Factores Asociados al Tiempo de Atenciandoacute;n de Pacientes con Diagnandoacute;stico de Iamcest Sometidos a Terapia de Reperfusiandoacute;n en dos Clandiacute;nicas en Ibaguandeacute;

Background: Cardiovascular disease is the number one cause of death in the world by killing 17,9 million people every year. The most frequent cardiovascular disease occurs as STEMI which related to the depiction of persistent depiction of EKG elevation with ST segment. This research is aiming for figure out the profile of reperfusion therapy at Dr. Soetomo General Academic Hospital, Surabaya. Methods: In this research, the data is collected using observation method, without any treatment applied with descriptive statistical analysis using table. The data collection techniques used is simple random sampling. Results: The STEMI patients at Dr. Soetomo General Academic Hospital Surabaya are dominated by referral patients (79,2%) from approximately 40 hospitals in East Java. Most of the patients were male, the ages between 51 – 60 years old with the most frequent risk factors was the combination of type 2 diabetes mellitus, hypertension, and smoking. The reperfusion therapy given was PCI with a door to balloon <120 minutes was 59.6%. Fibrinolytic that was done in <12 hours after onset was 82.9%. Patients with STEMI managed at Dr. Soetomo General Academic Hospital Surabaya, had mortality rates around 12.2%. Conclusion: Most of the STEMI patients in Dr. Sutomo General Academic Hospital Surabaya was a referral patient and had sufficiently good PCI and fibrinolytic reperfusion therapy, resulting in a low mortality rate.

A need-based approach to dynamic activity generation

Diferentes padrões dietéticos modulam múltiplos aspectos do processo aterosclerótico, como níveis lipídicos, resistência à insulina, metabolismo glicídico, pressão arterial, fenômenos oxidativos, função endotelial e inflamação vascular, o que consequentemente interfere na prevalência de eventos cardiovasculares. Este estudo investiga as evidências disponíveis na literatura sobre a alimentação na prevenção e tratamento das doenças cardiovasculares. Trata-se de uma revisão integrativa. A coleta de dados foi realizada no período de abril a junho de 2018 nas bases de dados: Lilacs, Medline, PubMed, Cinahl e Capes. Obteve-se uma amostra de 12 artigos. Os padrões alimentares mais bem estudados foram a Dieta mediterrânea (MedDiet) e a Abordagem dietética para parar a hipertensão (DASH). A MedDiet e a DASH reduzem a pressão arterial, os níveis de lipoproteína de alta densidade e colesterol total, a glicemia e o ganho de peso a longo prazo, retardando a progressão subclínica da aterosclerose, associada ao menor risco de eventos clínicos. As evidências mostram que a relação da alimentação na prevenção e tratamento das doenças cardiovasculares está cada vez mais elucidada. A utilização dessas dietas traz benefícios satisfatórios para a saúde cardiovascular.&#x0D; Palavras-chave: Fatores de risco. Doenças cardiovasculares. Prevenção de doenças.

Introduction : Myocardial infarction (MI) with 25- 30% mortality rate is one of the most common causes of death in most countries. According to recent data, MI is an increasing event in Iran. The aims of this study were to determine the 1-year survival rate and its correlates with MI among patients. Methods : This nonconcurrent cohort study was done on 113 patients with first acute MI who had been admitted in Imam Hossein hospital during the year 2004. Kaplan-Maier product limit and log rank test for survival analysis were used. Results : From 113 patients studied, there were 73(64.6%) males and their mean age was 63.9 ± 13.1 (range 16-89). According to of the past history of these patients relived that 23.9% had been smokers. The most frequent risk factors were hypertensions (53.1%), history of previous ischemic heart disease (35.4%), diabetes mellitus (24.8%) and heart block (6.2%). Thirty six (31.9%) of them died in first one-year after admission. The 1-year survival rate was 69 percent. Significant predictors of 1-year survival in our study were administration of streptokinase and use of s -blockers after discharge. Conclusion: We concluded that mortality in first year after MI has been significantly reduced because of therapies including thrombolysis and s -blockers.

