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Cuevas M, Frank M, Haacke W, Lüdke T. [Prehospital care of anaphylactic reactions by the air rescue and ground-based emergency services Dresden : An analysis of treatment and outcome]. HNO 2024:10.1007/s00106-024-01457-4. [PMID: 38592478 DOI: 10.1007/s00106-024-01457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Anaphylaxis can lead to a life-threatening situation. Therefore, rapid diagnosis and emergency treatment is indicated. Immediate treatment with intramuscular adrenaline (or intravascularly with sufficient medical expertise) in anaphylaxis with cardiovascular and/or respiratory symptoms is recommended by various guidelines. Previous studies have shown that anaphylaxis is often not treated according to guidelines and that adrenaline in particular is rarely administered. OBJECTIVE The aim of the study was to investigate the data on emergency treatment and outcomes of patients with anaphylaxis by the air rescue and ground-based emergency services Dresden. Moreover, the results of the air- and ground-based services were compared. The focus was on administration of adrenaline and outcomes. MATERIALS AND METHODS Data from the ground-based emergency service Dresden (from 2012 to 2016) and the air rescue service Dresden (from 2008 to 2015) related to anaphylactic reactions were analyzed retrospectively. The severity of the anaphylaxis, the emergency medication administered, further monitoring, and outcomes were analyzed. RESULTS Data from 152 adults/29 children were analyzed for air rescue and 1131 adults/223 children for the ground-based emergency service. Adults with grade II-IV anaphylaxis received adrenaline in 19% (air rescue) and 7% (ground rescue) of cases. Children with grade II-IV anaphylaxis received adrenaline in 7% (air rescue) and 8% (ground rescue) of cases. Immediate drug therapy led to an improvement in general condition in 96-98% (air rescue) and 72-77% (ground-based emergency service) of cases. A significant correlation was found between the administration of adrenaline and the improvement in outcome in the ground-based emergency cohort. CONCLUSION Guideline-compliant first-line therapy with adrenaline was not performed in the majority of the cases analyzed in this study. The significant effect of adrenaline on outcome demonstrated in this study emphases the need to improve the emergency treatment of anaphylactic reactions.
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Affiliation(s)
- Mandy Cuevas
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland
- Praxis für Hals‑, Nasen‑, Ohrenheilkunde und Allergologie, Freital, Deutschland
| | - Mark Frank
- Zentrale interdisziplinäre Notaufnahme, Städtisches Klinikum Dresden Friedrichstadt, Dresden, Deutschland
- DRF Stiftung Luftrettung gAG, Filderstadt, Deutschland
- Wissenschaftlicher Arbeitskreis der DRF Stiftung Luftrettung gemeinnützige AG, Filderstadt, Deutschland
| | - Wladimir Haacke
- Brand- und Katastrophenschutzamt Dresden, Feuerwehr und Rettungsdienst, Dresden, Deutschland
| | - Theresa Lüdke
- Medizinische Fakultät und Universitätsklinikum Carl Gustav Carus, Klinik und Poliklinik für Hals‑, Nasen- und Ohrenheilkunde, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Deutschland.
