onset to therapy (OTT) duration and National Institute Health Stroke Scale (NIHSS) scores will be assessed as the primary outcomes; safety assessment including intracerebral hemorrhage (ICH) and mortality will be assessed as the secondary outcomes. The Review Manager 5.3 will be used for meta-analysis and the evidence level will be assessed by using the method for Grading of Recommendations Assessment, Development and evaluation Continuous outcomes will be presented as the weighted mean difference or standardized mean difference with 95% confidence interval (CI), whereas dichotomous data will be expressed as relative risk with 95% CI. If heterogeneity existed (P < .05), the random effect model was used. Otherwise, we will use the fixed effect model for calculation. ETHICS AND DISSEMINATION: Ethical approval is not required because no primary data are collected. This review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42020200708.

Mobile Diabetes Telemedicine Clinics for Aboriginal First Nation People With Reported Diabetes in British Columbia.

OBJECTIVES: Our aim in this study was to assess the impact of the Mobile Diabetes Telemedicine Clinic, which serves First Nations communities in British Columbia, on clients' with diabetes condition and management. METHODS: A travelling team visits approximately 120 sites annually. Assessment of persons with diabetes includes interview, physical exam, point-of-care laboratory (glycated hemoglobin, blood glucose, lipid profile, kidney profile) and retinal fundus photographs. Nurses provide education and lifestyle, medication and wellness recommendations. The endocrinologist reviews records and provides further recommendations to primary care providers. To assess the impact at second and later visits, compared with the immediately preceding visit, we measured mean changes in body weight, glycated hemoglobin, urinary albumin:creatinine ratio and estimated glomerular filtration rate, as well as changes in proportions of clients meeting targets for blood pressure, low-density lipoprotein cholesterol, medications, smoking and physical activity. RESULTS: From 2012 to 2018, a total of 3,045 visits were completed by 1,056 clients with diabetes who attended on at least 2 occasions. Mean time since the preceding visit was 1.6 years. Mean change (after vs before) in glycated hemoglobin was 0.06 (95% confidence limit, -0.03 to 0.14), body weight 0.0 kg (-0.2 to 0.2), albumin:creatinine ratio 1.31 mg/mmol (0.27 to 2.35) and estimated glomerular filtration rate -4.8 mL/min (-6.2 to -3.4). The proportion of clients meeting both blood pressure targets (systolic <130 mmHg and diastolic <80 mmHg) increased from 25% at first visit to 33% at the second and 32% at the third or later visits (p<0.001, chi-square test). The proportion of those with low-density lipoprotein cholesterol of <2.0 mmol/L increased from 56% to 62% at the second visit and 69% at the third or later visits (p<0.001). The proportion of those taking renin-angiotensin-aldosterone system inhibitors or other antihypertensive agents and statins increased (p<0.001), and proportions decreased for smoking (p<0.001) and exercising ≥60 min/week (p=0.002). CONCLUSIONS: Weight and diabetic control were stabilized. Most management practices showed improvement.

Nurse-Led Mobile Health Clinics: An Opportunity for Student Scholarship and Faculty Practice.

BACKGROUND: The benefits of nurse-led mobile clinics to the communities they serve have been adequately documented in the nursing and health literature. Nurse-led clinics are credited with a variety of positive outcomes from improving access to care to helping build healthier communities. However, the impact of nurse-led clinics on nursing education has not been as widely discussed. METHOD: A nurse-led, mobile health clinic was established to serve individuals and families facing financial crisis and provide a practice site for students and faculty. RESULTS: Students developed nursing skills, including leadership, cultural awareness, active listening, critical thinking, effective communication, and collaboration. In the first 4 years of operation, 30 students have been assigned to the mobile clinic and approximately 2,250 visitors received free health care. CONCLUSION: These findings can inform the implementation of nursing curriculum or activities specifically designed for student involvement in nurse-led mobile health clinics and the development and advancement of nursing skills. [J Nurs Educ. 2020;59(10):594-596.].

A phenomenological study of nurses experience about their palliative approach and their use of mobile palliative care teams in medical and surgical care units in France.

