198 research outputs found
Myocardial Ischaemia National Audit Project - How the NHS cares for patients with heart attacks. Annual Public Report April 2014-March 2015
Get PDFThis report looks at heart attack treatment in England, Wales and Northern Ireland. It looks at the whole process from the call to the emergency services, to the prescription of preventive medications on discharge from hospital. It is based on data submitted by hospitals and emergency services, and is intended to cover every heart attack that is diagnosed.The report is prepared on behalf of the National Institute for Cardiovascular Outcomes Research (NICOR) - hosted at University College, London - for the Health Quality Improvement Partnership (HQIP
Prevalence of Cardiovascular Disease in Patients With Potentially Curable Malignancies A National Registry Dataset Analysis
Get PDFBackground: Although a common challenge for patients and clinicians, there is little population-level evidence on the prevalence of cardiovascular disease (CVD) in individuals diagnosed with potentially curable cancer. Objectives: We investigated CVD rates in patients with common potentially curable malignancies and evaluated the associations between patient and disease characteristics and CVD prevalence. Methods: The study included cancer registry patients diagnosed in England with stage I to III breast cancer, stage I to III colon or rectal cancer, stage I to III prostate cancer, stage I to IIIA non-small-cell lung cancer, stage I to IV diffuse large B-cell lymphoma, and stage I to IV Hodgkin lymphoma from 2013 to 2018. Linked hospital records and national CVD databases were used to identify CVD. The rates of CVD were investigated according to tumor type, and associations between patient and disease characteristics and CVD prevalence were determined. Results: Among the 634,240 patients included, 102,834 (16.2%) had prior CVD. Men, older patients, and those living in deprived areas had higher CVD rates. Prevalence was highest for non-small-cell lung cancer (36.1%) and lowest for breast cancer (7.7%). After adjustment for age, sex, the income domain of the Index of Multiple Deprivation, and Charlson comorbidity index, CVD remained higher in other tumor types compared to breast cancer patients. Conclusions: There is a significant overlap between cancer and CVD burden. It is essential to consider CVD when evaluating national and international treatment patterns and cancer outcomes
Long-case Observation in Undergraduate Medical Education. A case study
Get PDFClerking patients is a fundamental clinical skill acquired by medical students. Through this dialogue with patients clinicians understand both the pathophysiology of symptoms and the person experiencing them. While students receive instruction on individual components of clerking in clinical skills laboratories, it is rare for students to be observed clerking a patient, in a clinical setting, from beginning to end. Within Swansea University’s Graduate-Entry Medicine Programme, students participate in Long-Case Observations – a senior clinical teacher witnesses an entire interaction between student and patient, gives immediate feedback, and later written feedback. The student reflects on their performance by listing learning points.Using Case Study Research to explore the educational value of long-case observation, I performed semi-structured interviews with three second-year medical students. Transcripts were analysed using a hybrid approach of inductive and deductive coding and theme development. Other data were examined for supporting and contradictory evidence.The students found long-case observation educationally worthwhile. They used the experience to gauge their progress on the course; to prepare for professional practice; to form educational relationships with clinical teachers; and to spend time interacting (and considering future interactions) with patients. Its inclusion in the curriculum served to counter the influence of exam-driven learning, to emphasise the importance of student-patient and doctor-patient interactions and to demonstrate that clinical teachers valued undergraduate education and cared for the students.Long-case observation could be used to endorse a humane approach to patients, and reverse some of the erosive qualities of the hidden curriculum
Cardiopulmonary resuscitation
Get PDFA review article updating previous such articles, including information regarding management of cardiorespiratory arrest. The article also included self-assessment questions.The Resuscitation Council (UK) has published quality standards for practice and training, based on its 2015 guidelines. These guidelines align with similar international initiatives, taking account of new evidence from clinical trials of cardiac arrest management. In an effort to improve long-term survival after cardiac arrest in the community, national strategies confirm the importance of the ‘chain of survival’ concept that summarizes important components of successful resuscitation. They also promote the establishment of out-of-hospital cardiac arrest centres – hospitals that can provide optimal post-resuscitation interventions to patients showing a return of spontaneous circulation
Master of Science
Get PDFthesisGeologists have been concerned for many years with the significance of the zone of uplift, intrusion, and mineralization which extends westward from the Uinta Arch through the Park City, Alta, and Big Cottonwood stocks to the Bing ham stock, and thence via a sharp turn to the south into the Tintic and West Tintic districts. It Is the Intent of the present investigation to contribute to the knowledge of the West Tintic portion of this mineralized belt. This study is one of several being undertaken in the Sheeprock Mountains and adjoining areas under the direction of Dr. H. C Williams. Very little previous detailed geologic work has been done in this area, and this study constitutes the first detailed mapping program. Interpretations of geologic history are offered, but may be subject to modification as more data accumulates from the studies being conducted in adjoining areas
The UK vs Sweden : Is the NHS really so bad?
