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Age and Sex Differences in Duration of Pre-Hospital Delay, Hospital Treatment Practices, and Short-Term Outcomes in Patients Hospitalized with an Acute Coronary Syndrome/Acute Myocardial Infarction: A DissertationNguyen, Hoa L. 07 May 2010 (has links)
BackgroundThe prompt seeking of medical care after the onset of symptoms suggestive of acute coronary syndromes (ACS)/acute myocardial infarction (AMI) is associated with the receipt of coronary reperfusion therapy, and effective cardiac medications in patients with an ACS/AMI and is crucial to reducing mortality and the risk of serious clinical complications in these patients. Despite declines in important hospital complications and short-term death rates in patients hospitalized with an ACS/AMI, several patient groups remain at increased risk for these adverse outcomes, including women and the elderly. However, recent trends in age and sex differences in extent of pre-hospital delay, hospital management practices, and short-term outcomes associated with ACS/AMI remain unexplored.
The objectives of this study were to examine the overall magnitude, and changing trends therein, of age and sex differences in duration of pre-hospital delay (1986-2005), hospital management practices (1999-2007), and short-terms outcomes (1975-2005) in patients hospitalized with ACS/AMI.
MethodsData from 13,663 residents of the Worcester, MA, metropolitan area hospitalized at all greater Worcester medical centers for AMI 15 biennial periods between 1975 and 2005 (Worcester Heart Attack Study), and from 50,096 patients hospitalized with an ACS in 106 medical centers in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007 were used for this investigation.
Results In comparison with men years, patients in other age-sex strata exhibited significantly longer pre-hospital delay, with the exception of women < 65 years; had a significantly lower odds of receiving aspirin, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, statins, and undergoing coronary artery bypass graft surgery (CABG) surgery or percutaneous coronary intervention (PCI), and were significantly more likely to develop atrial fibrillation, cardiogenic shock, heart failure, and to die during hospitalization and in the first 30 days after admission. There was a significant interaction between age and sex in relation to the use of several medications and the development of several of these outcomes; in patients Conclusions Our results suggest that the elderly were more likely to experience longer prehospital delay, were less likely to be treated with evidence-based treatments during hospitalization for acute coronary syndrome, and were more likely to develop adverse outcomes compared to younger persons. Younger women were less likely to be treated with effective treatments and were more likely to develop adverse outcomes compared with younger men while there was no sex difference in these outcomes. Interventions targeted at older patients, in particular, are needed to encourage these high-risk patients to seek medical care promptly to maximize the benefits of currently available treatment modalities. More targeted treatment approaches during hospitalization for ACS/AMI for younger women and older patients are needed to improve their hospital prognosis.
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Zkušenosti pracovníků ZZS při výjezdech k pacientům v nepříznivé sociální situaci / The experience of EMS workers in accessing patients in an unfavourable social situationWollmannová, Alice January 2020 (has links)
The diploma thesis deals with the experiences of emergency medical workers when going to patients in an unfavorable social situation. Medical rescue service according to Act No. 374/2011 Coll. on emergency medical services, should provide pre-hospital emergency care to patients in acute life-threatening conditions. Nevertheless, the crews of the ambulance service go to patients whose problems fall more into the social field. These patients do not primarily need medical intervention, yet rescuers in the field have to deal with these situations. The aim of the diploma thesis was to find out and compare the experience of rescuers when going to patients in an unfavorable social situation. Find out how rescuers experience and interpret these situations, what situations they encounter during these trips and how they understand the concept of an unfavorable social situation. The theoretical part of this work deals with the definition of basic concepts in the field of emergency medical services and social work. The empirical part is devoted to qualitative research. It contains a description of the research methodology, analysis of interviews with rescuers and their evaluation. The result of the research is evidence that on an almost daily basis, lifeguards deal with these situations with clients...
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