| 1. |
- chayanin, Angthong, et al.
(författare)
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Disaster Medicine in Thailand: A Current Update. Are We Prepared?
- 2012
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Ingår i: Journal of the Medical Association of Thailand. - 0125-2208. ; 95:1, s. 42-49
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective: To investigate the level of major incident/disasters preparedness in Thailand by evaluating to-date data with main focus on past events and their outcomes to alert national medical societies for their roles in upcoming disasters/major incidents. Material and Method: Besides data from past disasters/major incidents (Jan 2006-Dec 2010), including injury details in each event; all information about current disasters/major incidents preparedness systems, triage and pre hospital management, standard of personnel, co-ordination and command centers, were reviewed by using data from Bangkok Emergency Medical Service, Narenthorn EMS of Rajavithi Hospital, Emergency Medical Institute of Thailand, Royal Thai Police, Department of Disaster prevention and mitigation (Ministry of Interior). Results: There was neither a national registry, nor an authentic centralization of the preparedness system. The current organization was found to be functional, but incomplete. The main dispatch center responsible for medical service in Bangkok metropolitan during the present study period was Bangkok EMS (“Erawan center”). In provincial areas, emergency medical services (Ministry of Public Health) in each province act as dispatcher in their corresponding regions in cooperation with the emergency operation divisions in their related area. Several private organizations also volunteered to assist. There was an increase in the number of disasters/major incidents in Thailand between 2006 and 2010; with a total number of 60,999 deaths, 346,763 wounded patients and 73 missing and total costs of 47,453.69 million Baht (1,581.79 million US Dollar). Discussion and Conclusion: There is an established and functional disaster management organization in Thailand with some overlapping difficulties and a need for improvement. Understanding the national need for registry, public information, preparedness, cooperation and coordination inside and outside hospitals, will not only save lives, but also would be beneficial for the country in terms of major economical measures. Keywords: Disaster Medicine, Thailand, Major incident, Mortality, Injury, Update
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| 2. |
- Djalali, A, et al.
(författare)
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Art of Disaster Preparedness in European Union:a Survey on the Health Systems. PLOS Currents Disasters. Dec 17 ed 1
- 2014
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Ingår i: PLOS Currents. - : Public Library of Science (PLoS). - 2157-3999.
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries. Method: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient. Results: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%). Conclusion: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal.
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| 3. |
- Djalali, Ahmadreza, et al.
(författare)
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Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.
- 2014
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Ingår i: Prehospital and disaster medicine. - 1049-023X. ; 29:4, s. 364-8
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Tidskriftsartikel (refereegranskat)abstract
- Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training.
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| 4. |
- Hansson, Jeanette, 1972, et al.
(författare)
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A Model to Select Patients Who May Benefit from Antibiotic Therapy as the First Line Treatment of Acute Appendicitis at High Probability.
- 2014
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Ingår i: Journal of Gastrointestinal Surgery. - : Springer Science and Business Media LLC. - 1091-255X .- 1873-4626. ; 18:5, s. 961-967
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Tidskriftsartikel (refereegranskat)abstract
- Randomized studies indicated that 88-95% of patients with acute appendicitis recover on antibiotics without surgery, although it is unclear which patient would benefit with high probability on antibiotics. We hypothesized that patients with phlegmonous appendicitis should be a group where antibiotics may be a sufficient treatment. Accordingly, our aim was to propose a model to support treatment application for unselected patients with acute appendicitis.
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| 5. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
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Estimation of healthcare resources at sporting events.
- 2010
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Ingår i: Prehospital and disaster medicine. - 1049-023X. ; 25:5, s. 449-55
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The consequences of a major incident at a sporting event could be catastrophic. Therefore, there should be an estimation of the healthcare resources at such events as part of the planning. Although there are National guidelines (e.g., Planning Safe Public Events: Practical Guidelines in Australia) defining the role of the healthcare system at sporting events, these guidelines either lack a simple calculating method to estimate the need for healthcare resources or the methods are complex and impractical to use. The objective of this study was to find a safe and easy method for the estimation of healthcare resources at sporting events. METHODS: A model for the estimation of healthcare resources at music events recently has been approved in Sweden. After minor adjustments, this model was used at sport events by a number of planning officers. The models' accuracy and usability was evaluated by analyzing its outcome in a pilot and a controlled study using different sporting and non-sporting scenarios. RESULTS: The pilot study showed that the model was valid and easily could be used for various sporting events. The obtained estimations were consistent with the methods used by experienced planning officers in 97% of cases. The results of the controlled study showed that by using this model, the minimum amount of resources required easily could be calculated at sporting events and by people with different backgrounds. CONCLUSIONS: This model safely can be used at sporting events.
