Emergency medical services key performance measurement in Asian cities

10.1186/s12245-015-0062-7International Journal of Emergency Medicine8

Effect of alcohol use on emergency department length of stay among minimally injured patients based on mechanism of injury: multicenter observational study

Objective This study aimed to evaluate the effect of alcohol use on emergency department (ED) length of stay (LOS) among minimally injured patients by mechanism of injury. Methods This was a retrospective study of injury surveillance data for injured patients (except poisoning), aged over 18 years, discharged home from the ED, and treated at seven academic EDs in Korea during 2008 to 2012. Patients were divided into alcohol-related and alcohol-unrelated groups based on self-report. We used multivariable quantile regression models for the analysis and adjusted covariates including age, sex, consciousness status, severity of injury, emergency medical service use, the season, day and time of visit, and hospital. To determine if there were different effects of alcohol use across mechanism of injury, all analyses were stratified by each mechanism. Results Among 192,200 patients, 95,807 patients were analyzed. The number of participants in the alcohol-related group was 16,249 (17.0%). In the multivariable quantile regression model, the alcohol-related group had significantly longer ED LOS at the 10th (7 minutes; 95% confidence interval [CI], 6 to 8), 50th (21 minutes; 95% CI, 19 to 23), and 90th (81 minutes; 95% CI, 74 to 87) percentiles when compared to the alcohol-unrelated group. The effect of alcohol use on increased ED LOS was most prominent in motor vehicle injuries. Conclusion We found that alcohol use was associated with increased emergency ED LOS. Furthermore, if we limited our attention to the effect of alcohol use on the number of patients, the burden of alcohol use on the ED would have been underestimated

Early Results from Posterior Cervical Fusion with a Screw-Rod System

PURPOSE: We performed 65 cases of posterior fusion surgery for cervical and/or high thoracic lesions using a polyaxial screw-rod system. PATIENTS AND METHODS: A total of 486 screws were implanted in 65 patients. RESULTS: Fixation of the screws was carried out over an average of 2.9 spinal segments. Upon evaluation by postoperative CT scans, twelve (2.5%) screws had suboptimal trajectories but two of these revealed radiculopathy in one patient and required screw repositioning. No vascular sequelae resulted. There has been no segmental motion in any of the cases to date. As for other complications, there was one case of dural tearing and two cases of lateral mass fractures. There were no infections or other wound healing problems or hardware failures. No patients had neurological deterioration after surgery. There were statistically significant improvements in the mean Neck Disability Index (NDI) scores and Visual Analogue Scale (VAS) scores in the preoperative and late postoperative follow-up evaluations. Although further studies are required to establish the long-term results of fusion rates and clinical outcomes. CONCLUSION: We cautiously suggest that the posterior polyaxial screw-rod system can be safely used as a primary or additional fusion method in this risky region. The successful and safe use of this method is dependent on a precise preoperative surgical plan and tactics for ensuring safe screw fixation.ope

Temporal Trends of Emergency Department Visits of Patients with Atrial Fibrillation:A Nationwide Population-Based Study

The question of list decoding error-correcting codes over finite fields (under the Hamming metric) has been widely studied in recent years. Motivated by the similar discrete linear structure of linear codes and point lattices in R N, and their many shared applications across complexity theory, cryptography, and coding theory, we initiate the study of list decoding for lattices. Namely: for a lattice L ⊆ R N, given a target vector r ∈ R N and a distance parameter d, output the set of all lattice points w ∈ L that are within distance d of r. In this work we focus on combinatorial and algorithmic questions related to list decoding for the well-studied family of Barnes-Wall lattices. Our main contributions are twofold: 1. We give tight (up to polynomials) combinatorial bounds on the worst-case list size, showing it to be polynomial in the lattice dimension for any error radius bounded away from the lattice’s minimum distance (in the Euclidean norm). 2. Building on the unique decoding algorithm of Micciancio and Nicolosi (ISIT ’08), we give a list-decoding algorithm that runs in time polynomial in the lattice dimension and worst-case list size, for any error radius. Moreover, our algorithm is highly parallelizable, and with sufficiently many processors can run in parallel time only poly-logarithmic in the lattice dimension. In particular, our results imply a polynomial-time list-decoding algorithm for any error radius bounded away from the minimum distance, thus beating a typical barrier for natural error-correcting codes posed by the Johnson radius

