The impact of helicopter emergency medical service on acute ischemic stroke patients: A systematic review.

BACKGROUND: Helicopter emergency medical services (HEMS) is commonly elected transport for acute ischemic stroke (AIS) known as a time-critical illness. AIM: To conduct a systematic review in order to explore the HEMS impact on healthcare status, process and outcome measures for AIS patients. METHODS: A systematic search was conducted of PubMed, Medline, CINAHL, Cochrane Library and Google Scholar. The gray literature and reference lists of included articles were also searched. Thirty studies met inclusion criteria. RESULTS: Using Donabedian's framework, two studies focused on the impact on healthcare structure, twenty-three explored the impact on process measures, and five focused on clinical outcomes. HEMS structure implications could not be assessed due to insufficient studies. HEMS showed no significant outcome benefit compared to ground emergency medical services (EMS) and the impact on process measures was ambiguous. CONCLUSIONS: HEMS necessity varied considerably between studies. More robust studies are needed for detection of the most suitable use of HEMS in AIS.

Reduction in stroke patients' referral to the ED in the COVID-19 era: A four-year comparative study

IntroductionCurrent reports indicate that the increased use of social distancing for preventive COID-19 distribution may have a negative effect on patients who suffering from acute medical conditions. AimWe examined the effect of social distancing on acute ischemic stroke (AIS) patients referral to the emergency department (ED) MethodA retrospective archive study was conducted between January 2017 and April 2020 in a comprehensive stroke center. We compare the number of neurologic consultations, time from symptoms onset to ED arrival, patients diagnosis with AIS, number of patients receiving treatment (tPA, endovascular thrombectomy (EVT) or combine) and in-hospital death. ResultsThe analysis included a total of 14,626 neurological consultations from the years 2017 to 2020. A significant decrease of 58.6% was noted during the months of January-April of the year 2020 compared to the parallel period of 2017. Percent of final AIS diagnosis for the year of 2020 represent 24.8% of suspected cases, with the highest diagnosis rate demarcated for the year of 2019 with 25.6% of confirmed patients. The most remarkable increase was noted in EVT performance through the examined years (2017, n=21; 2018, n=32; 2019, n=42; 2020, n=47). ConclusionCOVID-19 pandemic resulted in routing constraints on health care system resources that were dedicated for treating COVID-19 patients. The healthcare system must develop and offer complementary solutions that will enable access to health services even during these difficult times.

Effect of socioeconomic and ethnic characteristics on COVID-19 infection: The case of the Ultra-Orthodox and the Arab communities in Israel

BackgroundDuring infectious disease outbreaks the weakest communities are more vulnerable to the infection and its deleterious effects. In Israel, the Arab and Ultra-Orthodox Jewish communities have unique demographic and cultural characteristics that place them at risk for infection. ObjectiveTo examine the socioeconomic and ethnic differences in relation to COVID-19 testing, cases and deaths, and to analyze infection spread patterns in ethnically diverse communities. MethodsConsecutive data on COVID-19 diagnostic testing, confirmed cases and deaths collected from March 31st through May 1st, 2020 in 174 localities across Israel (84% of the population) were analyzed by socioeconomic ranking and ethnicity. FindingsTests were performed on 331,594 individuals (4{middle dot}29% of the total population). Of those, 14,865 individuals (4{middle dot}48%) were positive and 203 died (1{middle dot}37% of confirmed cases). The percentage of the population tested was 26% and the risk of testing positive was 2{middle dot}16 times higher in the lowest, compared with the highest socioeconomic category. The proportion of confirmed cases was 4{middle dot}96 times higher in the Jewish compared with the Arab population. The rate of confirmed cases in 2 Ultra-Orthodox localities increased relatively early and quickly. Other Jewish and Arab localities showed consistently low rates of confirmed COVID-19 cases, regardless of socioeconomic ranking. InterpretationCulturally different communities reacted differently to the COVID-19 outbreak and to government measures, resulting in different outcomes. Therefore, socioeconomic and ethnic variables cannot fully explain communities reaction to the pandemic. Our findings stress the need for designing a culturally adapted approach for dealing with health crises.

Is family history of coronary artery disease important in the emergency department triage?

