scholarly journals Twelve-Lead Electrocardiogram Acquisition With a Patchy-Type Wireless Device in Ambulance Transport: Simulation-Based Randomized Controlled Trial

10.2196/24142 ◽  
2021 ◽  
Vol 9 (4) ◽  
pp. e24142
Author(s):  
Sunyoung Yoon ◽  
Taerim Kim ◽  
Taehwan Roh ◽  
Hansol Chang ◽  
Sung Yeon Hwang ◽  
...  
Keyword(s):  
Emergency Medical Technician ◽  
Definitive Treatment ◽  
Controlled Study ◽  
Time Interval ◽  
Interval Time ◽  
Coronary Syndrome ◽  
Ambulance Transport ◽  
System Usability Scale ◽  
Significant Difference ◽  
Simulation Based

Background Cardiovascular disease is the leading cause of death worldwide. Early recognition, diagnosis, and reperfusion are the key elements of treatment for ST-segment elevation myocardial infarction. The absence of a prehospital 12-lead electrocardiogram (P12ECG) can cause definitive treatment delay and repeated transfer. Although guidelines highly recommend the measurement and transmission of P12ECG data, P12ECG use has not been widely established. Objective The aim of this study was to verify the time-efficiency and feasibility of the use of a patchy-type 12-lead ECG measuring and transmitting device (P-ECG) by an emergency medical technician (EMT) in an ambulance during patient transport. Methods This was a simulation-based prospective randomized crossover-controlled study that included EMTs. The participants were randomly assigned to one of two groups. Group A began the experiment with a conventional 12-lead ECG (C-ECG) device and then switched to the intervention device (P-ECG), whereas group B began the experiment with the P-ECG and then switched to the C-ECG. All simulations were performed inside an ambulance driving at 30 km/h. The time interval was measured from the beginning of ECG application to completion of sending the results. After the simulation, participants were administered the System Usability Scale questionnaire about usability of the P-ECG. Results A total of 18 EMTs were recruited for this study with a median age of 35 years. The overall interval time for the C-ECG was 254 seconds (IQR 247-270), whereas the overall interval time for the P-ECG was 130 seconds (IQR 112-150), with a significant difference (P<.001). Significant differences between the C-ECG and P-ECG were identified at all time intervals, in which the P-ECG device was significantly faster in all intervals, except for the preparation interval in which the C-ECG was faster (P=.03). Conclusions Performance of 12-lead ECG examination and transmission of the results using P-ECG are faster than those of C-ECG during ambulance transport. With the additional time afforded, EMTs can provide more care to patients and transport patients more rapidly, which may help reduce the symptoms-to-balloon time for patients with acute coronary syndrome. Trial Registration ClinicalTrials.gov NCT04114760; https://www.clinicaltrials.gov/ct2/show/NCT04114760

scholarly journals 12-Lead Electrocardiogram Acquisition with a Patchy-Type Wireless Device During Ambulance Transport (Preprint)

2020 ◽  
Author(s):  
Sunyoung Yoon ◽  
Tae Rim Kim ◽  
Taehwan Roh ◽  
Han Sol Chang ◽  
Sung Yeon Hwang ◽  
...  
Keyword(s):  
Interquartile Range ◽  
Emergency Medical Technicians ◽  
Definitive Treatment ◽  
Controlled Study ◽  
Patch Type ◽  
Early Reperfusion ◽  
Interval Time ◽  
Emergency Medical ◽  
System Usability Scale ◽  
Conventional Device