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Shetty A, Levesque JF, Jammal W. Lower urgency care in the emergency department, and the suitability of general practice care as an alternative. Med J Aust 2024; 220:217. [PMID: 38290980 DOI: 10.5694/mja2.52208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/16/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Amith Shetty
- NSW Health, Sydney, NSW
- University of Sydney, Sydney, NSW
| | - Jean-Frederic Levesque
- NSW Health, Sydney, NSW
- Centre for primary Health Care and Equity, University of New South Wales, Sydney, NSW
| | - Walid Jammal
- University of Sydney, Sydney, NSW
- Hills Family General Practice, Sydney, NSW
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Montalto M. Lower urgency care in the emergency department, and the suitability of general practice care as an alternative. Med J Aust 2024; 220:217. [PMID: 38290973 DOI: 10.5694/mja2.52219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 10/16/2023] [Indexed: 02/01/2024]
Affiliation(s)
- Michael Montalto
- Epworth Health Care, Melbourne, VIC
- Mobile Radiology Australia, Melbourne, VIC
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Myrskykari H, Iirola T, Nordquist H. The role of emergency medical services in the management of in-hospital emergencies: Causes and outcomes of emergency calls - A descriptive retrospective register-based study. Australas Emerg Care 2024; 27:42-48. [PMID: 37598030 DOI: 10.1016/j.auec.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 07/10/2023] [Accepted: 07/30/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Medical emergency teams (METs) are in place in some hospitals in Finland to respond to critical emergency events. However, in hospitals without dedicated METs, staff are instructed to call emergency medical services (EMS) to deal with emergencies. This study examined the reasons for calling EMS to hospitals and the outcomes of these calls. METHODS Descriptive retrospective register-based study of the response and management of in-hospital emergencies by EMS in the wellbeing services county of Southwest Finland. Patient care reports of the EMS and those of the hospitals were analysed. RESULTS In total, 138 medical emergencies managed by EMS were included in this study. 108 of these related to patients, and 25 related to hospital personnel. Cardiac arrest (n = 36) and a reduced level of consciousness (n = 29) were the most common in-hospital emergencies. In 68% of in-hospital emergencies managed by the EMS team, after calling 112, hospital personnel implemented various treatment measures. In 72% of cases, follow-up treatment was required. CONCLUSIONS Hospital personnel are able to initiate medical measures in emergencies, even when no MET is available. Although EMS are important in responding to in-hospital emergencies, they seem to be performing the same role as METs.
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Affiliation(s)
- Henna Myrskykari
- Emergency Medical Services, University of Turku and Turku University Hospital. PL 52, 20521 Turku, Finland
| | - Timo Iirola
- Emergency Medical Services, University of Turku and Turku University Hospital. PL 52, 20521 Turku, Finland
| | - Hilla Nordquist
- South-Eastern Finland University of Applied Sciences, Department of Healthcare and Emergency Care, Pääskysentie 1, 48220 Kotka, Finland.
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Nakano Y, Nakamura T, Tomatsu M, Miyaki Y, Suzuki K. Mediastinal hematoma as an unusual intrathoracic manifestation of Boerhaave Syndrome: A case report. Int J Surg Case Rep 2024; 116:109366. [PMID: 38354575 PMCID: PMC10943663 DOI: 10.1016/j.ijscr.2024.109366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 02/03/2024] [Accepted: 02/05/2024] [Indexed: 02/16/2024] Open
Abstract
INTRODUCTION Boerhaave Syndrome (BS) is rare but life-threatening condition caused by a sudden increase in the intraluminal pressure due to vomiting. We present a case of BS manifesting as a posterior mediastinal hematoma, indicative of a potentially fatal condition. PRESENTATION OF CASE A 51-year-old man presented with acute chest pain after vomiting. Enhanced Computed Tomography revealed mediastinal fluid with a left pleural effusion, leading to a diagnosis of BS. Emergency surgery revealed a posterior mediastinal hematoma with active bleeding due to a torn proper esophageal artery. Hemostasis and a wall repair were performed, and the patient was discharged uneventfully. DISCUSSION This case highlights two important aspects. Firstly, a spontaneous esophageal perforation can manifest as a mediastinal hematoma due to the subpleural arterial injury, delaying bacterial spillage. While preoperative thoracentesis may not always diagnose BS accurately, bloody thoracic drainage can serve as an alternative diagnostic sign. Secondly, the mediastinal hematoma itself poses a serious risk, as it can lead to a catastrophic outcome even before bacterial contamination occurs, emphasizing the necessity of a timely surgical intervention in BS cases. CONCLUSION BS can manifest as a mediastinal hematoma, and the absence of gastrointestinal content in the thoracic drainage does not rule out the possibility of BS. Prompt surgical intervention remains essential, as a mediastinal hematoma alone can result in a catastrophic outcome. This case highlights the significance of a comprehensive diagnostic assessment for BS.
