Mobile Teams Research Articles

Evaluation of interventions to prevent vasovagal reactions among whole blood donors: rationale and design of a large cluster randomised trial

BackgroundVasovagal reactions (VVRs) are the most common acute complications of blood donation. Responsible for substantial morbidity, they also reduce the likelihood of repeated donations and are disruptive and costly for blood services. Although blood establishments worldwide have adopted different strategies to prevent VVRs (including water loading and applied muscle tension [AMT]), robust evidence is limited. The Strategies to Improve Donor Experiences (STRIDES) trial aims to reliably assess the impact of four different interventions to prevent VVRs among blood donors.MethodsSTRIDES is a cluster-randomised cross-over/stepped-wedge factorial trial of four interventions to reduce VVRs involving about 1.4 million whole blood donors enrolled from all 73 blood donation sites (mobile teams and donor centres) of National Health Service Blood and Transplant (NHSBT) in England. Each site (“cluster”) has been randomly allocated to receive one or more interventions during a 36-month period, using principles of cross-over, stepped-wedge and factorial trial design to assign the sequence of interventions. Each of the four interventions is compared to NHSBT’s current practices: (i) 500-ml isotonic drink before donation (vs current 500-ml plain water); (ii) 3-min rest on donation chair after donation (vs current 2 min); (iii) new modified AMT (vs current practice of AMT); and (iv) psychosocial intervention using preparatory materials (vs current practice of nothing). The primary outcome is the number of in-session VVRs with loss of consciousness (i.e. episodes involving loss of consciousness of any duration, with or without additional complications). Secondary outcomes include all in-session VVRs (i.e. with and without loss of consciousness), all delayed VVRs (i.e. those occurring after leaving the venue) and any in-session non-VVR adverse events or reactions.DiscussionThe STRIDES trial should yield novel information about interventions, singly and in combination, for the prevention of VVRs, with the aim of generating policy-shaping evidence to help inform blood services to improve donor health, donor experience, and service efficiency.Trial registrationISRCTN: 10412338. Registration date: October 24, 2019.

Improving palliative care outcomes in remote and rural areas of LMICs through family caregivers: lessons from Kazakhstan.

Approximately 60 million people require palliative care worldwide, and nearly 80% of them live in low- and middle-income countries (LMICs). Providing palliative care in remote and rural areas of LMICs requires special consideration to ensure equitable access to healthcare. This perspective aims to deliver pragmatic, context-oriented policy recommendations designed to improve palliative care outcomes in Kazakhstan by capitalizing on existing resources and considering its unique geopolitical and sociocultural context. With approximately half of the population in Kazakhstan residing in remote and rural regions, the provision of healthcare services - specifically palliative care - mandates particular attention to ensure equal access to high-quality care. To understand challenges of implementing palliative care in remote and rural regions of Kazakhstan and to propose tailored solutions, 29 key stakeholders, including family caregivers, health professionals, and palliative care administrators, were identified in five regions of Kazakhstan. The main challenges encountered by family caregivers include lack of palliative care skills, the need for home-based care from mobile services, and high out-of-pocket expenditures. The challenges highlighted by healthcare providers and administrators were the lack of formal education in palliative care, shortage of opioids, and limited societal awareness and state support. Based on challenges elaborated from stakeholders and existing literature in palliative care and family caregiving, this perspective advocates against replicating the strategies implemented in high-income countries. Family caregivers play a critical role in implementing affordable and efficient palliative care in resource-limited settings. Enhancing their competencies through digital training and increasing access to palliative care services through mobile teams are tailored and localized solutions that address specific challenges in Kazakhstan. It is postulated that these recommendations may find utility in other LMICs, potentially benefiting nearly 48 million individuals who require these services.

