Local Medical Centers Research Articles

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

Strategies to minimize preventable morbidity and mortality resulting from pandemics like COVID-19.

East Tennessee State University James H. Quillen College of Medicine.

East Tennessee State University James H. Quillen College of Medicine.

The Medical Demands On The Multidisciplinary Team Of Team UK At The 2018 Invictus Games

73 military personnel competed at the 2018 Invictus Games in Sydney, Australia as part of Team UK. The medical support team consisted of two doctors, two nurses and two physiotherapists. PURPOSE: To describe the epidemiology of injury and illness of Team UK competitors at the 2018 Invictus Games and the medical demand on the multidisciplinary team (MDT) by role (doctor, nurse & physiotherapist). METHODS: Electronic medical notes of the 56 males and 27 females (mean age: 37.18 S.D. 7.67) Team UK athletes were recorded via PPS software platform (Rushcliff, UK 2018). All medical interactions were retrospectively analysed using Excel (Microsoft, USA 2019) by: presenting complaint, MDT role, time, venue, anatomical region, treatment and outcomes. RESULTS: Team UK comprised of 60 veterans and 13 serving military personnel. Self-declaration of baseline illness/impairment returned 8 spinal cord injuries, 23 limb deficiencies, 23 musculoskeletal, 6 traumatic brain injuries, 14 neurological and 23 psychological illnesses. In total 198 interactions occurred over the 14 days: 69 doctor interactions, 21 nursing interactions and 108 physiotherapist interactions. Of these 107 were new interactions and 91 follow-ups/re-presentations. Of new interactions 59 (55.1%) were musculoskeletal in origin, 15 (14.0%) were illness, 14 (13.1%) were wound care, 3 (2.8%) were emergency care, 1 (0.8%) was psychological support and 15 (14.0%) were classified as other. The most common anatomical regions were shoulder, lumbar spine and cervical spine. Three acute emergencies required hospital admission: a suspected spinal cord injury, a suspected stroke and a respiratory arrest. 7 interactions led to visits to the local medical centre and three resulted in a quarantine. The highest incidence of interactions occurred within the 6 day competition period: 123 (62.2%) vs. 75 (37.9%) on the 8 days pre/post-competition. The highest incidences by day were the second, the first and last day of competition. 82 (41.4%) interactions occurred outside of competition venues (e.g. transport/hotel). Only 13 (17.8%) athletes had no medical interactions. CONCLUSION: These results can be used to inform injury prevention programmes and the composition of future MDTs. The data presented will allow for comparative data to be collected at future Invictus Games.

Incorporating a Required Student Research Experience into a Terminal MS Nutrition Program

Abstract Objectives Research experiences for graduate students in MS nutrition programs are often optional due to limited faculty, physical, and fiscal resources. Thus, the objective of this work was to develop a protocol for instituting a required, rather than optional, research experience in a terminal MS nutrition program in a large, urban public college with high academic standards. Methods Faculty specified several options for fulfilling the required capstone research experience: original research, grant proposal, or systematic review of literature. Students determined area of interest and identified a qualified research mentor either inside or outside the program (spring 2019). Students prepared research proposals according to specific guidelines; and students met with a faculty coordinator in periodic group sessions to establish expectations for preparing Literature Review, Methods, and Results sections of eventual final paper (fall 2019). Students submitted required progress reports throughout to facilitate accountability. Students enrolled in a seminar-style course, with two members of faculty, which provided mentoring to refine drafts and culminated in oral presentations to share results (spring 2020). Lastly, students submitted final papers in spring semester to assure timely graduation. Results All students in the MS nutrition programs anticipating June 2020 graduation enrolled in the required capstone research experience (n = 27). The majority of students engaged in original research with fewer opting for preparation of a grant proposal or a systematic review. The majority were mentored by program faculty whereas others were mentored by researchers in the broader nutrition community, namely in local medical centers and large community-based organizations. Course grades for the research experience were determined as follows: proposal, 10%; progress reports, 15%; oral presentation, 10%; and final paper, 65%. Conclusions A required research experience undoubtedly elevates the academic acumen of graduate students and potentially supports faculty research. Furthermore, identifying qualified research mentors outside the program augments available faculty resources and research opportunities for students. Funding Sources None

Extracorporeal Membrane Oxygenation for Coronavirus Disease 2019 in Shanghai, China.

