ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

To investigate the hypothesis that plasmatic changes of lipoperoxidative markers are associated with deep venous thrombosis (DVT), peripheral venous blood samples were obtained from 10 patients with venographically proven DVT before starting anticoagulant therapy, and 36 ± 3 and 60 ± 3 hours later. Values of myeloperoxidase (MPO), 4-hydroxynonenal (HNE) and malondialdehyde (MDA) were compared with those of 10 age-matched control subjects. Despite individual variations, mean plasma MPO level was higher in the DVT group (p< 0.01), as were average plasma MDA (p< 0.001) and HNE (p< 0.01) levels. Separate analysis of the DVT cases showed that higher values of MDA, HNE and MPO were found in patients with either co-morbid diseases or clinically silent pulmonary embolism (PE). Good evidence exists for considering DVT a condition associated with an apparently excessive free radical production not buffered by efficient defence systems. A role of DVT itself cannot be excluded, but PE or other co-morbid diseases may participate in the oxidative stress. If confirmed in a larger series of patients, these findings could shed new light on the plasmatic changes associated with the propagation and complications of DVT, which in turn could have therapeutic implications.Unit of Angiology, Clinical Pharmacology University and S. Orsola-Malpighi Community Teaching Hospital of Bologna, ItalyTo investigate the hypothesis that plasmatic changes of lipoperoxidative markers are associated with deep venous thrombosis (DVT), peripheral venous blood samples were obtained from 10 patients with venographically proven DVT before starting anticoagulant therapy, and 36 ± 3 and 60 ± 3 hours later. Values of myeloperoxidase (MPO), 4-hydroxynonenal (HNE) and malondialdehyde (MDA) were compared with those of 10 age-matched control subjects. Despite individual variations, mean plasma MPO level was higher in the DVT group (p< 0.01), as were average plasma MDA (p< 0.001) and HNE (p< 0.01) levels. Separate analysis of the DVT cases showed that higher values of MDA, HNE and MPO were found in patients with either co-morbid diseases or clinically silent pulmonary embolism (PE). Good evidence exists for considering DVT a condition associated with an apparently excessive free radical production not buffered by efficient defence systems. A role of DVT itself cannot be excluded, but PE or other co-morbid diseases may participate in the oxidative stress. If confirmed in a larger series of patients, these findings could shed new light on the plasmatic changes associated with the propagation and complications of DVT, which in turn could have therapeutic implications.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

We carried out a prospective evaluation of 172 patients using our own risk score for patients transferred from the emergency department of a community hospital in Tudela, Spain, to main centres, during 1988. Although the data go back almost 10 years, this scoring has not been internationally published and is at present widely applied in Spain. Patients scoring less than 7 points were transferred under specialized nursing supervision (Group I), and those scoring equal to or over 7 points were transferred in a specially equipped intensive care unit surface ambulance and supervised by a physician and a nurse (Group II). There were 102 patients in Group I and 70 in Group II. Complications arising during transfer were defined as minor or serious. A low overall incidence of complications was recorded-a total of 29 cases (16.9% of all transfers). The incidence of complications was significantly higher in Group II patients (p< 0.005). One patient from Group II died during transport. All patients from Group II were admitted to the ICUs compared with only 20 (18.6%) from Group I (p< 0.001). Of a total of 23 deaths in hospital, nine were from Group I and 14 from Group II. During the first 24 hours after admission, six patients died from Group II and none from Group I. The application of risk scores has permitted to assign effectively technical and human resources for a safe interhospital transfer of critically ill patients.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This article outlines the recent status of ambulance services provided by Emergency Aid and Rescue Services (EARS) in the Republic of Turkey. EARS would seem to be the future model of emergency medical systems (EMS) in Turkey.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