BACKGROUND: Despite a broad consensus and recommendations, numerous international reports or studies have shown the difficulties of implementing palliative care within healthcare services. The objective of this study was to understand the palliative approach of registered nurses in hospital medical and surgical care units and their use of mobile palliative care teams. METHODS: Qualitative study using individual in depth semi-structured interviews and focus group of registered nurses. Data were analyzed using a semiopragmatic phenomenological analysis. Expert nurses of mobile palliative care team carried out this study. 20 registered nurses from three different hospitals in France agreed to participate. RESULTS: Nurses recognize their role as being witnesses to the patient's experience through their constant presence. This is in line with their professional values and gives them an "alert role" that can anticipate a patient-centered palliative approach. The physician's positioning on palliative care plays a key role in its implementation. The lack of recognition of the individual role of the nurse leads to a questioning of her/his professional values, causing inappropriate behavior and distress. According to nurses, "rethinking care within a team environment" allows for the anticipation of a patient-centered palliative approach. Mobile Palliative Care Team highlights the major role of physicians-nurses "balance" while providing personal and professional support. CONCLUSIONS: The Physician's positioning and attitude toward palliative approach sets the tone for its early implementation and determines the behavior of different staff members within healthcare service. "Recognition at work", specifically "recognition of the individual role of nurse" is an essential concept for understanding what causes the delay in the implementation of a palliative approach. Interprofessional training (physicians and nurses) could optimize sharing expertise. Registered nurses consider MPCT as a "facilitating intermediary" within the healthcare service improving communication. Restoring a balance in sharing care and decision between physicians and other caregivers lead care teams to an anticipated and patient-centered palliative approach according to guidelines.

Mobile Dental Delivery System: An Effective Protocol for Hygiene and Disinfection.

Mobile dental delivery systems (MDDSs) are receiving growing interest for reaching isolated patients, as well as in dental care for fragile and hospitalized patients, with the advantage of being able to be used from room to room or during general anesthesia (GA) in an operating room. Therefore, ensuring the care safety is crucial. The aim of this study was to elaborate and assess an MDDS maintenance protocol, containing the management of dental unit waterlines and adapted to specific conditions such as dental care under GA. A step-by-step protocol was established and implemented for an MDDS used during dental care under GA in children. Samples of the output water were collected at J0, J+1, 3, 6, 12, and 24 months, and cultured to observe the microbiological quality of the water. All the results (heterotrophic plate count at 22 °C, at 37 °C, and specific pathogenic germs sought) showed an absence of contamination. The protocol presented was effective over time and allowed ensuring the safety of care to be ensured when using MDDS, even during dental procedures under GA. As a result, it could be implemented by any dental care delivery structure wanting to reinforce the safety of its practice.

Image Quality and Performance Benchmarks in Vehicle and Hospital Mammography.

BACKGROUND: Whether the quality and clinical performance of mammograms obtained in vehicles and those obtained in fixed facilities are equal remains unknown. We compared the characteristics of examinees screened in hospital and vehicle settings. PATIENTS AND METHODS: Data from women who had undergone mammography at Shuang Ho Hospital from January 1, 2013, to December 31, 2016, were obtained from the Women's Breast Screening Database and used for analysis. The records revealed that 43,807 and 11,955 women had undergone mammography in vehicle and hospital settings, respectively. The performance benchmarks, including recall rate, cancer detection rate, and positive predictive value, in the 2 settings were compared. In addition, the image quality was compared by reviewing 110 records from each setting. RESULTS: The hospital mammograms had greater subtotal mean scores (189.2 ± 5.9) compared with the vehicle mammograms (185.5 ± 7.7; P < .0001) in the mediolateral oblique view. Mobile mammography contributed to a lower odds ratio of classification in the Breast Imaging Reporting and Data System categories of 0, 4, and 5. In general, all performance benchmarks, including the cancer detection rate and positive predictive value of mobile and hospital mammography, were satisfactory. However, the recall rate with the hospital mammography service was slightly greater than the acceptable benchmark. CONCLUSION: Mobile mammography services should be continued with improvements in image quality. The reduction in the number of patients with a category of 0 in the classification system in both mammography service settings and the enhancement of data linking to previous mammograms warrants additional attention.

Effectiveness of the Mobile Emergency Medical Services (SAMU): use of interrupted time series.

OBJECTIVE: To evaluate the performance of the Mobile Emergency Medical Services (SAMU) in the ABC Region, using myocardial infarction as tracer condition. METHODS: The analysis of interrupted time series was the approach chosen to test immediate and gradual effects of the intervention on the study population. The research comprised adjusted monthly time series of the hospital mortality rate by myocardial infarction in the period between 2000 and 2011. Data were extracted from the Mortality Information System (SIM), using segmented regression analysis to evaluate the level and trend of the intervention before and after its implementation. To strengthen the internal validity of the study, a control region was included. RESULTS: The analysis of interrupted time series showed a reduction of 0.04 deaths per 100,000 inhabitants in the mortality rate compared to the underlying trend since the implementation of the Emergency Medical Services (p = 0.0040; 95%CI: -0.0816 - -0.0162) and a reduction in the level of 2.89 deaths per 100,000 inhabitants (p = 0.0001; 95%CI: -4.3293 - -1.4623), both with statistical significance. Regarding the control region, Baixada Santista, the difference in the result trend between intervention outcome and post-intervention control of -0.0639 deaths per 100,000 inhabitants was statistically significant (p = 0.0031; 95%CI: -0.1060 - -0.0219). We cannot exclude confounders, but we limited their presence in the study by including control region series. CONCLUSIONS: Although the analysis of interrupted time series has limitations, this modeling can be useful for analyzing the performance of policies and programs. Even though the intervention studied is not a condition that in itself implies effectiveness, the latter would not be present without the former, which, integrated with other conditions, generates a positive result. SAMU is a strategy that must be expanded when formulating and consolidating policies focusing on emergency care.