Severe cases of coronavirus disease 2019 (COVID-19) cannot be adequately managed with mechanical ventilation alone. The role and outcome of extracorporeal membrane oxygenation (ECMO) in the management of COVID-19 is currently unclear. Eight COVID-19 patients have received ECMO support in Shanghai with seven with venovenous (VV) ECMO support and one veno arterial (VA) ECMO during cardiopulmonary resuscitation. As of March 25, 2020, four patients died (50% mortality), three patients (37.5%) were successfully weaned off ECMO after 22, 40, and 47 days support, respectively, but remain on mechanical ventilation. One patient is still on VV ECMO with mechanical ventilation. The partial pressure of oxygen/fractional of inspired oxygen ratio before ECMO initiation was between 54 and 76, and all were well below 100. The duration of mechanical ventilation before ECMO ranged from 4 to 21 days. Except the one emergent VA ECMO during cardiopulmonary resuscitation, other patients were on ECMO support for between 18 and 47 days. In conclusion, ensuring effective, timely, and safe ECMO support in COVID-19 is key to improving clinical outcomes. Extracorporeal membrane oxygenation support might be an integral part of the critical care provided for COVID-19 patients in centers with advanced ECMO expertise.

Factors Associated with Triage Modifications Using Vital Signs in Pediatric Triage: a Nationwide Cross-Sectional Study in Korea.

BackgroundPrevious studies on inter-rater reliability of pediatric triage systems have compared triage levels classified by two or more triage providers using the same information about individual patients. This overlooks the fact that the evaluator can decide whether or not to use the information provided. The authors therefore aimed to analyze the differences in the use of vital signs for triage modification in pediatric triage.MethodsThis was an observational cross-sectional study of national registry data collected in real time from all emergency medical services beyond the local emergency medical centers (EMCs) throughout Korea. Data from patients under the age of 15 who visited EMC nationwide from January 2016 to December 2016 were analyzed. Depending on whether triage modifications were made using respiratory rate or heart rate beyond the normal range by age during the pediatric triage process, they were divided into down-triage and non-down-triage groups. The proportions in the down-triage group were analyzed according to the triage provider's profession, mental status, arrival mode, presence of trauma, and the EMC class.ResultsDuring the study period, 1,385,579 patients' data were analyzed. Of these, 981,281 patients were eligible for triage modification. The differences in down-triage proportions according to the profession of the triage provider (resident, 50.5%; paramedics, 47.7%; specialist, 44.9%; nurses, 44.2%) was statistically significant (P < 0.001). The triage provider's professional down-triage proportion according to the medical condition of the patients showed statistically significant differences except for the unresponsive mental state (P = 0.502) and the case of air transport (P = 0.468).ConclusionDown-triage proportion due to abnormal heart rates and respiratory rates was significantly different according to the triage provider's condition. The existing concept of inter-rater reliability of the pediatric triage system needs to be reconsidered.

A public health campaing – health promotion in Roma minority population in the City of Zagreb

