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A new training course for triage. The experience of Triage Education Group in Pinerolo  [cached]
M. Civita,E. Mana,C. Sfasciamuro,C. Odetto
Emergency Care Journal , 2012, DOI: 10.4081/ecj.2012.2.23
Abstract: The article shows the results of the triage training course for healthcare assistants of the Emergency-Reception Department held in the education centre of Pinerolo, Italy. The course lasted three days (24 h in total), thus compling the Piedmont Regional Regulation DPR 43-15182 of 23/03/2005. Nineteen editions of the course had been held from December 2006 to December 2010. The present study reports the results of a satisfaction questionnaire about the ECM system (the one pertaining 2006-2007 years was different from the following years’ ones) and the data of a specific questionnaire given to participants in order to evaluate the actual effect of the methodology proposed.
Nurse's role in evaluating early treatment of acute pain during triage in ER
Patrizia Palermo,Anna Fagiani,Giorgio Bottino,Linda Crocco
Emergency Care Journal , 2007, DOI: 10.4081/ecj.2007.1.37
Abstract: The purpose of this study is to define the nurse's role in the evaluation and early treatment of acute pain during triage. The assumption is that the treatment of acute pain in A&E by the triage nurse, in certain well selected cases, improves the level of care provided. The study's subject population is represented by all the users accessing A&E between 13th June 2005 and 13th July 2005, and presenting acute pain. The isolated sample is represented by users whose pain can be attributed to the following clinical conditions: musculoskeletal pain, contusions and sprains, fractures, headaches, earache, toothache and renal or biliary colic. The investigation was performed with the use of a grid by the triage nurse and the VAS (Visual Analogue Scale) to measure the intensity of the pain, whereas a dedicated protocol was followed for drug administration. In the period considered, the overall number of users (population) reporting to A& E was 2443. Of these 439 users (sample) (19%) complained of acute pain attributable to the above clinical conditions. The role of the triage nurse in pain management is undoubtedly important in the phase of evaluation using dedicated scales. The nurse's role in drug administration remains to be defined, given that this research demonstrated how even in the presence of medium-high or high VAS levels, the acceptance of pharmacological treatment at triage is somewhat limited. This aspect will provide an interesting basis for future research aimed at understanding to what extent cultural or individual elements are responsible for this attitude.
Can a strong magnetic background modify the nature of the chiral transition in QCD?
Fraga, Eduardo S.;Mizher, Ana Júlia
High Energy Physics - Phenomenology , 2008, DOI: 10.1016/j.nuclphysa.2009.01.026
Abstract: The presence of a strong magnetic background can modify the nature and the dynamics of the chiral phase transition at finite temperature: for high enough magnetic fields, comparable to the ones expected to be created in noncentral high-energy heavy ion collisions at RHIC and the LHC, the original crossover is turned into a first-order transition. We illustrate this effect within the linear sigma model with quarks to one loop in the ${\rm MS}$ scheme for $N_{f}=2$.
ER triage in patients showing acute hypersensitivity reactions: one year's experience
Fernando Porro,Carlo Bergonti,Silvia Serafini,Gianluca Ghilardi
Emergency Care Journal , 2006, DOI: 10.4081/ecj.2006.3.28
Abstract: Acute hypersensitivity reactions include different clinical entities, the most threatening of which is anaphylaxis. In the Emergency Department, triage evaluation and decisions can be a determinant of successful treatment. We retrospectively studied 1009 patients who underwent triage in our ED because of acute hypersensitivity over a one year time period. Our aim was to correlate triage priority codes with the clinical manifestations registered at the medical examination, time spent in ED before and after the examination, and admission to hospital or discharge. Emergency codes (red or yellow code) were attributed to 10% of our cases, non-emergency codes (green o white) to 90%. Code grading was changed in 9 patients while awaiting medical evaluation. Severity of symptoms was underestimated in one case, and overestimated in 23. Hospital admission rate was greater among patients with more critical codes. No patient died. In conclusion evaluation, direct observation and re-evaluation are needed for the safe treatment of patients with hypersensitivity reactions in ED, even when initial clinical conditions appear stable.
