Showing papers by "Clinical Emergency Hospital Bucharest published in 2014"

Identifying deficiencies in national and foreign medical team responses through expert opinion surveys: implications for education and training.

Abstract: Introduction: Unacceptable practices in the delivery of international medical assistance are reported after every major international disaster; this raises concerns about the clinical competence and practice of some foreign medical teams (FMTs). The aim of this study is to explore and analyze the opinions of disaster management experts about potential deficiencies in the art and science of national and FMTs during disasters and the impact these opinions might have on competency-based education and training. Method: This qualitative study was performed in 2013. A questionnaire-based evaluation of experts’ opinions and experiences in responding to disasters was conducted. The selection of the experts was done using the purposeful sampling method, and the sample size was considered by data saturation. Content analysis was used to explore the implications of the data. Results: This study shows that there is a lack of competency-based training for disaster responders. Developing and performing standardized training courses is influenced by shortcomings in budget, expertise, and standards. There is a lack of both coordination and integration among teams and their activities during disasters. The participants of this study emphasized problems concerning access to relevant resources during disasters. Conclusion: The major findings of this study suggest that teams often are not competent during the response phase because of education and training deficiencies. Foreign medical teams and medically related nongovernmental organizations (NGOs) do not always

Education and Training Initiatives for Crisis Management in the European Union: A Web-based Analysis of Available Programs

Abstract: Introduction: Education and training are key elements of disaster management. Despite national and international educational programs in disaster management, there is no standardized curriculum available to guide the European Union (EU) member states. European- based Disaster Training Curriculum (DITAC), a multiple university-based project financially supported by the EU, is charged with developing a holistic and highlystructured curriculum and courses for responders and crisis managers at a strategic and tactical level. The purpose of this study is to qualitatively assess the prevailing preferences and characteristics of disaster management educational and training initiatives (ETIs) at a postgraduate level that currently exist in the EU countries. Methods: An Internet-based qualitative search was conducted in 2012 to identify and analyze the current training programs in disaster management. The course characteristics were evaluated for curriculum, teaching methods, modality of delivery, target groups, and funding. Results: The literature search identified 140 ETIs, the majority (78%) located in United Kingdom, France, and Germany. Master level degrees were the primary certificates granted to graduates. Face-to-face education was the most common teaching method (84%). Approximately 80% of the training initiatives offered multi- and cross-disciplinary disaster management content. A competency-based approach to curriculum content was present in 61% of the programs. Emergency responders at the tactical level were the main target group. Almost all programs were self-funded. Conclusion: Although ETIs currently exist, they are not broadly available in all 27 EU countries. Also, the curricula do not cover all key elements of disaster management in a standardized and competency-based structure. This study has identified the need to

Art of disaster preparedness in European union: a survey on the health systems.

Abstract: INTRODUCTION: Naturally occurring and man-made disasters have been increasing in the world, including Europe, over the past several decades. Health systems are a key part of any community disaster management system. The success of preparedness and prevention depends on the success of activities such as disaster planning, organization and training. The aim of this study is to evaluate health system preparedness for disasters in the 27 European Union member countries. METHOD: A cross-sectional analysis study was completed between June-September 2012. The checklist used for this survey was a modified from the World Health Organization toolkit for assessing health-system capacity for crisis management. Three specialists from each of the 27 European Union countries were included in the survey. Responses to each survey question were scored and the range of preparedness level was defined as 0-100%, categorized in three levels as follows: Acceptable; Transitional; or Insufficient. RESULTS: Response rate was 79.1%. The average level of disaster management preparedness in the health systems of 27 European Union member states was 68% (Acceptable). The highest level of preparedness was seen in the United Kingdom, Luxemburg, and Lithuania. Considering the elements of disaster management system, the highest level of preparedness score was at health information elements (86%), and the lowest level was for hospitals, and educational elements (54%). CONCLUSION: This survey study suggests that preparedness level of European Union countries in 2012 is at an acceptable level but could be improved. Elements such as hospitals and education and training suffer from insufficient levels of preparedness. The European Union health systems need a collective strategic plan, as well as enough resources, to establish a comprehensive and standardized disaster management strategy plan. A competency based training curriculum for managers and first responders is basic to accomplishing this goal. KEYWORDS: Disaster medicine; Disaster preparedness; Disaster epidemiology; Health systems; European Union. Language: en

