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BackgroundTelemedicine offers a unique opportunity to improve coordination and administration for urgent patient care remotely. In an emergency setting, it has been used to support first responders by providing telephone or video consultation with specialists at hospitals and through the exchange of prehospital patient information. This technological solution is evolving rapidly, yet there is a concern that it is being implemented without a demonstrated clinical need and effectiveness as well as without a thorough economic evaluation. ObjectiveOur objective is to systematically review whether the clinical outcomes achieved, as reported in the literature, favor telemedicine decision support for medical interventions during prehospital care. MethodsThis systematic review included peer-reviewed journal articles. Searches of 7 databases and relevant reviews were conducted. Eligibility criteria consisted of studies that covered telemedicine as data- and information-sharing and two-way teleconsultation platforms, with the objective of supporting medical decisions (eg, diagnosis, treatment, and receiving hospital decision) in a prehospital emergency setting. Simulation studies and studies that included pediatric populations were excluded. The procedures in this review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The Risk Of Bias In Non-randomised Studies–of Interventions (ROBINS-I) tool was used for the assessment of risk of bias. The results were synthesized based on predefined aspects of medical decisions that are made in a prehospital setting, which include diagnostic decision support, receiving facility decisions, and medical directions for treatment. All data extractions were done by at least two reviewers independently. ResultsOut of 42 full-text reviews, 7 were found eligible. Diagnostic support and medical direction and decision for treatments were often reported. A key finding of this review was the high agreement between prehospital diagnoses via telemedicine and final in-hospital diagnoses, as supported by quantitative evidence. However, a majority of the articles described the clinical value of having access to remote experts without robust quantitative data. Most telemedicine solutions were evaluated within a feasibility or short-term preliminary study. In general, the results were positive for telemedicine use; however, biases, due to preintervention confounding factors and a lack of documentation on quality assurance and protocol for telemedicine activation, make it difficult to determine the direct effect on patient outcomes. ConclusionsThe information-sharing capacity of telemedicine enables access to remote experts to support medical decision making on scene or in prolonged field care. The influence of human and technology factors on patient care is poorly understood and documented.

Lichen amyloidosis is a subtype of primary localized cutaneous amyloidosis (PLCA), which presents as discrete, firm, closely-set 1-3mm, dome-shapedbrown papules commonly involving the anterior aspect of shins and extensor surfaces of forearms. We present a case of an otherwise healthy man in his 30s with solitary facial involvement of lichen amyloidosis, which is very uncommon.

Although potassium hydroxide (KOH) is known to be effective in generating highly porous activated carbons, the mechanism of KOH activation has not been well elucidated. To develop porosity in carbon, a high KOH/carbon mass ratio must be maintained. Consequently, KOH, as the activating agent, represents a major part of the cost of the activation process. Focusing on the mechanism, particularly the activation products, the present work attempted to establish the technical feasibility of recycling KOH. Experiments revealed that the major products of KOH activation at 600-900°C are metallic K, K2CO3, CO and H2, which is supported by thermodynamic analysis. The overall reaction may be written as 6KOH + 4C = K2CO3 + 4K + 3H2 + 3CO. At temperatures over 900°C, K2CO3 becomes unstable and participates in activation reactions with carbon; a more suitable overall reaction would be KOH + C = CO + K + 0.5H2. As potassium ion is reduced to metallic K which is readily converted into KOH and hydrogen gas upon reacting with water, KOH recycling is feasible. The reuse of KOH in chemical activation could substantially reduce the cost of activation process. © 2011 Canadian Society for Chemical Engineering [ABSTRACT FROM AUTHOR]