ABSTRACT
Information and communication technologies, especially in the forms of mobile telecommunications, satellite imaging, and geographical information systems, promise to significantly improve the practice of humanitarian relief. A working group convened at the Humanitarian Action Summit 2009, has begun investigating the challenges to implementing these technologies in field operations, keeping in mind the ethical considerations of linking people to place, and pledging to build a community of practice among academics, practitioners, and developers.
Subject(s)
Geographic Information Systems , Telecommunications , Altruism , Geographic Information Systems/ethics , Humans , Satellite Communications/ethics , Software , Telecommunications/ethicsABSTRACT
INTRODUCTION: Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education. METHODS: Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates. RESULTS: Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration, (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis. DISCUSSION: Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences. CONCLUSIONS: The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.
Subject(s)
Disaster Planning/organization & administration , Emergency Medicine/education , Needs Assessment/organization & administration , Clinical Competence/standards , Global Health , Health Planning/organization & administration , Health Services Research , Humans , Interinstitutional Relations , International Cooperation , Program Development , Program Evaluation , Research , Risk AssessmentABSTRACT
Patients with vascular dementia show distinctive white matter lesions on MRI. We performed MRI on 34 patients with documented ischemic cerebrovascular disease to see whether demented and nondemented patients differ with respect to enlarged CSF spaces or white matter lesions. All eight demented patients had white matter lesions on MRI, just as did many borderline and nondemented patients. Enlargement of central CSF spaces was the only radiographic feature that was seen more commonly in demented than in nondemented patients with ischemic cerebrovascular disease.
Subject(s)
Brain/pathology , Cerebrovascular Disorders/pathology , Dementia/pathology , Magnetic Resonance Spectroscopy , Aged , Aged, 80 and over , Brain/diagnostic imaging , Cerebrovascular Disorders/complications , Dementia/etiology , Female , Humans , Ischemic Attack, Transient/pathology , Male , Middle Aged , RadiographyABSTRACT
Vascular dementia is a common and potentially reversible type of dementing illness. Simple, yet valid, assessment instruments are needed to quantitate the severity of cognitive and functional impairment in vascular dementia patients seen in consultation or studied in therapeutic trails. Among sixty-three patients with known ischemic cerebrovascular disease, we found thirteen who satisfied research criteria for vascular dementia, nineteen who were "borderline" and thirty-one who were not demented. We administered the Cognitive Capacity Screening Examination and the Functional Activities Questionnaire to these patients and found both tests capable of distinguishing demented from nondemented groups with a high degree of sensitivity and specificity. This battery of assessment instruments was especially helpful in evaluating patients who fell into the "borderline" category. Both tests can be easily administered at the bedside or during routine office visits.
Subject(s)
Brain Ischemia/diagnosis , Dementia/diagnosis , Neuropsychological Tests , Aged , Aged, 80 and over , Aspirin/therapeutic use , Brain Ischemia/drug therapy , Dementia/drug therapy , Double-Blind Method , Female , Humans , Male , Middle Aged , Ticlopidine/therapeutic useABSTRACT
The clinical course of vascular dementia has been described as a stepwise deterioration over time. We studied the chronologic course of cognitive performance over 1-4 years in seven patients with known ischemic cerebrovascular disease whose dementia subtype was assigned according to the clinical history and the pattern of white matter lesions seen on magnetic resonance imaging (MRI). One patient had the lacunar state, three had subcortical arteriosclerotic encephalopathy and three had multiple cortical and subcortical strokes. All were being treated with an antiplatelet agent and six received antihypertensive therapy. Four of the seven vascular dementia patients improved cognitively over the first year. A fluctuating course was eventually seen in all patients. None showed stepwise deterioration of cognitive function over time. The MRI was useful in subclassifying vascular dementia patients, but the clinical course did not appear to vary as a function of the dementia subtype.
