Emergency Medical Center Research Articles

The perspectives of Swedish registered nurses about managing difficult calls to emergency medical dispatch centres: a qualitative descriptive study

BackgroundTelephone triage at emergency medical dispatch centres is often challenging for registered nurses due to lack of visual cues, lack of knowledge about the patient, and time pressure – and making the right decision can be a matter of life and death. Some calls may be more difficult to handle, and more knowledge is needed about these calls to develop education and coping strategies. Therefore, the aim of this study was to describe the perspectives of registered nurses’ views about managing difficult calls to emergency medical dispatch centres.MethodsA descriptive design with a qualitative inductive approach was used. Three dispatch centers in mid-Sweden were investigated, covering about 950,000 inhabitants and handling around 114,000 calls per year. Individual interviews were carried out with a purposeful sample of 24 registered nurses. Systematic text condensation was conducted.ResultsSeven themes were generated: calls with communication barriers, calls from agitated or rude callers, calls about psychiatric illness, calls from third parties, calls about rare or unclear situations, calls with unknown addresses and calls regarding immediate life-threatening conditions. There was a strong consensus among the registered nurses about which calls were experienced as difficult, with the exception of calls about immediate life-threatening conditions. Some registered nurses thought calls about immediate life-threatening conditions were easy to handle as they simply adhered to protocol, while others described these calls as difficult and were emotionally affected.ConclusionThe registered nurses’ descriptions of difficult calls focused on the callers, while their own role, the organisational framework, and leadership were not mentioned. Many types of calls included difficulties, which could be related to the caller, their symptoms, or different circumstances. The registered nurses pointed to language barriers and rude, agitated callers as increasing problems. An investigation of actual emergency calls is warranted to examine the extent and nature of such calls.

Factors Influencing Early Readmission after Discharge against Medical Advice from the Emergency Department.

Discharge against medical advice (DAMA) and readmissions are important issues worldwide and can lead to adverse clinical outcomes, financial burden, and exposure of healthcare workers to unintended medical disputes. This study aimed to identify factors that affect readmissions within 48 h after DAMA. This retrospective study utilized the medical records of patients who visited an emergency medical center in Korea for treatment and were readmitted during a 10-year period. Factors predicting readmission after being DAMA were identified using logistic regression analysis. The total number of patients who were DAMA during the study period was 5445, of which 351 were readmitted to the emergency department within 48 h (6.4%). Factors influencing readmission included medical aid (odds ratio (OR) = 2.02, 95% confidence interval (CI): 1.46–2.83) and foreign worker insurance (OR = 2.07, 95% CI: 1.04–4.09) as their health insurance, as well as presenting for readmission by car (OR = 1.41, 95% CI: 1.08–1.82). Healthcare workers should treat patients who are DAMA and those who are likely to return with a more careful and preventative management strategy so that potential clinical, legal, and economic impacts of DAMA can be mitigated.

2-Domination in vague graphs

A vague graph is a generalized structure of a fuzzy graph that gives more precision, flexibility and compatibility to a system when compared with systems that are designed using fuzzy graphs. In this paper, the notions of (perfect-total) 2-dominating set and (perfect-total) 2-domination numbers on vague graphs are introduced and some properties are investigated. Especially, it is proven that in any strong vague graph on a Petersen graph, any minimal 2-dominating set is a minimal perfect 2-dominating set and minimal dominating set. Then, the concepts of (total) 2-cobondage set and (total) 2-cobondage number in vague graphs are expressed and related results obtained. Finally, an application related to Fire Stations and Emergency Medical centers is provided.

Surveillance of COVID-19 using a keyword search for symptoms in reports from emergency medical communication centers in Gironde, France: a 15year retrospective cross-sectional study.