Introduction: mortality in acute myocardial infarction with ST-segment elevation has decreased, despite this, there is evidence suggesting a long-term deterioration of quality of life in these patients.Objective: to evaluate the perceived quality of life and related factors in patients who had an ST-segment elevation myocardial infarction and received reperfusion treatment with fibrinolytics. Material and methods: application of EQ-5D-5L questionnaire to assess quality of life in patients with ST-segment elevation myocardial infarction selected among those admitted in the period from June 2007 to June 2017 in a private intensive care unit outside the country’s capital.Results: 86 patients were analyzed with a median age of 67.5 years (interquartile range = 59-77.5). 77% received fibrinolytics of which 74% presented reperfusion criteria. The treatment was initiated before 120 minutes in 74% of the cases.Among the survivors at the start of the study, 30 patients were selected at random for evaluation of the quality of life.The mean follow-up was 6 years (4-8) from the event. The altered aspects in quality of life were: mobility 6/23( 26%), self-care 4/23 (17%), usual activities 6/23( 26%), pain 4/23(17%) and an altered global quality of life 8/30( 27%).Ona scaleof 0-100, the perceived global quality of life level was 90 (70-99). The altered global quality of life is associated with heart failure after the event (67% vs 17%, p: 0.05) and at a time from the event less than five years (38% vs 6%, p: 0.02). Alterations in mobility are more frequent in women (57%) than in men (12%), p: 0.02, as well as in patients with pain (43%) vs without pain (6%), p: 0.03. Older age is associated with altered self-care (69 years [58-78] vs 92 years [87-93], p: 0.013).The delay in treatment (>120 minutes) is associated with alterations in mobility (80% vs 13%, p: 0.005), self-care (60% vs 7%, p: 0, 01) and limitation in usual activities (60% vs 13%, p: 0.03).Conclusions: patients with ST-segment elevation myocardial infarction who receive reperfusion treatment with fibrinolytics in our environment may have an alteration in the quality of life. The delay in treatment is associated with long-term altered quality of life.

Objective To guide the improvement and construction of Emergency Medical Service System, and investigate the epidemiological information of patients in pre-hospital emergency care in Huaihua city and probe the patients, characteristic. Methods The data were exported from the computer databases of Huaihua city, emergency medical center between 9-21, 2013 and 9-20, 2016.The thorough records of data from 12 744 aid patients were conducted to statistical analysis.The 7 033 male and 5 711 female between 1 month to 94 years old in that, the average ages is 51.8±22.6 . Specificly analyse different results of treatment [Pre-hospital care non-death, pre-hospital death (Pre-hospital cardiac death and Pre-hospital non-cardiac death)], that patients accepted pre-hospital emergency care of the time of deployment, arrival, spot, returning, drawing-out, and rescuing radius, quarterly distribution, types of diseases, the distribution of sexs and ages; this analyses the situation of ages of the different types of diseases about Pre-hospital medical care patients. Results (1) The scheduling time, running time, returning time and service radius about patients receiving pre-hospital care in the death group were less than those of the non-death group, and the rescue time and total time of the former were more than those of the latter respectively (P 0.05), but running time, returning time, total time and service radius of the sudden cardiac death groups were more than those of the non- sudden cardiac death groups, and returning time of the former was less than that of Pre-hospital care group of non-sudden cardiac death (P<0.01 or P<0.05). (2)The patients, amount in Pre-hospital medical care group, the non-death group, the death group, the non- sudden cardiac death group and the sudden cardiac death group were common in the first season of the year. (3)In 12 744 cases of pre-hospital medical care patients group, the patients, amount of trauma was at most, the percentage of the trauma group to the pre-hospital medical care group was 32.99%(4 204/12 744), whose age grades was by far among 21~50, which the patients, amount of traffic accident was at the most, and the others with a high incidence of the disease in sequence were circulatory system, nervous system, digestive system, poisoning group and respiratory system, whose age grades in circulatory system, nervous system, digestive system, respiratory system was by far above 51, the patients, age grades in poisoning group was patients by far among 21~50, which the patients, amount of acute alcoholism was at the most, the percentage of the acute alcoholism group to the poisoning group was 76.52%. (4)In 657 cases of aid death patients group, the death amount of trauma and poisoning group ranked at the 1th, 5th respectively, whose age grades was by far among 21~50.The death amount of diseases of circulatory system, nervous system, respiratory system and digestive system ranked at the 2th, 3th, 4th, 6th respectively, those patient’ age grades was by far above 51, in the further analysis, the amount of patients with pre-hospital of sudden cardiac death was at most in the death amount of diseases in circulatory system.(5) The total amount, the death amount and the sudden cardiac death amount of cases of male patients were more than those of female patients. (6) The percentage of the death group to the pre-hospital medical care group cases was 5.15%(657/12 744), and the percentage of the sudden cardiac death group to the pre-hospital medical care group cases was 1.11%(141/12 744), and the percentage of the sudden cardiac death patients group to the death group was 21.46%(141/657). Conclusions Trauma, especially in traffic accident injury, is the main cause of death of pre-hospital care in Huaihua city in recent years. The measures benefit to reduce icidence, mrtality in pre-hospital emergency medical care in the local aera by strengthening emergency first aid network construction, the rational preparation schedule settings, or the evidence for the existence of sudden cardiac death risk factors in patients with increased vigilance, making preventions plans for a particular season, disease and people, promoting the knowledge and skills of pre-hospital popularity, focusiong on cardio-cerebral vascular disease and respiratory disease prevention and control, improving the masses of the common early identification of critical capacity and other targeted initiatives. Key words: Pre-hospital emergency care; Pre-hospital death; Sudden cardiac death; Epidemiological study

