To see the other types of publications on this topic, follow the link: History of EMS.
Journal articles on the topic 'History of EMS'
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 'History of EMS.'
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
Yau, L., M. A. Mukarram, S. Kim, K. Arcot, K. Thavorn, M. Taljaard, M. Sivilotti, B. H. Rowe, and V. Thiruganasambandamoorthy. "LO31: Identification of high risk factors associated with 30 day serious adverse events among syncope patients transported to the emergency department by emergency medical services." CJEM 19, S1 (May 2017): S38. http://dx.doi.org/10.1017/cem.2017.93.
Full textAbstract:
Introduction: The majority of syncope patients transported to the emergency department (ED) by emergency medical services (EMS) are low-risk with very few suffering serious adverse events (SAE) within 30-days and over 50% are diagnosed with vasovagal syncope. These patients can potentially be diverted by EMS to alternate pathways of care (primary care or syncope clinic) if appropriately identified. We sought to identify high-risk factors associated with SAE within 30-days of ED disposition as a step towards developing an EMS clinical decision tool. Methods: We prospectively enrolled adult syncope patients who were transported to 5 academic EDs by EMS. We collected standardized variables at EMS presentation from history, clinical examination and investigations including ECG and ED disposition. We also collected concerning symptoms identified and EMS interventions. Adjudicated SAE included death, myocardial infarction, arrhythmia, structural heart disease, pulmonary embolism, hemorrhage and procedural interventions. Multivariable logistic regression was used for analysis. Results: 990 adult syncope patients (mean age 58.9 years, 54.9% females and 16.8% hospitalized) were enrolled with 137 (14.6%) patients suffering SAE within 30-days of ED disposition. Of 42 candidate predictors, we identified 5 predictors that were significantly associated with SAE on multivariable analysis: ECG abnormalities [OR=1.77; 95%CI 1.36-2.48] (non-sinus rhythm, high degree atrioventricular block, left bundle branch block, ST-T wave changes or Q waves), cardiac history [OR=2.87; 95%CI 1.86-4.41] (valvular or coronary heart disease, cardiomyopathy, congestive heart failure, arrhythmias or device insertions), EMS interventions or concerning symptoms [OR=4.88; 95%CI 3.13- 7.62], age >50 years [OR=3.18; 95%CI 1.68-6.02], any abnormal vital signs [OR=1.58; 95%CI 1.03-2.42] (any EMS systolic blood pressure >180 or <100 mmHg, heart rate <50 or >100/minute, respiratory rate >25/minute, oxygen saturation <91%). [C-statistic: 0.81; Hosmer Lemeshow p=0.30]. Conclusion: We identified high-risk factors that are associated with 30-day SAE among syncope patients transported to the ED by EMS. This will aid in the development of a clinical decision tool to identify low-risk patients for diversion to alternate pathways of care.
2
Yau, L., M. A. Mukarram, S. Kim, K. Arcot, K. Thavorn, M. Taljaard, M. Sivilotti, B. H. Rowe, and V. Thiruganasambandamoorthy. "LO083: Outcomes and resource utilization among syncope patients transported by emergency medical services." CJEM 18, S1 (May 2016): S58—S59. http://dx.doi.org/10.1017/cem.2016.120.
Full textAbstract:
Introduction: Syncope accounts for 1% of all annual emergency department (ED) visits in Canada with only 10.3% suffering serious adverse event (SAE) within 30-days. However, 66% are transported to ED by Emergency Medical Services (EMS). Our objectives were to assess 30 day SAE among syncope patients transported by Emergency medical services (EMS), assess the need to develop an EMS clinical decision aid, and estimate anticipated health care savings by diverting patients from the ED to alternative care pathways. Methods: We conducted a prospective cohort study at four tertiary care EDs from Feb 2012 to Feb 2013. We included patients ≥16 years of age with syncope and who arrived to the ED via EMS. We collected patient demographics, medical history, 30 day SAE, EMS time points (call received, EMS arrival on scene, EMS departure from scene, time of transfer of care in the ED), critical EMS interventions, and ED length of stay. We assessed for the occurrence of any SAE (death, arrhythmia, other cardiac and non-cardiac conditions) within 30 days of ED disposition. We used descriptive analysis, unpaired two-tailed t-test and chi-square test. Ethics approval was obtained at all study sites. Results: Of 1,475 ED patients with syncope during the study period, 992 (67.3%) arrived by EMS. Mean times (SD) for EMS arrival to the scene, patient assessment at the scene and transfer of patient from scene to the ED were 10.1 (6.4), 18.9 (8.3), and 14.6 (11.5) minutes respectively. Only two patients had critical interventions enroute (pacing and defibrillation). Overall 138 (13.9%) patients suffered a SAE; 32 (3.2%) detected by EMS, 58 (5.8%) detected during ED evaluation, 48 (4.8%) after ED disposition. The average ED length of stay was 5.9(4.2) hours. Based on average of cost from two sites, we estimated that total cost of transporting syncope patients from the scene to the ED to be $4 million in Canada. The total cost of ED care for syncope patients transported by EMS in Canada was calculated at $21.5 million. Conclusion: A substantial proportion of patients arriving to the ED via EMS suffer no SAE within 30 days. Correspondingly, our results suggest a need for an EMS clinical decision aid to divert low-risk syncope patients to alternative care pathways such as family physicians or rapid access clinics. If developed and implemented, this tool can potentially reduce EMS burden, ED crowding, and reduce healthcare costs.
3
Cain, James. "Unnatural History: Gender and Genealogy in Gerald of Wales's Topographia Hibernica." Essays in Medieval Studies 19, no. 1 (2002): 29–43. http://dx.doi.org/10.1353/ems.2003.0004.
Full text
4
Preum, Sarah Masud, Sile Shu, Homa Alemzadeh, and John A. Stankovic. "EMSContExt: EMS Protocol-Driven Concept Extraction for Cognitive Assistance in Emergency Response." Proceedings of the AAAI Conference on Artificial Intelligence 34, no. 08 (April 3, 2020): 13350–55. http://dx.doi.org/10.1609/aaai.v34i08.7048.
Full textAbstract:
This paper presents a technique for automated curation of a domain-specific knowledge base or lexicon for resource-constrained domains, such as Emergency Medical Services (EMS) and its application to real-time concept extraction and cognitive assistance in emergency response. The EMS responders often verbalize critical information describing the situations at an incident scene, including patients' physical condition and medical history. Automated extraction of EMS protocol-specific concepts from responders' speech data can facilitate cognitive support through the selection and execution of the proper EMS protocols for patient treatment. Although this task is similar to the traditional NLP task of concept extraction, the underlying application domain poses major challenges, including low training resources availability (e.g., no existing EMS ontology, lexicon, or annotated EMS corpus) and domain mismatch. Hence, we develop EMSContExt, a weakly-supervised concept extraction approach for EMS concepts. It utilizes different knowledge bases and a semantic concept model based on a corpus of over 9400 EMS narratives for lexicon expansion. The expanded EMS lexicon is then used to automatically extract critical EMS protocol-specific concepts from real-time EMS speech narratives. Our experimental results show that EMSContExt achieves 0.85 recall and 0.82 F1-score for EMS concept extraction and significantly outperforms MetaMap, a state-of-the-art medical concept extraction tool. We also demonstrate the application of EMSContExt to EMS protocol selection and execution and real-time recommendation of protocol-specific interventions to the EMS responders. Here, EMSContExt outperforms MetaMap with a 6% increase and six times speedup in weighted recall and execution time, respectively.
5
Long, Brit J., Luis A. Serrano, Jose G. Cabanas, and M. Fernanda Bellolio. "Opportunities for Emergency Medical Services (EMS) Care of Syncope." Prehospital and Disaster Medicine 31, no. 4 (May 23, 2016): 349–52. http://dx.doi.org/10.1017/s1049023x16000376.
Full textAbstract:
AbstractIntroductionEmergency Medical Service (EMS) systems are vital in the identification, assessment, and treatment of trauma, stroke, myocardial infarction, and sepsis patients, improving early recognition, resuscitation, and transport. Emergency Medical Service personnel provide similar care for patients with syncope. The role of EMS in the management of patients with syncope has not been reported.Hypothesis/ObjectiveThe objective of this study was to describe the management of out-of-hospital syncope by prehospital providers in an urban EMS system.MethodsThis was a retrospective cohort study of consecutively enrolled patients over 18 years of age, over a two-year period, who presented by EMS with syncope, or near-syncope, to a tertiary care emergency department (ED). Demographics included comorbidities, history, and physical exam findings documented by prehospital providers, as well as the interventions provided. Data were collected from standardized patient care records for descriptive analysis.ResultsOf the 723 patients presenting with syncope to the ED, 284 (39.3%) were transported by EMS. Compared to non-EMS patients, those who arrived by ambulance were older (mean age 65 [SD = 18.5] years versus 61 [SD = 19.2] years; P = .019). There were no statistically significant differences in cardiovascular comorbidities (hypertension, coronary artery disease, diabetes mellitus, stroke, or congestive heart failure) between EMS and non-EMS patients. The most common chief complaints were fainting (50.0%) and dizziness (44.7%). The most common intervention provided was cardiac monitoring (55.6%), followed by administration of normal saline infusion (50.5%), oxygen (41.9%), blood glucose check (41.5%), and electrocardiogram (EKG; 40.5%).ConclusionEmergency Medical Service personnel transport more than one-third of patients presenting to the ED with syncope. Documentation of key elements of the history (witnesses, prodrome, predisposing factors, and post-event symptoms) and physical examination were not recorded consistently.LongBJ, SerranoLA, CabanasJG, BellolioMF. Opportunities for Emergency Medical Services (EMS) care of syncope. Prehosp Disaster Med. 2016;31(4):349–352.
6
Poplas-Susic, Tonka, Zalika Klemenc-Ketis, Marija Komericki-Grzinic, and Janko Kersnik. "Glasgow coma scale in acute poisonings before and after use of antidote in patients with history of use of psychotropic agents." Srpski arhiv za celokupno lekarstvo 138, no. 3-4 (2010): 210–13. http://dx.doi.org/10.2298/sarh1004210p.
