To see the other types of publications on this topic, follow the link: Died in emergencies.
Journal articles on the topic 'Died in emergencies'
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 'Died in emergencies.'
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
Nkpozi, MO, BU Adukwu, UN Onwuchekwa, JA Chikezie, and C. Aluka. "Profile and Outcome of Medical Emergencies in a Teaching Hospital in the Commercial City of Aba, Southeast Nigeria." Journal of BioMedical Research and Clinical Practice 3, no. 3 (2020): 415–21. http://dx.doi.org/10.46912/jbrcp.167.
Full textAbstract:
Medical conditions present at the Accident and Emergency (A&E) or Emergency Department (ED) very often. Outcome of medical emergencies depends, among other factors, on the age of patients, gender, socioeconomic factors, medical conditions, their severity, time of patients' presentations, quality of care/treatment given and the available resources (manpower and facilities) in the A&E. There is a paucity of published literature on medical emergencies outcome in Aba, Southeast Nigeria. This study, therefore, set out to bridge this gap in knowledge. This was a 1-year observational study in which patients presenting to the A&E/ED of ABSUTH, Aba for treatment of a medical condition were consecutively recruited and followed up until discharged home, admitted to the medical wards or died in A&E. This study lasted from January 1, 2018 to December 31, 2018. Relevant data obtained were analyzed using Statistical Package for Social Sciences (SPSS) version 20.0 software. A total of 589 patients presented at A&E because of medical conditions/emergencies, made up of 269 (45.7%) males and 320 (54.3%) females. The commonest medical emergencies were DM related complications, acute malaria, HIV/AIDS, heart failure and stroke. Study subjects discharged home were 17.5%, 71.1% were admitted into the medical wards and 11.4% died. Medical emergencies, caused predominantly by non-communicable diseases (NCDs), contributed significantly to the A&E cases in the city of Aba, Nigeria and are associated with considerable mortality. It is recommended that efforts should be made to control the modifiable risk factors of NCDs while early detection and treatment of communicable and NCDs should be affected.
2
Ellis, Harold. "The Strangulated Umbilical Hernia of Queen Caroline." Journal of Perioperative Practice 24, no. 11 (2014): 259–60. http://dx.doi.org/10.1177/175045891402401105.
Full textAbstract:
One of the lessons we learn from medical history is how great the improvement has been in the management of commonplace surgical emergencies. Less than three hundred years ago, the Queen of England, in her healthy middle age, died of a straightforward strangulated umbilical hernia.
3
Babkina, О. P., D. О. Matyukhin, and I. А. Ushko. "DIAGNOSIS OF ALCOHOL INTOXICATION IN VICTIMS OF EMERGENCIES." Medical Science of Ukraine (MSU) 16, no. 2 (2020): 45–49. http://dx.doi.org/10.32345/2664-4738.2.2020.8.
Full textAbstract:
Relevance. In the case of death from injury, the question of whether the victim was intoxicated and to what extent, as the presence of alcohol intoxication could have affected the thanatogenesis of death is important. A reliable method of determining the concentration of ethanol in the body is its study in the blood, urine, and cerebrospinal fluid. But in extreme conditions, in large-scale disasters, during military conflicts, there may be difficulties in the selection, storage, transportation, and research of biological fluids. Therefore, the search for reliable non-invasive rapid methods is relevant.
 The objective is the development of a set of criteria for improving the accuracy of detecting the presence of ethanol and determining its amount in deaths due to trauma in emergencies by non-invasive rapid methods.
 Materials and methods. Review of scientific publications in international electronic scientometric databases PubMed, Embase, and Scopus by keywords. Search depth - 10 years (2008-2018). Comparison of literature data with the results of own research on the possibility of diagnosing alcohol intoxication to detect the presence and determination of ethanol in biological fluids (saliva, blood, urine) of persons who died and died in emergencies by indicative and evidentiary methods.
 Results. The possibility of using the non-invasive express method (indicator test strips) as a guide to detecting the presence and quantification of ethanol in the saliva of deaths and deaths from injuries in emergencies, conflicts, in the absence of the necessary conditions for blood storage and urine (lack of power supply, the impossibility of freezing objects, storage, destruction of objects during transportation, etc.) was described. It is proved that the average result of the quantitative content of ethanol in blood and urine, found in the evidence-based method of research (gas-liquid chromatography), coincides and confirms the result obtained by us in conducting a non-invasive rapid method using indicator test strips. In the course of the conducted researches, the conformity concerning objectivity and correctness of detection of the presence and quantitative content of ethyl alcohol with the use of indicator test strips which is confirmed by researches of blood, urine by evidential methods (gas-liquid chromatography) is proved.
 Conclusion. A non-invasive rapid method (indicator test strips) can be used as a guide to detect the presence of ethyl alcohol and determine its quantitative content in the saliva of the dead and deceased, with subsequent confirmation by evidence-based methods of research (gas-liquid chromatography) of blood, urine.
4
Nurlaily, Ari Pebru, Meri Oktariani, and Anestasia Pangestu Mei Tyas. "OPTIMIZATION OF DSME THROUGH INCREASED KNOWLEDGE OF PREVENTION OF COMPLICATIONS AND DIABETES EMERGENCIES IN WONOREJO VILLAGE." Darmabakti Cendekia: Journal of Community Service and Engagements 3, no. 1 (2021): 29. http://dx.doi.org/10.20473/dc.v3.i1.2021.29-32.
Full textAbstract:
Background: Many elderly convey blood sugar often up and down due to lack of attention to their diet. The condition became urgent because the elderly had previously died from complications accompanied by diabetic ulcers. In the posyandu area of wonorejo healthy elderly, DM disease is one of the diseases that are quite widely suffered by its citizens. Objective: The DSME education program for cadres and the elderly at Posyandu Wonorejo aims to increase knowledge and prevent diabetes complications. Method: This DSME program was conducted in four sessions, namely, session 1 discussing basic knowledge about DM (definition, etiology, classification, etiology, clinical manifestations, diagnosis, prevention, treatment, complications), session 2 discussing DM management including nutrition/diet arrangements, and physical activities/exercises that can be done, session 3 discussing foot care and stress management; and session 4 discusses the prevention of chronic and acute complications, and the patient's access to health care facilities. Results: There was an increase in knowledge and prevention of diabetes complications up to 93,75% after this activity was conducted.. Conclusion: The program is optimally implemented.
5
Prater, Laura, Phillip L. Wachowiak, Masami Otsubo, and Seuli Bose-Brill. "PREPARATION FOR THE END OF LIFE AND PERCEIVED QUALITY OF CARE PRIOR TO HOSPICE REFERRAL: A SURVEY OF CAREGIVERS." Innovation in Aging 3, Supplement_1 (2019): S910—S911. http://dx.doi.org/10.1093/geroni/igz038.3321.
Full textAbstract:
Abstract Lack of preparation for the end of life (EOL) can lead to poor outcomes for caregivers. The purpose of this study was to learn if perceived quality of EOL care and communication provided by the primary clinician prior to hospice referral is associated with caregivers’ perceived preparedness to deal with medical emergencies/complications at the EOL. We conducted a survey of caregivers of patients who died and were referred to hospice in the prior year. Perceived quality, was measured by the Quality of End of Life Care (QEOLC) scale, and “preparedness” was a binary measure asking if caregivers felt unprepared to deal with medical emergencies and/or complications related to the care of the patient at the EOL. We performed a bivariate analysis using a two-sample t-test to determine if QEOLC scores were greater among those indicating they were prepared compared to those indicating they were not prepared. We received a response rate of over 22.8% (49/215). Mean EOL scale scores were 82.0 (SD=3.8) for those reporting that they did not feel unprepared for medical emergencies/compilations that arose near the EOL, and 68.2 (SD=7.3) for those who reported that they did feel unprepared. Results show that the mean difference approached significance (t=1.85; p=0.07). Although results only approached significance, EOL care from clinicians involved prior to hospice enrollment may be perceived as higher quality among those who felt prepared to handle emergencies/complications. This finding suggests that caregivers highly value early EOL education and communication aiding in preparation for emergencies/complications arising after hospice referral.
6
Hasan, Sheikh Mahmood, HI Lutfur Rahman Khan, Abdul Wadud Chowdhury, KMN Sabah, and Md Rezaul Ekram. "Prevalence and Pattern of Cardiac Emergencies in a Tertiary Care Hospital of Bangladesh." Bangladesh Critical Care Journal 1, no. 1 (2013): 23–26. http://dx.doi.org/10.3329/bccj.v1i1.14361.
Full textAbstract:
Objective: Worldwide cardiac cases constitute a large portion of the medical emergencies. There is a paucity of data on the prevalence of cardiac emergencies in Bangladesh. The purpose of this study was to identify the pattern of presentation of cardiac emergencies in a tertiary care hospital in Bangladesh. Methods and Materials: A hospital based cross sectional study was carried out at a medical college hospital in Dhaka city. Hospital medical records of 2457 patients admitted in the Coronary Care Unit (CCU) between 1 July 2011 to 30 June 2012 were reviewed. Relevant socio demographic data were abstracted from the hospital record files. Result: About 4.5% of the total emergency hospital admission was on the CCU. The mean age of the admitted pateints was 55.5 (SD 9.56) years. Males were affected twice as females. Majority of the patients presented with Acute Myocardial Infarction (AMI) (42%), followed by Acute Left Ventricular Failure (19%) and Unstable Angina (16%). Small portion of the patients admitted with Cardiogenic Shock, Valvular heart Disease, Congestive Cardiac Failure and Variable Block. Hypertension (26%) and Diabetes Melitus (15%) was the two most common co-existing pathologies, along with Stroke, Respiratory Disease and Renal Disease. 13.5% patients died during their hospital stay. Conclusion: MI as the principal cause of cardiac emergencies is in coherence with other studies done abroad. High prevalence of Hypertention and Ischemic Heart Disease points to the dietery and lifestyle pattern of the people. Improvement of emergency care along with lifestyle modification is essential to minimize the burden of cardiac emergencies in Bangladesh. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14361 Bangladesh Crit Care J March 2013; 1: 23-26
7
C, Mboutol-Mandavo, Détsélé RC, Miéret JC, Akobande NE, Ondima IPL, and Odzébé AWS. "Management of Digestive Surgical Emergencies in Children in a Developing Country (Newborns Excluded)." Asploro Journal of Pediatrics and Child Health 2, no. 1 (2020): 19–29. http://dx.doi.org/10.36502/2020/asjpch.6152.
Full textAbstract:
Aim: It was a question of determining the epidemiological, diagnostic and therapeutic aspects of the digestive surgical emergencies of the child in our environment. Patients and Methods: This is a prospective and descriptive study carried out for 12 months in the pediatric surgery department. Results: During the study period, on 668 patients admitted we retained 87 cases of digestive surgical emergencies; representing a hospital frequency of 13%. The mean age was 7.6 ± 3.5 years (range 30 days and 16 years). We noted a male predominance with 61 boys (70.1%) for 26 girls (29.9%). The taxi was the most used form of transportation in 77 cases (88.5%). The average consultation time was 5.4 days ± 5.3 days (1 hour and 21-day extremes). Abdominal pain was the main reason for consultation with 66.7% of cases. Generalized acute peritonitis was the predominant diagnosis with 32 cases (39.1%), followed by strangulated parietal hernias with 17 cases (19.5%) and acute intestinal intussusception with 11 cases (12.6%). The postoperative course was complicated in 27 cases (33.7%). parietal suppurations were the most common complication with 77.8% of cases. Six patients (6.9%) died. Conclusion: Digestive surgical emergencies represent a frequent nosological entity in our practice. Abdominal pain is the first reason for consultation. Appendicular peritonitis are the first cause of digestive surgical emergency in children in our practice. They remain a worrying problem for pediatric surgeons.