Exploring the competencies of operating room nurses in mobile surgical teams based on the Onion Model: a qualitative study

BackgroundWith the frequent occurrence of public health emergencies, conflicts and natural disasters around the world, mobile surgical teams are becoming more crucial. The competency of the operating room (OR) nurse has a substantial impact on the effectiveness and quality of the surgical team’s treatment, still there is limited knowledge about OR nurse competencies in mobile surgical teams. This study aimed to explore the competencies of OR nurses in mobile surgical teams based on the Onion Model.MethodsWe conducted a qualitative descriptive study of participants from 10 mobile surgical teams in 2022. Twenty-one surgical team members were interviewed, including 15 OR nurses, four surgeons, and two anesthesiologists. Data were collected through semi-structured interviews. The data were analyzed using Mayring’s content analysis.ResultsTwenty-eight competencies were found in the data analysis, which were grouped into four major domains using the Onion Model. From the outer layer to the inner layer were knowledge and skills, professional abilities, professional quality, and personal traits. The qualitative data revealed several novel competencies, including triage knowledge, self and mutual medical aid, outdoor survival skills, and sense of discipline.ConclusionsThe application of the Onion Model promotes the understanding of competency and strengthens the theoretical foundations of this study. New competencies can enrich the content of the competencies of OR nurses. The results of this study can be used for clinical recruitment, evaluation and training of OR nurses in mobile surgical teams. This study encourages further research to develop competency assessment tools and training programs for OR nurses.

Target product profile: diagnostic test for Trypanosoma brucei gambiense.

Human African trypanosomiasis is a life-threatening parasitic infection endemic to sub-Saharan Africa. Around 95% of cases are due to Trypanosoma brucei gambiense, found in western and central Africa. Clinical signs and symptoms are nonspecific, current diagnostic tests are not sufficiently accurate, and parasitological confirmation of infection requires microscopic examination of body fluids and specialized techniques for concentrating parasites. Moreover, current treatment is not recommended on the basis of suspicion alone because it is not sufficiently safe. The availability of a simple and accurate diagnostic test to identify individuals harbouring parasites would widen treatment and help decrease disease prevalence. A subcommittee of the World Health Organization's Neglected Tropical Diseases Diagnostics Technical Advisory Group has developed a target product profile for a diagnostic tool to identify T. b. gambiense infection. This tool should have a high sensitivity for detecting T. b. gambiense but be simple enough to use in rural Africa. Ideally, the tool could be applied by any minimally trained individual in an unsophisticated peripheral health facility, or a mobile team in a village with little infrastructure. The test should be able to function under hot and humid conditions. Basic training should take under 2hours and the test should involve fewer than five steps. There should be no need for instrumentation or precision liquid handling. The test should yield a qualitative result in under 20minutes that can be easily observed, and one test should be sufficient for determining treatment. A unit cost below 1United States dollar (US$) would enable mass screening.

Survey on Cardiogenic Shock and the Use of ECMO and Impella in Spanish Cardiac Critical Care Units

Background: Previous studies suggest variability in the management of cardiogenic shock (CS). Methods: An anonymous survey was sent to Spanish hospitals. Results: We obtained 50 answers, mainly from cardiologists (36–72%). The annual average of ECMOs is 16.7 ± 11.3 applications in CS patients and of Impellas is 8.7 ± 8.3 applications in CS patients. Intra-aortic balloon counterpulsation is used in the majority of CS ECMOs (31–62%), and Impella is used in 7 (14%). In 36 (72%) cases, ECMO is used as a treatment for cardiac arrest. In 10 cases, ECMO removal is percutaneous (20%). In 25 (50%) cases, age is a relative contraindication; 17 have a mobile ECMO team (34%); and 23 (46%) have received ECMO patients from other centers in the last year. Pre-purged ECMO is only used in 16 (32%). ECMO implantation is carried out under ultrasound guidance in 31 (62%), only with angiography in 3 (6%) and with both in 11 (22%). The Swan–Ganz catheter is used routinely in 8 (16%), only in doubtful cases in 24 (48%), and in most cases in 8 (16%). The ECMO awake strategy is used little or not at all in 28 (56%), in selected cases in 17 (34%), and routinely in 5 (10%). Conclusion: Our study shows a huge variation in the management of patients with CS.