During periods such as the COVID-19 crisis, there is a need for responsive public health surveillance indicators related to the epidemic. To determine the performance of keyword-search algorithm in call reports to emergency medical communication centers (EMCC) to describe trends in symptoms during the COVID-19 crisis. We retrospectively retrieved all free text call reports from the EMCC of the Gironde department (SAMU 33), France, between 2005 and 2020 and classified them with a simple keyword-based algorithm to identify symptoms relevant to COVID-19. A validation was performed using a sample of manually coded call reports. The six selected symptoms were fever, cough, muscle soreness, dyspnea, ageusia and anosmia. We retrieved 38,08,243 call reports from January 2005 to October 2020. A total of 8539 reports were manually coded for validation and Cohen’s kappa statistics ranged from 75 (keyword anosmia) to 59% (keyword dyspnea). There was an unprecedented peak in the number of daily calls mentioning fever, cough, muscle soreness, anosmia, ageusia, and dyspnea during the COVID-19 epidemic, compared to the past 15 years. Calls mentioning cough, fever and muscle soreness began to increase from February 21, 2020. The number of daily calls reporting cough reached 208 on March 3, 2020, a level higher than any in the previous 15 years, and peaked on March 15, 2020, 2 days before lockdown. Calls referring to dyspnea, anosmia and ageusia peaked 12 days later and were concomitant with the daily number of emergency room admissions. Trends in symptoms cited in calls to EMCC during the COVID-19 crisis provide insights into the natural history of COVID-19. The content of calls to EMCC is an efficient epidemiological surveillance data source and should be integrated into the national surveillance system.

Simulation Trainings in the Optimization of Medical Care for Patients with Acute Coronary Syndrome

The study analyzes the effectiveness of simulation training aimed at introducing protocols for resuscitation and thrombolytic therapy for emergency medical workers and vascular centers in teamwork by analyzing the clinical outcomes of resuscitation measures, the number and effectiveness of thrombolytic therapy at the prehospital stage and in vascular centers. It has been shown that team simulation trainings contribute to improving the quality of medical care for patients with acute coronary syndrome, improving patient survival and their quality of life.

Methodology of emergency medical logistics for multiple epidemic areas in public health emergency.

Coronavirus disease 2019(COVID-19) has brought great disasters to humanity, and its influence continues to intensify. In response to the public health emergencies, prompt relief supplies are key to reduce the damage. This paper presents a method of emergency medical logistics to quick response to emergency epidemics. The methodology includes two recursive mechanisms: (1) the time-varying forecasting of medical relief demand according to a modified susceptible-exposed-infected- Asymptomatic- recovered (SEIAR) epidemic diffusion model, (2) the relief supplies distribution based on a multi-objective dynamic stochastic programming model. Specially, the distribution model addresses a hypothetical network of emergency medical logistics with considering emergency medical reserve centers (EMRCs), epidemic areas and e-commerce warehousing centers as the rescue points. Numerical studies are conducted. The results show that with the cooperation of different epidemic areas and e-commerce warehousing centers, the total cost is 6% lower than without considering cooperation of different epidemic areas, and 9.7% lower than without considering cooperation of e-commerce warehousing centers. Particularly, the total cost is 20% lower than without considering any cooperation. This study demonstrates the importance of cooperation in epidemic prevention, and provides the government with a new idea of emergency relief supplies dispatching, that the rescue efficiency can be improved by mutual rescue between epidemic areas in public health emergency.

The Financial Impact of a Partnership Between an Academic Medical Center and a Free Clinic

PurposeThe objective of this study is to examine the association between an academic medical center and free clinic referral partnership and subsequent hospital utilization and costs for uninsured patients discharged from the academic medical center's emergency department (ED) or inpatient hospital. MethodsThis retrospective, cross-sectional study included 6014 uninsured patients age 18 and older who were discharged from the academic medical center's ED or inpatient hospital between July 2016 and June 2017 and were followed for 90 days in the organization's electronic medical record to identify the occurrence and cost of subsequent same-hospital ED visits and hospital admissions. The occurrence of any subsequent ED visits or hospital admissions and the cost of subsequent hospital care were compared by free clinic referral status after inverse probability of treatment weighting. ResultsOverall, 330 (5.5%) of uninsured patients were referred to the free clinic. Compared with patients referred to the free clinic, patients not referred had greater odds of any subsequent ED visits or hospital admissions within 90 days (odds ratio, 1.8; 95% confidence interval: 1.7-2.0). For patients with any subsequent ED visits or hospital admissions, the mean cost of care for those who were not referred to the free clinic was 2.3 times higher (95% confidence interval: 2.0-2.7) compared to referred patients. ConclusionAn academic medical center-free clinic partnership for follow-up care after discharge from the ED or hospital admission is a promising approach for improving access to care for uninsured patients.

Diagnosis of Acute Central Dizziness With Simple Clinical Information Using Machine Learning.

