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PubMed2004

Rapid response car as a supplement to the helicopter in a physician-based HEMS system.

BACKGROUND: The purpose of this study was to describe the use of a rapid response car (RRC) as a supplement to the ambulance helicopter in a mixed urban/rural region in Norway. METHODS: Data from all the requested missions were collected from standard flight records. Operational factors, patient characteristics, primary diagnosis, treatment and modes of transport were registered and analyzed retrospectively. RESULTS: In 1999-2001, a total of 4777 requests were included in the study, resulting in the initiation of 3172 helicopter and 752 RRC missions. In the RRC missions, 224 patients received advanced medical treatment that would otherwise not have been provided. For 181 patients, the availability of the RRC was crucial for receiving the treatment of the helicopter emergency medical services (HEMS). The cost of equipping the base with the RRC increased the annual budget by less than one percent. CONCLUSION: The RRC was essential for solving missions in periods of non-flying conditions. The RRC increased the availability of the advanced prehospital life support offered by the HEMS in this region. Taking the modest increase in cost into consideration, it seems reasonable that this HEMS, covering mixed urban and rural areas, is equipped with such a vehicle.

Air Ambulances↗
PubMed2006

Rapid response teams can help reduce mortality, 'code' rates.

Process gets help to patients further upstream, to detect signs of deterioration earlier. Takes about six months to begin to see real results from rapid response teams. Web site offers resources to quality managers interested in learning more about the program.

Critical Care↗
PubMed2004

Mobile laboratory with rapid response instruments for real-time measurements of urban and regional trace gas and particulate distributions and emission source characteristics.

Recent technological advances have allowed the development of robust, relatively compact, low power, rapid response (approximately 1 s) instruments with sufficient sensitivity and specificity to quantify many trace gases and aerosol particle components in the ambient atmosphere. Suites of such instruments can be deployed on mobile platforms to study atmospheric processes, map concentration distributions of atmospheric pollutants, and determine the composition and intensities of emission sources. A mobile laboratory containing innovative tunable infrared laser differential absorption spectroscopy (TILDAS) instruments to measure selected trace gas concentrations at sub parts-per-billion levels and an aerosol mass spectrometer (AMS) to measure size resolved distributions of the nonrefractory chemical components of fine airborne particles as well as selected commercial fast response instruments and position/velocity sensors is described. Examples of the range of measurement strategies that can be undertaken using this mobile laboratory are discussed, and samples of measurement data are presented.

Air Pollutants↗
PubMed2005

An innovative rapid response radiotherapy program to reduce waiting time for palliative radiotherapy.

BACKGROUND: Waiting for radiation therapy (RT) in Ontario has been a major problem for the past decade. In 1996, the Toronto-Sunnybrook Regional Cancer Centre (TSRCC) initiated a Rapid Response Radiotherapy Program (RRRP) to provide timely palliative RT for symptom relief of patients with terminal cancer. PURPOSE: This study reviews the clinical activity of the RRRP over the past 8 years to evaluate if we are meeting the objectives of the program. MATERIALS AND METHODS: From the TSRCC oncology patient information system (OPIS) database, we retrieved the number of patients referred to the RRRP, their demographics, diagnosis and treatment for the calendar years 1996 to 2003 inclusive. We calculated the time interval between referral to consultation, consultation to simulation and the percentage of cases who started RT on their initial consultation for all new cases referred to the RRRP. RESULTS: From 1996 to 2003, the number of cases seen in consultation increased from just over 200 cases annually in the first 2 years to about 500 cases per year in the last 4 years, for a total of 3,290. There were 1,792 (54%) men and 1,498 (46%) women; median age was 69 years (range, 21-95 years). Breast, lung, genitourinary and gastrointestinal primaries accounted for over 80% of all referrals. The majority was referred for palliative treatment of symptomatic bone (70%) or brain (14%) metastases. The dose fractionation for bone metastases was a single 8-Gy fraction in 45%, 20 Gy in five fractions in 42%, 30 Gy in ten fractions in 4% and other dose fractionations in 9%. Nearly 90% were seen within 2 weeks of referral (38% within 1 week). Eighty-five percent were simulated on the day of their initial consultation. Sixty percent started their RT treatment on the day of their consultation visit. The overall median interval from referral to treatment was 8 days. CONCLUSION: Over the past 8 years, the annual number of new cases referred to the RRRP has doubled. The overall median interval from referral to consultation was 8 days. Sixty percent were simulated, planned and started treatment on the day of their initial consultation. We therefore are meeting our goal of providing rapid access to palliative RT for symptomatic cancer patients.

