Ambulant Treatment Research Articles

Sex differences in the pre-hospital ambulance delay, assessment and treatment of patients with acute coronary syndrome: a rapid evidence review.

Chest pain is a frequent symptom suffered by adult patients attended by ambulance. Evidence suggests female patients may suffer different symptoms to their male counterparts, potentiating differences in pre-hospital time delays, assessment and treatment. To explore the sex differences in the pre-hospital ambulance delay, assessment and treatment of patients with acute coronary syndrome (ACS). A rapid evidence review was conducted following the Cochrane rapid review guidelines. MEDLINE and CINAHL Complete were searched via EBSCOhost on 2 February 2023, and reference lists of included studies and reviews were screened. The Joanna Briggs Institute checklist for analytical cross-sectional studies was used to perform critical appraisal, and a narrative synthesis was conducted. From 216 articles screened, nine were included, representing over 3.1 million patients from five different countries. Female patients were more likely to suffer delays in time to first electrocardiogram (ECG) and delays in transport time to the emergency department by ambulance. Female patients were also less likely to receive an ECG, aspirin, glyceryl trinitrate and other analgesics. There are sex disparities in the pre-hospital ambulance delay, assessment and treatment of patients with ACS. Future research is urgently needed to fully understand the reasons for these observations.

Effect of a Targeted Ambulance Treatment Quality Improvement Programme on Outcomes from Out-of-Hospital Cardiac Arrest: A Metropolitan Citywide Intervention Study.

The performance of ambulance crew affects the quality of pre-hospital treatment, which is vital to the survival for out-of-hospital cardiac arrest (OHCA) patients, yet remains suboptimal in China. In this retrospective analysis study, we aimed to examine the effect of a citywide quality improvement programme on provision of prehospital advanced life support (ALS) by emergency medical service (EMS) system. EMS-treated adult OHCA patients after the implementation of the programme (1 January 2021 to 30 June 2022) were compared with historical controls (1 June 2019 to 31 August 2020) in Suzhou. Multivariable logistic regression analysis and propensity score matching procedures were applied to compare the outcomes between two periods for total OHCA cases and subgroup of cases treated by fixed or non-fixed ambulance crews. A total of 1465 patients (pre-period/post-period: 610/855) were included. In the 1:1 matched analysis of 591 cases for each period, significant improvement (p < 0.05) was observed for the proportion of intravenous (IV) access (23.4% vs. 68.2%), advanced airway management (49.2% vs. 57.0%), and return of spontaneous circulation (ROSC) at handover (5.4% vs. 9.0%). The fixed ambulance crews performed better than non-fixed group in IV access and advanced airway management for both periods. There were significant increases in IV access (AOR 12.66, 95%CI 9.02−18.10, p < 0.001), advanced airway management (AOR 1.67, 95% CI 1.30−2.16, p < 0.001) and ROSC at handover (AOR 2.37, 95%CI 1.38−4.23, p = 0.002) after intervention in unfixed group, while no significant improvement was observed in fixed group except for IV access (AOR 7.65, 95%CI 9.02−18.10, p < 0.001). In conclusion, the quality improvement program was positively associated with the provision of prehospital ALS interventions and prehospital ROSC following OHCA. The fixed ambulance crews performed better in critical care provision and prehospital outcome, yet increased protocol adherence and targeted training could fill the underperformance of non-fixed crews efficaciously.

Validation and Application of an HPLC-UV Method for Routine Therapeutic Drug Monitoring of Dalbavancin.

Dalbavancin is emerging as a promising alternative in the ambulant treatment of gram-positive infections that require long-term antibiotic treatment such as osteomyelitis, prosthetic joint infections, and endocarditis. The aim of the current study was to develop and validate a simple, rapid, and cost-effective high-performance liquid chromatography–ultraviolet spectrometry (HPLC–UV) method for the quantification of dalbavancin. Sample clean-up included a protein precipitation protocol, followed by chromatographic separation on a reverse phase HPLC column (C-18) with gradient elution of the mobile phase. Quantification was performed with the internal standard (caffeine) method. Linear relationships between peak area responses and drug concentrations were obtained in the range of 12.5–400 mg/L. The variation coefficient of precision and the bias of accuracy (both inter- and intraday) were less than 10%. The limit of quantification (LOQ) was 12.5 mg/L. The simple and reliable HPLC–UV assay described is a powerful tool for routine therapeutic drug monitoring (TDM) of dalbavancin in human serum in clinical laboratories. With a total process time of approximately 20 min, it allows for accurate and selective quantification up to the expected pharmacokinetic peak concentrations. The method was successfully used to analyze subsequent serum samples of three patients and showed good performance in monitoring serum levels.