BACKGROUND Cardiovascular disease is the leading cause of death worldwide. Early recognition, early diagnosis, and early reperfusion are the key elements of treatment for ST-segment elevation myocardial infarction. Absence of prehospital 12-lead electrocardiogram (P12ECG) can cause definitive treatment delay and repeated transfer. Although guidelines highly recommend the measuring and transmitting of P12ECG data, P12ECG use has not been widely established. OBJECTIVE The aim of this study was to verify the time-efficiency and feasibility of using a patchy-type 12-lead ECG measuring and transmitting device by an emergency medical technician (EMT) in the ambulance during patient transport. METHODS This was a prospective randomized crossover controlled study that was simulation-based and included 119 emergency medical technicians. Participants were randomly assigned to one of two groups. Group A first underwent experiments with a conventional device and then transferred to an intervention device, and group B first underwent experiments with an intervention device and then transferred to a conventional device. All tests were conducted inside an ambulance driving at 30 km/h. The time interval was measured from the beginning of the ECG test application to the completion of sending the results. After the simulation test, participants were administered the System Usability Scale. RESULTS A total of 18 emergency medical technicians were recruited in this study, and the median age was 35 years old. The overall interval time for the conventional device was 254 s (interquartile range 247-270), whereas the overall interval time for the intervention device was 130 s (interquartile range 112-150) for significant differences (P<.001). Significant differences between the conventional device and intervention device were identified in all time intervals, and for all intervals except interval 1, the intervention device was found to be significantly faster. In interval 1, the conventional device was found to be faster than the intervention device (P=.034). CONCLUSIONS The capture and transmission of P12ECG data using patch-type ECG recorders in the transporting ambulance is faster compared with the use of a conventional defibrillator device. This study is registered at ClinicalTrials.gov (NCT04114760). CLINICALTRIAL This study was approved by the Samsung Medical Center Institutional Review Board (No. 2019-04-004) and registered at ClinicalTrials.gov (NCT04114760).

The Violated Neck: Cervical Node Biopsy Prior to Definitive Treatment

1986 ◽  
Vol 94 (6) ◽  
pp. 605-610 ◽  
Author(s):  
K. Thomas Robbins ◽  
Randolph Cole ◽  
Jeffrey Marvel ◽  
Robert Fields ◽  
Patricia Wolf ◽  
...  
Keyword(s):  
Distant Metastases ◽  
Subsequent Treatment ◽  
Response To Treatment ◽  
Definitive Treatment ◽  
Wound Complications ◽  
Control Group ◽  
Time Interval ◽  
Adequate Treatment ◽  
Node Biopsy ◽  
Significant Difference

The intent of this study was to determine whether open neck biopsy for patients with squamous cell carcinoma metastatic to the neck influenced the biologic course of the disease or the response to treatment. One hundred ninety-two patients, treated over a 10-year period at M.D. Anderson Hospital and Tumor Institute, were reviewed; 102 of the 139 patients, whose primary site of disease was identified prior to definitive treatment, were matched with a control group of 204 patients. The results showed no significant difference in wound complications, neck recurrence, distant metastases, and 5-year survival. Also, time interval from the biopsy to subsequent treatment and the type of node biopsy did not appear to have any significant detrimental effect. On the basis of these findings, we conclude that, although it is important to refrain from proceeding with an open biopsy until a complete head and neck evaluation has been done, violation of the neck does not signify a poorer prognosis—provided adequate treatment is subsequently given.

The Violated Neck: Cervical Node Biopsy Prior to Definitive Treatment

1986 ◽  
Vol 94 (5) ◽  
pp. 605-610 ◽  
Author(s):  
K. Thomas Robbins ◽  
Randolph Cole ◽  
Jeffrey Marvel ◽  
Robert Fields ◽  
Patricia Wolf ◽  
...  
Keyword(s):  
Distant Metastases ◽  
Subsequent Treatment ◽  
Response To Treatment ◽  
Definitive Treatment ◽  
Wound Complications ◽  
Control Group ◽  
Time Interval ◽  
Adequate Treatment ◽  
Node Biopsy ◽  
Significant Difference

The intent of this study was to determine whether open neck biopsy for patients with squamous cell carcinoma metastatic to the neck influenced the biologic course of the disease or the response to treatment. One hundred ninety-two patients, treated over a 10-year period at M.D. Anderson Hospital and Tumor institute, were reviewed; 102 of the 139 patients, whose primary site of disease was identified prior to definitive treatment, were matched with a control group of 204 patients. The results showed no significant difference in wound complications, neck recurrence, distant metastases, and 5-year survival. Also, time interval from the biopsy to subsequent treatment and the type of node biopsy did not appear to have any significant detrimental effect. On the basis of these findings, we conclude that, although it is important to refrain from proceeding with an open biopsy until a complete head and neck evaluation has been done, violation of the neck does not signify a poorer prognosis—provided adequate treatment is subsequently given.

scholarly journals Comparison of Acceptance and Knowledge Transfer in Patient Information Before an MRI Exam Administered by Humanoid Robot Versus a Tablet Computer: A Randomized Controlled Study