Adult↗
PubMed2000

Referring physicians' satisfaction with the rapid response radiotherapy programme. Survey results at the Toronto-Sunnybrook Regional Cancer Centre.

For patients with advanced incurable cancer, radiotherapy provides effective palliation and improved quality of life. At the Toronto-Sunnybrook Regional Cancer Centre, the Rapid Response Radiotherapy Programme, a pilot programme in Ontario, was started in 1996 to provide timely palliative radiotherapy. Over 200 patients have been seen annually since 1996. Of the patients referred to the clinic, 90% were treated by palliative radiotherapy. Of those requiring radiotherapy, 80% received treatment on the day of their initial visits, and 90% of the irradiated patients received one to five treatments. The programme has been warmly welcomed by many community medical oncologists and palliative care consultants. Other centres in Canada have followed our example and set up similar clinics. We sent out a survey to all referring physicians to explore the strengths and weaknesses of our programme so as to improve our services. There has been an increase in the utilization of palliative radiotherapy because of the availability of our programme. As a result of this survey we corrected some of our deficiencies. We plan to survey our patients' needs and satisfaction to further improve our programme, since the patients are the ultimate consumers of the service.

Adult↗
PubMed2005

Hospitalists take on role in rapid response teams with early success.

When the Institute for Healthcare Improvement came out with its campaign to save 100,000 lives last December, one of the most prominent of the six suggestions made was for hospitals to form rapid response teams that would be available to check on at-risk patients before they became critically and irreversibly ill.

Critical Care↗
PubMed2006

System shows diversity in rapid response teams.

Some facilities get up and running quickly, while others take months to plan the program. Smaller facilities must be especially creative, identifying all possible responders with the critical thinking necessary. It's important to continually evaluate the effectiveness of your rapid response teams.

Critical Care↗
PubMedDate not supplied

Rapid response teams: a proactive strategy for improving patient care.

Cardiopulmonary resuscitation success rates have not changed in 30 years. Patient outcomes may improve if changes in a patient's condition are addressed at the onset of subtle deteriorations, rather than at the point of cardiac arrest. The rapid response team involves early intervention that demonstrates the ability to decrease cardiac arrest rates and improve patient mortality.

Cardiopulmonary Resuscitation↗
PubMed1994

Volume loading in predominant right ventricular infarction: bedside haemodynamics using rapid response thermistors.

Intravenous fluid loading is commonly used for the treatment of low cardiac output (CO) syndrome complicating severe right ventricular infarction (RVMI). We prospectively evaluated the effectiveness of this method in 11 consecutive patients (age 66 +/- 14 years) with severe RVMI, using a newer thermodilution method with rapid response thermistors. Volume loading was performed until pulmonary wedge pressure (PWP) reached 18 to 24 mmHg. Right atrial pressure (RAP), pressures of the right ventricle (RV) and pulmonary artery (PA), PWP, RV volumes, RV ejection fraction (RVEF), stroke volume (SV), CO, pulmonary vascular resistance (PVR) and RAP/PWP ratio were measured before and after volume loading. RAP rose from 12 +/- 4 to 19 +/- 5 mmHg (P < 0.0001) and its tracing showed a non-compliant pattern in all patients. RV end-diastolic pressure rose from 13 +/- 4 to 20 +/- 5 mmHg (P < 0.0001) and PWP from 14 +/- 3 to 20 +/- 6 mmHg (P < 0.0001). Mean PA pressure rose from 20 +/- 3 to reach 25 +/- 6 mmHg (P < 0.001), while PVR did not change significantly (117 +/- 39 vs 101 +/- 49 dyn.s.cm-5, P ns). RAP/PWP ratio rose from 0.85 +/- 0.14 to 1.05 +/- 0.07 (P < 0.01). The end-diastolic RV volume increased from 95 +/- 26 to 113 +/- 24 ml.m-2 (P < 0.001); however, RV end-systolic volume increased from 65 +/- 28 to 83 +/- 29 ml.m-2 (P < 0.01), thus SV did not change significantly (30 +/- 6 vs 30 +/- 8 ml.beat-1.m-2, P ns). RVEF decreased from 32 +/- 11 to 28 +/- 11% (P < 0.001). CO did not improve significantly (2.3 +/- 0.42 vs 2.4 +/- 0.62 l.min-1.m-2, P ns) neither did the clinical status.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Development of a unique decentralized rapid-response capability and contingency mass-casualty field hospital for the 1996 Democratic National Convention.

