[Telemedical prenotification in acute stroke treatment : Experiences from the Stroke Angel initiative from 2004 until the present]

OBJECTIVE

The Stroke Angel initiative investigates the implementation of telemedicine for improvement of preclinical communication between emergency medical services (EMS) and stroke units in cases of acute stroke.

MATERIAL AND METHODS

Stroke Angel is a technical system for the telemedical prenotification of patients in cases of suspected stroke at a stroke unit by the EMS. Within the framework of an observational study, the team has been investigating the effects of the system on door-to-computed tomography (CT) and door-to-needle times as well as the lysis rate in the neighboring regions of Rhön-Grabfeld and Bad Kissingen since 2005.

RESULTS

The system supports the acute treatment of neurological emergencies and functions as a catalyst for the interlinking of medical institutions in the region as well as for communication between emergency physicians/EMS and hospital physicians. The use of a computer-based data collection enables a continuous improvement process leading to an acceleration of internal clinical procedures and an increase of the lysis rate with the mortality rate staying constant.

CONCLUSION

Telemedicine is applicable in the preclinical care of acute stroke and, thanks to the computer-based data collection, leads to an increase in process transparency, which helps to improve the internal clinical processes in and around a stroke unit.

A dynamic oppositional biogeography-based optimization approach for time-varying electrical impedance tomography

Dynamic electrical impedance tomography-based image reconstruction using conventional algorithms such as the extended Kalman filter often exhibits inferior performance due to the presence of measurement noise, the inherent ill-posed nature of the problem and its critical dependence on the selection of the initial guess as well as the state evolution model. Moreover, many of these conventional algorithms require the calculation of a Jacobian matrix. This paper proposes a dynamic oppositional biogeography-based optimization (OBBO) technique to estimate the shape, size and location of the non-stationary region boundaries, expressed as coefficients of truncated Fourier series, inside an object domain using electrical impedance tomography. The conductivity of the object domain is assumed to be known a priori. Dynamic OBBO is a novel addition to the family of dynamic evolutionary algorithms. Moreover, it is the first such study on the application of dynamic evolutionary algorithms for dynamic electrical impedance tomography-based image reconstruction. The performance of the algorithm is tested through numerical simulations and experimental study and is compared with state-of-the-art gradient-based extended Kalman filter. The dynamic OBBO is shown to be far superior compared to the extended Kalman filter. It is found to be robust to measurement noise as well as the initial guess, and does not rely on a priori knowledge of the state evolution model.

Cost analysis of the surgical treatment of fractures of the proximal humerus

Aims

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost.

Methods

A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost

Results

The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of income

Discussion

Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs. Take home message: This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned. Cite this article: Bone Joint J 2016;98-B:249–59.

Addition of transversus abdominis plane block to patient controlled analgesia for laparoscopic high anterior resection improves analgesia, reduces opioid requirement and expedites recovery of bowel function

INTRODUCTION

Opioid sparing in postoperative pain management appears key in colorectal enhanced recovery. Transversus abdominis plane (TAP) blocks offer such an effect. This study aimed to quantify this effect on pain, opioid use and recovery of bowel function after laparoscopic high anterior resection.

METHODS

This was a retrospective analysis of prospective data on 68 patients. Patients received an epidural (n=24), intravenous morphine patient controlled analgesia (PCA, n=22) or TAP blocks plus PCA (n=22) determined by anaesthetist preference. Outcome measures were numerical pain scores (0-3), cumulative intravenous morphine dose and time to recovery of bowel function (passage of flatus or stool).

RESULTS

There were no differences in patient characteristics, complications or extraction site. The TAP block group had lower pain scores (0.7 vs 1.36, p<0.001) and morphine requirements (8 mg vs 15 mg, p=0.01) than the group receiving PCA alone at 12 hours and 24 hours. Earlier passage of flatus (2.0 vs 2.7 vs 3.4 days, p=0.002), stool (3.1 vs 4.1 vs 5.5 days, p=0.04) and earlier discharge (4 vs 5 vs 6 days, p=0.02) were also seen.

CONCLUSIONS

Use of TAP blocks was found to reduce pain and morphine use compared with PCA, expedite recovery of bowel function compared with PCA and epidural, and expedite hospital discharge compared with epidural.

