Measurement of physical activity among patients with heart failure typically requires a special approach due to the patients’ physical status. Nowadays, a technology is already available that can measure the kinematic movements in 3-D by a pacemaker and implantable defibrillator giving an assessment on software. The telemetry data can be transmitted to a central system. The research aims to elaborate the methods that help to compare of the data concerning physical activity both built-in an accelerometer in Cardiac Resychrinisation Therapy (CRT) devices and data obtained from an external Actigraph GT3XE-Plus Triaxial Activity Monitor. 5 persons participated in the pilot study (n=5); mean age: 57+- 13.37; BMI: 90.6+- 7.63. The Actigraph data from CRT device were examined in a 6-day-interval, between February 28 and March 5, 2014. The investigation started conducting a 6-minute walking test and continued with the measurement of daily physical activity. For data analysis descriptive statistics and linear regression analysis were used. It is clear from the data obtained from Actigraph that the MET values (mean: 1.17 ± 0.096) of the patients in the sample were extremely low due to their disease. However, some patients with higher physical activity than average (1.26; 1.28) seemed to be noteworthy, but they showed lower performance than healthy people. The physical activity of the patients during the 6-minute walking test corresponded to 1.9-2.48 MET. The physical activity of patients was found typically in the “light or moderate range” classifying the physical activity by Actigraph. Data from Actigraph are accurate and detailed making the physical activity of the patients measurable and appreciable. The results of the 6-minute walking test were in the category from moderate to very vigorous for individualized moderate physical performance based on Actigraph. It indicates the individual performance differences among patients. However, the daily physical performance is even lower than that of the 6- minute walking. We can conclude from the data related to the percentage of the average activity in CRT system to the average energy consumption and the improvement in the patients’ physical condition. Due to the limitations of the sampling frequency the different time intervals cannot be isolated in the different intensity ranges. Therefore, the percentage of the data of physical activity provided by the device may have a limited use.
The rapid global spread of COVID–19 has created numerous challenges for educational organizations of all levels around the world. Maritime Education and Training (MET) institutions are no exception and have faced major disruptions from the pandemic. Differing technological and organizational solutions have had to be quickly adapted in short timeframes in order to fill gaps and ensure continued teaching and learning. Although online education is nothing new, COVID-19 has accelerated the necessity for distributed learning, digital tools and infrastructure needed to not only cope, but excel in the restructuring of MET. In this article we present our experiences from the blended course offered to maritime bachelor students at our university in Norway through a case study. The findings from the study have revealed that although blended learning has helped continued education during the pandemic, it still has to overcome general as well as MET specific challenges to be successful in future. Considering the impact and challenges of the COVID-19 pandemic on MET, we further discuss the short-term responses and possible long-term solutions that can contribute to uninterrupted, high-quality learning for future MET. The use of emerging technologies for education, such as virtual reality (VR) and web-based training simulators, are likely to play an essential role in the future direction of MET.
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Rolą systemu Państwowe Ratownictwo Medyczne (PRM) jest świadczenie pomocy każdej osobie, która znajduje się w stanie nagłego zagrożenia zdrowotnego. System funkcjonuje w oparciu o jednostki organizacyjne, do których zaliczmy szpitalne oddziały ratunkowe, zespoły ratownictwa medycznego, centra powiadamiania ratunkowego oraz centra dyspozytorskie. Dysponenci jednostek systemu wyłaniani są z konkursu ofert, a następnie zawierają umowę z właściwym dla danego województwa oddziałem Narodowego Funduszu Zdrowia na udzielanie świadczeń zdrowotnych. Rolą szpitalnego oddziału ratunkowego jest zapewnienie wstępnej diagnostyki oraz podjęcie leczenia stabilizującego funkcje życiowe osób znajdujących się w stanie nagłego zagrożenia zdrowotnego. Zespoły ratownictwa medycznego pozostają w gotowości do wykonywania medycznych czynności ratunkowych w warunkach przedszpitalnych i są dysponowane do miejsca zdarzenia przez dyspozytora medycznego. W przypadku stwierdzenia stanu nagłego zagrożenia zdrowotnego, transportują pacjenta do najbliższego szpitalnego oddziału ratunkowego lub innego szpitala wskazanego przez dyspozytora medycznego albo lekarza koordynatora medycznego zgodnie ze wskazaniami medycznymi. Istnieją dwa rodzaje naziemnych zespołów ratownictwa medycznego – specjalistyczne (z lekarzem) i podstawowe (bez lekarza), w których kierownikiem zespołu jest pielęgniarka lub ratownik medyczny. Ważna rolę w Systemie pełnią również zespoły lotniczego pogotowia ratunkowego, w skład których wchodzi lekarz, ratownik medyczny i pilot. Zakres zadań poszczególnych zespołów uzależniony jest przede wszystkim od rodzaju wezwania oraz