Full textAbstract:
Introduction. Data on emergency interventions in poisonings are scarce. Objective. To determine the effectiveness of antidote therapy in acute poisoning-related emergency medical services (EMS) interventions. Methods. A prospective observational study included all poisoning-related intervention cases over 3 years (1999-2001) in the Celje region, Slovenia, covering 125,000 inhabitants. Data were recorded on an EMS form. Results. Psychoactive agents were present in 56.5% out of 244 poisoning-related EMS interventions. Prescription drugs were a cause of intoxication in 93 (39.2%) cases alone or in combination with alcohol or illegal drugs. More than one fifth of poisonings were due to the use of illegal drugs in 52 (21.9%) cases, 43 (18.1%) out of them heroin related. At the time of EMS arrival, more patients who ingested illegal drugs were in coma or comatose than the rest. 24 (45.3%) vs. 32 (17.3%) of poisoned patients were in coma (p<0.001). Glasgow Coma Scale (GCS) at the first contact was lower in patients who ingested illegal drugs than in the remaining patients (9.0 vs. 11.6, p=0.001). In 23.2% of the cases, an antidote was administered. In 29 (12.2%) naloxone and in 16 (6.7%) flumazenil was administered. Mean GCS after intervention was higher in all cases but significantly higher in illegal drug cases, 13.4 vs. 12.2 (p=0.001), with a mean positive change in GCS of 4.5 vs. 0.6 (p<0.001). In illegal drug users, mean change after antidote administration was 8.2 vs. 0.5 without antidote administration (p<0.001). Conclusion. High rate of successful antidote use during the intervention indicated the importance of good EMS protocols and the presence of a skilled doctor in the EMS team.
7
Jones, Courtney M. C., Erin B. Wasserman, Timmy Li, Ashley Amidon, Marissa Abbott, and Manish N. Shah. "The Effect of Older Age on EMS Use for Transportation to an Emergency Department." Prehospital and Disaster Medicine 32, no. 3 (February 13, 2017): 261–68. http://dx.doi.org/10.1017/s1049023x17000036.
Full textAbstract:
AbstractIntroductionPrevious studies have found that older adults are more likely to use Emergency Medical Services (EMS) than younger adults, but the reasons for this remain understudied.Hypothesis/ProblemThis study aimed to determine if older age is associated with using EMS for transportation to an emergency department (ED) after controlling for confounding variables.MethodsA cross-sectional survey study was conducted at a large academic medical center. Data on previous medical history, chief complaint, self-perceived illness severity, demographic information, and mode of arrival to the ED were collected on all subjects. Those who arrived to the ED via EMS also were asked reasons why they opted to call an ambulance for their illness/injury. Descriptive statistics were used to quantify survey responses, and multivariable regression was used to assess the independent effect of age on mode of ED arrival.ResultsData from 1,058 subjects were analyzed, 449 (42%) of whom arrived to the ED via EMS. Compared to adults<55 years, the unadjusted prevalence ratio for the association between age and EMS use was 1.18 (95% CI, 0.96-1.45) for subjects 55-79 years and 1.54 (95% CI, 1.18-2.02) for subjects ≥80 years. After adjustment for confounding variables, age remained a statistically significant risk factor for EMS use (P<.05).ConclusionOlder age is an independent risk factor for transportation to the ED via ambulance; however, this effect is attenuated by number of chronic medical conditions and history of depression. Additional research is needed to account for confounders unmeasured in this study and to elucidate reasons for the increased frequency of EMS use among older adults.JonesCMC, WassermanEB, LiT, AmidonA, AbbottM, ShahMN. The effect of older age on EMS use for transportation to an emergency department. Prehosp Disaster Med. 2017;32(3):261–268.
8
Keightley, Peter D., and Ohmi Ohnishi. "EMS-Induced Polygenic Mutation Rates for Nine Quantitative Characters in Drosophila melanogaster." Genetics 148, no. 2 (February 1, 1998): 753–66. http://dx.doi.org/10.1093/genetics/148.2.753.
Full textAbstract:
Abstract Polygenic mutations were induced by treating Drosophila melanogaster adult males with 2.5 mm EMS. The treated second chromosomes, along with untreated controls, were then made homozygous, and five life history, two behavioral, and two morphological traits were measured. EMS mutagenesis led to reduced performance for life history traits. Changes in means and increments in genetic variance were relatively much higher for life history than for morphological traits, implying large differences in mutational target size. Maximum likelihood was used to estimate mutation rates and parameters of distributions of mutation effects, but parameters were strongly confounded with one another. Several traits showed evidence of leptokurtic distributions of effects and mean effects smaller than a few percent of trait means. Distributions of effects for all traits were strongly asymmetrical, and most mutations were deleterious. Correlations between life history mutation effects were positive. Mutation parameters for one generation of spontaneous mutation were predicted by scaling parameter estimates from the EMS experiment, extrapolated to the whole genome. Predicted mutational coefficients of variation were in good agreement with published estimates. Predicted changes in means were up to 0.14% or 0.6% for life history traits, depending on the model of scaling assumed.
9
Scherer, Tara M., Stephan Russ, Cathy A. Jenkins, Ian D. Jones, Corey M. Slovis, Brittany L. Cunningham, and Tyler W. Barrett. "Predictors of Ambulance Transport in Patients with ST-Elevation Myocardial Infarction." Prehospital and Disaster Medicine 27, no. 3 (June 2012): 226–30. http://dx.doi.org/10.1017/s1049023x12000696.
Full textAbstract:
AbstractIntroductionDespite intense public awareness campaigns, many patients with ST-elevation myocardial infarction (STEMI) do not utilize Emergency Medical Services (EMS) transportation to the Emergency Department (ED). Predictors for mode of transport by EMS versus private vehicle in patients with an acute STEMI were investigated.HypothesisIt was hypothesized that patient characteristics, specifically older age, male sex, and a history of a prior cardiac intervention, would be associated with a higher likelihood of EMS utilization.MethodsA retrospective, observational cohort study was performed for all STEMI patients treated from April 1, 2007 through June 30, 2010 at an urban, academic ED with 24-hour cardiac catheterization available. Multivariable analyses with predetermined predictors (age, sex, prior cardiac intervention, weekend/evening arrival) were performed to investigate associations with mode of transport. Door-to-balloon (D2B) times were calculated.ResultsOf the 209 STEMI patients, 11 were excluded, leaving 198 for analysis. Median age was 60 years (IQR: 53-70), 138 (70%) arrived by private vehicle, and 60 (30%) by EMS. The primary analysis did not identify significant predictors for EMS, but a post-hoc model found that private insurance (OR 0.18; 95% CI, 0.07-0.45) was associated with fewer EMS transports. Although not statistically significant due to the great variability in time of arrival for STEMI patients transported by private vehicle, EMS transports had shorter D2B times. During business hours and weekend/evenings, EMS had D2B times of 50 (IQR: 42-61) and 58 minutes (IQR: 47-63), respectively, while private vehicle transports had median D2B times of 62 (IQR: 50-74) and 78 minutes (IQR: 66-106).ConclusionNo associations between mode of transport and patient age, sex, weekend/evening presentation and history of a prior cardiac intervention were identified. Privately insured patients were less likely to use EMS when experiencing a STEMI. More effective ways are needed to educate the public on the importance of EMS activation when one is concerned for acute coronary syndrome.Scherer TM, Russ S, Jenkins CA, Jones ID, Slovis CM, Cunningham BL, Barrett TW. Predictors of ambulance transport in patients with ST-elevation myocardial infarction. Prehosp Disaster Med. 2012;27(3):1-5.
10
Brown, Lawrence H., John E. Gough, and Wickham Simonds. "17. Can EMS Providers Adequately Assess Trauma Patients for Spinal Injury?" Prehospital and Disaster Medicine 11, S2 (September 1996): S28. http://dx.doi.org/10.1017/s1049023x00045623.
Full textAbstract:
Hypothesis: Assessments to rule out cervical spine injury performed by emergency medical services (EMS) personnel correlate well with assessments performed by emergency department (ED) physicians. Methods: EMS providers completed a data form based on their initial assessment of all immobilized adult patients. Data collected included the presence or absence of: neck pain/tenderness; altered mental status; history of loss of consciousness; drug/alcohol use; neurological deficit; and other painful/distracting injury. Immobilization was considered to be indicated if any one of the six physical findings was present. The ED physician caring for the patient completed an identical data form based on his/her assessment. Physicians and EMS providers were blinded to each other's assessments. The amount of discordance between the physician and EMS assessments was analyzed using McNemar's Chi-Square for matched pairs.Results: Five-hundred-seventy-three patients were included in the study. Physician and EMS assessments matched in 78.7% (n = 451) of the cases. In 13.6% (n = 78) of the cases, the EMS assessment indicated immobilization, but the physician assessment did not. In 7.7% (n = 44) of the patients, the physician assessment indicated immobilization, but the EMS assessment did not. The discordance between assessments was statistically significant (p <0.001). The presence of neck pain or tenderness accounted for the most discordance.
11
Nagel, Eugene. "Perspectives of Emergency Medical Services (EMS)." Prehospital and Disaster Medicine 1, S1 (1985): 111–14. http://dx.doi.org/10.1017/s1049023x00044034.
Full textAbstract:
Many of the world leaders in emergency medicine and in disaster medicine systems have made advances in these fields, and I compliment them on the accomplishments that I have seen over the years. Dr. Safar charged me to look ahead, if that is possible, and offer some perspective—obviously my own—on the next five to ten years. Hopefully, our future can be controlled in certain limits. Toynbee philosophized that when new and unanticipated challenges are presented, they represent great opportunity for response. If we fail to respond or if we respond in an inappropriate way, we may become a fossil in history—in this case, in the history of medicine. I have attempted to look at important challenges that I see in emergency medicine, and to predict from these a course that I think represents a proper response.The first challenge, one that you have heard of before, clearly is the most important one. It is the challenge of limited or relative resources. The term “relative” means that fraction of a country's or region's output or wherewithall that is available in a logical or rational way for emergency medicine.
12
Huo, Xiangyu, Li Zhang, and Mingli Yang. "Equation of state for the detonation products of energetic materials." Materials Express 11, no. 8 (August 1, 2021): 1269–87. http://dx.doi.org/10.1166/mex.2021.2033.
