Implementation of a stroke protocol with emergency physician-directed acute care decreased both door-to-needle time and onset-to-treatment time without increasing the rate of symptomatic intracerebral hemorrhage.

Abstract. Reliable and highly performant handling of large data stores constitutes one of the major challenges of cloud computing. In this paper, we propose a formalisation of a cloud solution implemented by F-Secure -a provider of secure data storage services. The solution is based on massive replication and the write-ahead logging mechanism. To achieve high performance, the company has abandoned a transactional model. We formally derive a model of the proposed architectural solution and verify data integrity and consistency properties under possible failure scenarios. The proposed approach allows the designers to formally define and verify essential characteristics of architectures for handling large data stores.

BackgroundThe share of patients leaving the emergency department without being seen by a physician (LWBS) is an important efficacy marker of emergency departments around the world. It has not however, been of special research interest in the Nordic countries. In this study, we assessed the LWBS rate in Kanta-Häme Central Hospital, in Hämeenlinna, Finland. Secondarily, we gathered information of LWBS patients along with all ED patients.MethodsIn this retrospective observational patient record study, our primary aim was to assess the LWBS rate of all patient visits (n = 41,631) over a 12-month period in a mid-sized Finnish secondary hospital ED. Alongside, we gathered specific information, such as age, gender, time of day and year for attendance, reason for attendance, return to healthcare and mortality after 7 and 30 days and after one year to show characteristics of LWBS patients. We present data and hourly distribution of the LWBS patients against all patient visits to the ED.ResultsA total of 305 LWBS cases were identified, leading to an LWBS rate of 0.73 %. Most LWBS took place during afternoon hours, when the ED was most crowded and waiting times were longest. Among LWBS patients, minor traumas and non-specific pain were the most common reasons for attending. Mortality among LWBS patients was naught (0.0 %) over a one-year follow-up.ConclusionsThe LWBS rate in the Kanta-Häme Central Hospital ED was low. Higher LWBS rate coincided with rush hours and longer waiting times. The proportion of minor traumas was greater than in some earlier studies. These results support the implementation of a fast track line for minor traumas in the ED.

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