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Biomedical subjects

D Bregman

Publications and source records attributed to D Bregman.

At least 91 records · Page 5Linked to original sources
PubMedDate not supplied

Assessment of intra-aortic balloon counterpulsation in cardiogenic shock.

Intra-aortic balloon pumping (IABP) has been shown to reverse the cardiogenic shock syndrome, but the long-term results (16 to 53% survival) have, in general, been disappointing. The most productive areas for the use of IABP are in the treatment of acute myocardial ischemia where in one report of 16 patients treated with IABP and surgery 15 survived and 13 were angina free, and in the open heart surgical setting where survival ranges from 42 to 70%. The implications of these treatment modalities are discussed.

Arrhythmias, Cardiac↗
PubMedDate not supplied

Does number of beds reflect the surgical capability of hospitals in wartime and disaster? The use of a simulation technique at a national level.

INTRODUCTION: The raw number of hospital trauma beds and occupancy has been used to assess the surgical capability of hospitals in wartime and disaster situations. The goal of this study was to examine and offer a better tool to determine the load of casualties that a hospital would be able to absorb and treat effectively during these situations. METHODS: Simulation software was applied to various wartime scenarios. It assessed the usefulness of a computerized simulation of operating room (OR) function under loading of "standard wartime casualties." Comparison of the functioning of similar hospitals was undertaken in order to identify possible methods to optimize the care delivered. A "what-if" module was used to define the optimal way to absorb mass casualties within the known resources of a given healthcare system. Each hospital was tested under different loading of "standard casualties." Average waiting time for surgery was used as a marker of the constant decay in the standards of care with the increasing patient load. RESULTS: Different, unique patterns of strategies for optimizing waiting periods were identified. Not all trauma centers responded by shortening waiting time by diverting the lightly injured patients from them either before or after triage. The reaction to alternate days' shift was unexpected. The temporal course of matching a patient with a functional operating room was more indicative of a hospital's capability to absorb casualties requiring surgery than was the pre-set number of beds available in the hospital. RECOMMENDATIONS: The use of simulation techniques might be useful method to assess the nationwide surgical capability. This is a complex dilemma that cannot be predicted with trivial guessing, even when combined with previous experience of triaging. Analyzing the weak points and bottlenecks at a national level might help in creating preparedness protocols.

Computer Simulation↗
PubMedDate not supplied

Hospital disaster management simulation system.

INTRODUCTION: Theoretically, simulation of disastrous situations has many advantages in that it prepares hospital staff to cope with the real scenario. It is a challenge to create the database and custom-making a friendly software while still keeping it representative of a real situation. This article describes experience with developing and implementing the use of simulation software as a drilling technique used by Israeli hospitals. METHODS: The application was developed using SIMAN/ARENA software. Knowledge and a database for a basic multi-casualty incident (MCI) were developed in the pilot phase. It contains detailed descriptions of the casualties which can be compared with the real hospital capabilities (staff and infrastructure). A consensus committee decided the crucial model issues and established the thresholds for quality performance indicators. Interfaces to the each hospital's information management systems (IMS) were developed and the various output documents of each exercised step were updated. Before drilling, the hospital managerial staff received notice and had to prepare the data on the anticipated resources required. The simulation staff, as well as representatives from the hospitals, then conducted the limited scale drill (LSD). RESULTS: During the LSD, the trained hospital staff were given two types of input: 1) copies of reports on patients entering the stations and had to enter them into its IMS; and 2) timed telephone notifications of problems in each station. During a 90 minutes drill, there were about 15 timely reports and 20 telephone problems. The evaluation of the LSD were based mainly on the following: 1) observing the staff solving various problems; 2) constructing a detailed picture of the situation; and 3) measuring the effectiveness of the hospital IMS. The drill ended with a discussion. Lessons are drawn from each drill in order to find methods for optimizing the conduct of the hospital. An animation tool proved to be useful in describing bottle necks in emergency room, diagnostic department, and operating rooms. CONCLUSIONS: Simulation techniques and a preparatory limited scale drill have advantages in evaluating and improving preparedness of hospitals for managing an MCI before a full scale drill is carried out.

Computer Simulation↗