To see the other types of publications on this topic, follow the link: Cardinal Type Service.
Journal articles on the topic 'Cardinal Type Service'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 journal articles for your research on the topic 'Cardinal Type Service.'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse journal articles on a wide variety of disciplines and organise your bibliography correctly.
1
Saeida Ardakani, Saeid, Majid Nejatian, Mohammad Ali Farhangnejad, and Mehran Nejati. "A fuzzy approach to service quality diagnosis." Marketing Intelligence & Planning 33, no. 1 (February 2, 2015): 103–19. http://dx.doi.org/10.1108/mip-02-2013-0035.
Full textAbstract:
Purpose – The purpose of this paper is to identify service quality dimensions that could enhance the level of services provided by a variety of carriers and rank them, accordingly. Design/methodology/approach – This research aims to identify service quality dimensions that could enhance the level of services provided by a variety of carriers and rank them, accordingly. Findings – The results show that “safety,” “timeliness,” and “variety and type of airplane” are the most important service quality criteria from the passengers’ viewpoint. It also indicates that the most and least important dimensions of service quality are “tangibles” and “responsiveness,” respectively. The results ranked the airlines from one to three as Emirates Airline, Mahan Air, and Iran Air. Originality/value – Most of the service quality criteria are descriptive and are stated using lingual expressions (cardinal or ordinal scales). Therefore, evaluation of perceptions and expectations of customers regarding service quality using non-fuzzy methods ignores the ambiguity involved in individual judgments.
2
. Laxmisha, A. S. "Ksfc - Real Promoter of Service Entrepreneurship." Ushus - Journal of Business Management 3, no. 1 (January 10, 2004): 44–49. http://dx.doi.org/10.12725/ujbm.4.5.
Full textAbstract:
Development of entrepreneurship is cardinal and most crucial to the industrial development. It is the process of encouraging a prospective entrepreneur to set up an industrial unit whether production, processing or servicing. The development of entrepreneurship is dependant upon the policies, programmes and approaches of the Government. This task is carried out by the agencies like KSFC, TECSOK, Banks etc. Among them KSFC is a premier money lending institution functioning in the state of Karnataka. The subsidies given by it have helped to bring into existence numerous business activities.
This paper is an attempt to see the type of entrepreneurship, i.e. industrial entrepreneurship of service entrepreneurship developed by the KSFC in Shimoga and Davangere districts of Karnataka State. The study based on both the secondary and primary data revealed that the Corporation is able to attract a large number of entrepreneurs in the service sector and assisting newer areas of activity. Careful selection and scanning of entrepreneurs, timely sanctions, need based lending policy, strengthening the entrepreneurial guidance, provision of working capital etc., are some of the suggestions offered by the paper. It has nourished many self made businessmen.
3
Feinberg, Bruce A., Joseph Cooper, Winston Wong, Daniel Winn, Tim Olson, Ram Swarup Trehan, and Jeffrey A. Scott. "Shifting revenue from drug sales to cognitive services: Impact on physician prescribing behavior." Journal of Clinical Oncology 31, no. 15_suppl (May 20, 2013): 6629. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.6629.
Full textAbstract:
6629 Background: Extensive literature has cited fee-for-service physician reimbursement methodology as a critical driver of resource utilization constituting overtesting, overtreatment, and an impediment to bending the cost curve in cancer care. CareFirst BlueCross BlueShield (CFBCBS) partnered with Cardinal Health Specialty Solutions to launch the first cancer clinical pathway in the US in Aug 2008. Physician participation was voluntary and reimbursement remained fee-for-service. Due to its early success with regard to savings and physician participation and compliance, an oncology medical home (MH) program was piloted in Jan 2011 offering a new physician reimbursement model, which shifted the source of revenue from margin on drug sales to cognitive services. This would allow physicians to focus on optimal patient (pt) care without the financial incentive to prescribe chemotherapy (chemo). We analyzed physician behavior modification after this change in reimbursement structure 1 year after implementation of the MH program. Methods: Practices that participated in the first pathways program were eligible to join the MH program. Claims data from CFBCBS were collected from Apr 2010 to Mar 2012. New and established pt visits, chemo administrations (admins) per pt and per practice, and % generic drug use were compared for year +1 versus year -1 of the MH program. Results: Fourteen practices (31 physicians, 478 pts) joined the MH program. In year +1, new pt visits increased by 2.7%, visits per established pt increased 1%, chemo admins per pt increased by 3%, and the percentage of regimens utilizing all generic drugs increased by 3.9%. Conclusions: Switching financial incentives from drug administration toward cognitive services did not significantly alter physician behavior with regard to the type or frequency of chemo admins or the frequency of pt visits. Whether this is because the physicians were mature pathways participants, influenced by brand-name prescription drug detailing, following National Comprehensive Cancer Network guidelines, or influenced by cognitive dissonance is speculative. Assumptions regarding fee-for-service reimbursement may not be applicable to chemo and will be further studied.
4
Took, Roxane L., Yifei Liu, and Peggy G. Kuehl. "A Study to Identify Medication-Related Problems and Associated Cost Avoidance by Community Pharmacists during a Comprehensive Medication Review in Patients One Week Post Hospitalization." Pharmacy 7, no. 2 (May 29, 2019): 51. http://dx.doi.org/10.3390/pharmacy7020051.
Full textAbstract:
Objectives: To determine the numbers of medication discrepancies and medication-related problems (MRPs) identified and resolved when providing a transitions of care comprehensive medication review (CMR) after hospital discharge within a community pharmacy; and to estimate the cost-avoidance value of this service. Methods: Community pharmacists provided CMRs to covered employees and dependents of a self-insured regional grocery store chain who were discharged from the hospital. Data was collected prospectively over 4 months. Discrepancies were identified among patients’ medication regimens by comparing the hospital discharge record, the pharmacy profile, and what the patient reported taking. MRPs were categorized into ten categories, as defined by the OutcomesMTM® Encounter Worksheet. Interventions were categorized using the severity scale developed by OutcomesMTM®, a Cardinal Health company. Data were analyzed using descriptive statistics and bivariate correlations. Results: Nineteen patients were enrolled in the program. Pharmacists identified 34 MRPs and 81 medication discrepancies, 1.8 and 4.3 per patient, respectively. The most common type of MRP was underuse of medication (70.6%). Significant positive correlations were found between the number of scheduled prescription medications and the number of medications with discrepancies (p ≤ 0.01; r = 0.825) and number of scheduled prescription medications and the number of MRPs (p ≤ 0.01; r = 0.697). Most commonly, the severity levels associated with the MRPs involved the prevention of physician office visits or addition of new prescription medications (n = 10 each); however, four emergency room visits and three hospitalizations were also avoided. The total estimated cost avoidance was $92,143, or $4850 per patient. Extrapolated annual cost savings related to this service would be $276,428. Conclusions: This transitions of care service was successful in identifying and addressing MRPs and discrepancies for this patient population. By providing this service, community pharmacists were able to prevent outcomes of various severities and to avoid patient care costs.
5
Thabane, Tebello, and Elizabeth Snyman-Van Deventer. "Pathological Corporate Governance Deficiencies in South Africa's State-Owned Companies: A Critical Reflection." Potchefstroom Electronic Law Journal 21 (January 10, 2018): 1–32. http://dx.doi.org/10.17159/1727-3781/2018/v21i0a2345.
Full textAbstract:
Globally, states use state-owned companies (SOCs) or public corporations to provide public goods, limit private and foreign control of the domestic economy, generate public funds for the fiscus, increase service delivery and encourage economic development and industrialisation. Particularly given its unique socio-political and economic dynamics, a country such as South Africa clearly needs this type of strategic enterprise. Yet, that does not mean that everything at our SOCs is as it should be. The beleaguered South African Broadcasting Corporation (SABC) has recently seen the resignation of board members, shareholder interference in its operational affairs, and a high turnover of chief accounting officers and other executive management members. Due to non-performance, it has also received several cash injections from its shareholder to enable it to continue to deliver its services. In addition, the shareholder minister took it upon herself to amend the SABC's memorandum of incorporation, conferring upon herself the authority to appoint, suspend or even dismiss key executive members. South African Airways (SAA), in turn, has had seven CEOs in less than four years, has had to be bailed out at a cost of R550 million, and has in addition been granted a R5 billion guarantee by the shareholder for a restructuring exercise. Other SOCs such as Eskom, the Post Office and Telkom have also experienced high board and executive management turnover, perennial underperformance necessitating regular bailouts, and challenges regarding the division of power between their boards and the various shareholder ministers. Another issue that seems to plague South Africa's SOCs is the appointment of board members and executive officials with questionable qualifications. By critically examining the corporate governance challenges besetting the SABC, SAA and Eskom in particular, this article seeks to explore the root causes of the corporate governance deficiencies of SOCs, and how their corporate governance can be enhanced. It is concluded that the challenges faced by the country's SOCs are twofold: firstly, the SOCs boards' lack of appreciation of the cardinal corporate governance rules, and secondly, the role of government as a single or dominant shareholder, which results in substantial political interference in the running of the SOCs. This dual problem requires a dual solution. To arrest the problem of poor corporate governance in SOCs, government as the shareholder should firstly appoint fit and proper directors, having followed a sound due-diligence process. Once it has established such properly skilled and competent boards, however, government should adopt an arm's-length approach to the affairs of the SOCs as a way of insulating these corporations from political interference
6
Bortolin, Michelangelo, Marco Ulla, Alessia Bono, Enrico Ferreri, Mariano Tomatis, and Sergio Sgambetterra. "Holy Shroud Exhibition 2010: Health Services During a 40-Day Mass-Gathering Event." Prehospital and Disaster Medicine 28, no. 3 (March 21, 2013): 239–44. http://dx.doi.org/10.1017/s1049023x13000216.