Energy Efficient Routing Protocols for Mobile Robots: A Review

Many vital applications benefit from mobile multi-robot teams, including search and rescue, environmental monitoring, military, unmanned space exploration, hazard detection and analysis. Communication between robots is important for group coordination and information sharing in mobile multi-robot teams. Because many mobile robot applications involve scenarios where communication infrastructure is destroyed or unavailable, mobile robot teams must regularly connect with one another through ADHOC networking. In such situations, low over-head and energy efficient routing systems for sending information are essential. The most difficult task is to provide a unified foundation for robot communication. The framework of Mobile Robots is described in this paper, as well as a review and analysis of several research papers on Energy Efficient Routing in Robotic Wireless sensor networks (RWSN).

Public health implications of severe floods in Pakistan: assessing the devastating impact on health and the economy

Natural disasters, including droughts, earthquakes, landslides, and floods, cause human mortality, property destruction, and social and economic turmoil. More than 33 million people in Pakistan have been impacted by floods due to the recent heavy rains. Many public hospitals, water treatment plants, and educational institutions have also been damaged or destroyed. Water and vector-borne diseases may have spread more widely due to the floods. A rapid health emergency response must be initiated to treat the injured, stocking healthcare facilities with vital supplies and back up mobile health teams in the impacted areas.

Psychiatric Boarding Patterns Among Publicly Insured Youths Evaluated by Mobile Crisis Teams Before and During the COVID-19 Pandemic

Psychiatric boarding occurs when patients needing intensive psychiatric services who are already under clinical supervision experience delays in their admission to psychiatric facilities. Initial reports have suggested that the US had a psychiatric boarding crisis during the COVID-19 pandemic; however, little is known about the consequences of this crisis for publicly insured youths. To estimate pandemic-associated changes in psychiatric boarding rates and discharge modalities for people aged 4 to 20 years who accessed psychiatric emergency services (PES) through a mobile crisis team (MCT) evaluation and were covered by Medicaid or health safety net programs. This retrospective cross-sectional study used data from the MCT encounters of a multichannel PES program in Massachusetts. A total of 7625 MCT-initiated PES encounters with publicly insured youths who lived in Massachusetts between January 1, 2018, and August 31, 2021, were assessed. Encounter-level outcomes (psychiatric boarding status, repeat visits, and discharge disposition) during a prepandemic period (January 1, 2018, to March 9, 2020) were compared with outcomes during a pandemic period (March 10, 2020, to August 31, 2021). Descriptive statistics and multivariate regression analysis were used. Among 7625 MCT-initiated PES encounters, the mean (SD) age of publicly insured youths was 13.6 (3.7) years; most youths identified as male (3656 [47.9%]), were of Black race (2725 [35.7%]) or Hispanic ethnicity (2708 [35.5%]), and spoke English (6941 [91.0%]). During the pandemic period, the mean monthly boarding encounter rate was 25.3 percentage points higher than the prepandemic period. After adjustment for covariates, the odds of an encounter resulting in boarding doubled during the pandemic (adjusted odds ratio [AOR], 2.03; 95% CI, 1.82-2.26; P < .001), and boarding youths were 64% less likely to be discharged to inpatient psychiatric care (AOR, 0.36; 95% CI, 0.31-0.43; P < .001). Publicly insured youths who boarded during the pandemic had significantly higher rates of 30-day readmissions (incidence rate ratio, 2.17; 95% CI, 1.88-2.50; P < .001). Boarding encounters during the pandemic were significantly less likely to end in discharge to inpatient psychiatric units (AOR, 0.36; 95% CI, 0.31-0.43; P < .001) or community-based acute treatment facilities (AOR, 0.70; 95% CI, 0.55-0.90; P = .005). In this cross-sectional study, publicly insured youths were more likely to experience psychiatric boarding during the COVID-19 pandemic and, if boarding, were less likely to transfer to a 24-hour level of care. These findings suggest that psychiatric service programs for youths were not prepared to support the levels of acuity and demand that emerged from the pandemic.

