Clinical handover between paramedics and emergency department staff: SBAR and IMIST-AMBO acronyms

This document is the Accepted Manuscript version of a Published Work that appeared in final form in International Paramedic Practice, copyright © MA Healthcare, after peer review and technical editing by the publisher. To access the final edited and published work [Yousaf Shah, Guillaume Alinier, & Yugan Pillaysee, ‘Clinical handover between paramedics and emergency department staff: SBAR and IMIST-AMBO acronyms’, International Paramedic Practice, Vol 6(2): 37-44, June 2016 http://www.magonlinelibrary.com/doi/abs/10.12968/ippr.2016.6.2.37Clinical handover at the paramedic/emergency department (ED) interface is a potentially critical episode in the patient care journey, as omission of information can adversely affect subsequent actions and the treatment provided in the ED. Standardisation of the handover contents and processes has shown to prevent errors and omissions and improve the handover process. This review article explores two handover tools, SBAR* and IMIST-AMBO**, both of which have been used to standardise handover contents at the paramedic/ED interface. IMIST-AMBO provides an explicit structure to handover that is concise, complete, tailored to paramedic-ED interface, and that also aligns with the general informational expectations of ED staff. SBAR is more widely used but less specific. Further research work is needed to compare them and understand their acceptability and acceptance by different global health systems, considering environmental and cultural factors. Training requirements to ensure their respective correct implementation also need to be determined for evidence-based recommendations to be made to the various emergency services stakeholders. *SBAR stands for Situation, Background, Assessment, and Recommendation. **IMIST-AMBO stands for Identification/Introduction, Mechanism of Injury/Medical complaint, Injuries/Information related to the complaint, Signs and Symptoms, Treatment given/Trends noted, Allergies, Medications, Background history, Other information.Peer reviewe

Satire and Humor in V. I. Dahl’s Popular Books

В статье представлены исследования в области комедийной поэтики сборников В. И. Даля «Солдатские досуги», «Матросские досуги», «Два сорока бывальщинок для крестьян». Здесь выявляются фольклорные и литературные источники комизма, проводятся параллели между далевскими сюжетами и пословичным, сказочным материалом. Писатель прибегает к комическому изображению жизненных событий для показания неприемлемости некоторых стереотипов поведения, просвещения и лёгкого усвоения информации военно¬служащими.The article presents a study of comic poetry collections by Vladimir Dal’ «Soldiers’ spare time», «Sailors’ spare time» and the series «The two forty stories for peasante». It identifies folklore and literature of comedy, and draws a parallel with proverbs and fairy-tale material. The writer uses the comic to events for the image reading unacceptability of certain stereotypes, educating and easy assimilatijn of information by military personnel

The role of carcinoembryonic antigen in predicting colorectal cancer in resource poor setting of Kwazulu-Natal, South Africa.

Masters Degree. University of KwaZulu-Natal, Durban.Background: Colorectal cancer (CRC) is the fourth most common malignancy in South Africa. Currently the most reliable screening tool, colonoscopy, is not readily accessible in resource-deprived settings of KwaZulu-Natal. The aim of this study was to determine whether serum CEA levels in patients symptomatic for lower GI pathology correlates with the histological presence and severity of primary colorectal cancer in a large referral centre within KwaZulu-Natal. Perhaps CEA may have a larger role as a marker for CRC development in these resource deprived communities. Patients and Methods: This study was a retrospective analysis of prospectively collected clinical data of 380 patients with colorectal cancer attending a tertiary referral centre in KwaZulu-Natal. Patients were of various age groups, various population groups and both genders. Serum levels of CEA were analysed and stratified into < 5 μg/l and ≥ 5 μg/l. Data were analyzed using descriptive statistics and findings were compared with those from the existing literature. Results: CEA levels were studied in 380 consecutive patients with known pre-treatment CEA levels. The mean CEA level of the study population was 170.0 ± 623.3 μg/l. The number of participants with a CEA level < 5μg/l was 151 (39.74%) whilst the majority 229 (60.26%) had a CEA level ≥ 5 μg/l. There was no significant correlation between CEA levels and gender (p=0.8) or age (p=0.6). CEA levels were highest in the Black African race group. Pairwise comparison demonstrated a statistically significant difference between the Black and Indian population groups (p=0.02). The current study demonstrates an upregulation of CEA as the stage of CRC progresses (p<0.0001). Conclusion: There was no significant difference in CEA levels across age and gender. A positive correlation was noted between CEA level and stage of CRC. CEA levels were highest in the black race group. Low sensitivity of CEA as a screening test for CRC was confirmed

