scholarly journals Pre-hospital Care for Suspected Stroke Patients, Cared for by Mobile Emergency Care Units in Northern Minas Gerais

2021 ◽  
Author(s):  
Lorenn Lages Gusmão ◽  
Israel Junior Borges do Nascimento ◽  
Gabriel Almeida Silqueira Rocha ◽  
João Antonio de Queiroz Oliveira ◽  
Geisiane Sousa Braga Machado ◽  
...  
Keyword(s):  
Emergency Care ◽  
Hospital Care ◽  
Minas Gerais ◽  
Stroke Patients ◽  
Suspected Stroke ◽  
Emergency Care Units

scholarly journals Prehospital time of suspected stroke patients treated by emergency medical service: a nationwide study in Thailand

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Phantakan Tansuwannarat ◽  
Pongsakorn Atiksawedparit ◽  
Arrug Wibulpolprasert ◽  
Natdanai Mankasetkit
Keyword(s):  
Emergency Medical Service ◽  
Medical Service ◽  
Life Support ◽  
Demographic Data ◽  
National Database ◽  
Stroke Patients ◽  
Emergency Medical ◽  
Significant Difference ◽  
Suspected Stroke ◽  
Prehospital Time

Abstract Background This work was to study the prehospital time among suspected stroke patients who were transported by an emergency medical service (EMS) system using a national database. Methods National EMS database of suspected stroke patients who were treated by EMS system across 77 provinces of Thailand between January 1, 2015, and December 31, 2018, was retrospectively analyzed. Demographic data (i.e., regions, shifts, levels of ambulance, and distance to the scene) and prehospital time (i.e., dispatch, activation, response, scene, and transportation time) were extracted. Time parameters were also categorized according to the guidelines. Results Total 53,536 subjects were included in the analysis. Most of the subjects were transported during 06.00-18.00 (77.5%) and were 10 km from the ambulance parking (80.2%). Half of the subjects (50.1%) were served by advanced life support (ALS) ambulance. Median total time was 29 min (IQR 21, 39). There was a significant difference of median total time among ALS (30 min), basic (27 min), and first responder (28 min) ambulances, Holm P = 0.009. Although 91.7% and 88.3% of the subjects had dispatch time ≤ 1 min and activation time ≤ 2 min, only 48.3% had RT ≤ 8 min. However, 95% of the services were at the scene ≤ 15 min. Conclusion Prehospital time from EMS call to hospital was approximately 30 min which was mainly utilized for traveling from the ambulance parking to the scene and transporting patients from the scene to hospitals. Even though only 48% of the services had RT ≤ 8 min, 95% of them had the scene time ≤ 15 min.

scholarly journals Hospital care of stroke patients: Importance of expert neurological care

2011 ◽  
Vol 26 (9) ◽  
pp. 510-517
Author(s):  
J. Alvarez-Sabín ◽  
M. Ribó ◽  
J. Masjuan ◽  
J.R. Tejada ◽  
M. Quintana
Keyword(s):  
Hospital Care ◽  
Stroke Patients

Quality of Hospital Care for Stroke Patients in The Netherlands

1997 ◽  
Vol 7 (5) ◽  
pp. 251-257 ◽  
Author(s):  
A. van Straten ◽  
J.H.P. van der Meulen ◽  
H. van Crevel ◽  
J.D.F. Habbema ◽  
M. Limburg
Keyword(s):  
The Netherlands ◽  
Hospital Care ◽  
Stroke Patients

scholarly journals Economic Evaluation of Home Care for Stroke Patients Compared to Hospital Care: A Systematic Review

Health Scope ◽  
2021 ◽  
Vol 10 (2) ◽  
Author(s):  
Maryam Khoramrooz ◽  
Asra Asgharzadeh ◽  
Saeide Alidoost ◽  
Zeynab Foroughi ◽  
Saber Azami ◽  
...  
Keyword(s):  
Systematic Review ◽  
Economic Evaluation ◽  
Home Care ◽  
Hospital Care ◽  
Cost Effective ◽  
Stroke Patients ◽  
Life Years ◽  
Effective Option ◽  
The Cost

