Morning surge and sleep surge in blood pressure--new clinical insights

There are 2 new clinical insights of blood pressure (BP) surge. One is that the exaggerated BP surge is risk of target organ damage and future cardiovascular events, independently of the average of the 24-hr BP level (Kario K: Hypertension 56: 765-773, 2010). The cardiovascular risk is potentiated at the time period of the exaggerated BP surge. In hypertensive patiens who exhibit morning BP surge, cardiovascular events occur most frequently in the morning, while in the obstructive sleep apnea patients who exhibit sleep BP surge, cardiovascular events occur most frequently during sleep period. Another aspect is that the exaggerated BP surge is the "prehypertension" which precede hypertension (Kario K: J Hypertens 25: 1573-1575, 2007). The new BP monitoring device which detect BP surge reproducibly would clarify clinical implication of BP surge more extensively.     

Public health nursing competencies for public health surge events

OBJECTIVE: To develop consensus regarding public health nursing competencies in the event of a public health surge event related to disaster. DESIGN AND METHODS: Using a 3-round Delphi approach, public health nurses (PHNs) and directors of nursing from local health departments, state nursing leaders, and national nursing preparedness experts reviewed and commented on 49 draft competencies derived from existing documents. RESULTS: The final 25 competencies were categorized into Preparedness (n=9), Response (n=8), and Recovery (n=7). The Preparedness competencies focus on personal preparedness; comprehending disaster preparedness terms, concepts, and roles; becoming familiar with the health department's disaster plan, communication equipment suitable for disaster situations; and the role of the PHN in a surge event. Conducting a rapid needs assessment, outbreak investigation and surveillance, public health triage, risk communication, and technical skills such as mass dispensing are Response phase competencies. Recovery competencies include participating in the debriefing process, contributing to disaster plan modifications, and coordinating efforts to address the psychosocial and public health impact of the event. CONCLUSIONS: Identification of competencies for surge events that are specific to public health nursing is critical to assure that PHNs are able to respond to these events in an effective and efficient manner.     

Comparison of autosurge versus surge protocols for discontinuous-flow centrifugation plateletapheresis

Autosurge is a new, highly automated protocol for collecting platelets by centrifugation plateletapheresis. It was developed to allow optimal cell collections with less operator effort than was required with the earlier, standard Surge protocol. The authors compared the cellular content of 201 platelet concentrates prepared by Surge with that of 120 concentrates prepared by Autosurge by the same group of operators, using the same cell separator. Platelet yields were similar (p = 0.775) for both protocols (mean X 10(-11) were 3.54 and 3.57 for Surge and Autosurge, respectively) and when subdivided according to preapheresis donor blood platelet counts, hematocrits, and leukocyte counts. Although platelet yields were comparable in concentrates prepared by either protocol, high donor hematocrit had less adverse effect on platelet yield when the Autosurge protocol was used. The composition of concentrates differed between protocols in that leukocytes contamination was significantly less (p less than 0.001) in units collected by Autosurge (3.4 X 10(8)) than in those collected by Surge (5.8 X 10(8)). Operator involvement can be less intense with Autosurge because the protocol includes automatic adjustment of cell separator settings for optimal plateletapheresis. The results of the direct comparison study were confirmed by data from 509 additional plateletapheresis procedures performed during routine blood center operation. Autosurge should replace Surge because the former easily produces platelet concentrates that contain fewer leukocytes without compromising platelet yields.     

Integrated plan to augment surge capacity

INTRODUCTION: Surge capacity is defined as a healthcare system's ability to rapidly expand beyond normal services to meet the increased demand for appropriate space, qualified personnel, medical care, and public health in the event ofbioterrorism, disaster, or other large-scale, public health emergencies. There are many individuals and agencies, including policy makers, planners, administrators, and staff at the federal, state, and local level, involved in the process of planning for and executing policy in respect to a surge in the medical requirements of a population. They are responsible to ensure there is sufficient surge capacity within their own jurisdiction. PROBLEM: The [US] federal government has required New York State to create a system of hospital bed surge capacity that provides for 500 adult and pediatric patients per 1 million population, which has been estimated to be an increase of 15-20% in bed availability. In response, the New York City Department of Health and Mental Hygiene (NYC DOH) has requested that area hospitals take an inventory of available beds and set a goal to provide for a 20% surge capacity to be available during a mass-casualty event or other conditions calling for increased inpatient bed availability. METHODS: In 2003, under the auspices of the NYC DOH, the New York Institute of All Hazard Preparedness (NYIHP) was formed from four unaffiliated, healthcare facilities in Central Brooklyn to address this and other goals. RESULTS: The NYIHP hospitals have developed a surge capacity plan to provide necessary space and utilities. As these plans have been applied, a bed surge capacity of approximately 25% was identified and created for Central Brooklyn to provide for the increased demand on the medical care system that may accompany a disaster. Through the process of developing an integrated plan that would engage a public health incident, the facilities of NYIHP demonstrate that a model of cooperation may be applied to an inherently fractioned medical system.     