Blind bougie first pass success endotracheal intubation process: An out-of-hospital case report

The blind bougie technique is performed when the epiglottis is visible to the intubator, but the vocal cords cannot be seen (Grade III Cormack-Lehane view). The blind bougie technique for endotracheal intubation is not routinely performed by Critical Care Paramedics for a failed intubation in the prehospital setting. However, at Hamad Medical Corporation Ambulance Service in the State of Qatar, the blind bougie technique is included in their failed airway clinical practice guidelines. This case report aims to describe the rapid sequence induction for intubation process and endotracheal tube placement in an adult trauma patient, presenting with a difficult airway, using the blind bougie technique in the out-of-hospital setting. A 35-year-old male patient was ejected from an all-terrain vehicle following a high-speed accident in the desert. The patient sustained an isolated head injury. Based on the patient’s clinical presentation, he required immediate endotracheal intubation for maintenance and protection of his airway prior to rapid transport to definitive care. Predictors of difficult airway were calculated. Using the blind bougie technique, endotracheal intubation was performed with first pass success. It is recommended that emergency medical services include the blind bougie technique of endotracheal intubation among their difficult airway procedures

Colorectal cancer cell line proteomes are representative of primary tumors and predict drug sensitivity

Proteomics holds promise for individualizing cancer treatment. We analyzed to what extent the proteomic landscape of human colorectal cancer (CRC) is maintained in established CRC cell lines and the utility of proteomics for predicting therapeutic responses. Proteomic and transcriptomic analyses were performed on 44 CRC cell lines, compared against primary CRCs (n=95) and normal tissues (n=60), and integrated with genomic and drug sensitivity data. Cell lines mirrored the proteomic aberrations of primary tumors, in particular for intrinsic programs. Tumor relationships of protein expression with DNA copy number aberrations and signatures of post-transcriptional regulation were recapitulated in cell lines. The 5 proteomic subtypes previously identified in tumors were represented among cell lines. Nonetheless, systematic differences between cell line and tumor proteomes were apparent, attributable to stroma, extrinsic signaling, and growth conditions. Contribution of tumor stroma obscured signatures of DNA mismatch repair identified in cell lines with a hypermutation phenotype. Global proteomic data showed improved utility for predicting both known drug-target relationships and overall drug sensitivity as compared with genomic or transcriptomic measurements. Inhibition of targetable proteins associated with drug responses further identified corresponding synergistic or antagonistic drug combinations. Our data provide evidence for CRC proteomic subtype-specific drug responses. Proteomes of established CRC cell line are representative of primary tumors. Proteomic data tend to exhibit improved prediction of drug sensitivity as compared with genomic and transcriptomic profiles. Our integrative proteogenomic analysis highlights the potential of proteome profiling to inform personalized cancer medicine

The Relationship between Protein Centrality and Essentiality in \u3cem\u3e Saccharomyces cerevisiae\u3c/em\u3e

With the recent shift in molecular biology to the study of proteins not as individual elements but as nodes in a larger network, the question arises of the impact of a central protein or gene in these networks. Previous studies have suggested that highly-connected proteins play a more important role in organism fitness. In this investigation, I examined the most highly connected proteins in the Saccharomyces cerevisiae protein network to determine these relationships. I used a variety of data analysis and mapping tools, such as Microsoft Excel, Python, and R, to filter through hundreds of thousands of protein-protein interactions, map these into genetic, physical, and combined networks, and analyze all of the nodes in these networks. The results showed that more essential proteins tend to be more highly connected within the interaction network; furthermore, they showed that older genes tended to have a higher chance of being essential, as well as being more central to the network. These results were especially clear in the physical protein interaction dataset, where a few genes such as YDR172W and YIL021W contained over 300 interactions. However, there were a few anomalies in the data, especially in the genetic network, which warrant more accurate testing in the future