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| 6. |
- Khorram-Manesh, Amir, 1958, et al.
(författare)
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Hospital Evacuation; Learning from the Past? Flooding of Bangkok 2011.
- 2013
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Ingår i: British Journal of Medical Research. - 2231-0614. ; 4:1, s. 395-415
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To evaluate hospital evacuation in light of recent hospital evacuations in Bangkok and surrounding areas. This information was compared with results reported in the literature. Study Design: Retrospective and qualitative. Place and Duration of Study: Bangkok, Thailand, December 1 to December 11, 2011. Methodology: Four facilities were included in this study, three hospitals and one “prehospital” facility, each of which had either experienced evacuation or had been receiving facilities during disaster response operations. Data were obtained using questionnaires and interviews to characterize facility backgrounds and capacities. Responses were obtained from one representative of each of the four Thai facilities. The questionnaire was designed for this study following recommendations by an earlier Swedish study that employed “risk and vulnerability analysis” (RVA), and was further adapted according to results of a literature review. Results: Overall, consistent results in the literature, as well as in the recent Thai disaster experience, about hospital evacuation indicate shortcomings in planning (including training), command and control, communication, support, resources and transportation. Patient safety, transfer of medical data, care and treatment of patients during transportations showed positive outcomes in recent Thai evacuations. Conclusion: Despite numerous previous findings and recommendations found in the literature, the need exists for continuous improvement in evacuating a hospital, especially in improving planning (coordinated emergency plans and synchronized exercises), leadership, communications and collaboration and implementation of best medical facility response to disasters.
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| 7. |
- Lennquist Montán, Kristina, 1974, et al.
(författare)
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Comparative study of physiological and anatomical triage in major incidents using a new simulation model.
- 2011
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Ingår i: American journal of disaster medicine. - 1932-149X. ; 6:5, s. 289-98
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Tidskriftsartikel (refereegranskat)abstract
- To develop and evaluate a simulation model making it possible to evaluate the accuracy and efficiency of different triage methods; to compare the results of physiological and anatomical triage performed by medical staff with different levels of skills with the use of this model.
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| 8. |
- Lennquist Montán, Kristina, 1974, et al.
(författare)
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Development and evaluation of a new simulation model for interactive training of the medical response to major incidents and disasters
- 2014
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Ingår i: European Journal of Trauma and Emergency Surgery. - : Springer Science and Business Media LLC. - 1863-9933 .- 1863-9941. ; 40:4, s. 429-443
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Tidskriftsartikel (refereegranskat)abstract
- The need for and benefit of simulation models for interactive training of the response to major incidents and disasters has been increasingly recognized during recent years. One of the advantages with such models is that all components of the chain of response can be trained simultaneously. This includes the important communication/coordination between different units, which has been reported as the most common cause of failure. Very few of the presently available simulation models have been suitable for the simultaneous training of decision-making on all levels of the response. In this study, a new simulation model, originally developed for the scientific evaluation of methodology, was adapted to and developed for the postgraduate courses in Medical Response to Major Incidents (MRMI) organized under the auspices of the European Society for Trauma and Emergency Surgery (ESTES). The aim of the present study was to describe this development process, the model it resulted in, and the evaluation of this model. The simulation model was based on casualty cards giving all information normally available for the triage and primary management of traumatized patients. The condition of the patients could be changed by the instructor according to the time passed since the time of injury and treatments performed. Priority of the casualties as well as given treatments could be indicated on the cards by movable markers, which also gave the time required for every treatment. The exercises were run with real consumption of time and resources for all measures performed. The magnetized cards were moved by the trainees through the scene, through the transport lines, and through the hospitals where all functions were trained. For every patient was given the definitive diagnosis and the times within certain treatments had to be done to avoid preventable mortality and complications, which could be related to trauma-scores. The methodology was tested in nine MRMI courses with a total of 470 participants. Based on continuous evaluations and accumulated experience, the setup of the simulation was step-wise adjusted to the present model, including also collaborating agencies such as fire and rescue services as well as the police, both on-scene and on superior command levels. The accuracy of the simulation cards for this purpose was evaluated as "very good" by 63 % of the trainees and as "good" by 33 %, the highest two of the six given alternatives. The participants' ranking of the extent that the course increased their competencies related to the given objectives on a 1-5 scale for prehospital staff had an average value of 4.25 +/- A 0.77 and that for hospital staff had an average value of 4.25 +/- A 0.72. The accuracy of the course for the training of major incident response on a 1-5 scale by prehospital staff was evaluated as 4.35 +/- A 0.73 and that by hospital staff as 4.30 +/- A 0.74. The simulation system tested in this study could, with adjustments based on accumulated experience and evaluations, be developed into a tool for the training of major incident response meeting the specific demands on such training based on recent experiences from major incidents and disasters. Experienced trainees in several courses evaluated the methodology to be accurate for this training, markedly increasing their perceived knowledge and skills in fields of importance for a successful outcome of the response to a major incident.