Abstract Background Researchers into health inequalities consistently show disadvantages in health status for various ethnic minority groups. Socially and economically Roma are one of the most vulnerable and disadvantaged groups. The Roma population of Zagreb approximates 2.755 according to the 2011 census. “Health promotion in Roma minority” is public health initiative undertaken in the City of Zagreb in 2018. Objectives The aim was to recognize the need for early risk factors prevention, to increase health literacy and to improve access to health-care in Roma minority. The stakeholders involved in this program were Roma NGOs, Andrija Stampar Institute of Public Health, local Medical Centre and City office for health. The role of Roma activist was inportant for including Roma population. Results In order to assess the health status and health-related lifestyle attributes a multidisciplinary approach was carried out including a total of 141 members of the Roma minority living in three different quarters. Activities included preventive exams, conducted workshops “Reproductive health”, “Access right to health-care”and “Healthy lifestyles”. Hypertension was found in 15,6% Roma using standard diagnostic criteria (i.e. BP ≥ 140/90 mm Hg). High blood shugar was found in 16,3% Roma. Screening mammography exams were also carried out including 73 Roma women over 50. BI-RADS 3 category was found in 17 women (23,3%) and BI-RADS 4 + 5 category was found in one woman. Conclusions The multisectoral collaboration and the involment of Roma activist could help to achieve better inclusion of Roma population, better perception of the health messages and behavioural changes. Health sector should promote and advocate for healthier lifestyle, but community and policy are to support and complement the actions. Access to health care cannot be discussed in isolation from other problems this population group experiences, such as poverty, restricted access to education and social exclusion. Key messages The empowerment is an outcome of health literacy, but does not automatically lead to empowerment. Individual’s social and cultural context must be in focus. The involment of Roma activist could help to achieve better results.

Measles outbreak at the Val Thorens ski station, France, 2019

Abstract During the 2019 winter season, a measles outbreak occurred at the Val Thorens ski station in France, in an area frequented by over 300,000 holiday-makers (70% foreigners) and 2,500 seasonal workers. Between 24/01/2019 and 15/04/2019, 55 cases were reported (18 confirmed and 37 clinical). Apart from 5 infected children under 2 years old attending the same nursery, cases were mainly seasonal workers between 19 and 41 years old. Five cases were hospitalised, one with severe pneumonia. Of the 36 cases with known vaccination status, 25 (69%) had not completed 2-dose vaccination. Other confirmed cases in visitors to Val Thorens were reported in neighbouring valleys (n = 3), and in other French regions. One case was reported the French overseas territory Guadeloupe (WHO ‘Americas’ region where measles has been eradicated). British, Belgian, Danish, Dutch and Irish authorities reported 7 cases in people who had stayed in the area. The list of exported cases is non-exhaustive. The regional health agency (ARS) provided increased information on epidemic risk and vaccination recommendations, particularly to health professionals and the town council. Identifying all contacts was difficult because many had occurred with seasonal workers. In addition to the approximately 150 vaccinations carried out by the Val Thorens medical centre from the start of the outbreak, only 41 other people were vaccinated in 5 free vaccination sessions organized in situ by the ARS, and the local medical and immunization centres. The large attendance at the station favoured the outbreak and its extension in France and abroad. Due to low measles vaccine coverage in France (80.3% for 2-dose cover in 2 years in 2017), outbreaks in non-vaccinated and not fully vaccinated populations are increasing, as seen in Val Thorens. Key messages A major measles epidemic occurring in an undervaccinated population in frequent contact with tourists, led to the extension of cases in France and Europe. Despite 5 free in situ vaccination sessions, with the mobilisation of local health professionals, few seasonal workers came to be vaccinated.

공공보건의료의 공공성 강화를 위한 정부간 협치: 법적 현상과 과제

Objectives: The purpose of this study is to suggest how central and local governments should enhance mutual cooperation in order to raise the publicness of public health care. Methods: Interpretation methodology of laws was used in this study; write carry out interpretation targeting the 「FRAMEWORK ACT ON HEALTH AND MEDICAL SERVICES」, 「PUBLIC HEALTH AND MEDICAL SERVICES ACT」, 「NATIONAL HEALTH PROMOTION ACT」, 「NATIONAL HEALTH INSURANCE ACT」, 「REGIONAL PUBLIC HEALTH ACT」, 「MEDICAL SERVICE ACT」, 「INFECTIOUS DISEASE CONTROL AND PREVENTION ACT」, 「ACT ON THE ESTABLISHMENT AND MANAGEMENT OF LOCAL MEDICAL CENTERS」 etc. And write try to divide the affairs of public health care medical services into national, institutional, autonomous, joint and common affairs, and attempt to analyze the authority of affair handling. That are based on the Supreme Court

Client, provider and community referrer perceptions of telehealth for the delivery of rural paediatric allied health services.

