Integrated modelling of medical emergency response process for improved coordination and decision support.

The medical emergency response comprises a domain with complex processes, encompassing multiple heterogeneous entities, from organisations involved in the response to human actors to key information sources. Due to the heterogeneity of the entities and the complexity of the domain, it is important to fully understand the individual processes in which the components are involved and their inter-operations, before attempting to design any technological tool for coordination and decision support. This work starts with the gluing together and visualisation of the interactions of involved entities into a conceptual model, along the identified five workspaces of emergency response. The modelling visualises the domain processes, in a way that reveals the necessary communication and coordination points, the required data sources and data flows, as well as the required decision support needs. Work continues with the identification and modelling of the event-driven discrete-time-based dynamics of the emergency response processes and their compositions, using Petri nets as the modelling technique. Subsequently, an integrated model of the process is presented, which facilitates the parallelisation of the tasks undertaken in an emergency incident.

Efficacy of an oral, 10-day course of high-dose calciferol in correcting vitamin D deficiency.

AIM: Treatment of vitamin D deficiency is an important aspect of the management of osteoporosis, particularly in the elderly. Most well-described regimens in current use involve daily dosing and thus require long-term compliance to be effective. In New Zealand, no preparation containing only low-dose vitamin D suitable for daily use is available. We describe a high-dose regimen for rapid correction of vitamin D deficiency, which makes use of the calciferol 50 000 international unit (IU) tablets available in this country. METHODS: Thirty two women (mean age 76 +/- 4 years; range 67-84 years) with serum 25-hydroxyvitamin D concentrations = or <10 microg/l were treated with oral calciferol 50 000 IU daily for 10 days. RESULTS: At an average time after treatment of four months, serum 25-hydroxyvitamin D increased from 8 +/- 1 microg/l to 21 +/- 5 microg/l, bringing all but one patient within the reference range (14-76 microg/l). Serum parathyroid hormone level decreased after treatment by 0.7 +/- 1.7 pmol/l (p <0.05), and alkaline phosphatase activity decreased by 5 +/- 11 u/l (p <0.05). Serum calcium increased by 0.06 +/- 0.08 mmol/l (p <0.001), but all values were within the reference range. Data collected from a separate cohort of elderly inpatients showed that similar increases could be achieved with a single 300 000 IU dose, and suggested that serum 25-hydroxyvitamin D levels decline with a half-life of 90 days. CONCLUSIONS: This regimen provides a simple, safe and effective way of managing vitamin D deficiency. Its short-term nature may result in higher compliance than daily dosing regimens.