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| 9. |
- Nero, C, et al.
(författare)
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Hospital evacuation: planning, assessment, performance and evaluation.
- 2012
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Ingår i: Journal of Acute Disease (JAD). - 2221-6189. ; 1:1, s. 58-64
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Tidskriftsartikel (refereegranskat)abstract
- Background: Malfunction in hospitals´ complex internal systems, or extern threats, may result in a hospital evacuation. Factors contributing to such evacuation must be identified, analyzed and action plans should be prepared. Our aims in this short report were 1) to evaluate the use of risk and vulnerability analysis as a basis for hospital evacuation plan, 2) to identify risks/hazards triggering an evacuation and evaluate the respond needed and 3) to propose a template with main key points for planning, performance and evaluation of such evacuation. Methods: A risk and vulnerability analysis at two county hospitals along with an online literature search based on the following keywords; “evacuation/closure”, “hospitals/medical facilities” and “disaster/hazards” alone or with “planning”, was conducted. Results: We found that although all hospitals have a disaster plan, there is a lack of knowledge and appropriate instruments to plan, perform and evaluate a hospital evacuation. Risk and vulnerability analysis can be used to identify key points in an evacuation such as threats and resources, which later can be used to plan, perform and evaluate an evacuation. Conclusion: There is a need for an elaborated evacuation planning for hospitals. An evacuation plan should continuously be drilled based on a risk and vulnerability analysis. A general guide can be used as foundation to plan, perform and evaluate such plan.
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| 10. |
- Novotny, Ann, 1982-, et al.
(författare)
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A pharmacological analysis of the cholinergic regulation of urokinase-type plasminogen activator, and plasminogen activator inhibitor-1 secretion in the human colon cancer cell line, HT-29
- 2010
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Ingår i: European Journal of Pharmacology. - : Elsevier BV. - 0014-2999 .- 1879-0712. ; 646:1-3, s. 22-30
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Tidskriftsartikel (refereegranskat)abstract
- Urokinase-type plasminogen activator (uPA) is an important factor for tumour cell invasion and metastasis. We recently showed that acetylcholine is an autocrine/paracrine growth factor for the human colon cancer cell line, HT-29, in part via the α7 subtype of the nicotinic acetylcholine receptors. In the current study, we investigated whether acetylcholine participates in the regulation of the protein expressions of also uPA and its receptor (uPAR) in the HT-29 cell line. Such were investigated by immunocytochemistry and Western blotting, and quantitation of uPA secretion was undertaken by ELISA. Stimulation of the cells for 24 h with nicotine caused increased uPA secretion with peak effect (78% above the control) occurring at a nicotine concentration of 10 nM. This effect was markedly inhibited by α-Bungarotoxin, thus showing the involvement of α7 nicotinic acetylcholine receptors. Basal uPA secretion was found to be partly dependent on ongoing activation of nicotinic receptors, suggesting tonic production of acetylcholine. Conversely, there was no cholinergic influence on the expression of uPAR. The current findings demonstrate novel aspects of receptor-mediated regulation of tumour metastatic potential via uPA secretion. This may suggest future pharmaceutical strategies in treatment of colorectal cancer.
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