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Affiliation(s)
- Yusuke Nakano
- Department of Gastrointestinal Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Toru Nakamura
- Department General Thoracic Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Makoto Tomatsu
- Department of Gastrointestinal Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Yuichiro Miyaki
- Department of Gastrointestinal Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
| | - Kazufumi Suzuki
- Department of Gastrointestinal Surgery, Seirei Hamamatsu General Hospital, 2-12-12 Sumiyoshi, Chuo-ku, Hamamatsu-city, Shizuoka 430-8558, Japan.
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Settelmeier S, Steven S, Post F, Ahrens I, Giannitsis E, Breuckmann F. New categorization of chest pain: noncardiac is in, atypical is out! Herz 2024:10.1007/s00059-024-05240-7. [PMID: 38427126 DOI: 10.1007/s00059-024-05240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/08/2024] [Indexed: 03/02/2024]
Abstract
Chest pain poses a diagnostic challenge in the emergency department and requires a thorough clinical assessment. The traditional distinction between "atypical" and "typical" chest pain carries the risk of not addressing nonischemic clinical pictures. The newly conceived subdivision into cardiac, possibly cardiac, and (probably) noncardiac causes of the presenting symptom complex addresses a much more interdisciplinary approach to a symptom-oriented diagnostic algorithm. The diagnostic structures of the chest pain units in Germany do not currently reflect this. An adaptation should therefore be considered.
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Affiliation(s)
- Stephan Settelmeier
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Hufelandstr. 55, 45147, Essen, Germany
| | - Sebastian Steven
- Med. Klinik III-Department for Cardiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Felix Post
- Internal Medicine, General and interventional Cardiology, Katholisches Klinikum Koblenz-Montabaur, Rudolf-Virchow-Str. 7-9, 56073, Koblenz, Germany
| | - Ingo Ahrens
- Krankenhaus der Augustinerinnen, Department for Cardiology and Intensive Care Medicine, Jakobstr. 27-31, 50678, Köln, Germany
| | - Evangelos Giannitsis
- Department for Internal Medicine III, Cardiology, Vascular Medicine and Pneumology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Frank Breuckmann
- Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Hufelandstr. 55, 45147, Essen, Germany.
- Cardiology, Pneumology, Neurology and Intensive Care Medicine, Klinik Kitzinger Land, Keltenstr. 67, 97318, Kitzingen, Germany.
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徐 训, 邵 校, 姬 爱. [Analysis of death cases in the oral emergency department]. Beijing Da Xue Xue Bao Yi Xue Ban 2024; 56:185-189. [PMID: 38318916 PMCID: PMC10845197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Indexed: 02/07/2024]
Abstract
In order to analyze the clinical characteristics of death cases in the oral emergency department of the stomatological hospital, and to improve the first aid technique before and in hospitals, we collected the clinical data of death cases in the Department of Oral Emergency in Peking University School and Hospital of Stomatology from January 2010 to January 2023 for retrospective analysis. General cha-racteristics, such as the patients' gender, age, chief complaint, maxillofacial diseases, systemic underlying diseases, rescue situation, cause of death and seasonal distribution of death were summarized. The results showed that a total of 8 death cases (5 males and 3 females) occurred during the 13-year period, ranging in age from 40 to 86 years, with a median age of 66 years. Among the 8 patients, 5 reported bleeding from oral cancer, 1 reported chest tightness and dyspnea after oral cancer surgery, 1 reported loss of consciousness after maxillofacial trauma, and 1 reported oral erosion and aphagia. All the 8 patients had one or more underlying diseases, such as hypertension, coronary heart disease, diabetes, renal failure, and cerebral infarction, etc. and 2 of them showed dyscrasia. Among them, the cause of death in 5 cases was respiratory and circulatory failure caused by oral cancer rupture and hemorrhage or poor surgical wound healing and hemorrhage; 1 case was uremia and hyperkalemia leading to circulatory failure; 1 case was asphyxia caused by swelling of oral floor tissue after maxillofacial trauma; and the other case was acute myocardial infarction caused circulatory failure after oral cancer surgery. According to the vital state at the time of treatment, 6 patients had loss of consciousness, respiratory and cardiac arrest before hospital, and 2 patients suffered from loss of consciousness, respiratory and cardiac arrest during treatment. All the patients received cardiopulmonary resuscitation and some advanced life support measures, and the average rescue time was 46 min. Due to the low incidence of death in the oral emergency department, medical personel have little experience in first aid. First aid training and drills and assessment should be organized regularly. First aid facilities should be always available and regularly maintained by special personnel, such as electrocardiogram (ECG) monitor, defibrillator, simple breathing apparatus, oxygen supply system, negative pressure suction system, endotracheal intubation and tracheotomy equipment. The death cases mainly occurred in the elderly patients with oral cancer bleeding and systemic underlying diseases. Education of emergency awareness for the elderly patients with oral cancer after surgery should be enhanced. Medical staff should strengthen first aid awareness and skills.