8
Khan, Fatima, Claudia Mitchell, and Marni Sommer. "Honoring the Legacy of Jackie Kirk." Girlhood Studies 11, no. 2 (2018): 1–12. http://dx.doi.org/10.3167/ghs.2018.110202.
Full textAbstract:
This year marks the tenth anniversary of the death of Jackie Kirk, a co-founder of Girlhood Studies: An Interdisciplinary Journal, and an incredibly effective member of the global education community who died at the hands of the Taliban in Afghanistan on 13 August 2008 while working on a project on girls’ education. As an activist and researcher Jackie had a great range of expertise, including that of dealing with education in emergencies, the challenges facing women teachers, and the menstruation-related needs of school-going girls, as well as a grasp of the importance of visual images in understanding the realm of girls’ education. She brought to her work an attention to critical theoretical concepts alongside the practical; she always placed girls and women (especially women teachers) at the center of her explorations, her analyses, and her recommendations for policy and practice.
9
Manickchund, Yashoda, and GP Hadley. "Paediatric surgery outreach: analysis of referrals to a tertiary paediatric surgery service to plan an outreach programme Kwa-Zulu Natal, South Africa." Tropical Doctor 47, no. 4 (2017): 305–11. http://dx.doi.org/10.1177/0049475517718103.
Full textAbstract:
Paediatric surgical disease is a neglected health problem. Patients travel great distances to tertiary level care for management. This study aimed at analysing referral patterns to design an outreach programme for paediatric surgery in KwaZulu Natal. Data forms of patients referred to the service between January and July 2016 were correlated with the clinical record. Delays in management were compared to morbidity and mortality. Out of 781, 158 referrals were accepted as emergencies. The majority (62%) were children aged < 1 year. Gastro-intestinal problems (38.4%) and congenital anomalies (26.9%) formed the majority. Patients who died had a significantly longer delay in transfer. Longer total delay was associated with statistically significant greater morbidity. In a setting where a large rural population is served by single-centre tertiary care, delays exist and contribute to morbidity. The authors advocate the establishment of an outreach programme to address these issues.
10
Pokorny, Jiri R. "Flood Disaster in the Czech Republic in July, 1997 — Operations of the Emergency Medical Service." Prehospital and Disaster Medicine 14, no. 1 (1999): 39–41. http://dx.doi.org/10.1017/s1049023x00028533.
Full textAbstract:
AbstractThis report is a review of the response and the activities of the Emergency Medical Services during a huge flood that devastated one-third of the territory of the Czech Republic in July 1997. The Emergency Medical Services personnel extracted by helicopter a great number of citizens who were trapped in their flats and homes. For diabetics and cardiacs who were isolated from the surface transport, the EMS personnel supplied necessary medication, and transported patients to hemodialysis.The cooperation between non-medical emergency services and the district crisis staff of the Integrated Rescue System, varied in different districts. However, in most flooded districts, the cooperation was satisfactory. In addition, a large number of volunteers helped in the first days of the flood.Unfortunately, 49 people died because of the flood. Nevertheless, since the EMS was able to manage the extraordinary needs, the number of emergencies and hospitalizations was low.
11
Rahman, Ganiyu A., and Samuel A. Debrah. "Complicated appendicitis: experience from central region of Ghana." International Surgery Journal 5, no. 1 (2017): 277. http://dx.doi.org/10.18203/2349-2902.isj20175910.
Full textAbstract:
Background: Acute appendicitis is a common surgical abdominal emergency. The aim of this study is to determine the incidence, presentation and immediate outcome of acute appendicitis in a new teaching hospital in Cape Coast.Methods: All patients who had surgery for acute appendicitis at the central regional Hospital, cape coast from 1st January 2011 to 25th October 2012 were retrospectively reviewed.Results: During the study period five hundred and four emergency surgical operations were performed. Abdominal emergency operations constituted 81.5% of these emergencies (411/504). Seventy-seven patients who had appendicectomy during the period constituted 18.7% of all abdominal emergencies. Seventy-six of the patients had requisite details for analysis and form the basis of this study. Appendicitis was seen more in the second and third decades of life with male preponderance. Thirty-one (40.3%) had complicated appendicitis (perforated/ ruptured appendicitis and gangrenous appendix). Though appendicitis is uncommon in children less than ten years, more than 80% presented with complicated appendicitis. Only 6.6% of patients were 50 years and above and they all presented with complicated appendicitis. In male patient with appendicitis, 33.3% presented with complicated appendicitis while in females, 57.9% presented with complicated appendicitis. Two (2.6%) patients died in the immediate postoperative period. Conclusions: About one out of five patients who had emergency abdominal surgical operation had acute appendicitis with 40% of them presenting with complicated appendicitis. Complicated appendicitis is more common in females, children less than 10 years and patients 50 years and above. Immediate postoperative mortality is associated with ruptured appendix.
12
Craig, Leigh Ann. "Royalty, Virtue, and Adversity: The Cult of King Henry VI." Albion 35, no. 2 (2003): 187–209. http://dx.doi.org/10.1017/s0095139000069817.
Full textAbstract:
In 1471, King Henry VI of England died in the Tower of London amid disputed circumstances. Between his death and Henry VIII’s break with Rome in the 1530s, he was venerated as a saint and martyr. Modern historians have generally dismissed this cult as a political phenomenon, created and used by the Tudors as they sought legitimacy. While there is some truth in that assessment, political allegiance was only a part of the impetus for the participation of Henry’s devotees in the cult. Alongside carefully crafted (and perhaps, artificial) portrayals of Henry’s virtues lay something else his former subjects found compelling: his very real political failures, and more importantly the adversity that they engendered. Henry’s devotees used these royal adversities as the basis from which to imagine a sympathetic relationship between themselves and “good King Herre” in which he had great concern for their fatal and near-fatal emergencies. These neglected devotional aspects of Henry VI’s cult are the subject of this article.
13
George-Moses, Crystal L., Paul Archibald, Selena T. Rodgers, and Mayra Lopez-Humphreys. "A Call for Person-Centered and City-Centered Student Supports." Urban Social Work 5, no. 2 (2021): 108–25. http://dx.doi.org/10.1891/usw-d-20-00021.
Full textAbstract:
The coronavirus disease of 2019 (COVID-19) pandemic is devastating the well-being of college students and society. This article examines the need for attention to collegiate mental health during public health emergencies, with a particular focus on college students in urban settings. The article begins with a brief description of the unique challenges faced by cities during pandemics and continues with a historical overview of pandemics. College students attending three public colleges (n = 719) were surveyed regarding the impact of COVID-19 on their psychological health. Preliminary findings reveal a prevalence of students (44.9%) reporting moderate or severe traumatic stress symptoms in response to COVID-19 stressors. A definition of what we define as “astonishing” is the high trending prevalence of college students reporting that they know someone who died due to COVID-19 (70.6%). The article concludes with recommendations for future research and offers person-centered approaches for social workers and leadership in higher education.
14
Nahid, Md Abu Kamal, Sanjida Rahman, and Ankur Jyotindra Shah. "Acute General Surgical Emergency and COVID-19 Is a Pandemic Challenge for Surgeons: A United Kingdom-Based Practical Experience." Journal of Patient Experience 8 (January 1, 2021): 237437352199773. http://dx.doi.org/10.1177/2374373521997735.
Full textAbstract:
Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of emergency surgery. A prospective observational study was performed between March 30, 2020, and June 30, 2020, at a large District General Hospital in England. The primary outcome was perioperative COVID-19-related complications, and secondary outcome measures included incidence of COVID-19 infections among the acute surgical patients, doctors, and healthcare workers. A total of 584 patients admitted through the emergency surgical pathway and 43% (n = 253) underwent surgical intervention. Approximately 5% (n = 30) patients contracted COVID-19 during the perioperative period and 6 of them died. Eight surgical doctors and 11 theater staff were confirmed for COVID-19 by swab test. Acute surgical emergencies and perioperative management of the urgent surgical patients during the COVID-19 pandemic is a global challenge, but adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.
15
Bundgaard, Johan S., Peter K. Jacobsen, Johannes Grand, et al. "Deep sedation as temporary bridge to definitive treatment of ventricular arrhythmia storm." European Heart Journal: Acute Cardiovascular Care 9, no. 6 (2020): 657–64. http://dx.doi.org/10.1177/2048872620903453.
Full textAbstract:
Background: Electrical storm and incessant ventricular tachycardia (VT) are characterized by the clustering of episodes of VT or ventricular fibrillation (VF) and are associated with a poor prognosis. Autonomic nervous system activity influences VT threshold, and deep sedation may be useful for the treatment of VT emergencies. Methods: We reviewed data from conscious patients admitted to our intensive care unit (ICU) due to monomorphic VT, polymorphic VT or VF at our tertiary center between 2010 and 2018. Results: A total of 46 conscious patients with recurrent ventricular arrhythmia, refractory to initial treatment, were referred to the ICU. The majority ( n = 31) were stabilized on usual care. The remaining treatment-refractory 15 patients (57 years (range 9–74), 80% males, seven with implantable cardioverter-defibrillators) with VT/VF storm ( n = 11) or incessant VT ( n = 4) due to ischemic heart disease ( n = 10), cardiomyopathy ( n = 2), primary arrhythmia ( n = 2) and one patient post valve surgery, were deeply sedated and intubated. A complete resolution of VT/VF within minutes to hours was achieved in 12 patients (80%), partial resolution in two (13%) and one (7%) patient died due to ventricular free-wall rupture. One patient with recurrent VT episodes needing repeated deep sedation developed necrotic caecum. No other major complications were seen. Thirteen (87%) patients were alive after a mean follow-up of 3.7 years. Conclusion: Deep sedation was effective and safe for the temporary management of malignant VT/VF refractory to usual treatment. In emergencies, deep sedation may be widely accessible at both secondary and tertiary centers and a clinically useful bridge to definitive treatment of VT.
16
Cavalier, Joanna S., Benjamin Goldstein, Cara L. O’Brien, and Armando Bedoya. "362. A Modified Early Warning Score Predicts Decompensation in COVID-19 Patients." Open Forum Infectious Diseases 7, Supplement_1 (2020): S251. http://dx.doi.org/10.1093/ofid/ofaa439.557.
