Narrow band imaging represents a promising endoscopic technique which allows real time characterization of colonic lesions by assessment of mucosal and vascular patterns. Due to the ability to make an optical biopsy, NBI could become a useful tool in clinical decisions regarding therapy and surveillance. The aim of this paper is to review the current knowledge on the optical diagnosis of colonic lesions by using NBI endoscopy. We reviewed research articles, reviews and meta-analyses from the PubMed and MEDLINE containing relevant data in this field. The validity of endoscopic criteria for the differentiation of adenoma and hyperplastic polyps, as well as of invasive cancer, has been evaluated in recent studies. Based on the prediction of polyp histology, new potential cost saving strategies have been proposed. Many reports are focused on the accuracy of optical biopsy by using NBI for predicting colonoscopy surveillance intervals and adenomatous histology in diminutive polyps, according to the Preservation and Incorporation of Valuable Endoscopic Innovations statement. Optical diagnosis is still under evaluation, and cannot yet be endorsed in routine practice. The high level of performance achieved by expert endoscopists needs to be replicated in the community utilizing reliable and standardized endoscopic criteria.
Background: The current study outlines some of the main particularities of both real and simulated mass casualty incidents (MCI) and disasters in Romania as reported by medical and paramedical participating personnel. Methods: A non-profit organization in Romania trained 1250 doctors, nurses and paramedics for proper MCI interventions through a dedicated programme for the last part of the year 2013. Half a year later, an email with a unique link to an online questionnaire was sent to each participant to assess their opinion over the participation in real or already simulated MCI or disasters. The questionnaire consisted of 25 specific topics, out of which only a fraction were considered for the current study. Results: Out of all participants, 145 doctors, 184 nurses and 115 paramedics provided valid answers, totaling 444 responders. Most participants were satisfied with the information about the location and type of the incident they would respond to. The amplitude of a given event is generally well anticipated under simulation conditions as compared to real events, where the amplitude tends to be higher rather than lower than expected (p=0.0082). About three quarters of participants under real or simulated events repeated or demanded repeating the information trafficked through mobile radios, almost a quarter misinterpreted the information, and almost a half reported delayed operations due to miscommunication. Conclusions: Simulations are a proper method of communication evaluation for mass casualty incidents and disasters, which can also stress the common communication issues encountered during a real MCI unfolding.
Objective: Mass casualty incidents and disasters require functional and efficient patient data management systems, as well as smart interconnections with patient tracking applications. Various initiatives developed and tested patient field charts for large-scale events but there is no one definite general format accepted. The current research proposes an upgraded model of the official patient field chart issued by the Romanian Department for Emergency Situations in 2015 to be used for large-scale events.
Measures: An upgraded model is created after a thorough content analysis, physical analysis, design upgrade and optimization process. Differences between the official and the upgraded model are measured and compared, and statistical computations are carried out.
Results: The main distinctive features of the patient field chart are dynamic triage, unique code identification, QR visual codes, wireless tags and irreversible clear contamination status highlighting. The upgrade process results in almost doubling the available active area without the need to change the document size format of the product. Visual elements and features are included to optimize operation workflow.
Conclusions: The upgraded model offers a variety of improvements for both the overall rescue effort as well as the end user of the product. It allows for previously unavailable features like unlimited dynamic triage and enables the use of electronic management solutions.
Introduction: Errors are frequent in health care and Emergency Departments are one of the riskiest areas due to frequent changes of team composition, complexity and variety of the cases and difficulties encountered in managing multiple patients. As the majority of clinical errors are the results of human factors and not technical in nature or due to the lack of knowledge, a training focused on these factors appears to be necessary. Crisis resource management (CRM), a tool that was developed initially by the aviation industry and then adopted by different medical specialties as anesthesia and emergency medicine, has been associated with decreased error rates.
The aim of the study: To assess whether a single day CRM training, combining didactic and simulation sessions, improves the clinical performance of an interprofessional emergency medical team.
Material and Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. Twenty individual interprofessional teams were created. Each team was assessed before and after the training, through two in situ simulated exercises. The exercises were videotaped and were evaluated by two assessors who were blinded as to whether it was the initial or the final exercise. Objective measurement of clinical team performance was performed using a checklist that was designed for each scenario and included essential assessment items for the diagnosis and treatment of a critical patient, with the focus on key actions and decisions. The intervention consisted of a one-day training, combining didactic and simulation sessions, followed by instructor facilitated debriefing. All participants went through this training after the initial assessment exercises.
Results: An improvement was seen in most of the measured clinical parameters.
Conclusion: Our study supports the use of combined CRM training for improving the clinical performance of an interprofessional emergency team. Empirically this may improve the patient outcome.
Objectives: Our study aimed to evaluate and compare the accuracy of C-reactive protein, Procalcitonin and Interleukine-6 in identifying serious bacterial infections (SBI) in children with fever without source.
Methods: 139 children, aged 7 days to 36 months, addressing the Emergency Department from a Romanian university hospital, were prospectively enrolled during 2013. C-reactive protein, Procalcitonin and Interleukin-6 were determined for every patient. SBI diagnosis was based on cultures results and chest radiographs.
Results: 31 patients (22.3%) had SBI. C-reactive protein [AUC: 0.87 (95%CI: 0.81-0.92)] and Procalcitonin [AUC: 0.83 (95%CI: 0.76-0.89)] proved strong prediction value for SBI and performed better than Interleukin-6 [AUC: 0.77 (95%CI: 0.69-0.84)]. For the group of children with the duration of fever less than 8 hours, Interleukin- 6 was the best predictor [AUC: 0.88 (0.76-0.95)].