Can vitamin A modify the activity of docetaxel in MCF-7 breast cancer cells?  [cached]
Ewa Czeczuga-Semeniuk,Dorota Lemancewicz,Slawomir Wolczyński
Folia Histochemica et Cytobiologica , 2008, DOI: 10.2478/4480
Abstract: Docetaxel is one of the most effective chemotherapeutic agents in the treatment of breast cancer. On the other hand, the vitamin A family compounds play the essential roles in many biological processes in mammary gland. The aim of our study was to investigate the effect of all-trans retinol, carotenoids (beta-carotene, lycopene) and retinoids (9-cis, 13-cis and all-trans retinoic acid) on the activity of docetaxel and to compare these effects with the estradiol and tamoxifen actions on human ER(+) MCF-7 breast cancer cell line. The evaluation was based on [3H] thymidine incorporation and the proliferative activity of PCNA and Ki 67 positive cells. In our study, the incorporation of [3H] thymidine into cancer cells was inhibited to 50% by 0.2, 0.5 and 1 microM of docetaxel in the 24-hour culture and addition of estradiol (0.001 microM) didn't influence the results. However, addition of tamoxifen caused a statistically significant decrease of the percentage of the proliferating cells in the culture medium with 0.2 and 0.5 microM of docetaxel (38.99 +/- 2.84%, p<0.01 and 40.67 +/- 5.62%, p<0.01) in comparison to the docetaxel only group. The above-mentioned observations were also confirmed with the use of the immunohistochemical investigations. Among the examined vitamin A family compounds, the simultaneous application of beta-carotene (0.1 microM) and docetaxel (0.2 microM) resulted in a statistically significant reduction in the percentage of proliferating cells (40.25 +/- 14.62%, p<0.01). Lycopene (0.1 microM), which stimulates the growth of breast cancer cells in a 24-hour culture, had an inhibitory effect (42.97 +/- 9.58%, p<0.01) when combined with docetaxel (0.2 microM). Although, beta-carotene and lycopene belong to the different chemical groups, they surprisingly had a similar inhibitory influence on both growth and proliferation of MCF-7 breast cancer cells when combined with docetaxel. The application of docetaxel either with beta-carotene or lycopene had comparable inhibitory effect on breast cells growth and proliferation as tamoxifen. Therefore, it may suggest a possible important role of these carotenoids in the breast cancer therapy in women especially when docetaxel is applied.
Can vitamin A modify the activity of docetaxel in MCF-7 breast cancer cells?  [cached]
Ewa Czeczuga-Semeniuk,Dorota Lemancewicz,Slawomir Wolczyński
Folia Histochemica et Cytobiologica , 2008, DOI: 10.5603/4480
Abstract: Docetaxel is one of the most effective chemotherapeutic agents in the treatment of breast cancer. On the other hand, the vitamin A family compounds play the essential roles in many biological processes in mammary gland. The aim of our study was to investigate the effect of all-trans retinol, carotenoids (beta-carotene, lycopene) and retinoids (9-cis, 13-cis and all-trans retinoic acid) on the activity of docetaxel and to compare these effects with the estradiol and tamoxifen actions on human ER(+) MCF-7 breast cancer cell line. The evaluation was based on [3H] thymidine incorporation and the proliferative activity of PCNA and Ki 67 positive cells. In our study, the incorporation of [3H] thymidine into cancer cells was inhibited to 50% by 0.2, 0.5 and 1 microM of docetaxel in the 24-hour culture and addition of estradiol (0.001 microM) didn't influence the results. However, addition of tamoxifen caused a statistically significant decrease of the percentage of the proliferating cells in the culture medium with 0.2 and 0.5 microM of docetaxel (38.99 +/- 2.84%, p<0.01 and 40.67 +/- 5.62%, p<0.01) in comparison to the docetaxel only group. The above-mentioned observations were also confirmed with the use of the immunohistochemical investigations. Among the examined vitamin A family compounds, the simultaneous application of beta-carotene (0.1 microM) and docetaxel (0.2 microM) resulted in a statistically significant reduction in the percentage of proliferating cells (40.25 +/- 14.62%, p<0.01). Lycopene (0.1 microM), which stimulates the growth of breast cancer cells in a 24-hour culture, had an inhibitory effect (42.97 +/- 9.58%, p<0.01) when combined with docetaxel (0.2 microM). Although, beta-carotene and lycopene belong to the different chemical groups, they surprisingly had a similar inhibitory influence on both growth and proliferation of MCF-7 breast cancer cells when combined with docetaxel. The application of docetaxel either with beta-carotene or lycopene had comparable inhibitory effect on breast cells growth and proliferation as tamoxifen. Therefore, it may suggest a possible important role of these carotenoids in the breast cancer therapy in women especially when docetaxel is applied.
Adiponectin Can Affect ER Signaling in Obese Breast Cancer Patients  [PDF]
Rana Jahanban Esfahlan, Nosratollah Zarghami, Samira Valiyari, Hamed Farshbaf Kamel, Maryam Daneshvar, Ali Jahanban Esfahlan, Majid Mobasseri, Kazem Nejati-Koshki
Journal of Cancer Therapy (JCT) , 2012, DOI: 10.4236/jct.2012.31015
Abstract: Background: While the various antitumororal activities of adiponectin as an adipocyte-derived hormone well studied, it is speculated that there is a crosstalk between adiponectin and esterogen receptor (ER) signaling. To test this hypothesis we evaluate the possible correlation between serum level of adiponectin with two estrogen receptors (ERα and ERβ) gene expression in breast cancer patients. Methods: In this case-control study, 70 women with breast cancer participated with different grades of obesity (36 none obese, BMI < 25 kg/m2 and 34 obese, BMI ≥ 25 kg/m2).The mean age of Participants was 44.53 yr ± 1.79 yr (21 yr - 70 yr) .Serum level of adiponectin determined by ELISA. Following quantitative expression of estrogen receptors mRNA in tumor tissues was evaluated by Real-time PCR. Results: We find a significant reverse correlation between serum level of Adiponectin and ERα mRNA (r = –0.229, n = 64, p = 0.035) but no correlation was between adiponectin and ERβ in samples (p = 0.228). The lower adiponectin multiplied the odds of having higher ERα mRNA level by a factor of OR = 4.33, 1.28 - 14.6, 95% confidence interval (CI) as compared with those that displayed a moderate or higher serum level of adiponectin (>7.02 ng/ml). The same odds for next estrogen receptor, ERβ, was not greater than unity (OR = 0.31, 0.06 - 1.56, 95% CI). Conclusion: According to the obtained results, it is speculated that as adiponectin can affect ERs gene expression, so affecting the steroid receptor signaling can be proposed as a new underling mechanism of action for this adipokine in breast cancer pathogenesis especially in obese ones.