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Affiliation(s)
- 训敏 徐
- />北京大学口腔医学院·口腔医院急诊科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 校 邵
- />北京大学口腔医学院·口腔医院急诊科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
| | - 爱平 姬
- />北京大学口腔医学院·口腔医院急诊科, 国家口腔医学中心, 国家口腔疾病临床医学研究中心, 口腔生物材料和数字诊疗装备国家工程研究中心, 北京 100081Department of Oral Emergency, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing 100081, China
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Narongsanoi P, Banharak S, Panpanit L, Chanaboon S, Damkliang J. Factors related to changes in severity among adult and older adult patients at an internal medicine department clinic: an embedded mixed-method study. Sci Rep 2024; 14:3914. [PMID: 38365937 PMCID: PMC10873346 DOI: 10.1038/s41598-024-54266-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 02/10/2024] [Indexed: 02/18/2024] Open
Abstract
The changes in aging plus the pathology of diseases can influence the changes in severity levels. This study aimed to examine the changes in levels of severity in patients while waiting to see a doctor. The study was conducted at an outpatient clinic in northeastern Thailand with a total of 421 patients who were assessed twice for levels of severity using the Emergency Severity Index. The 38 triage nurses screened patients, and 18 were interviewed when severity level changes were observed. Data were collected April 1-30, 2021. Quantitative data were analyzed by Chi-square test, Fisher's exact test, and logistic regression. Qualitative data were analyzed by content analysis. Most patients were female, between 18 and 59 years old. Most patients did not change their level of severity. However, increasing levels of severity were found in older adults. Factors related to the changes in severity levels were age group, chronic disease, chief complaint, educational level, the duration of travel to the outpatient clinic, type of vehicle, aging process and comorbidity, pathology of diseases, reassessment interval, nurse's experience, bypassing the patient triage process, patient's self-preparation, management of triage nurses, and assignment of direct healthcare staff until the end of the treatment. Increased severity was more frequently found in older adults, so closely monitored during waiting times at a clinic is needed. Setting rescreening as a policy and having sensitive screening guidelines and tools specific to older adults would contribute to early detection and immediate treatment of deteriorating symptoms and illness to help reduce complications and morbidity.Trial registration: https://osf.io/fp3j2 .
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Affiliation(s)
| | - Samoraphop Banharak
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand.