Get PDFSheng-Chia Chung and colleagues report in The Lancet (23 January 2014) an international comparison of cardiovascular patient mortality between the UK and Sweden. They suggest that “more than 10000 deaths at 30 days would have been prevented or delayed had UK patients experienced the care of their Swedish counterparts.” Further, they estimate that 1741 deaths would have been prevented in the UK had the Swedish pattern of primary percutaneous coronary intervention (PCI) and beta-blocker use been replicated in the NHS from 2004 to 2010. However, their study does not provide convincing evidence that faster uptake of primary PCI or beta-blockers on discharge would have had an effect on cardiovascular patient mortality in the UK
The effects of intravenous insulin infusions on early mortality for patients with acute coronary syndromes who present with hyperglycaemia: A matched propensity analysis using data from the MINAP database 2008–2012
Get PDFBACKGROUND:
In acute coronary syndrome, the use of intravenous insulin infusions (IVII) to control hyperglycaemia is based on limited evidence of survival benefit.
AIMS:
To compare 7 day survival for patients receiving IVII compared with those receiving routine care to control admission hyperglycaemia (>=11 mmol/l) in acute coronary syndrome.
METHODS AND RESULTS:
We used matched propensity analysis to examine observational data from the MINAP database between 2008 and 2012. We matched 5974 pairs of patients. We separately examined outcomes for ST elevation (STEMI) and non ST segment elevation (NSTEMI) infarctions, and those without known diabetes and those with type 2 diabetes. Survival benefit from the use of IVII was seen only in patients with STEMI not known to have diabetes at admission (adjusted hazard ratio (HR) 0.77 (95% confidence interval (CI) 0.64-0.92), p=0.005). Those with STEMI and existing type 2 diabetes who received IVII showed similar outcomes to routine care (HR 0.99 (95% CI 0.80-1.23), p=0.931). In patients with NSTEMI IVII was associated with significantly worse adjusted 7 day survival outcome than routine care, regardless of diabetes status; for those without known diabetes, HR 1.50 (95% CI 1.04-2.16), p=0.029, and for those with type 2 diabetes, HR 1.35 (95% CI 1.08-1.70), p=0.010.
CONCLUSION:
As used in current clinical practice to treat hyperglycaemia in acute coronary syndromes, IVII appears to be of benefit only for patients with STEMI who are not known to have diabetes. IVII is associated with adverse early outcomes in patients with NSTEMI
System energy optimisation strategies for metros with regeneration
Get PDFEnergy and environmental sustainability in transportation are becoming ever more important. In Europe, the transportation sector is responsible for about 30% of the final end use of energy. Electrified railway systems play an important role in contributing to the reduction of energy usage and CO2 emissions compared with other transport modes. For metro-transit systems with frequently motoring and braking trains, the effective use of regenerated braking energy is a significant way to reduce the net energy consumption. Although eco-driving strategies have been studied for some time, a comprehensive understanding of how regeneration affects the overall system energy consumption has not been developed. This paper proposes a multi-train traction power network modelling method to determine the system energy flow of the railway system with regenerating braking trains. The initial results show that minimising traction energy use is not the same as minimising the system energy usage in a metro system. An integrated optimisation method is proposed to solve the system energy-saving problem, which takes train movement and electrical power flow into consideration. The results of a study of the Beijing Yizhuang metro line indicate that optimised operation could reduce the energy consumption at the substations by nearly 38.6% compared to that used with the existing ATO operation
An integrated metro operation optimization to minimize energy consumption
Get PDFEnergy efficient techniques are receiving increasing attention because of rising energy prices and environmental concerns. Railways, along with other transport modes, are facing increasing pressure to provide more intelligent and efficient power management strategies. This paper presents an integrated optimization method for metro operation to minimize whole day substation energy consumption by calculating the most appropriate train trajectory (driving speed profile) and timetable configuration. A train trajectory optimization algorithm and timetable optimization algorithm are developed specifically for the study. The train operation performance is affected by a number of different systems that are closely interlinked. Therefore, an integrated optimization process is introduced to obtain the optimal results accurately and efficiently. The results show that, by using the optimal train trajectory and timetable, the substation energy consumption and load can be significantly reduced, thereby improving the system performance and stability. This also has the effect of reducing substation investment costs for new metros
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