ABSTRACT
BACKGROUND: The NVVC guideline on ST-elevation myocardial infarction forms the basis for the regional prehospital triage (PHT) project in Zuidoost Brabant. In this project diagnosis and treatment strategies are determined in the ambulance. AIM: To summarise quality assessment and clinical results after one year. METHODS: We evaluated the protocol and patient record form, the patient's call, assignment of tasks, diagnosis, treatment, time intervals, information to hospitals, cooperation and data transmission. Time delays were compared with time delays in a regional dry run before the start of the project and with time delays reported in the literature. RESULTS: Patients still wait over one hour before seeking medical attention. The GP received the majority (65%) of patient calls. In half of all cases (51%), GPs call the ambulance centre only after they have seen the patient. When the patient calls the ambulance centre (35%), information to the GP is either prompt or absent. In 77% of calls to 112 it remains unclear whether the GP was informed at all. The treatment strategy was correct in 97% of cases. Time between symptoms and call decreased in comparison with our local preliminary investigation. Quality assessment after one year shows protocol deviations that are either logical procedural improvements or correctable flaws with no substantial negative influence. CONCLUSION: Short-term clinical results are good, but structured follow-up is needed to reduce mortality in the long term, especially after thrombolysis. A guideline is a snapshot of a dynamic process. The PHT project allows rapid adaptations to be made to new paradigms.
ABSTRACT
Deformation of the surface of passive medial gastrocnemius muscle (MG) was measured in vivo while performing a hysteresis test. The gastrocnemius muscle of male rats were dissected free and the distal tendon was cut. The lateral head was separated from the medial head. The muscle origins were left intact. 60-70 fluorescent, polystyrene spheres (diameter 0.7 mm) were attached to the surface of the MG. During the experiment, two-dimensional video recordings of the movements of the MG were made. The coordinates of the marker centroids were obtained by computer processing of digitized images and marker displacements as a function of time were calculated. Green-Lagrange strains in two principal directions were calculated (epsilon 1, epsilon 2) for three specimens. epsilon 1 had approximately the same direction as the muscle fibers. The longitudinal strain of the fibers (20-30%) was larger than the strain of the aponeurosis (1-5%); p < 0.001. No significant difference was found between the values of the transverse strains of muscle fibers and aponeurosis; the value of epsilon 2 was -6 to -9% for both tissue structures.