Acute coronary syndrome in octogenarian patients: results from the international registry of acute coronary syndromes in transitional countries (ISACS-TC) registry

Abstract: We sought to investigate characteristics, treatment, and outcome of octogenarian patients during hospital stay for acute coronary syndrome (ACS) in a transitional country. This is a cohort study of 437 patients ≥ 80 years old, consecutively admitted with a diagnosis of ACS at 14 hospitals in 8 Eastern European countries reporting data to ISACS-TC registry. The primary endpoint was in-hospital mortality. The mean age of the study population was 83.5 years; 50.1% of the patients were women. Females, less frequently than males, had a history of myocardial infarction, smoking habit, and episodes of typical chest pain. But they were more often admitted with left ventricular dysfunction. The rate of reperfusion treatment (29.5%) was very low in patients with ST-elevation myocardial infarction (STEMI). Also, most of the overall study population had a non-invasive approach (women, 79% vs. men, 70.6%; P = 0.042). However, when the coronary anatomy was known, there were no differences in the rates of revascularization between genders. There was no difference in the rates of death between male (21%) and female (21.1%) patients. Univariate and multivariate analyses revealed that the independent predictors ( P < 0.05) of death in octogenarians were systolic blood pressure <100 mmHg (odds ratio [OR], 2.74), Killip class ≥ 2 (OR, 1.71), and STEMI as an index event (OR, 2.01). Evidence-based drugs (beta-blockers, statins, and ACE-inhibitors) had all independent significant protective effect on the hospital outcome. In conclusion, age is relevant in the prognosis of ACS, but its importance should be considered not secondary to other clinical factors.

Hypertension and acute coronary syndromes in Romania: data from the ISACS-TC registry

Abstract: There is little information on the incidence and prognostic significance of arterial hypertension (HTN) in acute coronary syndromes (ACSs), especially in the east European countries. We sought to investigate a registry of ACS patients in Romania, in order to better elucidate whether hypertensive patients are at higher risk of death and deserve a tailored approach for management and follow-up. The data of this study are a framework of the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) (ClinicalTrials.gov, [NCT01218776][1]). The present analysis focused on 2286 retrospective patients admitted to 23 hospitals in Romania with a diagnosis of ACS. Among 1450 hypertensive patients, 64.5% were admitted with a diagnosis of ST elevation myocardial infarction (STEMI), while the remaining was admitted with a diagnosis of non-STEMI (NSTEMI). When compared with non-hypertensive patients, hypertensive patients were older (mean age 60.3 vs. 66.7 years, P 65 years) patients with both STEMI and NSTEMI. Hypertensive ACS patients in Romania represent a higher risk group, since they are more often discharged with NYHA class ≥ III, are older and have an adverse clinical profile. In the elderly, the outcomes of the hypertensive patients are worse than non-hypertensive patients. [1]: /lookup/external-ref?link_type=CLINTRIALGOV&access_num=NCT01218776&atom=%2Fehjsupp%2F16%2Fsuppl_A%2FA20.atom

Extracorporeal Shockwave Therapy (ESWT) benefits in spastic children with Cerebral Palsy (CP)

Abstract: Introduction. ESWT refers to the use of Shock Waves in medical practice. It was used as an important tool in spasticity management of children with CP. The aim of our study was to evaluate the effect of a 3 session of ESWT on spastic upper and lower limbs muscles in children with CP. Methods. Sixty-three children (37 boys and 26 girls), mean age 99.57±53.74 months, were included in the study. We used focused ESWT, applied in 3 sessions during the admission of each child, on the mainly affected muscles, using the same parameters on all patients (energy – 0.15 mJ/mm2, shot dose - 500 shocks/ session, frequency - 10 Hz). All patients were assessed two times: once, in admission (before any physical or ESWT appliance) and second, at discharge (after receiving the entire prescribed treatment), following: Modified Ashworth Scale (MAS), Gross Motor Function Classification System (GMFCS), Gross Motor Function Measure 66 (GMFM-66) and also a Questionnaire on Pain caused by spasticity (QPS). Results. We found a better and significant decrease of MAS level in the ESWT treated group, thus leading to a concomitant decrease of QPS score and also increase of GMFM-66 score. Conclusion. ESWT, applied in 3 sessions, with 0.15 mJ/ mm2, using 500 shocks/ min and 10 Hz as frequency may decrease children spasticity level and pain caused by it and improve the gross motor function.