| | - Ladawan Panpanit
- Department of Gerontological Nursing, Faculty of Nursing, Khon Kaen University, Khon Kaen, Thailand
| | - Sutin Chanaboon
- Sirindhorn College of Public Health Khon Kaen, Khon Kaen, Thailand
| | - Jintana Damkliang
- Department of Adult and Gerontological Nursing, Faculty of Nursing, Prince of Songkla University, Hat Yai, Thailand
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Trentzsch H, Lefering R, Schweigkofler U. Imposter or knight in shining armor? Pelvic circumferential compression devices (PCCD) for severe pelvic injuries in patients with multiple trauma: a trauma-registry analysis. Scand J Trauma Resusc Emerg Med 2024; 32:2. [PMID: 38225602 PMCID: PMC10790519 DOI: 10.1186/s13049-023-01172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024] Open
Abstract
BACKGROUND Pelvic Circumferential Compression Devices (PCCD) are standard in hemorrhage-control of unstable pelvic ring fractures (UPF). Controversial data on their usefulness exists. Aim of the study was to investigate whether prehospital application of PCCD can reduce mortality and transfusion requirements in UPF. METHODS Retrospective cohort study. From 2016 until 2021, 63,371 adult severely injured patients were included into TraumaRegister DGU® of the German Trauma Society (TR-DGU). We analyzed PCCD use over time and compared patients with multiple trauma patients and UPF, who received prehospital PCCD to those who did not (noPCCD). Groups were adjusted for risk of prehospital PCCD application by propensity score matching. Primary endpoints were hospital mortality, standardized mortality rate (SMR) and transfusion requirements. RESULTS Overall UPF incidence was 9% (N = 5880) and PCCD use increased over time (7.5% to 20.4%). Of all cases with UPF, 40.2% received PCCD and of all cases with PCCD application, 61% had no pelvic injury at all. PCCD patients were more severely injured and had higher rates of shock or transfusion. 24-h.-mortality and hospital mortality were higher with PCCD (10.9% vs. 9.3%; p = 0.033; 17.9% vs. 16.1%, p = 0.070). Hospital mortality with PCCD was 1% lower than predicted. SMR was in favor of PCCD but failed statistical significance (0.95 vs. 1.04, p = 0.101). 1,860 propensity score matched pairs were analyzed: NoPCCD-patients received more often catecholamines (19.6% vs. 18.5%, p = 0.043) but required less surgical pelvic stabilization in the emergency room (28.6% vs. 36.8%, p < 0.001). There was no difference in mortality or transfusion requirements. CONCLUSION We observed PCCD overuse in general and underuse in UPF. Prehospital PCCD appears to be more a marker of injury severity and less triggered by presence of UPF. We found no salutary effect on survival or transfusion requirements. Inappropriate indication and technical flaw may have biased our results. TR-DGU does not contain data on these aspects. Further studies are necessary. Modular add-on questioners to the registry could offer one possible solution to overcome this limitation. We are concerned that PCCD use may be unfairly discredited by misinterpretation of the available evidence and strongly vote for a prospective trial.
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Affiliation(s)
- H Trentzsch
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Universität München, Ludwig-Maximilians-Universität, Schillerstr. 53, 80336, Munich, Germany.
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), Faculty of Health, University Witten/Herdecke, Cologne, Germany
| | - U Schweigkofler
- Department of Trauma and Orthopedic Surgery, BG Unfallklinik Frankfurt Am Main Friedberger, Landstr. 430, 60389, Frankfurt am Main, Germany
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Jenkins L, Johnston T, Armour R, Maria S. Informing Utstein-style reporting guidelines for prehospital thrombolysis: A scoping review. Australas Emerg Care 2024:S2588-994X(23)00090-8. [PMID: 38233295 DOI: 10.1016/j.auec.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 11/08/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Rural Australians with acute myocardial infarction (AMI) face higher mortality rates due to limited access to specialised cardiac services. Paramedic-administered prehospital thrombolysis (PHT) has emerged as an alternative to primary percutaneous intervention (pPCI) for patients facing barriers or delays to cardiac care. There is variability in PHT practices among Australian ambulance services, lacking standardised definitions and outcome measures. The aim of this scoping review was to identify quality indicators and influencing factors associated with outcomes for patients receiving PHT. METHODS A systematic search of literature in SCOPUS and Academic Search Complete, CINAHL and Health Source: Nursing/Academic Edition databases via EBSCO (Health) was conducted following the Joanna Briggs Institute methodology. Peer-reviewed studies from the past decade were screened using search criteria relevant to prehospital thrombolysis and quality indicators. Data extraction was performed and themed using five domains from the Utstein-style template commonly known for standardised prehospital cardiac arrest reporting. RESULTS After removing duplicates, the search yielded 3596 articles with 28 empirical studies meeting inclusion criteria for the review. These were primarily retrospective cohort studies performed in Australia, Canada and the United States. The scoping review identified 24 clinical quality indicators and factors related to Emergency Medical Service (EMS) systems, AMI recognition and ambulance dispatch, patient variables, PHT processes and patient outcomes. These findings correlate to the Donabedian structure-process-outcome quality of care model and have utility to inform future PHT reporting guidelines for jurisdictional ambulance services. CONCLUSIONS Given the variability in prehospital practice across Australian ambulance services, standardised reporting on quality indicators for PHT is needed. The Utstein-style template used to report data on pre-hospital cardiac arrest, trauma and airway management could be used for quality improvement in PHT. This review presents 24 quality indicators representing system, recognition and response, patient, process, and outcomes related to PHT. These results could be used to inform a future Delphi study and Utstein-like reporting guideline for prehospital thrombolysis.