2021 ◽  
Author(s):  
Dietrich Stoevesandt ◽  
Patrick Jahn ◽  
Stefan Watzke ◽  
Walter A. Wohlgemuth ◽  
Dominik Behr ◽  
...  
Keyword(s):  
Knowledge Transfer ◽  
Information Transfer ◽  
Humanoid Robot ◽  
Statistical Significance ◽  
University Hospital ◽  
Controlled Study ◽  
Hypothetical Scenario ◽  
System Usability Scale ◽  
Significant Difference ◽  
The University

Purpose To investigate whether a humanoid robot in a clinical radiological setting is accepted as a source of information in conversations before MRI examinations of patients. In addition, the usability and the information transfer were compared with a tablet. Methods Patients were randomly assigned to a robot or tablet group with their consent prior to MRI. The usability of both devices was compared with the extended System Usability Scale (SUS) and the information transfer with a knowledge query. Reasons for refusal were collected by a non-responder questionnaire. Results At the University Hospital Halle 117 patients were included for participation. There was no statistically significant difference in gender and age. Of 18 non-responders, 4 refused to participate partly because of the robot; for another 3 the reason could not be clarified. The usability according to SUS score was different with statistical significance between the groups in the mean comparison and was one step higher for the tablet on the adjective scale. There was no statistically significant difference in knowledge transfer. On average, 8.41 of 9 questions were answered correctly. Conclusion This study is the first application, in a clinical radiological setting, of a humanoid robot interacting with patients. Tablet and robot are suitable for information transfer in the context of MRI. In comparison to studies in which the willingness to interact with a robot in the health care sector was investigated, the willingness is significantly higher in the present study. This could be explained by the fact that it was a concrete use case that was understandable to the participants and not a hypothetical scenario. Thus, potentially high acceptance for further specific areas of application of robots in radiology can be assumed. The higher level of usability perceived in the tablet group can be explained by the fact that here the interface represents a form of operation that has been established for years in all population groups. More frequent exposure to robots could also improve the response in the future. Key Points: Citation Format

scholarly journals Comparison of Intranasal Midazolam and Rectal Diazepam as Anticonvulsant in Children

2016 ◽  
Vol 35 (2) ◽  
pp. 117-122
Author(s):  
Prastiya Indra Gunawan ◽  
Fadil Rulian ◽  
Darto Saharso
Keyword(s):  
Time Interval ◽  
Onset Of Action ◽  
Interval Time ◽  
Rank Analysis ◽  
Acute Seizures ◽  
Standard Management ◽  
Rectal Route ◽  
Rectal Diazepam ◽  
Significant Difference ◽  
Intranasal Midazolam

Introduction: Rectal diazepam is reputed as the gold-standard management of childhood seizures. Otherwise, intranasal (IN) midazolam has no first-pass metabolism and faster onset of action. The effectiveness and easier route of these drugs are important choices for faster seizure cessation. The aim of this study was to clarify the effectiveness of intranasal midazolam compared with rectal diazepam for seizure termination.Material and Methods: The children, one month until 18 years of age, presented with acute seizures. Patients were randomly classified into two groups with either received intranasal midazolam or rectal diazepam for seizure termination. Interval time of drug administration to cease seizure was compared. The log-rank analysis was used for statistical analysis. Side effect of both drugs were evaluated.Results: There were 60 patients enrolled the study, 30 in each group. The median time interval for seizures cessation with intranasal midazolam was 42 seconds, otherwise in rectal diazepam group was 180 seconds. There was statistically significant difference interval time between two groups (p<0.01). None of the both groups had any significant side effects statistically.Conclusion: Intranasal midazolam is effective to terminate a seizure in children. It can be used as an alternative treatment for seizures in patients with intravenous or rectal route difficulties.J Nepal Paediatr Soc 2015;35(2):117-122  

Motion Sickness: Comparison of Metoclopramide and Diphenhydramine to Placebo

2011 ◽  
Vol 26 (4) ◽  
pp. 305-309 ◽  
Author(s):  
Stephanie Rubio ◽  
Lori Weichenthal ◽  
Jim Andrews
Keyword(s):  
Motion Sickness ◽  
Sierra Nevada ◽  
Signs And Symptoms ◽  
Controlled Study ◽  
Fresno County ◽  
Rescue Dose ◽  
Vas Score ◽  
Ambulance Transport ◽  
Significant Difference ◽  
Double Blinded