Spinal Cord Tumors of the Thoracolumbar Junction Requiring Surgery: A Retrospective Review of Clinical Features and Surgical Outcome

PURPOSE: A retrospective review of medical records and imaging studies. To investigate characteristic clinical features and surgical outcomes of spinal cord tumors (SCTs) of the thoracolumbar junction (TLJ). The spinal cord transitions to the cauda equina in the TLJ. The TLJ contains the upper and lower motor neurons of the spinal cord and cauda equina. As a result, the clinical features of lesions in the TLJ vary, and these anatomical characteristics may affect surgical outcome. MATERIALS AND METHODS: Pathological diagnosis, clinical features, neurological signs, and surgical outcomes were investigated in 76 patients surgically treated at our institute for SCTs arising from T11 to L2. The patients were divided into epiconus (T11-12, n=18) and conus groups (L1-2, n=58). RESULTS: Patients in the epiconus group had hyperactive deep tendon reflexes (DTRs), while those in the conus group had hypoactive DTRs (p < 0.05). Nine patients were misdiagnosed with intervertebral disc diseases (IVDs) before correct diagnoses were made. It was impossible to definitively determine the exact cause of symptoms in four patients who had both SCTs and IVDs. CONCLUSION: Among SCTs of the TLJ, the epiconus group displayed upper motor neuron syndrome and the conus group displayed lower motor neuron syndrome. SCTs of the TLJ were frequently misdiagnosed as IVDs due to symptomatic similarities. SCTs of the TLJ should be included in differential diagnosis of back and leg pain, and it is highly recommended that routine lumbar magnetic resonance imaging include the TLJ.ope

Evaluation of demands, usage and unmet needs for emergency care in Yaoundé, Cameroon: a cross-sectional study.

OBJECTIVES: To assess the burden of emergent illnesses and emergency care system usage by Yaoundé residents and to evaluate unmet needs for emergency care and associated barriers. DESIGN: A cross-sectional study using a community-based survey. SETTING: Yaoundé, Cameroon. PARTICIPANTS: All residents living in Yaoundé were selected as the target population to investigate the needs and usage of emergency care in Yaoundé. 14 households in every health area (47 in total) were selected using 2-stage sampling. PRIMARY OUTCOME MEASURES: Unmet needs for emergency care. RESULTS: Among the 3201 participants from 619 households who completed the survey, 1113 (34.8%) with median age of 22 experienced 1 or more emergency conditions in the previous year. Respondents who experienced emergency conditions used emergency units (7.0%), outpatient clinics (46.5%) or hospitalisation (13.0%), and in overall, 68.8% of them reported unmet needs for emergency care. The primary reasons for not seeking healthcare were economic issues (37.2%) and use of complementary medicine (22.2%). Young age (adjusted OR (95% CI) 1.80 (1.23 to 2.62)), rental housing (1.50 (1.11 to 2.03)) and moderate household income (0.60 (0.36 to 0.99)) were associated with unmet needs for emergency care. CONCLUSIONS: Residents of Yaoundé had a high demand for emergency care, and high unmet needs were observed due to low emergency care usage. Development of a cost-effective, universal emergency care system is urgently needed in Cameroon

Duplication of the Extrahepatic Bile Duct in Association with Choledocholithiasis as Depicted by MDCT

We report here on an extremely rare case of duplicated extrahepatic bile ducts that was associated with choledocholithiasis, and this malady was visualized by employing the minimum intensity projection images with using multi-detector row CT. The presence of duplicated extrahepatic bile ducts with a proximal communication, and the ducts were joined distally and they subsequently formed a single common bile duct, has not been previously reported