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At least 667 records · Page 37Linked to original sources
PubMed2002

Response time effectiveness: comparison of response time and survival in an urban emergency medical services system.

UNLABELLED: Emergency medical services (EMS) administrators seek methods to enhance system performance. One component scrutinized is the response time (RT) interval between call receipt and arrival on scene. While reducing RTs may improve survival, this remains speculative and unreported. OBJECTIVE: To determine the effect of current RTs on survival in an urban EMS system. METHODS: The study was conducted in a metropolitan county (population 620,000). The EMS system is a single-tier, paramedic service and provides all service requests. The 90% fractile RT specifications required for county compliance include 10:59 minutes for emergency life-threatening calls (priority I) and 12:59 minutes for emergency non-life-threatening calls (priority II). All emergency responses resulting in a priority I or priority II transport to a Level 1 trauma center emergency department over a six-month period were evaluated to determine the relation between specified and arbitrarily assigned RTs and survival. RESULTS: Five thousand, four hundred twenty-four transports were reviewed. Of these, 71 patients did not survive (1.31%; 95% CI = 1.04% to 1.67%). No significant difference in median RTs between survivors (6.4 min) and nonsurvivors (6.8 min) was noted (p = 0.10). Further, there was no significant difference between observed and expected deaths (p = 0.14). However, mortality risk was 1.58% for patients whose RT exceeded 5 minutes, and 0.51% for those whose RT was under 5 minutes (p = 0.002). The mortality risk curve was generally flat over RT intervals exceeding 5 minutes. CONCLUSIONS: In this observational study, emergency calls where RTs were less than 5 minutes were associated with improved survival when compared with calls where RTs exceeded 5 minutes. While variables other than time may be associated with this improved survival, there is little evidence in these data to suggest that changing this system's response time specifications to times less than current, but greater than 5 minutes, would have any beneficial effect on survival.

Emergency Medical Services↗
PubMedDate not supplied

[Problems of medical monitoring of patients and requirements for computer monitoring systems].

Medical monitoring of patients is intended for controlling their physiological parameters, providing information to the medical staff as of critical, precritical physiological values, as well as for accumulating information on the patients' condition in time (trends). The existing monitoring systems require further improvement by expanding the types of measuring channels connected to them, providing a definite service, adaptability to a concrete medical institution. The basic orders to develop and produce such systems were got from the leading medical institutions of the Republic of Udmurt. A list of physiological parameters requiring monitoring, specifications of transducer systems and measuring channels (as a table), as well as demands by for channels, as required, records written down into the trend, as results is given. Possible variants of the design and use of computer monitors are provided.

Humans↗
PubMed2001

[Improving the system of medical examinations in individuals working with occupational hazards nowadays].

To solve the problem of medical examinations system improvement according to Russian Federation Health Ministry Order No. 90, the Department for Occupational Hygiene Supervision specified several directions: -cooperation with medical commissions of health care facilities and with occupational safety divisions at industrial enterprises to determine contingents and volume of further research; - organization of conferences in municipal health care department with representatives of health care facilities and employers; - cooperation with specialists in public hygiene and occupational center for complex inspection of health care facilities; - preparation of information for and participation for and participation in interdepartmental commission conference based on clinical expert commission in occupational pathology center and in municipal department on work safety; - cooperation with occupational pathology center in activities of license committee.

Female↗
PubMed1987

Availability, accessibility, acceptability, and adaptability: four attributes of African ethno-medicine.

Many years of ethno-medical research in Africa have increased our knowledge of different aspects of indigenous medical systems. Like any other cultural system, indigenous medical systems have been undergoing changes over the years as African countries continue to experience tremendous alterations in their ecological systems, socio-economic activities, political and cultural life. These changes have had some impact on the practice of indigenous medicine in many parts of Africa. Compared with bio-medical services, ethno-medicine is usually characterized as more available, accessible, acceptable, and adaptable. This paper seeks to draw attention to the need to re-examine these attributes as applied to ethno-medical practices in contemporary Africa in view of the present rate of social change in most African countries.

Africa↗
PubMed1998

UltraTrainer--a training system for medical ultrasound examination.

This paper introduces the prototype of the computer program UltraTrainer, which could simplify the education and training of physicians working with medical ultrasound systems. The UltraTrainer replaces probe and patient by a magnetical tracking system and 3D-data from a real examination, which are registered with a phantom. In this way the UltraTrainer makes a simulation of the real ultrasound examination possible, which can be useful for students and physicians. This paper describes the system components and gives an overview of potential applications.

Computer Simulation↗
PubMed1978

Medication delivery time requirements in centralized and decentralized unit dose drug distribution systems.

