An Optimal control approach to marketing-production planning

The problem of finding an optimal advertising and production policy in a firm is analysed using a recently proposed model of a marketing-production system. First, it is shown that the optimal control problem underlying the proposed model is a partially singular control problem. Then, a reverse-time parametric solution procedure is designed to determine the optimal advertising and production policy for the proposed model. Finally, it is shown that the results derived from the new model are applicable to problems of capacity expansion in a firm.     

An advanced emergency care delivery system.

In order to provide for immediate expert emergency care at the site of an accident or sudden illness and during the transport to the emergency department, different options have been taken in East and West. In Leuven, Belgium an intermediate solution to the problem ha been chosen, firstly be developing a concise, fully portable set of medical equipment, and secondly by forming a "mobile emergency group" within the emergency department, consisting of nurses (male and female) with experience in critical care and selected through a specially conceived training program. This "mobile emergency group" is capable of administering advanced emergency care at the order of a physician present at the scene, or giving orders by radio. The "mobile emergency group" provides emergency care in the ambulances and in the hospital.     

Rethinking preparedness planning in disaster emergency care: lessons from a beyond-surge-capacity event

Since the COVID-19 pandemic has occurred, nations showed their unpreparedness to deal with a mass casualty incident of this proportion and severity, which resulted in a tremendous number of deaths even among healthcare workers. The World Society of Emergency Surgery conceived this position paper with the purpose of providing evidence-based recommendations for the management of emergency surgical patients under COVID-19 pandemic for the safety of the patient and healthcare workers. A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) through the MEDLINE (PubMed), Embase and SCOPUS databases. Synthesis of evidence, statements and recommendations were developed in accordance with the GRADE methodology. Given the limitation of the evidence, the current document represents an effort to join selected high-quality articles and experts’ opinion. The aim of this position paper is to provide an exhaustive guidelines to perform emergency surgery in a safe and protected environment for surgical patients and for healthcare workers under COVID-19 and to offer the best management of COVID-19 patients needing for an emergency surgical treatment. We recommend screening for COVID-19 infection at the emergency department all acute surgical patients who are waiting for hospital admission and urgent surgery. The screening work-up provides a RT-PCR nasopharyngeal swab test and a baseline (non-contrast) chest CT or a chest X-ray or a lungs US, depending on skills and availability. If the COVID-19 screening is not completed we recommend keeping the patient in isolation until RT-PCR swab test result is not available, and to manage him/she such as an overt COVID patient. The management of COVID-19 surgical patients is multidisciplinary. If an immediate surgical procedure is mandatory, whether laparoscopic or via open approach, we recommend doing every effort to protect the operating room staff for the safety of the patient.     

Simulation-assisted burn disaster planning

The aim of the study was to evaluate the Swedish medical systems response to a mass casualty burn incident in a rural area with a focus on national coordination of burn care. Data were collected from two simulations of a mass casualty incident with burns in a rural area in the mid portion of Sweden close to the Norwegian border, based on a large inventory of emergency resources available in this area as well as regional hospitals, university hospitals and burn centres in Sweden and abroad. The simulation system Emergo Train System^® (ETS) was used and risk for preventable death and complications were used as outcome measures: simulation I, 18.5% (n = 13) preventable deaths and 15.5% (n = 11) preventable complications; simulation II, 11.4% (n = 8) preventable deaths and 11.4% (n = 8) preventable complications. The last T1 patient was evacuated after 7 h in simulation I, compared with 5 h in simulation II. Better national coordination of burn care and more timely distribution based on the experience from the first simulation, and possibly a learning effect, led to a better patient outcome in simulation II. The experience using a system that combines both process and outcome indicators can create important results that may support disaster planning.     

Simulation-based medical planning for cardiovascular disease: visualization system foundations.

A technique for visualizing computational models along with volumetric imaging data in a real-time, interactive, simulation-based medical planning system for cardiovascular disease treatment is described. This technique involves an ordered rendering of faceted geometry and volumetric image data. We have developed a software system based on this image-fusion technique that is capable of capturing and representing the inherent anatomic constraints of an individual patient. Such constraints must be represented accurately in a medical planning system to ensure the validity of a potential procedure. A hypothetical clinical scenario is described for which vascular treatment plans were constructed pre-operatively without reference to the physical anatomic structure. These models were later embedded into patient-specific diagnostic MRA scans to establish the anatomic context for physiologic observations.     

Helicopter emergency medical system in the Basel region

Between 1986 and 1988, 999 patients were treated on the emergency scene, then transported with the rescue-helicopter in the Basle area. 687 were victims of a trauma (70.5%) and 287 patients were suffering from an acute internal medicine disease. We performed in-field therapy on the accident scene itself in 53.9% of all the cases. According to our scoring system the presence of a physician was absolutely necessary in 56% of all the cases. Air rescue by helicopter allows fast transportation of patients and immediate high quality intensive care. The low mortality rate during treatment before transport (2.6%) and during the transport itself (0.3%) shows that early beginning of medical treatment on the accident scene is connected to better survival chances.     

