Mobile Medical Care Research Articles

Initiating pain and palliative care outpatient services for the suburban underserved in Montgomery County, Maryland: Lessons learned at the NIH Clinical Center and MobileMed.

With the ongoing expansion of palliative care services throughout the United States, meeting the needs of socioeconomically marginalized populations, as in all domains of healthcare, continues to be a challenge. Our specific aim here was to help meet some of these needs through expanding delivery of pain and palliative care services by establishing a new clinic for underserved patients and collecting descriptive data about its operation. In November of 2014, the National Institutes of Health Clinical Center's Pain and Palliative Care Service (PPCS) launched a bimonthly offsite pain and palliative care outpatient clinic in collaboration with Mobile Medical Care Inc. (MobileMed), a private not-for-profit primary care provider in Montgomery County, Maryland, serving underserved area residents since 1968. Staffed by NIH hospice and palliative medicine clinical fellows and faculty, the clinic provides specialty pain and palliative care consultation services to patients referred by their primary care healthcare providers. A patient log was maintained, charts reviewed, and referring providers surveyed on their satisfaction with the service. The clinic had 27 patient encounters with 10 patients (6 males, 4 females, aged 23-67) during its first 7 months of operation. The reason for referral for all but one patient was chronic pain of multiple etiologies. Patients had numerous psychosocial stressors and comorbidities. All primary care providers who returned surveys (n = 4) rated their level of satisfaction with the consultation service as "very satisfied" or "extremely satisfied." This brief descriptive report outlines the steps taken and logistical issues addressed to launch and continue the clinic, the characteristics of patients treated, and the results of quality-improvement projects. Lessons learned are highlighted and future directions suggested for the clinic and others that may come along like it.

Comparative analysis of time spent by the fire department on call of elderly victims fall in collective transport.

Introduction: The public transport is a major form of transportation in the cities and the increasing elderly population became many users this means of transport. Objective: The objective of the research was to compare the time spent by the fire department in the care of elderly fall victims in mass transportation between two cities. Method: Data were collected by analyzing the database record of the overall occurrences of the fire department on the fall of elderly people in public transport in the cities of Curitiba and Maringá between the years 2005-2012. Collected were the region the city where the event occurred; hospitals for referral of victims and the time spent in attending these events by teams of firemen from the cities. Results: Increased occurrence of falls in the elderly collective transport four times in Maringá was observed. The frequency of these occurrences happened mainly in the central region in both cities and time attendance differed significantly and in Maringa most visits took place within an hour and Curitiba with over an hour. Conclusion: We conclude that further studies should be conducted and management strategies of public transportation employees so they can improve the time spent on mobile medical care.

Design and Application of Medical Monitoring System Based on Android

With the development of information and communication technology and the advent of new technologies including wireless communication, smart handheld mobile terminals and wearable medical sensor detection technology, mobile medical care is facing its development opportunity. In this context, our medical monitoring system combines wireless communication technology with wearable medical sensor and designs a remote medical monitoring of multiple physiological parameters. With the support of Android devices, this system offers medical reports retrieval, online diagnosis and health guidelines. It provides users with multi-functional, instant, real-time monitoring and interactive medical services in a high efficient low cost way, which enables remote interrogation and medical care become possible.

Mobile medical care units: an innovative use of Medicare funding.

Medicare is an underutilized payment source for home-delivered health care services for homebound elderly. An innovative service provision for home health care, Mobile Medical Care Units (MMCU), is presented. MMCU consist of a multidisciplinary team of health care professionals who are responsible for following the health care needs of their elderly patients on a continuous long-term basis across settings. This comprehensive care has significant impacts on homebound elderly and the health care industry. MMCU have the potential to be covered more inclusively by primary or supplemental health insurance plans, including Medicare, Medicaid, and HMO's, or by special funding from state aging departments.

Requirements and design spaces of mobile medical care

Pervasive care and chronic disease management to reduce institutionalization is a priority for most western countries. The realization of next generation ubiquitous and pervasive healthcare systems will be a challenging task, as these systems are likely to involve a complex structure. Such systems will consist of various devices, ranging from resource-constrained sensors and actuators to complex multimedia devices, supporting time critical applications. This is further compounded by cultural and socio-economical factors that must be addressed for next generation healthcare systems to be widely diffused and used. These factors have a direct impact on the system and security models and will require further understanding to encourage users to embrace and adopt the new technology. These models must capture not only the perceived value of the new technology and its ease of use, but most importantly the perceived risk of using this technology. This paper outlines the design space of pervasive health monitoring with body sensor networks and derives the requirements for connected pervasive medical care systems. Commercial and academic mobile medical sensor systems have been mapped to the requirements derived and a comparative analysis of state of the technology is given.

A Mobile Medical Care Approach Targeting Underserved Populations in post-Hurricane Katrina Mississippi

On August 29, 2005, Hurricane Katrina devastated the Gulf Coast Mississippi region, damaging health care infrastructure and adversely affecting the health of populations left behind. Operation Assist, a project of the Children's Health Fund and the Columbia University Mailman School of Public Health, operated mobile medical units to provide health services to underserved populations in the affected areas. Data collected from all patient encounters from September 5-20, 2005 demonstrate that in addition to common respiratory illnesses, skin conditions, and minor injuries, a high proportion of visits were for vaccine administration and chronic medical problems including hypertension, diabetes, and asthma. Mobile medical units staffed by primary care clinicians experienced in dealing with the clinical and social needs of the underserved and comfortable working in a resource-poor environment can make a positive contribution to post-disaster care.