To examine allied health client, provider and community referrer perceptions of telehealth for the delivery of rural paediatric allied health services to facilitate adoption. A qualitative design employed semistructured interviews with the three key stakeholder groups. Stakeholders were associated with BUSHkids (The Royal Queensland Bush Children's Health Scheme), a not-for-profit organisation serving children and families in Queensland, Australia. Thirty-nine stakeholders (12 clients, 16 providers and 11 community referrers). Participants were asked about familiarity with telehealth, willingness to use telehealth and perceived barriers and facilitators to telehealth acceptability. Fifty-nine percent ofparticipants had experiencedtelehealth and 77 percentwerewilling to use it. Participants perceived that technology problems were a barrier to telehealth, that children would not be able to concentrate on or enjoy telehealth sessions, that relationships and communication would be inferior to in-person sessions, and that telehealth was inappropriate for disciplines employing physical touch. Participants identified access to health services as a key benefit of telehealth, said that technology problems could be worked around, and saidthat telehealth services could be supported with internal partners (eg, assistants) and external partners (eg, local medical centres). They also identified a variety of telehealth benefits to families (eg, convenience, privacy). Overall, telehealth was acceptable to stakeholders. Providers need training to facilitate child participation online and identify alternatives to physical touch. Co-learning opportunities should be used to address low provider and referrer self-efficacy.

Evaluation of Validity of the Korean Triage and Acuity Scale

The aim of this study was to identify the predictive validity of the Korean Triage and Acuity Scale (KTAS). This methodological study used data from National Emergency Department Information System for 2016. The KTAS disposition and emergency treatment results for emergency patients aged 15 years and older were analyzed to evaluate its predictive validity through its sensitivity, specificity, positive predictive value, and negative predictive value. In case of death in the emergency department, or where the intensive care unit admission was considered an emergency, the sensitivity, specificity, positive predictive value, and negative predictive value of the KTAS were 0.916, 0.581, 0.097, and 0.993, respectively. In case of death in the emergency department, or where the intensive or non-intensive care unit admission was considered an emergency, the sensitivity, specificity, and positive predictive value, and negative predictive value were 0.700, 0.642, 0.391, and 0.867, respectively. The results of this study showed that the KTAS had high sensitivity but low specificity. It is necessary to constantly review and revise the KTAS level classification because it still results in a few errors of under and over-triage. Nevertheless, this study is meaningful in that it was an evaluation of the KTAS for the total cases of adult patients who sought help at regional and local emergency medical centers in 2016.

Training in ACHD - A sonographer's viewpoint & systematic approach to echocardiography in ACHD

Background Adult Congenital Heart Disease (ACHD) is a highly specialised field of cardiology. Regardless of complexity, all ACHD patients should be seen at least once by an expert from a specialist centre and a care plan provided. The holistic care of ACHD patients is delivered by a multidisciplinary team with specialised knowledge. Although echocardiographic imaging is fundamental in the care of ACHD patients, these patients require access to many other services. Certain conditions will always require continuing specialist care, including (but not exclusively): patients with congenitally corrected transposition of the great arteries, repaired tetralogy of Fallot, repaired coarctation of the aorta, and patients who have undergone atrial switch, arterial switch, or Fontan procedures/operations. Unfortunately, ACHD patients do get lost to specialist follow up, often in the transition from childhood to adulthood. The loss to appropriate cardiology follow-up can be substantial and this ‘gap’ in care may put patients at increased risk of adverse outcome. These patients may present to a local medical centre or hospital leading to referrals to adult echocardiography service providers. The adult cardiac sonographer without specialist knowledge should not feel obliged to perform an echocardiogram (echo) on an individual with ACHD, due to the complexities often associated. In particular, when not performed by those with expertise in CHD, diagnoses can be missed. However, there will be circumstances when it is not appropriate to decline an echo. In such instances it is best practice to apply a systematic segmental approach to the echo to adequately demonstrate anatomy and any corrective surgery/procedures. It is important that the sonographer is aware of their knowledge gaps as well as the limitations of the test. Wherever possible, patients should be referred to a specialist centre to ensure an adequate continuum of care. Presentation Outline The purpose of these presentations: ▪ Illustrate why the care of adults with CHD should have input from an ACHD Specialist. ▪ Demonstrate the importance of understanding the ACHD patient's condition to ensure an adequate echo assessment. ▪ Provide practical echocardiographic imaging techniques in the assessment of ACHD including: ▪ A comprehensive systematic segmental approach. ▪ Echocardiographic examples demonstrating this systematic segmental approach. ▪ Case Studies ▪ Highlight the following: ▪ Importance of following a systematic segmental approach and describing only what you see. ▪Never feel obliged to perform an echocardiogram on a patient with CHD when unfamiliar with the patient's condition. ▪ Always consider referring the patient to an ACHD Specialist Centre.