Emergency department triage: an ethical analysis
Ramesh P Aacharya, Chris Gastmans, Yvonne Denier
BMC Emergency Medicine , 2011, DOI: 10.1186/1471-227x-11-16
Abstract: In emergency department triage, medical care might lead to adverse consequences like delay in providing care, compromise in privacy and confidentiality, poor physician-patient communication, failing to provide the necessary care altogether, or even having to decide whose life to save when not everyone can be saved. These consequences challenge the ethical quality of emergency care. This article provides an ethical analysis of "routine" emergency department triage. The four principles of biomedical ethics - viz. respect for autonomy, beneficence, nonmaleficence and justice provide the starting point and help us to identify the ethical challenges of emergency department triage. However, they do not offer a comprehensive ethical view. To address the ethical issues of emergency department triage from a more comprehensive ethical view, the care ethics perspective offers additional insights.We integrate the results from the analysis using four principles of biomedical ethics into care ethics perspective on triage and propose an integrated clinically and ethically based framework of emergency department triage planning, as seen from a comprehensive ethics perspective that incorporates both the principles-based and care-oriented approach.Emergency care is one of the most sensitive areas of health care. This sensitivity is commonly based on a combination of factors such as urgency and crowding [1]. Urgency of care results from a combination of physical and psychological distress, which appears in all emergency situations in which a sudden, unexpected, agonizing and at times life threatening condition leads a patient to the emergency department (ED).The Australasian College for Emergency Medicine (ACEM) defines ED overcrowding as the situation where ED function is impeded primarily because the number of patients waiting to be seen, undergoing assessment and treatment, or waiting to leave exceeds the physical and/or staffing capacity of the ED [2]. ED overcrowding is a common
Nurses’ and doctors perceptions regarding the implementation of a triage system in an emergency unit in South Africa
JE Augustyn, VJ Ehlers, SP Hattingh
Health SA Gesondheid , 2009,
Abstract: Triage assessment of patients on arrival at an emergency unit is an essential function in quality emergency care provision, and is a cost-effective and time saving venture. This study investigated nurses’ and doctors’ perceptions about the implementation of the Cape Triage Score in one emergency unit. The challenges encountered prior to the implementation of the Cape Triage Score and the roles and core competencies of the triage nurse were addressed as well as the strengths and weaknesses of the Cape Triage Score. In this descriptive, quantitative and exploratory study, 15 nurses and doctors completed questionnaires. The challenges decreased and the sorting of patients improved after the implementation of the Cape Triage Score. Other strengths of this system included that the triage nurse prioritised patients, as opposed to the receptionist or the administrative staff; and nurses could undertake preliminary investigations without waiting for doctors’ orders to do so. The weaknesses of the implemented Cape Triage Score included that it was not fully functional 100% of the time, and that it was diffi cult to maintain during peak admission periods due to a shortage of nurses. The recommendations included that management should be convinced of the system’s benefi ts; nurses should perform the triage function on a rotation basis; more nurses should be available during peak periods; and that the administrative and reception staff should also be orientated about the triage system.
Triage, monitoring, and treatment of mass casualty events involving chemical, biological, radiological, or nuclear agents  [cached]
Ramesh Aruna,Kumar S
Journal of Pharmacy and Bioallied Sciences , 2010,
Abstract: In a mass casualty situation due to chemical, biological, radiological, or nuclear (CBRN) event, triage is absolutely required for categorizing the casualties in accordance with medical care priorities. Dealing with a CBRN event always starts at the local level. Even before the detection and analysis of agents can be undertaken, zoning, triage, decontamination, and treatment should be initiated promptly. While applying the triage system, the available medical resources and maximal utilization of medical assets should be taken into consideration by experienced triage officers who are most familiar with the natural course of the injury presented and have detailed information on medical assets. There are several triage systems that can be applied to CBRN casualties. With no one standardized system globally or nationally available, it is important for deploying a triage and decontamination system which is easy to follow and flexible to the available medical resources, casualty number, and severity of injury.
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