Full textAbstract:
AbstractIntroductionMass-gathering events require varying types and amounts of medical resources to deal with patient presentations as well as careful planning for environmental health management. The Holy Shroud Exhibition was hosted in Torino, Italy, between April and May 2010. The venue was a unique mass-gathering event which lasted several weeks. It was held in a limited area in the center of the city and it was attended by a large and heterogeneous population. A dedicated Health Care Service was created for the event.MethodsThis study is a retrospective analysis of clinical presentations of patients who were managed by the Medical Services during the event. The main study outcomes included Patient Presentation Rate (PPR), type of injuries and illnesses, and the Transport to Hospital Rate (TTHR).ResultsThe PPR and TTHR were both low (0.27 and 0.039 respectively). The majority of patients presented with low severity codes and no sudden cardiac death (SCD) or cardiac arrest occurred. Cardiac and trauma emergencies were most frequent categories of presentation. A number of pediatric patients (19.37%) were treated by the event Medical Service. Approximately two million persons participated in the 40-day event.ConclusionThe experience for this 40-day event supported having an on-site, organized, dedicated Medical Service that decreased overcrowding of the local Emergency Medical System and hospitals. It is recommended that, for such events, there be recruitment of emergency physicians with experience in mass-gathering events, recruitment of pediatricians, and training for professionals during the planning process.BortolinM, UllaM, BonoA, FerreriE, TomatisM, SgambetterraS. Holy Shroud Exhibition 2010: health services during a 40-day mass-gathering event. Prehosp Disaster Med. 2013;28(3):1-6.
7
Moralejo, E., and S. Werres. "First Report of Phytophthora ramorum on Rhododendron sp. in Spain." Plant Disease 86, no. 9 (September 2002): 1052. http://dx.doi.org/10.1094/pdis.2002.86.9.1052a.
Full textAbstract:
Phytophthora ramorum has been recently described (4) from isolates collected since approximately 1993, from Rhododendron and Viburnum in the Netherlands and Germany. Since 2001 and 2002, respectively, there have been unconfirmed reports from Poland and Great Britain (1). There are growing concerns about this oomycete since it has been recognized as the causal agent of sudden oak death in California, where thousands of oaks and tanoaks (Quercus agrifolia, Q. kelloggii, Q. parvula var. shrevei, and Lithocarpus densiflorus) have died. Since the first outbreak in Marin County, California in 1995, (3) the epidemic has remained concentrated mainly along the Pacific Coast near San Francisco but has been reported in Oregon (2). There have been no reports of oaks or other trees affected in Europe. During February 2002, E. Moralejo surveyed several nurseries in Mallorca, (Balearic Islands, Spain) to verify the presence of P. ramorum on rhododendron. Two shipments of rhododendrons, from the towns of Palma and Santa Maria del Camí, showed twig blight and necrotic spots at leaf tips and margins. Less than 0.5% of the aerial parts of the potted plants of both sets were affected. Isolations from symptomatic tissue consistently yielded cultures of Phytophthora using selective media (corn meal agar supplemented with nystatin, rifampicin, and ampicillin). Pure cultures were obtained from three isolates by hyphal-tip transfers on carrot piece agar (CPA) and identified as P. ramorum on the basis of morphological and cultural characters (4). Colonies grown on CPA at 17°C were appressed with sparse aerial mycelium and formed typical concentric growth rings under 16 h fluorescent light. Cardinal temperatures for vegetative growth were 2°C (minimum), 20°C (optimum), and 28°C (maximum). Daily radial growth was 3 to 3.2 mm at 20°C. Sporangia formed singly or in clusters on aerial sporangiophores in the absence of free water, and were mainly semipapillate, caducous, with a very short or no pedicel, ellipsoidal to elongated-ovoid, with a length/breath ratio of 1.9 to 2.1. Large spherical, terminal, and intercalary chlamydospores, 32 to 72 μm in diameter, were readily formed in agar. The mating type of these isolates from Mallorca was A1 based on dual cultures on CPA with four different heterothallic Phytophthora species. Crossing was successful with P. cryptogea BBA 63651 mating type A2. Oogonia were subglobose and measured 24 to 32 μm in diameter. Oospores were plerotic. Antheridia were always amphigynous, and mainly barrel-shaped to spherical, 14 to 22 μm in diameter One of the three isolates also produced a very small number of gametangia with the A2 tester strain P. cinnamomi BBA 62660, but the oospores appeared degenerate. Only A1 mating type strains of P. ramorum have been found in Europe. The Mallorca isolates have been deposited in the culture collection of the Federal Biological Research Centre for Agriculture and Forestry (BBA), Germany. To our knowledge, this is the first report of P. ramorum in Spain. Further research is urgently needed to assess whether the Mediterranean evergreen oak ecosystem is in danger. References: (1) EPPO Reporting Service. Published on-line, http://www.eppo.org/PUBLICATIONS/EPPO_RS/reporting_service.html Publication no. 2002/040 and 2002/077. (2) E. M. Goheen et al. Plant Dis. 86:441, 2002. (3) D. M. Rizzo et al. Plant Dis. 86:205, 2002. (4) S. Werres et al. Mycol. Res. 105:1155, 2001.
8
Martini, Cardinal Carlo Maria. "Bernard Lonergan at the Service of the Church." Theological Studies 66, no. 3 (September 2005): 517–26. http://dx.doi.org/10.1177/004056390506600302.
Full textAbstract:
[Cardinal Martini, archbishop emeritus of Milan, and currently scholar in residence in Jerusalem, delivered this inaugural address on November 17, 2004, during a three-day international congress held at the Gregorian University on the occasion of the 100th anniversary of the birth of the Canadian Jesuit Bernard J. F. Lonergan (1904–1984). The congress explored the contribution of Lonergan to Christian theology and, in particular, his proposal for a new methodology capable of assuring the internal unity of theology as well as fostering its many integrations with the natural and human sciences, historical research, philosophical reflection, and other types of knowing. Cardinal Martini in his lecture brought out the person of Lonergan as well as his ecclesial and cultural significance.]
9
Byrne-Davis, L. M. T., D. Marchant, E. R. Bull, D. Gyles, E. Dean, and J. K. Hart. "How do members of a fire and rescue service perceive expanding their roles to deliver more health care services?" Journal of Public Health 41, no. 3 (August 21, 2018): 593–99. http://dx.doi.org/10.1093/pubmed/fdy148.
Full textAbstract:
Abstract Background Increasingly, public sector workers are being required to expand their roles into public health. Fire and rescue services, as part of the Emergency Medical Response trial, are at the forefront of role expansion, with increasing capacity due to reducing numbers of fires in recent years. Firefighter roles, successfully implemented, include responding to cardiac arrests and conducting checks on health and wellbeing in people’s own homes. In this study, we explored fire service members’ perceptions about this role expansion, to increase understanding of how role expansion can be introduced and supported. Methods We interviewed 21 firefighters and team members about their perceptions of new roles. Interviews were conducted, transcribed and thematically analysed until reaching thematic saturation. Results Perspectives differed for responding to cardiac arrests and wellbeing checks. Cardiac arrests were seen as aligned with core roles and thus more acceptable. For both types of new role participants wanted more training and opportunities to provide feedback on implementation. Conclusions How team members viewed role expansion depended on new role alignment with core role, training and being able to give feedback to management to shape future services.
10
Novick, William M., Gregory L. Stidham, Tom R. Karl, Robert Arnold, Darko Anić, Sri O. Rao, Victor C. Baum, Kathleen E. Fenton, and Thomas G. Di Sessa. "Paediatric cardiac assistance in developing and transitional countries: the impact of a fourteen year effort." Cardiology in the Young 18, no. 3 (June 2008): 316–23. http://dx.doi.org/10.1017/s1047951108002175.
Full textAbstract:
AbstractBackgroundPaediatric cardiac services are poorly developed or totally absent in underdeveloped countries. Institutions, foundations and interested individuals in those nations in which sophisticated paediatric cardiac surgery is practised have the ability to alleviate this problem by sponsoring paediatric cardio-surgical missions to provide care, and train local caregivers in developing, transitional, and third world countries. The ultimate benefit of such a programme is to improve the surgical abilities of the host institution. The purpose of this report is to present the impact of our programme over a period of 14 years.MethodsWe specifically reviewed our database of patients from our missions, our team lists, surgical results, and the number and type of personnel trained in the institutions that we have assisted. In order for the institution to be entered into the study, the foundation had to provide at least 2 months of training. In addition, the institution had to respond to a simple questionnaire concerning the number and types of surgery performed at their facility before and after intervention by the foundation.ResultsWe made 140 trips to 27 institutions in 19 countries, with 12 of the visited institutions qualifying for inclusion. Of these, 9 institutions reported an increase in the number and complexity of cases currently being performed in their facility since the team intervened. This goal had not been accomplished in 3 institutions. The reasons for failure included the economic situation of the country, hospital and national politics, personality conflicts, and continued lack of hardware and disposables.ConclusionsPaediatric cardiac service assistance can improve local services. A significant commitment is required by all parties involved.
11
Saha, Arup Kumar, Shaik Abdullah Al Mamun, Diti Rani Das, Wahedul Alam Almajidi, Most Shahana Afroge Khan, SM Sadequl Hasan, and Farhana Nasrin. "The Evaluation of Cardiac Emergency Management in National Institute of Cardiovascular Diseases Hospital, Dhaka, Bangladesh." Bangladesh Journal of Dental Research & Education 2, no. 2 (August 26, 2013): 52–57. http://dx.doi.org/10.3329/bjdre.v2i2.16245.
Full textAbstract:
Emergency department is one of the most important part of the hospital and also vulnerable to criticism. The reputation of a hospital rests to a large extent on the service of emergency department. The sudden and unexpected nature on the emergency produces panic and psychological disturbances to the relatives, which must be valued and borne in mind during organization and management of services. A descriptive type of cross sectional study was conducted at Emergency Department of National Institute of Cardiovascular Hospital, Dhaka to evaluate the existing facilities, waiting time for the patients for receiving treatment, emergency referral rate and availability of health personnel, overall management and patients suggestion to improve the services of the emergency department. A total of 150 patients were interviewed by a structured questionnaire and a checklist was utilized for equipments and drugs. It was observed that the mean age 49.49 years. About 38.7% patients were attended by doctor within 6-10 minutes. Shifting of the patients form emergency department to another hospital was 12%. 87.3% patients were satisfied with time to complete treatment. In emergency department 69.3% patients were satisfied with reception facility, 89.3% patients were satisfied with given treatment, 92% patients were satisfied with doctors service and 74% patients were satisfied with the service of the support staff. About 90% patients were satisfied with overall management. The findings of cardiac emergency services obtained through check-list were fairly comparable with the opinions expressed by the patients. For further management of emergency department patients gave suggestion for arrangement of waiting room and toilet facility, X-ray and other laboratory facility for emergency patient should be made available for all the duty shift, drugs should be supply adequately and on regular basis. They suggested for augmentation of the equipments, drugs and security and other facilities and recruitment of some trained service providers. According to the patients the Emergency Department is well-studded to manage most of the cardiac emergencies. However, specific problems identified by different stakeholders need to be critically appraised by the authority to improve the services further.DOI: http://doi.dx.org/10.3329/bjdre.v2i2.16245 Bangladesh Journal of Dental Research & Education Vol.2(2) 2012: 52-57
12
Lee, Si Jin, Kap Su Han, Eui Jung Lee, Sung Woo Lee, Myung Ki, Hyeong Sik Ahn, and Su Jin Kim. "Impact of insurance type on outcomes in cardiac arrest patients from 2004 to 2015: A nation-wide population-based study." PLOS ONE 16, no. 7 (July 14, 2021): e0254622. http://dx.doi.org/10.1371/journal.pone.0254622.
