10 research outputs found
Accuracy of early shock recognition by paramedics: a multicenter prospective observational study in Japan
Get PDFObjective: Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.
Materials and Methods: This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.
Results: The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11–0.51). Patients without systolic hypotension were more frequently missed during diagnosis.
Conclusions: Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics
Intentional transit practice through a nearby hospital for remote area emergencies provides earlier primary care than helicopter emergency medical services alone in rural emergencies: a single-center, observational study
Get PDFObjective: Providing emergency care to serious patients in rural areas remains challenging. Intentional transit practice involves transporting a serious patient to a nearby hospital while requesting the Helicopter Emergency Medical Services (HEMS). This study aims to evaluate its effectiveness on earlier primary medical interventions and the decision of the destination hospital.
Patient and Methods: We conducted a single-center, retrospective observational study at a HEMS base hospital in a rural area of Japan. The study participants included patients who underwent the intentional transit practice between April 2012 and March 2019. We compared actual times to estimated times for each case treated with the HEMS alone (HEMS-alone model). Outcomes were the time from ambulance call to reaching the physician (physician reaching time), arrival at the final destination facility (destination hospital arrival time), and helicopter waiting time at the landing zone (helicopter waiting time). Subgroup analyses by region and an analysis of the relationship between diagnostic tests performed at the transit hospital and the type of destination facility were performed.
Results: Eighty-seven patients were eligible for analysis. Compared to the HEMS-alone model, the intentional transit practice reduced the physician reaching time (median [interquartile] min) (26 [21–32] vs. 37 [29–47], P<0.0001) while increasing the destination hospital arrival time and the helicopter waiting time (71 [58–93] vs. 65 [59–80], P=0.03; 24 [18–34] vs. 19 [18–21], P<0.0001; respectively). Subgroup analysis showed a consistent result for physician reaching time but heterogeneity in the other time courses by region. Diagnostic tests were related to transportation to facilities other than the HEMS base hospital.
Conclusion: The intentional transit practice is beneficial for providing primary care earlier than the HEMS alone and for transport to more specific facilities. However, it delays arrival at the destination facility and increases helicopter waiting time
Cylinder to Cylinder Deviations in Combustion and Emission at Idling in DI Diesel Engines with Pilot Injection
Get PDFPilot injection in DI Diesel Engines is a very effective method reducing nitrogen oxides and noise. However the injection behavior of small quantities of pilot fuel is unstable，and the cylinder-to-cylinder deviations in injection mass and spray development occur in multi-cylinder direct injection diesel engines. This study investigates the correlation between cylinder-to-cylinder deviations in spray development and combustion and emissions when the pilot injection was applied at idling. It was found that the cylinder-to-cylinder deviations in spray behavior are not the sole reason for the deviations in combustion and emission, but that peculiar conditions to a cylinder such as air movement and in-cylinder carbon deposits also play a role. In this study the HC components in the exhaust gas with and without pilot injection was investigated, and it is shown that deviations in combustion with pilot injection result in deviations in low carbon component emissions and in the rate of pressure rise which is responsible for exhaust odor and engine noise.application/pdfjournal articl
Perpendicular Magnetic Anisotropy in Amorphous Rare Earth-Transition Metal Films
No full textapplication/pdfExperimental studies on the perpendicular magnetic anisotropy in amorphous TbCo prepared by rf sputtering have been carried out and the results obtained have been compared with those in other amorphous rare earth-transition metal films. it has been found that the perpendicular anisotropy of TbCo films greatly depends on a negative bias voltage applied to the substrate during sputtering. Because of their large magnetostriction, the anisotropy results from the planar stress due to the substrate constraint occupies considerably part in the whole perpendicular anisotropy in TbCo films. Annealing for one hour at 300℃ destroys the perpendicular anisotropy almost completely. Magnetostriction plays an important role in the magnetization process in amorphous films without crystalline anisotropy. However, few studies have been done on magnetostriction in amorphous films. Therefore, a cantilever capacitance apparatus has been set up for measuring the magnetostriction constant. It has been found that using a standard Fe0.4Ni0.60 film for calibration, this apparatus is accurate enough and very useful.departmental bulletin pape
Accuracy of early shock recognition by paramedics: a multicenter prospective observational study in Japan
Get PDFObjective: Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.
Materials and Methods: This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.
Results: The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11–0.51). Patients without systolic hypotension were more frequently missed during diagnosis.
Conclusions: Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.Citation:
Tanohata R, Saito K, Nagano T, Ochiai H. Accuracy of early shock recognition by paramedics: a multicenter prospective observational study in Japan. J Rural Med. 2025 Apr;20(2):125-131. doi: 10.2185/jrm.2024-053. Epub 2025 Apr 1