Prehospital Stroke Management Optimized by Use of Clinical Scoring vs Mobile Stroke Unit for Triage of Patients With Stroke: A Randomized Clinical Trial.

Importance: Transferring patients with large-vessel occlusion (LVO) or intracranial hemorrhage (ICH) to hospitals not providing interventional treatment options is an unresolved medical problem. Objective: To determine how optimized prehospital management (OPM) based on use of the Los Angeles Motor Scale (LAMS) compares with management in a Mobile Stroke Unit (MSU) in accurately triaging patients to the appropriate hospital with (comprehensive stroke center [CSC]) or without (primary stroke center [PSC]) interventional treatment. Design, Setting, and Participants: In this randomized multicenter trial with 3-month follow-up, patients were assigned week-wise to one of the pathways between June 15, 2015, and November 15, 2017, in 2 regions of Saarland, Germany; 708 of 824 suspected stroke patients did not meet inclusion criteria, resulting in a study population of 116 adult patients. Interventions: Patients received either OPM based on a standard operating procedure that included the use of the LAMS (cut point ≥4) or management in an MSU (an ambulance with vascular imaging, point-of-care laboratory, and telecommunication capabilities). Main Outcomes and Measures: The primary end point was the proportion of patients accurately triaged to either CSCs (LVO, ICH) or PSCs (others). Results: A predefined interim analysis was performed after 116 patients of the planned 232 patients had been enrolled. Of these, 53 were included in the OPM group (67.9% women; mean [SD] age, 74 [11] years) and 63 in the MSU group (57.1% women; mean [SD] age, 75 [11] years). The primary end point, an accurate triage decision, was reached for 37 of 53 patients (69.8%) in the OPM group and for 63 of 63 patients (100%) in the MSU group (difference, 30.2%; 95% CI, 17.8%-42.5%; P < .001). Whereas 7 of 17 OPM patients (41.2%) with LVO or ICH required secondary transfers from a PSC to a CSC, none of the 11 MSU patients (0%) required such transfers (difference, 41.2%; 95% CI, 17.8%-64.6%; P = .02). The LAMS at a cut point of 4 or higher led to an accurate diagnosis of LVO or ICH for 13 of 17 patients (76.5%; 6 triaged to a CSC) and of LVO selectively for 7 of 9 patients (77.8%; 2 triaged to a CSC). Stroke management metrics were better in the MSU group, although patient outcomes were not significantly different. Conclusions and Relevance: Whereas prehospital management optimized by LAMS allows accurate triage decisions for approximately 70% of patients, MSU-based management enables accurate triage decisions for 100%. Depending on the specific health care environment considered, both approaches are potentially valuable in triaging stroke patients. Trial Registration: ClinicalTrials.gov identifier: NCT02465346.

[Interest of extrahospital multidisciplinary unit of neuro-psycho-geriatric intervened in nursing home: Analysis of 288 interventions]. / Intérêt d'une unité mobile multidisciplinaire extra-hospitalière de neuro-psychogériatrie intervenant en EHPAD : analyse de 288 interventions.

INTRODUCTION: Geriatrics Mobile Units are a new organisation operating in nursing homes. Their mission is to propose globally oriented neuro-psychiatric and geriatric care. The purpose of the study is to assess their activity and impact over a 21-month period. METHOD: A prospective single center study of UMNPG's data including intervention characteristics, patient characteristics, recommendations and reassessment after intervention. The Neuropsychiatric Inventory Nursing Home version (NPI-NH) was measured during intervention and reassessed after 30 days (Student's t-test). RESULTS: From March 2014 to December 2015, UMNPG conducted 288 interventions mainly for medical advices (81%), clinical assessments (54%) and health care team support (46%). The average age was 84.6±7.3years, 73.3% of whom were women. The patients were dependent (62% of GIR 1 or 2) with dementia (60%) and under several medications (83.7%). The symptoms were mainly agitation/aggression (76.4%), anxiety (75%), depression (66.7%), irritability (60.4%), aberrant motor behaviour (55.9%) and delusions (48.6%). The main proposals of UMNPG were a change in treatment (79.5%), a health care team support (85.4%) and hospitalization (8.4%). The rate of follow-up on recommendation was 83% on the 15th day and 80% on the 30th day. The rate of avoided hospitalizations was 16%. The average NPI-NH decreased (on day 0 NPI=50±19.2; on day 30 NPI=33.9±19.6, p<0.001). CONCLUSION: UMNPG-EHPAD intervenes for frail elderly residents with multiple disorders in crisis situations. Medical recommendations help to support people in nursing homes and decrease NPI-NH. UMNPG-EHPAD is part of geriatric network strengthening the city/hospital connection.