OBJECTIVE: To explore the role of family history (FH) as a risk factor for ST elevation myocardial infarction (STEMI) in the emergency department (ED) setting during nurse triage and to analyze the clinical outcomes and time lags of patients with and without FH of coronary artery disease (CAD). METHODS: A retrospective archive study was conducted in 2017 in a public tertiary ED at an academic teaching hospital. Data were collected from the electronic medical record for the period of January 2015 to December 2016 on STEMI patients. Of the 335 patients identified with STEMI we included 140 (41.8%) who were eligible to the study inclusion criteria and treated at the ED. Patients transferred directly to the catheterization lab were excluded. We collected and compared information from nurse and physician records on known risk factors for STEMI in adherence to American Heart Association guidelines and hospital outcomes between patients with and without FH of CAD. Logistic regressions were performed to identify the contribution of each risk factor on hospital outcomes. RESULTS: A negligible number of triage nurses documented if the patient had a FH compared to physicians (5.7% vs. 98.8%). Patients with and without FH of CAD were similarly evaluated at ED triage. However, patients with FH transferred earlier to the catheterization lab and had lower hospital readmission rates. Logistic regression analysis showed that FH is a protective factor for ED revisit for general and cardiac reasons. CONCLUSION: There is a need to retrieve information on FH of CAD for all patients presenting with symptoms suggestive of STEMI at ED triage.

Choosing wisely in the ED: The diagnostic cascade of needless medical testing in a two-level study.

BACKGROUND: The diagnostic cascade in the emergency department (ED) has not been fully elucidated. Aim To inspect whether the usage of consulting medicine and imaging contributes to hospital outcomes. We also propose a theoretical model for better understanding the diagnostic cascade of needless medical testing. METHODS: A two-level study was conducted. The first local phase was a retrospective archive study that was conducted between 2014 and 2017 in a tertiary hospital. We extracted the number of requested imaging and consultations for each patient, and main time lags were calculated. The second-phase (January-April 2018) was conducted on a national level. We examined 22 hospitals with the emphasis on five hospital outcomes: recurrent ED visits (within 24 h), median waiting time at the ED, rate of early discharge at the same day and day after and percentage of patients spending >4 h in the ED. RESULTS: A 5% upsurge in CT scans was observed (p = .032), and a significant increase was found in the number of consultations (14%, p = .002). On a national level, a linear regression model found that the proportion of patients discharged from the hospital on the same day and on the day after and the proportion of patients staying in the ED > 4 h predict ED recurrence visits within 24 h (p = .025; R2 = 46.3%). CONCLUSIONS: Upsurge in resource usage in the ED leads to a diagnostic cascade of health consumption. Further study is necessary to examine the proposed model in a global scale.

Uptake mechanism of metabolic-targeted gold nanoparticles.

AIM: To elucidate the interactions, uptake mechanisms and cytotoxicity profile of glucose-functionalized gold nanoparticles (2GF-GNPs), for expanding and advancing the recently proposed technology of metabolic-based cancer detection to a variety of cancer diseases. METHODS: Several cell types with different metabolic features were used to assess the involvement of GLUT-1 and different endocytosis pathways in 2GF-GNP uptake, and the cytotoxicity profile of 2GF-GNPs. RESULTS: Cellular uptake of 2GF-GNP strongly correlated with GLUT-1 surface expression, and occurred mainly through clathrin-mediated endocytosis. 2GF-GNPs showed no toxic effect on cell cycle and proliferation. CONCLUSION: These findings promote development of metabolic-based cancer detection technologies, and suggest that 2GF-GNPs may enable specific cancer detection in a wide range of tumors characterized by high GLUT-1 expression.

Controlled release of analgesic drugs from porous bioresorbable structures for various biomedical applications.

Pain is one of the most common patient complaints encountered by health professionals and remains the number one cause of absenteeism and disability. In the current study, analgesic-eluting bioresorbable porous structures prepared using the freeze-drying of inverted emulsions technique were developed and studied. These drug-eluting structures can be used for coating fibers or implants, or for creating standalone films. They are ideal for forming biomedically important structures that can be used for various applications, such as wound dressings that provide controlled release of analgesics to the wound site in addition to their wound dressing role. Our investigation focused on the effects of the inverted emulsion's parameters on the shell microstructure and on the resulting drug-release profile of ibuprofen and bupivacaine. The release profiles of ibuprofen formulations exhibited a diffusion-controlled pattern, ranging from several days to 21 days, whereas bupivacaine formulations exhibited an initial burst release followed by a three-phase release pattern over a period of several weeks. Higher organic to aqueous phase ratios and higher polymer contents reduced the burst release of both drugs and prolonged their release due to lower porosity. Overall, the drug-eluting porous structures loaded with either ibuprofen or bupivacaine demonstrated a promising potential for use in various applications that require pain relief.