Full textAbstract:
Abstract Background The novel coronavirus disease (COVID-19) results in severe illness in a significant proportion of patients, necessitating a way to discern which patients will become critically ill and which will not. In one large case series, 5.0% of patients required an intensive care unit (ICU) and 1.4% died. Several models have been developed to assess decompensating patients. However, research examining their applicability to COVID-19 patients is limited. An accurate predictive model for patients at risk of decompensation is critical for health systems to optimally triage emergencies, care for patients, and allocate resources. Methods An early warning score (EWS) algorithm created within a large academic medical center, with methodology previously described, was applied to COVID-19 patients admitted to this institution. 122 COVID-19 patients were included. A decompensation event was defined as inpatient mortality or an unanticipated transfer to an ICU from an intermediate medical ward. The EWS was calculated at 12-hour and 24-hour intervals. Results Of 122 patients admitted with COVID-19, 28 had a decompensation event, yielding an event rate of 23.0%. 8 patients died, 13 transferred to the ICU, and 6 both transferred to the ICU and died. Decompensation within 12 and 24 hours were predicted with areas under the curve (AUC) of 0.850 and 0.817, respectively. Using a three-tiered risk model, use of the customized EWS score for patients identified as high risk of decompensation had a positive predictive value of 44.4% and 11.1% and specificity of 99.3% and 99.6% and 12- and 24-hour intervals. Amongst medium-risk patients, the score had a specificity of 85.0% and 85.4%, respectively. Conclusion This EWS allows for prediction of decompensation, defined as transfer to an ICU or death, in COVID-19 patients with excellent specificity and a high positive predictive value. Clinically, implementation of this score can help to identify patients before they decompensate in order to triage at time of presentation and allocate step-down beds, ICU beds, and treatments such as remdesivir. Disclosures All Authors: No reported disclosures
17
Woyessa, Ashenafi Habte, Birhanu Yadecha Dibaba, Getahun Fetensa Hirko, and Thanasekaran Palanichamy. "Spectrum, Pattern, and Clinical Outcomes of Adult Emergency Department Admissions in Selected Hospitals of Western Ethiopia: A Hospital-Based Prospective Study." Emergency Medicine International 2019 (August 6, 2019): 1–10. http://dx.doi.org/10.1155/2019/8374017.
Full textAbstract:
Background. There has been a steady rise in the absolute number of emergency room admissions over the last few decades. The healthcare delivery system of a country is required to be adjusted to patterns of morbidity and mortality to mitigate the minimized prolonged ill health consequences and premature death of adults. The spectrum, patterns, morbidity, and mortality of health and health-related emergency conditions for which patients visit hospitals often reflect the magnitude of different health problems in a society. The objective of this study was therefore to assess the spectrum, pattern, characteristics, and clinical outcomes of emergency department admissions among adult people who visited EDs of the selected hospitals in western Ethiopia. Methodology. Hospital-based prospective cross-sectional study design was utilized. To select hospitals to be included in the study, the area sampling technique was used. Five administrative zones in west Oromia were selected as geographical clusters. Then, four hospitals were randomly selected from each zone. Finally, the consecutive sampling technique was utilized to recruit the study participants. Results. The mean age of the patients admitted to emergency departments (EDs) of the selected hospitals was 34.98 years. The male-to-female ratio of the respondents was nearly equal (1 : 1.04). While one-fourth (20.4%) of the patients arrived by ambulances (without identifying reason), 23.6% of them visited the emergency department as they had no other place to go. Medical emergencies (45.4%) were the leading types of emergencies followed by traumatic emergencies (27.3%). Respiratory distress (12.43%), extremity fractures (9.61%), and hypertensive disorders (8.6%) were among the top leading causes of adult ED admissions. Vital signs were deranged in about 59.4% of the cases. The most common type of immediately life-threatening problems identified on arrival was impairment of breathing (37%), followed by circulatory compromises (30%). Emergency department admission patterns were variable with peak admissions in the month of February and the lowest in November. The vast majority (90.9%) of emergency patients survived. While 8.5% of patients died of the various types of emergency conditions, the final clinical outcome was not identified in 1.5% of the patients. Conclusion. This study has showed mixed cases with varied patterns and outcomes of adult emergency department admissions. As overall there is a need to be alert during specific seasons, actions must be taken to improve the readiness of existing emergency room services. Furthermore, it is worthwhile to invest further on standardizing and organizing prehospital services at the community level.
18
R., Aruna Rani, Dheeba Jayanthi R., and Eswari S. "Study of maternal and fetal outcome in antepartum eclampsia in a tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 3 (2018): 1108. http://dx.doi.org/10.18203/2320-1770.ijrcog20180902.
Full textAbstract:
Background: In modern obstetrics, the prevalence of Eclampsia and its complications are high, so we decided to study pregnancy outcome in all Antepartum Eclampsia patients. The present study was carried out to investigate the maternal and fetal outcome in patient with Antepartum eclampsia.Methods: A prospective study was conducted in Government Mohan Kumaramangalam Medical College Hospital, Salem, India over a period of one year from January 2016 to December 2016 in all Antepartum Eclampsia patients. Analysis was done regarding the age of women, parity, gestational age, imminent symptoms, mode of delivery, fetal outcome and maternal morbidity and mortality.Results: Incidence of Antepartum Eclampsia in our hospital is 0.7%. It is more common in age group of 20 to 25years (68.5%) and primigravida (56%) and gestational age >37 weeks (51.85%). Commonest mode of delivery was by caesarean section (72%). Out of 54 patients of Antepartum Eclampsia 3 (5.5%) died and 18 (33%) had complications. Out of 50 live babies, 16 (32%) died.Conclusions: Eclampsia is still one of the important and common obstetric emergencies and it has a significant role in maternal and fetal outcome. The early identification of risk factors and timely intervention is needed to improve maternal and perinatal outcome.
19
Witt, John Fabian. "A Lost Theory of American Emergency Constitutionalism." Law and History Review 36, no. 3 (2018): 551–91. http://dx.doi.org/10.1017/s0738248018000317.
Full textAbstract:
In the wake of the Civil War, Columbia Law School professor Francis Lieber, architect of some of the Lincoln administration's most important legal strategies, set out to write a definitive text on martial law and the emergency power. Lieber's text would have summed up his view of the legal lessons of the Civil War. Lieber died in 1872, leaving an unfinished manuscript to his son, Guido Norman Lieber, soon to become the Judge Advocate General of the Union Army. Norman Lieber worked on the manuscript but never finished it. Hidden deep in the younger Lieber's papers in the National Archives, the manuscript summarizes a strand of thinking about constitutional emergencies that first emerged in the controversies over slavery, then animated Emancipation and the broader legal strategy of the Lincoln White House, before running headlong into the post-war backlash signaled by the Supreme Court's 1866 decision inEx Parte Milligan. Building on debates over martial law in Anglo-American empire, the Liebers’ thinking embraced a forceful but constrained approach that made a cabined form of necessity the central principle of emergency governance in the modern state.
20
Rodriguez Zorro, Andres, and Jairo Hernando Vivas Diaz. "Death caused by appendicular knotting and small-bowel strangulation in a child: A case report and review." Medicine, Science and the Law 58, no. 2 (2018): 115–18. http://dx.doi.org/10.1177/0025802418756780.
Full textAbstract:
Acute appendicitis is one of the most common surgical emergencies in paediatrics. However, acute appendicitis in early infancy is an uncommon condition. Furthermore, strangulation of the small intestine through appendicular knotting is described as very unusual in the literature and is generally not well-diagnosed in the clinical context. This article reports the case of a 23-month-old girl who entered the emergency department with a three-day history of abdominal symptoms and who died in less than 24 hours without receiving surgical intervention. The case turned judicial at the request of the parents who claimed lack of clarity in the diagnosis. A medico-legal autopsy was ordered to clarify the cause and manner of death. The autopsy documented herniation, strangulation and torsion of a 70 cm segment of the jejunum/ileum through an appendicular knot caused by the attachment of the distal end of the inflamed appendage to the ileum. The case is relevant because it is the first case of death by appendicular knot and strangulation of small bowel in an infant reported in the literature. The importance of autopsy to clarify the clinical diagnosis is noted.
21
KASABALIS (Δ. ΚΑΣΑΜΠΑΛΗΣ), D., N. SOUBASIS (Ν. ΣΟΥΜΠΑΣΗΣ), D. PARDALI (Δ. ΠΑΡΔΑΛΗ) та ін. "Οξύς υποφλοιοεπινεφριδισμος (αδισσώνια κρίση) στο σκύλο: αναφορά σε έξι περιστατικά". Journal of the Hellenic Veterinary Medical Society 62, № 1 (2017): 13. http://dx.doi.org/10.12681/jhvms.14829.
Full textAbstract:
Medical records of six dogs admitted with acute hypoadrenocorticism were reviewed. All 6 animals were bradycardic and had prolonged capillary refilling time. Hypothermia was detected in 5/6 animals. Clinicopathological evaluation on admission revealed anemia (3/6 dogs), increased (2/6) and normal (2/6) lymphocyte and eosinophil counts, azotemia and hyperkalemia (6/6), hyponatremia, in 5/6 dogs in which sodium was measured with a sodium (Na) : potassium (K) ratio lower than 24, hypoglycemia (2/6) and hypercalcemia, hypocholosterolemia, increased serum alkaline phosphatase and alaninoaminotransferase activities, one dog each. Urine specific gravity was lower than 1025 in 4 dogs. Thoracic radiographs and abdominal ultrasonography disclosed microcardia (2/6), pleural effusion (2/6) and ascites (1/6). Two dogs (2/6), also, presented atrial standstill or atrioventricular block, detected on electrocardiograms. In all 6 animals emergency treatment included the use of intravenous normal saline and glucocorticoids (dexamethasone) immediately after the completion of an ACTH stimulation test with tetracosactide. Two dogs died, one during the 1st day and the other on the 4th day of hospitalization, the latter after the sudden appearance of severe hemorrhagic gastroenteritis. Hospitalization time in the remaining 4 dogs ranged from 3 to 10 days. Prolongation of hospitalization was associated with worsening of anemia, hypoalbuminemia, neurologic complications and non-responsive azotemia. Four dogs (4/6) were discharged on oral prednisolone and fluodrocortisone, but one died after a week for unknown reasons. Acute hypoadrenocorticism is a life threatening condition requiring emergency treatment for a successful outcome. Its inclusion in the differential diagnosis of canine emergencies, presented with acute weakness and gastrointestinal signs, is mandatory, but for its confirmation a complete laboratory and, most importantly, an ACTH stimulation test are always required.
22
Kaushik, Sonali, Khurram Akhter, Barnaby Rufford, et al. "The Use of Laparostomy in Patients With Gynecologic Cancer: First Report From a UK Cancer Center." International Journal of Gynecologic Cancer 23, no. 5 (2013): 951–55. http://dx.doi.org/10.1097/igc.0b013e31829169fc.