Increasing the efficiency of a mobile EPI strategy using injectable polio vaccine in Africa

In 1980, partners initiated a mobile simplified EPI (Expanded programme on immunization) strategy for immunizing, with mobile teams, rural and urban populations in Western Africa. This strategy delivered EPI vaccines in two sessions: 1) 3-8 month-old children: BCG-Diphteria Tetanus Pertussis + reinforced killed Polio vaccine; 2) 9-15 month-old children: Diphteria Tetanus Pertussis + reinforced killed Polio vaccine, Measles-Yellow Fever. This strategy was compared to WHO-UNICEF extended EPI strategy, but results were never published in the context of a planned rapid polio eradication with oral polio vaccine. For comparison with standard WHO-UNICEF extended EPI strategy, using oral polio vaccine in four sessions, all the costs generated by these two strategies in 1988 have been collected in two adjacent zones in Burkina Faso, Western Africa: 203,642 inhabitants for WHO-UNICEF extended EPI strategy (Yako); 109,483 inhabitants for mobile simplified EPI strategy (Gourci). An EPI coverage survey at the end of this year has been done in these two adjacent zones with efficiency (costs per fully immunized child) computed. In Africa, the simplified mobile EPI strategy using reinforced killed polio vaccine was found two times more efficient (12.71 US$ per fully immunized child) than WHO-UNICEF extended EPI strategy using oral polio vaccine (29.67 US$ per fully immunized child), even if DTP-reinforced killed polio vaccine (0.52 US$ per dose) was more expensive than DTP and oral polio vaccine (0.14 US$ for the combined dose). The missed opportunities uncaught up would have doubled coverage in the WHO-UNICEF extended EPI strategy, versus only a 10% increase with the mobile simplified EPI strategy. The main reason for uncaught up missed opportunities in WHO extended EPI strategy was the absence of requested vaccine delivered by a health agent when attending population at meeting point, due to insufficient cold box volume carried on his moped for transport of vaccine. After 30 years, since 1990, of poliomyelitis eradication in Africa using oral polio vaccine and with non-added costs in this study of polio mass campaigns, these results should be published to review EPI strategy.

NAUNEHAL; Integrated immunization and MNCH interventions: A quasi-experimental study-Protocol.

Great improvements in the health of newborns, children, and women in Pakistan are needed. A large body of literature has demonstrated that the majority of maternal, newborn, and child deaths are preventable with essential health strategies including immunization, nutrition interventions, and child health interventions. Despite the importance of these interventions for the health of women and children, access to services continues to be a barrier. Furthermore, demand for services also contributes to low coverage of essential health interventions. Given the emerging threat of COVID-19 coupled with already weak maternal and child health, delivering effective and feasible nutrition and immunization services to communities, and increasing demand and uptake of services is a pressing and important need. This quasi-experimental study aims to improve health service delivery and increase uptake. The study included four main intervention strategies including community mobilization, mobile health teams offering MNCH and immunization services, engagement of the private sector, and testing of a comprehensive health, nutrition, growth, and immunization app, Sehat Nishani, for a period of 12 months. The target group of the project were women of reproductive age (15-49 years) and children under-five. The project was implemented in three union councils (UCs) in Pakistan including Kharotabad-1(Quetta District, Balochistan), Bhana Mari (Peshawar District, Khyber Pakhtunkhwa) and Bakhmal Ahmedzai (Lakki Marwat district, Khyber Pakhtunkhwa). Propensity score matching based on size, location, health facilities, and key health indicators of UC was conducted to identify three matched UCs. A household baseline, midline, endline and close-out assessment will be conducted for evaluating coverage of interventions as well as the knowledge, attitude, and practices of the community in the MNCH and COVID-19 context. Descriptive and inferential statistics will be used to test hypotheses. As well, a detailed cost-effectiveness analysis will be conducted to generate costing data for these interventions to effectively inform policymakers and stakeholder on feasibility of the model. Trial registration: NCT05135637.