Medication delivery time requirements in centralized and decentralized unit dose drug distribution systems were compared. Four stages in the receipt of medication orders and the delivery of doses were identified, and the time required to perform each stage was recorded by pharmacist observers for seven days in each system. In the centralized system, it required 138--220 minutes to deliver doses after orders were ready to be collected at the nursing station, with the time varying according to order type. The same cycle required 1--40 minutes in the decentralized system. Delays in medication delivery were shorter in the decentralized system.

Georgia↗
PubMed2005

mobilePDR: a mobile medical information system featuring update via Internet.

This paper presents an analysis of usability of mobile prescription reference systems in medical practice, and presents implementation of mobilePDR (Physician's Desk Reference). Various aspects of mobilePDR are discussed: main functions, information content, performance and design issues, independent evaluation with other similar tools, and lessons learned from the system development.

Computers, Handheld↗
PubMed2002

Electrocardiographic electrodes provide the same results as expensive special sensors in the routine monitoring of anesthetic depth.

UNLABELLED: The Bispectral Index (BIS) is a mathematically derived electroencephalographic (EEG) derivative that has been introduced to monitor depth of anesthesia (1,2). The A-2000 BIS monitoring system (Aspect Medical Systems, Inc., Newton, MA) is currently the only commercially available system to monitor depth of anesthesia. In several studies, its propensity to optimize the use of hypnotics to maintain and achieve a certain depth of anesthesia has been described (3,4). Some studies have even proposed that the routine use of the monitoring system can decrease awareness (1,5), an increasing factor in malpractice claims. The cost-benefit calculations for BIS monitoring suffer from the fact that like its predecessor, the 1000-A BIS monitor, the A-2000 BIS monitoring system demands the use of expensive, special electrodes (6). Although the application of the single-use BIS sensor is very comfortable and easy to use, its high price of approximately $10-20 US prevents many anesthesiologists from using it. Furthermore, whereas the former model of the monitor (1000-A BIS monitor; Aspect Medical Systems, Inc.) used standardized connectors, which allowed the use of other electrodes such as electrocardiogram (ECG), the new monitoring system makes this very difficult because of special connectors that match the equivalent connector at the proximal BIS sensor site. The purpose of this prospective study was to compare BIS values derived from the original BIS sensor with BIS values derived from commercially available ECG electrodes. This comparison was made possible by designing and manufacturing a connector allowing the use of ECG electrodes. IMPLICATIONS: The Bispectral Index (BIS) monitor adequately monitors depth of anesthesia. The routine use of this monitor has been hampered by the benefit-cost equation because only special expensive electrodes can be used. We examined the agreement of BIS values obtained by original sensor electrodes and commercial electrocardiogram (ECG) electrodes. These ECG electrodes can replace more expensive BIS sensors.

Anesthesia, General↗
PubMed1998

[Concept of acceptable risk in space flight medical support system].

The concept of acceptable risk is considered in the context of the system of medical support to space missions. Risk is defined as probability of cosmonaut's health and life deterioration as a result of spaceflight impacts on the human body. Mathematical formulas giving the general characteristic of the relations among risk components, total risk, and human survivability in flight and after its end. The earlier published quantitative recommendations for these parameters are inserted as illustration.

Ecological Systems, Closed↗
PubMed1984

Behavioral convergence and institutional separation: an analysis of plural medicine in Sri Lanka.

In Sri Lanka, as in India, two formally structured systems of medical service exist side-by-side. While Western-style biomedicine is believed to be useful, Ayurvedic medicine is also well established and commonly used. Underlying one explanation for the existence of plural medical systems is the idea that traditional and Western systems of medicine provide unique treatments for distinct problems, and patients having certain characteristics select them accordingly. A brief review of several studies in Sri Lanka suggest, however, that Western and Ayurvedic physicians practice medicine in similar ways, are selected for treatment of very similar symptoms, and from the patient's point of view are often indistinguishable from each other. A second structural explanation rests on the fact that, as institutions, Western and Ayurvedic medicine have effectively divided up territory and jobs to the satisfaction of each; this division allows for upward mobility, through medicine, for young people from different segments of society. Thus these medical systems persist, not because each provides something unique for patients, but because they provide access to status and power for the physicians themselves.

Delivery of Health Care↗
PubMed2003

Is the medical justice system broken?

The current lawsuit culture is creating a crisis in US health care. The broad perception that anyone can sue for almost anything has fundamentally altered the practice of medicine, eroding the quality and availability of health care. Current reform proposals to "cap" one category of damages are not nearly ambitious enough. Providing relief to doctors squeezed by insurance premiums is important but will not heal the deep distrust that skews daily decisions, nor will it provide incentives to overhaul outdated practices. The United States needs an entirely new system of medical justice. Its first goal is to be reliable: reliable in protecting patients against bad practices, reliable in protecting physicians who act reasonably, and reliable in interpreting standards of care.

Culture↗