Practical Emergency Ultrasound Flashcards with Augmented Reality in Teaching Point-of-Care Ultrasound in ER

BACKGROUND: The use of point-of-care ultrasound (POCUS) has recently proposed the integration of ultrasound into undergraduate medical education. However, the evidence of learning tool for this integration has not been well studied. AIM: The aim of this study was to compare the levels of knowledge improvement of the 6th year medical students before and after receiving the POCUS training in two ways: By employing the traditional methods and by utilizing the new learning tool. METHODS: The practical ultrasound flashcards were developed by a Thai physician. In the study, the 6th year medical students were enrolled and randomized to become members of either the flashcard group or the control group. Participants in both groups attended a 4-week ultrasound training course. Before and after the training course, all students were evaluated using the multiple-choice questions. In addition, the subjects’ attitudes and perceptions about the flashcards were evaluated using a questionnaire. RESULTS: A total of 46 students participated in this study and were randomly assigned to either the flashcard group (n = 23) or the control group (n = 23). It was discovered that the students in the flashcard group had performed better on the POCUS knowledge post-test than those in the control group had. Most students had been satisfied with the flashcards (mean 5 Likert scores = 4.48). However, the students had rated their confidence score to perform POCUS at 3.96 out of 5.0. CONCLUSIONS: Medical students who used the ultrasound flashcards to learn POCUS had resulted in better knowledge scores rather than the others who attended the standard ultrasound training course only. However, it was not possible to evaluate the practical skills and the clinical decision-making processes in this study

Use of a Motorlance to Deliver Emergency Medical Services; a Prospective Cross Sectional Study

Introduction: Access time to patients with critical or emergent situations outside the hospital is a critical factor that affects both severity of injury and survival. This study aimed to compare the access time to the scene of an emergency situation between a traditional ambulance and motorlance. Methods: This prospective cross sectional study was conducted on all users of emergency call, Srinagarind Hospital, Thailand, from June to December 2018, who received a registration number from the command center. Results: 504 emergency-service operations were examined over a six-month period, 252 (50%) of which were carried out by motorlance. The mean activation time for motorlance and ambulance were 0.57 ± 0.22 minutes and 1.11 ± 0.18 minutes, respectively (p<0.001). Mean response time for motorlance was significantly lower (5.57 ± 1.21 versus 7.29 ± 1.32 minutes; p < 0.001). The response times during 6 a.m. to 6 p.m. were 5.26 ± 1.11 minutes for motorlance and 7.15 ± 1.39 minutes for ambulance (p < 0.001). These measures for night time (6 p.m. to 6 a.m.) were 5.58 ± 1.21 minutes and 8.01 ± 1.30 minutes, respectively (p < 0.001). The mean automated external defibrillator (AED) waiting time for motorlance and ambulance were 5.26 ± 2.36 minutes and 9.24 ± 3.30 minutes, respectively (p = 0.012). The survival rate of patients after AED use in motorlance and ambulance was 80% versus 37.5%; p<0.001. Conclusion: Emergency service delivery by motorlance had lower mean activation time, response time, AED time, and mortality rate of cardiac arrest patients compared to ambulance. It seems that motorlance could be considered as an effective and applicable device in emergency medical service delivery, especially in crowded cities with heavy traffic

Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension

Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework

Clinical treatment outcomes of hypertensive emergency patients: Results from the hypertension registry program in Northeastern Thailand

Abstract Hypertensive emergency care is a challenge in clinical practices due to vital organ complications that may lead to unfavorable outcomes if left untreated. The objectives of this study were to determine the prevalence, clinical characters, treatment, and outcomes of hypertensive emergency patients. A retrospective cohort study was conducted at a university hospital in Northeast Thailand from January 2016 to December 2019. Hypertensive crises patients were consecutively registered to the Hypertension Registry Program. There were 263 674 patients who were admitted to the ER, 60,755 of whom had BP ≥ 140/90 mm Hg and 1,342 of whom were diagnosed with a hypertensive emergency (127 per 100 000 patient‐year). The mean age was 66 years old, and 52.1% of the registered patients were men. The most common target organ damage was caused by stroke (49.8%), followed by acute heart failure (19.3%), and then by acute coronary syndrome (6.5%). Intravenous antihypertensive medication was given in 42.1% of the patients, and 80% were admitted to the hospital. The in‐hospital mortality rate was 1.6%. In conclusion, hypertensive emergencies were not uncommon among the emergency patients. Strokes caused the most common target organ damage. Although there was a high hospital admission rate, the mortality rate was low

The effect of pursed‐lip breathing combined with number counting on blood pressure and heart rate in hypertensive urgency patients: A randomized controlled trial