Elderly patients whose hospitalization was medication-related were more likely to receive medication recommendations by clinical pharmacist than patients whose hospitalization was unlikely medication-related in non-geriatric units

BackgroundElderly patients are often polymedicated, and drug-related hospitalizations are common in this population. In our hospital, pharmacists from the mobile geriatric team (MGT) coordinate medication reviews (MR) for elderly patients hospitalized in non-geriatric wards, to prevent iatrogenic. ObjectiveThe aim of this work is to determine whether the drug-related origin of hospitalizations can be considered as a targeting criterion for performing MRs. Material and methodWe conducted a retrospective study of data from patients who received a MGT's MR between March 2021 and December 2022, from a single center of more than 1000 beds. The drug-related origin of the hospitalization was estimated as probable or unlikely by the AT-HARM10 tool. Between the two groups, we compared the number of potentially inappropriate prescriptions detected by the PIM-check and START/STOPP tools, drug-drug interactions (DI), unintended discrepancies (UDI) at entry reconciliation, the drug burden index (DBI), and the number of drug-related problems (DRP) i.e., START/STOPP score + DI + UDI. Linear regression of the number of DRP by AT-HARM10 score was computed. Results110 patients were included. 56 hospitalizations were estimated MRH and 54 non-MRH. Mean age (85.1 ± 7.0), ADL (3.8 ± 1.9), IADL (2.0 ± 1.6), and number of medications at entry (8.9 ± 3.8) were comparable in the 2 groups. Compared with non-MRH group, MRH group had a higher number of START/STOPP criteria (5.7 ± 3.5 vs 3.0 ± 2.6; p < 0.05), PIM-check overuses (2.1 ± 1.7 vs 1.4 ± 1.4; p < 0.05), DI (8.4 ± 9.0 vs 4.7 ± 4.7; p < 0.05), UDI at entry (4.0 ± 3.34 vs 2.2 ± 2.1; p < 0.05), and higher DBI score (0.9 ± 0.7 vs 0.3 ± 0.4; p < 0.05). The number of DRP was higher in group P (17.6 ± 10.8 vs 9.8 ± 6.3; p < 0.00.5). Linear regression showed a positive correlation between AT-HARM10 score and the number of DRP (r = 0.5, p < 0.05) with a coefficient of 7.7 (CI95% = [4.3; 11.1]) and an intercept of 9.8. DiscussionThese results allow us to consider AT-HARM10 score as a targeting criterion for performing MR for elderly patients, as part of a curative approach to drug iatrogenic for these patients.

The effectiveness of prehospital cardiopulmonary resuscitation

An analysis of the Yakutsk Emergency Department documentation for 2018–2022 was carried out in order to assess the effectiveness of prehospital cardiopulmonary resuscitation. It was revealed that over a number of years, the Department has maintained a fairly high level of successful resuscitation with restored cardiac activity (increased from 0 % in 2005 to 44.7 % in 2022). The result was achieved through continuous managerial efforts (training of mobile team personnel, increasing readiness for extended resuscitation in all mobile teams, gradual acquisition of technical equipment for providing comprehensive emergency services, daily quality control of medical services provided to patients, effective functioning of the operational department). A high-quality resuscitation performed by the teams contributes to the reduced mortality from preventable causes.

Sociological research to study the quality of emergency medical aid to the population of the Republic of Uzbekistan by the method of questionnaire

In order to improve the system of emergency medical aid in the Republic of Uzbekistan, the issues of its availability and quality, as well as resources, technology and the results of the functioning of the system should be considered and analyzed taking into account the opinion of the heads of medical organizations, medical workers providing emergency medical care, as well as from the standpoint of study of patient satisfaction. To this end, a sociological study was conducted in 2021, the program of which included studying the opinions of the heads of medical organizations providing emergency medical care (stage 1) and employees of mobile ambulance teams (stage 2). Statistical and analytical methods were used. The data obtained allow us to note, in general, a positive assessment of the state of emergency medical care in the Republic of Uzbekistan by the heads of medical organizations. At the same time, according to the survey data, the medical workers themselves need to improve the working conditions of mobile teams, due to the significant volumes of non-core work, as well as the heavy work-load due to the high population density in the service area. The problems are exacerbated by the lack of informatization and automation of ambulance units, as well as the factor of “professional burnout” of personnel.