Psychotherapy for Eating Disorders : Assessment Skills and Creativity in General Ambulant Treatment

Psychotherapy for Eating Disorders : Assessment Skills and Creativity in General Ambulant Treatment

Ambulant treatment with a digital chest tube for prolonged air leak is safe and effective.

BackgroundOutpatient or ambulatory treatment for prolonged air leak (PAL) has been reported previously in various studies. Evidence regarding efficiency and safety is nevertheless poor. This report describes the experience of 10 years ambulatory care with a digital chest drain system monitored by specialized nurses in our centre. The aim of the study is to give further insights in the effectiveness and safety of this treatment.MethodsRetrospective data of 10 years ambulatory care for PAL were examined. One hundred and forty patients with PAL after pneumothorax or pulmonary surgery were included.ResultsA total of 140 patients with PAL were included. Treatment was successful in 112 patients (80.0%). Hospital readmission was necessary in 33 patients (23.6%) and 28 (20.0%) of them received additional treatment. Additional treatment consisted of video-assisted thoracoscopic surgery (VATS) in 19 patients (13.6%), new chest tube placement in 8 patients (5.7%) and pleurodesis (with talc slurry) in 1 patient (0.7%). Minor complications occurred in 10 patients (7.1%), major complications requiring readmission occurred in 14 patients (10.0%).ConclusionsAmbulatory treatment of PAL with a digital monitoring device resulted in a high success rate with a limited complication rate.

Resilience of Adolescents Diagnosed with Anxiety and Their Parents in Clinical Sample

Abstract Anxiety disorder is the most frequent psychiatric problem among children and adolescents. Research proved that resilience can be a protective factor in coping with psychological difficulties. Our research focuses on these aspects of resilience. Aims: We aimed to investigate the resilience and anxiety level of families with adolescents who were diagnosed with anxiety disorders. The clinical sample included 40 adolescents who were diagnosed with anxiety disorders and who received ambulant treatment. (18 boys and 22 girls; age: M=13.37 years, SD=1.46). Members of the control group were recruited from schools and they were normally developing adolescents without any psychiatric diagnosis. (18 boys and 19 girls, age: M=13.7 years; SD=1.56) DASS-21, Ten items Connor-Davidson Resilience Scale and self-made demographic sheet were used. Regarding the resilience, a Significant difference was found between the clinical and the sample group both among the mothers and their children. However, in the case of fathers, no discrepancy was found. Our results suggest that there is a significant, moderate positive relationship between the resilience of the mother and their children. Nevertheless, similar mechanisms in the fathers’ case cannot be registered. In the control group, the fathers’ perception of their child’s resilience proved to be the strongest predictive factor (beta=0,495). On the contrary in the clinical group, the maternal perception was more accurate. (beta=0,06). Resilience can serve as a protective factor against anxiety. Our results can be useful for practitioners and draw attention to the importance of intrafamily mechanisms in coping with anxiety and mood disorders.

Mobile Stroke Units: Current and Future Impact on Stroke Care.

Ischemic stroke is a leading cause of death and major disability that impacts societies across the world. Earlier thrombolysis of blocked arteries with intravenous tissue plasminogen activator (tPA) and/or endovascular clot extraction is associated with better clinical outcomes. Mobile stroke units (MSU) can deliver faster tPA treatment and rapidly transport stroke patients to centers with endovascular capabilities. Initial MSU trials in Germany indicated more rapid tPA treatment times using MSUs compared with standard emergency room treatment, a higher proportion of patients treated within 60 minutes of stroke onset, and a trend toward better 3-month clinical outcomes with MSU care. In the United States, the first multicenter, randomized clinical trial comparing standard versus MSU treatment began in 2014 in Houston, TX, and has demonstrated feasibility and safety of MSU operations, reliability of telemedicine technology to assess patients for tPA eligibility without additional time delays, and faster door-to-groin puncture times of MSU patients needing endovascular thrombectomy in interim analysis. Scheduled for completion in 2021, this trial will determine the cost-effectiveness and benefit of MSU treatment on clinical outcomes compared with standard ambulance and hospital treatment. Beyond ischemic stroke, MSUs have additional clinical and research applications that can profoundly impact other cohorts of patients who require time-sensitive neurological care.

