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1.
Ceska Gynekol ; 86(1): 46-53, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33752409

RESUMO

OBJECTIVE: To present a comprehensive overview of the female adolescent population focused on physical development and reproductive healthcare. METHODS: A summary of available literature using our own experience with the treatment of patients with eating disorders. CONCLUSION: Approximately 0.5% of adolescents suffer from eating disorders (EDs) in the Czech Republic. EDs have the highest incidence during adolescence, it is a period when growth spurt, bone mineralization and reproductive organ development occur. EDs have a significant negative effect on development and can irreversibly lead to its impairment.


Assuntos
Anorexia Nervosa , Transtornos da Alimentação e da Ingestão de Alimentos , Ginecologia , Adolescente , Ambulâncias , Anorexia Nervosa/epidemiologia , Anorexia Nervosa/terapia , Criança , República Tcheca , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/epidemiologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Feminino , Humanos
2.
Sci Total Environ ; 768: 145176, 2021 May 10.
Artigo em Inglês | MEDLINE | ID: mdl-33736302

RESUMO

In 2020, Coronavirus disease 2019 (COVID-19) pandemic has brought a huge impact in daily life and has prompted people to take preventive measures. In the summertime, however, the Japanese government has cautioned that some COVID-19 pandemic conditions may affect the risk to heatstroke. This study investigated how the COVID-19 pandemic setting affected heatstroke-related ambulance dispatches (HSAD). Daily HSAD data and relevant weather parameters from June to September from 2016 to 2020 of 47 prefectures in Japan were obtained from the Fire and Disaster Management Agency (FDMA) database. A binary variable representing COVID-19 impact was created, whereby years 2016 to 2019 were coded as 0, while 2020 as 1. We employed a two-stage analysis in elucidating the impact of COVID-19 pandemic on HSAD. Firstly, we regressed HSAD with the COVID-19 binary variable after adjusting for relevant covariates to obtain prefecture-specific effect estimates. Prefecture-specific estimates were subsequently pooled via random effects meta-analysis in generating the pooled estimate. Pooled Relative Risk (RR) of HSAD during the COVID-19 pandemic was 0.78 (95% Confidential Interval [CI], 0.75-0.82). We found an overall statistically significant decrease in HSAD risk during the COVID-19 pandemic in Japan. Specifically, the decrease in the risk of HSAD may be linked to the COVID-19 precautionary measures such as stay-home request and availability of alternative consultation services, which may have decreased the direct exposure of the population to extreme heat.


Assuntos
Golpe de Calor , Ambulâncias , Golpe de Calor/epidemiologia , Humanos , Japão/epidemiologia , Pandemias
3.
Z Gerontol Geriatr ; 54(2): 99-105, 2021 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-33595695

RESUMO

Geriatric patients are a frequent group of patients in the ambulance service. In recent years, many structured course systems have been established in the German-speaking countries and help not only to speak the same language but also to improve the communication and care of patients in the ambulance service and emergency admission. While emergency physicians and ambulance personnel have increasingly dealt with structured processes in the fields of trauma, children and cardiovascular disorders in various course systems in order to minimize risks, there is only one course system established a few years ago that deals exclusively with the geriatric patient. Although this is the most common group of patients in emergency care, there is a risk of making mistakes due to the lack of structures and routine. The geriatric education for emergency medical services (GEMS) course system can help to ensure a structured emergency care and communication in the care of geriatric patients.


Assuntos
Serviços Médicos de Emergência , Idoso , Ambulâncias , Humanos
4.
Rev Bras Enferm ; 74Suppl 1(Suppl 1): e20200657, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33605363

RESUMO

OBJECTIVE: To reflect on the safe care exercised by the pre-hospital care team by emergency ambulance in times of coronavirus infection. METHOD: A reflection and description of how to provide safe care to the patient and the professional during pre-hospital care in times of coronavirus infection. RESULTS: To ensure the health of all those involved in the care, health professionals who work in pre-hospital care by emergency ambulance should use the recommended Personal Protective Equipment (PPE), such as the use of surgical masks and N95, N99, N100, PFF2 or PFF3, the use of an apron or overall, goggles and face shield, gloves and a hat. The entire team must receive training and demonstrate the ability to use PPE correctly and safely. FINAL CONSIDERATIONS: The professional working in the pre-hospital care by ambulance is exposed to a series of occupational risks that need to be discussed and minimized through professional training.