od szacowanego czasu dotarcia do miejsca zdarzenia, który powinien być jak najkrótszy. System wspomagany jest przez jednostki współpracujące, w szczególności Państwową i Ochotniczą Straż Pożarną, Policję, Górskie Ochotnicze Pogotowie Ratunkowe, Tatrzańskie Ochotnicze Pogotowie Ratunkowe, Wodne Ochotnicze Pogotowie Ratunkowe, a także inne stowarzyszenia i organizacje, które wykonują działania ratownicze w ramach swoich zadań statutowych. Decyzją wojewody mazowieckiego – obszar Mazowsza podzielony jest na 6 rejonów operacyjnych określających obszar działania poszczególnych dysponentów zespołów ratownictwa medycznego. SPZOZ „RM-MEDITRANS” Stacja Pogotowia Ratunkowego i Transportu Sanitarnego w Siedlcach jest dysponentem 21 zespołów ratownictwa medycznego w rejonie operacyjnym 14-04. Na przełomie ostatnich lat w rejonie 14-04 można zaobserwować wzrost liczby wyjazdów zespołów ratownictwa medycznego, w tym również wyjazdów nieuzasadnionych. Wskazuje to na konieczność edukacji społeczeństwa w zakresie zasad funkcjonowania systemu ratownictwa medycznego, który nie powinien pełnić funkcji „przychodni na kółkach”. Problemem dysponentów jednostek jest również zbyt niskie finansowanie oraz samo istnienie procedury konkursowej z NFZ, która niekiedy powoduje sztuczne zaniżanie cen usług. Kontraktowanie umów na ratownictwo medyczne przez Narodowy Fundusz Zdrowia na zbyt krótki okres czasu nie pozwala na pełen rozwój potencjału jednostki. Pomimo tego, na podstawie analizy dostępnych danych stwierdzić należy, że System Państwowe Ratownictwo Medyczne w rejonie 14-04 działa efektywnie, a jego organizacja zapewnia bezpieczeństwo zdrowotne ludności.
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The role of Emergency Medical Services System (EMSS) in Poland is considered in this article, as a part of national emergency system. Its main purpose is to provide the qualified first aid to people being in life or health threatening conditions, either in traffic accidents, sudden diseases, catastrophes or potential and more common now, in dangers of terrorist attacks. The functioning of the system is determined by the Act on State Emergency Medical Services, signed on 8th September 2006 with its subsequent regulations. Implementation of tasks of the system is undertaken by system units such as the Hospital Casualty Departments, the Medical Emergency Teams (MET,) as well as the Emergency Communication Centre (ECC), accepting notifications and Dispatchers Centres. Owners of system units chosen in an open competition sign contracts with appropriate units of National Health Fund (NFZ) to provide quick and competent medical assistance in case of emergencies. One of the tasks of Hospital Casualty Departments is to supply preliminary diagnosis and treatment or to stabilize vital functions of people in sudden life or health threatening conditions. The division of Hospital Casualty Departments into well-equipped medical units with qualified staff helps in fulfilling the tasks. Most importantly, Medical Emergency Teams (MET) are dispatched to perform rescue operations in outof- hospital conditions such as the place of an accident. In life or health threatening conditions patients are taken to the nearest Hospital Casualty Department or another unit, as told by a dispatcher or a coordinating doctor accordingly with medical indications. Medical Emergency Teams (MET) are divided into two types: the first one with a doctor, and the second one with a paramedic or a nurse managing the actions. Moreover, the integral and significant part of the system also includes Helicopter Emergency Medical Service (HEMS) with a doctor, a paramedic and a pilot. The range of tasks of the units is mainly determined by the type of a notification, and by approximated the shortest arrival time. The system is supported by cooperating units including The State/Volunteer Fire Brigade, the Police, Mountain Volunteer Search and Rescue (GOPR), Tatra Volunteer Search and Rescue (TOPR) and Volunteer Water Rescue Service (WOPR). Diversity of rescue operations is also performed by other units or social organisations qualified to take emergency actions defined in the Act. In practice, as the process is exemplified by author, due to Mazovian Voivode’s decision, the Mazovia Region is divided into six areas of operation determining the range of actions of particular dispatchers of Medical Emergency Teams chosen in an open competition organised by National Health Fund (NFZ). SPZOZ “RM-MEDITRANS” Emergency Medical Service and Sanitary Transport in Siedlce administers 21 Medical Emergency Teams in the 14-04 region. In recent years, in the mentioned region, the number of accepted notifications has significantly risen including the false ones. The constant necessity of educating society is proved essential to understanding the functioning of Emergency Medical Services that is commonly treated as a kind of “clinic on wheels.” Finally, the low level of financing by the owners of the system units, poses the main source of problems. Additionally, competitions announced by National Health Fund (NFZ) artificially make the prices of the services lower, and signing short-term contracts deprives the units of the capability of full development. Upon the analysis up to date, it can be affirmed that the Emergency Medical Services System (EMSS) in Poland, in the 14-04 region, functions effectively and its organisational scheme provides basic health security for population of the area.
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