Abstract Hypertensive urgency (HT urgency) is an alarming sign of uncontrolled hypertension. It is aggravated by nonadherence to medication, as well as psychosocial stress. Mindfulness is beneficial for reducing stress, while deep and slow breathing is effective for lowering blood pressure (BP). In our study, we aimed to assess BP and heart rate effects in HT urgency patients practicing pursed‐lip breathing and number counting (PLB with NC)—a practice that promotes mindfulness with deep/slow breathing patterns. In a randomized controlled trial, 110 patients were equally allocated to intervention and control groups. The intervention group was trained and encouraged to do PLB with NC during their emergency room admission, while the control group received conventional medical care. The mean systolic BP (SBP), diastolic BP (DBP), and HR of the intervention group in the 3rd hour were significantly lower than the baseline values at −28.2 mm Hg (95%CI;‐23.5 to −32.4), −17.1 mm Hg (95%CI;‐14.2 to −20.0), and −4.9 beats per minute (bpm) (95%CI;‐4.0 to −5.8), respectively. In the control group, both the mean SBP and DBP were also significantly lower in the 3rd hour. However, HR reduction was inconclusive. When the two groups were compared, a greater degree of reduction was found in the intervention group for SBP (9.80 mm Hg, 95%CI; 4.10 to 15.50), DBP (7.69 mm Hg, 95%CI; 3.61 to 11.77), and HR (3.85 bpm, 95%CI; 1.99 to 5.72). In conclusion, PLB with NC was effective for lowering BP and HR. It might be used as a complementary treatment for HT urgency patients

The effect of mountaineering on the association between blood pressure and physical activity: A new multi‐sensor ambulatory blood‐pressure monitoring device. The Mount Fuji Study

Abstract It has not been fully investigated whether the response of blood pressure (BP) to activity at high altitudes differs from that at low altitudes or how temperature is involved in these differences. The author compared BP response to accelerometer measurements during mountaineering and daily living. In 15 healthy people (mean age 33 ± 6 years), a new multi‐sensor ambulatory BP monitoring (ABPM) device equipped with barometer, thermometer, and accelerometer was used to measure BP responses to activity during a trip to Mt. Fuji and during daily living. Associations between physical activity (log‐transformed 5‐min average values of accelerometer just before each ambulatory BP) and the corresponding BP were obtained from 843 and 676 readings during the Mt. Fuji trip and daily living, respectively. All ambulatory systolic BP (SBP) parameters were significantly higher during the Mt. Fuji trip than during daily living (all p < .01). There were significant positive correlations between physical activity and corresponding BPs in both mountaineering and daily living (all p < .01), and there was an interaction between BPs and physical activity according to the two conditions (p < .01). On Mt. Fuji, multivariate regression analysis showed increased physical activity and lower temperature were associated with increased 24‐h SBP and diastolic BP (DBP) (all p < .05). The goodness‐of‐fit values of the association between activity and 24‐h SBP or DBP were improved by adding temperature to the model of both 24‐h SBP and DBP. However, these associations were not found in the daily living model. BP response to activity was more pronounced during mountaineering than daily living

The effects of foot reflexology on blood pressure and heart rate: A randomized clinical trial in stage‐2 hypertensive patients

Abstract Hypertension (HT) is a prominent cardiovascular risk factor. Although there are various pharmacological treatment choices for this condition, many patients fail to adhere to them, making non‐pharmacological options attractive alternatives. Foot reflexology has been proven to decrease blood pressure (BP), but data are limited in patients with stage‐2 HT. We conducted a randomized clinical trial to examine the effectiveness of foot reflexology in reducing BP and heart rate (HR). Stage‐2 HT patients were enrolled and randomized into the intervention and the control groups (n = 47, each), the former of which underwent foot reflexology during a follow‐up visit. Office BP and HR were measured before and at 15 and 30 min after the procedure in the intervention group and after resting in the control group. In the intervention group, systolic BP (SBP), diastolic BP (DBP), and HR at 15 min were significantly lower than at baseline: −3.29 mm Hg (95%CI; −5.64 to −0.93), −1.71 mm Hg (95%CI; −3.11 to −0.32), and −1.71 beats per min (bpm; 95%CI; −2.88 to −0.54), respectively. Similar trends were also observed at 30 min. However, when compared with the control group, only the reduction in HR was significant (−4.96 bpm; 95%CI, −9.63 to −0.28). We conclude that foot reflexology was effective in reducing HR in stage‐2 HT patients and partially effective in reducing BP

Hypertensive emergencies in Asia: A brief review

Abstract Hypertensive emergency is one of the most challenging conditions to treat in the emergency department (ED). From previous studies, about 1%–3% of hypertensive individuals experienced hypertensive emergencies. Its prevalence varied by country and region throughout Asia. Asian populations have more different biological and cultural backgrounds than Caucasians and even within Asian countries. However, there is a scarcity of research on clinical features, treatment, and outcomes in multinational Asian populations. The authors aimed to review the current evidence about epidemiology, clinical characteristics and outcomes, and practice guidelines in Asia. Five observational studies and nine clinical practice guidelines across Asia were reviewed. The prevalence of hypertensive emergencies ranged from .1% to 1.5%. Stroke was the most common target organ involvement in Asians who presented with hypertensive emergencies. Although most hypertensive emergency patients required hospitalization, the mortality rate was low. Given the current lack of data among Asian countries, a multinational data repository and Asian guidelines on hypertensive emergency management are mandatory