Assuntos
Ambulâncias/normas , Serviços Médicos de Emergência/normas , Auxiliares de Emergência/normas , Segurança do Paciente/normas , Equipamento de Proteção Individual/normas , Guias de Prática Clínica como Assunto , Transporte de Pacientes/normas , Adulto , Ambulâncias/estatística & dados numéricos , Brasil , Feminino , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Segurança do Paciente/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos
5.
JAMA ; 325(5): 454-466, 2021 02 02.
Artigo em Inglês | MEDLINE | ID: mdl-33528537

RESUMO

Importance: Effects of thrombolysis in acute ischemic stroke are time-dependent. Ambulances that can administer thrombolysis (mobile stroke units [MSUs]) before arriving at the hospital have been shown to reduce time to treatment. Objective: To determine whether dispatch of MSUs is associated with better clinical outcomes for patients with acute ischemic stroke. Design, Setting, and Participants: This prospective, nonrandomized, controlled intervention study was conducted in Berlin, Germany, from February 1, 2017, to October 30, 2019. If an emergency call prompted suspicion of stroke, both a conventional ambulance and an MSU, when available, were dispatched. Functional outcomes of patients with final diagnosis of acute cerebral ischemia who were eligible for thrombolysis or thrombectomy were compared based on the initial dispatch (both MSU and conventional ambulance or conventional ambulance only). Exposure: Simultaneous dispatch of an MSU (computed tomographic scanning with or without angiography, point-of-care laboratory testing, and thrombolysis capabilities on board) and a conventional ambulance (n = 749) vs conventional ambulance alone (n = 794). Main Outcomes and Measures: The primary outcome was the distribution of modified Rankin Scale (mRS) scores (a disability score ranging from 0, no neurological deficits, to 6, death) at 3 months. The coprimary outcome was a 3-tier disability scale at 3 months (none to moderate disability; severe disability; death) with tier assignment based on mRS scores if available or place of residence if mRS scores were not available. Common odds ratios (ORs) were used to quantify the association between exposure and outcome; values less than 1.00 indicated a favorable shift in the mRS distribution and lower odds of higher levels of disability. Results: Of the 1543 patients (mean age, 74 years; 723 women [47%]) included in the adjusted primary analysis, 1337 (87%) had available mRS scores (primary outcome) and 1506 patients (98%) had available the 3-tier disability scale assessment (coprimary outcome). Patients with an MSU dispatched had lower median mRS scores at month 3 (1; interquartile range [IQR], 0-3) than did patients without an MSU dispatched (2; IQR, 0-3; common OR for worse mRS, 0.71; 95% CI, 0.58-0.86; P < .001). Similarly, patients with an MSU dispatched had lower 3-month coprimary disability scores: 586 patients (80.3%) had none to moderate disability; 92 (12.6%) had severe disability; and 52 (7.1%) had died vs patients without an MSU dispatched: 605 (78.0%) had none to moderate disability; 103 (13.3%) had severe disability; and 68 (8.8%) had died (common OR for worse functional outcome, 0.73, 95% CI, 0.54-0.99; P = .04). Conclusions and Relevance: In this prospective, nonrandomized, controlled intervention study of patients with acute ischemic stroke in Berlin, Germany, the dispatch of mobile stroke units, compared with conventional ambulances alone, was significantly associated with lower global disability at 3 months. Clinical trials in other regions are warranted.


Assuntos
Serviços Médicos de Emergência , Fibrinolíticos/uso terapêutico , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , Ambulâncias , Berlim , Avaliação da Deficiência , Despacho de Emergência Médica , Medicina de Emergência , Feminino , Humanos , /diagnóstico por imagem , Masculino , Estudos Prospectivos , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Neurol Sci ; 42(2): 467-473, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33409830