Full textAbstract:
Energetic materials (EMs) are one of the necessities in many military and civilian applications. Measuring the thermodynamic behaviors of detonation products of EMs at high temperature and high pressure, their equations of state (EOSs) not only serve as a basis in the design of novel materials, but also provide valuable information for their practical applications. The EOS study has a long history, but keeps moving all the time. Various EMs have been developed, the EOS of detonation products provides abundant information in the thermochemistry, hydromechanics and detonation physics, which in turn feedbacks the development of novel EMs and their EOSs. With the development of experimental techniques and computer simulations, many EOSs have been proposed for various explosives in recent years. While experiments keep their fundamental roles, integrated theory-experiment study has become the main approach to the EOS establishment for novel EMs. Moreover, computer simulations based on interatomic and/or intermolecular interaction will have great potential in the future when big data and artificial intelligence are introduced into the field.
13
Tangherlini, Niels, Julian Villar, John Brown, Robert M. Rodriguez, Clement Yeh, Benjamin T. Friedman, and Paul Wada. "The HOME Team: Evaluating the Effect of an EMS-based Outreach Team to Decrease the Frequency of 911 Use Among High Utilizers of EMS." Prehospital and Disaster Medicine 31, no. 6 (September 19, 2016): 603–7. http://dx.doi.org/10.1017/s1049023x16000790.
Full textAbstract:
AbstractObjectivesThe San Francisco Fire Department’s (SFFD; San Francisco, California USA) Homeless Outreach and Medical Emergency (HOME) Team is the United States’ first Emergency Medical Services (EMS)-based outreach effort using a specially trained paramedic to redirect frequent users of EMS to other types of services. The effectiveness of this program at reducing repeat use of emergency services during the first seven months of the team’s existence was examined.MethodsA retrospective analysis of EMS use frequency and demographic characteristics of frequent users was conducted. Clients that used emergency services at least four times per month from March 2004 through May 2005 were contacted for intervention. Patterns for each frequent user before and after intervention were analyzed. Changes in EMS use during the 15-month study interval was the primary outcome measurement.ResultsA total of 59 clients were included. The target population had a median age of 55.1 years and was 68% male. Additionally, 38.0% of the target population was homeless, 43.4% had no primary care, 88.9% had a substance abuse disorder at time of contact, and 83.0% had a history of psychiatric disorder. The HOME Team undertook 320 distinct contacts with 65 frequent users during the study period. The average EMS use prior to HOME Team contact was 18.72 responses per month (SD=19.40), and after the first contact with the HOME Team, use dropped to 8.61 (SD=10.84), P<.001.ConclusionFrequent users of EMS suffer from disproportionate comorbidities, particularly substance abuse and psychiatric disorders. This population responds well to the intervention of a specially trained paramedic as measured by EMS usage.TangherliniN, VillarJ, BrownJ, RodriguezRM, YehC, FriedmanBT, WadaP. The HOME Team: evaluating the effect of an EMS-based outreach team to decrease the frequency of 911 use among high utilizers of EMS. Prehosp Disaster Med. 2016;31(6):603–607.
14
Johnston, Mark. "The Gilded Age and the Commodification of the Medieval: George Barrie's American Edition (1880) of Michaud's History of the Crusades." Essays in Medieval Studies 32, no. 1 (2016): 23–56. http://dx.doi.org/10.1353/ems.2016.0002.
Full text
15
Gu, Hong-Qiu, Zhen-Zhen Rao, Xin Yang, Chun-Juan Wang, Xing-Quan Zhao, Yi-Long Wang, Li-Ping Liu, et al. "Use of Emergency Medical Services and Timely Treatment Among Ischemic Stroke." Stroke 50, no. 4 (April 2019): 1013–16. http://dx.doi.org/10.1161/strokeaha.118.024232.
Full textAbstract:
Background and Purpose— Emergency medical services (EMSs) are critical for early treatment of patients with ischemic stroke, yet data on EMS utilization and its association with timely treatment in China are still limited. Methods— We examined data from the Chinese Stroke Center Alliance for patients with ischemic stroke from June 2015 to June 2018. Absolute standardized difference was used for covariates’ balance assessments. We used multivariable logistic models with the generalized estimating equations to account for intrahospital clustering in identifying demographic and clinical factors associated with EMS use as well as in evaluating the association of EMS use with timely treatment. Results— Of the 560 447 patients with ischemic stroke analyzed, only 69 841 (12.5%) were transported by EMS. Multivariable-adjusted results indicated that those with younger age, lower levels of education, less insurance coverage, lower income, lower stroke severity, hypertension, diabetes mellitus, and peripheral vascular disease were less likely to use EMS. However, a history of cardiovascular diseases was associated with increased EMS usage. Compared with self-transport, EMS transport was associated with significantly shorter onset-to-door time, door-to-needle time (if prenotification was sent), earlier arrival (adjusted odds ratio [95% CIs] were 2.07 [1.95–2.20] for onset-to-door time ≤2 hours, 2.32 [2.18–2.47] for onset-to-door time ≤3.5 hours), and more rapid treatment (2.96 [2.88–3.05] for IV-tPA [intravenous recombinant tissue-type plasminogen activator] in eligible patients, 1.70 [1.62–1.77] for treatment with IV-tPA by 3 hours if onset-to-door time ≤2 hours, and 1.76 [1.70–1.83] for treatment with IV-tPA by 4.5 hours if onset-to-door time ≤3.5 hours). Conclusions— Although EMS transportation is associated with substantial reductions in prehospital delay and improved likelihood of early arrival and timely treatment, rate of utilization is currently low among Chinese patients with ischemic stroke. Developing an efficient EMS system and promoting culture-adapted education efforts are necessary for improving EMS activation.
16
McGinn, Bernard. "Ordering the Times: The Theology of History in Augustine’s De civitate Dei and Joachim of Fiore’s Concordia Novi ac Veteris Testamenti." Essays in Medieval Studies 35, no. 1 (2021): 1–19. http://dx.doi.org/10.1353/ems.2021.0001.
Full text
17
Uusitalo, Jenna. "Scandinavian Legal Realism and the Challenge of Recognizing Emergency Medical Service as a Legal Norm." Bratislava Law Review 4, no. 2 (December 31, 2020): 129–46. http://dx.doi.org/10.46282/blr.2020.4.2.192.
Full textAbstract:
Emergency medical service (EMS) forms a sub-category of the internationally recognized right to health. However, despite the codification of the right to health in various human rights conventions which have been implemented in national legislation, EMS still seems to be regarded as an economic expense or a political decision rather than a legal norm or a human right. This paper evaluates the causes for such a misunderstanding, primarily through Scandinavian Legal Realism which emphasizes the social contextualization of law. Supplementary scholarly views, as well as a history of human rights, are also applied to support the main arguments. Essentially, the paper claims that the challenge of recognizing EMS as a legal norm is associated with the relatively abstract and impersonalized nature of emergency care.
18
McIsaac, Sarah, Randy S. Wax, Brit Long, Christopher Hicks, Christian Vaillancourt, Robert Ohle, and Paul Atkinson. "Just the Facts: Protected code blue – Cardiopulmonary resuscitation in the emergency department during the coronavirus disease 2019 pandemic." CJEM 22, no. 4 (April 24, 2020): 431–34. http://dx.doi.org/10.1017/cem.2020.379.
Full textAbstract:
Emergency medical services (EMS) is called for a 65-year-old man with a 1-week history of cough, fever, and mild shortness of breath now reporting chest pain. Vitals on scene were HR 110, BP 135/90, SpO2 88% on room air. EMS arrives at the emergency department (ED). As the patient is moved to a negative pressure room, he becomes unresponsive with no palpable pulse. What next steps should be discussed in order to protect the team and achieve the best possible patient outcome?
19
Keightley, Peter D., Esther K. Davies, Andrew D. Peters, and Ruth G. Shaw. "Properties of Ethylmethane Sulfonate-Induced Mutations Affecting Life-History Traits in Caenorhabditis elegans and Inferences About Bivariate Distributions of Mutation Effects." Genetics 156, no. 1 (September 1, 2000): 143–54. http://dx.doi.org/10.1093/genetics/156.1.143.
Full textAbstract:
Abstract The homozygous effects of ethylmethane sulfonate (EMS)-induced mutations in Caenorhabditis elegans are compared across life-history traits. Mutagenesis has a greater effect on early than late reproductive output, since EMS-induced mutations tend to cause delayed reproduction. Mutagenesis changes the mean and variance of longevity much less than reproductive output traits. Mutations that increase total or early productivity are not detected, but the net effect of mutations is to increase and decrease late productivity to approximately equal extents. Although most mutations decrease longevity, a mutant line with increased longevity was found. A flattening of mortality curves with age is noted, particularly in EMS lines. We infer that less than one-tenth of mutations that have fitness effects in natural conditions are detected in the laboratory, and such mutations have moderately large effects (~20% of the mean). Mutational correlations for life-history traits are strong and positive. Correlations between early or late productivity and longevity are of similar magnitude. We develop a maximum-likelihood procedure to infer bivariate distributions of mutation effects. We show that strong mutation-induced genetic correlations do not necessarily imply strong directional correlations between mutational effects, since correlation is also generated by lines carrying different numbers of mutations.
20
Gordon, D. L., and R. A. Cowley. "Educating for the Future of Emergency Medical Services Systems." Prehospital and Disaster Medicine 2, no. 1-4 (1986): 171–74. http://dx.doi.org/10.1017/s1049023x00030739.
Full textAbstract:
A bachelor's degree in EMS management was the initial course of studies in an academic program designed to prepare people to work in a variety of occupations in EMS.This paper includes a brief history of that program, its purposes, goals and curriculum and the first data on follow up of its graduates.In the United States of America, the Emergency Medical Systems (EMS) act of 1973 stimulated people from a variety of fields and backgrounds to work together to develop and manage emergency systems of care; it also raised the question of how to prepare people to meet the future needs of the system. At that time, and with few exceptions, there was little or no academic involvement directed to the concept of the system of EMS and there was a dearth of persons with predictable knowledge and skills in this area. The apparent need for preparing leadership personnel for EMS became the focus of thinking by the Maryland Institute of Emergency Medical Services Systems (MIEMSS) and the University of Maryland, Baltimore County (UMBC).
21
Prasad A., Rajhans, Kulkarni Priya Y., Kelkar Dhananjay S., Jog Sameer A., Ranade Gouri, Utpat Sonal, and Hande Varsha. "Clinico-social parameters of diabetes among patientsutilizing emergency medical services." International Journal of Research in Medical Sciences 5, no. 1 (December 19, 2016): 219. http://dx.doi.org/10.18203/2320-6012.ijrms20164553.