Ending a Treatment Relationship

Ending a Treatment Relationship

Measles: a new danger for Ukraine's children! The need for an effective and timely vaccination prevention campaign for an insidious disease that comes from afar.

Measles, a highly contagious and dangerous disease that can cause disability or even death, remains endemic in Ukraine. This is a serious public health problem that absolutely needs to be monitored. Indeed, in the years 2017-2019, Ukraine was hit by a major measles epidemic, which caused serious problems for the population. The numerous efforts to contain the spread of measles in the country are now waning in the face of a devastating war, which has already lasted for over a year, and the COVID-19 pandemic, which has further complicated the general situation. In this paper, the authors highlight a very serious public health problem and invoke the immediate implementation of an effective vaccination policy. The percentages of measles vaccination coverage in Ukraine have decreased drastically since the beginning of the conflict (which began on February 24, 2022), and this is a source of concern regarding the possibility of a new major measles epidemic. Indeed, a measles epidemic at this time would have frightening consequences, given the conditions in which the Ukrainian population is now living. The United Nations estimates that at least 6 million people have been displaced within Ukraine as a result of the conflict, and this internal mass exodus has significantly affected vaccination coverage and adherence to vaccination schedules, despite the efforts of the Ukrainian health authorities. The ministry of health has prioritized vaccination programs with the help of the World Health Organization (WHO) and UNICEF, which are ensuring the free supply and delivery of vaccines through the deployment of mobile vaccination teams, even in areas where health facilities are not accessible. The main objective is to vaccinate as many people as possible in order to avoid a new epidemic, which could spread to the whole of Ukraine and also to other countries.

Improved leprosy elimination efforts in Somalia, 2015–2021: achievements in a challenging environment and the way forward

Background Since leprosy was eliminated as a public health problem in 2000, trends in case detection have been declining. However, from 2015, case detection in the WHO Eastern Mediterranean (EM) region increased mainly due to reports from Somalia that re-instated the national programme. As Somalia reported 57% of new cases in the EM region in 2021, we reviewed the national control programme activities and the characteristics of reported cases to understand leprosy transmission in the country. Methods From 2012 to 2021, we extracted data from WHO’s Global Health Observatory and the national leprosy control programme’s patient register in Somalia. From 2015 onwards, leprosy cases were detected by the Federal Ministry of Health through mobile teams conducting “skin camps” in 47 districts across seven regions. We analyzed data to describe the overall case detection rate and rates per period, place and person, including severity measured by grade two disability (G2D) and multibacillary (MB) cases. Results The overall case detection rate increased 11-fold between 2012 and 2021, from 6 cases per million in 2012 to 106 cases per million in 2021 in females and from 16 cases per million in 2012 to 132 cases per million in 2021 in males. Case detection among children under 15-years of age also increased from 4 cases per million in 2012 to 13 cases per million in 2021. Initially, the proportion of MB cases and G2D at the time of diagnosis increased from 60% and 11% in 2012 to 87% and 42% in 2015 respectively, when the national programme resumed leprosy control activities. By 2021, the MB proportion decreased to 45% and G2D proportion also decreased to 2%. From 2015 to 2021, four regions in Somalia reported 77% of the new cases and 83% of cases with G2D: Lower Shabelle, Middle Juba, Lower Juba and Middle Shabelle. Conclusion “Skin-camps” for case detection were effective in finding hidden leprosy cases and reducing the delay in diagnosis over time. The constant case detection rate among the female population, equal to the male population, points to sufficient programme reach. However, low disability rates persisted among this population which could be due to continued underlying stigma. Reports of new cases among children suggest ongoing transmission requiring prevention strategies such as single dose rifampicin post-exposure prophylaxis.