Full textAbstract:
Objectives There do not appear to be many studies which have examined the socio-economic burden and medical factors influencing the mortality and hospital costs incurred by patients with cardiac arrest in South Korea. We analyzed the differences in characteristics, medical factors, mortality, and costs between patients with national health insurance and those on a medical aid program. Methods We selected patients (≥20 years old) who experienced their first episode of cardiac arrest from 2004 to 2015 using data from the National Health Insurance Service database. We analyzed demographic characteristics, insurance type, urbanization of residential area, comorbidities, treatments, hospital costs, and mortality within 30 days and one year for each group. A multiple regression analysis was used to identify an association between insurance type and outcomes. Results Among the 487,442 patients with cardiac arrest, the medical aid group (13.3% of the total) had a higher proportion of females, rural residents, and patients treated in low-level hospitals. The patients in the medical aid group also reported a higher rate of non-shockable conditions; a high Charlson Comorbidity Index; and pre-existing comorbidities, such as hypertension, diabetes mellitus, and renal failure with a lower rate of providing a coronary angiography. The national health insurance group reported a lower one-year mortality rate (91.2%), compared to the medical aid group (94%), and a negative association with one-year mortality (Adjusted OR 0.74, 95% CI 0.71–0.76). While there was no significant difference in short-term costs between the two groups, the medical aid group reported lower long-term costs, despite a higher rate of readmission. Conclusions Medical aid coverage was an associated factor for one-year mortality, and may be the result of an insufficient delivery of long-term services as reflected by the lower long-term costs and higher readmission rates. There were differences of characteristics, comorbidities, medical and hospital factors and treatments in two groups. These differences in medical and hospital factors may display discrepancies by type of insurance in the delivery of services, especially in chronic healthcare services.
13
Tomazini Nesello, Pietro Felice, Guilherme Foletto, Eduardo Pflug Comparsi, and Olga Sergueevna Tairova. "Change in Profile of Entrants in a Brazilian Large Cardiovascular Rehabilitation Service." Open Access Macedonian Journal of Medical Sciences 3, no. 3 (July 7, 2015): 384–90. http://dx.doi.org/10.3889/oamjms.2015.083.
Full textAbstract:
BACKGROUND: There are references regarding physical activity and cardiovascular disease since the nineteenth century. New evidences support that cardiac rehabilitation is closely related to therapeutic success after major coronary events. Although the benefits of cardiac rehabilitation programs are well established, referencing and enrolment in such services remain low.AIM: The aim of this paper is to describe the profile changes throughout the years in a large cardiac rehabilitation service in Brazil.MATERIAL AND METHODS: This is a retrospective analysis of medical records of all patients referred to cardiac rehabilitation service of the Institute of Sports Medicine, University of Caxias do Sul from March 2003 to July 2014. Data collection was carried out using SPSS software and the statistical analysis with Student’s t-test, ANOVA test and chi square test.RESULTS: It has seen a substantial increase of patients, mostly routed via universal health system, also an increase of post-myocardial infarction patients and ex-smokers. Also, it was seen few patients in the 7th and 8th life decades, and men were in majority since the beginning.CONCLUSION: An increase in the number of patients referred by universal health system occurred because there is a governmental interest in this type of program. About tobacco, hospitalizations appear to be influential in the decision of abandonment. There was a substantial increase of patients with more severe disease which is in accordance with the latest guidelines of Cardiovascular and Metabolic Rehabilitation.
14
Rush, Kathy L., Nelly D. Oelke, Matt Shay, and Robert C. Reid. "The Diverse Journeys of Rural Older Adults with Atrial Fibrillation." European Journal for Person Centered Healthcare 3, no. 4 (December 1, 2015): 487. http://dx.doi.org/10.5750/ejpch.v3i4.1022.
Full textAbstract:
Rationale, aims and objectives: Atrial fibrillation (AF) is a serious chronic heart condition characterized by an irregular, rapid heartbeat and unpredictable course. Patients with AF often struggle with managing the impact of the disease on daily activities. Afflicted rural dwelling patients face added challenges including inequities in health services and a lack of cardiac specialty services. AF patient journeys through the healthcare system have not been well documented, but offer a valuable tool for improving patient management and outcomes. The purpose of this study was to document individual AF patient journeys of rural living older adults. Method: This study used a 6-month longitudinal design to examine the rural healthcare experiences of 10 AF patients. AF patient journeys were mapped using information gathered through interviews, written logs, photographs and an electronic health record review. Thematic analysis was used in clustering common features of the healthcare journeys of older adult patients with AF and a typology developed to describe them. Results: Each patient’s journey with AF was unique. Symptom and disease severity, health service utilization and needs emerged as differentiating features in the identification of 3 journey types: (1) Stable, (2) Chronically Unstable and (3) Acute Crisis. Conclusions: These journey types provide a valuable person-centered tool to assess patient needs at any point in the AF trajectory and to address salient risks that accompany each type to improve management of the increasing number of persons suffering from AF.
15
Thoits, Peggy A. "Motivations for Peer-Support Volunteering: Social Identities and Role-Identities as Sources of Motivation." Nonprofit and Voluntary Sector Quarterly 50, no. 4 (January 6, 2021): 797–815. http://dx.doi.org/10.1177/0899764020983897.
Full textAbstract:
Motivations for volunteering described by functional theory are loosely related to the types and duration of these activities. The motivating effects of individuals’ social- and role-based identities may need inclusion. Identity theories suggest that entering a specific service activity depends on whether the service benefits a social group with which a person identifies, while persisting in the work depends on rewards and legitimation gained from the role-identity of “volunteer.” Former cardiac patients’ motivations for engaging in peer-support volunteering were explored ( n = 84). Respondents’ primary motive for starting this work was to reduce current patients’ anxieties, suggesting identification with cardiac patients in general. Respondents viewed their “volunteer” role-identity as deeply rewarding, promoting long-term involvement. Identification with the sponsoring organization (Mended Hearts) supplied additional benefits, supporting continued involvement. Social- and role-identities help to explain the start and persistence of this type of volunteer work and likely influence other volunteer activities.
16
Berry, Nada S., Jon E. Folstad, Jerry L. Bauman, and Jerrold B. Leikin. "Follow-up Observations on 24-Hour Pharmacotherapy Services in the Emergency Department." Annals of Pharmacotherapy 26, no. 4 (April 1992): 476–80. http://dx.doi.org/10.1177/106002809202600403.
Full textAbstract:
OBJECTIVE: To analyze the impact of 24-hour clinical pharmacy (CP) services in the emergency department (ED). DESIGN: A review of the “on-call report forms” and written consultations provided by CP between July 1985 and December 1987. SETTING: The University of Illinois Hospital. MAIN OUTCOME MEASURES: Patient-related versus non—patient-related cases; solicitor, type of and time per consultation; drug concentration determinations by CP; and comparison with other ED consultation services. RESULTS: Of 3787 consultations 3650 (96 percent) were patient-related, 137 (4 percent) were non—patient-related. Consultations were solicited from another individual in 2774 cases (73 percent); they were initiated by the clinical pharmacists in 831 cases (22 percent). Of the patient-related consultations, 1215 (33.3 percent) involved pulmonary disease, 796 (21.8 percent) toxicology, 635 (17.4 percent) seizures, 411 (11.3 percent) cardiac cases, 268 (7.3 percent) pharmacokinetics, and 325 (8.9 percent) miscellaneous. Consultations were solicited by physicians (1806, 65 percent), nurses (652, 23.5 percent), cardiac arrest page (237, 8.5 percent), patients (45, 2 percent), or pharmacists (34, 1 percent). They averaged 100 minutes each. Of 2197 drug concentrations, 1939 (88 percent) were completed by the clinical pharmacist. Concentrations were obtained for theophylline (1055, 54.4 percent), phenytoin (511, 26.4 percent), phenobarbital (324, 16.7 percent), and acetaminophen (49, 2.5 percent). Compared with other consultation services, CP ranked first in regard to frequency of use. CONCLUSIONS: The CP consultation service in the ED was as well used as most physician consultation services and tended to involve specific therapeutic areas that have implications for the training of emergency department clinical pharmacists.
17
Soontornpipit, Pichitpong. "Comparison of Implantable Antennas for Cardiovascular Patients." Applied Mechanics and Materials 781 (August 2015): 595–98. http://dx.doi.org/10.4028/www.scientific.net/amm.781.595.
Full textAbstract:
Implantable device cardiac observation (ICDO) such as pacemaker requires communication with medical devices outside the body in order to monitor or control the parameters of the organ it is supporting. Three types of implantable antennas have been investigated to determine their performances on two patient conditions: normal and hyperglycemia. Folded dipole, serpentine microstrip, and waffle-type Planar Inverted-F (PIFA) antennas are operated in the 402-405 MHz, which is medical implant communication services (MICS) band. Detailed analysis of the design issues of the antennas and comparative results of simulations and measurements are presented.
18
Gettys, Lyn A., and Kimberly A. Moore. "Greenhouse Culture and Production of Four Ornamental Native Wetland Plants." HortTechnology 28, no. 3 (June 2018): 332–36. http://dx.doi.org/10.21273/horttech03818-17.