Full textAbstract:
ObjectiveTo report on the use of laparostomy after major gynecologic cancer surgery.MethodsOperative records and surgical databases of patients who underwent major open abdominal surgery over a 6.5-year period at a tertiary referral center were searched. Patients who had diagnostic procedures, operative laparoscopy, and surgery for vulval cancer were excluded. All patients who had laparostomy were identified; and the diagnosis, indication for laparostomy, method of temporary cover, and complications were recorded.ResultsA total of 1592 laparotomies, including 37 emergencies, were performed. Of these, 14 patients (0.88%) had a laparostomy. Seven patients had primary cancer and 7 had recurrent cancer. As more patients had surgery for primary disease, laparostomy was more common in patients who underwent surgery for recurrent cancer. Seven patients had ovarian/fallopian tube/primary peritoneal cancer, 4 patients had uterine cancer, 2 patients had cervical cancer, and one patient had vaginal cancer. Ten laparostomies (71.4%) were performed after an emergency procedure; thus, laparostomy was approximately 100 times more common after emergency than elective major surgery. Massive bowel distension and bowel wall edema were the major indications for laparostomy. The method of temporary closure was variable, and a sterile saline bag was the most commonly used. The laparostomy was closed in all but 2 patients, most often on postoperative day 2 or 3. Two patients (14.3%) died within 30 days of the laparostomy, and 2 others died at postoperative days 40 and 62. Three of these 4 patients had recurrent cancer, and 2 patients had emergency procedures.ConclusionsThe overall incidence of laparostomy associated with laparotomy for gynecological cancer surgery was less than 1:100 cases, was more common after surgery for recurrent cancer, and in particular, was approximately 100 times more common after emergency procedures. The 30-day operative mortality rate was 14.3%.
23
D'AMBRUOSO, LUCIA, PETER BYASS, and SITI NURUL QOMARIYAH. "‘MAYBE IT WAS HER FATE AND MAYBE SHE RAN OUT OF BLOOD’: FINAL CAREGIVERS' PERSPECTIVES ON ACCESS TO CARE IN OBSTETRIC EMERGENCIES IN RURAL INDONESIA." Journal of Biosocial Science 42, no. 2 (2009): 213–41. http://dx.doi.org/10.1017/s0021932009990496.
Full textAbstract:
SummaryMaternal mortality persists in low-income settings despite preventability with skilled birth attendance and emergency obstetric care. Poor access limits the effectiveness of life-saving interventions and is typical of maternal health care in low-income settings. This paper examines access to care in obstetric emergencies from the perspectives of service users, using established and contemporary theoretical frameworks of access and a routine health surveillance method. The implications for health planning are also considered. The final caregivers of 104 women who died during pregnancy or childbirth were interviewed in two rural districts in Indonesia using an adapted verbal autopsy. Qualitative analysis revealed social and economic barriers to access and barriers that arose from the health system itself. Health insurance for the poor was highly problematic. For providers, incomplete reimbursements, and low public pay, acted as disincentives to treat the poor. For users, the schemes were poorly socialized and understood, complicated to use and led to lower quality care. Services, staff, transport, equipment and supplies were also generally unavailable or unaffordable. The multiple barriers to access conferred a cumulative disadvantage that culminated in exclusion. This was reflected in expressions of powerlessness and fatalism regarding the deaths. The analysis suggests that conceiving of access as a structurally determined, complex and dynamic process, and as a reciprocally maintained phenomenon of disadvantaged groups, may provide useful explanatory concepts for health planning. Health planning from this perspective may help to avoid perpetuating exclusion on social and economic grounds, by health systems and services, and help foster a sense of control at the micro-level, among peoples' feelings and behaviours regarding their health. Verbal autopsy surveys provide an opportunity to routinely collect information on the exclusory mechanisms of health systems, important information for equitable health planning.
24
ROY, Rakesh. "Role of palliative care department in modifying ICU admissions for patients with advanced cancer: A study." Journal of Clinical Oncology 30, no. 15_suppl (2012): e19517-e19517. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e19517.
Full textAbstract:
e19517 Background: Admission of cancer patients are on the rise in the Intensive Care Unit due to advancement in healthcare facilities. But limited number of ICU beds, health resources and lack of structured Palliative Care services are a matter of concern. Methods: A retrospective study was conducted in an Indian tertiary cancer centre from Jan – Jun 2010 to find out total number and cause of ICU admission of advanced cancer patients when a Palliative Care Department did not exist. Information source were case files and interviews after appropriate consent. Exclusion criteria - age < 18 years, post operative care, complications arising from a major surgery, established oncological emergencies, patients with curative intent. With a 24 hr Palliative Care department under operation from Aug 2010 - another similar study was performed from Jan – Jun 2011. Results: Jan – Jun 2010: Total admissions 542. 297 patients matched the exclusion criteria. Of the remaining 245 patients (45.2%) considered for the study 35 patients (14.2%) died. 11 patients (4.4%) were put on ventilator. Average occupancy of bed 5 days. Commonest cause was respiratory distress. Review of the case notes revealed 54 patients (22%) were admitted due to lack of Palliative Care service. Study was repeated from Jan – Jun 2011 after the initiation of a Palliative care Department from Aug 2010. Out of 487 patients, 195 patients (40%) were considered for study. 18 (9.2%) died. 6 patients (3%) were put on ventilator. The average duration of stay was 4 days. Components of Palliative Care like good communication, early consent from patients as to where they wish to die, do not resuscitate policy for some patients in the background of ethical issues, 24 hour Palliative care service, emergency helpline, home based care, good psychological counselling etc were identified as the key reasons for reduced admissions. Conclusions: Effective round the clock Palliative care service can increase ICU bed turnover, reduce misery of the patients and their family members, save resources, giving patients with longer survival chances a hope to live longer.
25
Candel, Francisco Javier, Jesús Canora, Antonio Zapatero, et al. "Temporary hospitals in times of the COVID pandemic. An example and a practical view." Revista Española de Quimioterapia 34, no. 4 (2021): 280–88. http://dx.doi.org/10.37201/req/041.2021.
Full textAbstract:
We describe the most widely used temporary hospital in Europe during the first pandemic wave, its structure, function, and achievements. Other models of care developed during the pandemic around the world were reviewed including their capacity, total bed/ICU bed ratio and time of use. We particularly analyzed the common and differential characteristics of this type of facilities. IFEMA Exhibition Center was transformed into a temporary 1,300-bed hospital, which was in continuous operation for 42 days. A total of 3,817 people were treated, generally patients with mild to moderate COVID-19, 91% of whom had pneumonia. The average length of stay was 5 to 36 days. The most frequent comorbidities were hypertension (16.5%), diabetes mellitus (9.1%), COPD (6%), asthma (4.6%), obesity (2.9%) and dementia (1.6%). A total of 113 patients (3%) were transferred to another centers for aggravation, 19 (0.5%) were admitted to ICU and 16 patients (0.4%) died. An element of great help to reducing the overload of care in large hospitals during peaks of health emergencies could be these flexible structures capable of absorbing the excess of patients. These must be safe, breaking domestic transmission and guarantee social and emotional needs of patients. The success of these structures depends on delimitation in admission criteria taking into account the proportion of patients who may require, during admission, assistance in the critical care area.
26
Gladkikh, P. F., I. D. Kosachev, and R. N. Lemeshkin. "MITIGATION OF CONSEQUENCES OF AN EARTHQUAKE IN ARMENIA IN THE WINTER OF 1988. (TO THE 30 ANNIVERSARY OF ACCIDENT)." Medicо-Biological and Socio-Psychological Problems of Safety in Emergency Situations, no. 2 (September 26, 2018): 5–15. http://dx.doi.org/10.25016/2541-7487-2018-0-2-05-15.
Full textAbstract:
Relevance. In December 1988, the Armenian Soviet Socialist Republic suffered a catastrophic earthquake in the area where lived up to 1 million people. The cities of Spitak, Leninakan, Kirovokan, Stepanavan and more than 300 other settlements were totally or partly destroyed. More than 25 thousand people died. The republic lost up to 40% of the production capacity. This Armenian tragedy showed a need for a system of prevention and elimination of natural and technogenic emergency situation. Owing to the experience from elimination of medical and sanitary consequences, main principles of Disaster medicine as a new branch of health care were coined.Intention. To assess retrospectively experience of elimination of medical and sanitary consequences of December 1988 earthquake in the Armenian Soviet Socialist Republic using forces and assets of the USSR armed forces.Methodology. The scientific literature on mitigation of consequences of earthquakes as indexed in the Russian state library and Scientific electronic library was studied. Personal experience and experience of participation of military-medical experts in mitigation of consequences of Spitak (Armenia) earthquake was analyzed and compared with current aspects of the theory and practice of disaster medicine.Results and Discussion. Delivery of health care to the population was complicated since many medical institutions were destroyed; losses of military-medical service in earthquake area were at least 50–60 %. Soldiers and military physicians of the Transcaucasian military district were the first responders, and the leadership in mitigation of consequences was assigned mainly to the Ministry of Defense of the USSR and its Central military-medical administration. At the same time, more than 111 foreign states provided humanitarian aid. The main idea was to accumulate forces and assets for qualified medical care in close proximity to affected regions with subsequent air evacuation of injured to the cities of Yerevan, Tbilisi, Moscow and Leningrad. Further it became clear that more than 25 thousand people died, over 15 thousand were rescued from ruined buildings, 427 wounded died in hospitals, 140 thousand became disabled, 514 thousand became homeless.Conclusion. The experience gained by the USSR during mitigation of consequences of technogenic and natural disasters of the second half of the 20th century required formation of the Russian Rescue Corps (RRC) as the State committee with the subsequent transformation in the separate Ministry of the Russian Federation for Civil Defence, Emergencies and Elimination of Consequences of Natural Disasters (Emercom of Russia). To deliver health care to wounded, sick and injured during emergency situations, the All-Russian Service for Disaster Medicine was established with the Service of Disaster Medicine within the Russian Defense Ministry as an important component.
27
Farzianpour, Fereshteh, Khatere Ramezani, Najmeh Bahmanziari, and Omolbanin Atashbahar. "Frequency and Risk Factors Associated with Mortality in Pregnant Women in Tehran-Iran." Global Journal of Health Science 9, no. 3 (2016): 138. http://dx.doi.org/10.5539/gjhs.v9n3p138.
Full textAbstract:
<p><strong>BACKGROUND &amp; OBJECTIVES:</strong> Ending mortality in pregnant women is not just a health challenge, but a development challenge. The purpose of this study was to access the frequency and risk factors associated with maternal mortality in Tehran from 2008 to 2011.</p><p><strong>METHODS: </strong>The present study was a case-control study with a population group which consists of all the women who have died since the beginning of pregnancy up to 42 days after delivery from the year 2008 to 2011 and a control group which consists of all delivered pregnant women with a perfect record in the hospitals (n=16) in Tehran from 2008 to 2011. In the case group, sampling was done through census (n = 113) and random sampling was used in the control group and 327 people were selected. Data collection tool was a record sheet consisting of two parts: demographic and risk factors associated with pregnancy which was completed using the data in the case and control groups. Finally, SPSS 22, descriptive statistics and statistical tests such as Chi-square, t-test and Fisher were used to analyze the data.</p><p><strong>RESULTS:</strong> Maternal deaths were reported in Tehran from 2008 to 2011 and the ratio was 15.8 in 100 thousand of live births during the period. Among the mothers who died, 73.5% of them were 18 to 34 years old, 1.22% were 35 years old or above and only 4.4% were less than 18 years of age. Of these mothers that died, 83.2% lived in the city and 16.8% lived in rural areas, but there were significant relationship between age, place of residence and maternal deaths. In combination with other risk factors, such as pregnancy age, pregnancy number, number of abortions, underlying medical condition, access to appropriate prenatal care, methods of delivery, factors of delivery, and the time may be between two last pregnancy, a significant difference was observed between the case and control groups, except for the distance between the two last pregnancy.</p><p><strong>CONCLUSION: </strong>Maternal mortality has been declining over the years; due to the identified factors associated with maternal death, proposed strategies, such as improving the quality of hospital services in the field of obstetric emergencies, improving the quality and coverage of prenatal care, avoidance of selective cesarean sections, identifying high risk pregnancies and referrals to specialized centers.</p>
28
Leak, Ashley Nicole, Deborah K. Mayer, Debbie Travers, Annah Wyss, and Anna Waller. "Why do cancer patients die in the emergency department (ED)? Analysis of 283 deaths in North Carolina EDs in 2008." Journal of Clinical Oncology 30, no. 15_suppl (2012): 6119. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.6119.