Mean platelet volume variability in young patients with non-ST elevation acute myocardial infarction.

Abstract: Introduction: Platelet activation plays an important role in the pathophysiology of non-ST elevation acute coronary syndromes (ACS). Mean platelet volume (MPV), an indicator of platelet reactivity, was previously associated with an increased risk of acute coronary events. Objective: To investigate the MPV variability in young patients presenting with NSTEMI, as compared to young patients with cardiovascular risk factors and no overt ischemic cardiac disease, as well as with elderly patients presenting with NSTEMI. Methods: We analyzed data from 174 patients admitted in our cardiology department between January 2009 and December 2010: 35 patients younger than 45 years of age with NSTEMI, 41 patients younger than 45 without ACS and 98 patients older than 45 with NSTEMI. Results: Young patients with NSTEMI had a significantly higher mean MPV (8.88 ± 1.14fl) than young patients without ACS (8.31 ± 0.37fl, p<0.01), while the older subjects with NSTEMI had the highest mean MPV (9.48 ± 1.35fl, p=0.02). MPV correlated with age (r=0.375, p<0.0001). After a multivariate analysis, elevated levels of MPV were independent predictors of NSTEMI in young patients (odds ratio [OR] 2.75, 95% CI 1.04–7.92, p=0.04), while hypertension (OR 0.34, 95% CI 0.6–1.78, p=0.20), dyslipidemia (OR 1.61, 95% CI 0.17–14.51, p=0.67), obesity (OR 5.77, 95% CI 0.80–41.53, p=0.08) and smoking status (OR 8.97, 95% CI 0.84–95.26, p=0.06) were not. Conclusion: NSTEMI is associated with high MPV in old as well as in young patients. Elevated MPV is predictive for NSTEMI in young patients, separately of a high cardiovascular risk profile.

Translating clinical research of Molecular Biology into a personalized, multidisciplinary approach of colorectal cancer patients.

Abstract: Although multimodal treatment has brought important benefit, there is still great heterogeneity regarding the indication and response to chemotherapy in Stage II and III, and individual variations related to both overall survival and toxicity of new therapies in metastatic disease or tumor relapse. Recent research in molecular biology led to the development of a large scale of genetic biomarkers, but their clinical use is not concordant with the high expectations. The Aim of this review is to identify and discuss the molecular markers with proven clinical applicability as prognostic and/or predictive factors in CRC and also to establish a feasible algorithm of molecular testing, as routine practice, in the personalized, multidisciplinary approach of colorectal cancer patients in our country. Despite the revolu¬tion that occurred in the field of molecular marker research, only Serum CEA, Immunohistochemical analysis of mismatch repair proteins and PCR testing for KRAS and BRAF mutations have confirmed their clinical utility in the management of colorectal cancer. Their implementation in the current practice should partially resolve some of the controversies related to this heterogenic pathology, in matters of prognosis in different TNM stages, stage II patient risk stratification, diagnosis of hereditary CRC and likelihood of benefit from anti EGFR therapy in metastatic disease. The proposed algorithms of molecular testing are very useful but still imperfect and require further validation and constant optimization.

Burnei's technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta.

Abstract: Background Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected, which required an extensive use of the wheel chair or bed immobilization of the patient The concomitant correction of the complex deformities, coxa vara/valga and femoral integrated configuration, have been a progress which allowed the patients to walk with or without support Purpose The purpose of this study is to present the Burnei's technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with osteogenesis imperfecta Study design The paper is about a retrospective study done in a single center, which analyses Burnei technique and other procedures described in literature Patient sample The content of the article is based on a 12 years experience on a batch of 51 patients with osteogenesis imperfecta from which 10 patients (13 hips) presented frontal plane deviations of the femoral neck Outcome measures All the patients with osteogenesis imperfecta who presented coxa vara or valga were submitted to investigations with the purpose of measuring blood loss, the possibility of extending the surgical intervention to the leg, the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care Burnei's technique: The operation was first performed in 2002 A subtrochanteric osteotomy was made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or by using a cuneiform resection associated with muscular disinsertions Only telescopic rods were used for osteosynthesis Discussions There are a few articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta Some of them are the techniques described by Finidori, Wagner and Fassier Conclusions Burnei's technique is simple; it corrects the varus and valgus deviations concomitantly with Sofield-Millar Even though only a telescopic rod is used, no stress fractures were seen postoperatively, deviation recurrence or assembly loss

Hepatocellular carcinoma among cirrhotics--utility of screening and surveillance programs--review article.