Full textAbstract:
Background: Diabetes mellitus (DM) is increasing in its potential in developing countries. Rise in diabetic patients calling emergency medical services (EMS) is expected. It calls for thorough assessment of patients with DM utilizing EMS. In the present study, was to assess magnitude of DM among patients utilizing EMS and its clinico-social parameters.Methods: It was hospital record based observational study of patients calling EMS delivered by a tertiary care hospital in Pune, Maharashtra, India during 1st January 2013 to 31st December 2014. Patients with incomplete records were excluded. A person with medical background was trained to extract required information from hospital records. Patients with previously diagnosed DM were considered those who were on diet, oral hypoglycemic agents or taking insulin therapy and newly diagnosed patients with DM were considered those with the value of glycemia on admission >200 mg/dl in first 24 hours. Data analysis was done using SPSS 15.0 software.Results: 45.8% (894/1951) were Patients with DM out of that 78.19% (699/894) were known to have DM while 28.81% (195/1951) were new cases of DM. 5.1% (100/1951) patients had uncontrolled DM. DM was significantly more in >60 years age group and in urban residents (p<0.001). Patients with DM were significantly more to have breathlessness, altered sensorium and dyspnoea as major purpose to call EMS (p<0.001, <0.001 and 0.045 respectively). Other co-morbidities in the form of Hypertension, other cardiovascular abnormalities, COPD, CKD and history of CVA were significantly more among Patients with DM (p<0.001, except for COPD, p=0.027).Conclusions: There was a high burden of patients with DM on EMS. EMS teams should be well trained to diagnose and manage such emergencies. Mass awareness of screening for DM and its proper management will help to decrease such burden.
22
Freese, John, Neal J. Richmand, Robert A. Silverman, James Braun, Bradley J. Kaufman, and John Clair. "Impact of Citywide Blackout on an Urban Emergency Medical Services System." Prehospital and Disaster Medicine 21, no. 6 (December 2006): 372–78. http://dx.doi.org/10.1017/s1049023x00004064.
Full textAbstract:
AbstractIntroduction:On 14 August 2003, New York City and a large portion of the northeastern United States experienced the largest blackout in the history of the country. An analysis of such a widespread disaster on emergency medical service (EMS) operations may assist in planning for and managing such disasters in the future.Methods:A retrospective review of all EMS activity within New York City's 9-1-1 emergency telephone system during the 29 hours during which all or parts of the city were without power (16:11 hours (h) on 14 August 2003 until 21:03 h on 15 August 2003) was performed. Control periods were established utilizing identical time periods during the five weeks preceding the blackout.Results:Significant increases were identified in the overall EMS demand (7,844 incidents vs. 3,860 incidents; p<0.001) as well as in 20 of the 62 calltypes of the system, including ca rd i ac arrests (119 vs.76, p= 0.043).Significant decreases were found only among calls related to psychological emergencies (114 vs. 221; p= 0.006) and drugor alcohol-related emergencies (78 vs. 146; p = 0.009). Though median response times increased by only 60 seconds, median call-processing times within the 9-1-1 emergency telephone system EMS dispatch center of the city increased from 1.1 to 5.5 minutes.Conclusions:The citywide blackout resulted in dramatic changes in the demands upon the EMS system of New York City, the types of patients for whom EMS providers were assigned to provide care, and the dispositions for those assignments. During this time of increased, system-wide demand, the use of cross-trained firefighter and first-responder engine companies resulted in improved response times to cardiac arrest patients. Finally, the ability of the EMS dispatch center to process the increased requests for EMS assistance proved to be the rate-limiting step in responding to these emergencies.These findings will prove useful in planning for future blackouts or any disaster that may broadly impact the infrastructure of a city.
23
Biggers, William A., Brian S. Zachariah, and Paul E. Pepe. "Emergency Medical Vehicle Collisions in an Urban System." Prehospital and Disaster Medicine 11, no. 3 (September 1996): 195–201. http://dx.doi.org/10.1017/s1049023x00042941.
Full textAbstract:
AbstractIntroduction:Emergency medical services collisions (EMVCs) are a largely unexplored area of emergency medical services (EMS) research. Factors that might contribute to an EMVC are numerous and include use of warning lights and siren (WL&S). Few of these factors have been evaluated scientifically. Similarly, the incidence and severity of EMVCs is poorly documented in the literature. This study sought to define the incidence and severity of, and where possible, identify any contributing factors to EMVCs in a large urban system.Methods:Retrospective study of all collisions involving vehicles assigned to the EMS Division of the Houston Fire Department in calendar year 1993. Fifty-one ambulances were operational 24 hours per day during calendar year 1993. Houston EMS received 150,000 requests for assistance, made 180,000 vehicular responses, and accrued 2,651,760 miles in 1993.Results:Eighty-six EMVCs were identified during the study period. The gross incidence rate was therefore 3.2 EMVC/100,000 miles driven or 4.8 collisions/10,000 responses. Of the 86 EMVCs, 74 (86%) files were complete and available for evaluation. Major collisions, determined according to injuries or vehicular damage, accounted for 10.8% of all EMVCs. There were 17 persons transported to hospitals from EMS collisions, yielding an injury incidence of 0.64 injuries/100,000 miles driven or 0.94 injuries/10,000 responses. There were no fatalities. The majority of collisions (85.1%) occurred at some site other than an intersection. There was no statistical association between occurrence at an intersection and severity, day versus night, weekend versus weekday, presence or absence of precipitation, or use of WL&S versus severity of collision. Drivers with a history of previous EMVCs were involved in 33% of all collisions. The presence of prior EMVCs was associated (p < 0.001) with the number of persons transported from the collision to a local hospital. Five drivers, all with previous EMVCs, accounted for 88.2% (15/17) of all injuries.Conclusions:A few drivers with previous EMVCs account for a disproportionate number of EMVCs and nearly 90% of all injuries. This risk factor—history of previous EMVC—has not been reported in the EMS literature. It is postulated that this factor ultimately will prove to be the major determinant of EMVCs. Data collection of EMS collisions needs to be standardized and a proposed collection tool is provided.
24
Yang, Hsiao-Pei, Ana Y. Tanikawa, Wayne A. Van Voorhies, Joana C. Silva, and Alexey S. Kondrashov. "Whole-Genome Effects of Ethyl Methanesulfonate-Induced Mutation on Nine Quantitative Traits in Outbred Drosophila melanogaster." Genetics 157, no. 3 (March 1, 2001): 1257–65. http://dx.doi.org/10.1093/genetics/157.3.1257.
Full textAbstract:
Abstract We induced mutations in Drosophila melanogaster males by treating them with 21.2 mm ethyl methanesulfonate (EMS). Nine quantitative traits (developmental time, viability, fecundity, longevity, metabolic rate, motility, body weight, and abdominal and sternopleural bristle numbers) were measured in outbred heterozygous F3 (viability) or F2 (all other traits) offspring from the treated males. The mean values of the first four traits, which are all directly related to the life history, were substantially affected by EMS mutagenesis: the developmental time increased while viability, fecundity, and longevity declined. In contrast, the mean values of the other five traits were not significantly affected. Rates of recessive X-linked lethals and of recessive mutations at several loci affecting eye color imply that our EMS treatment was equivalent to ∼100 generations of spontaneous mutation. If so, our data imply that one generation of spontaneous mutation increases the developmental time by 0.09% at 20° and by 0.04% at 25°, and reduces viability under harsh conditions, fecundity, and longevity by 1.35, 0.21, and 0.08%, respectively. Comparison of flies with none, one, and two grandfathers (or greatgrandfathers, in the case of viability) treated with EMS did not reveal any significant epistasis among the induced mutations.
25
Kurilin, Sergey P., Andrey M. Sokolov, and Nikolai N. Prokimnov. "A computer program for electromechanical system operational diagnostics based on the topological approach." Journal Of Applied Informatics 16, no. 4 (August 31, 2021): 62–73. http://dx.doi.org/10.37791/2687-0649-2021-16-4-62-73.
Full textAbstract:
The paper presents a method, a mathematical model, and a computer program for the operational diagnostics of an electromechanical system (EMS). During EMS operation, service aging changes the properties of the parametric matrices of the windings and, as a consequence, the characteristics of the EMS vector space. Periodic testing of the vector space offers relevant and reliable data on the current health of the EMS, its changes during operation, and the risk of loss of function. The object of the study is an asynchronous electric motor (AEM). It is urgent to automate the process of assessing the current health of an AEM and to organize the storage of information on its states at different stages of its life cycle. To solve the problem, software (SW) for accumulation of information on AEM operation and for evaluation of its basic performance metrics has been developed in the Python programming language. The SW is based on the topological approach to diagnostics, which implies the analysis of the current responses of motor rotor windings to phase voltage pulses. The SW enables one to determine the rate of the service aging of an item, the probability of its survival and residual life, to obtain access to the history of previous diagnostics, and to visualize the in-service history of the above-mentioned performance metrics. The developed SW can be used to increase the AEM operation efficiency and to plan engineering or repair work; it can also be used as an information source for re- engineering and modification of existing AEMs. The described SW can be extended to perform operational diagnostics based on the topological approach of devices of various types. Also, this SW can be considered as a separate information component of the digital twin of a complex EMS, which will allow us to study the main indicators of its reliability, fault tolerance and operational efficiency at all stages of the life cycle.
26
Semmlack, Saskia, Désirée Yeginsoy, Rainer Spiegel, Kai Tisljar, Stephan Rüegg, Stephan Marsch, and Raoul Sutter. "Emergency response to out-of-hospital status epilepticus." Neurology 89, no. 4 (June 28, 2017): 376–84. http://dx.doi.org/10.1212/wnl.0000000000004147.