Background: Acute dizziness is a common symptom among patients visiting emergency medical centers. Extensive neurological examinations aimed at delineating the cause of dizziness often require experience and specialized training. We tried to diagnose central dizziness by machine learning using only basic clinical information.Methods: Patients were enrolled who had visited an emergency medical center with acute dizziness and underwent diffusion-weighted imaging. The enrolled patients were dichotomized as either having central (with a corresponding central lesion) or non-central dizziness. We obtained patient demographics, risk factors, vital signs, and presentation (non-whirling type dizziness or vertigo). Various machine learning algorithms were used to predict central dizziness. The area under the receiver operating characteristic curve (AUROC) was measured to evaluate diagnostic accuracy. The SHapley Additive exPlanations (SHAP) value was used to explain the importance of each factor.Results: Of the 4,481 visits, 414 (9.2%) were determined as central dizziness. Central dizziness patients were more often older and male and had more risk factors and higher systolic blood pressure. They also presented more frequently with non-whirling type dizziness (79 vs. 54.4%) than non-central dizziness. Catboost model showed the highest AUROC (0.738) with a 94.4% sensitivity and 31.9% specificity in the test set (n = 1,317). The SHAP value was highest for previous stroke presence (mean; 0.74), followed by male (0.33), presentation as non-whirling type dizziness (0.30), and age (0.25).Conclusions: Machine learning is feasible for classifying central dizziness using demographics, risk factors, vital signs, and clinical dizziness presentation, which are obtainable at the triage.

Laboratory analysis of acute acetaminophen overdose patients in Emergency Medical Centers: including analysis of one toxicological laboratory data

Purpose: Acetaminophen (APAP) is a widely available drug responsible for a large part of drug-induced hepatotoxicity in developed countries. Although acetaminophen overdose cases in Korea are being continuously reported, there are no reports related to the level of this drug in the patient's blood or of laboratory analysis at emergency departments (ED). This study sought to analyze the acetaminophen overdose cases at a toxicological laboratory and to survey APAP analysis services offered at select EDs. Methods: We analyzed the demographic and analytic data at a toxicological laboratory run by the National Emergency Medical Center (NMC) in 2019-2020. We surveyed the APAP laboratory service in the 38 regional emergency medical centers (EMCs) and 68 local EMCs near the toxicological laboratory. Results: We studied 175 acute poisoning cases (112 women) with positive blood APAP results (mean age 47.0±24.1 years). Suicide attempts comprised 40.0% of the cases and 30.3% APAP overdose events. In the univariate analysis, we observed that patients were significantly younger, with fewer underlying medical diseases. There were a higher number of APAP overdose events, more favorable initial mental status, more toxic quantity intake in the above treatment line group (p<0.05), In multivariate analysis, the toxic amount intake was significantly more frequent in the above treatment line group (p<0.01). Hospital APAP analysis services were available in six EMCs (3/38 regional and 3/68 local). The hospital blood APAP level reporting intervals were shorter than outside-hospital laboratory services (p<0.01, regional 7.0±3.0 vs. 40.6±27.5, local 5.3±3.1 vs. 57.9±45.1 hours). The NMC toxicological laboratory reporting interval was shorter than the other outside-hospital laboratories (p<0.01, regional 5.7±0.6 vs. 50.2±22.7 local 7.5±3.0 vs. 70.5±41.5 hours). Conclusion: Over the treatment line group, toxic amount intake was significantly more frequent. Only six of 106 EMCs have their own APAP analysis service in their hospitals.

Description of call handling in emergency medical dispatch centres in Scandinavia: recognition of out-of-hospital cardiac arrests and dispatcher-assisted CPR