Prevalence of complete and incomplete right bundle branch block in young athletes: A local study

Sparse data exists to characterize the disease prevalence in athletic patients with complete and incomplete right bundle branch block: (CRBBB) and (IRBBB) respectively. We sought to determine this prevalence in a local sport medical centre. We analysed ECG of athletes on-going a routine and mandatory medical examination in our local sport medical centre. All participants had 2 months of regular activity for at least 4 hours a week (h/w) prior to inclusion. Median follow-up period was 18 months. Five hundred and forty-eight athletes were enrolled in the study. History, physical examination and a 12 lead standard ECG was performed for all the participants. Demographic and baseline information for the study participants are exposed in Table 1. BBBD pattern was found in 77 (14%) participants, only one had CRBBB. IRBBB prevalence was 13.86% and CRBBB 0.1%. The athlete with CRBBB had not associated electrocardiographic anomalies suggesting Brugada syndrome or arrythmogenic right ventricle cardiomyopathy. He had a normal Treadmill stress test. His echocardiogram showed mild right ventricle dilatation and was allowed to continue his activity. No events were noticed in this population subset. RBBB is not rare in athlete's community. IRBBB is more common and considered benign. CRBBB is more rare and needs further work-up.

Nursing Partnerships in Research and Quality Improvement Within a Large Integrated Health Care System.

Within a large integrated health care system that includes local, regional, and national medical centers and offices, quality and patient safety teams, and research institutes, more than 58 000 nurses are employed, with the vast majority providing point-of-care service to patients and members. A small but increasingly important number of nurses are involved in quality improvement and research teams to improve patient care. Within this environment, a number of developments point to a growing need for nursing leadership in systems-level and delivery science policies and research. This article describes a partnership between clinical operations leaders and researchers (nurse scientists) to determine and utilize evidence-based practices to meet a system goal. The first objective of this article is to describe the barriers and potential solutions in combining practice, quality improvement, and research efforts across regions within a large integrated health care system. The second objective is to describe the uniqueness and importance of nurse leaders across interdisciplinary teams to simultaneously pursue research, quality improvement, and operational goals for the organization.

Implementing Group Prenatal Care in Southwest Georgia Through Public-Private Partnerships.

Introduction CenteringPregnancy® is well-regarded as an innovative group model of prenatal care. In 2009, Georgia's Southwest Public Health District partnered with local obstetricians and medical centers to expand prenatal care access and improve perinatal outcomes for low-income women by implementing Georgia's first public health administered CenteringPregnancy program. This paper describes the successful implementation of CenteringPregnancy in a public health setting with no prior prenatal services; assesses the program's first 5-year perinatal outcomes; and discusses several key lessons learned. Methods Prenatal and hospital medical records of patients were reviewed for the time period from October 2009 through October 2014. Descriptive analyses were conducted to examine demographic and clinical characteristics of women initiating prenatal care and to assess perinatal outcomes among patients with singleton live births who attended at least three CenteringPregnancy sessions or delivered prior to attending the third session. Results Six hundred and six low-income women initiated prenatal care; 55.4 and 36.4% self-identified as non-Hispanic black and Hispanic, respectively. The median age was 23years (IQR 20, 28). Nearly 69% initiated prenatal care in the first trimester. Perinatal outcomes were examined among 338 singleton live births. The 2010-2014 preterm birth rate (% of births < 37weeks gestation at delivery) and low birth weight rate (% of births < 2500g) were 9.1 and 8.9%, respectively. Nearly 77% of women initiated breastfeeding. Discussion CenteringPregnancy administered via public-private partnership may improve access to prenatal care and perinatal outcomes for medically underserved women in low-resource settings.