Different injury patterns after snowboard in children and adolescents

BackgroundSnowboarding is a very common sport especially among young adults. Common injuries are hand, wrist, shoulder and ankle injuries. Purposeof this study was to analyze different injury pattern in children and young adults comparing with adults. MethodsPatients who were admitted for ambulant or stationary treatment as a result of injury practicing snowboard received a questionnaire and were divided into three groups (children, young adults and adults) according to their age. Between october 2002 and may 2007 1929 injured snowboard sportsmen were included in the study. Data such as location, date and time of accident as well as information about the slope were carried out. In addition snowboard skills were classified and patients were questioned whether they wore special protectors. Results32.5% of injured patients were female (n = 626) and 67.5% male (n = 1303) with a mean age of patients of 21.9 (7–66) years. 13% of all patients were in group I (children), 19.2% in group II (young adults) and 67.8% in group III (adults).Most common injuries with 60% of all accidents were injuries of the hand wrist especially in children beginning with snowboard sports. Injuries on the regular track were most common followed by jumps in the kicker park and rails in the fun-park. 20.6% in group I, 13.6% in group II and 12.8% group III did not wear any protectors. ConclusionChildren and adolescents presented different injury patterns than adults. Young participants of up to 14 years of age are endangered especially during the first days of learning this sport. Further development of protectors with regard to biomechanical characteristics is important to achieve an optimal protective effect. Level of evidence2b

Ambulance use for ‘primary care’ problems: an ethnographic study of seeking and providing help in a UK ambulance service

ObjectivesTo explore what factors shape a service user’s decision to call an emergency ambulance for a ‘primary care sensitive’ condition (PCSC), including contextual factors. Additionally, to understand the function and...

Abstract TP282: Prehospital Acute Stroke Treatment by Critical Care Physicians in a Mobile Stroke Unit

Background: Mobile Stroke Units (MSU) diagnose and treat stroke prehospitally to reduce time from symptom onset-to-treatment (OTT). Several MSU-models exist world wide, but the best framework for MSUs are still unknown. Many models depend on in-hospital personnel working in the prehospital field. The MSU in Treat-NASPP (Norwegian Acute Stroke Prehospital Project) mimics the Norwegian Helicopter Emergency Medical Services and adds diagnostics and treatment of acute stroke to the existing prehospital emergency system. Objective: To investigate if the Treat-NASPP MSU-model is timesaving and safe. Methods: Treat-NASPP started 15th of May 2017 and is an ongoing, prospective, controlled intervention study. The inclusion criteria are: age over 18 years, not pregnant and clinical stroke symptoms with onset within the last 4 hours. The MSU is manned with an anesthesiologist trained in prehospital critical care, a nurse and a paramedic, and it is active 8 a.m. to 8 p.m. on weekdays 2 weeks per month. The control group is dispatch with ordinary ambulance and in-hospital treatment. The emergency medical communication center dispatches the MSU and/or ordinary ambulance whenever acute stroke is suspected. Results: By 1st of July 2018, 74 patients are included in the study. In the intervention group (N=49) 23 (46%) received thrombolysis, and in the control group (N=25), 10 (40%) received thrombolysis. Median (quartiles) OTT time was 98 minutes (72-184) in the MSU-group and 120,5 (107-169) in the control group, p=0,211. Median (quartiles) emergency call-to-treatment time was 29,5 minutes shorter in the MSU group compared with the control group (62 (52-71) vs 91,5 (75-97), p=0.006). Median (quartiles) mRS day 30 was 0 (0-1) in the MSU group and 0,5 (0-1,75) in the control group. No serious adverse events or symptomatic intracranial hemorrhages have occurred. Conclusion: The preliminary results indicate that adding diagnostics and treatment of acute stroke to the work-list of prehospital critical care physicians in an MSU-system, is timesaving and safe.