Full textAbstract:
Wetland restoration is an important way to improve ecosystem services, but many wetland nurseries lack the facilities that are traditionally used to produce large numbers of native plants used in these projects. Our goal was to evaluate growth and performance of four wetland species in a variety of substrates, fertilizer regimes, and irrigation methods under greenhouse conditions. Plants were grown in pots with drainage holes filled with one of four substrates (potting substrate, topsoil, sand, 50/50 mix of topsoil, and sand) amended with 0, 1, 2, or 4 g of 15N–3.9P–10K controlled-release fertilizer per liter of substrate. Irrigation was supplied via an overhead system or subirrigation. After 16 weeks of production, plants were scored for visual quality and plant height before a destructive harvest. Broadleaf sagittaria (Sagittaria latifolia) was mostly unaffected by substrate type but performed best when subirrigated and fertilized with 4 g·L−1 of fertilizer. Growth of skyflower (Hydrolea corymbosa) and cardinal flower (Lobelia cardinalis) was best when fertilized with 2 or 4 g·L−1 of fertilizer and grown using overhead irrigation. String lily (Crinum americanum) was unaffected by substrate type but produced the largest plants when subirrigated. These experiments provide guidance for cultivating these wetland species under greenhouse conditions, which may allow growers to efficiently produce plant material needed for the restoration market.
19
Forrest, P., J. Y. Cheong, M. P. Vallely, P. J. Torzillo, P. N. Hendel, M. K. Wilson, P. G. Bannon, M. S. Bayfield, R. Herkes, and S. W. Walker. "International Retrieval of Adults on Extracorporeal Membrane Oxygenation Support." Anaesthesia and Intensive Care 39, no. 6 (November 2011): 1082–85. http://dx.doi.org/10.1177/0310057x1103900616.
Full textAbstract:
A retrieval service was established in New South Wales to provide mobile extracorporeal membrane oxygenation support to patients with severe, acute cardiac or respiratory failure. This service has also retrieved four adult patients from Nouméa, New Caledonia to Sydney on extracorporeal membrane oxygenation support, which are the first international retrievals of this type from Australia. We discuss our experience with these patients, three of whom survived to hospital discharge. However, one patient referred from New Caledonia died before extracorporeal membrane oxygenation could be established.
20
Lavery, Robert F., James Doran, Bartholomew J. Tortella, and Ronald P. Cody. "A Survey of Advanced Life Support Practices in the United States." Prehospital and Disaster Medicine 7, no. 2 (June 1992): 144–50. http://dx.doi.org/10.1017/s1049023x00039388.
Full textAbstract:
AbstractStudy Objective:A national survey was conducted to determine the sponsorship of emergency medical services (EMS) projects, composition of EMS advanced life support (ALS) teams, types of medications and equipment carried, and procedures approved for use by EMS systems in the United States.Methods:A mail survey was sent to 211 training supervisors of EMS services across the United States in 1989. The survey requested demographic and service-related information, including types of EMS sponsorship, composition of ALS teams, medications and equipment carried, and procedures which personnel have been trained to use. Medications carried were correlated with advanced cardiac life support (ACLS), the American College of Emergency Physicians (ACEP) recommended drug lists, and with the sponsoring agency.Results:One-hundred seventy (70%) survey forms were returned. The major providers of ALS in the United States are fire departments (36%), followed by private providers (26%), hospitals (22%), and local governments (16%). The most common ALS team composition was two paramedics followed by one paramedic and one emergency medical technician (EMT). Most ALS services carry all of the recommended ACLS medications; a much smaller percentage carry all of the drugs recommended by ACEP. Fire department based ALS units carried the least number of medications; hospital-based ALS units carried the highest number of medications. Combined, over 80 different medications were carried by the services responding to the survey.Conclusion:The use of ACLS drugs and procedures are well-established nation-wide; less accepted are the medications recommended by ACEP. While over 80 different medications are carried by the EMS systems that responded to this survey, only a small fraction have been investigated in the prehospital setting.
21
Hoberty, P. D. "Quality Assurance and the Service Domain in Cardiac and Pulmonary Rehabilitation." Clinical & Investigative Medicine 30, no. 3 (June 1, 2007): 40. http://dx.doi.org/10.25011/cim.v30i3.1743.
Full textAbstract:
Background: Little is known about the quality assurance methods used on cardiac and pulmonary rehabilitation. Also, little is known as to what extent the service domain is evaluated and what methods are employed. Knowledge of what is being done in these regards may facilitate programs effectively and efficiently measuring these outcomes.
Methods: A survey was mailed to 1/3 of the programs (approximately 400) in both cardiac and pulmonary rehabilitation listed in the AACVPR Program Guide 2004. The survey included questions that would add to the knowledge of what is the extent of practice and methods. 12 components of quality assurance were listed and 14 components of patient satisfaction were assessed as to the frequency of use. It was pilot tested and revised.
Results: The usable return rate was 48%. Program directors of both types of programs claimed daily formal assessment of most of the 12 areas listed for quality assurance. The three highest being assessment of adverse events, safety, and patient satisfaction. The three lowest use was in the area of efficiency, timeliness and continuity of care. The service domain was assessed as comparable to the other three: health, clinical and behavioral domains. Patient satisfaction was the most commonly assessed component of the service domain with more than 90% of both types of programs measuring program effectiveness, overall program quality and friendliness of the staff. Managers most commonly cited the acquisition of new equipment as the endpoint as the end results of patient satisfaction assessment.
Conclusions: There was surprising similarity in results from programs in cardiac and pulmonary rehabilitation. Quality assurance is very frequently assessed in both. Concern for adverse events, safety, and patient satisfaction predominate.
22
Anthony, Cara. "Modesty in the Service of Justice: Retrieving Tradition and Reversing the Gaze." Horizons 36, no. 2 (2009): 265–84. http://dx.doi.org/10.1017/s0360966900006381.
Full textAbstract:
ABSTRACTIn recent years, concern for “modesty” has become more prominent in American religious circles. Recent advocates of modest clothing for women voice important concerns, but also perpetuate problematic attitudes toward women, especially poor women and women of color. Thomas Aquinas' description of modesty corrects this error, because it includes modesty of the mind. Contemporary developments in moral theology then enable us to relate both mental and physical modesty to the cardinal virtue of justice, where modesty decenters the self and makes room for other people to flourish. Findings from social psychologists illuminate the dynamics of social power, and clarify specific ways that mental and physical modesty work under the rubric of justice. These findings suggest that men and women may face different challenges in the practice of modesty, and so Christians must attend to all types of modesty in order to adequately address the question of appropriate clothing.
23
Salmi, Issa. "The Lived Experience of Nurses Working in Cardiology Services with Online Continuing Professional Programs in Advancing their Specialized Clinical Practice: Phenomenology Study Methodology." Clinical Cardiology and Cardiovascular Interventions 4, no. 2 (February 9, 2021): 01–10. http://dx.doi.org/10.31579/2641-0419/102.
Full textAbstract:
Introduction: Nurses should be committed to undertake continuing professional development (CPD) courses to advance nursing practice and guarantee lifelong learning. Online CPD programs may allow nurses to fulfil the demand for specialty competency. Aim: This study focuses on utilising online (CPD) activities to develop cardiac nurses’ ability to perform advanced clinical skills. Method: The study was conducted in one of the largest accredited teaching hospitals in South Australia. The department is staffed by a specialised multi-professional team, some of whom have completed specialised cardiac post-graduation diploma courses in order to meet the complex needs of cardiac patients. To keep the team abreast of the latest developments in practice, the in-service education department at local study setting runs several CPD programs for the cardiology department via varied learning modes, such as online CPD programs, classroom learning and bedside-based learning. The nursing team maintains advanced clinical skills through online CPD, orientation programs, and in-service classroom-based courses. Regarding online CPD courses, electrocardiography interpretation and underwater sealing draining management courses are mandatory courses which all registered nurses must complete while working in medical or surgical cardiac wards. Results: The interview process was conducted in five stages: 1. Determining the type of the interview where in such types of qualitative studies the researcher should focus on the fundamental question of the phenomenological inquiry throughout the unstructured, in-depth interview process. 2. Making initial contact where the researcher established a rapport with the participant and prepared them mentally by giving them the participant information sheet. 3. Context of the interview where interviews be conducted in a quiet room in the School of Nursing in order to maintain participant privacy and anonymity, participants requested to conduct the interviews in their work setting. Nonetheless, the researcher ensured that participant privacy and anonymity was upheld. 4. Selecting the lived experience where Each participant was interviewed once. Interview duration was 15 to 30 minutes. The interviews started with a grand tour question. Grand tour questions are very broad questions asked by the interviewer at the early stage of an interview to obtain a description of the event or experience. 5. All interviews were concluded by thanking the participant and offering them the choice to have a copy of their interview transcript to verify what they had said. The researcher wrote an interview summary after listening to the interviews on the same day. The summary was prepared to help the researcher evaluate the amount of data gathered and identify whether the point of data saturation was reached. In addition, writing the summary helped the researcher reflect on the interview and gain an understanding of the participant experience Conclusion This study explained the process of data collection, describing the setting, nature of participants and process of data collection using phenomenological interview. As the human experience is complex, gathering in-depth data should be systematic to ensure that the researcher has obtained the most sufficient data to explore the essence of the experience.
24
Jaiswal, Lokesh Shekher, Jagat Narayan Prasad, Prashant Shah, and Narendra Pandit. "Establishing Cardiac Surgery in Eastern Nepal: Early Results." Journal of Nepal Health Research Council 16, no. 3 (November 2, 2018): 257–63. http://dx.doi.org/10.3126/jnhrc.v16i3.21420.
Full textAbstract:
Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years). The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.
25
Shinohara, Mafumi, Takashi Muguruma, Chiaki Toida, Masayasu Gakumazawa, Takeru Abe, and Ichiro Takeuchi. "Daytime admission is associated with higher 1-month survival for pediatric out-of-hospital cardiac arrest: Analysis of a nationwide multicenter observational study in Japan." PLOS ONE 16, no. 2 (February 10, 2021): e0246896. http://dx.doi.org/10.1371/journal.pone.0246896.