RESUMO

BACKGROUND AND PURPOSE: The COVID-19 pandemic has impacted the reperfusion therapy for acute ischemic stroke (AIS) patients. Huizhou City utilized its experience with the SARS and MERS breakouts to establish a reperfusion treatment program for AIS patients. METHOD: This is a retrospective study on 8 certified stroke hospitals in Huizhou City from January 2020 to May 2020. We analyzed the number of AIS patients with reperfusion therapy, stroke type (anterior/posterior circulation stroke), modes of transport to hospital, NIHSS score, onset to door time (ODT), door to needle time (DNT), and door to puncture time (DPT). The analysis was compared with baseline data from the same time period in 2019. RESULT: In 2020, the number of AIS patients receiving reperfusion therapy decreased (315 vs. 377), NIHSS score increased [8 (4, 15) vs. 7 [ (1, 2)], P = 0.024], ODT increased [126 (67.5, 210.0) vs. 120.0 (64.0, 179.0), P = 0.032], and DNT decreased [40 (32.5, 55) vs. 48 (36, 59), P = 0.003]. DPT did not change. Seventy percent of AIS patients indicated self-visit as their main mode of transport to the hospital. In both periods, mild stroke patients were more likely to self-visit than utilize emergency systems [2019: 152 (57.6%) vs. 20 (45.6%), P = 0.034; 2020: 123 (56.9%) vs. 5 (14.7%), P < 0.001]. The NIHSS score for self-visiting patients was lower for patients who utilized the ambulance system in both years [self-visit: 6.00 (3.00, 12.00), ambulance: 14.00 (9.00, 19.00), P < 0.001]. The volume of reperfusion patients was lower in 2020; however, the decrease was only significant (P = 0.028) in February 2020. CONCLUSION: During the COVID-19 pandemic in 2020, the number of AIS patients receiving reperfusion therapy significantly decreased when compared to the same period in 2019. The patients' condition increased severity, ODT increased, and the DNT decreased. DPT was not significant for self-visiting and ambulance patients. Moderate to severe stroke patients were more likely to utilize ambulance services.


Assuntos
/terapia , Avaliação de Processos em Cuidados de Saúde/estatística & dados numéricos , Reperfusão/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Transporte de Pacientes/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Ambulâncias/estatística & dados numéricos , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Índice de Gravidade de Doença
7.
JAMA Netw Open ; 4(1): e2033318, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33427886

RESUMO

Importance: Appropriate use of helicopter emergency medical service (HEMS) is important in ensuring that patients with critical illness or injury receive adequate treatment. Objective: To investigate the association between use of HEMS compared with use of ground EMS (GEMS) and mortality overall and in a subgroup of patients with critical illness or injury. Design, Setting, and Participants: This register-based, nationwide cohort study used data retrieved from Danish registries from October 1, 2014, to April 30, 2018. Patients receiving GEMS originated from dispatched HEMS missions for which a helicopter was unavailable. For the primary analysis, patients from accepted HEMS missions and patients from missions in which HEMS was dispatched but unavailable were included. The secondary analysis included patients assigned a hospital International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis considered a critical illness or injury. These patients were selected via a consensus-based agreement among all authors by reviewing the Danish version of the World Health Organization's ICD-10 classification. Data were analyzed from March to June 2020. Exposures: Dispatch of HEMS vs GEMS unit (primary analysis) and treatment and transport by HEMS vs GEMS unit among patients with critical illness or injury (secondary analysis). Main Outcomes and Measures: One-year mortality was retrieved from the Danish Civil Registration System. Results: Among 10 618 patients (median [interquartile range] age, 60 [42-72] years; 6834 [64.4%] men) included in the primary analysis, 9480 patients (89.3%) received HEMS and 1138 patients (10.7%) received GEMS. Median (interquartile range) age was 60 (42-72) years, and 6834 patients (64.4%) were men. Adjusted cumulative 1-year mortality was 23.2% (95% CI, 22.4%-24.1%) among patients receiving HEMS vs 24.5% (95% CI, 21.9%-27.1%) among patients receiving GEMS. The difference in mortality risk for HEMS compared with GEMS was not statistically significant (hazard ratio, 0.94 [95% CI, 0.84-1.06]). Among 2260 patients with critical illness or injury receiving HEMS, compared with 315 patients with critical illness or injury receiving GEMS, adjusted cumulative 1-year mortality was 25.1% (95% CI, 23.5%-26.7%) vs 27.1% (95% CI, 22.0%-32.1%). The difference in mortality risk for HEMs compared with GEMs was not statistically significant (hazard ratio, 0.91 [95% CI, 0.73-1.14]). Conclusions and Relevance: This study found that 1 year after dispatch, the use of HEMS, compared with the use of GEMS, was not associated with a statistically significant difference in mortality overall or mortality among patients with critical illness or injury. Further research is needed to determine whether optimized dispatch systems may be associated with further improvements in survival among selected patients.


