Risk stratification in providing inter-facility transport: Experience from a specialized transport team.

BACKGROUND: The role of Inter-facility transport (IFT) of patients is an emerging specialty requiring service reorganization, diversion of major trauma to trauma center. This study aimed to determine the patients who are more prone to en route adverse event during the period of 22:00 to 07:00, based on critical in-patient needs provided by the Emergency Department (ED) nursing staff at Alice Ho Miu Ling Nethersole Hospital (AHNH). METHODS: This study included all 22:00 to 07:00 IFTs accompanied by ED nurses at AHNH for a period of 28 months from August 2006 until December 2008. The transports were reviewed for: (1) age, (2) gender, (3) transport configuration, (4) clinical category, and (5) physiological instability before transport. RESULTS: A total of 79 patients were transported during the 22:00 to 07:00 timeframe within the study period. The types of patients were mainly neurosurgical emergencies (n=32; 40.5%), surgical emergencies (n=28; 35.4%), and upper gastrointestinal bleeding (UGIB) (n=11; 13.9%). En route adverse events were encountered by the accompanying nurses in 16 transports (20.3%) with a higher incidence of adverse events during transport of surgical emergencies, UGIB and patients who were physiological unstable before transport (P< 0.05). CONCLUSION: A specialized transport team from the ED can assist other clinical departments by providing expert care during IFT. In spite of the high quality of care, adverse events do commonly occur.

99mTc-labeled vasoactive intestinal peptide analog for rapid localization of tumors in humans.

In recent years, imaging tumors with receptor-specific biomolecules has been the focus of increasing interest. Vasoactive intestinal peptide (VIP) has a high affinity for specific receptors that are expressed in high density on a large number of malignant tumors. VIP was modified (TP 3654) without compromising its biologic activity and labeled with 99mTc. Pharmacokinetics and feasibility studies were performed in 3 healthy volunteers and 11 patients with a history of cancer. Imaging was performed for up to 2 h after injection. Within 24 h after injection of 99mTc-TP 3654 (370-555 MBq/5 microg), approximately 70% of the tracer cleared through the kidneys and 20% through the liver. Blood clearance was rapid. No adverse reaction was noted in any subject. All known tumors were clearly delineated within 20 min. Findings were compared with the results of 99mTc-methoxyisobutyl isonitrile, CT, MRI, or histology. There was concordance in 9 patients. In the other 2 patients, only the VIP scan was positive for tumors known to express VIP receptors. The early results of imaging tumors with 99mTc-VIP are promising and warrant further study.

Imaging tumors in humans with Tc-99m-VIP.

Vasoactive intestinal peptide (VIP) was modified at the C terminus with a spacer and four amino acids to serve as a chelating moiety. The modified peptide, TP 3654, was labeled with Tc-99m and evaluated in normal volunteers, as well as in patients with a history of cancer. Renal clearance (67%) was the primary route of excretion, with approximately 20% of the radioactivity clearing through the hepatobiliary system. No adverse reaction was noted in any of the subjects and all, except one small, of the known lesions as seen by CT, MRI, Tc-99m-MIBI, or mammography were correctly identified within a few minutes of an i.v. injection of approximately 10 mCi of Tc-99m-TP 3654 (specific activity 11.3 x 10(3) Ci/m mol). The scans were in concordance in nine patients. In the remaining two, one with a visible mass in the neck from high grade spindle cell sarcoma and the other with a palpable mass in a breast from ductal epithelial hyperplasia, were localized only with Tc-99m-TP 3654, but not with Tc-99m-MIBI. Both malignancies are known to express VIP receptors. The VIP analog promises to be a nontoxic and reliable agent for imaging cancers in humans that express VIP receptors.

Universal renormalization of saddle-point integrals for condensed Bose gases.

When treating the ground-state contribution exactly, a variant of the saddle-point method emerges that works even for condensed Bose gases. Results thus obtained, such as canonical partition functions, differ by universal renormalization factors from those provided by the conventional but incorrect scheme. The amended method yields the statistical properties of ideal and very weakly interacting Bose gases with a fixed number of particles with particular simplicity.

Postcatheterization retroperitoneal hematoma due to spontaneous lumbar arterial hemorrhage.

A patient developed retroperitoneal hemorrhage after cardiac catheterization, initially thought to be a complication of the puncture. Diagnostic evaluation revealed the source to be spontaneous bleeding from a lumber artery, which was successfully embolized. Spontaneous hemorrhage is a recognized complication of anticoagulation therapy and must be considered in the differential diagnosis even in the face of a seemingly obvious source of bleeding.

Emergency Medical Services System in Hong Kong: a pearl in the South China Sea.

Each Emergency Medical Services (EMS) system is unique in its development and scope of practice. In many instances, it incorporates components of other models. It is important to the intellectual growth of the Emergency Medical Technicians that they visualize EMS design from an international perspective. This article describes the EMS system that exists in Hong Kong. It explores the changes that are occurring, defines the relationship between Hong Kong and China, and considers the influence that this evolving model might have on China after 1997.

Emergency medical services systems in the United States and China: a developmental comparison.

International emergency medical services (EMS) consultation requires many sensitivities to cross-cultural issues. Contemporary EMS models in developed countries have, by necessity, a systems framework. This study compares evolving EMS systems in the United States and China. It is concluded, that, no matter what the potential and cultural differences might be, a systems framework inherently will emerge in EMS development. As such, the EMS components recognized often will expose an evolving systems approach with more similarities than differences and can reveal strategies for improvement. Providing a developmental comparison process is a necessary first phase in analysis of a country's systems development or restructuring.