Full textAbstract:
Objective Hospital characteristics, such as hospital type and admission time, have been reported to be associated with survival in adult out-of-hospital cardiac arrest (OHCA) patients. However, findings regarding the effects of hospital types on pediatric OHCA patients have been limited. The aim of this study was to analyze the relationship between the hospital characteristics and the outcomes of pediatric OHCA patients. Methods This study was a retrospective secondary analysis of the Japanese Association for Acute Medicine-out-of-hospital cardiac arrest registry. The period of this study was from 1 June 2014 to 31 December 2015. We enrolled all pediatric patients (those 0–17 years of age) experiencing OHCA in this study. We enrolled all types of OHCA. The primary outcome of this study was 1-month survival after the onset of cardiac arrest. Results We analyzed 310 pediatric patients (those 0–17 years of age) with OHCA. In survivors, the rate of witnessed arrest and daytime admission was significantly higher than nonsurvivors (56% vs. 28%, p < 0.001: 49% vs. 31%; p = 0.03, respectively). The multiple logistic regression model showed that daytime admission was related to 1-month survival (odds ratio, OR: 95% confidence interval, CI, 3.64: 1.23–10.80) (p = 0.02). OHCA of presumed cardiac etiology and witnessed OHCA were associated with higher 1-month survival. (OR: 95% CI, 3.92: 1.23–12.47, and 6.25: 1.98–19.74, respectively). Further analyses based on the time of admission showed that there were no significant differences in the proportions of patients with witnessed arrest and who received bystander cardiopulmonary resuscitation and emergency medical service response time by admission time. Conclusion Pediatric OHCA patients who were admitted during the day had a higher 1-month survival rate after cardiac arrest than patients who were admitted at night.
26
Jaiswal, Lokesh Shekher, Jagat Narayan Prasad, Prashant Shah, and Narendra Pandit. "Establishing Cardiac Surgery in Eastern Nepal: Early Results." Journal of Nepal Health Research Council 16, no. 3 (October 30, 2018): 257–63. http://dx.doi.org/10.33314/jnhrc.v16i3.1033.
Full textAbstract:
Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years).The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.Keywords: CABG; cardiac surgery; congenital heart disease; early results; RHD.
27
Starfield, Barbara. "Primary Care in the United States." International Journal of Health Services 16, no. 2 (April 1986): 179–98. http://dx.doi.org/10.2190/0dj6-7lp0-9eww-66fb.
Full textAbstract:
In the United States many of the cardinal features of primary care are absent. Medical practitioners usually do not provide services to a defined panel of patients and are not distributed according to the extent or type of health needs in the population or to population size. Findings from research indicate the benefits of longitudinally, comprehensiveness, first contact care, and coordination. Some of the new developments in the organization and financing of services may facilitate the attainment of some of these characteristics, but the implementation of even a rudimentary primary care system will require a greater commitment to the training of primary care personnel and better deployment of resources. In the absence of a societal commitment to a health system based upon levels of care and community orientation, a research agenda to determine the benefits and costs of various alternative approaches is suggested.
28
Levy, Steven B., and Henry Cohen. "Screening, Diagnosis, and Pharmacotherapy for Type 2 Diabetes Mellitus." Journal of Pharmacy Practice 16, no. 2 (April 2003): 127–37. http://dx.doi.org/10.1177/0897190003016002008.
Full textAbstract:
Type 2 diabetes is increasing in prevalence. It is pragmatic to screen patients for diagnostic testing. Diet, exercise, and oral therapy remain the primary treatment modalities for type 2 diabetes. First generation sulfonylureas have fallen out of favor due to adverse effects. Second generation sulfonylureas, metformin, or their combinations are recommended first-line. Glipizide and glimepiride are preferred in elderly, hepatically, and renally impaired patients. Metformin is not recommended with chronic heart failure, renal insufficiency, and in the elderly due to lactic acidosis risks. Glitazones are for second-line therapy, should be used cautiously with cardiac insufficiencies, and require routine monitoring of liver enzymes. Meglitinides, not first-line, may offer an alternative to sulfonylureas. Alpha-glucosidase inhibitors, most effective with impaired glucose tolerance, may be combined with sulfonylureas or metformin. Pharmacists play an integral role in management and pharmacotherapy services in diabetes may be implemented in collaborative drug therapy monitoring for maximizing cost effectiveness.
29
Pires, Beatriz Eva, Clesnan Mendes-Rodrigues, Fabiola Alves Gomes, Rosângela De Oliveira Felice, Iolanda Alves Braga, Omar Pereira de Almeida Neto, and Livia Maria Ambrósio da Silva. "Comparing outcomes of patients submitted to coronary artery bypass graft surgery accompanied in a general or cardiac Intensive Care Unit." Clinical Nursing Studies 7, no. 1 (September 11, 2018): 39. http://dx.doi.org/10.5430/cns.v7n1p39.
Full textAbstract:
Background: Cardiovascular diseases are the main cause of death and loss of quality of life in the long term. In the USA, cardiac surgeries represent the most performed surgery category, with an average cost of USD 40,000. Because it is a complex procedure and leads the patient to a critical post-operative state, there is a necessity of intensive care.Objective: Compare the health indicators of patients submitted to postoperative myocardial revascularization surgery when they are in a general Intensive Care Unit (GICU) or in a cardiac Intensive Care Unit (CICU) in a Brazilian institution.Methods: This is a quantitative, retrospective, descriptive study of patients submitted to a coronary artery bypass grafting surgery in a hospital of high complexity. Data were collected from the medical records and grouped into two phases. Phase 1 is the pre-implantation of the CICU, with a total of 50 patients, in a period in which the postoperative of myocardial revascularization surgeries were performed in the GICU. The second phase corresponds to the postoperative period performed in the CICU, with a total of 60 patients.Results: Males were predominant in the study, with the mean age being over 60 years. The most frequent comorbidities in the two groups were systemic arterial hypertension, dyslipidemias and type 2 diabetes mellitus. The main postoperative complications were surgical site infections, cardiac arrhythmias and pleural effusion. After the implementation of the specialized ICU, there was a reduction in the total hospitalization time and a reduction in cost by day and total cost of hospitalization.Conclusions: The specialized ICU promoted a reduction in the total hospitalization time of patients submitted to coronary artery bypass grafting surgeries and a reduction in hospital costs for the Brazilian public health service, facts that demonstrate the importance of these specialized services in high complexity hospitals.
30
Ali, Humaira, Junaid M. Alam, and Shazia Naureen. "N-TERMINAL PRO-B-TYPE NATRIURETIC PEPTIDES IN INFANTS AND CHILDREN WITH NON-CARDIAC DISEASES." PAFMJ 71, no. 3 (June 29, 2021): 840–43. http://dx.doi.org/10.51253/pafmj.v71i3.3781.
Full textAbstract:
Objective: To evaluate the levels of N-terminal pro-B-type Natriuretic Peptide in infants and children with non-cardiac diseases especially respiratory diseases.
Study Design: Cross-sectional study.
Place and Duration of Study: Department of Chemical Pathology/Biochemistry Laboratory Services of Liaquat National Hospital Karachi Pakistan, from Dec 2018 to Nov 2019.
Methodology: Infants and children admitted to the Pediatric department with non-cardiac diseases were included in the study. Non-probability consecutive sampling was done. Blood was taken and analyzed for N- terminal pro-B-type Natriuretic Peptide, Troponin I, urea, creatinine, Lactate dehydrogenase, Creatinine Kinase, lactate and sodium analysis.
Results: Out of the 93 patients, 74 (80%) were diagnosed with respiratory disorders, with bronchopneumonia making up 54 (59%) Bronchiolitis 15 (17%) and 4% had miscellaneous respiratory diseases. Out of the remaining 20%, 8 (9%) patients were diagnosed with sepsis, and the remaining 11% were diagnosed with miscellaneous diseases. There was a positive correlation of N- terminal pro-B-type Natriuretic Peptide with Troponin I, urea, creatinine, Creatinine Kinase and Lactate dehydrogenase levels (p<0.05).
Conclusion: N- terminal pro-B-type Natriuretic Peptide levels were found to be raised in pediatric patients with non-cardiac diseases especially broncho-pneumonia and in future it may be used as a marker of bronchopneumonia in children.
31
Dennis, Sarah M., Mark Harris, Jane Lloyd, Gawaine Powell Davies, Nighat Faruqi, and Nicholas Zwar. "Do people with existing chronic conditions benefit from telephone coaching? A rapid review." Australian Health Review 37, no. 3 (2013): 381. http://dx.doi.org/10.1071/ah13005.
Full textAbstract:
Objective. To examine the effectiveness of telephone-based coaching services for the management of patients with chronic diseases. Methods. A rapid scoping review of the published peer reviewed literature, using Medline, Embase, CINAHL, PsychNet and Scopus. We included studies involving people aged 18 years or over with one or more of the following chronic conditions: type 2 diabetes, congestive cardiac failure, coronary artery disease, chronic obstructive pulmonary disease and hypertension. Patients were identified as having multi-morbidity if they had an index chronic condition plus one or more other chronic condition. To be included in this review, the telephone coaching had to involve two-way conversations by telephone or video phone between a patient and a provider. Behaviour change, goal setting and empowerment are essential features of coaching. Results. The review found 1756 papers, which was reduced to 30 after screening and relevance checks. Most coaching services were planned, as opposed to reactive, and targeted patients with complex needs who had one or more chronic disease. Several studies reported improvements in health behaviour, self-efficacy, health status and satisfaction with the service. More than one-third of the papers targeted vulnerable people and telephone coaching was found to be effective for these people. Conclusions. Telephone coaching for people with chronic conditions can improve health behaviour, self-efficacy and health status. This is especially true for vulnerable populations who had difficulty accessing health services. There is less evidence for improvements in quality of life and patient satisfaction with the service. The evidence for improvements in health service use was limited. This rapid scoping review found that telephone-based coaching can enhance the management of chronic disease, especially for vulnerable groups. Further work is needed to identify what models of telephone coaching are most effective according to patients’ level of risk and co-morbidity. What is known about the topic? With the increasing prevalence of chronic diseases more demands are being made of limited health services and resources. Telephone health coaching for people with or at risk of chronic diseases is seen as a means of supporting people to manage their health and reducing the burden on the healthcare system. What does this paper add? Telephone coaching interventions were effective for vulnerable people with chronic disease(s). Often the vulnerable populations had worse control of their chronic condition at baseline and demonstrated the greatest improvement compared with those with better control at baseline. Planned (i.e. weekly or monthly telephone calls to support the patients with chronic disease) and unscripted telephone coaching interventions appear to be most effective for improving self-management skills in people from vulnerable groups: the planned telephone coaching services had the advantage of regular contact and helping people develop their skills over time, whereas the unscripted aspect allowed the coach to tailor support to the patient’s individual needs What are the implications for practitioners? Telephone coaching is an effective means of supporting people with chronic diseases to manage their own health. Further work is needed to embed telephone coaching within existing services. Good linkages with the patient’s general practitioner are important. This might be a regular report, updates via the patient e-health record, or provision for contact if a problem is identified or linking to the patient e-health record.
