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The present report describes the quality of care, including in hospital mortality for more than 22.000 STEMI patients admitted in 60 Belgian hospitals for the period 2008-2016. We found a strong increase in the use of primary PCI over time, particularly for patients that were admitted first in a non-PCI capable hospital, reaching a penetration rate of ,95%. The transition of thrombolysis to transfer for pPCI in the setting of a STEMI network was, however, associated with an increase of the proportion of patients with prolonged (,120 min) diagnosis-to-balloon time (from 16 to 22%), suggesting still suboptimal interhospital transfer ...
BACKGROUND: Delayed diagnoses of pulmonary tuberculosis contribute to the spread of the epidemic. METHODS: This study aims to identify risk factors associated with patient delay (from symptoms onset to the first visit), health system delay (from the first visit to the tuberculosis treatment initiation) and total delay (sum of the patient and the health system delay) in low income and high tuberculosis burden countries. A systematic literature review has been performed using the keywords: tuberculosis; delay, care seeking; health care seeking behavior; diagnosis and treatment. Only quantitative studies showing delays for pulmonary tuberculosis adult cases were included in this review. RESULTS: Low income, gender, rural life, unemployment, ageing and misunderstanding the microbial cause of tuberculosis are associated with delayed diagnoses. Systemic factors including low health care coverage, patient expenditures and entry into the health system by consulting a traditional healer or a non
Background: In Myocardial infarction (MI) it is well established that timely diagnosis and treatment may reduce mortality and improve the prognosis. Therefore it is important that patients with MI seek medical care as soon as possible. Patients with diabetes have a higher risk for MI and worse prognosis compared to patients without diabetes. Previous research is inconclusive regarding symptoms and pre-hospital delay times in MI among patients with diabetes and there is lack of research in how patients with diabetes perceive, interpret and respond to MI symptoms. Aim: The overall aim of this thesis was to explore symptoms and care seeking behaviour during MI in patients with diabetes. Methods: This thesis comprises four studies. Studies I and II were based on data from the Northern Sweden MONICA myocardial infarction registry to describe symptoms in 4028 patients (I) and pre-hospital delay and factors associated with pre-hospital delay of ≥ 2 h in 4266 patients (II). Study III included 694 ...
Rega is most frequently called out to deal with winter sport, road, occupational and Alpine accidents. It also carries out numerous interhospital transfer flights. In addition, Rega transports organs, blood, medicaments and medical specialists ...
Transit agency launches plan on 1-California that sets goal of alleviating system delays Although the reliability of Muni has been a perennial problem in San Francisco, Mayor Gavin Newsom said it wasnt until last month, when he was left standing on the corner of Fillmore and California streets after four crowded Muni buses rolled byRead more...
The nonuniformity of STEMI treatment strategies in the United States contributes to untimely reperfusion therapy and complicates the overall process of STEMI care.6,9 In the current program, the 4-step algorithm provided the STEMI-referral ED physician with standardized pharmacological or mechanical reperfusion options and empowered this physician to activate the process of care at the STEMI-accepting facility without prior cardiologist consultation, a strategy previously demonstrated to reduce reperfusion delays.9 Within the design of the protocol, several important observations were noted. First, despite the primary goal of using interhospital transfer for PPCI, full-dose fibrinolytic therapy was required in ≈10% of this rural patient population. Inclement weather conditions and unanticipated helicopter unavailability contributed to the unexpected interhospital transfer delays, requiring use of an alternative reperfusion strategy. Unlike other transfer PCI programs4 that use controversial ...
Symptoms and pre-hospital delay times in relation to infarct related artery (IRA) in ST-elevation myocardial infarction (STEMI) patients - a survey report from the SymTime study group ...
A 73 year old woman presented with angina 22 years after saphenous vein grafts. All three grafts were in excellent condition, with the exception of a severe stenosis in the proximal portion of the circumflex graft (panel A). For elective percutaneous coronary intervention (PCI), a FilterWire distal protection device was deployed in the body of the graft before pre-dilatation with a 2.5 × 15 mm Maverick balloon. Aiming to minimise the risk of distal embolisation, a (self expanding nitinol) Symbiot polymer covered stent (4.0 × 20 mm) was deployed (panel B). These stents require post-inflation to optimise deployment. Following in-stent inflation (4.0 × 15 mm Extensor) a new filling defect (white arrow) was immediately apparent within the stent at its proximal end (panel C). Filling defects (white arrows) were also present within the FilterWire device (black arrows) (panel C). The in-stent debris was presumed to be material extruded from the proximal margin of the covered stent after high ...