AbstractObjectives: This is an evaluation of the efficacy of metoclopramide (MTCP) or diphenhydramine (DPH) to relieve symptoms of motion sickness in patients being transported via ambulance in a mountainous setting.Methods: This is a prospective, randomized, double-blinded, placebo-controlled study of patients transported by ambulance in the Sierra Nevada mountains of Fresno County. Consenting patients who met the inclusion criteria were asked to rate their motion sickness every five minutes using a visual analog scale (VAS) during transport. If motion sickness occurred, they were randomized to receive MTCP (20 mg IV), DPH (50 mg IV), or placebo (normal saline), and remaining symptoms were recorded every five minutes. If signs and symptoms of motion sickness persisted after 15 minutes, a rescue dose of MTCP was offered.Results: Twenty-six patients were enrolled in the study. Twenty-two (84.6%) developed motion sickness and were randomized to MTCP, DPH, or placebo. Eight patients received MTCP, seven received DPH, and seven received placebo. The MTCP group showed a statistically significant decrease in the mean VAS score at 15 minutes compared to the DPH and placebo groups. There was no significant difference in the decrease in VAS score between the placebo and the DPH group. Twelve out of 22 patients requested a rescue dose of MTCP after 15 minutes. At 25 minutes, there was no significant difference in the VAS score between the three groups.Conclusion: During ambulance transport in a mountainous setting, the administration of MTCP is superior to both DPH and placebo in the treatment of motion sickness. Diphenhydramine is not superior to placebo.

scholarly journals An easy and effective test to evaluate tear film stability as a self diagnosis of dry eye syndrome: Blinking tolerance time (BTT)

2020 ◽  
Author(s):  
Hyung Bin Hwang ◽  
Yong Ho Ku ◽  
Eun Chul Kim ◽  
Hyun Seung Kim ◽  
Man Soo Kim ◽  
...  
Keyword(s):  
Dry Eye ◽  
Intraclass Correlation ◽  
Tear Film ◽  
Controlled Study ◽  
Cutoff Score ◽  
Time Interval ◽  
Film Stability ◽  
Tolerance Time ◽  
Significant Difference ◽  
Tear Film Stability

Abstract Background: To introduce a new diagnostic test, blinking tolerance time (BTT) to evaluate tear film stability. We will compare it with tear break-up time (tBUT) and validate the value of the BTT as a new self-diagnostic tool for assessing tear film instability.Methods: This was a prospective controlled study involving 212 eyes of 106 participants aged 20–79 years. One hundred fourteen eyes of 57 dry eye patients and 98 eyes of 49 healthy subjects were included in the study. All patients and subjects were administered the following diagnostic tests of dry eye disease: Ocular Surface Disease Index, BTT, tBUT, slit lamp examination, corneal stain score, and Schirmer I test (without anesthesia). Patients and subjects were instructed to not to blinking as possible as he or she can after reset blinking. Examiner measure the time interval between reset blinking and next blinking. tBUTou was defined as the mean of the average of three tBUT values in the right and left eyes. Correlations between BTT and tBUTou were also evaluated. To evaluate the diagnostic efficacy of the BTT and tBUT, ROC curves were generated to obtain a cutoff score, and the sensitivities of the tests against the specificity at all possible thresholds were plotted.Results: Spearman’s correlation analysis showed a statistically significant, weakly positive correlation between BTT and tBUTOU (r = 0.447; p=0.000). The intraclass correlation coefficient (ICC) of the tBUT was 0.679 (95% confidence interval [CI]: 0.575–0.765) and the ICC of the BTT was 0.904 (95% CI: 0.867–0.932). The AUC of the tBUTOU was 0.678 and that of the BTT was 0.628. There was no statistically significant difference between these two AUC values (p=0.641). When the cutoff value of BTT was set to 8.1 sec, the sensitivity of the BTT was 63.3% and the specificity was 56.1%.Conclusion: As a simple and new self-diagnostic diagnosis of dry eye, BTT has diagnostic value in clinical practice. The BTT test has a unique advantage in that it can be used for self-diagnostic diagnosis of dry eye. The BTT test can also be widely used in the clinical setting because it is an inexpensive and simple procedure.