Association between clinical observations and a mobile crisis team's level of care recommendations.

Mobile mental health crisis programs are a widely used and valuable community resource. Literature analyzing the service, however, is sparse and descriptive in nature. This study uses multinomial logistic regression to analyze clinical data from a mobile crisis program in Pennsylvania over 12 months. 793 individuals recommended to various levels of care were analyzed. Clinical and demographic presentations were used as predictor variables and level of care recommendation as outcome variable. Several clinical presentations were found to increase the likelihood of various levels of care recommendations. These findings are discussed in light of current suicide intervention and data-driven practice.

Examining the Return on Investment of the Breath of Life Mobile Pediatric Asthma Clinic in a Rural Region with Small Metropolitan Statistical Areas.

The current study sought to examine the return on investment (ROI) of a mobile pediatric asthma clinic in a rural region with small metropolitan statistical areas, in terms of reduced costs attributed to preventable emergency department visits, inpatient admission, school absenteeism, cost of education, and parent work absenteeism. For fiscal years 2015 and 2016, an average return of $1.32 and a community ROI of $1.45 was estimated. Estimated benefits were $445,125.00 and cost avoidance was $263,853.01. A mobile pediatric asthma clinics operating in less densely populated regions is able to yield a positive ROI.

Challenges in Implementing International Standards for the Field Hospital Emergency Department in a Disaster Zone: The Israeli Experience.

BACKGROUND: Medical response to world disasters has too often been poorly coordinated and nonprofessional. To improve this, several agencies, led by the World Health Organization (WHO), have developed guidelines to provide accreditation for Foreign Medical Teams (FMTs). There are three levels, with the highest known as FMT Type-3 providing outpatient as well as inpatient surgical emergency care in addition to inpatient referral care. In November 2016, the WHO certified the Israel Defense Forces Field Hospital as the first FMT Type-3. OBJECTIVES: The objectives of this article are to describe the challenges in implementing these international standards for the field hospital emergency department in a disaster zone. DISCUSSION: There are general standards for all levels of FMTs, as well as specific requirements for the FMT-3. These include a mechanism of appropriate triage, two operating suites, 40 regular beds, four to six intensive care unit beds, radiology facilities, and various staff specialties. Despite the sophistication of the field hospital, there are many challenges. Logistical challenges include constructing the hospital in a disaster zone and equipment issues. There are staff challenges such as becoming oriented to a new and difficult environment. Patient challenges include cultural differences, language barriers, and issues of follow-up. There are often ethical challenges unique to the disaster zone. CONCLUSION: By presenting the experience and challenges of the first FMT Type-3, we hope that more countries can join this initiative and improve disaster care throughout the world.

What is a "Maison des Adolescents"? A history of integrated youth health care services in France.

AIM: Since 1999, the development of more than 100 "Maisons des Adolescents" (MDAs) has enabled young persons to gain access to specific care in integrated youth-friendly facilities in France. To contribute to the development and standardization of international youth-friendly health care services, this review provides insight into the French MDA facilities. METHODS: This socio-historical analysis includes a systematic review of articles referring to the MDAs (selection through title and/or abstract), ministry reports and newspaper articles, from 1999 to 2018. RESULTS: If the various medical programmes of MDAs depend on the priorities of local teams rather as well as on official regulations, all MDAs offer the following essential services: a "Health and Prevention Space" open daily; multidisciplinary consultations; a mobile team visiting youth hospitalized in medical units; a mobile team able to meet adolescents at their homes; an open centre for art workshops; refresher and remedial courses for school work; network meetings and parent support groups. The MDAs from the start addressed an age group (young people aged 11-21 years) rather than an illness. They thus provide primary prevention for adolescents according to the World Health Organization definition of health as "a state of complete physical, mental and social well-being." This medical and political movement was shaped by the epistemological background of its first leaders. CONCLUSION: Although more cohort studies to evaluate their early interventions would be useful, the success of the MDA network is already widely acknowledged by users, professionals and policy makers.