Enhanced Recovery in Mild Acute Pancreatitis: A Randomized Controlled Trial.

Acute pancreatitis (AP) is a leading cause of hospitalization for a gastrointestinal illness in the United States. We hypothesized that enhanced recovery approaches may lead to earlier time to refeeding in patients with AP. We performed a double-blind, randomized controlled trial of patients admitted with mild AP from July 2016 to April 2017 at a tertiary medical center. Participants were randomly assigned to receive either enhanced recovery consisting of nonopioid analgesia, patient-directed oral intake, and early ambulation versus standard treatment with opioid analgesia and physician-directed diet. Primary study end point was time to oral refeeding on an intent-to-treat basis. Secondary end points included differences in pancreatitis activity scores, morphine equivalents, length of stay, and 30-day readmissions. Forty-six participants enrolled. Median age was 53.1 years, and 54.3% were female. There was significant reduction in time to successful oral refeeding in the enhanced recovery versus standard treatment group (median, 13.8 vs 124.8 hours, P < 0.001). Pancreatitis activity scores trended lower at 48 to 96 hours among patients assigned to enhanced recovery (mean, 43.6 vs. 58.9, P = 0.32). No differences found in length of stay or 30-day readmissions. In this randomized controlled trial, enhanced recovery was safe and effective in promoting earlier time to refeeding in patients hospitalized with AP.

Introduction of a novel questionnaire to assess the quality of postdischarge outpatient care and socioeconomic state after severe multiple injury.

Trauma registries provide knowledge about the pathophysiological events that follow severe injuries but only little is known about outpatient care and socioeconomic consequences at later stages in case of survival. We introduce a novel questionnaire to specifically assess the quality of postdischarge outpatient care and socioeconomic burden up to two years after severe multiple injury. Observational Study. Postdischarge outpatient treatment and socioeconomic burden within two years after severe trauma. Severely injured adult trauma patients (Injury Severity Score 9 and ICU admission). A new questionnaire was introduced in context of a two-year follow-up mail survey. The response rate was 57% (150/264 patients; 73% male, mean 45 years, mean ISS 17/New ISS 22; 99% blunt trauma). Rehabilitation measures were conducted in 70% of patients while 87% underwent outpatient treatment after discharge from the acute care facility. Further in-hospital stays were observed in 63% of patients and 19% reported the need for ongoing permanent care. Pain medication was taken by 74% of patients after discharge while 32% were still on pain medication at two years. 35% had been on sick leave >1 year while 18% had entirely lost their job. Every second patient reported financial disadvantages. The questionnaire yielded detailed information about the quality of outpatient care after discharge and confirmed the high socioeconomic burden among patients at two years after severe multiple injury. Long- term impairments after severe trauma are described frequently. Evaluation of ambulant treatment is the first step to optimize long- term rehabilitation and re-integration.

Pre-hospital management of acute stroke patients eligible for thrombolysis \u2013 an evaluation of ambulance on-scene time

BackgroundStroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component. We aimed to analyse ambulance OST in stroke patients eligible for thrombolysis and identify potential areas of time optimization.MethodsA study-specific registration form was developed to record detailed information about OST consumption in cases where the Emergency Medical Services (EMS) suspected a stroke from July 2014–May 2015. Registration forms were completed by ambulance personnel and included details on estimated time spent: 1) localising patient, 2) clinical examination, 3) consulting with the on-call neurologist, 4) mobilising patient to the ambulance, 5) treatment in ambulance before departure. Additionally, estimated total OST was noted. For patients found eligible for further evaluation at a stroke centre, time points were analysed using multivariate Poisson regressions.ResultsA total of 520 cases were included. The median OST was 21 min (Interquartile Range (IQR) 16–27). Time consumption was significantly lower (17 vs 21 min, p = 0.0015) when electrocardiography (ECG) was obtained in-hospital instead of on-scene, when intravenous (IV) access was established during transportation instead of before transportation (17 vs 21 min, p < 0.0001), and when the quality of communication with the stroke centres was rated as “good” as opposed to “acceptable/poor” (21 vs 23 min, p = 0.014). Neither the presence of relatives nor ambulance trainees had a significant effect on OST.ConclusionsIn-hospital ECG recording and IV cannulation during transport were found to reduce OST, while “acceptable/poor” communication was found to prolong OST relative to “good” communication. These components of pre-hospital stroke management represent potential opportunities for lowering OST with relatively simple changes, which could ultimately lead to earlier treatment and better patient outcome.Trial registrationUnique identifier: NCT02191514.

