由“ambulance”所联想到的

在美国几乎所有的人都有“family doctor／家庭(特约)医生”，人们通常是按“family doctor”的医嘱就医．或到药店买所需药品。然而，当人们在旅行或外出时，突然出现高烧、呼吸困难或因某种事故负伤了，已不可能同“family doctor”联系，这时应马上向旅馆工作人员或行人请求帮助呼叫“ambulance”：

Air temperature was associated with ambulance transports in Osaka area, Japan

We investigated the link between ambulance transports and meteorological parameters of summer by using daily data in Osaka area, Japan. Daily observations for ambulance transports (from July 1 to September 30, 2009) were obtained from Fire Department Service in Osaka. Data of meteorological parameters in Osaka area, Japan (from July 1 to September 30, 2009) were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports was analyzed. A total of 49,526 ambulance transports were observed from July 1 to September 30, 2009 in Osaka, Japan. Ambulance transports were significantly correlated with mean air temperature (r = 0.298), the highest air temperature (r = 0.347), the lowest air temperature (r = 0.209) and daylight hours (r = 0.301). The higher air temperature was associated with higher ambulance transports of summer in Osaka area, Japan.

The relation between ambulance transports due to heat stroke and air temperature using daily data in Okayama prefecture, Japan

The aim of this study was to investigate the link between ambulance transports due to heat stroke and air temperature by using daily data of ambulance transports in Okayama prefecture, Japan. Daily observations for ambulance transports due to heat stroke from July to September in 2010 in Okayama prefecture, Japan were obtained from Fire and Disaster Management Agency in Japan. Data of meteorological parameters in Okayama prefecture, Japan were also obtained from Japan Meteorological Agency. Effect of meteorological parameters on ambulance transports due to heat stroke was analyzed. A total of 1133 ambulance transports due to heat stroke were observed in from July to September of 2010 in Okayama prefecture, Japan. Ambulance transports due to heat stroke was significantly correlated with air temperature. In addition, number of subjects with ambulance transports due to heat stroke over 34°C in the highest air temperature was 21.2 ± 9.8 per day. Higher air temperature was closely associated with higher ambulance transports due to heat stroke by using daily data in Okayama, prefecture, Japan.

A GIS-Based Decision Support System for Reducing Air Ambulance Response Times: A Case Study on Public Schools in Jeddah City

In injuries reducing ambulance response time (time from injury to hospital arrival) is an important factor for saving people’s lives. Helicopter emergency medical services can reduce out-of-hospital transport times because of their high speed and their ability to travel in straight paths?unlike ground ambulance which are restricted to road network paths, as well as the ability toaccess rural or remote area injuries that are difficult to reach by ground ambulance. GIS technology aids air ambulance movement planning to reduce out-of-hospital response time based on mathematical and geographic models to support decision making which is necessary from out-of-hospital care providers. The goal of this study is to use GIS to develop an efficient DSS to outline where air ambulance can reduce response times, by using spatial analysis tools to create Euclidean distance and direction zones around receiving hospitals. The study concludes that GIS technology can be used to develop an efficient DSS to outline where air ambulance can reduce response times, by creating surfaces of Euclidean allocation, direction, and distance that can be used to improve initial response times for the civil defense air rescue and air ambulance services.

The higher air temperature was closely associated with higher ambulance transports due to heat stroke in elderly Japanese

To investigate the link between higher air temperature and ambulance transports due to heat stroke, especially in elderly subjects, using daily data in Sai-tama prefecture in August, 2010, Japan. We obtained daily data of air temperature in Saitama prefecture in August, 2010, Japan from Japan Meteorological Agency. Number of ambulance transports due to heat stroke was also used by Saitama prefecture official website. The effect of high air temperature on am-bulance transports due to heat stroke was evaluated. A total of 1688 ambulance transports due to heat stroke was observed in Saitama prefecture in August, 2010, Japan. Seven hundred and twenty one subjects (42.7%) were over the age of 65. Mean air temperature, the highest air temperature and day light hours were significantly associated with ambulance transports due to heat stroke in total subjects (mean air temperature: r = 0.749, p < 0.0001) and the over the age of 7. In addition, by separate analysis as classified by age groups, the correlation coefficient between ambulance transports due to heat stroke and mean air temperature was the highest in subjects with over 65. However, the lowest air temperature was not cor-related with ambulance transports due to heat stroke. Higher air temperature was closely associated with higher ambulance transports due to heat stroke using daily data in Saitama prefecture in August, 2010, Ja-pan, especially in elderly subjects.

