Pre-hospital management protocols and perceived difficulty in diagnosing acute heart failure

Aim To illustrate the pre-hospital management arsenals and protocols in different EMS units, and to estimate the perceived difficulty of diagnosing suspected acute heart failure (AHF) compared with other common pre-hospital conditions. Methods and results A multinational survey included 104 emergency medical service (EMS) regions from 18 countries. Diagnostic and therapeutic arsenals related to AHF management were reported for each type of EMS unit. The prevalence and contents of management protocols for common medical conditions treated pre-hospitally was collected. The perceived difficulty of diagnosing AHF and other medical conditions by emergency medical dispatchers and EMS personnel was interrogated. Ultrasound devices and point-of-care testing were available in advanced life support and helicopter EMS units in fewer than 25% of EMS regions. AHF protocols were present in 80.8% of regions. Protocols for ST-elevation myocardial infarction, chest pain, and dyspnoea were present in 95.2, 80.8, and 76.0% of EMS regions, respectively. Protocolized diagnostic actions for AHF management included 12-lead electrocardiogram (92.1% of regions), ultrasound examination (16.0%), and point-of-care testings for troponin and BNP (6.0 and 3.5%). Therapeutic actions included supplementary oxygen (93.2%), non-invasive ventilation (80.7%), intravenous furosemide, opiates, nitroglycerine (69.0, 68.6, and 57.0%), and intubation 71.5%. Diagnosing suspected AHF was considered easy to moderate by EMS personnel and moderate to difficult by emergency medical dispatchers (without significant differences between de novo and decompensated heart failure). In both settings, diagnosis of suspected AHF was considered easier than pulmonary embolism and more difficult than ST-elevation myocardial infarction, asthma, and stroke. Conclusions The prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre-hospital conditions

Home-based HIV testing for men who have sex with men in China: a novel community-based partnership to complement government programs.

The coverage of HIV testing among Chinese men who have sex with men (MSM) remains low after the scale-up of free HIV testing at government-sponsored testing sites. We evaluated the feasibility of home-based HIV self-testing and the willingness to be HIV tested at community-based organizations (CBO).We recruited MSM via on-line advertisement, where they completed an on-line informed consent and subsequent questionnaire survey. Eligible MSM received HIV rapid testing kits by mail, performed the test themselves and reported the result remotely.Of the 220 men taking a home-based HIV self-testing, 33 MSM (15%) were seropositive. Nearly 65% of the men reported that they were willing to take HIV testing at CBO, while 28% preferred receiving free HIV testing in the government programs at local Centers for Disease Control and Prevention (CDC). Older and lower-income MSM, those who self-reported homosexual orientation, men with no history of sexually transmitted diseases and a lower number of sexual partners in the past six months were associated with preference for taking HIV testing at CBOs. The top three self-reported existing barriers for HIV testing were: no perception of HIV risk (56%), fear of an HIV positive result being reported to the government (41%), and fear of a positive HIV test result (36%).Home-based HIV self-testing is an alternative approach for increasing the coverage of HIV testing among Chinese MSM. CBO-based HIV testing is a potential alternative, but further studies are needed to evaluate its feasibility

Effects of the intensity of prehospital treatment on short-term outcomes in patients with acute heart failure: the SEMICA-2 study

International audienc

Self-reported barriers for HIV testing among 220 MSM those who took HIV home testing in this study.

<p>Self-reported barriers for HIV testing among 220 MSM those who took HIV home testing in this study.</p

Factors associated with willingness to go to community-based organization (CBO) for taking HIV testing among Chinese men who have sex with men.

<p><b>Note:</b> Numbers in parentheses are percentages. OR: odds ratio; CI: confidence interval; CBO: community-based organization.</p><p>*covariates presented by median and interquartile range;</p>†<p>Adjusted for age and ethnicity;</p>‡<p>Adjusted for age, ethnicity and education;</p>§<p>Adjusted for age, ethnicity, education, sexual orientation, sexual role and self-reported STDs history;</p>¶<p>Adjusted for age, ethnicity, education, sexual orientation, and sexual role;</p>#<p>Sample size is smaller due to missing data;</p><p>**Adjusted for age, ethnicity, and sexual orientation.</p

Self-reported barriers for HIV testing among 495 MSM who took clinic-based testing in a contemporaneous parallel study (Li X, <i>et al</i>[9]).

<p>Self-reported barriers for HIV testing among 495 MSM who took clinic-based testing in a contemporaneous parallel study (Li X, <i>et al</i><a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0102812#pone.0102812-Feng1" target="_blank">[9]</a>).</p

Factors associated with willingness to go to local CDC for taking HIV testing among Chinese men who have sex with men.

<p><b>Note:</b> Numbers in parentheses are percentages. OR: odds ratio; CI: confidence interval; CBO: community-based organization.</p><p>*covariates presented by mean and interquartile range;</p>†<p>Adjusted for age and ethnicity;</p>‡<p>Adjusted for age, ethnicity and education;</p>§<p>Adjusted for age, ethnicity, education, sexual orientation, sexual role and self-reported STDs history;</p>¶<p>Adjusted for age, ethnicity, education, sexual orientation, and sexual role;</p>#<p>Sample size is smaller due to missing data;</p><p>**Adjusted for age, ethnicity, and sexual orientation.</p

Socio-demographic characteristics and sexual behaviors among Chinese men who have sex with men who took HIV home testing.

<p><b>Note:</b> Numbers in parentheses are percentages. IQR-interquartile range.</p>†<p>Chi-square test;</p>‡<p>Satterthwaite approximation t-test;</p>§<p>Smaller sample size due to missing data.</p