Prehospital response to respiratory distress by the public ambulance system in a Ukrainian city.

The capability of the public ambulance system in Ukraine to address urgent medical complaints in a prehospital environment is unknown. Evaluation using reliable sources of patient data is needed to provide insight into current treatments and outcomes. We obtained access to de-identified computer records from the emergency medical services (EMS) dispatch center in Poltava, a medium-sized city in central Ukraine. Covering a five-month period, we retrieved data for urgent calls with a patient complaint of respiratory distress. We evaluated ambulance response and treatment times, field diagnoses, and patient disposition, and analyzed factors related to fatal outcomes. Over the five-month period of the study, 2,029 urgent calls for respiratory distress were made to the Poltava EMS dispatch center. A physician-led ambulance typically responded within 10 minutes. Seventy-seven percent of patients were treated and released, twenty percent were taken to hospital, and three percent died in the prehospital phase. On univariate analysis, age over 60 and altered mental status at the time of the call were strongly associated with a fatal outcome. The EMS dispatch center in a medium-sized city in Ukraine has adequate organizational infrastructure to ensure that a physician-led public ambulance responds rapidly to complaints of respiratory distress. That EMS system was able to manage most patients without requiring hospital admission. However, a prehospital fatality rate of three percent suggests that further research is warranted to determine training, equipment, or procedural needs of the public ambulance system to manage urgent medical conditions.

Health care utilization and cost after discharge from a mental health hospital; an RCT comparing community residential aftercare and treatment as usual

BackgroundCommunity residential aftercare (step-down) services can ease the transition after a mental health hospital stay for patients with severe mental illness (SMI).AimsTo investigate use of community and specialised mental health care services and costs in patients with SMI the first 12 months after discharge from a mental health hospital (MHH), comparing community residential aftercare (CRA) and treatment as usual.MethodsAn open parallel group randomised controlled trial with 41 participants. Data on use of specialist services (hospital, ambulant treatment and outpatient treatment) and community services (residential stays, home help, home care nursing, mental health consultation) were collected from specialist and community registers and health records.ResultsFor the primary outcome, utilisation of community mental health services, the intervention group used, on average, 29% fewer hours (mean differences − 21.6 h, 95% CI -93.1 to 44.9, p = .096) with a cost saving of 29% (mean differences − 1845 EUR, 95% CI -8267 to 4171, p = .102), but the estimates were imprecise. For the secondary outcome, the study groups had the same total number of inpatient days (66 days), but the intervention group had on average of 13.4 fewer inpatient days in the mental health hospital (95% CI -29.9 to 0.9. p = .008). The number of inpatient admissions (mean difference − 0.9 admissions, 95% CI -3.5 to 1.5, p = .224) and readmissions (− 0.8, 95% CI -2.5 to 0.9. p = .440) was lower in the intervention group. The intervention group had on average a total cost saving of 38.5% (mean differences − 23,071 EUR, 95% CI -45,450 to 3027. p = .057). A post hoc multivariable regression analysis controlling for baseline characteristics gave a reduction in total cost in favour of the intervention group of − 19,781 EUR (95% CI -44,072 to 4509, p=,107).ConclusionIn this study, it was not possible to draw a definite conclusion about the effect, due to the small sample and imprecision of the estimates. The direction of the results and size of the point estimate, in addition to findings in other studies, indicates that transferring patients ready for discharge from mental hospital to community residential aftercare can have the potential to reduce total consumption of health services and costs without increased hospital admissions.Trial registrationRegistered in clinicaltrials.gov (NCT01719354)