Assuntos
Resgate Aéreo , Ambulâncias , Estado Terminal/mortalidade , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Aeronaves , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros
8.
Emerg Med Australas ; 33(2): 375-378, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33387383

RESUMO

COVID-19 poses significant challenges to pre-hospital and retrieval medicine (PHRM) clinicians - and many are unique to this area of clinical practice. We share the experiences of the South Australian Ambulance Service (SAAS) MedSTAR Emergency Medical Retrieval Service in preparing for the COVID-19 pandemic in the pre-hospital and retrieval setting - including the role of a multidisciplinary leadership team; challenges and potential approaches to screening for COVID-19; personal protective equipment for pre-hospital and aeromedical taskings; issues arising with interstate retrievals; and the role of telehealth. Although novel solutions allowed SAAS MedSTAR to continue to deliver high-quality care, considering the resource implications involved in undertaking the transfer of patients with COVID-19, it is clear that significant community disease transmission threatens to overwhelm any PHRM service. Should Australia face a significant future outbreak, it is conceivable that some PHRM operations may need to be reduced or suspended entirely.


Assuntos
/epidemiologia , Serviços Médicos de Emergência/organização & administração , Controle de Infecções/organização & administração , Ambulâncias , Humanos , Exposição Ocupacional/prevenção & controle , Pandemias , Equipamento de Proteção Individual , Austrália do Sul/epidemiologia
9.
J Stroke Cerebrovasc Dis ; 30(3): 105602, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33461026

RESUMO

OBJECTIVE: We aim to report intra-arterial thrombectomy transfer metrics for ischemic stroke patients that were transferred to hub hospitals for possible intra-arterial thrombectomy in multiple geographic regions throughout the state of Texas and to identify potential barriers and delays in the intra-arterial thrombectomy transfer process. METHOD: We prospectively collected data from 8 participating Texas comprehensive stroke/thrombectomy capable centers from 7 major regions in the State of Texas. We collected baseline clinical and imaging data related to the pre-transfer evaluation, transfer metrics, and post-transfer clinical and imaging data. RESULTS: A total of 103 acute ischemic stroke patients suspected/confirmed to have large vessel occlusions between December 2016 to May 2019 that were transferred to hubs as possible intra-arterial thrombectomy candidates were enrolled. A total of 56 (54%) patients were sent from the spoke to the hub via ground ambulance with 47 (46%) patients traveling via air ambulance. The median spoke arrival to hub arrival time was 174 min, median spoke arrival to departure from spoke was 131 min, and median travel time was 39 min. The spoke arrival time to transfer initiation was 68 min. CT-perfusion obtained at the spoke and earlier initiation of transfer were statistically associated with shorter transfer times. CONCLUSION: Transfer of intra-arterial thrombectomy patients in Texas may take over 4 h from spoke arrival to hub arrival. This time may be shortened by earlier transfer initiation and acceptance.


Assuntos
Fibrinolíticos/administração & dosagem , Transferência de Pacientes , Trombectomia , Terapia Trombolítica , Tempo para o Tratamento , Idoso , Ambulâncias , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Texas , Trombectomia/efeitos adversos , Terapia Trombolítica/efeitos adversos , Fatores de Tempo , Resultado do Tratamento
10.
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 234-240, jan.-dez. 2021. ilus, tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1150664

RESUMO

Objetivo: Identificar, por meio de bases de dados, as principais evidências científicas e estratégias voltadas para a segurança do paciente no atendimento pré-hospitalar. Metodologia: Trata-se de uma revisão integrativa nas bases de dados da Lilacs e Medline via PubMed, CINAHL e Web of Science que com recorte temporal entre 2013 a 2017. Resultados: Captou-se 650 artigos, após critérios de elegibilidade, foram obtidos 15 para análise. Emergiram-se duas categorias de evidências como resultados: a influência do treinamento como garantia de registro e continuidade dos cuidados com segurança ao paciente; a garantia da segurança do paciente baseada na expertise da equipe de atendimento pré-hospitalar. Conclusão: Espera-se ampliar as discussões sobre a segurança do paciente no atendimento pré-hospitalar. Assim, possa-se lançar meios de garantir um cuidado livre de danos aqueles que necessitam de cuidados em saúde extra-hospitalar


Objective: To identify, through databases, the main scientific evidence and strategies aimed at patient safety in prehospital care. Methods: This is an integrative review of the Lilacs and Medline databases via PubMed, CINAHL and Web of Science, with a temporal cut between 2013 to 2017. Results: A total of 650 articles were obtained, after eligibility criteria, 15 for analysis. Two categories of evidence emerged as results: the influence of training as a guarantee of registration and continuity of care with patient safety; ensuring patient safety based on the expertise of the prehospital care team. Conclusion: It is hoped to broaden discussions on patient safety in prehospital care. Thus, means of guaranteeing a care free of damages can be introduced those who need extra-hospital health care