Negative-pressure pneumatic separator:a new solution for hard-coal beneficiation

Hard coal is an important source of energy worldwide.Owing to the imperfections of excavation technology,most run-of-mine coals must be processed before they can be utilised as fuel.In this study,tests on the dry separation process were performed with numerous different raw hard coal and coal waste material samples,using a newly designed and constructed negative-pressure pneumatic separator(NPPS).The experiments revealed the effects of the feed-material properties and material processing conditions.These experiments were preceded by additional tests for evaluating the influence of each device operating parameter on the process,to determine the optimal method of supplying the feed material.The calorific value of the processed materials was improved by 5%–40%,while a minimal output yield of products(60%–70%)was maintained.The trials indicated that in coal material processing,the developed NPPS can be used for not only raw coal enrichment but also coal recovery from materials stored at coal-waste dumps.The main advantages of the device are its mobility,low material processing cost,and lack of water consumption during operation.

Lower air temperature is associated with higher ambulance transports in Sakata area, Yamagata prefecture, Japan

To investigate the link between low air temperature and ambulance transports in Japan. Data on climate parameters i.e. air temperature, humidity and daylight hours in Sakata area, Yamagata prefecture, Japan, which is northern part (Tohoku) in Japan, was obtained from Japan Meteorological Agency. Monthly data on ambulance transports due to acute disease from 2005 to 2011 was also directly obtained from Sakata area official website, Japan. The relations between air temperature and ambulance transports were evaluated by ecological study. Ambulance transports per day were 10.1 ± 1.0 and mean air temperature was 13.0 ± 8.4 (°C). Ambulance transports per day were weakly and negatively correlated with mean air temperature, mean of the highest air temperature, mean of the lowest air temperature, the highest air temperature and daylight hours. It was also weakly and positively correlated with mean humidity. However, the relation between ambulance transports and mean air temperature was well estimated by quadratic curve (r = 0.633,

Perception of Effects of Shiftwork Questionnaire (PESQ) among Ambulance Service Staff in Saudi Arabia: An Exploratory Factor Analysis

Objective: Despite efforts in describing the impact of shiftwork on the performance of health care workers, the perception of ambulance service staff is largely unexplored. This study attempted to develop the Perception of Effects of Shiftwork Questionnaire (PESQ) using a factor analysis approach to determine the underlying dimensions. Methods: A 16-item Likert scale research instrument, designed to gather information about the perceived effects of shiftwork on the respondents’ health, social relationships, and career quality, was floated to 375 ambulance services personnel in Saudi Arabia during March and April 2021. Results: Based on factor analysis, the questionnaire has three dimensions with varying reliability, namely “perceived effects on social relationship” (α = 0.815), perceived effects on health (α = 0.787) and “perceived effects on career quality” (α = 0.602). Over-all, the research instrument had an acceptable internal consistency (α = 0.829). Conclusion: The three-dimension model was analyzed simultaneously using parallel analysis and confirms that the three-factor model is the most ideal for the research instrument. Further research, however, is recommended to improve the internal consistency of the items which measure the perceived effects on career quality.

Triage and Risk Concept: Application Proposal for Pre-Hospital Emergencies in a Psychiatric Ambulance in the City of Buenos Aires

The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.

Characteristics of non-conveyance ambulance runs: A retrospective study in the Netherlands

Dear editor,Emergency medical services(EMS)have developed from conveyance facilities into providers of advanced pre-hospital care.[1,2]Alongside this development there is a growing demand for EMS care,and the number of ambulance deployments is increasing.[3,4]Suggested reasons for this growing demand are changes in social support of people,accessibility of healthcare and social facilities,and the aging population.