Effect of music (Brahms lullaby) and non-nutritive sucking on heel lance in preterm infants: A randomized controlled crossover trial.

ObjectivesThis study examined a more effective pain management method, without sucrose, on heel lance in preterm infants using the Premature Infant Pain Profile (PIPP).DesignIn a nonblinded, randomized controlled, two-period, two-sequence crossover trial, 25 infants were randomly allocated to intervention (a Brahms lullaby with non-nutritive sucking, facilitated tucking and holding) or standard care (facilitated tucking and holding).SettingLocal Perinatal Medical Centre’s NICU in Japan, July 2014 until June 2015.Outcome measuresThe primary outcome variable was PIPP, and secondary outcomes were heart rate (HR), oxygen saturation, and abnormal HR (> baseline mean plus 2 SDs, or <120 minus 2 SDs).ResultsThe infants were 33.8 weeks gestational age at birth, 1,983.7 g birth weight, and 32 to 35 weeks postconceptual age. At all 10 measurement points, constructed of every 30 seconds postheel lance, mean PIPP of infants during the intervention (3.6 to 2.4) was significantly lower than during the standard care (8.0 to 4.6) (range, P=0.0039 to P<0.0001). All PIPP reduction rates from the 30 seconds point were similar between the two groups. The HR of preterm infants at the 120 seconds points were significantly lower (P=0.0151), and the HRs of 6 points were considerably lower during the intervention than during the standard care (range, P≤0.0879 to P≥0.049). The abnormal HR total number was significantly lower during the intervention (2) than the standard care (23) (frequency ratio=0.087, P<0.0001).ConclusionThis method demonstrated stronger analgesia, early pain relief, and maintenance of homeostasis on heel lance in preterm infants.

Prediction of lower extremity motor recovery in persons with severe lower extremity paresis after stroke

ABSTRACTObjective: To investigate the extent of motor recovery and predict the prognosis of lower extremity (LE) recovery in patients with severe LE paresis after strokeMethods: 137 patients with severe LE paresis after stroke were recruited from a local medical centre. Voluntary LE movement was assessed with the LE subscale of the Stroke Rehabilitation Assessment of Movement (STREAM-LE). Univariate and stepwise regression analyses were used to investigate 25 clinical variables (including demographic, neuroimaging, and behavioural variables) for finding the predictors of LE recovery.Results: The STREAM-LE at discharge (DCSTREAM-LE) of the participants covered a very wide range (0–19). Specifically, 5.1% of the participants were nearly completely recovered, 11.7% were moderately recovered, 36.5% were slightly recovered, and 46.7% remained severely paralysed. ‘Score of STREAM-LE at admission (ADSTREAM-LE)’ and ‘volume of lesion and oedema’) were significant predictors of LE movement at discharge, explaining 25.1% of the variance of the DCSTREAM-LE (p < 0.001).Conclusions: LE motor recovery varied widely in our participants, indicating that patients’ recovery might not follow simple rules. The low predictive power (about a quarter) indicates that LE motor recovery in patients with severe LE paresis after stroke was hardly predictive.

Local emergency medical communication centres - staffing and populations.