Abstract: Screening of known cirrhotics for hepatocellular cancer (HCC) has long been a contentious topic. Studies to date have failed to conclusively prove or disprove the validity of α-fetoprotein (AFP) and hepatic ultrasound as screening mechanisms for HCC among cirrhotics. It is not clear whether these screening mechanisms provide any benefit in terms of reduced morbidity and mortality. Screening for HCC among cirrhotics by using AFP and/or imaging at every 6 months correlate with HCC diagnosis, thus portending better treatment options and an improved prognosis. Screening all the known cirrhotics for HCC may lead to decreased mortality.

A Web-based E-training Platform for biomedical engineering education

Abstract: This paper presents the results of the Leonardo da Vinci project (Transfer of Innovation), named “A Web-based E-Training Platform for Extended Human Motion Investigation in Orthopaedics”. The project addresses to medical and engineering professionals, proposing formation of specialists that will systematically apply the principles of medical and bioengineering sciences in finding solutions that will lead in improving health conditions. The main outcome of the project was a Virtual Training & Communication Centre ORTHO-eMAN for innovative education - on-line educational and training material accessed via a standard web browser, which provides an integrated on-line learning environment. Interactivity allows trainees to test their knowledge and provides immediate feedback using images and cases that they might encounter in clinical practice.

Particularities in coronary revascularization in elderly patients presenting with ST segment elevation acute myocardial infarction (STEMI)

Abstract: V soucasne době se stale zvysuje incidence infarktu myokardu s elevacemi useku ST (STEMI) u starsich osob. V nejnovějsich guidelines se doporucuje okamžite invazivni vysetřeni a připadna primarni perkutanni koronarni intervence (PCI) u vsech pacientů bez ohledu na věk. Podle literarnich udajů se vsak intervencni lecba starsich pacientů se STEMI neprovadi v dostatecne miře.Cilem nasi studie bylo posoudit výsledky hospitalizace starsich pacientů pro STEMI oproti mladsim osobam z hlediska systematicke intervencni lecby. Zajimali jsme se rovněž o některa, podle nas významna specifika lecby starsich pacientů se STEMI.Posoudili jsme udaje 975 po sobě nasledujicich pacientů se STEMI přijatých do jednoho centra v obdobi od ledna 2012 do cervence 2013; z toho 203 (20,8 %) pacientů bylo ve věku 75 let a vice.V porovnani s mladsimi osobami byli starsi pacienti větsinou ženy (47,2 % vs. 22,7 %; p I: 21,1 % vs. 7,2 %; p < 0,001). U obou skupin byla stanovena podobna doba ischemie, 54,1 % vs. 55,1 % s převozem do nemocnice do sesti hodin.U starsi skupiny bylo provedeno meně PCI (74,3 % vs. 85,7 %; p = 0,02). Rozsah lezi na koronarnich tepnach se významně nelisil, až na dva připady postiženi kmene leve věncite tepny u starsich pacientů (12,2 % vs. 5,1 %; p < 0,001).Mezi oběma skupinami nebyly významne rozdily v lecbě během hospitalizace (dualni antiagregacni lecba, antikoagulace, beta-blokatory, inhibitory enzymu konvertujiciho angiotensin [ACE]/blokatory receptorů AT1 pro angiotensin II a statiny). Nemocnicni mortalita vsech nasich pacientů byla 4,41 %, s hodnotami 11,3 % u starsi skupiny a 2,59 % ve skupině ve věku < 75 let (p < 0,001).Výsledky lecby starsich pacientů se STEMI během pobytu v nemocnici byly horsi, se zvýsenou mortalitou, zvlastě u osob se srdecnim selhanim již při přijmu. U starsich pacientů bylo provedeno meně PCI, i když ve farmakoterapii nebyl žadný rozdil zjistěn. U vsech pacientů bez ohledu na věk je nutno uplatňovat strategii okamžiteho koronarografickeho vysetřeni a v připadě potřeby primarni PCI.