Higher Temperatures Were Closely Associated with Higher Ambulance Transports in Takamatsu Area,Japan

The link between high temperatures and ambulance transports in Takamatsu area, Japan was investigated. Monthly observations for ambulance transports (2004-2008) were obtained from Fire Department Service in Takamatsu. Data of temperatures in Takamatsu area, Japan (2004-2008) were used by Japan Meteorological Agency. Effect of high temperatures on ambulance transports was analyzed. By using data from July to September, there were not clear differences of mean temperatures and ambulance transports among years. Ambulance transports were significantly correlated with parameters of temperatures. Correlation coefficient rate between ambulance transports and the mean temperature of maximum temperatures in a month was highest among parameters (r = 0.738, p = 0.0017). In addition, ambulance transports were also significantly correlated with the number of days over the level of 32?C in a month (r = 0.782, p = 0.0006). Higher temperatures were closely associated with higher ambulance transports in Takamatsu area, Japan.

Feasibility of using ultrasound in ambulances in Saudi Arabia

BACKGROUND In developed countries,the economic feasibility of using ultrasound in ambulances before arriving at the hospital has been achieved through comprehensive studies,and this of course does not apply to Arab countries,as there are no current studies to support this.Therefore,this study is a preliminary measure of the economic feasibility of using ultrasound in ambulances in Saudi Arabia.AIM To measure the demand for ultrasound equipment in ambulances in Saudi Arabia.METHODS A cross-sectional study of five different groups of participants including radiation technologists,emergency physicians,paramedics,Red Crescent managers and the public.Email and social media were used to deliver a questionnaire to these groups.The questionnaire included specific questions to measure the purpose of ultrasound use in each group of participants.RESULTS Each group had some knowledge on ultrasound and its benefits.More than 50%in each study group supported the availability of ultrasound in ambulances.Additionally,60%of emergency physicians reported that they had difficulties in venous access,checking the presence of internal bleeding,recognizing pregnancy in trauma cases,and inserting endotracheal tubes,and the majority of them confirmed the effective role of ultrasound in achieving such tasks.Almost all paramedics(93.33%),physicians(98.89%),and Saudi Red Crescent managers(96.3%)emphasized the importance of communication between ambulance staff and emergency departments.Moreover,most physicians(77.78%),and technologists(82.73%)supported the presence of paramedics in ambulances to operate ultrasound in order to improve patient outcomes.CONCLUSION Most of the study groups evaluated had knowledge on ultrasound and supported the presence of ultrasound devices in ambulances.

Do the Right Patients use the Ambulance Service in South-Eastern Finland?-A Prospective Descriptive Study of Ambulance Dispatching in Relation to the Ambulance Staff’s Assessment of Patients’Needs in a Subset in the South East of Finland

Background: Several Emergency Medical Systems use a criteria-based prioritization system for ambulance response. The emergency medical priority dispatching of ambulances was introduced in the 1980s. In a system of this kind, the operators at the medical emergency dispatch centers have to assess the patients’ symptoms and the need for ambulance response. The prioritization of the ambulance response is based on the seriousness of the patient’s symptoms, his/her current condition and, in the case of trauma, the trauma mechanism. The priority system is supposed to optimize the use of the ambulance service and to match and meet the patients’ needs with an adequate response from the ambulances. The aim of this study was to describe the dispatching and utilization of the ambulance service in a part of Finland. Results: There was a substantial divergence between the initial priority assigned and the patients’ medical status at the scene. The ambulance staff confirmed the need for ambulance transport for 65% of all the patients who were assigned an ambulance by the dispatch center. Conclusions: Using a criteria-based dispatch protocol, the dispatch operator works with a wider safety margin in the priority assessments for ambulance response than was actually confirmed by the ambulance personnel at the scene. In this sample, there may be some overuse of the ambulance service. According to the assessments made by the ambulance staff, 35% of the patients did not require ambulance transport. The emergency system has to accept and work with safety margins. At the same time, there must be a balance between a safety margin and a waste of limited resources.

The Application of Information Systems to Improve Ambulance Response Times in the UK

Emergency ambulance services in the UK are tasked with providing pre-hospital patient care and clinical services with a target response time between call connect to on-scene attendance.In 2017,NHS England introduced four new response time categories based on patient needs.The most challenging is to be on-scene for a life-threatening situation within seven minutes of the call being connected when such calls are random in terms of time and place throughout a large territory.Recent evidence indicates emergency ambulance services regularly fall short of achieving the target ambulance response times set by the National Health Service(NHS).To achieve these targets,they need to undertake transformational change and apply statistical,operations research and artificial intelligence techniques in the form of five separate modules covering demand forecasting,plus locate,allocate,dispatch,monitoring and re-deployment of resources.These modules should be linked in real-time employing a data warehouse to minimise computational data and generate accurate,meaningful and timely decisions ensuring patients receive an appropriate and timely response.A simulation covering a limited geographical area,time and operational data concluded that this form of integration of the five modules provides accurate and timely data upon which to make decisions that effectively improve ambulance response times.

