The effect of an emergency department clinical “triggers” program based on abnormal vital signs

AbstractObjectiveTo determine the effect of a clinical triggers program in the Emergency Department (ED) setting that utilized predetermined abnormal vital signs to activate a rapid assessment by an emergency physician led multidisciplinary team.MethodsA retrospective, separate sample, pre-post intervention study following implementation of an ED triggers program. Abnormal vital sign criteria that warranted a trigger response included: heart rate <40 or >130 beats/min, respiratory rate <8 or >30 respirations/min, systolic blood pressure <90 mm Hg, or oxygen saturation <90% on room air. The primary outcome investigated was time to physician evaluation with secondary outcomes being the time to disposition decision and time to first critical therapeutic intervention.ResultsThe median time to physician evaluation was reduced by 25% from 28 min to 21 min (P<0.05). The median time to disposition decision was decreased by 12% from 154 minutes to 135 minutes (P<0.05). The median time to first intervention was 46 min and 43 min (P=0.33) in the before and after groups, which did not represent a statistically significant difference.ConclusionsIn our model, the implementation of an ED triggers program resulted in a modest decreased time to physician evaluation and disposition decision but not time to intervention

Design point performance and optimization of humid air turbine power plants

With the recent drive towards higher thermal efficiencies and lower emission levels in the power generation market, advanced cycle power plants have become an increasingly appealing option. Among these systems, humid air turbines have been previously identified as promising candidates to deliver high efficiency and power output with notably low overall system volume, weight and emissions footprint. This paper investigates the performance of an advanced humid air turbine power cycle and aims to identify the dependencies between key cycle design variables, thermal performance, weight and cost by means of a parametric design optimization approach. Designs of the main heat exchangers are generated, aiming to ascertain the relationship between their technology level and the total weight and acquisition cost of them. The research outcomes show that the recuperator and the intercooler are the two components with the largest influence on the thermal efficiency and the total cost. The total weight of the power system is driven by the technology level of the recuperator and the economizer. Finally, the effectiveness of the aftercooler seems to have the greatest impact in reducing the total acquisition cost of the system with minimum penalty on its thermal efficiency

Prevalence of infection with high-risk human papillomavirus in women in Colombia

AbstractThe prevalence of human papillomavirus (HPV) infections in 2109 females inhabiting five cities of Colombia was determined. Of the 49.2% with an HPV infection, 59.8% were infected with more than one viral type. Species 7 (of the the genus Alphapapillomavirus) was associated with multiple infections. Analysis of the socio-demographic data revealed a statistically significant protective effect associated with the status of civil union (civil recognition of cohabitation without marriage), and indigenous ethnicity proved to be a risk factor for HPV infection. This is the first study comparing HPV infection among women from geographical regions of Colombia with different socio-cultural structures

Eliminating Amylase Testing from the Evaluation of Pancreatitis in the Emergency Department

Background: Alterations in serum biomarkers have been used to evaluate for pancreatitis in the emergency department (ED). Studies have shown lipase to be as sensitive and more specific than amylase in diagnosing pancreatitis and that amylase plus lipase does not improve accuracy over lipase alone.Objective: To determine effects of interventions to decrease ordering of amylase in the evaluation of pancreatitis.Methods: We conducted a pre- and post-cohort study. The number of amylase and lipase tests ordered in the ED was recorded prior to intervention to establish a baseline. We introduced an educational intervention to order lipase without amylase. A second intervention involved removing amylase from bedside order entry forms. We introduced a third intervention that included deleting amylase from trauma order forms, and decoupling amylase and lipase in the computer ordering system. We recorded the number of lipase and amylase tests in weekly aggregates for comparison to the baseline. Data analysis using students t-test, standard deviation and p values are reported.Results: Before interventions 93% of patients had both tests ordered. Educational interventions resulted in a decrease to 91% (p=0.06) of co-ordering. Further interventions decreased the percentage of patients evaluated with both tests to 14.3%. This translates into a decrease in patient charges of approximately $350,000 a year.Conclusion: Using simple structured interventions in the ED can reduce amylase ordering. Educational programming alone was not effective in significantly decreasing amylase ordering; however, education plus system-based interventions decreased amylase ordering. [West J Emerg Med. 2010; 11(4):344-347.

Ophthalmologic Procedures in the Emergency Department

Ophthalmologic emergencies account for up to 3% of visits to emergency departments in the United States Visual acuity testing A simple but vital part of the ophthalmologic examination is a test of visual acuity. This is essential for all patients who have ocular or visual complaints. The affected and non-affected eyes should be tested individually, and then together, using a Snellen chart or equivalent. If the patient wears corrective lenses during the examination (or is not wearing lenses that are usually used), this should be noted. A critical part of the visual acuity examination is that decreased visual acuity should be rechecked using a pinhole card. A pinhole corrects for most refractive errors, by ensuring that only light striking the lens perpendicularly reaches the retina. Initially abnormal visual acuity that corrects with a pinhole indicates a problem with the lens, and is less concerning to an emergency physician. If this does not correct the visual problems, it indicates pathology that is more likely located within the retina or central nervous system