Background: Recognition that primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) if delivered in a timely fashion resulted in national efforts successful in reducing time to treatment. To determine whether the decreasing door-to-balloon (DTB) time is associated with a reduction in mortality, we evaluated 12,210 STEMI patients undergoing primary PCI in Massachusetts between 1/2005 and 9/2010.. Methods: We used prospectively collected data compiled, audited, and analyzed by the Massachusetts Data Analysis Center, the state mandated PCI registry.. Results: The mean age of the population was 61.9 years, with 29% women and 6.1% in cardiogenic shock. Between 2005 and 2010, median door-to-balloon time decreased from 85.0 to 67.5 minutes in patients presenting directly to PCI hospitals and from 153.5 to 113.0 minutes in patients requiring inter-hospital transfer for PCI. DTB time ≤90 minutes increased from 56.8% to 77.1% ...
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Methods and Results-The Minneapolis Heart Institutes Level 1 Regional ST-Segment-Elevation Myocardial Infarction program is designed to facilitate emergent transfer for PCI in patients with ST-segment-elevation myocardial infarction from 31 rural and community hospitals. To determine the effect of emergent transfer, questionnaires were given to 152 patients and their families who survived to hospital discharge with a 65.8% response rate (mean age, 63.9 years; 29% women). Ninety-five percent of patients felt the reasons and process of transfer were well explained, and 97% felt transfer for care was necessary. Despite this, 15% of patients would have preferred to stay in their local hospital. The majority of the families felt the transfer process (88%) and family members condition (94%) were well explained. Although 99% felt it was necessary for their family member to be transferred for specialized care, 11% of families still would have preferred that their family members remain at the local ...
About one in five patients with gallbladder pain don t have emergency surgery when they first need it, a new study finds. Most patients who require emergency ga
BACKGROUND: Timely primary percutaneous coronary intervention (PPCI) cannot be offered to all patients with ST-segment-elevation myocardial infarction (STEMI). Pharmaco-invasive (PhI) strategy has been proposed as a valuable alternative for eligible patients with STEMI. We conducted a randomized study to compare the efficacy and safety of a PhI strategy with half-dose fibrinolytic regimen versus PPCI in patients with STEMI. METHODS: The EARLY-MYO trial (Early Routine Catheterization After Alteplase Fibrinolysis Versus Primary PCI in Acute ST-Segment-Elevation Myocardial Infarction) was an investigator-initiated, prospective, multicenter, randomized, noninferiority trial comparing a PhI strategy with half-dose alteplase versus PPCI in patients with STEMI 18 to 75 years of age presenting ≤6 hours after symptom onset but with an expected PCI-related delay ...
The operations performed by the Lausanne base include road and sports accidents, interhospital transfer flights and the transport of organs. The rescue helicopter flies to locations in the towns and the country, in the mountains and on and by the water. Assisted by its operation partners - rescue services, police, fire services and many others - the Lausanne base flies approx. 800 missions per year, around a third of them at night. ...
Medicare-for-all makes a good first impression, but support plunges when people are asked if theyd pay higher taxes or put up with treatment delays to get it. The survey, released Wednesday by the...
In people with a primary HIV infection, the need to restart treatment during chronic HIV infection can be delayed if they receive a 24-week long temporary
Information will update every 5 minutes. ER Wait Times are approximate and provided for informational purposes only. Estimated Wait Times as of: Tuesday, December 12, 2017 6:20 PM ...
Results. Seven percent of all patients received a TT (5% unilateral, 2% bilateral). Ninety-seven percent of all patients with a TT were endotracheally intubated. The success rate for correctly placed chest tubes was 78%. Twenty-two percent of the chest tubes were misplaced (i.e., too far in the chest, twisted, or bent); half of those had to be corrected, with one needing to be replaced. There were no statistical differences in the frequency of Monaldi or Bülau positions, or the frequency of left or right chest TT. In addition, the two positions did not differ in misplacement rates or the need for intervention. Helicopter emergency medical services physicians used the Monaldi position significantly more frequently than the Bülau position. In-hospital physicians performing interhospital transfer used the Bülau position significantly more frequently, whereas ground emergency medical physicians had a more balanced relationship between the two positions. Tube thoracostomy had no influence on ...
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Information will update every 5 minutes. ER Wait Times are approximate and provided for informational purposes only. Estimated Wait Times as of: Sunday, November 19, 2017 11:07 AM ...