Objetivo: Identificar, por medio de bases de datos, las principales evidencias científicas y estrategias dirigidas a la seguridad del paciente en la atención prehospitalaria. Método: Se trata de una revisión integrativa en las bases de datos de Lilacs y Medline vía PubMed, CINAHL y Web of Science que con recorte temporal entre 2013 a 2017. Resultados: Se captó 650 artículos, después de criterios de elegibilidad, fueron obtenidos 15 para análisis. Se surgieron dos categorías de evidencias como resultados: la influencia del entrenamiento como garantía de registro y continuidad de los cuidados con seguridad al paciente; la garantía de la seguridad del paciente basada en la experiencia del equipo de atención prehospitalaria. Conclusión: Se espera ampliar las discusiones sobre la seguridad del paciente en la atención prehospitalaria. Así, se pueda lanzar medios de garantizar un cuidado libre de daños a aquellos que necesitan cuidados en salud extrahospitalaria


Assuntos
Humanos , Masculino , Feminino , Assistência Pré-Hospitalar , Serviços Pré-Hospitalares , Segurança do Paciente , Ambulâncias , Serviços Médicos de Emergência
11.
Esc. Anna Nery Rev. Enferm ; 25(2): e20200274, 2021. tab, graf
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1133827

RESUMO

RESUMO Objetivo verificar as causas da não conferência do carro de emergência e o efeito sobre a taxa de adesão, por meio do emprego de ferramentas da qualidade em uma Unidade de Terapia Intensiva Neonatal. Método pesquisa mista do desenho exploratório sequencial, desenvolvida com enfermeiros e fonte documental na Unidade de Terapia Intensiva Neonatal de hospital universitário, em três etapas: 1) Brainstorming para levantamento das causas de não conferência/construção de Lista de Verificação; 2) Coleta/análise de dados pela aplicação da Lista de Verificação e Diagrama de Pareto; 3) Análise documental. Utilizou-se o teste qui-quadrado para verificar o efeito do emprego das ferramentas de qualidade na adesão à conferência. Resultados 13 causas de não conferência do carro de emergência foram identificadas, sendo oito evitáveis e cinco não evitáveis. As causas evitáveis (n=63) representaram 87,5%, sendo as principais: falta de hábito (n=17; 27%), priorizar atividades assistenciais (n=17; 27%) e realizar divisão do cuidado dos pacientes/priorizar atividades administrativas (n=9; 14,3%). A aplicação das ferramentas da qualidade teve efeito significativo (p-valor<0,001) na adesão à conferência. Conclusão e implicações para a prática o emprego das ferramentas da qualidade foi factível para a identificação causal da não conferência do carro de emergência e melhoria na sua adesão.


RESUMEN Objetivo verificar las causas de la no conferencia del automóvil de emergencia y el efecto sobre la tasa de adherencia, mediante el uso de herramientas de calidad en una Unidad de Cuidados Intensivos Neonatales. Método investigación de métodos mixtos de diseño exploratorio secuencial. Fue desarrollado con enfermeras y una fuente documental en la Unidad de Cuidados Intensivos Neonatales de un hospital universitario, en tres etapas: 1) Brainstorming (Lluvia) de ideas para estudiar las causas de la no conferencia y construir una Lista de verificación; 2) Recopilación/análisis de datos mediante la aplicación de la Lista de verificación y el Diagrama de Pareto; 3) Análisis documental. Se utilizó la prueba de chi-cuadrado para verificar el efecto del uso de herramientas de calidad en la adherencia a la conferencia. Resultados se identificaron 13 causas de no conferencia del automóvil de emergencia, ocho eran prevenibles y cinco no prevenibles. Las causas evitables (n=63) representaron el 87,5%, siendo las principales: falta de hábito (n=17; 27%), priorizar las actividades de atención (n=17; 27%) y realizar la división de la atención a los pacientes/priorizar las actividades administrativas (n=9; 14.3%). La aplicación de herramientas de calidad tuvo un efecto significativo (p<0,001) en la adherencia a la conferencia. Conclusión e implicaciones para la práctica el uso de herramientas de calidad fue factible para la identificación causal del control no diario del carro de emergencia y en la mejora de su adherencia.