全膝关节置换术后早期下床活动最佳证据总结

目的:系统检索并汇总全膝关节置换术后早期下床活动的最佳证据,为早期下床活动的临床实施提供理论指导。方法:根据“6S”金字塔模型由上至下系统检索各指南网站、中外文数据库及髋膝关节外科等专业协会网站中关于全膝关节置换术后早期下床活动的相关文章,由2名研究者独立进行质量评价并总结相关证据。结果:共纳入13篇文献,包括3篇指南、2篇系统评价、6篇专家共识和2篇随机对照试验(RCT),从健康教育、活动前评估和指导、实施下床活动、下床活动安全保障4个方面汇总26个证据条目。结论:本研究汇总了全膝关节置换术后早期下床活动的最佳证据,临床工作人员应将符合临床情景的最佳证据与病人偏好及相应医疗条件相结合,制定针对性干预策略,以改善病人预后。

Benefits of early ambulation within 24 h after total knee arthroplasty:a multicenter retrospective cohort study in China

Background:Postoperative care has been evolving since the concept of enhanced recovery after surgery(ERAS)was introduced in China.This study aimed to evaluate the effects of early ambulation within 24h after unilateral total knee arthroplasty(TKA)on postoperative rehabilitation and costs in a Chinese population.Methods:This cohort study of patients with knee osteoarthritis who had undergone TKA at 24 large teaching hospitals between January 2014 and November 2016 involved 2687 patients who began ambulating within 24h(Group A)and 3761 patients who began ambulating later than 24h(Group B).The outcome measurements,such as length of stay(LOS),total hospitalization costs,dynamic pain level,knee flexion range of motion(ROM),results of the 12-Item Short Form Survey(SF-12),incidence of thromboembolic events and other complications,were recorded and compared.Results:The early ambulation group(Group A)had a shorter LOS and lower hospitalization costs and pain levels than the late ambulation group(Group B).There was a favorable effect in enhancing ROM for patients in Group A compared with patients in Group B.In Group A,patients had significantly higher postoperative SF-12 scores than those in Group B.The incidence of deep venous thrombosis(DVT)and pulmonary infection was significantly lower in Group A than in Group B.The incidence of pulmonary embolism(PE)and other complications did not differ between the two groups.Conclusions:Early ambulation within 24h after TKA was associated with reduced LOS,improved knee function,lower hospitalization costs and lower incidence of DVT and pulmonary infection in the Chinese population.

Effect of Intermittent Pneumatic Compression on Functional Level and Quality of Life in Community-Dwelling Older Adults with Limited Ambulation Due to Leg Pain: A Randomized Controlled Trial

Background and Purpose: Walking difficulties are defined as any reduction in speed, balance, or change of gait, causing limited ambulation. These difficulties are a common problem in older adults and may greatly affect their quality of life (QOL) and restrict their personal independence and participation. This study aimed to determine the effect of intermittent pneumatic compression (IPC) on lower leg pain, walking capacity, functional mobility, ankle range of motion (AROM), and QOL of community-dwelling older people with walking difficulties. Methods: In this randomized controlled trial, 34 eligible participants with self-reported lower limb pain and limited ambulation were randomized either to the intermittent pneumatic compression intervention group (IPCIG) or static compression control group (SCCG). The IPCIG and SCCG were trained to receive IPC and SC respectively for both lower legs and instructed to continue the application independently at home for 15 minutes per session, 2 sessions a day, 7 days per week for 4 weeks independently at the home. Outcome measures of lower leg pain, AROM, walking capacity, and functional mobility were assessed at baseline and at the first, second, third, and fourth weeks after randomization. Quality of life was assessed at baseline and immediately after the intervention. Results and Discussion: IPCIG showed a more significant improvement compared to the SCCG at the post-interventional stage for QOL and all the subscales. The findings show that “80% improved QOL” is 53% higher with the application of IPC than with SC for 4 weeks. The IPCIG showed a more significant improvement in the 6-minute walk test (6 MWT) at the third and fourth weeks compared to the SCCG. A pairwise comparison of mean values of 6 MWT over 4 weeks within the IPCIG showed a significant difference between all the weeks. Pairwise comparisons between groups at each time point showed that the IPCIG showed a more significant improvement in the timed up and go (TUG) test at the third and fourth weeks compared to the SCCG. Pairwise comparison of mean values of TUG test within the IPCIG showed a significant difference over 4 weeks, except between the second and third weeks, fourth week, and third and fourth weeks. The IPCIG showed a more significant improvement in lower leg pain between all weeks except the first week compared to the SCCG. Pairwise comparison of mean values of lower leg pain over 4 weeks within the IPCIG showed a significant difference among all weekly outcomes except between 1 and 2 weeks. The IPCIG showed a more significant improvement in left and right ankle dorsiflexion ROM at the third and fourth weeks compared to the SCCG. Conclusions: The IPC was effective in reducing lower leg pain and increasing the AROM and improving the walking capacity, functional mobility level, and QOL of community-dwelling older people with walking disabilities. Walking disability in old age is a common condition requiring physical therapy. Intermittent pneumatic compression can be used as a physical therapy modality for this patient group.