Full textAbstract:
6119 Background: Emergency departments (ED) in the US are utilized by cancer patients for symptom management, treatment side effects, oncologic emergencies, and/or end of life care. EDs have become a place where acute care needs are addressed and there are discussions about end of life care. The purpose of this study was to describe characteristics of cancer patients who died in the ED, highlighting lung cancer patients and their ED visit characteristics. Methods: A secondary data analysis of ED visit data fromthe North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT), a population database of 110 of the 112 EDs in NC in 2008. This was a descriptive, retrospective analysis providing descriptive statistics of patient demographics including: sex, age at death, insurance, cancer type, and visit categories (hour, day, month). Free text chief complaints, as recorded by the health care provider, were cleaned and categorized. Results: There were37,760 ED visits by 27,644 patients associated with cancer; 283 (1%) of these visits resulted in death in the ED. The most common chief complaints of those who died were respiratory distress (17.3%), neurological changes (13.4%), and pain (5.7%). Of all cancer deaths, 63% were male with a mean age of 66 (SD 14.2). Over a third (N= 104, 36.7%) of cancer ED visits resulting in death had a code for lung cancer listed. Medicare was the insurance provided for almost half (47.3%) of these patients. Majority of deaths occurred on a patient’s first ED visit (70.9%). Although a third (34.7%) of deaths occurred during weekends, over a third (37.5%) occurred during weekday clinic hours. Conclusions: Even though deaths in the ED were infrequent, this study provides insight into reasons patients visit the ED. Some patients were enrolled in Hospice and/or had a DNR documented. This study can inform future research associated with precipitating factors leading up to the ED visit (e.g. worsening shortness of breath, location of care prior to ED visit). This study illustrates the importance of research on discussion of end of life care needs (advanced directives, code status, use of Hospice services) with cancer patients and their family before they reach the final stage of their disease.
29
Bielska, Iwona A., Lauren Jewett, Mark Embrett, et al. "Canada’s multi-jurisdictional COVID-19 Public Health response – January to May 2020." Zdrowie Publiczne i Zarządzanie 18, no. 1 (2020): 88–105. http://dx.doi.org/10.4467/20842627oz.20.009.12663.
Full textAbstract:
In late January 2020, the first COVID-19 case was reported in Canada. By March 5, 2020, community spread of the virus was identified and by May 26, 2020, close to 86,000 patients had COVID-19 and 6,566 had died. As COVID-19 cases increased, provincial and territorial governments announced states of public health emergency between March 13 and 20, 2020. This paper examines Canada’s public health response to the COVID-19 pandemic during the first four months (January to May 2020) by overviewing the actions undertaken by the federal (national) and regional (provincial/territorial) governments. Canada’s jurisdictional public health structures, public health responses, technological and research endeavours, and public opinion on the pandemic measures are described. As the pandemic unravelled, the federal and provincial/territorial governments unrolled a series of stringent public health interventions and restrictions, including physical distancing and gathering size restrictions; closures of borders, schools, and non-essential businesses and services; cancellations of non-essential medical services; and limitations on visitors in hospital and long-term care facilities. In late May 2020, there was a gradual decrease in the daily numbers of new COVID-19 cases seen across most jurisdictions, which has led the provinces and territories to prepare phased re-opening. Overall, the COVID-19 pandemic in Canada and the substantial amount of formative health and policy-related data being created provide an insight on how to improve responses and better prepare for future health emergencies.
30
Cuciureanu, Iulian Dan, Cristina Croitoru, Victor Constantinescu, and Tudor Cuciureanu. "DELIRIUM IN ACUTE NEUROLOGICAL CARE DEPARTMENT. CAUSES, PATHOGENESIS AND MANAGEMENT." Romanian Journal of Neurology 16, no. 3 (2017): 89–93. http://dx.doi.org/10.37897/rjn.2017.3.2.
Full textAbstract:
Defined as an organic decline, often transient, ondulant, mainly of cognitive function, memory, language, delirium is often considered the attribute of patients hospitalized with multiple illnesses. Medical costs, and subsequent psychological implications, prognostic particularities gives him a special social importance. Although with multiple recognized etiology, its pathogenesis is partially known, involving relays and neural networks. In the presence of known predisposing factors and under some precipitating influence like acute metabolic or inflammatory disorders (interleukins 1, 6, caspaze), infections, vascular endothelial dysfunction that cause malfunctions of neurotransmitters (GABA, glutamate, acetylcholine, melatonin) occurs, mainly, an atentionale matrix disruption (attention modulation is done through the collaboration of the neocortex, thalamus and brainstem’s reticular substance) as well as structural changes of neural networks and their interaction with cerebral default network. Its prevalence is estimated at the time of admission between 11-30% of patients. Early identification of patients at risk and multifactorial and multidisciplinary approach represents efficient solution to prevent delirium consequences. Authors performed a synthetic rundown of the main theorical aspects of delirium and exemplify by a retrospective study in “Prof. Dr. N. Oblu” Neurologycal Clinic of Emergencies hospital, Iasi. From 3,707 patients admitted in one year, 32% had impaired language and only 7% have presented confusional syndrome: 58% in ischemic strokes or haemorrhagic (9%), epilepsy (18%), intracerebral tumors (1.8%), metabolic encephalopathies (7%), neurodegenerative disorders (22%), infections (3%). Ages prevailed over 60 years and males (64%), low outcome in 15%, 80% had improvement in evolution and 5% died.
31
Srinivas, G., Y. S. Aashik, and Manoj Muthalik. "Study of the pattern, intent behind and outcome of acute poisoning in a tertiary care centre." International Journal of Advances in Medicine 8, no. 1 (2020): 103. http://dx.doi.org/10.18203/2349-3933.ijam20205472.
Full textAbstract:
Background: Acute poisoning is one of the major medical emergencies with significant morbidity and mortality. Appropriate planning, prevention and management techniques can be designed by knowing the nature, severity and outcome of acute poisoning cases. Most of the poisoning is due to the intention of deliberate self-harm. This study aimed to study the pattern and outcome of acute poisoning and the intent behind poisoning. Methods: This is a cross sectional study which included 100 acute poisoning cases in a tertiary care hospital. The study includes data regarding age, sex, time elapsed after intake of poison; name of the poisonous substance, duration of hospitalization, severity and outcome were collected in the prestructured proforma. Intent behind poisoning was calculated using Beck’s suicide intent score. Results: Incidence was more common among males (69%) but there was no significant correlation between gender and mortality. Mean age of presentation was 35.66 years but age of presentation and mortality correlation was not statistically significant (t=0.92, p=0.3). Organophosphorous compound poisoning (36%) was the most common type of poisoning. Total mortality was found to be 12%. Beck’s suicide intent scores were higher in patients who died and statistically significant (t=8.96, p=0.0001). Maximum patients expired when there was a delay in admission to hospital by more than 8 hours after exposure. Conclusions: Poisoning is more common in young males. The overall mortality depends on type of poison, time elapsed since exposure to hospital arrival, suicidal intent and many other factors. Early care in a tertiary care center may help to reduce mortality in India.
32
Voichenko, V. V., G. G. Roshchin, O. O. Dyadyk, et al. "Expediemcy of using a comprehensive approach in the identification of missing persons." Biomedical and Biosocial Anthropology, no. 37 (December 26, 2019): 10–14. http://dx.doi.org/10.31393/bba37-2019-02.
Full textAbstract:
The identification of missing persons in armed conflict and with mass casualties in emergencies has its own characteristics and requires an integrated approach to increase accuracy and objectivity. The aim of the study justification of the appropriateness of an integrated approach in identifying persons missing in an armed conflict with mass casualties. In the work, archival materials of forensic medical examinations of the commemorative institution “Dnipropetrovsk Regional Bureau of Forensic Medical Examination” were used regarding those who died during the armed conflict with mass casualties in eastern Ukraine during 2014-2019. Research methods: anthropometric, morphometric, photographic, radiological, forensic methods, computer simulation method, molecular genetic, statistic. The article sets out the domestic experience of increasing the objectivity and accuracy of identifying missing persons and determining the characteristics of bodily injuries and traumatic factors through an integrated approach using anthropometric, morphometric, photographic, radiological, molecular genetics and medical and criminalistics methods and in situations of armed conflict with mass casualties. However, the presence of only a modern morgue and the latest equipment in the laboratory department of the forensic medical examination bureau is not a guarantee of a successful examination to identify the deceased. As the experience of different countries in the case of mass natural and man-made disasters shows – the key element is the correct and consistent organization of research. The experience of conducting identification studies in Ukraine of missing persons in an armed conflict with mass casualties of people indicates the appropriateness of applying an integrated approach that improves the objectivity and accuracy of the study.
33
Kishore, Lalit, Sumit Naraniya, Deepak Verma, Parul Yadav, Ambrav Vedprakash, and Ratan Raj. "A clinico-epidemiological study of complicated external hernia." Clinical Surgery Research Communications 4, no. 4 (2020): 01–05. http://dx.doi.org/10.31491/csrc.2020.12.062.
Full textAbstract:
Background: Abdominal wall hernias are among the most commonly encountered surgical problem. Irreducibility, obstruction, and strangulation are its commonest complications which usually presents as acute emergencies. Emergency repair of complicated hernias is associated with poor prognosis and a high rate of postoperative complications even with better care, improved anesthetic management and advanced surgicaltechniques. Methods: The aim of the study was to evaluate incidence, morbidity, and mortality in complicated hernia and to compare with it non-complicated hernia. This study was conducted in the Department of General Surgery, Dr. Sampurnanand Medical College, Jodhpur, Rajasthan, from July 2018 to December 2019 on twenty-eight patients of complicated hernia and compared with similar no of uncomplicated hernia patients. Results: The mean age of the patients was 52 years with male to female ratio of 11:3 in the complicated external hernia group. The majority of the patient (60.7%) underwent herniorrhaphy, followed by hernioplasty (14.3%). Most of the patients (89.2%) survived without any post-operative morbidity, 7.1% of them developing wound sepsis while 3.5% of patients died after surgery due to septic shock. Conclusion: Complicated external hernias occur in all age groups but are more common in older age and show preponderance in males. All patients present with irreducible swelling with no cough impulse. The indirect inguinal hernia is the most common type and herniorrhaphy is the most preferred operative procedure in the complicated hernia. Wound sepsis was the most common complication. Morbidity and mortality may be attenuated with proper surgical and post-operative management. Keywords: Abdominal wall hernia; complicated hernia; herniorrhaphy; hernia
34
Isikber, Cem, Muge Gulen, Salim Satar, et al. "Evaluation of the frequency of patients with cancer presenting to an emergency department." Revista da Associação Médica Brasileira 66, no. 10 (2020): 1402–8. http://dx.doi.org/10.1590/1806-9282.66.10.1402.