Conclusions: Both C-reactive protein and Procalcitonin are strong and similar predictors for SBI, and Interleukin- 6 might be a better SBI screening tool for children with shorter duration of fever.
Objective: To evaluate the impact of a single day Crisis Resource Management (CRM) oriented team training, combining didactic and simulation sessions, on work satisfaction of the healthcare staff working in an Emergency Department. Methods: Seventy health professionals with different qualifications, working in an emergency department, were enrolled in the study. After enrollment, participants were asked to complete a work satisfaction questionnaire and to choose a day for the training session according to their availability. Each training session took place in the simulation center and consisted of several elements: didactic session and simulation session, followed by instructor facilitated debriefing. The lecture was focused on medical errors and CRM principles. Two months after, they were asked to complete again the work satisfaction questionnaire. Results: There were no significant improvements on the items evaluated through the work satisfaction questionnaire for none of the professional categories involved, except for ‘the possibility to refer the patient to a specialist whenever was considered necessary’ for the doctors. Improvements were seen for the same professional category on the following items: workload, leisure time, level of stress at work, time and energy spent on administrative tasks. Conclusions: The findings of this study do not support the effectiveness of a single day CRM training as a tool to improve the work satisfaction among medical staff in ED. Further research is necessary.
Introduction. In search for explanations of the clinical heterogeneity in patients with haemophilia (PwH) with the same mutation or degree of factor VIII deficiency, the coexistence of single or associated prothrombotic risk mutations has been widely evaluated. Objective. The evaluation of the frequency of prothrombotic risk mutations and polymorphisms in PwH in comparison with the general population. Method. The study was performed on 113 consecutive PwH consisting of PCR technology aiming to detect: factor V Leiden - G 1691A (FVL) and prothrombin (PT) - G 20210 A mutations, methylentetrahydrofolat - reductase (MTHFR) and plasminogen activator inhibitor type 1 (PAI-1) polymorphisms. Results. Within the whole study group, 52.21% patients have been identified with associated prothrombotic risk mutations or polymorphisms, 40.70% with one and 7.08% without any such alterations. The global frequency was characterized by the predominance of PAI-1 polymorphism present in 82.29% and MTHFR in 52.21% of patients. Heterozygous variants of PT G20210A, FV G1691A, MTHFR and PAI-1 were found in 7.96%, 9.73%, 39.82% and 53.98% cases, respectively. According to the disease severity, in 89 patients with severe hemophilia, the following frequencies of polymorphisms were found: for MTHFR 52.80%, for FV G1691A 5.61%, for PT G20210A 8.99% and for PAI-1 polymorphism 79.77%. Conclusions. The frequency of FV, PT and PAI-1 genes alterations in our group of hemophilia patients is higher than in the normal population. Nevertheless, considering their uneven distribution in different ethnic groups and geographical regions, more studies on a larger age- and sex-matched patient population are needed.
Background: Emergency dental care is provided at the Mureș County Emergency Hospital in Tîrgu Mureș since February 2012, however, there is little information available regarding its activity. Therefore, the aim of the study was to evaluate the prevalence and diagnosis of dental emergency cases treated in this dental office over the first two years. Material and methods: This two-year retrospective study was based on the analysis of patients’ dental records who were treated at the Dental Office of the Mureș County Emergency Hospital in Tîrgu Mureș. Results: In the first year 5567 patients were treated, whereas in the second year their number was significantly higher, 7213 patients. Pulp infections presented the highest prevalence in both years: 32.38% and 34.74%, respectively. Compared to the first year (n = 1,803) significantly more cases (p = 0.001) were treated with this diagnosis in the second year (n = 2,506). Periodontal infections were significantly more frequent (p <0.001) in the second year compared to the first - 951 cases (13.18%) vs. 681 (12.23%) cases. Conclusions: The main reasons of emergency dental treatments were dental and periodontal infections. The results suggest that dental care is unaffordable to socially disadvantaged persons, and this fosters radical treatment of pain in this free of charge 24 h dental emergency office.
Introduction. The unsatisfactory results of the survival in patients with acute lymphoblastic leukemia (ALL) until 2000 in our center have led us to improve the approach of diagnosis and therapy. Since 2003 in all patients the following have been performed: flow cytometry, conventional genetic diagnosis, FISH (fluorescent in situ hybridization), and molecular biology. Objectives. Our aims were to identify solutions to increase patients’ survival. Patients and method. It is a single-center, retrospective study of 136 patients with ALL treated at 3rd Pediatric Clinic of Timisoara, over a period of 10 years (2003-2012), where survival was assessed. Results. Morphologically, 86% of the patients were L1 type, 13% L2 type and 1% L3 type. Flow citometry revealed that 68% were ALL with B precursors, and 19% with T immunophenotype. Acute leukemia with mixed phenotype (biphenotypic) was identified in 2.3% of patients and 10.7% of the forms were acute leukemia with myeloid markers. In 27.7% of patients, mutations were detected by the RT-PCR method, the most commonly identified was TEL-AML1 (ETV6- RUNX1) accounting for 12.7% of the cases. Relapse-free survival at 5 years for the entire group was 59%, and for the group treated between 2008 and 2012 it was 72%. Conclusion. Our analysis confirms the decisive value of laboratory investigations for the prognosis and improvement of supportive therapy.