32
Oxley, K., and J. Baxter. "B-type natriuretic peptide: use and misuse in the older patient." Reviews in Clinical Gerontology 22, no. 3 (May 9, 2012): 179–83. http://dx.doi.org/10.1017/s0959259812000068.
Full textAbstract:
SummaryB-type natriuretic peptide (BNP) and the inactive N-terminal fragment of the precursor (NT-proBNP) are hormones predominantly produced by the cardiac myocyte. It has been shown that very high levels of circulating natriuretic peptides correlate with a diagnosis of heart failure. In view of this, the current NICE, SIGN and European Society of Cardiology guidelines on heart failure recommend the measurement of natriuretic peptides as part of the diagnostic pathway for patients with suspected heart failure in primary care. Patients should be stratified according to results, with high-risk patients referred and reviewed by specialist services within 2 weeks. There has also been interest regarding the potential use of natriuretic peptides in disease surveillance, therapeutic monitoring and in-patient discharge planning. Consequently, it is a test that we will encounter with increasing frequency in clinical practice.Heart failure is common in older people, hence geriatricians need to have an understanding of the implications of natriuretic peptide levels. The test can be affected by both physiological and pharmacological factors and this should be taken into consideration when interpreting results.
33
Auroy, Yves, Dan Benhamou, Laurent Bargues, Claude Ecoffey, Bruno Falissard, Frédéric Mercier, Hervé Bouaziz, and Kamran Samii. "Major Complications of Regional Anesthesia in France." Anesthesiology 97, no. 5 (November 1, 2002): 1274–80. http://dx.doi.org/10.1097/00000542-200211000-00034.
Full textAbstract:
Background Several previous surveys have estimated the rate of major complications that occur after regional anesthesia. However, because of the increase in the use of regional anesthesia in recent years and because of the introduction of new techniques, reappraisal of the incidence and the characteristics of major complications is useful. Methods All French anesthesiologists were invited to participate in this 10-month prospective survey based on (1) voluntary reporting of major complications related to regional anesthesia occurring during the study period using a telephone hotline service available 24 h a day and managed by three experts, and (2) voluntary reporting of the number and type of regional anesthesia procedures performed using pocket booklets. The service was free of charge for participants. Results The participants (n = 487) reported 56 major complications in 158,083 regional anesthesia procedures performed (3.5/10,000). Four deaths were reported. Cardiac arrest occurred after spinal anesthesia (n = 10; 2.7/10,000) and posterior lumbar plexus block (n = 1; 80/10,000). Systemic local anesthetic toxicity consisted of seizures only, without cardiac toxicity. Lidocaine spinal anesthesia was associated with more neurologic complications than bupivacaine spinal anesthesia (14.4/10,000 vs. 2.2/10,000). Most neurologic complications were transient. Among 12 that occurred after peripheral nerve blocks, 9 occurred in patients in whom a nerve stimulator had been used. Conclusion This prospective survey based on a free hotline permanent telephone service allowed us to estimate the incidence of major complications related to regional anesthesia and to provide a detailed analysis of these complications.
34
Kwok, Chun Shing, Jessica Bennett, Sonia Curry, Debbie Jackson, Hayley Burke, Michelle Beeston, Elizabeth Powell, et al. "Cardiology referrals before and during the COVID-19 pandemic: a health service evaluation." British Journal of Cardiac Nursing 16, no. 7 (July 2, 2021): 1–6. http://dx.doi.org/10.12968/bjca.2021.0004.
Full textAbstract:
Background/Aims The COVID-19 pandemic has resulted in unprecedented changes to healthcare services. This study aimed to evaluate the impact of the COVID-19 pandemic on referrals to cardiology services in a tertiary hospital. Methods Royal Stoke University Hospital has a cardiac assessment nurse team that provides rapid access to specialist cardiology opinion. All referrals are recorded on a database, which was used to determine how COVID-19 affected the number and types of referrals to cardiology during March–September 2019 and March–September 2020. Results A total of 12 447 referrals were made to the cardiac assessment nurse teams over the evaluation period. Compared to the average number of referrals across all months, there was a decline of 10.5%, 31.2% and 18.5% during March, April and May 2019 respectively. Comparing 2020 to 2019, there were more 999 calls (17.7% vs 15.7%) and accident and emergency referrals (46.5% vs 45.0%), and fewer interhospital referrals (16.0% vs 19.6%). In terms of advice provided for the 999 referrals, a greater number were advised to go to the accident and emergency department (10.5% vs 0%) and direct phone advice provided to those in other settings increased (11.7% vs 0.1%) in 2020. Conclusions The COVID-19 pandemic was associated with a reduction in the number of overall referrals to cardiology, while also demonstrating a shift towards more advice to attend the accident and emergency department for assessment or direct phone advice being provided about management in the community.
35
OLIVER, ALEX, and TIMOTHY SMILEY. "CANTORIAN SET THEORY." Bulletin of Symbolic Logic 24, no. 4 (December 2018): 393–451. http://dx.doi.org/10.1017/bsl.2018.10.
Full textAbstract:
AbstractAlmost all set theorists pay at least lip service to Cantor’s definition of a set as a collection of many things into one whole; but empty and singleton sets do not fit with it. Adapting Dana Scott’s axiomatization of the cumulative theory of types, we present a ‘Cantorian’ system which excludes these anomalous sets. We investigate the consequences of their omission, examining their claim to a place on grounds of convenience, and asking whether their absence is an obstacle to the theory’s ability to represent ordered pairs or to support the arithmetization of analysis or the development of the theory of cardinals and ordinals.
36
Harrison, Alex S., and Patrick Doherty. "Does the mode of delivery in routine cardiac rehabilitation have an association with cardiovascular risk factor outcomes?" European Journal of Preventive Cardiology 25, no. 18 (September 6, 2018): 1925–33. http://dx.doi.org/10.1177/2047487318798923.
Full textAbstract:
Aims Cardiac rehabilitation is one of the most cost-effective interventions for patients with cardiovascular disease. Worldwide supervised group-based cardiac rehabilitation is the dominant mode of delivery followed by facilitated self-managed (FSM), which is emerging as part of a cardiac rehabilitation menu. Modern research evidence, using trials and well-resourced interventions, suggests FSM is comparable to supervised rehabilitation in its outcomes for patients; however, this is yet to be established using routine clinical practice data. Methods Including 81,626 patients from routine clinical data in the National Audit of Cardiac Rehabilitation, this observational study investigated whether mode of delivery, supervised or FSM, was associated with similar cardiac rehabilitation outcomes. Hierarchical regression models included patient and service covariates such as age, gender, cardiac rehabilitation duration and programme staff type. Results The results showed 85% of the population received supervised cardiac rehabilitation. The FSM group were significantly older, female and predominantly in lower socioeconomic groups. The results showed that all patients on average benefit from cardiac rehabilitation, independently of mode of delivery, across all risk factors. Additional benefit of 13% and 11.4% increased likelihood of achieving the target state for physical activity and body mass index respectively when using FSM approaches. Conclusion This is the first study to investigate traditional cardiovascular risk factors with cardiac rehabilitation mode of delivery using routine clinical data. Both modes of delivery were associated with comparable statistically significant positive outcomes. Despite having equivalent outcomes, FSM cardiac rehabilitation continues to be underutilised, with less than 20% of patients receiving this mode of delivery in the UK.
37
Zaccaro, Antonietta, and Antonio Bonacaro. "REGIONAL CARDIAC NETWORK: THE EXPERIENCE AT THE EMERGENCY MEDICAL SERVICE 118 IN THE BASILICATA REGION IN ITALY." International Journal of Research -GRANTHAALAYAH 3, no. 5 (May 31, 2015): 95–110. http://dx.doi.org/10.29121/granthaalayah.v3.i5.2015.3019.
Full textAbstract:
The aim of the regional cardiac networks is to offer to those patients affected by Acute Myocardial Infarction (AMI) the quickest and the most efficient treatment in relation to patients' characteristics and to the place where the event occurs. This article describes the experience developed by the Regional Emergency Medical Service of the Basilicata Region (Italy) in creating such a network. The structure of the network, the epidemiological data along with the different types of pathway used in the management of Non-ST elevation acute coronary syndromes are delineated with the aim to offer an overview of the clinical practices actually in place.
A retrospective observational study was conducted in 2012 with the aim to understand the incidence of AMI in its various forms: ST segment elevation myocardial infarction (STEMI) and Non-ST elevation acute coronary syndromes (NSTEACS).
The development of the Regional Cardiac Network has been shedding light on AMI and giving patients the chance to receive a customized treatment according to their clinical conditions. Further studies are recommended in order to understand the impact of these practices in terms of reduction of mortality and complications.
38
Pescariu, Silvius Alexandru, Cristina Tudoran, Gheorghe Nicusor Pop, Sorin Pescariu, Romulus Zorin Timar, and Mariana Tudoran. "Impact of COVID-19 Pandemic on the Implantation of Intra-Cardiac Devices in Diabetic and Non-Diabetic Patients in the Western of Romania." Medicina 57, no. 5 (May 3, 2021): 441. http://dx.doi.org/10.3390/medicina57050441.
