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Background and Purpose:The purpose of this study was to assess factors causing delay in treatment of acute stroke in a tertiary care institute in South India.Methods:All clinically suspected cases of acute stroke presenting to the emergency department over a period of 1 year were prospectively followed up and data collected as per a preset pro forma. The various time intervals from stroke onset to definitive management and other pertinent data were collected. The time delays have been evaluated in the decision tree model: Chi-squared Automatic Interaction Detection. Significance was assessed at 5% level of significance (P < 0.05).Results:The mean prehospital time delay for all clinically suspected stroke (n = 361) in our institute was 716 min and the median time 190 min. The mean total in-hospital delay was 94.17 ± 54.5 min and median time being 82 min. The onset of symptoms to first medical contact was the main interval that influenced the prehospital delay. Computed tomographic (CT) diagnosis to stroke unit admission influenced the in-hospital delay the most.Conclusions:Lack of awareness regarding stroke leads to delayed seeking of treatment for the same. The factors that contribute to the in-hospital delay included patient admission procedure delay, lack of staff to transport the patient, and the distance between the stroke unit and CT room. Educating the community with regard to “stroke” and implementation of a better pre- and in-hospital stroke care system is a need of the hour in the country.

Diagnostic study, level III. Prognostic study, level III.

Objective: Emergency Medicine being a young specialty in India, we aimed to assess the level of disaster preparedness and planning strategies among various academic Emergency Departments (EDs) across India during the COVID-19 pandemic. Methods: A cross-sectional multicentric survey was developed and disseminated online to various academic EDs in India and followed up over a period of 8 weeks. All results were analysed using descriptive statistics. Results: 28 Academic Emergency Medicine Departments responded to the study. Compared to Pre-COVID period, COVID-19 pandemic has led to 90% of centres developing separate triage system with dedicated care areas for COVID suspect/infected in 78.6% centres with nearly 70% utilizing separate transportation pathways. Strategizing and executing the Institutional COVID-19 treatment protocol in 80% institutes were done by Emergency Physicians. Training exercises for airway management and PPE usage were seen in 93% and 80% centres respectively. Marked variation in recommended PPE usage were observed across EDs in India. Conclusions: Our study highlights the high variance in the level of preparedness response among various EDs across India during the pandemic. Preparedness for different EDs across India needs to be individually assessed and planned according to the needs and resources available.

Outpatients attending for conservative dental treatment were presented with eight instructions which they were asked to remember. The instructions were either written or spoken, and were in a positive or negative form. Patients treated with nitrous oxide remembered fewer instructions than those treated with local analgesia alone, and this effect of nitrous oxide was particularly marked for written instructions. Patients receiving local analgesia alone were more likely to remember positive than negative instructions in their original syntactical form, but this bias was not evident in the nitrous oxide group. In a second experiment both normal and dentally phobic patients were read dental and general instructions both before and during inhalation of 30 per cent nitrous oxide. Both groups showed a nitrous oxide-induced reduction in partially recalled instructions. There was interesting evidence for a different attentional bias in our two patient groups. The normal group remembered more general than dental instructions, whereas the phobic group showed the opposite pattern, yielding a significant patient group x type of instruction interaction.KEY woms-Nitrous oxide, memory, attention, syntax, cognitive bias. INTRODUCTIONThere have been several reports of impairments in memory for lists of digits and nouns following inhalation of 30 per cent nitrous oxide (Steinberg, 1954;Kortilla et a/., 1981), the impairments being in acquisition (Steinberg and Summerfield, 1957;Block et al., 1988;Mewaldt et al., 1988). Impairments are not restricted to artificial material, but have also been found in recognition of faces (Norton et al., 1984) and memory for dental events (File et al., 1991).Task difficulty seems to determine whether or not memory impairments are detected after nitrous oxide. Thus. no impairments were found in an easy recall task (Norton et al., 1984) or in a recognition task made easier by repetitions (Block et al., 1988). The purpose of Experiment 1 was to investigate whether clinically used concentrations of nitrous oxide reduced memory for dental instructions and if any such reduction was dependent on the syntax of the instructions and whether they were written or spoken. Mehler (1963) found better recall of active, affirmative instructions than of passive or negative ones, and File and Jew (1973) also found * Author to whom correspondence should be addressed.better recall of airline safety instructions when these were positive, rather than negative, and when passengers heard them rather than read them.In Experiment 2 we investigated whether there was an interaction between the effects of nitrous oxide and the patient group. In Experiment 1 and the File et al. (1992) study the patients receiving nitrous oxide were dental phobics and their memory was compared with a control group receiving similar dental treatment under local analgesia alone. In Experiment 2 we therefore examined the effects of nitrous oxide on memory for instructions in a group of normal and a group of dentally phobic patients. There is some evi...

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