Study rationale and design of OPTIMISE, a randomised controlled trial on the effect of benchmarking on quality of care in type 2 diabetes mellitus

BACKGROUND: To investigate the effect of physician- and patient-specific feedback with benchmarking on the quality of care in adults with type 2 diabetes mellitus (T2DM). METHODS: Study centres in six European countries were randomised to either a benchmarking or control group. Physicians in both groups received feedback on modifiable outcome indicators (glycated haemoglobin [HbA1c], glycaemia, total cholesterol, high density lipoprotein-cholesterol, low density lipoprotein [LDL]-cholesterol and triglycerides) for each patient at 0, 4, 8 and 12 months, based on the four times yearly control visits recommended by international guidelines. The benchmarking group also received comparative results on three critical quality indicators of vascular risk (HbA1c, LDL-cholesterol and systolic blood pressure [SBP]), checked against the results of their colleagues from the same country, and versus pre-set targets. After 12 months of follow up, the percentage of patients achieving the pre-determined targets for the three critical quality indicators will be assessed in the two groups. RESULTS: Recruitment was completed in December 2008 with 3994 evaluable patients. CONCLUSIONS: This paper discusses the study rationale and design of OPTIMISE, a randomised controlled study, that will help assess whether benchmarking is a useful clinical tool for improving outcomes in T2DM in primary care. TRIAL REGISTRATION: NCT00681850.Cardiovasc Diabeto

Impact of antidote quantity, timing and prehospital strategies in nerve agent mass casualty events: a simulation study

IntroductionMass casualty incidents (MCIs) involving nerve agents pose major challenges for emergency medical response due to rapid symptom onset, hazardous environments, and operational uncertainties. Several gaps remain in the knowledge about the prehospital response to nerve agent MCI treatment strategies and logistical decision-making. To address these gaps, this study uses Discrete Event Simulation to evaluate the impact of advanced medical stabilization (AMS) team arrival time, antidote availability, and evacuation policy on patient survival during an urban chemical-traumatic MCI with a subway sarin release scenario.MethodsA validated simulation model (SIMEDIS) was adapted to represent the full prehospital response chain, including triage, antidote administration, AMS, dry decontamination, further on-site stabilization in the forward medical post and transport to categorized hospitals. Two transport policies were modeled: Scoop&Run (rapid transport of victims to hospitals) and Stay&Play (on-site stabilization before transport). We simulated various AMS team arrival times and antidote availability scenarios to assess their impact on survival. Locations of deaths were analyzed to identify critical points of failure in the medical response chain.ResultsAMS team arrival time, antidote availability, and evacuation policy significantly influenced mortality among the 25 salvageable victims. The number of deaths ranged from 8.0 (32%) in the most favorable case to 23.8 (95.2%) in the least favorable. Earlier AMS team arrival and greater antidote availability were associated with fewer deaths, particularly under the Scoop&Run policy. Stay&Play resulted in more deaths unless medical and transport capacity were significantly enhanced. Location-of-death analysis revealed preventable bottlenecks, especially during decontamination and hospital transport under the Stay&Play model.DiscussionThe results highlight the importance of rapid hospital transport, swift antidote availability and administration during urban chemical MCIs. AMS team arrival time emerged as the strongest predictor of preventable mortality, showing a sigmoid-shaped curve where delays beyond 11 min led to sharp increases in death. Antidote supply showed a dose-dependent effect, but the impact diminishes with delayed administration, underscoring the need for timely delivery over sheer volume. To reduce preventable deaths in chemical MCIs, policy makers should focus on streamlining AMS team deployment, prioritizing rapid evacuation, and addressing logistical bottlenecks in decontamination and transport

Family Relationship, Water Contact and Occurrence of Buruli Ulcer in Benin

Mycobacterium ulcerans disease (Buruli ulcer) is the most widespread mycobacterial disease in the world after leprosy and tuberculosis. How M. ulcerans is introduced into the skin of humans remains unclear, but it appears that individuals living in the same environment may have different susceptibilities. This case control study aims to determine whether frequent contacts with natural water sources, family relationship or the practice of consanguineous marriages are associated with the occurrence of Buruli ulcer (BU). The study involved 416 participants, of which 104 BU-confirmed cases and 312 age, gender and village of residence matched controls (persons who had no signs or symptoms of active or inactive BU). The results confirmed that contact with natural water sources is a risk factor. Furthermore, it suggests that a combination of genetic factors may constitute risk factors for the development of BU, possibly by influencing the type of immune response in the individual, and, consequently, the development of BU infection per se and its different clinical forms. These findings may be of major therapeutic interest