This article describes the planning, development, and execution of a unique, decentralized, and flexible medical response capability that was developed for the 1996 Democratic National Convention in Chicago. Concerns for coordinated acts of violence, terrorism, toxicologic exposures, and logistic problems posed by the United Center prompted the development of a decentralized and flexible rapid-response plan. Contingency planning for the remote possibility of a full-scale disaster led to the additional development of a contingency mass-casualty field hospital on site. The plans for this mass-gathering response are described in considerable detail. Forty-four patient encounters across the four days of the convention were recorded, with a combination of minor injuries and potentially serious medical presentations. The 1.46 EMS encounters per 1,000 attendees at the Democratic National Convention is comparable to other utilization rates for mass gatherings in the literature. Proactive attention to comprehensive contingency planning for equipment, supplies, personnel, and organizational needs, especially when multiagency response and cooperation are required, is essential.

Chicago↗
PubMed2005

Low circulating soluble interleukin 2 receptor level predicts rapid response in patients with refractory rheumatoid arthritis treated with infliximab.

BACKGROUND: Treatment with infliximab induces a rapid therapeutic response in most patients with active rheumatoid arthritis. Factors predicting good response are not well known. OBJECTIVE: To study the predictive value of baseline level of soluble interleukin 2 receptor (sIL2R), a marker of lymphocyte activation, on the treatment response. METHODS: 24 patients with active rheumatoid arthritis received intravenous infusions of infliximab at study entry, at two weeks, at six weeks, and at eight week intervals thereafter. Outcome was evaluated at six weeks and 22 weeks. Clinical assessment and standard laboratory tests were made and the DAS28 disease activity score was calculated. Serum sIL2R level at entry was measured by automated immunoassay analyser (Immulite). The mean change in DAS28 score from entry to six weeks and 22 weeks was calculated and related to sIL2R level using baseline adjusted robust regression analysis. RESULTS: Baseline level of serum sIL2R (mean (SD), 621 (325) U/ml) did not correlate with baseline DAS28 score (r = 0.24 (95% confidence interval, -0.18 to 0.58)). At six weeks DAS28 scores improved, with a mean change of -2.53 (-3.08 to -1.98) (p<0.001). This change was predicted by low baseline sIL2R level (regression coefficient per 100 U/ml: 0.205 (0.003 to 0.407) (p = 0.047)). At 22 weeks the DAS28 scores improved, with a mean change of -2.26 (-2.75 to -1.77) (p<0.001). The change was not predicted by baseline sIL2R level. CONCLUSIONS: Low baseline sIL2R level may predict a rapid clinical response in patients with refractory rheumatoid arthritis treated with infliximab.

Adult↗
PubMed1999

Pulmonary capillaritis associated with the antiphospholipid antibody syndrome and rapid response to plasmapheresis.

OBJECTIVE: Pulmonary capillaritis is an uncommon complication of antiphospholipid antibody syndrome but has important therapeutic implications. CASE REPORT: A patient with antiphospholipid antibody syndrome presented with haemoptysis and respiratory failure. Investigation including open lung biopsy, demonstrated vasculitis as the underlying pathology, rather than thrombosis. The patient responded promptly to methylprednisolone, cyclophosphamide and plasmapheresis. CONCLUSION: Plasmapheresis has not previously been described in this setting and the rapid response suggests that it should be considered in severe disease.

Antiphospholipid Syndrome↗
PubMed2002

Rapid response to infliximab in severe pustular psoriasis, von Zumbusch type.

Tumor necrosis factor-alpha (TNF-alpha) is a chemokine secreted by T cells which is thought to play a critical role in the pathophysiology of psoriasis. The monoclonal antibody, infliximab, complexes with TNF-alpha, rendering it inactive. A recent clinical trial has reported the clinical benefit and safety of infliximab in moderate to severe plaque psoriasis. We report a case of rapid response and clinical benefit using infliximab in severe pustular psoriasis of von Zumbusch.

Adult↗
PubMed1985

Rapid response of intrasplenic lesions to steroids in non-Hodgkin's lymphoma.