Clinico-pathological findings of Clostridium perfringens type D enterotoxaemia in goats and its hemolytic activity in different erythrocytes

The present investigation was conducted to study the effects of experimental Clostridium perfringens type D enterotoxaemia in teddy goats. Clinical signs started to appear after 30 min of experimental infection like anorexia, diarrhea, dehydration, frothing and dyspnea. Gross lesions consisted of severe congestion in tissues of varying intensity with enlarged mesenteric lymph nodes while histological examination revealed edema of lungs, kidney, and lymph nodes and to some extent in brain along with hemorrhages in lungs and intestines. Clostridium perfringens type D carrying alpha and epsilon toxin genes were amplified with amplicon size about 247 bp and 665 bp, respectively. Human erythrocytes showed the highest hemolysis, 68%, followed by mice, 57%, against culture supernatants. The percentage of hemolysis was significantly higher at 37°C as compared to 25°C except for rabbit and dog.

A comparison of 2-octyl cyanoacrylate with nylon for wound closure of knee arthroscopy portals

OBJECTIVE

To compare the cosmetic results, complications and patient satisfaction of 2-octyl cyanoacrylate (Dermabond, Ethicon Inc. Somerville, NJ, USA), a liquid bonding agent, with 3-0 nylon sutures (Ethilon, Ethicon Inc) skin closure in two groups of patients undergoing elective knee arthroscopy at 6 weeks.

METHOD

The retrospective clinical audit recruited patients undergoing knee surgery for the first time between October 2010 and August 2011. The patients were either treated with the liquid bonding agent or nylon sutures. The patients in the bonding agent group were allowed to shower as normal on postoperative day one, while patients in the suture group kept their wounds dry for 2 weeks.

RESULTS

Between the two groups (40 patients per group) there was no difference in the cosmetic outcome (p=0.285), patient satisfaction (p=0.29), pain scores (p=0.44) or wound complication rate (p<0.05). Patient satisfaction was high in both groups. Furthermore, 83.75% of all patients indicated they would prefer the liquid bonding closure over nylon sutures if undergoing the same procedure in the future as they could shower the next day and avoid suture removal.

CONCLUSION

2-octyl cyanoacrylate is safe to use in the short term in knee arthroscopy providing comparable results to nylon suture closure. Allowing patients to shower the next day appears to cause no adverse effects.

DECLARATION OF INTEREST

The authors would like to state that they do not have any economic or social interest in any of the products used or mentioned. No grant or finance was received for this study, nor any input from other sources.

The use of light-based (optical) detection systems as adjuncts in the detection of oral cancer and oral potentially malignant disorders: a systematic review

INTRODUCTION

In recent decades, optical techniques utilising the principles of chemiluminescence and tissue autofluorescence have emerged to facilitate the early detection of any oral mucosal changes suspicious of cancer.

PURPOSE

To evaluate the effectiveness of devices that utilise the principles of chemiluminescence and tissue autofluorescence as adjuncts in the detection of oral cancer and oral potentially malignant disorders (OPMDs).

METHODS

A systematic review of the published literature to evaluate the effectiveness of the ViziLite(®) and ViziLite(®) Plus with toluidine blue, MicroLux™/DL and the VELscope™ as aids in the detection of oral cancer and OPMDs.

RESULTS

Twenty-five primary studies published between 2004 and 2013 satisfied our criteria for selection - 13 utilised chemiluminescence and 12 tissue autofluorescence. Some had utilised both study methods on the same population. Chemiluminescence shows good sensitivity at detecting any OPMDs and oral cancer. However, it preferentially detects leukoplakia and may fail to spot red patches. The additive use of toluidine blue may improve specificity. Tissue autofluorescence is sensitive at detecting white, red and white and red patches, and the area of fluorescence visualisation loss (FVL) often extends beyond the clinically visible lesion. However, in addition to OPMDs, VELScope may detect erythematous lesions of benign inflammation resulting in false-positive test results.

CONCLUSION

There is limited evidence for their use in primary care, and these tools are better suited to specialist clinics in which there is a higher prevalence of disease and where experienced clinicians may better discriminate between benign and malignant lesions.

[Sub-celluiar localization of PELPK1 in Arabidopsis thaliana as determined by translational fusion with green fluorescent protein reporter]

PELPK1, a novel Arabidopsis thaliana gene was earlier annotated to encode a protein of sub-family, PELPK under hydroxyproline-rich glycoprotein (HRGP) super-family of proteins. Previous bioinformatics and computational analyses predicted PELPK1 to contain an amino-terminal signal peptide destined towards the secretory pathway. In the present study, transgenic plants were developed harboring a translational fusion construct comprising of PELPK1 coding sequence (PELPK1-CDS) and green fluorescent protein (GFP) reporter to determine the localization of PELPK1 in Arabidopsis plants. By employing the techniques of confocal laser scanning microscopy, immunolabeling of GFP with quantum dot (Q-dot), and transmission electron microscopy (TEM), it is shown that the translational fusion product is predominantly deposited to the cell wall. These results are in agreement with the earlier bioinformatics prediction that the PELPK1 is transported via the secretory pathway.