ABSTRACT Objective to verify the causes of the not checking of the emergency car and the effect on the adherence rate by using quality tools in a Neonatal Intensive Care Unit. Method mixed methods research of sequential exploratory design, developed with nurses and a documentary source in the Neonatal Intensive Care Unit of a university hospital, in three stages: 1) Brainstorming to survey the causes of not checking/ building a Checklist; 2) Data collection/analysis by applying the Pareto Checklist and Diagram; 3) Documentary analysis. The chi-square test was used to verify the effect of using quality tools in the adherence to checking. Results 13 causes of not checking of the emergency car were identified, eight of which are preventable and five non-preventable. The preventable causes (n=63) represented 87.5%, the main ones being: lack of habit (n=17; 27%), prioritizing care activities (n=17; 27%), and dividing the care of patients / prioritize administrative activities (n=9; 14.3%). The application of quality tools had a significant effect (p-value <0.001) in the adherence to checking. Conclusion and implications for practice the use of quality tools was feasible for the causal identification of the daily emergency car not checking and improvement in its adherence.


Assuntos
Humanos , Recém-Nascido , Qualidade da Assistência à Saúde , Ambulâncias , Gestão da Qualidade , Unidades de Terapia Intensiva Neonatal , Lista de Checagem/métodos , Segurança do Paciente , Enfermeiras e Enfermeiros
12.
J Nurs Adm ; 51(1): 33-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33278199

RESUMO

Mobile supplemental hospitals were an important asset to community response in preparing for the recent pandemic. MED-1 is a Mobile Emergency Department that has adapted and evolved to the changing needs of communities in times of disaster and nondisaster. An overview of the asset (MED-1), the operations, and use is provided to demonstrate how mobile supplemental hospitals can effectively meet a range of healthcare needs. Innovative utilization of MED-1 has secured its future as an effective resource averaging 100 days of deployment per year.


Assuntos
Ambulâncias , Defesa Civil/métodos , Planejamento em Desastres/métodos , Defesa Civil/tendências , Planejamento em Desastres/tendências , Humanos , Desenvolvimento de Programas/métodos
13.
Artigo em Inglês | MEDLINE | ID: mdl-33374768

RESUMO

To evaluate the prevalence of bloodborne infections (BBIs) and assess the incidence and selected risk factors for sharps injuries (SIs), a cross-sectional serosurvey was performed between December 2018 and October 2019 among 286 paramedics (76.5% males; mean age, 37 years) from 17 randomly selected ambulance stations in the West Pomeranian region of Poland. An ELISA system was used to detect anti-HBc, anti-HCV, and anti-HIV. HBV vaccination uptake was 95.6%; 7.3% (95% CI: 4.6-11.0%) paramedics were anti-HBc positive, and anti-HCV/anti-HIV seropositivity was not reported. Almost one-fourth of paramedics reported having had ≥1 SI during the preceding year (Me = 6.0, range 1-100). Most recent exposures primarily took place during an emergency procedure (76.7%), in an ambulance (45.2%), caused by hollow-bore needles (73.8%), and were not reported (50.0%). Additionally, 52.2% of paramedics reported needle recapping, and 52.6% did not use safety engineered devices (SEDs) at work. Mean knowledge score was low (2.6 ± 1.7); 3.4% had never participated in infection-control (IC) training, and those not trained were more likely to suffer a SI (odds ratio (OR) 4.64; p = 0.03). Due to frequent SIs, of which half are unreported, paramedics remain at risk of acquiring occupational BBIs. SI risk could be reduced by providing training on IC procedures, ensuring better compliance with safe work practices, and supplying more SEDs.


Assuntos
Pessoal Técnico de Saúde/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha , Exposição Ocupacional , Adulto , Ambulâncias , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Polônia/epidemiologia
14.
Gerokomos (Madr., Ed. impr.) ; 31(4): 221-225, dic. 2020. tab
Artigo em Espanhol | IBECS | ID: ibc-198741

RESUMO

OBJETIVO: Determinar la frecuencia de factores de riesgo de maltrato en personas ancianas asistidas por la unidad móvil de emergencias extrahospitalarias de Segovia. METODOLOGÍA: Se trata de un estudio descriptivo, con el fin de describir los factores de riesgo presentes en las personas ancianas de la investigación. La muestra está formada por 365 participantes mayores de 65 años. RESULTADOS: La muestra es homogénea por género (188 hombres y 177 mujeres); el grupo mayoritario es el de 71 a 90 años (67,9%). La edad media es de 80 años (σ = 8,91); el estado de salud mayoritario es de grado medio (41,6%); los grados de dependencia leve y moderado suponen en total un 56,7%; la presencia de deterioro cognitivo es del 50,4%; la frecuencia de incontinencia urinaria es de un 72,1%; el aislamiento social lo padecen el 24,4%; la situación actual es en el 51,2%, el 24,4% tienen depresión, abusan del alcohol el 13,2%, pocos viven en instituciones (15,6%) y la relación con el cuidador es buena en el 86% de los casos. CONCLUSIONES:La población seleccionada es bastante envejecida, lo que en sí ya supone más riesgo de padecer maltrato. Las personas con riesgo de maltrato por estado de salud general, deterioro cognitivo y dependencia suponen casi la mitad de la muestra. La incontinencia urinaria es el factor más común. Los trastornos depresivos no son frecuentes, al igual que el consumo de alcohol, pero su ponderación es muy elevada. Cabe destacar que la demora en solicitar ayuda es alta, muchos son hiperfrecuentadores, y algunos están malnutridos y se caen de forma repetida