Full textAbstract:
Background and Objectives: COVID-19 pandemic severely impacted public health services worldwide, determining a significant decrease of elective cardiovascular (CV) procedures, especially in patients with associated chronic diseases such as diabetes mellitus (DM). Materials and Methods: This study was first started in 2019 in the western of Romania, to analyze the differences regarding the implantations of intra-cardiac devices such as permanent pacemakers (PPM), cardiac resynchronization therapy (CRT), or implantable cardioverter-defibrillators (ICD) in 351 patients with and without DM and the situation was reanalyzed at the end of 2020. Results: of the first 351 patients with and without DM. 28.20% of these patients had type 2 DM (p = 0.022), exceeding more than twice the prevalence of DM in the general population (11%). Patients with DM were younger (p = 0.022) and required twice as often CRT (p = 0.002) as non-diabetic patients. The state of these procedures was reanalyzed at the end of 2020, a dramatic decrease of all new device implantations being observed, both in non-diabetic and in patients with type 2 DM (79.37%, respectively 81.82%). Conclusions: COVID-19 pandemic determined a drastic decrease, with around 75% reduction of all procedures of new intra-cardiac devices implantation, both in non-diabetics, this activity being reserved mostly for emergencies.
39
Zeitz, Kathryn, Hugh Grantham, Robert Elliot, and Chris Zeitz. "Out-of-Hospital Cardiac Arrest—Review of Demographics in South Australia to Inform Decisions about the Provision of Automatic External Defibrillators within the Community." Prehospital and Disaster Medicine 25, no. 6 (December 2010): 521–26. http://dx.doi.org/10.1017/s1049023x00008700.
Full textAbstract:
AbstractIntroduction:Sudden, out-of-hospital cardiac arrest (OHCA) has an annual incidence of approximately 50 per 100,000 population. Public access defibrillation is seen as one of the key strategies in the chain-of-survival for OHCA. Positioning of these devices is important for the maximization of public health outcomes. The literature strongly advocates widespread public access to automated external defibrillatiors (AEDs). The most efficient placement of AEDs within individual communities remains unclear.Methods:A retrospective case review of OHCAs attended by the South Australia Ambulance Service in metropolitan and rural South Australia over a 30-month period was performed. Data were analyzed using Utstein-type indicators. Detailed demographics, summative data, and clinical data were recorded.Results:A total of 1,305 cases of cardiac arrest were reviewed. The annual rate of OHCA was 35 per 100,000 population. Of the cases, the mean value for the ages was 66.3 years, 517 (39.6%) were transported to hospital, 761 (58.3%) were judged by the paramedic to be cardiac, and 838 (64.2%) were witnessed. Bystander cardiopulmonary resuscitation (CPR) was performed in 495 (37.9%) of cases. The rhythm on arrival was ventricular fibrillation (VF) or ventricular tachycardia (VT) in 419 (32.1%) cases, and 315 (24.1%) of all arrests had return of spontaneous circulation (ROSC) before or on arrival at the hospital. For cardiac arrest cases that were witnessed by the ambulance service (n = 121), the incidence of ROSC was 47.1%.During the 30-month period, there only was one location that recorded more than one cardiac arrest. No other location recorded recurrent episodes.Conclusions:This study did not identify any specific location that would justify defibrillator placement over any other location without an existing defibrillator. The impact of bystander CPR and the relatively low rate of bystander CPR in this study points to an area of need. The relative potential impact of increasing bystander CPR rates versus investing in defibrillators in the community is worthy of further consideration.
40
Comino, Elizabeth J., Duong Thuy Tran, Jane R. Taggart, Siaw-Teng Liaw, Warwick Ruscoe, Jill M. Snow, and Mark F. Harris. "A preliminary study of the relationship between general practice care and hospitalisation using a diabetes register, CARDIAB." Australian Health Review 37, no. 2 (2013): 210. http://dx.doi.org/10.1071/ah12175.
Full textAbstract:
Background. Diabetes can be effectively managed in general practice (GP). This study used record linkage to explore associations between diabetes care in GP and hospitalisation. Methods. Data on patients with type 2 diabetes were extracted from a Division of GP diabetes register (CARDIAB) for 2002–05 and were linked to the New South Wales Admitted Patient and Emergency Department (ED) Data Collection to create a unit record data collection containing demographic, clinical and health service records. Rates of admission and ED presentation per patient-year of follow up were calculated for the year following CARDIAB record. Results. The study included 1178 diabetic patients with 2959 patient-years of follow up. Their mean age was 65.7 years and duration of diabetes was 5.9 years. All-cause admission and ED presentation rates were 0.7 and 0.2 per patient-year of follow up respectively and length of admission 3.2 days (s.d. 11.7 days). Admission was associated with age, duration of diabetes and prior admission. The number of processes of care recorded for each patient-year was associated with admission. Admission and length of stay were not associated with achievement of clinical targets. Conclusions. These data suggest that receipt of processes of care, rather than clinical targets, will prevent admission. One explanation may be that continuity of care in GP provides opportunity for early intervention and treatment. What is known about the topic? Diabetes is a serious public health problem that is largely managed in primary care. Health care planners use health service use (hospital admissions) for diabetes as an indicator of primary care. Guidelines for diabetes care are known to be effective in reducing diabetes-related complications. What does this paper add? This paper created a linked data collection comprising demographic and clinical data from general practice and administrative health records of hospital admissions and emergency department presentations. The paper explores the associations between processes of primary care and control of diabetes and cardiovascular risk factors, and use of health services for a general practice population with diabetes. What are the implications for practitioners? The study suggests that processes of care and not technical control of diabetes and cardiovascular risk factors are important in preventing hospital admission. Continuity of care in general practice that ensures implementation of processes of care provides opportunity for early intervention and treatment.
41
Reger, TB, and D. Roditski. "Bloodless medicine and surgery for patients having cardiac surgery." Critical Care Nurse 21, no. 4 (August 1, 2001): 35–44. http://dx.doi.org/10.4037/ccn2001.21.4.35.
Full textAbstract:
Changes in patients' care mandate that nursing care be amenable to change. With the advent of new technology, systems of care delivery are evolving. Blood transfusion practices that were once considered standards are being reexamined and redefined. Nurses, in their roles as patients' advocates and educators, must be cognizant of changes in practice and be prepared to deliver competent care. The effectiveness of techniques of bloodless medicine and surgery originally designed to serve the needs of Jehovah's Witnesses is accepted today, and other groups of patients are choosing this type of care. Furthermore, as blood conservation strategies are refined and perfected, they most likely will be used by a greater number of patients undergoing cardiac surgery. Specific guidelines have been developed for point-of-care service for patients undergoing bloodless cardiac surgery. Nursing care throughout the hospital stay, from preadmission to discharge, is tailored to meet these patients' emotional and physical needs. Quality comprehensive nursing care is required to make bloodless medicine and surgery programs successful.
42
Carveth, Stephen W., and William H. Montgomery. "Coordination with Ground Emergency Medical Services in Cardiac and Respiratory Emergencies in Flight (abstract)." Journal of the World Association for Emergency and Disaster Medicine 1, no. 1 (1985): 75. http://dx.doi.org/10.1017/s1049023x00032829.
Full textAbstract:
Emergency Medical Services (EMS) have taken great strides toward the development of city and statewide programs. However, once a person embarks on a plane or on a ship for any extended period of time, the EMS are at times meager and at other times not coordinated well with ground EMS. The American Heart Association has developed a protocol for basic and advanced cardiac life support to exist in all major air terminals, and especially within aircraft of all types. Particularly important are those aircrafts carrying large numbers of people for extended periods of time.
43
Zhidkova, E. A., N. B. Naigovzina, M. R. Kalinin, E. M. Gutor, and K. G. Gurevich. "The Analysis of the Causes of Sudden Deaths Among Workers of Locomotive Crews." Kardiologiia 59, no. 6 (June 27, 2019): 42–47. http://dx.doi.org/10.18087/cardio.2019.6.2552.
Full textAbstract:
Purpose: to analyze causes of sudden death (SD) of workers of locomotive crews. Materials and methods. We performed the retrospective analysis of SDs of employees of Joint Stock Company ( JSC) “Russian Railways” for the period 2009–2017 (total 119 cases). Results. As a rule, the combination of risk factors of development of cardiovascular diseases was present, but the SCORE scale risk of cardiac death was average. However, in 60 % of cases at life risks were not correctly assessed. Differences were found between the deceased depending on what type of locomotive they steered. Also, a part of SD victims overworked during the last month (year). Conclusion. Further improvement of work of medical service of JSC “Russian Railways” is necessary.
44
Bandorski, Dirk, Ralf Jakobs, Martin Brück, Reinhard Hoeltgen, Marcus Wieczorek, and Martin Keuchel. "Capsule Endoscopy in Patients with Cardiac Pacemakers and Implantable Cardioverter Defibrillators: (Re)evaluation of the Current State in Germany, Austria, and Switzerland 2010." Gastroenterology Research and Practice 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/717408.
Full textAbstract:
Background and Aims. The study was a repeated evaluation of the experience of capsule endoscopy (CE) in patients with cardiac pacemaker or implantable cardioverter defibrillator (ICD).Patients and Methods. A standardized questionnaire was sent by the manufactors Given Imaging and Olympus to all centers in Germany, Austria, and Switzerland providing capsule endoscopy service. The questionnaire covers the number of examined patients, monitoring during CE, check of the electric implants before and after CE, occurrence of arrhythmia, quality of CE video, complications, indication of CE, and type of institution.Results. Overall 580 questionnaires were sent to the users. 26/5% (Germany/Austria + Switzerland) of the questionnaires were sent back anonymously to the authors. 114 centers (82 hospitals, 11 surgeries, 21 without specification) replied. In 58 centers (51%), patients with cardiac pacemaker (n=300) and ICDs (n=80) underwent uneventful capsule endoscopy. The predominant indication (patients with CP 97%, patients with ICD 100%) was mid gastrointestinal bleeding.Conclusion. The results of our inquiry show that in spite of formal contraindication CE is increasingly applied in bleeding patients with cardiac pacemakers/ICDs and seems to be safe even in a large cohort.
45
Levy, Matthew J., Kevin G. Seaman, Michael G. Millin, Richard A. Bissell, and J. Lee Jenkins. "A Poor Association Between Out-of-Hospital Cardiac Arrest Location and Public Automated External Defibrillator Placement." Prehospital and Disaster Medicine 28, no. 4 (May 23, 2013): 342–47. http://dx.doi.org/10.1017/s1049023x13000411.