BackgroundThe European resuscitation council have highlighted emergency medical dispatch centres as an important key player for early recognition of Out-of-Hospital Cardiac Arrest (OHCA) and in providing dispatcher assisted cardiopulmonary resuscitation (CPR) before arrival of emergency medical services. Early recognition is associated with increased bystander CPR and improved survival rates. The aim of this study is to describe OHCA call handling in emergency medical dispatch centres in Copenhagen (Denmark), Stockholm (Sweden) and Oslo (Norway) with focus on sensitivity of recognition of OHCA, provision of dispatcher-assisted CPR and time intervals when CPR is initiated during the emergency call (NO-CPRprior), and to describe OHCA call handling when CPR is initiated prior to the emergency call (CPRprior).MethodsBaseline data of consecutive OHCA eligible for inclusion starting January 1st 2016 were collected from respective cardiac arrest registries. A template based on the Cardiac Arrest Registry to Enhance Survival definition catalogue was used to extract data from respective cardiac arrest registries and from corresponding audio files from emergency medical dispatch centres. Cases were divided in two groups: NO-CPRprior and CPRprior and data collection continued until 200 cases were collected in the NO-CPRprior-group.ResultsNO-CPRprior OHCA was recognised in 71% of the calls in Copenhagen, 83% in Stockholm, and 96% in Oslo. Abnormal breathing was addressed in 34, 7 and 98% of cases and CPR instructions were started in 50, 60, and 80%, respectively. Median time (mm:ss) to first chest compression was 02:35 (Copenhagen), 03:50 (Stockholm) and 02:58 (Oslo). Assessment of CPR quality was performed in 80, 74, and 74% of the cases. CPRprior comprised 71 cases in Copenhagen, 9 in Stockholm, and 38 in Oslo. Dispatchers still started CPR instructions in 41, 22, and 40% of the calls, respectively and provided quality assessment in 71, 100, and 80% in these respective instances.ConclusionsWe observed variations in OHCA recognition in 71–96% and dispatcher assisted-CPR were provided in 50–80% in NO-CPRprior calls. In cases where CPR was initiated prior to emergency calls, dispatchers were less likely to start CPR instructions but provided quality assessments during instructions.

Development and validation of a scoring system for mortality prediction and application of standardized W statistics to assess the performance of emergency departments

BackgroundIn-hospital mortality and short-term mortality are indicators that are commonly used to evaluate the outcome of emergency department (ED) treatment. Although several scoring systems and machine learning-based approaches have been suggested to grade the severity of the condition of ED patients, methods for comparing severity-adjusted mortality in general ED patients between different systems have yet to be developed. The aim of the present study was to develop a scoring system to predict mortality in ED patients using data collected at the initial evaluation and to validate the usefulness of the scoring system for comparing severity-adjusted mortality between institutions with different severity distributions.MethodsThe study was based on the registry of the National Emergency Department Information System, which is maintained by the National Emergency Medical Center of the Republic of Korea. Data from 2016 were used to construct the prediction model, and data from 2017 were used for validation. Logistic regression was used to build the mortality prediction model. Receiver operating characteristic curves were used to evaluate the performance of the prediction model. We calculated the standardized W statistic and its 95% confidence intervals using the newly developed mortality prediction model.ResultsThe area under the receiver operating characteristic curve of the developed scoring system for the prediction of mortality was 0.883 (95% confidence interval [CI]: 0.882–0.884). The Ws score calculated from the 2016 dataset was 0.000 (95% CI: − 0.021 – 0.021). The Ws score calculated from the 2017 dataset was 0.049 (95% CI: 0.030–0.069).ConclusionsThe scoring system developed in the present study utilizing the parameters gathered in initial ED evaluations has acceptable performance for the prediction of in-hospital mortality. Standardized W statistics based on this scoring system can be used to compare the performance of an ED with the reference data or with the performance of other institutions.

Whole truths but half the blood: Addressing the gap between the evidence and practice of pre-hospital and in-hospital blood product use for trauma resuscitation.

In recent years, several studies have demonstrated the efficacy of using pre-hospital blood product and in-hospital whole blood for trauma resuscitation. While some observations suggest an encouraging uptake of this evidence by emergency medical service (EMS) agencies and trauma centers, a nationwide characterization of blood product utilization for bleeding trauma patients remains unknown. The objective of this study is to determine nationwide estimates of pre-hospital blood product and in-hospital whole blood utilization for trauma resuscitation. All adult trauma patients reported to the National Emergency Medical Services Information System (NEMSIS) dataset 2019 were included. Proportions of patients who received any pre-hospital blood product were calculated. The American College of Surgeons (ACS) Trauma Quality Programs (TQP) databases 2015-2017 and first quarter of 2020 were used to calculate the proportion of ACS-verified trauma centers that transfused whole blood. Among a total of 3,058,804 pre-hospital trauma patients, only 313 (0.01%) received any blood transfusion; 208 (0.21%) patients with systolic blood pressure (SBP) ≤90 mmHg and 121 (0.67%) patients with SBP ≤90 mmHg and heart rate ≥120 beats per minute received any blood product. The proportion of ACS-verified trauma centers transfusing whole blood increased from 16.7% (45/269) in 2015 to 24.5% (123/502) in first quarter of 2020. Despite strong evidence and recommendations, pre-hospital utilization of blood products for trauma resuscitation remains low. Additionally, while the overall in-hospital whole blood use also remains low, its use has increased at ACS-verified trauma centers over the past 5 years.