Pengaruh Fleksibilitas Jam Kerja dan Stres Kerja terhadap Integritas Karyawan di PT Bank Negara Indonesia Tbk

Employee integrity plays an important role in maintaining company trust and reputation. This study aims to analyze the effect of flexibility of working hours and work stress on employee integrity at PT Bank Negara Indonesia Inc. The purpose of this study was to analyze the effect of working hour flexibility and work stress on employee integrity at PT Bank Negara Indonesia Tbk, especially in the DGL (Digital Development) division in the mobile banking team. The research design adopted in this study is quantitative research with a descriptive approach. Data were collected from 33 respondents through questionnaires. The data were analyzed by carrying out instrument tests which include validity and reliability tests, classical assumption tests, then followed by multiple linear regression, partial tests, simultaneous tests and coefficient of determination tests. The results of this study show that partially, flexibility in working hours has a positive and statistically insignificant effect on employee integrity. Job stress has a negative and statistically significant effect on employee integrity. Simultaneously, both variables affect employee integrity at PT Bank Negara Indonesia Tbk. The results of this study have important implications for company management in developing strategies that improve employee integrity.

Vascular complications after peripheral veno-arterial extracorporeal life support cannulation in cardiogenic shock

BackgroundExtra Corporeal Life Support (ECLS) is an evolving therapy in therapy-resistant cardiogenic shock (CS). Vascular cannulation in emergency situations can be accomplished through puncture of the femoral vessels by specialised teams. Since lower limb ischemia constitutes one of the major complications following cannulation, a distal perfusion cannula (DPC) has emerged as standard of care. We here aimed to analyse the impact of the DPC on limb perfusion and 6-month survival rate. MethodsIn a retrospective study from January 2012 to December 2018, 98 patients with cardiogenic shock and peripheral (v-a) ECLS implantation with documented limb perfusion status were identified and analysed. Demographic data, laboratory parameters, cause of CS, comorbidities, limb perfusion complications and complication management were analysed. Results53 patients (54%) received ECLS therapy in referral centers by our mobile ECLS team, while in 45 patients (46%) the cannulation occured in our center. 71 patients (72%) received a DPC (group A) at the time of ECLS implantation, whereas 27 (28%) (group B) did not or received later (14 patients owing to limb ischemia). 44 patients (45%) developed limb ischemia as a complication of ECLS therapy (31% in group A and 81% in group B- p < 0.001). The 6-month survival rate was 28% in our study cohort (30% in group A and 22% in group B- p = 0.469). ConclusionLower limb ischemia remains a serious complication after peripheral ECLS cannulation in CS, especially when a DPC is absent. Standardised DPC implementation may reduce the rate of severe limb complications in peripheral ECLS.

Importance of consultations using mobile teams in the screening and treatment of neglected tropical skin diseases in Benin.

Since 2013, the World Health Organization has recommended integrated control strategies for neglected tropical diseases (NTDs) with skin manifestations. We evaluated the implementation of an integrated approach to the early detection and rapid treatment of skin NTDs based on mobile clinics in the Ouémé and Plateau areas of Benin. This descriptive cross-sectional study was performed in Ouémé and Plateau in Benin from 2018 to 2020. Consultations using mobile teams were performed at various sites selected by reasoned choice based on the epidemiological data of the National Program for the Control of Leprosy and Buruli Ulcer. All individuals presenting with a dermatological lesion who voluntarily approached the multidisciplinary management team on the day of consultation were included. The information collected was kept strictly anonymous and was entered into an Excel 2013 spreadsheet and analyzed with Stata 11 software. In total, 5,267 patients with various skin conditions consulted the medical team. The median age of these patients was 14 years (IQR: 7-34 years). We saw 646 (12.3%) patients presenting NTDs with skin manifestations, principally scabies, in 88.4% (571/646), followed by 37 cases of Buruli ulcer (5.8%), 22 cases of leprosy (3.4%), 15 cases of lymphatic filariasis (2.3%) and one case of mycetoma (0.2%). We detected no cases of yaws. This sustainable approach could help to decrease the burden of skin NTDs in resource-limited countries.

Caregiver in a mobile geriatric team, a new profession

The caregiver plays a key role in the mobile geriatric team. She has a very varied activity. She performs geriatric assessments, evaluates toilets, transmits geriatric culture, maintains the city-hospital link, intervenes in residential facilities for dependent elderly people (Ehpad), performs post-emergency telephone interviews and provides training to paramedics. Testimonial.