Full textAbstract:
Objective:To determine the implications of first responses of emergency medical services (EMS) to out-of-hospital status epilepticus (SE) on outcome.Methods:From 2005 to 2014, prehospital and in-hospital data were assessed in consecutive adults admitted to an academic medical center with out-of-hospital SE. Logistic regression was performed to identify variables with a robust association between missed epileptic events by the EMS and no recovery to functional baseline in survivors.Results:Among 213 SE patients, 150 were admitted via EMS. While nonconvulsive SE (NCSE) was missed by the EMS in 63.7%, convulsive SE (CSE) was not missed except in 4 patients with transformation into subtle SE. Missed NCSE was more likely with older age (odds ratio [OR]per year 1.06, 95% confidence interval [CI] 1.02–1.10, p = 0.003) and no seizure history (OR 6.64, 95% CI 2.43–18.1, p < 0.001). The area under the receiver operating characteristic curve for prediction of missed NCSE by these variables was 0.839. Independent predictors for not receiving benzodiazepines were increasing age (ORper year 1.05, 95% CI 1.01–1.08, p = 0.008) and higher Glasgow Coma Scale score (ORper increasing unit 1.21, 95% CI 1.09–1.36, p = 0.001). Missed NCSE was independently associated with increased odds for no return to functional baseline in survivors (OR 3.83, 95% CI 1.22–11.98, p = 0.021).Conclusions:Among patients admitted with out-of-hospital SE, CSE is mostly recognized while NCSE is frequently missed especially in patients with increasing age and no seizure history. This calls for heightened awareness for out-of-hospital NCSE in such patients, as missed NCSE is associated with lack of treatment and less recovery to functional baseline in survivors independent of established outcome predictors.
27
Schober, Patrick, Sebastiaan M. Bossers, and Lothar A. Schwarte. "Intracranial Hematoma Detection by Near Infrared Spectroscopy in a Helicopter Emergency Medical Service: Practical Experience." BioMed Research International 2017 (2017): 1–6. http://dx.doi.org/10.1155/2017/1846830.
Full textAbstract:
In (helicopter) emergency medical services, (H)EMS, the prehospital detection of intracranial hematomas should improve patient care and the triage to specialized neurosurgical hospitals. Recently, noninvasive detection of intracranial hematomas became possible by applying transcranial near infrared spectroscopy (NIRS). Herein, second-generation devices are currently available, for example, the Infrascanner 2000 (Infrascan), that appear suited also for prehospital (H)EMS applications. Since (H)EMS operations are time-critical, we studied the Infrascanner 2000 as a “first-time-right” monitor in healthy volunteers (n=17, hospital employees, no neurologic history). Further, we studied the implementation of the Infrascanner 2000 in a European HEMS organization (Lifeliner 1, Amsterdam, The Netherlands). The principal results of our study were as follows: The screening for intracranial hematomas in healthy volunteers with first-time-right intention resulted in a marked rate of virtual hematomas (false positive results, i.e., 12/17), rendering more time consuming repeat measurements advisable. The results of the implementation of the Infrascanner in HEMS suggest that NIRS-based intracranial hematoma detection is feasible in the HEMS setting. However, some drawbacks exist and their possible solutions are discussed. Future studies will have to demonstrate how NIRS-based intracranial hematoma detection will improve prehospital decision making in (H)EMS and ultimately patient outcome.
28
Кишенкова, О., and O. Kishenkova. "To the Question of Evolution and Current State of Teaching History of Regions in the Context of History of Russia." Profession-Oriented School 6, no. 4 (September 26, 2018): 33–40. http://dx.doi.org/10.12737/article_5b9a1c23d4b947.49646792.
Full textAbstract:
The article considers the question of formation and development of teaching regional history. The main development stages of regional educational and methodical sets (EMS) have been allocated, which are caused by adoption of the normative documents defi ning the purposes and the maintenance of school education:The mandatory minimum content of basic general and complete secondary education in 1998/1999; State Education Standard 2004, Federal State Educational Standard of Basic General Education (it is put into operation with 9/1/2013); Federal state educational standard of secondary general education (it is put into operation with 9/1/2014); Historical and Cultural Standard of 2013. The article describes the characteristics of regionalEMS, the problems of their further development.
29
Stewart, Ronald D. "Introduction to Emergency Medical Services (EMS) Organization." Prehospital and Disaster Medicine 1, S1 (1985): 109–10. http://dx.doi.org/10.1017/s1049023x00044022.
Full textAbstract:
Experience and history have taught us that much can be done for the sick and injured before such patients reach the hospital. From the legacy of the Good Samaritan to the modern day organization of emergency medical services, the immediate care of those stricken has undergone significant change in both philosophy and practice. While many prehospital care organizations with roots established deeply in the past still flourish, modern emergency care, in the new world at least, has developed rapidly only over the past ten years.In the United States, a concerted effort to improve the care of the wounded during the Civil War led to the introduction of the “flying ambulances” used earlier by Napoleon's Chief Surgeon, Larrey. Americans made significant contributions to acute care with the work of such noted men as Crile, with his form of external pneumatic counterpressure; Kouwenhoven, Knickerbocker and Jude at lohns Hopkins; Beck and the first reported defibrillation in a patient; Safar and his co-workers with the rediscovery of mouth-to-mouth; and many others.
30
Brown, D. R., A. Carter, J. Goldstein, J. Jensen, A. Travers, T. Dobson, and P. Cosgrove. "P016: Evaluating the impact of a novel mobile care team (MCT) on the prevalence of ambulatory care sensitive conditions presenting to emergency medical services in Nova Scotia." CJEM 18, S1 (May 2016): S83. http://dx.doi.org/10.1017/cem.2016.192.
Full textAbstract:
Introduction: Hospitalization due to ambulatory care sensitive conditions (ACSC) is a proxy measure for access to primary care. Emergency medical services (EMS) are increasingly called when primary care cannot be accessed. A novel paramedic-nurse EMS Mobile Care Team (MCT) was implemented in an under-serviced community. The MCT responds in a non-transport unit to bookings from EMS, emergency and primary care and to low-acuity 911 calls in a defined geographic region. Our objective was to compare the prevalence of ACSC in ground ambulance (GA) responses before and after the introduction of the MCT. Methods: A cross-sectional analysis of GA and MCT patients with ACSC (determined by chief complaint, clinical impression, treatment protocol and medical history) one year pre- and one year post-MCT implementation was conducted for the period Oct. 1, 2012 to Sept. 30, 2014. Demographics were described. Predictors of ACSC were identified via logistic regression. Prevalence was compared with chi-squared analysis. Results: There were 975 calls pre- and 1208 GA/95 MCT calls post-MCT. ACSC in GA patients pre- and post-MCT was similar: n=122, 12.5% vs. n=185, 15.3%; p=0.06. ACSC in patients seen by EMS (GA plus MCT) increased in the post-period: 122 (12.5%) vs. 204 (15.7%) p=0.04. Pre vs post, GA calls differed by sex (p=0.007) but not age (65.38 ± 15.12 vs. 62.51 ± 20.48; p=0.16). Post-MCT, prevalence of specific ACSC increased for GA: hypertension (p<0.001) and congestive heart failure (p=0.04). MCT patients with ACSC were less likely to have a primary care provider compared to GA (90.2% and 87.6% vs. 63.2%; p=0.003, p=0.004). Conclusion: The prevalence of ACSC did not decrease for GA with the introduction of the MCT, but ACSC in the overall patient population served by EMS increased. It is possible more patients with ACSC call or are referred to EMS for the new MCT service. Given that MCT patients were less likely to have a primary care provider this may represent an increase in access to care, or a shift away from other emergency/episodic care. These associations must be further studied to inform the ideal utility of adding such services to EMS and healthcare systems.
31
Varnaseri, Helena, Tony Lavender, and Lona Lockerbie. "An investigation of the mediating factors in the relationship between early childhood adversity and borderline personality characteristics in forensic inpatients." Journal of Forensic Practice 18, no. 1 (February 8, 2016): 17–30. http://dx.doi.org/10.1108/jfp-02-2015-0016.
Full textAbstract:
Purpose – The purpose of this paper is to investigate whether early maladaptive schema (EMS) and autobiographical memory specificity mediate the relationship between abuse and attachment in childhood with Borderline Personality Disorder (BPD) characteristics among forensic inpatients. Design/methodology/approach – The study adopted a quantitative cross-sectional design. In total, 34 male adults residing in medium secure facilities completed self-report measures. Data were analysed using bootstrapped mediation procedures. Findings – The study’s hypotheses received partial support. The EMS of “entitlement/grandiosity” and autobiographical memory specificity differentially mediated the relationship between emotional and physical abuse and neglect, and parental care and overprotection with BPD characteristics, including trait anger and the frequent expression of anger. In line with attachment theory and the functional avoidance mechanism (Williams et al., 2007), the proposed mediators are conceptualised as adaptive responses to early adversity with potential maladaptive consequences for later interpersonal functioning. Research limitations/implications – These provisional findings will require further exploration with specific investigation of the relationship between EMS and autobiographical memory specificity. It is recommended that future research replicates the study’s design with a larger sample and investigate the role of other mediators and moderators in this complex relationship. Examples of these are mentalisation, social problem-solving capabilities, social support and adult attachment styles. Practical implications – Clinical implications encourage the incorporation of these mediators into clinical formulation, intervention and ward practices. Originality/value – For forensic inpatients with a history of adversity, interventions working directly with EMS and specificity of autobiographical memory, e.g. schema therapy (Young, 1999), mentalisation and mindfulness may be useful. Furthermore, the relationship between EMS and specificity of autobiographical memory with interpersonal experience and functioning can be incorporated into clinical formulation.
32
Kim, S., O. Cook, L. Yau, M. A. Mukarram, K. Arcot, A. Ishimwe, K. Thavorn, et al. "MP27: Costs of emergency syncope care in Canada." CJEM 19, S1 (May 2017): S74. http://dx.doi.org/10.1017/cem.2017.193.
Full textAbstract:
Introduction: Syncope is a common emergency department (ED) presentation and constitutes 1% of all ED visits, approximately 160,000 visits annually across Canada. Lack of standardized syncope care has economic and cost implications. Currently, emergency medical services (EMS) is over utilized, variations in ED management exist and a substantial proportion (46.5%) are hospitalized for cardiac monitoring. Our previous studies have proposed ways to reduce health care utilization through development of EMS clinical decision tool, ED risk scores and remote cardiac monitoring. We sought to: 1) Estimate costs associated with syncope care in the pre-hospital, ED and inpatient settings; and 2) Determine potential cost savings if the proposed alternate strategies were adopted. Methods: A prospective cohort study was conducted in five Canadian EDs from 2010-2014. We enrolled adult (≥16 years) syncope patients and excluded those with prolonged loss of consciousness, mental status changes, seizure, significant trauma, or alcohol/illicit drug abuse. Demographics, medical history, mode of arrival, EMS time points, reasons for hospitalization, ED and inpatient length of stay, final ED diagnosis and any serious adverse event within 30 days of index visit were collected. Descriptive and inferential statistics were used. Results: Out of 4,064 patients enrolled, 67.3% were transported to the ED by EMS and the average cost per event was $262.78 (range at study sites: $156.43-$553.03). The average cost per ED visit was $267.98 (range: $174.66-$374.95). 12.9% of the patients were admitted and the average of cost per admission was $9,886.15 (range: $9,715.23-$10,277.98). Syncope is associated with an estimated total annual cost of $257 million. In Canada, we estimate that diverting low-risk patients will save $5 million in the pre-hospital setting and $15 million in the ED annually, and implementing a remote cardiac monitoring strategy will save $50 million annually. Conclusion: It is estimated that the proposed strategies will save $70 million annually. This is likely an underestimation as cost savings due to reduction in investigations related to diversion of ED patients, reduction in ED length of stay and hospitalization are unaccounted. Adoption of similar strategies will likely lead to significantly higher cost savings in countries with higher resource utilization for syncope management.