Identification of Indicators for the Evaluation of Health Disaster Management Interventions during the Relief Phase: Scoping Review of the Peer-Reviewed Literature

Introduction: Disasters have existed for many ages and although they are known to threaten health, there is still lack of evidence regarding the effectiveness of health disaster response interventions. Indicators are primordial for the evaluation of such interventions. The main objective of this study was to map the output, outcome and impact indicators used to evaluate health interventions in disasters and to identify gaps in the existing peer-reviewed literature. Methods: A scoping review of the peer-reviewed literature was performed. Scopus, Web of Science and Pubmed were the 3 databases in which the search was launched. All references published in the peer-reviewed literature in English, Dutch or French since 1990 were eligible for inclusion if they met all the inclusion criteria. Characteristics of the studies, the interventions and indicators identified were charted. Interventions were categorized using an extraction template. Results: A total of 8329 articles were identified. After removal of duplicates, 5578 unique studies were screened of which 56 met all inclusion criteria. The selected articles contained 86 interventions and 1387 indicators which could be grouped into 619 unique indicators. Of these indicators the majority were output indicators (70,8%). Of the remaining indicators 28,8% were outcome indicators and only 2 (0,3%) were impact indicators. For almost half (47,7%) of the interventions, no outcome or impact indicators were identified. The highest proportions of outcome indicators were found in medical care interventions and overall response interventions. Conclusion: This scoping review identified the existence of many indicators, however most of them were output indicators. In order to generate evidence on the effectiveness of interventions, the priority should lie on determining outcome and impact indicators. If health disaster management wants to become a scientific discipline, several steps must be undertaken. First, there is an urgent need for the standardization of definitions and the development of a glossary. Second, the identification of indicators should begin with the determination of interventions needed in disaster response after which systematic scoping reviews should be performed in order to identify the most appropriate indicators. Lastly, data collection should be standardized, and a universally accepted reporting template should be implemented. [SJEMed 2024; 5(1.100): S74-S74

The use of ultrasound by emergency medicine teams after earthquakes: a scoping review

Introduction: Earthquakes can have a significant impact on imaging modalities available in the surrounding hospitals. Ultrasound can offer several advantages in earthquake response scenarios but is underrepresented in the bibliometric analysis on imaging modalities after earthquake. This scoping review aims to analyse the gap in literature by examining the possible roles of ultrasound during different timeframes after an earhtquake. Methods: A scoping review was carried out using the PRISMA method searching Pubmed, Scopus and Web of Science. Grey literature was searched and snowballing was performed on the reference list. Results were extracted into 3 time cathegories for use during the first 72 hours after, during the first 6 weeks after, and follow up of patients during the years after the earthquake. Results: A total of 13034 studies were put into COVIDENCE TM, 69 references were found in Grey literature, 24 articles were witheld for extraction. Limitations: Articles were excluded based on language exclusion criteria so valuable information may be missing from the final selection. Discussion: During the first 72 hours after the earthquake ultrasound has been proven usefull for IO placement during rescuscitation, triaging patiens using Focussed Assessment with Sonography in Trauma, diagnosis of rhabdomyalisis and nerve injuries, evaluation of the need for renal replacement therapy, regional anesthesia through ultrasound guided nerve blocks and ultrasound guided procedures like evacuation of abcedations. During the first 6 weeks after the earthquake it can be primarily used in the hospital for regional anesthesia and procedures, and in remote shelters for Deep Venous Trombosis screening. In the years after the earhtquake the main use is follow up of stress cardiomyopathy and nerve injuries. Conclusion: Ultrasound has demonstrated diverse applications, ranging from triaging patients, detecting injuries, guiding procedures, and providing long-term follow-up. Its portability, real-time visualization, and rapid accessibility make it a valuable tool in resource-constrained and post-disaster settings. [SJEMed 2024; 5(1.100): S72-S72