Analytical toxicology service model at the subregional center level for severe acute poisoning

Acute poisoning may necessitate identification of the toxic agent; however, several acutely poisoned patients are treated with minimal laboratory assistance. We investigated whether focused reference to laboratory toxicology tests conducted during a pilot project for a subregional analytical toxicology service influences treatment decisions. Patients with acute poisoning presented to the level 1 regional emergency medical center from May 2018 to April 2019 were initially reviewed. Poison samples were referred to the subregional toxicological analytical service. In total, 253 substance samples were tested among 111 patients during the study. According to the reported drug levels, 3 (1.2%) samples contained lethal doses, 49 (19%) had toxic levels, and 28 (11%) contained detectable levels of a lethal toxin or pesticide. Disagreement between the clinical assessment and laboratory analyses was found for 62 patients (fair kappa = 0.24, 56%), and they often had lower Glasgow Coma Scale, higher severity scores, older age, and less likelihood of receiving gastrointestinal decontamination. The regional analytical toxicology services were helpful for diagnostic planning and therapeutic management of acute poisoning. For seriously poisoned patients with inconsistent histories, it is necessary to reevaluate the classic therapeutic process based on the medical history.

Nurse-Administered Analgesic Treatment in Italian Emergency Medical Services: A Nationwide Survey.

BackgroundAcute pain is common among patients requiring assistance from prehospital emergency medical services (EMS). Nonetheless, the undertreatment of pain in this context remains a frequent phenomenon. Timely and effective analgesia is a crucial feature in emergency medicine. To ensure analgesia provision, prehospital paramedics and nurses can administer analgesics via standard operating protocols or under a physician’s remote supervision. Information about such protocols in Italian EMS is lacking.ObjectiveEvaluation of the availability of nurse’s standard analgesia protocols in Italy’s prehospital EMS settings.MethodsA cross-sectional online survey involved all 74 Italian emergency medical dispatch centres (EMDCs). Aside from descriptive statistics, we used χ2-analysis and Spearman-rank correlation to look for associations between geographical areas’ dependence upon independent variable categories and their correlations.ResultsOf all the 74 Italian EMDCs, 70 (94.6%) completed the survey, covering 100 provinces out of a total of 107 (93.5%). Operating nurses’ prehospital analgesia protocols are available in 46 provinces (46.0%). The availability of prehospital analgesia protocols is more extended in northern Italy EMDCs (n=30, 66.7%) than in central Italy (n=9, 42.8%) and southern Italy and islands (n=7, 20.6%). Morphine (76.1% for medical patients and 95.7% for trauma) and paracetamol (89.1% for both) are the most common drugs included in the prehospital analgesia protocols.ConclusionDespite international consensus on the necessity, efficacy, and safety of nurses’ prehospital analgesia provision, nurse-administered analgesia protocols are available in less than half of Italian provinces, with substantial differences between northern, central, and southern areas. These results indirectly indicate potential undertreatment of prehospital pain in Italy and yield practice improvements.

The Correlation Between Perceived Organizational Support and Quality of Work Life in the Operational Staff of Tehran Medical Emergency Center, 2019

The Correlation Between Perceived Organizational Support and Quality of Work Life in the Operational Staff of Tehran Medical Emergency Center, 2019

Identifying the predictors of turnover intention based on psychosocial factors of nurses during the COVID-19 outbreak.

AimsBecause of the direct contact nurses have with patients, they are exposed to more stressful events during the outbreak of infectious diseases, which increases their turnover intention, highly impacting not only nurses, but also patients and organizations. The present study aimed to identify the predictors of turnover intention based on psychosocial factors in nurses of Ardabil pre‐hospital emergency and educational and medical centres during the COVID‐19 outbreak.DesignThe present descriptive‐analytical study was conducted in June, 2020.MethodsA total of 479 nurses working in Ardabil pre‐hospital emergency and educational and medical centres to fight COVID‐19 were recruited for this study using the census method. Data were collected using the Demographic Information Questionnaire, Turnover Intention Questionnaire, Weiss & Marmar Impact of Event Scale‐Revised (IES‐R), General Health Questionnaire (12 C‐GHQ) and Job Content Questionnaire (JCQ). Data were analysed with SPSSv.22 software using correlation, t test, analysis of variance, multiple regression and descriptive tests.ResultsThe mean turnover intention score of nurses was 41.73 with a standard deviation of 12.11. The results of correlation coefficient revealed a positive relationship between PTSD, general health, job demand and job strain with turnover intention (p ≤ .01) and a positive and significant relationship between social support and turnover intention (p ≤ .01). Multiple regression analysis showed that the variables of gender, marital status, work position, decision latitude, social support, job strain, general health and post‐traumatic stress disorder (PTSD) were predictors of turnover intention.ConclusionJob stressors during the COVID‐19 outbreak have led to an increase in nurses’ turnover intention. Identifying and managing the factors related to job stressors will make it possible to prevent nurses’ turnover intention in such critical situations.