33
Slavin, Sabreena J., Heidi Sucharew, Kathleen Alwell, Charles J. Moomaw, Daniel Woo, Opeolu Adeoye, Matthew L. Flaherty, et al. "Prehospital neurological deterioration in stroke." Emergency Medicine Journal 35, no. 8 (April 27, 2018): 507–10. http://dx.doi.org/10.1136/emermed-2017-207265.
Full textAbstract:
Background and purposePatients with stroke can experience neurological deterioration in the prehospital setting. We evaluated patients with stroke to determine factors associated with prehospital neurological deterioration (PND).MethodsAmong the Greater Cincinnati/Northern Kentucky region (population ~1.3 million), we screened all 15 local hospitals’ admissions from 2010 for acute stroke and included patients aged ≥20. The GCS was compared between emergency medical services (EMS) arrival and hospital arrival, with decrease ≥2 points considered PND. Data obtained retrospectively included demographics, medical history and medication use, stroke subtype (eg, ischaemic stroke (IS), intracerebral haemorrhage (ICH), subarachnoid haemorrhage (SAH)) and IS subtype (eg, small vessel, large vessel, cardioembolic), seizure at onset, time intervals between symptom onset, EMS arrival and hospital arrival, EMS level of training, and blood pressure and serum glucose on EMS arrival.ResultsOf 2708 total patients who had a stroke, 1092 patients (median (IQR) age 74 (61–83) years; 56% women; 21% black) were analysed. PND occurred in 129 cases (12%), including 9% of IS, 24% of ICH and 16% of SAH. In multivariable analysis, black race, atrial fibrillation, haemorrhagic subtype and ALS level of transport were associated with PND.ConclusionHaemorrhage and atrial fibrillation is associated with PND in stroke, and further investigation is needed to establish whether PND can be predicted. Further studies are also needed to assess whether preferential transport of patients with deterioration to hospitals equipped with higher levels of care is beneficial, identify why race is associated with deterioration and to test therapies targeting PND.
34
Fedorova, Anastasiia. "CHANGES IN THE SEMANTICS OF LEGAL LEXIS IN THE INDO-EUROPEAN LANGUAGES (based on the materials, retrieved from the thesis paper “Formation of the legal terminological semantics in the Indo-European languages”)." Naukovy Visnyk of South Ukrainian National Pedagogical University named after K. D. Ushynsky: Linguistic Sciences 2019, no. 29 (November 2019): 272–91. http://dx.doi.org/10.24195/2616-5317-2019-29-19.
Full textAbstract:
The history of legal lexis dates back to the ancient times of ancient peoples. The study of legal language enables the reconstruction of Indo-European ritual-legal ancients at verbal, linguistic levels. Archaic societies had no legal culture, instead, the norms of customary law of ancient societies were referred to as “pre-law”, which included syncretism of law, religion, myth, poetry, and morality. The syncretic ritual and legal consciousness of the ancient peoples in the pre-state period and in the early state formations has its specific reflection in a language that receives such a definition as “the language of law”. The system of “language of law” of Indo-European peoples is partly outlined in today’s scientific survey by describing changes in the semantics of legal lexis in the Indo-European languages, based on the analysis of the distinguished evolutionary models of semantics (EMS) in the Germanic, Slavonic and Iranian languages. The evolutionary model of semantics is a method of inquiry and a procedural scheme for explaining the history of legal meaning. 79 EMS were distinguished during the research, showing the genesis of the meaning 'power', 'lord', 'to rule', 'law', '(religious) law', 'pledge', '(blood) feud', 'court', 'judge'. Using data of the distinguished EMS, that clearly shows the change in the semantic volume of a word, a specific type of change in the meaning of legal lexis in the lexical and semantic system of the Indo-European languages was identified for each EMS, namely, expanding, narrowing (specializing), amelioration or pejoration of the meaning of the word. The study found that quantitatively the semantic derivation of the Indo-European legal terminology most experienced the type of narrowing of the meaning of the word, which, according to the researchers, belongs to the semantic universals. Metaphorical and metonymic changes in the meaning in the legal lexis of the Indo-European languages were also highlighted, that will need further study.
35
Michelson, Edward A., and Kenneth S. Pearlman. "84. Over-Utilization of Prehospital Rapid Blood Glucose Measurements." Prehospital and Disaster Medicine 11, S2 (September 1996): S48. http://dx.doi.org/10.1017/s1049023x0004601x.
Full textAbstract:
Purpose: Determination of rapid blood glucose (RGB) by colorimetric stick test aids in the prehospital identification and treatment of hypoglycemia. The test may be applied unnecessarily to patients not at risk for, and in clinical situations not associated with hypoglycemia. We attempted to estimate the rate of over-utilization of RGB in a large urban EMS setting.Methods: All run sheets during a one week period from 7 sites providing radio command to both city and private EMS units serving a large urban population were screened. Those runs including RGB determination were further classified for presence or absence of a test indication. RGB was considered indicated with history or finding of: altered mental status, decreased level of consciousness, seizure, syncope and near syncope, generalized weakness or dizziness, with or without a history of diabetes.Results: 613 RGB determinations were identified during one week (annual rate = 31,876). 371 (61%) met indication criteria for test performance, and 242 (39%) failed to meet criteria. The patient complaint in cases not meeting criteria included; cardiac - 80, respiratory distress - 66, trauma - 38, abdominal pain -15, burns - 12, OB - 8, CVA - 6. Moreover, among these patients fewer than half had a history of diabetes. If this rate of over-utilization were maintained for one year, in excess of 12,500 extra tests would be performed in this system.
36
Sweeney, Thomas A., Jeffrey W. Runge, Michael A. Gibbs, Janet M. Carter, Robert W. Schafermeyer, and James A. Norton. "16. First Responder Defibrillation Does Not Increase Survival from Sudden Cardiac Death in a Two-Tiered Urban-Suburban EMS System." Prehospital and Disaster Medicine 11, S2 (September 1996): S28. http://dx.doi.org/10.1017/s1049023x00045611.
Full textAbstract:
Purpose: The use of automatic external defibrillators (AED) by emergency medical service (EMS) first responders (FR) is widely advocated based largely on reports from one metropolitan area, but widespread impact on survival remains unproven. We hypothesized that the addition of AEDs to an EMS system with short FR and prolonged paramedic response times (4 vs. 10 minutes) would improve survival from sudden cardiac death.Methods: Prospective, controlled, crossover study (AED vs. no AED) of consecutive cardiac arrests managed by 24 FR fire companies from 1992–1995 in a city of 440,000. Patients were stratified by the Utstein criteria. Primary end-point was survival to hospital discharge among patients with bystander witnessed arrests of cardiac etiology. Power was set at 0.8 to detect a 10% difference in survival.Results: A total of 627 patients were studied. Groups were comparable for age, gender, history of myocardial infarction, congestive heart failure or diabetes, arrest at home, bystander CPR, and ventricular fibrillation (VF) as initial rhythm.
37
Nohr, Laura, Theresa Steinhäuser, Alexis Lorenzo Ruiz, Juan Emilio Sandoval Ferrer, and Ulrike von Lersner. "Causal attribution for mental illness in Cuba: A thematic analysis." Transcultural Psychiatry 56, no. 5 (June 10, 2019): 947–72. http://dx.doi.org/10.1177/1363461519853649.
Full textAbstract:
Explanatory models (EMs) for illness are highly relevant for patients, and they are also important for clinical diagnoses and treatment. EMs serve to capture patients' personal illness narratives and can help reveal how culture influences these narratives. While much research has aimed to understand EMs in the Western hemisphere, less research has been done on other cultures. Therefore, we investigated local causal attributions for mental illness in Cuba because of its particular history and political system. Although Cuban culture shares many values with Latin American cultures because of Spanish colonization, it is unique because of its socialist political and economic context, which might influence causal attributions. Thus, we developed a qualitative interview outline based on the Clinical Ethnographic Interview and administered interviews to 14 psychiatric patients in Havana. We conducted a thematic analysis to identify repeated patterns of meaning. Six patterns of causal attribution for mental illness were identified: (1) Personal shortcomings, (2) Family influences, (3) Excessive demands, (4) Cultural, economic, and political environment in Cuba, (5) Physical causes, and (6) Symptom-related explanations. In our sample, we found general and Cuba-specific patterns of causal attributions, whereby the Cuba-specific themes mainly locate the causes of mental illness outside the individual. These findings might be related to Cubans' socio-centric personal orientation, the cultural value of familismo and common daily experiences within socialist Cuban society. We discuss how the findings may be related to social stigma and help-seeking behavior.
38
Dehem, Roger. "Le système monétaire européen à la lumière de l’expérience et de la théorie monétaires." Études internationales 12, no. 3 (April 12, 2005): 465–74. http://dx.doi.org/10.7202/701233ar.
Full textAbstract:
In the light of monetary experience and theory, the EMS appears to be unsustainable. Monetary history of the past sixty years shows that every attempt to stabilise the international monetary System has been frustrated as a consequence of divergent egocentric monetary policies. The breakdown of the rules of the gold standard game in the twenties, as well as the use of money as an instrument in national macroeconomic policies under the Bretton Woods regime have ultimately led to the demise of the fixed exchange rates System. In the sixties, European views on monetary policies were quite divergent, but in the seventies institutional attempts were made to bring them apparently into line. The "snake" arrangements, initiated in 1972, soon degenerated. The more ambitious attempt of 1979, the institutionally more elaborate EMS, suffers from the same basic weakness as all the previous ones. It lacks a common monetary standard, such as the one proposed in the 1975 Ail-Saints Manifesto. Such a standard is a necessary and a sufficient condition for a sustainable common monetary System.