OBJECTIVE: to determine the frequency of risk factors of abuse in elderly people assisted by the emergency mobile unit of extra-hospital emergencies in Segovia. METHODOLOGY: it ́s a descriptive study with the purpose of describing the risk factors present in the elderly people of the research. The sample consists of 365 participants over 65 years. RESULTS: the sample is homogeneous by gender (188 men and 177 women), the majority group is 71 to 90 years (67.9%). The average age is of 80 years (σ = 8.91), the majority health status is of medium degree (41.6%), the degree of media dependence and the moderate one suppose a total of 56.7%, the presentation of a cognitive is 50.4%. The frequency of urinary incontinence is 72.1%, social isolation appears in 24.4, the current situation is 51.2%, 24.4%, alcohol abuse, 13.2%, few they live in institutions (15.6%). The relationship with the caregiver is good in 86% of cases. CONCLUSIONS: the population has been quite old, what is already in it ́s more risk of suffering abuse. People at risk of abuse by general health status, cognitive knowledge and dependence, account for almost half of the sample. Urinary incontinence is the most common factor. Depressive disorders are not frequent, as is the consumption of alcohol, but its weight is very high. Highlight that the delay in requesting help is high, being many hyperusers, and some are malnourished and fall repeatedly


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Maus-Tratos ao Idoso/prevenção & controle , Ambulâncias , Incontinência Urinária/epidemiologia , Disfunção Cognitiva/epidemiologia , Cuidadores/estatística & dados numéricos , Maus-Tratos ao Idoso/estatística & dados numéricos , Unidades Móveis de Saúde , Isolamento Social , Fatores de Risco , Unidades de Terapia Intensiva , Estudos Transversais , Inquéritos e Questionários
16.
BMJ Open ; 10(12): e044726, 2020 12 23.
Artigo em Inglês | MEDLINE | ID: mdl-33361171

RESUMO

OBJECTIVE: To examine the impact of a 5-week national lockdown on ambulance service demand during the COVID-19 pandemic in New Zealand. DESIGN: A descriptive cross-sectional, observational study. SETTING: High-quality data from ambulance electronic clinical records, New Zealand. PARTICIPANTS: Ambulance records were obtained from 588 690 attendances during pre-lockdown (prior to 17 February 2020) and from 36 238 records during the lockdown period (23 March to 26 April 2020). MAIN OUTCOME MEASURES: Ambulance service utilisation during lockdown was compared with pre-lockdown: (a) descriptive analyses of ambulance events and proportions of event types for each period, (b) absolute rates of ambulance attendance (event types/week) for each period. RESULTS: During lockdown, ambulance patients were more likely to be attended at home and less likely to be aged between 16 and 25 years. There was a significant increase in the proportion of lower acuity patients (Status 3 and Status 4) attended (p<0.001) and a corresponding increase in patients not transported from scene (p<0.001). Road traffic crashes (p<0.001) and alcohol-related incidents (p<0.001) significantly decreased. There was a decrease in the absolute number of weekly ambulance attendances (ratio (95% CI), 0.89 (0.87 to 0.91), p<0.001), attendances to respiratory conditions (0.74 (0.61 to 0.86), p=0.01), and trauma (0.81 (0.77 to 0.85), p<0.001). However, there was a significant increase in ambulance attendances for mental health conditions (1.37 (1.22 to 1.51), p=0.005). CONCLUSIONS: Despite the relative absence of COVID-19 in the community during the 5-week nationwide lockdown, there were significant differences in ambulance utilisation during this period. The lockdown was associated with an increase in ambulance attendances for mental health conditions and is of concern. In considering future lockdowns, the potential implications on a population's mental well-being will need to be seriously considered against the benefits of elimination of virus transmission.