Scientific basis for the selection of emergency medical examination gloves for emergency medical technicians, paramedics, firefighters, and emergency department personnel. An update

The use of powder-free natural rubber or latex-free emergency medical examination gloves is especially important to emergency medical technicians, paramedics, firefighters, and emergency department personnel to avoid eliciting an allergic reaction in the latex sensitized patient. The majority of our emergency medical technicians, paramedics, and firefighters are now wearing powder-free emergency medical examination gloves that comply with the stringent codes and standards established by the National Fire Protection Association (NFPA), while very few hospital emergency department personnel have been provided with NFPA-approved gloves. There are four well-defined goals of this report that will assist emergency medical services, fire departments, and hospitals in the selection and purchase of emergency medical examination gloves. First, we will review again the stringent regulations for emergency medical examination gloves that are outlined by the NFPA. This design and performance standard was devised by the NFPA to address protective clothing for emergency medical operations. The design and performance requirement of the emergency medical examination gloves were described in the NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 1997 Edition. As of September 2003, the emergency medical examination glove must meet the new design and performance requirements of emergency medical examination gloves discussed in NFPA 1999, Standard on Protective Clothing for Emergency Medical Operations, 2003 Edition.     

An interactive problem-solving approach to teach traumatology for medical students

Aim  

We aimed to evaluate an interactive problem-solving approach for teaching traumatology from perspectives of students and consider its implications on Faculty development.     

Microsim医学模拟系统在急救护理技能操作培训中的应用

目的 探讨Microsim医学模拟培训系统在急救护理技能操作培训中的应用效果.方法 将参加急救护理技能培训的护理人员120人随机分为对照组与观察组各60人.对照组采用传统的操作练习模式 ;观察组应用Microsim医学模拟培训系统进行训练.结果 观察组急救护理技能理论及操作考核成绩显著优于对照组(均P＜0.05),观察组91.6％及以上的护士认为本培训方式有利于提高学习兴趣和综合能力.结论 应用Microsim医学模拟培训系统进行急救护理技能操作培训,可有效提高护士的综合能力.     

The anesthesiologist's role in the French emergency medical system

The present system of French emergency medicine and its philosophy were described from my experience at SAMU (service d'aide medicale urgente). Three factors of emergency medicine; pre-hospital care, emergency transport and emergency information service are managed by anesthesiologists. Anesthesiologists on duty at the tele-medicine center give medical team instructions to start at once. The team is composed of an anesthesiologist, a nurse and an ambulancier. They start to give intensive care medicine to critically ill patients on the spot. The philosophy of SAMU is that doctors should go out of the hospital. Anesthesiologists in the area organize the emergency medical system in France.     

An osteopathic approach to asthma.

Asthma has become a serious challenge to clinical medicine today, with an increase in incidence, morbidity, and mortality over the past two decades. Asthma continues to be a problem despite increased knowledge of the pathophysiology of asthma coupled with the development of a variety of new and innovative medications that can be used to treat asthma. Five areas involving asthma management are reviewed and involve a failure to do the following: (1) identify disease instability and progression; (2) adopt an optimal pharmacologic treatment plan; (3) identify and help the patient avoid environmental triggers; (4) evaluate and treat certain disruptive psychodynamic issues; and (5) use essential non-pharmacologic modes of therapy such as osteopathic manipulation, nutritional considerations, physical training, and controlled breathing techniques that may help to favorably modify the asthma disease process.     

日本新型急救医疗救援体系的分析与借鉴

日本急救医疗体系比较发达,一般把急救患者分检为I级、II级和III级,再送到相应的医疗机构进行救治。急救医疗从业人员都是专业的人员,能够及时有效地对急救患者进行诊治。现在日本正在进行急救医疗体系的改革,成立了相关委员会并形成一些基础改革,主要是增加急救医疗的投入及专业急救医生的提高。这些对我国急救医疗体系现存的一些问题有一定借鉴意义。     

急诊预检分诊系统研发及应用

目的探讨急诊预检分诊系统用于改善医疗服务质量的效果。方法随机选择2014年1~2月及2016年1~2月急诊预检分诊各1 000例患者为对照组和观察组,对照组采用传统的预检分诊方法,观察组采用基于法国预检分诊指南研发的急诊预检分诊系统进行预检分诊。结果与对照组比较,观察组分诊准确率由91.6%上升为98.7%,平均分诊时间由(145.34±68.15)s缩短为(99.58±28.73)s,患者对病情分级、等待分诊时间、等待看诊时间满意率提高(均P0.01)。结论急诊预检分诊系统的应用实现了临床信息共享,提高了急诊分诊准确率,缩短了分诊时间,有利于改善急诊医疗服务质量。     

An approach to complex tracheostomal complications.

Fistula formation following laryngectomy, most commonly pharyngocutaneous, is the most feared non-fatal complication with an incidence range from 5 to 30%. Tracheoesophageal fistulae are rare and are, most often, associated with the creation of a surgical speech fistula or the stomal recurrence of a malignant tumour. We present five cases of complex post-laryngectomy fistulae and a new approach to management. We advocate debridement of infected or necrotic tissue, primary suture of the oesophageal and tracheal defects with interposition of healthy viable tissue as a free transfer. If necessary, the trachea can be mobilised and the tracheostome is lowered to healthy tissue outside the radiotherapy field, with excision of the manubrium and hemi-clavicles. This technique allows reconstruction as a single stage procedure and does not preclude the future creation of a further tracheoesophageal fistula for voice rehabilitation.