112 Ambulansı ile Çocuk Acile Getirilen Hastaların Değerlendirilmesi

Objective: In this study, it was aimed to determine the evaluation of appropriate and necessary interventions and treatments which were made for patients admitted to pediatric emergency department by 112 ambulance. Materials and Methods: Patients which were admitted to Pediatric Emergency Medicine Department by 112 ambulance between November 1st., 2011 – November 30th., 2013 were included in this study retrospectively. Gender of the patients, date and time of admittance, time during transport, place where cases were taken, reason for hospital admittance, if the patient was referred, whether the given information is provided, the ambulance case record form was filled completely, treatment in ambulance, intubation was performed, diagnoses in emergency department, consultation, outcome of the patients, diagnoses and departments of the patients who were hospitalised were recorded. Results: Total 7425 patients were included in the study. Of 55.7% patients were male and 44.3% were female. It was determined that most of the patients were taken from the place of scene (45.7%). Most of the patients were transported between 08:00 am to 17:00 pm (44.4%). Of the 85.3% patients were transported because of diagnosis and treatment. It was determined that IV line were applied to 87.2% of the patients, vital signs were obtained 90.2% of the patients, pulse oximetry were applied 91.3% of the patients, treatment were initiated 67.7% of the patients during transport. The most common diagnoses were trauma (34,1%) but 90,4% of all trauma patient discharged with diagnosis of minor trauma. Most of the patients were consultated to pediatric surgery and hospitalised to the department of pediatrics (61.2%). It was found that 84.5% of the patients were discharged from the emergency department, 15% of them were hospitalised and 0.1% of them were died. Conclusion: The most common cause of admittance was trauma. Necessary medical interventions were during ambulance transport. Because of the high discharge ratio, it might be said that the ambulance personal should pay more attention to the triage.

What fluids are given during air ambulance treatment of patients with trauma in the UK, and what might this mean for the future? Results from the RESCUER observational cohort study

ObjectivesWe investigated how often intravenous fluids have been delivered during physician-led prehospital treatment of patients with hypotensive trauma in the UK and which fluids were given. These data were used...

05 Exploring why ‘primary care’ problems end up receiving ambulance treatment: early findings from a pre-hospital ethnographic study

BackgroundAn increasing part of the Ambulance Service workload can more accurately be described as ‘urgent care’ cases, many of which could potentially be managed by timely contact with Primary Care....

Seeking ambulance treatment for ‘primary care’ problems: a qualitative systematic review of patient, carer and professional perspectives

ObjectivesTo understand the reasons behind, and experience of, seeking and receiving emergency ambulance treatment for a ‘primary care sensitive’ condition.DesignA comprehensive, qualitative systematic review. Medline, Embase, PsychInfo, Cumulative Index of...

Efficacy and safety of a compound supplement containing glucosamine, chondroitin, and five bioactive ingredients in volunteers with knee joint pain

Abstract Purpose This study was designed to evaluate the efficacy and safety of a compound supplement containing glucosamine (GS), chondroitin sulfate (CS), and five bioactive ingredients for improvement of knee osteoarthritis (OA). Methods Sixteen volunteers aged ≥40 years with knee pain and without ambulant treatment participated in a 6-week randomized, double-blind, placebo-controlled study. They were assigned to the dietary supplement or placebo groups (n = 8, respectively) and ingested six capsules twice daily. The OA symptoms of each subject were determined in pre- and post-treatment periods using a visual analog scale for pain (VAS pain) and four Japanese Knee Osteoarthritis Measure (JKOM) subscales (joint stiffness, daily living, social activities, and general health condition). For safety and biomarker assessments, blood and urine samples were tested. Results In the treatment group, the subjective symptoms of VAS pain and three JKOM subscale scores except for social activities were significantly improved compared to pre-treatment. Among them, the pattern of change in joint stiffness and total JKOM scores showed a significant difference between groups (p = 0.008 and 0.041, respectively). The serum level of interleukin-6, a systemic inflammation biomarker, was significantly decreased in the treatment group after 6 weeks (p = 0.019), whereas the level remained stable in the placebo group (p = 0.690). Diagnostic urine and hematological parameters revealed no serious adverse differences following dietary supplementation over the 6-week study. Conclusion These findings suggest that the compound supplementation of functional food ingredients has potential as an adjunctive and safe therapy for knee OA.