39
Wibring, Kristoffer, Markus Lingman, Johan Herlitz, Sinan Amin, and Angela Bång. "Prehospital stratification in acute chest pain patient into high risk and low risk by emergency medical service: a prospective cohort study." BMJ Open 11, no. 4 (April 2021): e044938. http://dx.doi.org/10.1136/bmjopen-2020-044938.
Full textAbstract:
ObjectivesTo describe contemporary characteristics and diagnoses in prehospital patients with chest pain and to identify factors suitable for the early recognition of high-risk and low-risk conditions.DesignProspective observational cohort study.SettingTwo centre study in a Swedish county emergency medical services (EMS) organisation.ParticipantsUnselected inclusion of 2917 patients with chest pain contacting the EMS due to chest pain during 2018.Primary outcome measuresLow-risk or high-risk condition, that is, occurrence of time-sensitive diagnosis on hospital discharge.ResultsOf included EMS missions, 68% concerned patients with a low-risk condition without medical need of acute hospital treatment in hindsight. Sixteen per cent concerned patients with a high-risk condition in need of rapid transport to hospital care. Numerous variables with significant association with low-risk or high-risk conditions were found. In total high-risk and low-risk prediction models shared six predictive variables of which ST-depression on ECG and age were most important. Previously known risk factors such as history of acute coronary syndrome, diabetes and hypertension had no predictive value in the multivariate analyses. Some aspects of the symptoms such as pain intensity, pain in the right arm and paleness did on the other hand appear to be helpful. The area under the curve (AUC) for prediction of low-risk candidates was 0.786 and for high-risk candidates 0.796. The addition of troponin in a subset increased the AUC to >0.8 for both.ConclusionsA majority of patients with chest pain cared for by the EMS suffer from a low-risk condition and have no prognostic reason for acute hospital care given their diagnosis on hospital discharge. A smaller proportion has a high-risk condition and is in need of prompt specialist care. Building models with good accuracy for prehospital identification of these groups is possible. The use of risk stratification models could make a more personalised care possible with increased patient safety.
40
Seaman, Elizabeth L., Mathew J. Levy, J. Lee Jenkins, Cassandra Chiras Godar, and Kevin G. Seaman. "Assessing Pediatric and Young Adult Substance Use Through Analysis of Prehospital Data." Prehospital and Disaster Medicine 29, no. 5 (August 4, 2014): 468–72. http://dx.doi.org/10.1017/s1049023x1400079x.
Full textAbstract:
AbstractIntroductionSubstance use in young adults is a significant and growing problem. Emergency Medical Services (EMS) personnel often encounter this problem, yet the use of prehospital data to evaluate the prevalence and magnitude of substance abuse has been limited.Hypothesis/ProblemThis study evaluated drug and alcohol use through the use of prehospital and EMS data in one suburban county in Maryland (USA). The primary hypothesis was that the type of drug being abused is associated with age. The secondary hypothesis was substance abuse incidence is associated with location. The tertiary hypothesis was that substance abuse is associated with a history of mental illness.MethodsDeidentified patient care reports (PCRs) were obtained during a 24-month period from October 2010 through September 2012 for patients 0 through 25 years of age. Inclusion criteria included chief complaint of alcohol overdose, drug overdose, or the use of naloxone.ResultsThe primary hypothesis was supported that age was associated with drug category (P < .001). Younger adolescents were more likely to use household items, prescription drugs, or over-the-counter drugs, whereas older adolescents were more likely to use illicit drugs. The secondary hypothesis was supported that both alcohol (P < .001) and drugs (P < .001) were associated with location of call. Calls involving alcohol were more likely to be at a home or business, whereas calls involving drugs were more likely to be at home or at a public venue. The tertiary hypothesis was supported that both alcohol (P = .001) and drug use (P < .001) were associated with history of mental illness. Older adolescents were more likely to report a history of mental illness. Chi-squared tests indicated there were significant differences between genders and drug category (P = .002) and gender and current suicide attempt (P = .004). Females were more likely to use prescription drugs, whereas males were more likely to use illicit drugs. Calls involving younger adolescents under 18 were more likely to be at school or the mall, whereas calls involving older adolescents were likely to be at a prison, public venue, or a business.ConclusionAll three hypotheses were supported: the type of substance being abused was associated with both age and location, and substance abuse was associated with a history of mental illness. This research has important implications for understanding how EMS resources are utilized for substance use. This information is valuable in not only the education and training of prehospital care providers, but also for the targeting of future public health interventions.SeamanEL, LevyMJ, JenkinsJL, GodarCC, SeamanKG. Assessing pediatric and young adult substance use through analysis of prehospital data. Prehosp Disaster Med. 2014;29(4):1-6.
41
Lazanyi, Kornelia, and Maya Lambovska. "READINESS FOR INDUSTRY 4.0 RELATED CHANGES: A CASE STUDY OF THE VISEGRAD FOUR." Ekonomicko-manazerske spektrum 14, no. 2 (December 30, 2020): 100–113. http://dx.doi.org/10.26552/ems.2020.2.100-113.
Full textAbstract:
Industrial revolution refers to a period in human history in which revolutionary scientific discoveries and inventions that affect the functioning of society as a whole take place. Changes resulting from industrial revolutions sooner or later affect all sectors of the economy. The Fourth Industrial Revolution, also known as Industry 4.0, has brought with it many changes. Industry 4.0 has spread rapidly and has become a current phenomenon. Within the theoretical part of the contribution, the authors deal with development, definition, and comparison of industrial revolutions. The aim of the contribution is to examine the readiness of the Visegrad Four countries for changes connected with Industry 4.0. Several national initiatives responding to Industry 4.0 have been launched across Europe in recent years. Their purpose is to regulate the realization of Industry 4.0 and its consequences. Almost every member state of the European Union has its own national initiative, responding to Industry 4.0. Within the practical part of the contribution, authors focused on initiatives responding to Industry 4.0 in the V4 countries. To examine the readiness of the V4 countries for the challenges related to the Fourth Industrial Revolution - Industry 4.0, secondary data - The Digital Economy and Society Index (DESI) - was used, as well as a z-score calculation. The resulting z-scores show which countries currently achieve the best results in terms of the Drivers of Production values when compared to the GDP per capita. To see how each country is doing compared to the mean value of the respective indicators, z-scores were calculated for each of them.
42
Ge, Huijian, Xianli Lv, Hui Ren, Hengwei Jin, Yuhua Jiang, Hongwei He, Peng Liu, and Youxiang Li. "Influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling." Journal of NeuroInterventional Surgery 9, no. 10 (September 15, 2016): 958–62. http://dx.doi.org/10.1136/neurintsurg-2016-012635.
Full textAbstract:
ObjectiveTo investigate the influence of CYP2C19 genetic polymorphisms on clinical outcomes of intracranial aneurysms treated with stent-assisted coiling.MethodsBetween September 2014 and October 2015, we prospectively recruited 215 patients with intracranial aneurysms who were treated with stent-assisted coiling. CYP2C19 genotypes were determined and clopidogrel response was tested. The primary endpoints included symptomatic or silent ischemic events, and bleeding events. The secondary endpoint was clinical outcome at 3 months.ResultsOf the 215 patients, 108 (50.2%) were classified as intermediate metabolizers (IMs, CYP2C19*1/*2, *1/*3), 76 (35.3%) as extensive metabolizers (EMs, CYP2C19*1/*1) and 31 (14.4%) as poor metabolizers (PMs, CYP2C19*2/*2, *2/*3, *3/*3). Carriers of CYP2C19 loss-of-function (LOF) alleles (*2 or *3, p=0.001), especially PMs (p=0.004), had an increased risk for clopidogrel resistance. After the procedures, cerebral ischemic events occurred in 69 patients (32.1%) and bleeding was seen in 20 patients (9.3%). In comparison with IMs and PMs, EMs had a lower risk for ischemic events (21.1% vs 37.0% and 41.9%, p=0.02 and 0.027, respectively) and a relatively higher risk for bleeding events (18.4% vs 5.6% and 0%, p=0.006 and 0.01, respectively). Based on multivariate analysis, the carriage of CYP2C19 LOF alleles (p=0.032) and clopidogrel resistance (p=0.047) were considered as predictors of cerebral ischemic events, and EMs were significantly associated with bleeding (p=0.002). Posterior circulation aneurysms (p=0.038), hemorrhagic history (p=0.001) and poor metabolic genotypes (p=0.001) could result in poor clinical outcomes (modified Rankin Scale >2).ConclusionsCYP2C19 genetic polymorphisms had significant influence on the antiplatelet effect of clopidogrel, and could be considered as risk factors of ischemic or bleeding events and even clinical outcomes of patients with intracranial aneurysms treated with stent-assisted coiling.
43
da Costa, Fernando. "A Survey of Articles in the Newsletter of the EMS about the History and Activities of Full Member Societies of the EMS (Issue 1, September 1991 – Issue 104, June 2017)." EMS Newsletter 2017-6, no. 104 (2017): 61–63. http://dx.doi.org/10.4171/news/104/10.
Full text
44
Piluso, Giandomenico. "Reshaping the external constraint. Franco Modigliani, Tommaso Padoa-Schioppa and the EMS, 1977-1993." HISTORY OF ECONOMIC THOUGHT AND POLICY, no. 2 (March 2021): 97–119. http://dx.doi.org/10.3280/spe2020-002006.
Full textAbstract:
During a decade of stagflation in the 1970s, a sea of changes on the interna-tional stage led to major macroeconomic imbalances that gave central bankers a different role in relation to governments and policy-makers. In Europe, this coin-cided with the relaunching of the project for European integration. The Italian case shows how governments and central bankers interacted in shaping adjustment strategies. The Bank of Italy had a pivotal role in shaping the country's economic policies, relying on its capacity for economic analysis. The adjustment strategy formulated in the "Pandolfi Plan" of 1978 was conceived largely by an economist at the Bank of Italy, Tommaso Padoa-Schioppa. Further developing analyses conducted jointly with Franco Modigliani the previous year, the plan focused on the macroeconomic effects of high labour costs in the wake of a full ("100% and plus") wage indexing and rising government deficits. The policy proposal revolved around a few targets, namely investments and economic growth, and an explicit principle of fairness in the labour market. The Pandolfi Plan pledged to Italy's en-during participation in the European integration process by combining economic development with adhesion to the "European choice", which meant joining the European Monetary System (EMS). The European agreements governing EMS membership replaced the standard external economic constraints, i.e. the balance of payments and exchange rate, with a new kind of semi-legal external constraint ingrained in the governance structure of the European Community. The nature of this new semi-legal external constraint as a fiscal discipline mechanism eventually emerged more clearly with the Maastricht Treaty.