Full textAbstract:
SUMMARY OBJECTIVE: This study aims to determine the demographic characteristics of cancer patients admitted to an emergency department and determine the relationship between the frequency of admission to the emergency department and oncological emergencies and their effect on mortality. METHODS: This observational, prospective, diagnostic accuracy study was performed in the ED of a tertiary care hospital. Patients over the age of 18 who were previously diagnosed with cancer and admitted to the emergency service for medical reasons were included in the study. We recorded baseline characteristics including age, gender, complaints, oncological diagnosis, metastasis status, cancer treatments received, the number of ED admissions, structural and metabolic oncological emergency diagnoses in the ED, discharge status, length of hospital stay, and mortality status. RESULTS: In our study, 1205 applications related to the oncological diagnosis of 261 patients were examined. 55.6% of the patients were male, and 44.4% were female. The most common metabolic oncological emergency was anemia (19.5%), and the most common structural oncological emergency was bone metastasis-fracture (4.6%.) The mean score of admission of patients to the emergency department was four times (min: 1 max: 29) during the study period. A total of 49.4% (n: 129) of the patients included in the study died during follow-up, and the median time of death was 13 days after the last ED admission. CONCLUSION: The palliation of patient symptoms in infusion centers that will be established in the palliative care center will contribute to the decrease in the frequency of use of emergency services.
35
Twersky, Sylvia, and Adam Davey. "National Hospitalization Trends Among Centenarians in the United States." Innovation in Aging 4, Supplement_1 (2020): 375. http://dx.doi.org/10.1093/geroni/igaa057.1207.
Full textAbstract:
Abstract Continued increases in life expectancy mean than an unprecedented number of individuals are reaching centenarian status, often with complex health concerns. Little research has addressed acute care experiences of centenarians. To address this knowledge gap, we analyzed 10 years of hospital admissions data from a total of 52618 centenarians (aged 100 to 115 years) in the nationally representative National Inpatient Study (NIS) with the aim of characterizing centenarian (mean age 101.4 years, 80% women, 24.2% non-White, 91.3% Medicare, 72.2% emergencies, 18.6% urgent) hospitalizations. Mean length of stay (LOS) decreased from 6.1 to 5.1 days (2000-2009). Over the same period, mean total charges rose from $13373 to $25026; they were $4478 lower for women than men and $4032 more for centenarians age 105 years and older than ages 100 to 104, despite comparable LOSs. Mean LOS was approximately 0.7 days longer for non-Whites than Whites, and mean total charges were approximately $6531 higher for non-Whites than Whites. The 10 most common admission diagnoses were consistent with frailty and end stage cognitive impairment including pneumonia, congestive heart failure, urinary tract infections, fracture of neck of femur, septicemia, fluid and electrolyte disorders, aspiration pneumonitis, acute cerebrovascular disease, acute myocardial infarction, and gastrointestinal hemorrhage, and 10.0% of centenarians died in hospital. We link individual-level data with hospital and state characteristics over the same time period in order to provide a more detailed analysis of individual and system-level characteristics that contribute toward health disparities in hospitalizations and health outcomes among centenarians.
36
Singh, Samiksha, Pat Doyle, Oona Maeve Renee Campbell, Govindaraju Venkata Ramana Rao, and Gudlavalleti V. S. Murthy. "Pregnant women who requested a ‘108’ ambulance in two states of India." BMJ Global Health 3, no. 3 (2018): e000704. http://dx.doi.org/10.1136/bmjgh-2017-000704.
Full textAbstract:
We studied the pregnant women, who requested a ‘108’ ambulance in two Indian states (Andhra Pradesh (AP) and Himachal Pradesh (HP)). We conducted a cross-sectional telephone survey to study the characteristics and outcomes of those who (1) were transported using ‘108’ ambulance, (2) were sent ‘108’ ambulance but did not use it and (3) were not assigned a ‘108’ ambulance. We conducted interviews within 24 hours of clients’ call and followed them up at 48 hours, on the 7th and 28th day. 90% of pregnant women callers in AP and only 16% in HP were from poorer socioeconomic circumstances. 22.5% of women who were not provided an ambulance in HP lived in tribal areas. A higher proportion of women who were transported using ‘108’ reported either a high-risk condition (AP, 22%; HP, 27%) or an early complication in pregnancy (AP and HP, 16%), compared with the other groups (AP, 18% and 8%; HP, 19% and 16%). In AP, women who were sent an ambulance but did not use it had higher prevalence of obstetric emergency (9.8%) compared with the other groups (ambulance used, 7.4%; not assigned, 4.1%). One-fifth of women in AP and one-seventh in HP delivered by caesarean section. One woman who called, but was not transported by ‘108’, died in AP. Ten stillbirths and 22 neonatal deaths were reported in AP and 17 and 16, respectively, in HP. Strategies are required to improve ‘108’ service for tribal areas in HP. The ‘108’ services should be improved to reduce non-use of ambulance, especially for women who report obstetric emergencies.
37
Jiya, Fatima B., Nma M. Jiya, Mika’ilu A. Jangebe, et al. "Predictors of mortality and loss to follow up among children with malignancies in a resource constraint community in Nigeria." International Journal of Contemporary Pediatrics 8, no. 6 (2021): 968. http://dx.doi.org/10.18203/2349-3291.ijcp20212035.
Full textAbstract:
Background: Childhood malignancies are on the increase globally and are of public health concern with associated poor outcome in resource constraint settings. The objective of the study was to determine the factors associated with in-hospital mortality in children with malignant tumours, the predictors of mortality and those of loss to follow up.Methods: A 2 year prospective survey of children aged 1 month-14 years admitted into the paediatric ward of Usmanu Danfodiyo University Teaching Hospital (UDUTH) Sokoto with histologic diagnosis of malignant tumour.Results: There were 26 (74.3%) males and 9 (25.7%) females diagnosed of malignant tumours with male:female=3:1 and mean age at presentation of 6.8±4.0 years. Majority 25 (71.4%) were from low social class. Twenty-four (68.6%) of the subjects had metastasis at presentation. Tumours diagnosed were mainly nephroblastoma 12 (34.3%), rhabdomyosarcoma 09 (25.7%), retinoblastoma 4 (11.4%), and leukaemias 4 (11.4%). Eighteen (51.4%) subjects were discharged after initial course of treatment 15 (42.9%) died and 02 (5.7%) left against medical advice. Of the 18 subjects that were discharged, 16 (88.9%) were lost to follow up. Shock (p=0.01), multiple organ failure (p=0.02), hyperleucocytosis (p=0.04), acute kidney injury (p=0.04) and metastatic disease (p=0.04) were associated with in-hospital mortality. On logistic regression analysis, shock (p<0.001), multiple organ failure (p=0.04) and hyperleucocytosis (p=0.04) were independent predictors of mortality. Residence outside the study location was associated (p=0.04) with loss to follow up.Conclusions: The high in-hospital mortality and loss to follow-up in this study can be reduced by prompt identification and management of oncologic emergencies, and the provision of support services to the children and their caregivers.
38
Chen, Benny J., Divino Deoliveira, and Nelson Chao. "Insulin-Like Growth Factor 1 Protects against Lethal Irradiation." Blood 112, no. 11 (2008): 3488. http://dx.doi.org/10.1182/blood.v112.11.3488.3488.
Full textAbstract:
Abstract Ionizing irradiation can cause bone marrow failure leading to death. Effective therapeutic agents capable of promoting or accelerating the recovery of the hematopoietic and/or immune compartment following radiation injury are limited. We and others have previously demonstrated that recombinant human growth hormone promotes hematopoietic and immune recovery following stem cell transplantation and irradiation. Published data suggest that growth hormone elicits its pro-hematopoietic effects via action of insulin-like growth factor 1 (IGF1). Since IGF1 has recently been approved by the Federal Drug Administration to treat other conditions, IGF1 could be brought to the clinic rapidly upon demonstration of its activity. In this study, we sought to determine whether IGF1 has radioprotective activity. The studies were performed using BALB/c mice. Recombinant human insulin-like growth factor 1 (rhIGF1) was administered at a dose of 100 mcg/dose, i.v., once a day, starting within one hour after irradiation. BALB/c mice were irradiated with 7.5 Gy and treated with saline or rhIGF1 for 5 days. In the saline control group, all mice (10 out of 10 mice) died within 25 days following irradiation. By contrast, four out of 10 mice (40%) in the rhIGF1-treated group survived more than 100 days after irradiation (Figure, P<0.01). These data indicate that rhIGF1 can protect against lethal irradiation. Because one of the primary causes of death following irradiation is infections, we next sought to determine the effects of rhIGF1 on immune recovery. Compared with the saline control group, treatment with rhIGF1 for 5 days on irradiated (7.5 Gy) BALB/c mice significantly accelerated the recovery of CD4 and CD8 T cell subsets, B cells, and NK cells following irradiation. Our data demonstrate that rhIGF1 could potentially serve as a medical countermeasure in radiation emergencies. Figure Figure
39
Bhuyian, Md Akbar Hossain, Md Abdullah Al Farooq, Md Minhajuddin Sajid, et al. "Decreased Morbidity and Mortality from Intestinal Ascariasis: Experience of a Single Center." Journal of Paediatric Surgeons of Bangladesh 2, no. 2 (2014): 73–78. http://dx.doi.org/10.3329/jpsb.v2i2.19551.
Full textAbstract:
Background: Ascariasis is a common gastrointestinal infestation worldwide. It affects more children who live in poor hygenic condition. Pediatric surgeons are supposed to manage related surgical complications of ascariasis.Objective: To evaluate the recent pattern of occurrence of intestinal and biliary ascariasis with morbidity and mortality related to it.Materials and Methods:Study design: Retrospective study.Period of study: Study was conducted between Jan 2006 - Dec 2011 (total 06 years).Place of study: This study was carried out in the department of Pediatric Surgery, Chittagong Medical College Hospital (CMCH), Chittagong; Bangladesh.Study Subjects: Patients admitted and diagnosed as intestinal (1591) and biliary (181) ascariasis in the department of Pediatric surgery, CMCH were evaluated.Results: A total of 1772 patients were admitted with surgical complication of ascariasis. Among them 1591 (89.78%) patients were diagnosed as intestinal ascariasis and 181 (10.22%) patients as biliary ascariasis. Age range was 6 months to 12 years with mean age of 6 years for intestinal ascariasis. Biliary ascariasis presented between 3 years to 12 years with mean age of 7 years. Male (1060) suffered more than female (531). Male to female ratio was 2:1 for intestinal ascariasis while females (120) suffered more than male(61) in biliary ascariasis ( ratio 2: 1). Total 231 surgery both elective and emergencies were done.Discussion: Most of the patients (52-81% ) were treated by endoscopic removal of worm from common bile duct. Some patients (15 - 31 %) were treated successfully by conserevative approach. Only a few patients needed open surgical procedure. No patient had died from biliary ascariasis and death from complications of intestinal ascariasis reduced from 20% to 4% over the last 6 years.Conclusion: There has been a reduced number of disease burden over the last few years from ascariatic and biliary ascariasis.DOI: http://dx.doi.org/10.3329/jpsb.v2i2.19551
40
Abbas Shah, Tajammal. "PREVALENCE OF ROAD TRAFFIC ACCIDENTS." Professional Medical Journal 23, no. 04 (2016): 378–82. http://dx.doi.org/10.29309/tpmj/2016.23.04.1492.
