Helicopter EMS (HEMS) allows for patients to be quickly transported into regional cardiac centers, often to receive primary percutaneous coronary intervention (PCI). Since PCI is a time-critical therapy, it is importa...
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Helicopter EMS (HEMS) allows for patients to be quickly transported into regional cardiac centers, often to receive primary percutaneous coronary intervention (PCI). Since PCI is a time-critical therapy, it is important that patients get to primary PCI as quickly as possible. HEMS crews’ “on-scene” times for trauma patients have been extensively studied, and recent years have seen many efforts to minimize the time required to prepare patients for transport. There has been less attention to interfacility transport “scene times” for HEMS crews at referring hospitals;this includes stabilization times for preparing cardiac patients for loading onto aircraft for HEMS transport to primary PCI. In the absence of guiding evidence, system benchmarking and quality improvement are difficult. Therefore the current study was undertaken, to assess and describe the HEMS crew “on-scene” times or “patient stabilization times” (PSTs) at referring hospitals, for interfacility transported cardiac patients flown for primary PCI. Descriptive analysis identified a PST median of 19 minutes (interquartile range 15 - 24), and univariate analyses using Kruskal-wallis testing found no association between prolonged PST and sending unit type (Emergency Department versus other), off-hours transports, or relatively frequent (at least monthly) use of HEMS (p for all comparisons > 0.64). Outlier PSTs, defined a priori as those exceeding the median by at least a half-hour, were found in 12% of all cases. These data could be useful as a starting point for system planning and benchmarking efforts in regionalized systems of acute cardiac care.
BACKGROUND The recommended monitoring tools for evaluating nucleot(s)ide analogue renal toxicity,such as estimated glomerular filtration rate(eGFR)and phosphatemia,are late markers of proximal *** early markers are av...
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BACKGROUND The recommended monitoring tools for evaluating nucleot(s)ide analogue renal toxicity,such as estimated glomerular filtration rate(eGFR)and phosphatemia,are late markers of proximal *** early markers are available,but no consensus exists on their *** To determine the 24 mo prevalence of subclinical proximal tubulopathy(SPT),as defined with early biomarkers,in treated vs untreated hepatitis B virus(HBV)-monoinfected *** A prospective,non-randomized,multicenter study of HBV-monoinfected patients with a low number of renal comorbidities was *** patients were separated into three groups:Naïve,starting entecavir(ETV)treatment,or starting tenofovir disoproxil(TDF)*** on the early markers of SPT,the eGFR and phosphatemia,were collected *** was defined as a maximal tubular reabsorption of phosphate/eGFR below 0.8 mmoL/L and/or uric acid fractional excretion above 10%.The prevalence and cumulative incidence of SPT at month 24(M24)were *** data were analyzed using analyses of variance or Kruskal-wallis tests,whereas chi-squared or Fisher’s exact tests were used to analyze qualitative *** analyses were used to adjust for any potential confounding *** Of the 196 patients analyzed,138(84 naïve,28 starting ETV,and 26 starting TDF)had no SPT at *** M24,the prevalence of SPT was not statistically different between naïve and either treated group(21.1%vs 30.7%,P<0.42 and 50.0%vs 30.7%,P=0.32 for ETV and TDF,respectively);no patient had an eGFR lower than 50 mL/min/1.73 m²or phosphatemia less than 0.48 mmoL/*** the multivariate analysis,no explanatory variables were identified after *** cumulative incidence of SPT over 24 mo(25.5%,13.3%,and 52.9%in the naïve,ETV,and TDF groups,respectively)tended to be higher in the TDF group vs the naïve group(hazard ratio:2.283,P=0.05).SPT-free survival at M24 was 57.6%,68.8%,and 23.5%for the naïve,ETV,and TD
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