45
HALLIGAN, DANIEL L., ANDREW D. PETERS, and PETER D. KEIGHTLEY. "Estimating numbers of EMS-induced mutations affecting life history traits in Caenorhabditis elegans in crosses between inbred sublines." Genetical Research 82, no. 3 (December 2003): 191–205. http://dx.doi.org/10.1017/s0016672303006499.
Full textAbstract:
Inbred lines of the nematode Caenorhabditis elegans containing independent EMS-induced mutations were crossed to the ancestral wild-type strain (N2). Replicated inbred sublines were generated from the F1 offspring under conditions of minimal selection and, along with the N2 and mutant progenitor lines, were assayed for several fitness correlates including relative fitness (w). A modification of the Castle–Wright estimator and a maximum-likelihood (ML) method were used to estimate the numbers and effects of detectable mutations affecting these characters. The ML method allows for variation in mutational effects by fitting either one or two classes of mutational effect, and uses a Box–Cox power transformation of residual values to account for a skewed distribution of residuals. Both the Castle–Wright and the ML analyses suggest that most of the variation among sublines was due to a few (~1·5–2·5 on average) large-effect mutations. Under ML, a model with two classes of mutational effects, including a class with small effects, fitted better than a single mutation class model, although not significantly better. Nonetheless, given that we expect there to be many mutations induced per line, our results support the hypothesis that mutations vary widely in their effects.
46
Rowe, B. H., S. Patrick, P. Duke, K. Lobay, M. Haager, B. Deane, C. Villa-Roel, and M. Nabipoor. "P110: A prospective cohort study to evaluate sex differences in presentations and management for patients presenting to emergency departments with atrial fibrillation and flutter." CJEM 20, S1 (May 2018): S95—S96. http://dx.doi.org/10.1017/cem.2018.308.
Full textAbstract:
Introduction: Atrial fibrillation and flutter (AFF) represent the most common arrhythmia presentations to emergency departments (EDs). Some research suggests that women with AFF experience different symptoms, receive different treatment and have worse outcomes than men. This study explored sex differences in risk factors, medication, and outcomes before and after ED visits for acute AFF. Methods: Adult patients presenting to the one of three hospitals affiliated with the University of Alberta with acute AFF were enrolled. Following informed consent, each patient completed a survey administered by a trained researcher, administrative ED information (e.g., ED times) was collected from the ED information system, a chart review on treatments was conducted and patients were contacted for follow-up at 7 days via telephone. Descriptive (median and interquartile range {IQR} and proportions) and simple (Wilcoxon-Mann-Whitney, chi-square, z-proportion) statistics are presented for continuous and dichotomous outcomes. Results: Overall, 217 patients were enrolled; the median age was 64 years (IQR: 55, 73) and 39% were female. Males presenting to the ED with AFF were 10 years younger than females (p<0.001); however, females weighed significantly less (median weight 69 vs. 95 kg; p<0.001), consumed less alcohol (12 vs 60 drinks/year; p<0.001) and were less likely to be ex-smokers (p=0.022) than men with AFF. Women arrived by Emergency Medical Services (EMS) (p=0.037), experienced palpitations (p=0.042), and reported a history of hypertension (p=0.022) more frequently than men. Females were more often prescribed oral anticoagulants before (p= 0.041) and after (p=0.011) the ED visit, and females with a history of AFF were less likely to present without anticoagulant/antiplatelet therapy (p=0.015). Overall, both sexes had similar attempts at cardioversion (59.4% vs. 61.3%) and hospitalizations (12.5% vs. 8.6%), respectively. If initial chemical cardioversion failed, females were more likely to receive subsequent electrical cardioversion (60.0% vs. 26.7%, p=0.036) than men. Conclusion: Overall, both women and men present frequently to the ED with AFF. Compared to men with AFF, women present with symptoms 10 years later, have different risk factors, experience more severe symptoms and use EMS more commonly; however, outcomes were similar. Unexplained sex-based variations in-ED and post-ED management are evident and these differences warrant further scrutiny.
47
Fialho, Libânia Melo Nunes, Ricardo Silva Pinho, Jaime Lin, Thais Soares Cianciarullo Minett, Maria Sylvia de Souza Vitalle, Mauro Fisberg, Mario Fernando Prieto Peres, Luiz Celso Pereira Vilanova, and Marcelo Rodrigues Masruha. "Sleep terrors antecedent is common in adolescents with migraine." Arquivos de Neuro-Psiquiatria 71, no. 2 (January 11, 2013): 83–86. http://dx.doi.org/10.1590/s0004-282x2013005000006.
Full textAbstract:
Migraines and sleep terrors (STs) are highly prevalent disorders with striking similarities. The aim of this study was to evaluate the effect of the antecedent of STs by comparing adolescents suffering from migraines with healthy controls in a large consecutive series. METHODS: All patients were subjected to a detailed headache questionnaire and were instructed to keep a headache diary during a two-month period. The age range was 10 to 19 years. The diagnosis of STs was defined according to the International Classification of Sleep Disorders. RESULTS: A total of 158 participants were evaluated. Of these participants, 50 suffered from episodic migraines (EMs), 57 had chronic migraines (CMs) and 51 were control subjects (CG). Participants who had a history of STs had significantly more migraines than participants who did not. CONCLUSIONS: Migraine is strongly associated with a history of STs in the adolescent population independent of demographics and pain intensity.
48
Fazel, Mojtaba, Fatemeh Hamidi, and Elham Afshari. "Brugada Syndrome – Report of Familial Occurrence Diagnosed in the Emergency Department." Journal Of Cardiovascular Emergencies 6, no. 1 (March 1, 2020): 17–19. http://dx.doi.org/10.2478/jce-2020-0001.
Full textAbstract:
AbstractIntroduction: Brugada syndrome represents the clinical manifestation of a rare disease with genetic etiology. The syndrome is characterized by ventricular dysrhythmias associated with syncope or sudden cardiac death in the lack of any structural cardiac disease. The diagnosis of Brugada syndrome is established if a type 1 electrocardiographic (ECG) pattern of ST-segment and QRS morphology is present, in association with certain clinical manifestations and/or familial history.Case presentation: A 31-year-old male patient, without any medical history, presented in the emergency department (ED) of a clinical center. His only complaints consisted in palpitations, chest discomfort, and emotional stress related to the recent death of his wife. Earlier on the same day, his wife, a 25-year-old female was brought via emergency medical services (EMS) to the ED after presenting ventricular fibrillation. The female patient presented a long term history of chest pain and one year prior to this episode she presented idiopathic ventricular fibrillation, for which she had undergone implantation of an automated cardioverter defibrillator. As the couple were cousins, the EMS specialist suspected the presence of a familial cardiac disorder. The electrocardiogram of the male patient revealed a coved-type ST-segment elevation of 4 mm in leads V1–V3 compatible with type 1 Brugada syndrome.Conclusion: In case of Brugada syndrome, a genetic disorder associated with increased risk of SCD, the patient's first-degree relatives should be investigated as well, in order to identify the presence of the syndrome and to prevent SCD. As the sole established effective therapeutic measure for patients diagnosed with Brugada syndrome, ICD implantation should be considered in order to decrease the risk of syncope and SCD. This case is particular because a rare disease with familial etiology was identified in both husband and wife, who were cousins.
49
Dell, Edmund. "The Report of the Three Wise Men." Contemporary European History 2, no. 1 (March 1993): 35–68. http://dx.doi.org/10.1017/s0960777300000308.
Full textAbstract:
These days, the institutions of the European Community, and especially the Commission, are criticised for being, if anything, too effective and for submerging the sovereignty of member states in the interests of a concept of European union not universally shared. In the late 1970s the perceived problem was very different. The economic crisis following the breakdown of Bretton Woods and the oil price hike had caused a resurgence of nationalism within the Community and the reemergence of barriers to trade. ‘[S]ince about 1973, trade integration among the original six members has largely stagnated, as new market barriers outweighed new liberalising action, and economic growth was cut in half.’2 The one recent achievement, the European Monetary System (EMS), had been largely created outside the machinery of the Treaty of Rome. There was resentment within the Community at its failure to protect member states against the onset of crisis or to help them to find a way out of it. There was resentment at the way in which, at a time of crisis, France, Germany and the UK tended to ignore the Community, and their obligations under the Treaty of Rome, and to enter into consultations with the USA and Japan about matters which affected all member states.
50
Fedoruk, Oles. "Censor History of Kulish’s Novel “The Black Council”: Introductional Remarks." Слово і Час, no. 8 (August 11, 2019): 30–45. http://dx.doi.org/10.33608/0236-1477.2019.08.30-45.
Full textAbstract:
A censor history is one of the most important issues in the textual study of Kulish’s novel “The Black Council”. However, this problem has never been considered before by the Ukrainian scholars, and even more general issue, i.e. “Kulish and the Censorship”, was not involved much into the field of research. This paper gives an introduction to this topic shedding some light on the censor history of “The Black Council”.Relations between Kulish and the tsarist censorship in different times were ambiguous which was caused by several reasons. The first one was individual approach of the censors to his works which might be connected, in particular, with the trial of Saints Cyril and Methodius Brotherhood (1847). Other reason was general persecution of the Ukrainian literature, especially after the Ems Ukase (1876). In order to circumvent censorship Kulish published his works also abroad. Before Kulish was arrested he wrote his works without paying particular attention to the censorship.
The first writer’s concerns about possible restrictions that might be imposed on his works by the censorship arose with the novel “The Black Council”. Kulish’s arrest radically changed circumstances of his life and creative activity. Until 1856 he had to submit his works to prior censorship consideration and used pseudonym Nikolai M. (the name of his friend Nikolai Makarov) to avoid these restrictions. The Third Department of His Imperial Majesty’s Personal Chancellery allowed Kulish to publish his works on the base of the general censor regulations only in April 1856. In a short time Kulish sent the manuscript of “The Black Council” to the censorship committee.