In this study we present the development of a conceptual framework for a hybrid agent-based discrete event simulation model within the context of emergency medical services. There are many existing simulation models of emergency medical services (EMS), but each is considered in isolation, rather than as a single node in a complex web of regional EMS. The aim of this research is to develop a hybrid approach tool, using distributed simulation technology, that would enable interactions between existing EMS models and so provide an integrated network of the different components of the EMS. This would provide possibilities for integrated efficiency improvement scenarios and system analysis. This concept is illustrated using an agent-based ambulance service model and a discrete event EMS model. The advantages of such a technique is that expensive and time-consuming models can be reused and expanded to incorporate influencing external factors.

Clinical case: A 58-year-old woman called 9-1-1 with acute onset of chest pain that had persisted for 30 minutes. She had a history of hypertension, hyperlipidemia, and type 2 diabetes mellitus but no previous history of myocardial infarction or heart failure. Her medications included aspirin, atorvastatin, lisinopril, and metoprolol. Paramedics were dispatched, and a prehospital ECG demonstrated 3- to 4-mm ST-segment elevation in leads I, aVL, and V2 through V6 (Figure 1). Her examination revealed a regular pulse of 90 bpm, a blood pressure of 100/60 mm Hg, clear lungs, and normal heart sounds with no murmurs. Paramedics interpreted the prehospital ECG and activated the catheterization laboratory en route to the hospital. On hospital arrival, the patient was transported directly to the catheterization laboratory. Coronary angiography demonstrated an occluded proximal left anterior descending artery, which was successfully treated with balloon angioplasty and a stent. The pertinent time intervals were as follows: paramedic dispatch to balloon time, 56 minutes; paramedic arrival at the scene to balloon time, 46 minutes; hospital door to balloon time, 23 minutes. Her biomarkers revealed a peak troponin T of 2.42 ng/mL and a peak creatine kinase muscle-brain isoenzyme of 26.8 ng/mL. An echocardiogram demonstrated normal left ventricular ejection fraction of 55%, with mild anterior hypokinesis, and the patient was discharged on hospital day 3. Figure 1. Prehospital ECG. American Heart Association national guidelines,1–3 as well as other consensus and scientific statements,4–11 recommend that emergency medical services (EMS) acquire and use prehospital ECGs to evaluate patients with suspected acute coronary syndrome. Despite these recommendations, prehospital ECGs are used in fewer than 10% of patients with ST-segment–elevation myocardial infarction (STEMI),12,13 and this rate has not substantially changed since the mid-1990s. Furthermore, even when a prehospital ECG is acquired, the information is often not …