Effect of pelvic fixation on ambulation in children with neuromuscular scoliosis

BACKGROUND The effect of posterior spinal fusion(PSF)incorporating the pelvis on an ambulatory patient’s ability to mobilize after the fusion is not well understood.AIM To see whether a posterior spinal fusion with pelvic fixation using iliac or sacral alar iliac screws in ambulatory neuromuscular scoliosis(NMS)patients influences postoperative ambulatory ability.METHODS A retrospective review of all patients with NMS that underwent PSF with fixation incorporating the pelvis between January 1,2012 and February 29,2019.A total of 118 patients were eligible,including 11 ambulatory patients.The primary outcome was the maintenance of ambulatory status postoperatively.Secondary outcomes included postoperative curve magnitude,pelvic obliquity,and complications,comprising infections,instrumentation failure,and any unplanned returns to the operative room.RESULTS The ambulatory function was maintained in all 11 ambulatory NMS patients.One patient had an improvement in functional status with equipment-free ambulation postoperatively.An average postoperative follow-up was 19 mo.The overall complication rate was 19.4%(n=23)with no significant differences between the groups in infection(P=0.365),hardware failure(P=0.505),and reoperation rate(P=1.0).Ambulatory status did not affect complication rate(P=0.967).CONCLUSION Spinal fusion to the pelvis in ambulatory patients with NMS provides effective deformity correction without the reduction in ambulatory capabilities.

加速康复八段锦对老年胃癌病人术后早期下床活动的影响

目的探讨加速康复八段锦对改善老年胃癌病人术后早期下床活动的效果。方法纳入2020年3月至2022年6月江苏省中医院普外科收治的61例胃癌病人为研究对象,所有病人均择期行腹腔镜胃癌根治手术。根据入院顺序将研究对象分为对照组(30例)和研究组(31例),对照组围手术期给予常规加速康复外科措施,研究组在此基础上接受加速康复八段锦运动方案。对比2组术后首次下床活动时间、肛门排气排便时间、经口进食时间、住院时间、术后并发症及不良事件发生情况。结果2组间年龄及性别比较,差异没有无统计学意义(P>0.05);研究组术后首次下床活动时间短于对照组(P<0.05),术后24、48、72 h下床落实率高于对照组(P<0.05)。2组间术后并发症及活动相关不良事件发生率比较,差异没有统计学意义(P>0.05)。结论胃癌术后加速康复八段锦能促进老年胃癌病人早期下床活动,促进术后胃肠功能恢复,且安全、可行。

青少年特发性脊柱侧凸患者术后早期离床活动的研究进展

青少年特发性脊柱侧凸行后路矫形融合术患者术后早期离床活动可促进呼吸、胃肠、肌肉骨骼等多系统功能恢复,有利于预防肺部感染、压力性损伤和下肢深静脉血栓形成。文章综述了青少年特发性脊柱侧凸患者术后早期离床活动的时机、内容、效果、影响因素、存在问题等研究进展,旨在为临床医护人员安全有效地指导青少年特发性脊柱侧凸患者术后早期离床活动及相关研究提供参考。