Assuntos
Ambulâncias/normas , Controle de Doenças Transmissíveis/métodos , Serviço Hospitalar de Emergência , Pandemias/prevenção & controle , Quarentena , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Gravidade do Paciente , Estudos Retrospectivos , Adulto Jovem
17.
Air Med J ; 39(5): 340-342, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33012469

RESUMO

In late 2019, a novel coronavirus was identified as the cause of a cluster of atypical pneumonia cases in Wuhan, China. It subsequently spread throughout China and around the world, quickly becoming a public health emergency. In March 2020, the World Health Organization declared coronavirus disease 2019 a pandemic. This article explores the preparation and early experiences of a large Canadian critical care transport program during the coronavirus disease 2019 pandemic focused on 6 broad strategic objectives centered around staff welfare, regular and transparent communication, networking, evidenced-based approach to personal protective equipment, agile mission planning, and an expedited approach to clinical practice and policy updates and future state modeling.


Assuntos
Comunicação , Infecções por Coronavirus , Cuidados Críticos/organização & administração , Disseminação de Informação , Liderança , Pandemias , Transferência de Pacientes/organização & administração , Pneumonia Viral , Transporte de Pacientes/organização & administração , Medicina Aeroespacial , Resgate Aéreo , Ambulâncias , Betacoronavirus , Colúmbia Britânica , Prática Clínica Baseada em Evidências , Humanos , Equipamento de Proteção Individual/provisão & distribução , Resiliência Psicológica
18.
Bull Cancer ; 107(11): 1129-1137, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33036742

RESUMO

PURPOSE: Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home. MATERIALS AND METHODS: Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes. RESULTS: In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros. CONCLUSION: Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.


Assuntos
Ambulâncias/economia , Institutos de Câncer/provisão & distribução , Acesso aos Serviços de Saúde/economia , Neoplasias/radioterapia , Transporte de Pacientes/economia , Ambulâncias/estatística & dados numéricos , Custos e Análise de Custo , França , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Estatísticos , Neoplasias/economia , Paris , Qualidade de Vida , Alocação de Recursos , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Incerteza
19.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 5905-5908, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33019318

RESUMO

Early inter-hospital ambulance transport of premature babies is associated with more severe brain injury. The mechanism is unclear, but they are exposed to excessive noise and vibration. Smart-routing may help minimise these exposure levels and potentially improve outcomes.An app for Android smartphones was developed to collect vibration, noise and location data during ambulance journeys. Four smartphones, with the app installed, were provided to the local neonatal transport group to attach to their incubator trolleys. An example of route comparison was performed on the roads used between Nottingham City Hospital (NCH) and Leicester Royal Infirmary (LRI).Almost 1,700 journeys were recorded over the space of a year. 39 of these journeys travelled from NCH to LRI, comprising of 9 different routes. Analysis was performed on all recorded data which travelled along each road. For routes from NCH to LRI, the route with least vibration was also the quickest. Noise levels, however, were found to increase with vehicle speed. Ambulance drivers in the study did not tend to take the quickest, smoothest or quietest route.Android smartphones are a practical method of gathering information about the in-ambulance environment. Routes were found to vary in vibration, noise and speed, suggesting these could be minimised. The next step is to combine recorded and clinical data to try and define an ideal neonatal comfort metric which can then be fed into the routing. Roll-out of the app around the UK is also planned.Clinical relevance-Transferring preterm neonatal infants to specialist units lead to worse outcomes. By reducing the levels of vibration and noise the infants are exposed to during transport, we hope to improve outcomes.


Assuntos
Ambulâncias , Macas (Leitos) , Humanos , Lactente , Recém-Nascido de Baixo Peso , Recém-Nascido , Ruído , Vibração
20.
Open Heart ; 7(2)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33106441

RESUMO

OBJECTIVES: To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19. METHODS: We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes RESULTS: There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19. CONCLUSION: These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.


Assuntos
Infecções por Coronavirus , Procedimentos Clínicos/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Avaliação de Processos e Resultados em Cuidados de Saúde/organização & administração , Pandemias , Intervenção Coronária Percutânea , Pneumonia Viral , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia , Idoso , Ambulâncias/organização & administração , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Infecções por Coronavirus/transmissão , Bases de Dados Factuais , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação , Londres/epidemiologia , Masculino , Pessoa de Meia-Idade , Admissão do Paciente , Segurança do Paciente , Intervenção Coronária Percutânea/efeitos adversos , Intervenção Coronária Percutânea/mortalidade , Pneumonia Viral/diagnóstico , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Pneumonia Viral/transmissão , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Trombose/mortalidade , Trombose/terapia , Fatores de Tempo , Tempo para o Tratamento/organização & administração , Resultado do Tratamento
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