Six-Month Outcome of Emergency Percutaneous Coronary Intervention in Resuscitated Patients After Cardiac Arrest Complicating ST-Elevation Myocardial Infarction

The outcome of resuscitated patients after cardiac arrest complicating acute myocardial infarction remains poor, primarily because of the relatively low success rates of cardiopulmonary resuscitation management. Existing data suggest potential beneficial effects of early myocardial reperfusion, but the predictors of survival in these patients remain unknown. From 1995 to 2005, 186 patients (78% men; mean age, 60.4+/-13.8 years) underwent immediate percutaneous coronary intervention after successful resuscitation for cardiac arrest complicating acute myocardial infarction. Prompt prehospital management was performed by mobile medical care units in 154 of 186 patients, whereas 32 had in-hospital cardiac arrest. Infarct location was anterior in 105 patients (56%), and shock was present on admission in 96 (52%). Percutaneous coronary intervention (stenting rate 90%) was successful in 161 of 186 patients (87%). Six-month survival rate was 100 of 186 (54%), and 6-month survival free of neurological sequelae was 46%. By multivariate analysis, predictors of 6-month survival were a shorter interval between the onset of cardiac arrest and arrival of a first responder (odds ratio, 0.67; 95% CI, 0.54 to 0.84), a shorter interval between the onset of cardiac arrest and return of spontaneous circulation (odds ratio, 0.91; 95% CI, 0.87 to 0.96), and absence of diabetes (odds ratio, 7.30; 95% CI, 1.80 to 29.41). In patients with resuscitated cardiac arrest complicating acute myocardial infarction, prompt prehospital management and early revascularization were associated with a 54% survival rate at 6 months. A strategy including adequate prehospital management, early revascularization, and specific care in dedicated intensive care units should be strongly considered in resuscitated patients after cardiac arrest complicating acute myocardial infarction.

Perspectives from MTF USNS Mercy

Perspectives from MTF USNS Mercy

Physicians With Heart

To the Editor. —Medical News & Perspectives 1 recently ran several articles physicians whose efforts for the medically underserved have made a positive impact. Another such hero is H. Arnold Meyersburg, a psychiatrist in private practice in Kensington, Md. Almost two dozen years ago, as president of a voluntary tutoring group for children from low-income families, he became aware of their difficulty in obtaining health care in affluent Montgomery County, Maryland. Under Dr Meyersburg's leadership, perseverance, and activism, and with help from a few dedicated community leaders, Mobile Medical Care was born after a difficult labor and delivery. In April 1970, its first clinic opened in a church in Ken-Car, a low-income black community, literally on the other side of the railroad tracks. The Ken-Car citizens' association helped coordinate activities, a small foundation donated seed money, the local Red Cross chapter offered supplies and recruited nurse volunteers, and a

Role of Anesthesiology in Emergency Medical Services (EMS) in Poland

Improvements of results in emergency care of critically ill patients can be realized if EMS organizations are properly based on local conditions. The Emergency Medical Unit is the first of three parts of the Integrated Health Service in Poland. The second part is in-hospital treatment. The third part is outpatient care. In most hospitals, the head of the department of anesthesiology and intensive therapy coordinates each emergency medical unit. Each unit consists of ambulances (mobile intensive care units), admission (emergency) rooms, and an intensive medical care unit (ICU). A specialization program was created and physicians who complete this type of training obtain the title “specialist in anesthesiology and intensive therapy.”This four year specialization program contains the educational elements necessary to administer all types of modern anesthesia, and provides full preparation for work in mobile and stationary intensive medical care units as well. Such training has also given these specialists the chance to initiate treatment methods for chronic pain. An examination consisting of practical tests, multiple choice written knowledge tests, and oral tests completes the program. The latter is a conversation with a commission, consisting of full professors and associate professors in anesthesiology and intensive therapy.

Mobile medical care to the elderly: an evaluation.

Mobile medical care to the elderly: an evaluation.

For the Street Scene: Mobile Medical Care?

This is a report of a mobile medical care unit housed in a Winnebago camper model that goes out into the community, fully staffed and equipped for action. The 12 to 15 mile trip that the van makes each evening permits the staff an opportunity to get to where the young people are; they get close to the young people, offer rides, and find out “what's happening.” The use of the street worker, the nurse, the volunteer, and the philosophy of a patient advocacy system are thoroughly detailed. The description of practical aspects of the outreach components of such a clinic facility offers much to all who are in crisis intervention as well as community‐reach project endeavors.

Mobile medical care for alienated youths

Present elements in our medical system—individual and institutional—can be recombined in nontraditional ways to explore new directions in health care. An attempt has been made to reach alienated youth by meeting them on their own terms in a spirit of service free of criticism or by trying to persuade them to compromise their own beliefs. These young people develop small "communes" or "families," joining together at specific locations to form a larger social unit: the street community. The use of a mobile medical van was considered to be a workable way to bring a diversity of medical services, principally for the treatment of acute physical disorders, to youths living in the streets. This is a report of six months' experience with a volunteer-staffed, "free," highly mobile service available to street youths. It has provided an effective outreach program that might lend itself to improving service to other segments of our society.