Irregular vague graphs

A vague graph is a generalized structure of a fuzzy graph that gives more precision, flexibility and compatibility to a system when compared with systems that are designed using fuzzy graphs. In this paper, the new concepts of (totally) irregular, strongly (totally) irregular, highly totally irregular, neighborly totally irregular, edge-irregular of vague graphs are introduced and generalized, and some properties and related results are investigated. Then, we present the concepts of homomorphism, weak isomorphism, co-weak isomorphism and isomorphism of irregular vague graphs and some results on (total) domination number, (total) 2-domination number, (total) cobondage number and (total) 2-cobondage number. Finally, one of their applications related to location map of Fire Stations and Emergency Medical centers in urban regions of ​​a metropolis is presented.

Awareness of Temporary Field Emergency Medical Centers Operated by Paramedics on a First-Come-First-Served Basis in a Mass Casualty Disaster

This study was conducted to identify the need for the operation of temporary field emergency medical centers (TFEMC) by paramedics on a first-come-first-served basis at disaster sites where mass casualties occurred. The survey was conducted on 119 emergency doctors and paramedics from five fire departments under the Ulsan City Fire Department. More than 77.9% of the paramedics surveyed had been dispatched for the handling of many casualties at least once, but only 31.5% of them had experienced the establishment and operation of TFEMC. Awareness of triage showed a significant difference according to work career (F = 3.455, p = .009) and assigned work (F = 3.955, p = .004). Awareness of the disaster medical response system was significantly different according to rank (F = 5.299, p = .002), work career (F = 5.575, p = .000), age (F = 3.420, p = .018), and assigned work (F = 3.114, p = .016). There was no statistically significant difference in the awareness regarding TFEMCs. Most of the paramedics answered that they had not received mass casualty-focused education and that they needed related professional education. Therefore, for the efficient operation of TFEMCs managed by paramedics on a first-come-first-served basis, it is necessary to develop and implement various related professional training courses that combine theoretical training and field practice regarding the operation of TFEMCs, thus providing many paramedics an opportunity for education.

Fluorescence Based on Surface Plasmon Coupled Emission for Ultrahigh Sensitivity Immunoassay of Cardiac Troponin I.

This work demonstrates the quantitative assay of cardiac Troponin I (cTnI), one of the key biomarkers for acute cardiovascular diseases (the leading cause of death worldwide) using the fluorescence-based sandwich immune reaction. Surface plasmon coupled emission (SPCE) produced by non-radiative coupling of dye molecules with surface plasmons being excitable via the reverse Kretschmann format is exploited for fluorescence-based sandwich immunoassay for quantitative detection of cTnI. The SPCE fluorescence chip utilizes the gold (2 nm)-silver (50 nm) bimetallic thin film, with which molecules of the dye Alexa 488 (conjugated with detection antibodies) make a near field coupling with the plasmonic film for SPCE. The experimental results find that the SPCE greatly improves the sensitivity via enhancing the fluorescence signal (up to 50-fold) while suppressing the photo-bleaching, permitting markedly enhanced signal-to-noise ratio. The limit of detection of 21.2 ag mL−1 (atto-gram mL−1) is obtained, the lowest ever reported to date amid those achieved by optical technologies such as luminescence and label-free optical sensing techniques. The features discovered such as ultrahigh sensitivity may prompt the presented technologies to be applied for early diagnosis of cTnI in blood, particularly for emergency medical centers overloaded with patients with acute myocardial infarction who would suffer from time-delayed diagnosis due to insufficient assay device sensitivity.

東京ルール固定地域医療センター(二次救急)における脳神経外傷治療の現状

東京ルール固定地域医療センター(二次救急)における脳神経外傷治療の現状