Young people’s consumption of illicit substances at mass events (e.g., music festivals; school-leaver events) is a major health concern to authorities world-wide. Police are required to enforce laws on illicit substances at such mass events, but critics claim that heavy-handed police enforcement can alienate patrons and reduce their willingness to seek help from police in the event of an adverse reaction or overdose. In recent years, police in Australia have been urged to shift their approach from a ‘law enforcement’ approach to a ‘harm reduction’ approach at these types of events, particularly when dealing with young people. Harm reduction policing approaches focus on supply, demand and harm-minimisation associated with illicit drugs, with recent literature proposing that police discretionary decision-making and interpersonal interactions with users aimed at building trust and respect can contribute toward secondary harm reduction (Stevens, 2013). Despite the call for harm reduction policing approaches at these events, police still use crackdown tactics in Australia. These policing tactics have been linked to excessive consumption of drugs to avoid detection (e.g., Dunn & Degenhardt, 2009; Hickey et al., 2012). To foster young patrons’ help-seeking in illicit substance emergencies at mass events, it is important to better understand how they perceive police at mass events and policing responses that target illicit substances. Research demonstrates that public perceptions of procedural justice policing—fair treatment and fair decision-making—influences a range of attitudes and behaviours in citizens, including: satisfaction with police, compliance with police directives, trust in police, and willingness to cooperate with police (e.g., Hinds & Murphy, 2007; Sunshine & Tyler, 2003). This prior research also shows that relational concerns regarding procedural justice tend to be more important for shaping attitudes and behaviours toward police than instrumental concerns, such as perceived risk of sanction or perceptions that police are effective. Adopting a procedural justice framework, my research explores for the first time how policing approaches at mass events influences young peoples’ trust in police, their willingness to cooperate with police, and their help-seeking behaviours in the event of adverse reactions to illicit substances. A mixed methods approach is adopted across three studies. Study 1 includes observations of two mass events in Queensland (a two-week high-school graduation celebration known as ‘Schoolies’, and a music event known as ‘Stereosonic’) and interviews with 19 Queensland Police Service officers. Study 2 uses the interviews with police officers, while Study 3 includes a survey of 440 youth who attended the Schoolies event during the same years as the observations and interviews. Study 1 found that the policing approach in the first week of Schoolies more closely aligned with a harm minimisation approach than the second week of Schoolies or the Stereosonic music festival. It was also found to demonstrate more characteristics of procedural justice policing compared to Stereosonic (the other mass event studied). Study 2 revealed that police had varied understandings of procedural justice and noted several barriers in its practice but indicated that the principles underlying its framework were important for policing youth at these events. Study 3 indicated that youth’s self-reported help-seeking was driven more by instrumental concerns such as a perceived risk of sanction for wrongdoing than relational factors such as procedural justice. However, perceptions of procedural justice and trust in police dominated young peoples’ willingness to cooperate with police, with procedural justice being very important to fostering trust. Further, young people were more likely to say they would seek help from police at mass events for a friend than themselves, and also when they perceived policing tactics to be less law enforcement focused. This thesis fills several gaps in the literature. It is the first to explore the theoretical link between young people’s perceptions of procedural justice, trust, and willingness to seek help for an adverse consequence associated with illicit substance use. It is also the first to compare policing tactics employed at Schoolies to another youth mass event, and the influence policing tactics at these events have on youth trust in police and willingness to cooperate and seek help. This thesis raises important implications for the widespread applicability of the procedural justice framework, and for how police should best approach policing mass events in the future.

Advances in stroke care will have the greatest effect on stroke outcome if care is delivered within a regional stroke system designed to improve both efficiency and effectiveness. The ultimate goal of stroke care is to minimize ongoing injury, emergently recanalize acute vascular occlusions, and begin secondary measures to maximize functional recovery. These efforts will provide stroke patients with the greatest opportunity for a return to previous quality of life and decrease the overall societal burden of stroke.

Tuberculosis (TB) is an infectious disease caused by the bacteria of the Mycobacterium groups that is Mycobacterium Tuberculosis. Most of the TB germs attack the lungs, but can also on other organs. In Indonesia based on the Survei Kesehatan Rumah Tangga (SKRT) in 2001 showed TB is the first cause of death in the group of infectious diseases. To determine the factors that affect the rate of healing of patients with TB is using regression analysis, because the dependent variable is the time of failure that equipped with censorship then used cox proportional hazard regression. Cox proportional hazard regression is a regression model that is often used in survival analysis. Survival analysis is the phrase used to describe the analysis of data in the form of times from a well-defined time origin until the occurrence of some particular event or end-point. The cases examined in this study are the factors that affect the rate of healing of patients with TB in Puskesmas Kecamatan Kembangan Jakarta Barat. The conclusion state that the factors affecting the rate of healing of patients with TB are a source of transmitting and medicine records. Keywords : Tuberculosis, Survival Analysis, Cox Proportional Hazard Regression

Part 7: The Era of Reperfusion

Modelling life trajectories and mode choice using Bayesian belief networks

This article examines the uncertain events encountered in the construction process of highway projects in South Africa, so as to evaluate their impact on the construction time of such projects. The rationale for this examination stems from the view held by scholars that highways are complex projects initiated in dynamic environments, which are often beset by different uncertainties and a lack of appropriate evaluation of the uncertain events that occur during the construction process. The research made use of a review of existing literature in the area of uncertainty management and modelling in infrastructure projects, to guide the direction of the study, brainstorming, and interviews conducted with highway experts to identify the factors of uncertainty that impact construction time on infrastructure projects. A simple uncertainty matrix for South African highway projects was developed using a quantitative model and descriptive statistics. It emerged from the study that the uncertain events that affect the construction time of highway projects are distributed across economic, environmental, financial, legal, political, social and technical factors. Also, it was found that each factor contains several uncertain events, which impact on construction time differently, through a combination of the uncertain events of the individual construction activities. Based on the findings, it can be concluded that construction time on South African highway projects is significantly related to the social and technical factors of uncertainties. The matrix developed will be useful in modelling uncertainty of the cost and time of individual construction activities in highway projects.

Use of emergency medical services in acute myocardial infarction and subsequent quality of care: Observations from the national registry of myocardial infarction 2