There are several examples of inadequate staffing at local emergency medical communication centres (LEMCs) resulting in limited availability and long waits on the telephone. There are no guidelines for population size or the staffing of a LEMC. In the following, we present models of catchment areas and staffing. Traffic intensity on Saturdays and Sundays was based on data on figures for patient contacts at seven LEMCs in 2014 and 2015. We defined the minimum optimal population base as at least 50 % probability of ≥ 10 contacts in the course of a night duty. The Erlang-C formula was used to estimate service level and hence staffing requirements on the basis of population and response-time requirements. We have surveyed the combined staffing requirements of all the LEMCs in Norway. The minimum optimal population base was 29 134. In 2016, 48 of 103 LEMCs were smaller than this. In order to be able to satisfy the response-time requirements in the Norwegian Emergency Medicine Regulations, 112 LEMC night operators and 158 day operators would be necessary for the whole of Norway. A reduction of the response-time requirement from 120 to ten seconds would require 9.8 % more operators at night and 17 % more operators during the day. The models we have presented provide a basis for planning the population base and staffing of LEMCs. Significantly stricter response-time requirements will result in limited need for more personnel.

Telephone counselling by nurses in Norwegian primary care out-of-hours services: a cross-sectional study

BackgroundThe primary care out-of-hours (OOH) services in Norway are characterized by high contact rates by telephone. The telephone contacts are handled by local emergency medical communication centres (LEMCs), mainly staffed by registered nurses. When assessment by a medical doctor is not required, the nurse often handles the contact solely by nurse telephone counselling. Little is known about this group of contacts. Thus, the aim of this study was to investigate characteristics of encounters with the OOH services that are handled solely by nurse telephone counselling.MethodsNurses recorded ICPC-2 reason for encounter (RFE) codes and patient characteristics of all patients who contacted six primary care OOH services in Norway during 2014. Descriptive statistics and frequency analyses were applied.ResultsOf all telephone contacts (n = 61,441), 23% were handled solely by nurse counselling. Fever was the RFE most frequently handled (7.3% of all nurse advice), followed by abdominal pain, cough, ear pain and general symptoms. Among the youngest patients, 32% of the total telephone contacts were resolved by nurse advice compared with 17% in the oldest age group. At night, 31% of the total telephone contacts were resolved solely by nurse advice compared with 21% during the day shift and 23% in the evening. The share of nurse advice was higher on weekdays compared to weekends (mean share 25% versus 20% respectively).ConclusionThis study shows that nurses make a significant contribution to patient management in the Norwegian OOH services. The findings indicate which conditions nurses should be able to handle by telephone, which has implications for training and routines in the LEMCs. There is the potential for more nurse involvement in several of the RFEs with a currently low share of nurse counselling.

Survey of Activated Charcoal Administration for Poisoning Patients Visited in Emergency Medical Centers and Emergency Staff&amp;apos;s Perception in Korea

Purpose: Activated charcoal (AC) has been widely used as a universal antidote. Currently, emergency medical centers in Korea cannot administer AC due to discontinuation of the supply of commercial ready-mixed AC suspension. This study was conducted to investigate the proportion of emergency medical centers that administer AC to poisoning patients and provide basic information for emergency physicians and toxicologists. Methods: A prospective telephone survey of all of the included emergency medical institutions was conducted. The type of emergency medical institution, average annual number of patients admitted to the emergency department, annual average number of patients who were poisoned and whether the hospital currently utilizes gastric lavage and administration of AC were determined. Results: AC was administered to poisoning patients in 40% of regional emergency medical centers, 59.3% of local emergency medical centers, and 45.9% of local emergency medical rooms. Overall, 37% of total emergency medical institutions did not administer AC due to discontinuation of the commercial ready-mixed AC suspension. Additionally, 77% of emergency physicians in institutions without AC knew AC is necessary for poisoning patients. The rate of vomiting experienced by the medical staff according to types of charcoal showed that the average rate of vomiting was 33% for commercial ready-mixed activated charcoal suspension and 51% for self-prepared charcoal powder (p=0.02). Conclusion: AC should be secured promptly in emergency medical institutions. Before the supply of commercial ready-mixed AC suspension becomes again it is essential to develop a standardized regimen for self-preparation of charcoal powder and to educate emergency physicians and toxicologists to its use.