scholarly journals The effect of obstructive sleep apnoea on timing of acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M.H Muhmad Hamidi ◽  
H Sani ◽  
M.A Ibrahim ◽  
K.S Ibrahim ◽  
A.B Md Radzi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Risk ◽  
Systolic Function ◽  
Strong Association ◽  
Multiple Logistic Regression Analysis ◽  
Sleep Apnoea ◽  
Neck Circumference ◽  
Coronary Syndrome ◽  
Obstructive Sleep ◽  
Significant Difference

Abstract Background and objective Acute coronary syndrome (ACS) remains the principal cause of death in Malaysia. It is estimated about 20% of ACS occurs at nighttime during sleep between 12am to 6am. Factors associated with nocturnal ACS are unknown. Acute nocturnal pathophysiological response to obstructive sleep apnea (OSA) may increase risk of nocturnal ACS. We hypothesized that OSA risk is associated with timing of ACS onset. Methodology This study included 200 patients with ACS who underwent coronary angiogram for which the time of chest pain onset was clearly identified and divided into 2 groups; nocturnal ACS (12am-5.59am) and non-nocturnal ACS (6am–11.59pm). Two validated questionnaires, STOP-BANG and Epworth Sleepiness Scale (ESS) were self-administered by subjects to determine OSA risk. All subjects timing of ACS onset, OSA risk, demography, anthropometric measurements, comorbidities and echocardiographic characteristics were analyzed. Results Acute coronary syndrome occurs nocturnally in 19% of ACS patients. The prevalence of high risk OSA individuals among ACS patients is 43%. There is significantly higher prevalence of high risk OSA individuals in nocturnal ACS group of 95% compared to 30% of high risk OSA individuals in non-nocturnal ACS group (p=0.001). Nocturnal ACS patients was significantly younger (50.1±8.7yrs, p=0.001), had higher BMI (33.9±4.3kg/m2, p=0.005), waist circumference (106.7±10.3cm, p=0.003) and larger neck circumference (44.6±3.3cm, p=0.001) compared to non-nocturnal ACS group. These groups had similar prevalence of other comorbidities for ACS and showed no significant difference between left and right ventricular systolic function. In multiple logistic regression analysis, the most significant predictors for nocturnal ACS are OSA risk, neck circumference and age. Conclusion There is a strong association between high risk OSA individuals and nocturnal ACS onset. Patient with nocturnal ACS onset should be screened for OSA and prioritized for polysomnography. OSA prevalence according to ACS onset Funding Acknowledgement Type of funding source: None

scholarly journals The prognostic and diagnostic significance of the neutrophil-to-lymphocyte ratio in hepatocellular carcinoma: a prospective controlled study

2021 ◽  
Author(s):  
Philip J. Johnson ◽  
Sofi Dhanaraj ◽  
Sarah Berhane ◽  
Laura Bonnett ◽  
Yuk Ting Ma
Keyword(s):  
Hepatocellular Carcinoma ◽  
Regression Analysis ◽  
Prognostic Factor ◽  
Cox Regression ◽  
Prognostic Models ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Background The neutrophil–lymphocyte ratio (NLR), a presumed measure of the balance between neutrophil-associated pro-tumour inflammation and lymphocyte-dependent antitumour immune function, has been suggested as a prognostic factor for several cancers, including hepatocellular carcinoma (HCC). Methods In this study, a prospectively accrued cohort of 781 patients (493 HCC and 288 chronic liver disease (CLD) without HCC) were followed-up for more than 6 years. NLR levels between HCC and CLD patients were compared, and the effect of baseline NLR on overall survival amongst HCC patients was assessed via multivariable Cox regression analysis. Results On entry into the study (‘baseline’), there was no clinically significant difference in the NLR values between CLD and HCC patients. Amongst HCC patients, NLR levels closest to last visit/death were significantly higher compared to baseline. Multivariable Cox regression analysis showed that NLR was an independent prognostic factor, even after adjustment for the HCC stage. Conclusion NLR is a significant independent factor influencing survival in HCC patients, hence offering an additional dimension in prognostic models.

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