Quality Improvement Report: Six year audit of cardiac arrests and medical emergency team calls in an Australian outer metropolitan teaching hospital

Problem In-hospital cardiac arrest often represents failure of optimal clinical care. The use of medical emergency teams to prevent such events is controversial. In-hospital cardiac arrests have been reduced in several single centre historical control studies, but the only randomised prospective study showed no such benefit. In our hospital an important problem was failure to call the medical emergency team or cardiac arrest team when, before in-hospital cardiac arrest, patients had fulfilled the criteria for calling the team.Design Single centre, prospective audit of cardiac arrests and data on use of the medical emergency team during 2000 to 2005.Setting 400 bed general outer suburban metropolitan teaching hospital.Strategies for change Three initiatives in the hospital to improve use of the medical emergency team: orientation programme for first year doctors, professional development course for medical registrars, and the evolving role of liaison intensive care unit nurses.Key measures for improvement Incidence of cardiac arrests.Effects of the change Incidence of cardiac arrests decreased 24% per year, from 2.4/1000 admissions in 2000 to 0.66/1000 admissions in 2005.Lessons learnt Medical emergency teams can be efficacious when supported with a multidisciplinary, multifaceted education system for clinical staff.     

24-hour pattern in lag time of response by firemen to calls for urgent medical aid

The aim of the study was to assess the group 24-h pattern of lag time (LT) in response by regular and volunteer firemen (RFM and VFM) to calls for medical help (CFMH), specifically calls for out-of-hospital cardiac arrest (OHCA). LT, duration in min between a CFMH and departure of service vehicle equipped with a semiautomated defibrillator and generally staffed with four well-trained and ready-to-go FM, represents the integrated duration of several processes, each with separate reaction and decision-making times. The exact time of each CFHM (in min, h, day, month, yr) was recorded electronically, and the exact departure time from the station of the responding FM vehicle was recorded by an on-duty FM. Overall, CFMH made up 53 ± 9% (SEM) of all emergencies calls for aid. To standardize the study methods, the reported findings are based on 568 CFMH specifically regarding OHCA that occurred during the 4-yr study span (January 2005 to December 2008). CFMH exhibited a 24-h pattern with a major peak at 10:00 h (mean ± SEM: n = 9.5 ± 1.6) and major trough at 01:00 h (n = 1.3 ± 0.3; t test, p??.05). In CFMH/h pooled time series, ANOVA-detected differences between the hourly means (p?相似文献   

Method of ultrastructural analysis with the aid of measuring television complex]

The area of the section of presynaptic dense projections of the active zone of axondendritic synapses of the rat's cortex was measured using a television complex. Tissue specimens were contrasted with phosphotungstic acid. Morphometry was carried out in the regime of error correction in measurement, the errors arising in scanning process of image. The area of the section of mitochondria, lysosome, nucleoli, channels and tanks of the endoplasmic reticulum may be measured by the method suggested. Quantitative data, obtained by the morphometry of the synapse ultrastructure, may serve a basis for understanding the mechanism by which synapses are involved in information processes of the central nervous system.     

Temporal variation in detection of marsh birds during broadcast of conspecific calls

ABSTRACT.   The decline in populations of several species of marsh birds in North America has prompted development of a monitoring protocol that involves the broadcast of conspecific calls to enhance detection of these secretive species. However, with a standardized protocol, temporal (seasonal) and geographic variation in responses to the broadcast of calls could lead to inadequate monitoring of migratory species with large ranges. Our objective was to examine temporal variation in the response of marsh birds to playback of conspecific calls in west-central and northern New York to determine if use of the current protocol would permit effective monitoring of their populations. From 11 April to 8 July 2005, we conducted 572 surveys at 143 survey points on 16 marshes and detected 663 individuals of our target species. Our results revealed more detections of American Bitterns ( Botaurus lentiginosus ) and Pied-billed Grebes ( Podilymbus podiceps ) early in our survey period, and more detections of Virginia Rails ( Rallus limicola ) and Least Bitterns ( Ixobrychus exil is) later in our survey period. Only 22% of Least Bitterns were detected before 28 May, whereas 76% of American Bitterns and 70% of Pied-billed Grebes were detected before 28 May. With the current recommended monitoring protocol, surveys are to be completed during a 44-day period that includes three 10-day sampling periods separated by 1 week. However, our results indicate that this protocol would lead to inadequate and inaccurate monitoring of marsh birds in New York. Given that the timing of peak detection of different species of marsh birds varies geographically, we recommend flexibility in the timing and duration of surveys so that surveys can be synchronized with location-specific peak-detection periods.     

Randomised trial of a mobile coronary care unit for emergency calls.

A randomised trial was conducted to assess the value of sending a mobile coronary care unit (MCCU) to all emergency calls other than those for children or for patients injured in road-traffic accidents or brawls. Over 15 months 6223 calls for emergency ambulances were considered for the study, but a routine ambulance had to be dispatched on 2583 occasions because the MCCU was not available. A group of 1664 patients was randomly allocated to transport by the MCCU and 1676 patients to routine transport. In these groups the prehospital mortality among patients with heart attacks was 45% and 47%, and no patient survived resuscitation attempts long enough to leave hospital. During the same period general practitioners sent 190 patients with heart attacks to hospital in routine ambulances and none of them died during the interval between the call for the ambulance and arrival at hospital. Although it may be worth equipping all emergency ambulances with a defibrillator, MCCUs as at present envisaged will not appreciably affect mortality from heart attacks.     

Bioacoustic analysis of frog calls from northeast India

Mating calls of three frog species abundant in northeast IndiaRana tigerina,Rana cyanophlyctis andRana limnocharis were recorded in the fields of Assam and Meghalaya during their breeding season (July-August, 1991). The calls were analysed for their temporal and spectral characters. They were species specific, with distinct call duration and call period, number of pulses per call and interpulse interval, and dominant frequency and frequency domain. A comparison of the mating calls ofRana cyanophlyctis with those of the siblingRana ehrenbergi from Yemen showed differences in their temporal and spectral characters, supporting the suggestion that these two species are distinct species, rather than subspecies of the same species. Differences in the temporal and spectral pattern were found in the mating calls of morphologically alike specimens ofRana limnocharis, indicating that the present morphotypeRana limnocharis in northeast India is composed of several species.     

Follow-up of emergency ambulance calls in Nottingham: implications for coronary ambulance servie.

Information about patients in ambulance service records has been linked to that in the patients'' hospital records in an attempt to make the most efficient use of a special ambulance service for patients suspected of having heart attacks. During one week 248 emergency (999) calls for an ambulance were made by the public in the city of Nottingham. The quality of information given to the ambulance centre was poor, and all four patients eventually found to have had a myocardial infarction were described as having collapsed. A further study of patients who were also described as having collapsed has led to a system which allows an ambulance controller to send a "coronary ambulance" only in answer to those emergency calls where there is a reasonable possibility that the patient has had a heart attack.