A 70 year old woman had a [99mTc]sulfur colloid liver/spleen scan that showed splenomegaly and multiple intrasplenic defects. The lesions failed to concentrate radiogallium. Thirteen days later, after being on steroid therapy, the spleen had decreased in size and the lesions were only barely apparent. The intrasplenic process, due to non-Hodgkin's lymphoma, was thus markedly sensitive to steroids. It is uncertain if such rapid regression can be employed as a prognostic indicator in non-Hodgkin's lymphoma and suggests the need for further monitoring. The differential diagnosis of the rapid response of intrasplenic lesions to steroids is a limited one, and likely includes sarcoidosis.

Aged↗
PubMed2004

Analytic evaluation and application of a novel spectrophotometric serum lithium method to a rapid response laboratory.

The authors present an evaluation of the Lithium DST spectrophotometric method developed by Thermotrace (Victoria, Australia) on a Hitachi 917 analyzer. Accuracy was assessed by method comparison with an ion-selective electrode (ISE; Roche Integra 700) (n = 80). Linearity, within-run and between-run precision, and susceptibility to interference by hemolysis, icterus, lipemia, and sodium were assessed. The method was linear to 3.0 mM/L, and analyzer auto-dilution extended the reportable range to 7.2 mmol/L. Within-run coefficient of variation was 1.5% at 0.68 mmol/L and 0.7% at 2.06 mM/L. Between-run precision for the same lithium concentrations assayed daily for 20 days were 3.1% and 1.9%, respectively. Method agreement with ISE was excellent, with an intercept of 0.000 and slope of 1.000 by Passing Bablock regression analysis. Hemolysis, icterus, lipemia, and high and low sodium levels did not significantly interfere. The manufacturer's recommended calibration stability of 1 week was confirmed. The authors conclude that this method is reliable, accurate, and precise. The Thermotrace serum lithium spectrophotometric method provides a useful alternative to ISE or flame photometry, facilitates workstation consolidation on the Hitachi 917 multiple-channel analyzer, and is well adapted for use in a rapid response laboratory.

Antimanic Agents↗
PubMedDate not supplied

Rapid responses to aldosterone in human distal colon.

Aldosterone at normal physiological levels induces rapid increases in intracellular calcium and pH in human distal colon. The end target of these rapid signaling responses are basolateral K+ channels. Using spectrofluorescence microscopy and Ussing chamber techniques, we have shown that aldosterone activates basolateral Na/H exchange via a protein kinase C and calcium-dependent signaling pathway. The resultant intracellular alkalinization up-regulates an adenosine triphosphate (ATP)-dependent K+ channel (K(ATP)) and inhibits a Ca2+ -dependent K+ channel (K(Ca)). In Ussing chamber experiments, we have shown that the K(ATP) channel is required to drive sodium absorption, whereas the K(Ca) channel is necessary for both cyclic adenosine monophosphate and calcium-dependent chloride secretion. The rapid effects of aldosterone on intracellular calcium, pH, protein kinase C and K(ATP), K(Ca) channels are insensitive to cycloheximide, actinomycin D, and spironalactone, indicating a nongenomic mechanism of action. We propose that the physiological role for the rapid nongenomic effect of aldosterone is to prime pluripotential epithelia for absorption by simultaneously up-regulating K(ATP) channels to drive absorption through surface cells and down-regulating the secretory capacity by inhibiting K(Ca) channels involved in secretion through crypt cells.

Aldosterone↗
PubMed1988

5-HT3 receptors mediate rapid responses in cultured hippocampus and a clonal cell line.

Serotonin (5-HT) induces a large inward current accompanied by a conductance increase when applied focally to either neurons of mouse hippocampal cultures or cells of the NG108-15 clonal cell line. In both systems, the response is blocked by ICS 205-930, curare, and metoclopramide, while 2-methyl-5-HT is an agonist. The actions of ICS 205-930 and 2-methyl-5-HT indicate that the response is mediated by the 5-HT3 receptor. In NG108-15 cells the response activated in as little as 35 ms. The rapidity of the response suggests a direct coupling between the 5-HT3 receptor and a channel, which are probably both part of a single membrane protein. In both cell types, prolonged application of 5-HT resulted in desensitization; the rates of desensitization were accelerated by the adenylate cyclase activator forskolin. The 5-HT3 receptor has much in common with the nicotinic receptor and is probably involved in rapid synaptic transmission in the mammalian brain. Since this response is modulated by manipulations that elevate intracellular cAMP levels, the central synapses in which this receptor operates may exhibit plasticity.

Animals↗