Knowledge, attitude, and practice of paramedics in Qatar regarding the use of personal protective equipment against COVID-19

Background: Internationally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, causing corona virus disease (COVID-19), has increased the demand on healthcare services and resources 1 . The proper use of personal protective equipment (PPE) by paramedics has recently become apparent 2 . The risk of COVID-19 transmission has increased during prehospital life-saving procedures generating aerosols such as non-invasive ventilation, tracheal intubation, and external chest compressions, especially when working in a confined ambulance compartment 3 . Paramedics are encouraged to increase body-surface-isolation by donning additional PPE (high-filtration facemasks/face shields/surgical gowns/surgical hoods) during all patient encounters 2 . This study aimed to better understand paramedics’ knowledge, attitude, and practice of PPE utilization in the State of Qatar during the COVID-19 pandemic. Methods: This prospective and quantitative study focused on the collection of descriptive data utilizing a purpose-designed online survey. Around 1300 frontline paramedics employed by Hamad Medical Corporation Ambulance Service (HMCAS) were invited via email to participate in the study. Results: 282 paramedics completed the survey. 90.4% were male and 78.7% had a bachelor's degree. 97.1% completed the mandatory HMCAS online infection control training program, 82.9% completed an N95 mask fit test in the last 5 years, and 91.5% completed the hand hygiene training program. The study found paramedics to be knowledgeable about COVID-19 and its transmission (98.2%) (Table 1). Paramedics’ attitude was mainly positive towards the use of PPE to prevent the spread of the virus which was synchronous with their practice. Conclusion: An effective model to curb the spread of COVID-19 amongst healthcare workers must consider the knowledge, attitude, and practice of first responders. This sample demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitude and good infection control practices were a demonstrative effort to mitigate risks associated with the spread of the virus in the prehospital setting

What is the optimal position of an intubator wearing CBRN-PPE when intubating on the floor : a manikin study

Original article can be found at: http://www.sciencedirect.com/science/journal/03009572 Copyright Elsevier Ireland Ltd.Prompt airway management following a CBRN incident is linked to improved patient survival. However, responding rescuers will have to wear CBRN-PPE and treat patients positioned on the floor which will adversely impact on intubation skill performance.Peer reviewe

Comparison of two training programmes on paramedic-delivered CPR performance

Pregalathan Govender, Yugan Pillay, Guillaume Alinier, ‘Comparison of two training programmes on paramedic-delivered CPR performance’, poster presented at the Hamad Medical Corporation Annual Research Day, Doha, Qatar, 28 October, 2014.Peer reviewe

Prospective observational study of levosimendan and weaning of difficult-to-wean ventilator dependent intensive care patients.

To evaluate the role of levosimendan in improving cardiac performance and the success rate of weaning from mechanical ventilation in ventilatordependent, difficult-to-wean patients with impaired cardiac function in the intensive care unit. Prospective, observational study in the ICU of Westmead Hospital, a university-affiliated tertiary referral hospital in Sydney, NSW, between January 2003 and October 2004. 47 ICU patients who were ventilator-dependent for > or =10 days and had failed a weaning or extubation attempt due to respiratory insufficiency were identified as difficult to wean from mechanical ventilation. All were assessed by transthoracic or transoesophageal echocardiography. Twelve who had impaired left ventricular performance (demonstrated by left ventricular ejection fraction [LVEF] <40%) and were already established on diuretic and vasodilator treatment were given a 24-hour infusion of levosimendan. LVEF was measured again within 24 hours after infusion, and weaning from mechanical ventilation and extubation were re-attempted, when clinically deemed feasible. Levosimendan administration was associated with significantly improved LVEF (28.3% before v 34.6% after, P=0.04) and PaO2/FIO2 ratio (179mmHg v 197mmHg, P=0.002) and reduced FIO2 (0.45 v 0.39, P=0.01). These changes were associated with significant improvement in the success rate in weaning from mechanical ventilation (P=0.02), with seven of the 12 patients successfully weaned after levosimendan therapy, and six surviving to hospital discharge. There was no significant difference in any other important parameter between pre- and post-levosimendan weaning attempts. Levosimendan may provide significant benefit to ventilator-dependent patients with impaired left ventricular function. Randomised controlled trials appear justified