Pesamosca osteoplasty: surgical procedure for the spatial correction of cubitus varus or valgus post malunited supracondylar fractures of the humerus.

Abstract: Introduction Supracondylar fractures of the humerus represent a current concern in the child's and adolescent's osteo-articular pathology. Even though orthopedic reductions are made correctly, fractures can become displaced when managed only by cast immobilization and complications may arise. The most frequent complications encountered in "Prof. Dr. Alexandru Pesamosca" Clinique, Bucharest, Romania, due to supracondylar humeral fractures, are valgus or varus deviations with angles that can sometimes exceed 40 degrees as a result of malunion. Varus or valgus deformations were rarely encountered after surgical treatment. The goal of this study is to present an alternative surgical technique to correct varus and valgus deformations as well as malrotation. Material and method The study is a retrospective analysis of a 96 children study group surgically managed during 1985 and 2013. In the first period, various surgical techniques have been performed: cuneiform resections, step-cut osteotomies, open wedge osteotomies with external fixation, epiphysiodesis, hemichondrodiatasis and Pesamosca metaphyseal diaphyseal osteoplasty. Starting with 2005, all the cases that presented such complications--28 out of 96 (29.1%)--were managed with the Pesamosca procedure. Due to the malunion of supracondylar humeral fractures only varus or valgus deformities were admitted in the study. The malunion due to the pathologic fractures encountered in osteogenesis imperfecta or fibrous dysplasia was precluded. The experience accumulated with the other surgical techniques used in 68 out of 96 patients (70.9%) determined us to exclusively use the Pesamosca osteoplasty following the year 2005, seeing the simplicity and the efficiency of this procedure. Results The outcome was very good. In 5 cases out of the 28 (17%) an apparent residual elbow was encountered and one case of relapse (3%) was noted due to inadequate term of cast immobilization. The elbow's mobility was completely recovered, the thoracic member's axis was appropriate and the metaphyseal diaphyseal osteotomy site healed completely in 3 months' time. Conclusions Compared to other surgical techniques, the Pesamosca technique offers to the surgeon the possibility of correcting the varus or the valgus deformity as well as the malrotation in a simple, secure and efficient manner.

Ordinary symptom for a serious pathology - giant solitary fibrous tumor of the pleura.

Abstract: The solitary fibrous tumor of the pleura (SFTP) is a rare primary tumor arising from mesenchymal cells in the areolar tissue subjacent to the mesothelial-lined pleura. From an epidemiological standpoint, solitary fibrous tumors of the pleura account for less than 5% of primary pleural tumors, and commonly affect patients in the sixth and seventh decades. We presented the case of a 38-year-old woman, without any significant pathological history, who presented at the emergency room for unspecific respiratory symptoms. Imagistic investigations showed a giant opacity in the upper half part of the left hemithorax. The patient underwent surgery and en bloc resection of the tumor (30/25 cm) in oncological limits was performed. Definite diagnosis - solitary fibrous tumor of the pleura - was obtained through histological examination and immunohistochemistry. Even if SFTP are benign tumors, a long follow-up period is mandatory as even patients with complete resection are at risk of recurrence several years after surgery.

Bone Substitute Used in a Bilateral Calcaneal Fracture-Case Presentation

Abstract: Modern traumatology is characterized by high energy trauma, simultaneously affecting parts of the body especially in young patients. One of the most severe aspects resulting of high energy trauma is that of multiple skeletal injuries, with bone loss, which require complex treatment; this refers both to methods of filling the bone defects and to interdisciplinary approach whenever soft tissues are injured, as well. This case demonstrate the impact of modern approach in high energy trauma, with multiple aspects: bone substitutes as effective technique of bone filling and prevention of septic complications, as well as team work for concomitant treatment of associated injuries. The outcome of the patient, compared to the initial status, demonstrate the benefit of bone substitutes for a rapid recovery of trauma patients, with major impact on social and professional recovery.