Context: Stroke is one of the main causes of premature death and disability, imposing significant costs on the healthcare system, especially due to expensive hospital care. Home care service is one of the interventions used in the last two decades to reduce the cost of services provided for stroke patients in different countries. Objectives: The present study aimed to systematically review studies related to the economic evaluation of home care compared to hospital care for stroke patients. Data Sources: A search was conducted between January 1990 and January 2021. PubMed, Scopus, Web of Science, and Embase databases were searched systematically. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to select the studies. Data Extraction: To evaluate the quality of studies included in this systematic review, Drummond’s ten-item checklist was used. Results: Five economic evaluation studies were included in this review. The included studies reported different results regarding the effect of home care on improving different indicators and the cost-effectiveness ratio of home care to hospital care. Most previous studies reported that home care is a more cost-effective option for improving many indicators, such as physical function and quality-adjusted life years (QALY), and for reducing mortality and institutionalization, compared to hospital care. Conclusions: Home care is a more cost-effective option than hospital care for stroke patients with regard to some indicators, such as the Barthel index for Activities of Daily Living, Modified Rankin Scale (mRS), quality of life, mortality, and institutionalization. However, there are some exemptions to this conclusion. Due to limitations, such as heterogeneity of interventions in the existing studies, different levels of patients’ disabilities, different perspectives toward economic evaluation, and differences in the healthcare systems of countries, further research is needed according to the context of each country based on clinical trials.

Paediatric cardiac arrest and resuscitation provided by physician-staffed emergency care units

1997 ◽  
Vol 41 (2) ◽  
pp. 260-265 ◽  
Author(s):  
P. SUOMINEN ◽  
R. KORPELA ◽  
M. KUISMA ◽  
T. SILFVAST ◽  
K. T. OLKKOLA
Keyword(s):  
Cardiac Arrest ◽  
Emergency Care ◽  
Paediatric Cardiac Arrest ◽  
Emergency Care Units

Clinical Practice Guidelines

2021 ◽  
Vol 3 (1) ◽  
pp. 1-155
Author(s):  
Malaysian Society of Neurosciences
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Hospital Care ◽  
Elderly Population ◽  
Mechanical Thrombectomy ◽  
Rapid Development ◽  
Reperfusion Therapy ◽  
Current Evidence ◽  
Older Person ◽  
Stroke Patients

The 1st Clinical Practice Guideline (CPG) on the management of ischaemic stroke was published in 2006 and the second edition was published in 2012. Since then, there was a rapid development in the management of acute stroke, mainly with the improvement and advancement of reperfusion therapy, encompassing both medical thrombolysis and mechanical thrombectomy. Furthermore, the importance of timely intervention, especially in the emergency department, had significantly improved the outcome in stroke patients. Therefore, this current CPG emphasizes the hyperacute management and has introduced new chapters, for example, emergency medical services. With the growing numbers of elderly population in Malaysia, we have also included a new chapter on stroke in the older person. This 3rd edition was developed to provide a clear and concise approach based on current evidence with the focus being on the efforts to reduce time and improve pre-hospital care. We have summarised and adapted relevant clinical trials data and published literatures to our local practice.

scholarly journals P105: Transforming emergency stroke care through innovation: Canadas first stroke ambulance

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S94-S94
Author(s):  
L. Morrison ◽  
S. Amlani ◽  
T. Jeerakathil ◽  
A. Shuaib ◽  
H. Kalashyan
Keyword(s):  
Health Economic ◽  
Economic Analysis ◽  
Patient Care ◽  
Tertiary Care ◽  
Added Value ◽  
Rural Setting ◽  
Stroke Patients ◽  
Health Economic Analysis ◽  
Economic Implications ◽  
Suspected Stroke