Full textAbstract:
To see the percentage, the different groups affected and pattern of injury by roadtraffic accidents among patients attending a unit of surgery in a teaching hospital. Objectives: Tosee the percentage of trauma among patients admitted in one surgical unit of a tertiary hospitalin one year and to compare this with the patients admitted in all surgical units of same tertiaryunit. To evaluate the pattern of trauma, male to female ratio, affected age groups, mechanismof injury, the organs affected, and the mortality rate in one surgical unit of a tertiary hospital of3rd most populated city of Pakistan during one year. Study Design: Prospective study. Setting:Surgical Unit II at Allied Hospital Faisalabad. Period: January 2009 to February 2010. Materialsand Methods: Patients admitted during this period for road traffic accidents in surgical unit IIof Allied Hospital Faisalabad were 94 (4.8 %) out of total 1956 patients presented and admittedin surgical unit II during this year. Total number of patients admitted in all surgical units of thishospital were 7388 while 21,400, patients received and admitted by all other specialties throughemergency units of Allied Hospital Faisalabad. Patients with road traffic accidents admitted insurgical unit II through emergency unit of this hospital were part of this study. Among these94 patients 78 patients (82.97%) were adults and 18 children (19.14%). Patients with all otheremergencies modalities and minor injuries treated and discharged from emergency wereexcluded from this study. Results: Out of 1956 patients admitted in Surgical Unit II from total 7388of all surgical admissions and 21400 all emergencies ward patients, 94 patients (4.8%, 1.27%,and 0.439% respectively) were injured by road traffic accidents. Out of these 94 patients, 78patients (82.97%) were adults and 18 children (19.14%) patients. 58 patients (61.70%) were malesand 36 patients (38.29%) were females. 43 patients (45.74%) were pedestrians, 10 patients were(10.63%) on bicycles, 26 patients were (27.65%) on motorcycle while 15 patients (15.95%) werein other vehicles. 52 patients (55.31%) developed head injuries, 10 patients (10.93%) blunt traumaabdomen, 5 patients (5.31%) blunt trauma chest and 26 patients (27.65%) skeletal injuries ( 10patients forearm bones fracture, 6 patients with fracture mid-shaft of tibia, another 5 patients withfracture lower 1/3rd of femur and 5 patients with hand bones fracture ). All patients were treated bycombined specialty trauma surgeons. 3 patients (3.19%) died out of which 2 patients (2.12%) withsevere head trauma and one pedestrian (1.06%) with blunt trauma abdomen and lower chest. Allother patients survived and recovered with some morbidity. Conclusion: Road traffic trauma isone of major dilemma of our society. 94 road traffic accidents causalities were admitted duringone year in one surgical unit of a tertiary care center and 3 patients died. It is an alarming signto properly protect people, educate general population, employ dedicated road safety staff andfollow rules and regulation of traffic authorities.
41
Mulcahy, Kathryn. "Hypoglycemic Emergencies." AACN Advanced Critical Care 3, no. 2 (1992): 361–69. http://dx.doi.org/10.4037/15597768-1992-2008.
Full textAbstract:
Optimal control of blood glucose requires a balance of diet, exercise, and in some cases, medications. Many factors can cause a state of imbalance, resulting in extremes of glucose control. Hypoglycemia is defined generally as a blood glucose level lower than 50 mg/dL. Although the causes of hypoglycemic episodes are diverse, the management is always aimed at normalizing the plasma glucose concentration. Treatment ranges from simple carbohydrate ingestion in mild to moderate cases to intravenous administration of glucose when the reaction is severe and loss of consciousness occurs. Recognition of warning signs and prompt treatment is essential in all cases
42
Friedman, Matt S., Alex Plocki, Antonios Likourezos, et al. "A Prospective Analysis of Patients Presenting for Medical Attention at a Large Electronic Dance Music Festival." Prehospital and Disaster Medicine 32, no. 1 (2016): 78–82. http://dx.doi.org/10.1017/s1049023x16001187.
Full textAbstract:
AbstractMass-Gathering Medicine studies have identified variables that predict greater patient presentation rates (PPRs) and transport to hospital rates (TTHRs). This is a descriptive report of patients who presented for medical attention at an annual electronic dance music festival (EDMF). At this large, single EDMF in New York City (NYC; New York, USA), the frequency of patient presentation, the range of presentations, and interventions performed were identified.This descriptive report examined consecutive patients who presented to the medical tent of a summertime EDMF held at an outdoor venue with an active, mobile, bounded crowd. Alcohol was available for sale. Entry was restricted to persons 18 years and older. The festival occurred on three consecutive days with a total cumulative attendance of 58,000. Medical staffing included two Emergency Medicine physicians, four registered nurses, and 86 Emergency Medical Services (EMS) providers. Data collected included demographics, past medical history, vital signs, physical exam, drug and alcohol use, interventions performed, and transport decisions.Eighty-four patients were enrolled over 2.5 days. Six were transported and zero died. The ages of the subjects ranged from 17 to 61 years. Forty-three (51%) were male. Thirty-eight (45%) initially presented with abnormal vital signs; four (5%) were hyperthermic. Of these latter patients, 34 (90%) reported ingestions with 3,4-methylenedioxymethamphetamine (MDMA) or other drugs. Eleven (65%) patients were diaphoretic or mydriatic. The most common prehospital interventions were intravenous normal saline (8/84; 10%), ondansetron (6/84; 7%), and midazolam (3/84; 4%).Electronic dance music festivals are a growing trend and a new challenge for Mass-Gathering Medicine as new strategies must be employed to decrease TTHR and mortality. Addressing common and expected medical emergencies at mass-gathering events through awareness, preparation, and early, focused medical interventions may decrease PPR, TTHR, and overall mortality.FriedmanMS, PlockiA, LikourezosA, PushkarI, BazosAN, FrommC, FriedmanBW. A prospective analysis of patients presenting for medical attention at a large electronic dance music festival. Prehosp Disaster Med.2017; 32(1):78–82.
43
Ghavamzadeh, Ardeshir, Kamran Alimoghaddam, Mahdi Jalili, et al. "Result of APL treatment associated with more experience of centers and more treatment as consolidation." Journal of Clinical Oncology 31, no. 15_suppl (2013): 7069. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.7069.
Full textAbstract:
7069 Background: The first line therapy strategy remains controversial in acute promyelocytic leukemia (APL) patients. Arsenic trioxide (AS2O3) approved in relapsed or resistance patients and recently studies reveals benefits of AS2O3in first line therapy. Regardless of these, important challenges are early mortality during remission induction and post treatment relapse. Methods: Between 2000 and 2012, patients suffered APL whose was new case and confirmed by t(15;17) translocation with RT-PCR, enrolled in study. Until 2007, patients received 28 days AS2O3(0.15 mg/kg iv) as induction and after 28 days rest, treatment continued for 2 courses of consolidation therapy with the same dose and after 2007, two additional consolidation courses, one and two year after start treatment, was added for prevent post treatment relapse. At beginning of 2nd and 3th consolidation, consider CSF cytology and RT-PCR for detection of APL cells and weekly CNS prophylaxis by MTX and cytarabine, IT chemotherapy start if needed. Patients received no other treatment. Results: Totally 271 patients enrolled in study. Ninety six patients received 3 dose and 175 patients received 5 dose of AS2O3. Fifty four (20%) patients died during remission induction before achieve remission. In recent years, early mortality rate reduced below 10% compared with more than 24% in the early years. With median follow-up of 30 months, 170 (78.4%) patients among 217 patients (whose survived after successful induction therapy) were alive (mortality rate: 21.6%) and 2.5-year overall survival and leukemia free survival was 85% and 73% respectively. The cumulative incidence of relapse in group which received three courses of AS2O3 and group which received five courses of AS2O3was 41.5% and 12.6%, respectively (95%CI: 2.5-9.6, P-value=0.0001). Conclusions: Currently according recent studies, AS2O3 has been considered as first line therapy in APL patients but either early mortality or post treatment relapse remain challengeable factors which affect treatment result. Expedite the referral of patients and improvement of emergencies care can reduce early mortality. The next step might be in order to achieve best treatment strategy for reduce post treatment relapse.
44
Hughes-McCormack, Laura Anne, Ruth McGowan, J. P. Pell, et al. "Birth incidence, deaths and hospitalisations of children and young people with Down syndrome, 1990–2015: birth cohort study." BMJ Open 10, no. 4 (2020): e033770. http://dx.doi.org/10.1136/bmjopen-2019-033770.
Full textAbstract:
ObjectiveTo investigate current Down syndrome live birth and death rates, and childhood hospitalisations, compared with peers.SettingGeneral community.ParticipantsAll live births with Down syndrome, 1990–2015, identified via Scottish regional cytogenetic laboratories, each age–sex–neighbourhood deprivation matched with five non-Down syndrome controls. Record linkage to Scotland’s hospital admissions and death data.Primary outcomeHRs comparing risk of first hospitalisation (any and emergency), readmission for children with Down syndrome and matched controls were calculated using stratified Cox proportional hazards (PH) model, and length of hospital stay was calculated using a conditional log-linear regression model.Results689/1479 (46.6%) female and 769/1479 (51.9%) male children/young people with Down syndrome were identified (1.0/1000 births, with no reduction over time); 1235 were matched. 92/1235 (7.4%) died during the period, 18.5 times more than controls. More of the Down syndrome group had at least one admission (incidence rate ratio(IRR) 72.89 (68.72–77.32) vs 40.51 (39.15–41.92); adjusted HR=1.84 (1.68, 2.01)) and readmissions (IRR 54.85 (51.46–58.46) vs 15.06 (14.36–15.80); adjusted HR=2.56 (2.08, 3.14)). More of their admissions were emergencies (IRR 56.78 (53.13–60.72) vs 28.88 (27.73–30.07); first emergency admission adjusted HR=2.87 (2.61, 3.15)). Children with Down syndrome had 28% longer first admission after birth. Admission rate increased from 1990–2003 to 2004–2014 for the Down syndrome group (from 90.7% to 92.2%) and decreased for controls (from 63.3% to 44.8%).ConclusionsWe provide contemporaneous statistics on the live birth rate of babies with Down syndrome, and their childhood death rate. They require more hospital admissions, readmissions emergency admissions and longer lengths of stays than their peers, which has received scant research attention in the past. This demonstrates the importance of statutory planning as well as informal support to families to avoid added problems in child development and family bonding over and above that brought by the intellectual disabilities associated with Down syndrome.