Full textAbstract:
AbstractIntroductionMuch attention has been given to the strategic placement of automated external defibrillators (AEDs). The purpose of this study was to examine the correlation of strategically placed AEDs and the actual location of cardiac arrests.MethodsA retrospective review of data maintained by the Maryland Institute for Emergency Medical Services Systems (MIEMSS), specifically, the Maryland Cardiac Arrest Database and the Maryland AED Registry, was conducted. Location types for AEDs were compared with the locations of out-of-hospital cardiac arrests in Howard County, Maryland. The respective locations were compared using scatter diagrams and r2 statistics.ResultsThe r2 statistics for AED location compared with witnessed cardiac arrest and total cardiac arrests were 0.054 and 0.051 respectively, indicating a weak relationship between the two variables in each case. No AEDs were registered in the three most frequently occurring locations for cardiac arrests (private homes, skilled nursing facilities, assisted living facilities) and no cardiac arrests occurred at the locations where AEDs were most commonly placed (community pools, nongovernment public buildings, schools/educational facilities).ConclusionA poor association exists between the location of cardiac arrests and the location of AEDs.LevyMJ, SeamanKG, MillinMG, BissellRA, JenkinsJL. A poor association between out-of-hospital cardiac arrest location and public automated external defibrillator placement. Prehosp Disaster Med. 2013;28(4):1-6.
46
Corrao, S. "The complex pa¬tient with diabetes and cardio-renal comorbidities: a mana¬gement model proposal." Journal of AMD 23, no. 3 (November 2020): 190. http://dx.doi.org/10.36171/jamd20.23.3.3.
Full textAbstract:
Type 2 diabetes mellitus (DM) is a metabolic disorder and its prevalence has been increasing in the world population and represents one of the chronic diseases with the highest socioeconomic impact on the health systems. It is expected that in the next decade life expectancy and population aging will increase with the consequences of the increasing incidence of diabetes and its associated comorbidities. (DM) is the main cause of chronic kidney disease and it is associated with a significant increasing in cardiovascular risk. The coexistence of cardiac and kidney diseases on a metabolic basis, named “cardiorenal metabolic syndrome”, in elderly patients affected by multimorbidity increase their clinical and care complexity. In order to assess clinical complexity it is necessary to change paradigm from a reactive approach to a proactive one and the integration of territorial, hospital and social services according to the Chronic Care Model (CCM) is important. The proactive management of the complex patient suffering from chronic diseases and multimorbidity has been implemented at the National ARNAS Civico Hospital in Palermo with the MUSE (Multidimensional aSsessment of Elderly) project. The interaction between hospital and territorial services to respond to patients’ needs should be a priority. The hospital must therefore be conceived as a highly specialized center for chronic disease management that works with primary care according to a multidimensional and multidisciplinar model of care reducing rehospitalization and negative outcomes in patients affected by chronic diseases. KEY WORDS diabetes mellitus type2; comorbidity; management model; complexity; cardiorenal syndrome.
47
Handberry, Maya, Lara Bull-Otterson, Mengtao Dai, N. Clay Mann, Eric Chaney, Jeff Ratto, Kalanthe Horiuchi, et al. "Changes in Emergency Medical Services Before and During the COVID-19 Pandemic in the United States, January 2018–December 2020." Clinical Infectious Diseases 73, Supplement_1 (July 15, 2021): S84—S91. http://dx.doi.org/10.1093/cid/ciab373.
Full textAbstract:
Abstract Background As a result of the continuing surge of coronavirus disease 2019 (COVID-19), many patients have delayed or missed routine screening and preventive services. Medical conditions, such as coronary heart disease, mental health issues, and substance use disorder, may be identified later, leading to increases in patient morbidity and mortality. Methods National Emergency Medical Services Information System data were used to assess 911 emergency medical services (EMS) activations during 2018–2020. For specific activation types, the percentage of total activations was calculated per week, and Joinpoint analysis was used to identify changes over time. Results Since March 2020, the number of 911 EMS activations has decreased, while the percentages of on-scene death, cardiac arrest, and opioid use/overdose EMS activations were higher than prepandemic levels. During the early pandemic period, percentages of total EMS activations increased for on-scene death (from 1.3% to 2.4% during weeks 11–15), cardiac arrest (from 1.3% to 2.2% during weeks 11–15), and opioid use/overdose (from 0.6% to 1.1% during weeks 8–18). The percentages then declined but remained above prepandemic levels through calendar week 52. Conclusions The COVID-19 pandemic has indirect consequences, such as relative increases in EMS activations for cardiac events and opioid use/overdose, possibly linked to disruptions is healthcare access and health-seeking behaviors. Increasing telehealth visits and other opportunities for patient–provider touch points for chronic disease and substance use disorders that emphasize counseling, preventive care, and expanded access to medications can disrupt delayed care-seeking during the pandemic and potentially prevent premature death.
48
Lee, Joon, and David M. Maslove. "Customization of a Severity of Illness Score Using Local Electronic Medical Record Data." Journal of Intensive Care Medicine 32, no. 1 (May 12, 2015): 38–47. http://dx.doi.org/10.1177/0885066615585951.
Full textAbstract:
Purpose: Severity of illness (SOI) scores are traditionally based on archival data collected from a wide range of clinical settings. Mortality prediction using SOI scores tends to underperform when applied to contemporary cases or those that differ from the case-mix of the original derivation cohorts. We investigated the use of local clinical data captured from hospital electronic medical records (EMRs) to improve the predictive performance of traditional severity of illness scoring. Methods: We conducted a retrospective analysis using data from the Multiparameter Intelligent Monitoring in Intensive Care II (MIMIC-II) database, which contains clinical data from the Beth Israel Deaconess Medical Center in Boston, Massachusetts. A total of 17 490 intensive care unit (ICU) admissions with complete data were included, from 4 different service types: medical ICU, surgical ICU, coronary care unit, and cardiac surgery recovery unit. We developed customized SOI scores trained on data from each service type, using the clinical variables employed in the Simplified Acute Physiology Score (SAPS). In-hospital, 30-day, and 2-year mortality predictions were compared with those obtained from using the original SAPS using the area under the receiver–operating characteristics curve (AUROC) as well as the area under the precision-recall curve (AUPRC). Test performance in different cohorts stratified by severity of organ injury was also evaluated. Results: Most customized scores (30 of 39) significantly outperformed SAPS with respect to both AUROC and AUPRC. Enhancements over SAPS were greatest for patients undergoing cardiovascular surgery and for prediction of 2-year mortality. Conclusions: Custom models based on ICU-specific data provided better mortality prediction than traditional SAPS scoring using the same predictor variables. Our local data approach demonstrates the value of electronic data capture in the ICU, of secondary uses of EMR data, and of local customization of SOI scoring.
49
Masalar, Aurelian Lucian, Eugen Linga, Sorin Crișan, Dan Rădulescu, and Elena Buzdugan. "Characteristics of Cardiac Rhythm and Conduction Abnormalities Diagnosed in Mobile Emergency Units in Central Romania." Journal Of Cardiovascular Emergencies 3, no. 4 (December 1, 2017): 172–80. http://dx.doi.org/10.1515/jce-2017-0025.
Full textAbstract:
Abstract Background: Cardiac arrhythmias and conduction abnormalities are frequently identified by emergency medical service staff in patients requesting emergency services. Methods: We conducted a prospective observational study that aimed to analyze the characteristics of rhythm and conduction abnormalities in prehospital settings, in patients who requested emergency medical assistance for symptoms indicative for an arrhythmia or conduction abnormalities. Results: From 180 patients included in the study (90 from a tertiary and 90 from a non-tertiary medical center), 92.78% presented an arrhythmia and 15.56% a conduction abnormality. A clear etiology was found in only 29.44% of cases. Ischemic patients presented a higher rate of atrial fibrillation (AF) (p <0.0001), while sinus tachycardia was more common in non-ischemic subjects (p = 0.02). Patients younger than 50 years of age presented higher rates of sinus tachycardia (p <0.0001) and right bundle branch block (p = 0.001), while those older than 50 years presented higher rates of AF (p <0.0001) and ventricular extrasystole (p = 0.014). There were no differences regarding the type of arrhythmia diagnosed in emergency settings, neither between genders or provenance environments, nor between regions served by a tertiary versus non-tertiary base station hospital. Conclusions: The most frequently diagnosed arrhythmias in prehospital settings were atrial fibrillation and sinus tachycardia, while atrioventricular blocks were the most frequent conduction disturbances. Young patients more frequently present sinus tachycardia or right bundle branch blocks, while older subjects are more prone to develop ischemia-related AF and ventricular extrasystole. The lack of any significant differences between systems served by a tertiary vs. non-tertiary medical center indicates an efficient emergency system of care regardless of the geographical region.
50
Mourato, Felipe Alves, Lúcia Roberta R. Villachan, and Sandra da Silva Mattos. "Prevalence and profile of congenital heart disease and pulmonary hypertension in Down syndrome in a pediatric cardiology service." Revista Paulista de Pediatria 32, no. 2 (June 2014): 159–63. http://dx.doi.org/10.1590/0103-0582201432218913.
Full textAbstract:
OBJECTIVE:To determine the frequence and profile of congenital heart defects in Down syndrome patients referred to a pediatric cardiologic center, considering the age of referral, gender, type of heart disease diagnosed by transthoracic echocardiography and its association with pulmonary hypertension at the initial diagnosis.METHODS:Cross-sectional study with retrospective data collection of 138 patients with Down syndrome from a total of 17,873 records. Descriptive analysis of the data was performed, using Epi-Info version 7.RESULTS: Among the 138 patients with Down syndrome, females prevailed (56.1%) and 112 (81.2%) were diagnosed with congenital heart disease. The most common lesion was ostium secundum atrial septal defect, present in 51.8%, followed by atrioventricular septal defect, in 46.4%. Ventricular septal defects were present in 27.7%, while tetralogy of Fallot represented 6.3% of the cases. Other cardiac malformations corresponded to 12.5%. Pulmonary hypertension was associated with 37.5% of the heart diseases. Only 35.5% of the patients were referred before six months of age.CONCLUSIONS: The low percentage of referral until six months of age highlights the need for a better tracking of patients with Down syndrome in the context of congenital heart disease, due to the high frequency and progression of pulmonary hypertension.