An ongoing collaborative partnership between the University of Massachusetts Medical Center, Boston University Medical Center, the Armenian Ministry of Health, and the Emergency Hospital of Yerevan, Armenia has been established since 1993. The primary goal of this partnership is to reform and improve the delivery of emergency medical care through a process of education and training that is reproducible, practical, and self-sustaining for the advancement of health care into the future. A six-step educational process was developed, using Armenia as the initial model site for this format. Through the development of a regional training center and two emergency medicine training curricula, the partnership has trained over 1800 health care workers and first responders. Preliminary results from pre- and post-course examinations show a significant overall improvement in scores. An ongoing trauma database collection also shows significant improvement in the number of advanced life support measures being implemented since the inception of this educational training programme. This educational strategy has subsequently been replicated in nine similar partnerships in other countries of the New Independent States, formed after the dissolution of the former Soviet Union in 1990. We believe this six-step educational format is effective for the development and improvement of emergency medical systems in developing countries worldwide.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This paper evaluates the impact of an early revisit including symptom evaluation and an exercise electrocardiogram on recurrency of symptoms and readmissions during 1 year of follow-up among patients coming to hospital with chest pain or an initial suspicion of acute myocardial infarction (AMI) but in whom the suspicion was quickly ruled out. Patients below the age of 65 admitted to the emergency department (ED) at Sahlgrenska Hospital due to chest pain or other symptoms raising a suspicion of AMI who were either directly discharged from the ED or discharged within 1 day after having AMI ruled out. Patients were allocated to two groups: (1) patients being re-evaluated in a chest pain clinic less than a week after discharge from hospital (intervention group) and (2) patients handled routinely with no formalized follow-up (control group). The intervention group (n=484) and the control group (n=374) were comparable at baseline. During 1 year of follow-up, patients in the intervention group had a lower rate of readmissions to the ED than patients in the control group (17.4% versus 24.9%,p< 0.05) and a lower rate of rehospitalizations (15.9% versus 23.3%,p< 0.05). The proportion of patients being on sick leave at any time during the follow-up did not differ and neither did the recurrency of symptoms. The introduction of a chest pain clinic for patients early discharged from hospital after having AMI ruled out indicated beneficiency in terms of a lower rate of readmissions to the ED and a lower requirement of rehospitalizations. However, a methodological weakness in the randomization procedure suggest carefulness in interpretation.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

The aim of this study was to assess the incidence of injuries to patients who have had a plaster cast removed by oscillating circular saw at the Alexandra Hospital, Redditch, and to recommend measures to avoid such injuries. The record of each patient who had his/her plaster removed was kept in the plaster room and later studied. Over a 12-month period (1995–96), 3875 plaster casts were removed; 28 patients (0.72%) sustained abrasions or burns over the skin. Recently there has been a sudden rise in the number of cases who sustained injury or burns by oscillating saw following plaster cast removal and a few patients have demanded compensation from the hospital. These incidences prompted the start of this study. The identified cause of injury was the removal of a plaster cast by an inexperienced, ill-trained user or blunt saw blade. Strict protocols were required and have been introduced at the Alexandra Hospital to avoid litigation.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

This study was undertaken to determine the frequency and type of continuing education required in areas with various populations and evaluate the resuscitation knowledge and skills possessed by Standard First Aid Class (SFAC) ambulance crews, who play a major role as prehospital care providers in Japan. Two hundred SFAC ambulance crews were classified into four subgroups based on the population of the areas they serve a population greater than 400 000, 150 000–400 000, 50 000–150 000 and less than 50 000. A survey regarding continuing education in each area revealed that the EMS systems with smaller populations had less adequate continuing education than in larger populated areas. A written test consisted of 80 multiple choice questions showed no difference among each population subgroup. In the five-point skills test, however, it was demonstrated that the resuscitation skills, particularly those required for the airway management, of SFAC ambulance crews in the areas populated by less than 50 000 had deteriorated more than those in larger communities. These findings re-emphasized the importance of adequate continuing education in low-volume, part-time, rural EMS systems where lack of clinical exposure is a significant limiting factor for skill retention.

ISSN:0969-9546    

出版商:OVID    

年代:1998

数据来源: OVID