Introduction: A two-year Stroke Ambulance (SA) pilot project was implemented at the University of Alberta Hospital (UAH) in February, 2017, the first in the world to utilize this specialized technology in a rural setting. The primary objective is to evaluate clinical and economic implications of timely SA assessment and treatment of hyperacute stroke patients who present to non-stroke centres in rural Alberta and might otherwise have received delayed treatment, or not at all, due to prolonged transfer times. Methods: A steering committee and seven working groups were established, with representation from Alberta Health Services (AHS) programs impacted, to ensure comprehensive project development and implementation. The SA portable CT scanner, point of care laboratory, and videoconference system facilitate diagnosis of stroke in the field. The multidisciplinary team includes a stroke fellow, advanced & primary care paramedics, registered nurse, CT technologist, and telestroke physician. When not dispatched, the team provides stroke expertise and patient care in the emergency department (ED) and diagnostic imaging. The service model includes suspected stroke patients presenting to non-stroke centres within a 250 Km radius of Edmonton (Phase I); patients presenting to Edmonton Zone (EZ) hospitals without CT capability and/or tPA protocols (Phase 2); and expedited transport from EZ hospitals to the UAH for urgent endovascular therapy (EVT) (Phase 3). A health economic analysis will compare stroke ambulance care with standard care. Results: The SA has responded to 54 dispatches, 13 patients thrombolyzed and 3 patients receiving EVT. Median rendezvous to CT time was 10 minutes, median rendezvous to tPA time was 21 minutes, and mean time from symptom onset to tPA was 180 minutes. There were no complications. After SA imaging and assessment, 18 patients were repatriated back to their local community hospital, avoiding unnecessary admission to tertiary care. Conclusion: Our preliminary experience demonstrates that the SA offers a novel approach to performing timely evaluation and treatment of suspected stroke from non-stroke centres and may serve as an excellent triage mechanism, reducing avoidable admissions to overcapacity tertiary care EDs. The SA team provides added value to the ED with stroke expertise and patient care. A comprehensive health economic analysis will determine cost-effectiveness and whether spread is feasible.

scholarly journals Does the “Morning Morality Effect” Apply to Prehospital Anaesthesiologists? An Investigation into Diurnal Changes in Ethical Behaviour

Healthcare ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 101
Author(s):  
Anne Craveiro Brøchner ◽  
Lars Grassmé Binderup ◽  
Caroline Schaffalitzky de Muckadell ◽  
Søren Mikkelsen
Keyword(s):  
Sleep Deprivation ◽  
Working Conditions ◽  
Emergency Care ◽  
Surrogate Marker ◽  
Self Control ◽  
Ethical Behaviour ◽  
Diurnal Changes ◽  
Night Time ◽  
Emergency Care Units

The “morning morality effect”—the alleged phenomenon that people are more likely to act in unethical ways in the afternoon when they are tired and have less self-control than in the morning—may well be expected to influence prehospital anaesthesiologist manning mobile emergency care units (MECUs). The working conditions of these units routinely entail fatigue, hunger, sleep deprivation and other physical or emotional conditions that might make prehospital units predisposed to exhibit the “morning morality effect”. We investigated whether this is in fact the case by looking at the distribution of patient transports to hospital with and without physician escort late at night at the end of the shift as a surrogate marker for changing thresholds in ethical behaviour. All missions over a period of 11 years in the MECU in Odense were reviewed. Physician-escorted transports to hospital were compared with non-physician-escorted transports during daytime, evening, and night-time (which correlates with time on the 24 h shifts). In total, 26,883 patients were transported to hospital following treatment by the MECU. Of these, 27.4% (26.9%–27.9%) were escorted to the hospital. The ratio of patient transports to hospital with and without physician escort during the three periods of the day did not differ (p = 1.00). We found no evidence of changes in admission patterns over the day. Thus, no evidence of the expected “morning morality effect” could be found in a prehospital physician-manned emergency care unit.

Incidental pulmonary embolism in suspected stroke patients undergoing carotid CT angiography

2018 ◽  
Vol 123 (6) ◽  
pp. 399-405 ◽  
Author(s):  
Guang-Liang Chen ◽  
Dong-Hui Shen ◽  
Jin Wei ◽  
Hua Wang ◽  
Yuan-Fen Liu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Ct Angiography ◽  
Stroke Patients ◽  
Incidental Pulmonary Embolism ◽  
Suspected Stroke
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