45
Saku, S. A., R. Linko, and R. Madanat. "Outcomes of Triggering the Emergency Response Team at a High-Volume Arthroplasty Center." Scandinavian Journal of Surgery 109, no. 4 (2019): 336–42. http://dx.doi.org/10.1177/1457496919857263.
Full textAbstract:
Background and Aims: Emergency Response Teams have been employed by hospitals to evaluate and manage patients whose condition is rapidly deteriorating. In this study, we aimed to assess the outcomes of triggering the Emergency Response Teams at a high-volume arthroplasty center, determine which factors trigger the Emergency Response Teams, and investigate the main reasons for an unplanned intensive care unit admission following Emergency Response Team intervention. Material and Methods: We gathered data by evaluating all Emergency Response Team forms filled out during a 4-year period (2014–2017), and by assessing the medical records. The collected data included age, gender, time of and reason for the Emergency Response Teams call, and interventions performed during the Emergency Response Teams intervention. The results are reported as percentages, mean ± standard deviation, or median (interquartile range), where appropriate. All patients were monitored for 30 days to identify possible intensive care unit admissions, surgeries, and death. Results: The mean patient age was 72 (46–92) years and 40 patients (62%) were female. The Emergency Response Teams was triggered a total of 65 times (61 patients). The most common Emergency Response Team call criteria were low oxygen saturation, loss or reduction of consciousness, and hypotension. Following the Emergency Response Team call, 36 patients (55%) could be treated in the ward, and 29 patients (45%) were transferred to the intensive care unit. The emergency that triggered the Emergency Response Teams was most commonly caused by drug-related side effects (12%), pneumonia (8%), pulmonary embolism (8%), and sepsis (6%). Seven patients (11%) died during the first 30 days after the Emergency Response Teams call. Conclusion: Although all 65 patients met the Emergency Response Teams call criteria, potentially having severe emergencies, half of the patients could be treated in the arthroplasty ward. Emergency Response Team intervention appears useful in addressing concerns that can potentially lead to unplanned intensive care unit admission, and the Emergency Response Teams trigger threshold seems appropriate as only 3% of the Emergency Response Teams calls required no intervention.
46
Fried, Jessica G., Michael Joseph Lariviere, Ravi Bharat Parikh, et al. "Design and implementation of outpatient-based rapid MRI protocols to rule out metastatic spinal cord compression and brain metastases." Journal of Clinical Oncology 37, no. 15_suppl (2019): e18307-e18307. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e18307.
Full textAbstract:
e18307 Background: Metastatic spinal cord compression (MSCC) and symptomatic brain metastases (mets) are potential emergencies that demand coordinated multidisciplinary management. Patients (pts) with concerning symptoms are often referred to the Emergency Department (ED) for expedited imaging, but most do not require subsequent ED or inpatient management. Unnecessary ED visits incur substantial cost to the health system and patients, and cause psychosocial stress for patients often near the end-of-life. To improve access to expedited outpatient imaging for high-risk pts and reduce unnecessary ED visits, we developed outpatient rapid MRI protocols and pathways to rule out MSCC and brain mets. Methods: Tailored abbreviated MRI protocols were developed to allow rapid acquisition of brain ( < 13 minutes) and full spine ( < 25 minutes) exams. Dedicated appointments were reserved on the daily MRI schedule. Exams were immediately interpreted and reported by Radiology to the ordering clinician. This pathway was piloted within the Thoracic Oncology group beginning in 10/2018. Results: Referring specialties included Radiation Oncology (50%), Medical Oncology (36%), Pulmonology (7%), and Surgery (7%). For 6 pts who had outpatient rapid brain imaging, median time from order to exam start was 4.3 h (1.8-31) and order to final report 6.8 h (3.2-34.1). Brain mets were found in 4/6 patients. Only 1/4 positive studies required subsequent ED management. For 8 pts referred for rapid spine imaging, median time from order to exam start was 14.4 h (2.2-72.5) and order to final report 16.7 h (4.0-74.4). Only 1 patient was found to have cord compression and required ED/inpatient management. Overall, 86% of patients did not require ED or inpatient admission. 3 pts (all with negative imaging) died a median 13.4 d (1.4-28.3) after order placement. Conclusions: Outpatient rapid MRI protocols facilitate same-day imaging, interpretation, and management, improving care for thoracic oncology pts with new concerning neurologic symptoms and reducing unnecessary ED visits. Future work will expand access beyond Thoracic Oncology and further quantify improvements in cost savings and patient quality of life.
47
Shoigu, Yulia S., Lydia N. Timofeeva, Natalia V. Tolubaeva, et al. "Features of providing emergency psychological aid to people experiencing loss in emergency situations." National Psychological Journal 41, no. 1 (2021): 115–26. http://dx.doi.org/10.11621/npj.2021.0110.
Full textAbstract:
Background. In many countries frontline emergency workers of different specialties face the need to inform people of their relatives’ death and to support them during the acute period following the message. The need for psychological training in this area is evident. However, the research in this area is not only complicated in terms of logistics, but also hindered by a number of ethical difficulties. The analysis presented in this paper has significant practical value and draws on the unique professional perspective of the EMERCOM emergency psychologists who provide psychological support to people experiencing loss in an acute period — relatives and loved ones of those who died in emergencies. Objective. To give an outline of approaches to psychological support in cases of loss, of the factors influencing adaptation to a loss, and of the opportunities for early psychological interventions. Design. The theoretical overview presents the analysis of foreign experience and main approaches to announcing the death of a relative. The following section describes and analyses the main approaches and practical experience of the EMERCOM psychologists. The conclusion outlines the possibilities of a systematic approach to providing emergency psychological aid in cases of loss. Results. The study presents a list of characteristics of support providers, recipients and situations that need to be taken into account when choosing a strategy of work with people experiencing a recent loss. Conclusion. The study allows to single out three main thematic blocks, the consideration of which is necessary when choosing a strategy for dealing with loss in an acute period. First, features of the situation; second, characteristics of the person experiencing loss; third, the characteristic of the support provider. The process of psychological support, as described in the paper, includes assessment and consideration of the objective characteristics of the situation, the recipient’s characteristics and response, and the characteristics of the specialist himself. The interpretation of relationship between these factors and their influence on the condition of the person who experiences a loss allows the psychologist to choose the most effective strategy for providing psychological support.
48
Lee, Seung Jae, Ji Hye Kim, Seung Baik Han, Jin Hui Paik, and Areum Durey. "Prognostic Factors Predicting Poor Outcome in Cancer Patients with Febrile Neutropenia in the Emergency Department: Usefulness of qSOFA." Journal of Oncology 2018 (October 11, 2018): 1–7. http://dx.doi.org/10.1155/2018/2183179.
Full textAbstract:
Background/Aims. Febrile neutropenia is considered as one of the most important and potentially life-threatening oncologic emergencies, which requires prompt medical assessment and treatment with antibiotics. This was a single-center retrospective study that investigated the prognostic factors predicting poor outcome in patients with cancer who presented with febrile neutropenia at the emergency department (ED). Methods. The medical records of patients diagnosed with febrile neutropenia in the ED from January 2014 to December 2017 were reviewed. Patients aged >18 years who were diagnosed with a malignancy were included in the analysis. Febrile neutropenia was defined as an absolute neutrophil count < 1,000/mm3 with a temperature greater than 38°C. Patients were divided into two groups: those who were admitted at the intensive care unit (ICU) or those who died in the hospital (case group) and those who were admitted at general wards and were discharged (control group). The two groups were compared to determine the factors associated with poor prognosis. Results. We identified 104 patients (25 and 79 from the case and control groups, respectively) with cancer who presented with febrile neutropenia at the ED during the study period. Lower blood pressure, platelet count, and HCO3- level, higher CRP and creatinine level, and the presence of bacteremia were more commonly observed in the case group than in the control group. In the multiple logistic regression analysis, the following independent predictors significantly correlated with ICU admission and in-hospital mortality: quick sequential (sepsis-related) organ failure assessment (qSOFA) score (odds ratio [OR]: 4.62; 95% confidence interval [CI]: 1.17–18.22; p=0.285), hemoglobin level (OR: 0.51; 95% CI: 0.33–0.78; p=0.002), total bilirubin level (OR: 7.69; 95% CI: 1.29–45.8; p=0.025), and respiratory tract infection (OR: 29.65; 95% CI: 3.81–230.7; p=0.0012). Conclusions. The qSOFA can be a useful bedside tool for patients with cancer who present with febrile neutropenia at the ED. Moreover, it can help emergency physicians in identifying patients at risk of poor prognosis and in initiating prompt empirical antimicrobial therapy. Further studies must be conducted to validate the efficacy of the qSOFA in these patients in the ED.
49
Bagnenko,, S. F., Yu S. Polushin, I. V. Shlyk, et al. "The Pavlov University experience in medical assistance for patients with the novel coronavirus infection: first results and lessons." Messenger of ANESTHESIOLOGY AND RESUSCITATION 18, no. 2 (2021): 7–16. http://dx.doi.org/10.21292/2078-5658-2021-18-2-7-16.
Full textAbstract:
The constant mutation of the virus and the complicated epidemiological situation in other countries keep the probability of a third wave of the pandemic in the Russian Federation fairly high. It is important to summarize the gained experience as fast as possible to use it appropriately once it is needed.The objective: to analyze the specific parameters of care for critically ill patients with the novel coronavirus infection in Pavlov Multidisciplinary Medical Center.Subjects and methods. This is a result-based report on the work performed by the Infection Center, which was deployed twice in Pavlov Multidisciplinary Medical Center (from 28.04.2020 to 03.08.2020 and from 01.11.2020 to 15.03.2021). Totally, 3,830 patients with SARS-CoV-2 were managed (1,680 patients during the first deployment and 2,150 patients during the second one). In the preparatory period, the operation of the emergency department based on the inpatient emergency medical department (EMD) had been simulated to clarify its staff structure and the procedure for admission, examination, and treatment of patients. Here we compare the organizational approaches during the first and second waves of the pandemic and present the characteristics of the demographic data of the treated patients, the incidence of certain complications, and outcomes.Results. The overall lethality in the Center made 6.2%. Despite the experience gained in the first wave, the results of treatment during the second wave (autumn-winter) did not improve (5.7% died in the first wave and 6.7% in the second one). Lethality in ICU and EMD was 40.0% and 49.6%, in ICU only – 38.5% and 46.9% respectively. A moderate lethality increase in ICU was due to the concentration of critically ill and most critically ill patients. There were 51.4% of patients with comorbidities and 53.5% were above 65 years of age. Refinement and differentiation of tasks performed by departments, simulation of the operation of the Center before opening made it possible to increase the throughput of the medical unit avoiding rush during admission and deterioration the quality of treatment.Conclusion. Certain aspects of the organization of medical care affect the performance of a multidisciplinary medical institution transformed into an infectious diseases hospital. The experience gained under such circumstances can be useful in other emergencies with a large number of victims and patients.
50
Learner, Michael, James Pickering, and Roy Wiles. "Diel emergence patterns of chironomids." Internationale Revue der gesamten Hydrobiologie und Hydrographie 75, no. 5 (1990): 569–81. http://dx.doi.org/10.1002/iroh.19900750501.
Full text