Chronotherapeutics: a surge of ideas

Chronotherapeutics is advancing hypertension treatments beyond once-daily dosing by synchronizing the maximum levels of medication during times when cardiovascular risk is highest. It has long been established that patients are at higher risk for cardiovascular events-including myocardial infarction, stroke, and sudden death-in the early morning hours. Using novel oral delivery methods, chronotherapeutic medication synchronizes the delivery of blood pressure drug within the period of rates risk, significantly reducing both absolute blood pressure numbers and, especially important, the rate of blood pressure increase. These therapies have also shown the ability to maintain adequate blood pressure levels during the trough period. Several blood pressure medications now have chronotherapeutic formulations including the calcium channel blockers verapamil and diltiazem and the beta-blocker propranolol.     

大规模伤害事件时二级以上医院伤患激增应对能力的专家共识

医院伤患激增应对能力(hospital surge capacityand capability)是指在大规模伤害事件(如自然灾害、大型事故、恐怖袭击或其他突发公共卫生事件)发生后,医院需要迅速收治大量伤患,在有限资源条件下满足迅速增加的医疗需求的综合能力[1].由于大规模伤害事件造成的资源供给和需求之间的不平衡,伤员激增的应对计划是一种为医院优化医疗救治资源的途径.根据国际经验,医院伤员激增应对能力主要包括四个方面(缩写为4S):即医院激增应对管理体系(system)、激增应对空间(space)、激增应对人员(staff)和激增应对物资(supplies)的综合管理能力[1-5].     

Hospitals' preparation for surge of patients helps with new Joint Commission standards

To meet new surge capacity accreditation standards, hospitals are looking at their current plans to handle a sudden influx of patients and determining what works well for infectious patients. Consider putting two stretchers in a room. Determine how to establish room numbers for the second patient's record; you can start numbering after the last room number on the floor. Also, the second patient will need a call light, room divider, and meal trays. Consider twice-a-day bed meetings routinely for clinical directors. Notify physicians when you need beds, and have case managers to assist with transportation. Bring a phlebotomist to the ED, and have physicians help plan care at triage.     

Development of a state medical surge plan, Part II: Components of a medical surge plan.

In 2003, the Utah State Department of Health received funding from the Health Resources and Services Administration to develop a medical surge plan to increase the number of available hospital beds in the state by 1250 beds, including 125 beds for burn or critical trauma patients. A prior article discussed the planning procedures and process. This article describes the major components of the plan, including analysis of threats, direction and control, activation and system response; communications; and critical issues.     

Hospital bed surge capacity in the event of a mass-casualty incident

INTRODUCTION: Traditional strategies to determine hospital bed surge capacity have relied on cross-sectional hospital census data, which underestimate the true surge capacity in the event of a mass-casualty incident. OBJECTIVE: To determine hospital bed surge capacity for the County more accurately using physician and nurse manager assessments for the disposition of all in-patients at multiple facilities. METHODS: Overnight- and day-shift nurse managers from each in-patient unit at four different hospitals were approached to make assessments for each patient as to their predicted disposition at 2, 24, and 72 hours post-event in the case of a mass-casualty incident, including transfer to a hypothetical, onsite nursing facility. Physicians at the two academic institutions also were approached for comparison. Age, gender, and admission diagnosis also were recorded for each patient. RESULTS: A total of 1,741 assessments of 788 patients by 82 nurse managers and 25 physicians from the four institutions were included. Nurse managers assessed approximately one-third of all patients as dischargeable at 24 hours and approximately one-half at 72 hours; one-quarter of the patients were assessed as being transferable to a hypothetical, on-site nursing facility at both time points. Physicians were more likely than were nurse managers to send patients to such a facility or discharge them, but less likely to transfer patients out of the intensive care unit (ICU). Inter-facility variability was explained by differences in the distribution of patient diagnoses. CONCLUSIONS: A large proportion of in-patients can be discharged within 24 and 72 hours in the event of a mass-casualty incident (MCI). Additional beds can be made available if an on-site nursing facility is made available. Both physicians and nurse managers should be included on the team that makes patient dispositions in the event of a MCI.     

Paroxysmal sympathetic surge associated with gamma hydroxybutyrate.

Gamma hydroxybutyrate is increasingly being used recreationally in the United Kingdom. We present a case of gamma hydroxybutyrate overdose associated with paroxysmal sympathetic storm, a phenomenon usually confined to patients who have sustained traumatic brain injury.