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Affiliation(s)
- Louis Jenkins
- Faculty of Science and Health, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia
| | - Tania Johnston
- Faculty of Science and Health, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Ambulance Tasmania, Hobart, Tasmania, Australia
| | - Richard Armour
- Faculty of Science and Health, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia; Department of Paramedicine, School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Sonja Maria
- Faculty of Science and Health, School of Nursing, Paramedicine and Healthcare Sciences, Charles Sturt University, Bathurst, New South Wales, Australia.
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Yang WJ, Yoon JY. Dental trauma trends in emergency care:a comparative analysis before, during, and after COVID-19. J Korean Assoc Oral Maxillofac Surg 2023; 49:339-346. [PMID: 38155087 PMCID: PMC10761316 DOI: 10.5125/jkaoms.2023.49.6.339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023] Open
Abstract
Objectives This analysis details the characteristics of dental trauma in South Korea during the coronavirus disease 2019 (COVID-19) (DC) pandemic and compares them in patients before and after COVID-19 (BC and AC, respectively). Materials and Methods Data were collected from medical records of patients who visited Seoul National University Bundang Hospital's Emergency Dental Care Center during three 12-month periods: BC, DC, and AC (BC from March 1, 2019 to February 29, 2020; DC from March 1, 2020 to February 28, 2021; AC from March 1, 2022 to February 28, 2023). A retrospective review was conducted to investigate patient age, sex, time of visit, cause, and diagnosis. The study included 1,544 patients: 660 BC, 374 DC, and 510 AC. Results Significant difference in age and sex was not observed among the three periods; 1-9 years of age was the largest group (38.3% in BC, 29.6% in DC, and 27.8% in AC), and the percentage of male patients was greater than of female patients (male proportion as 63.5% in BC, 67.4% in DC, and 64.9% in AC). The number of patients generally peaked at a Saturday night in spring (for BC: May, Saturday, 18:00-19:59; for DC: March, Saturday, 18:00-19:59; for AC: April as the second most (October as the most peaked), Saturday, 20:00-21:59). The primary etiology of the dental trauma was identical in the three periods: falls, followed by sports. The most frequent diagnosis was laceration, followed by tooth avulsion and jaw fracture. Conclusion Significant differences were not found between the characteristics and patterns of dental trauma in the BC, DC, and AC periods. However, due to the pandemic and social distancing, activities decreased and associated dental trauma-related incidents declined.
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Affiliation(s)
- Woo-Jung Yang
- Department of Conservative Dentistry, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji-Young Yoon
- Department of Conservative Dentistry, Section of Dentistry, Seoul National University Bundang Hospital, Seongnam, Korea
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Gianola S, Castellini G, Biffi A, Porcu G, Napoletano A, Coclite D, D'Angelo D, Di Nitto M, Fauci AJ, Punzo O, Iannone P, Chiara O. Volume replacement in the resuscitation of trauma patients with acute hemorrhage: an umbrella review. Int J Emerg Med 2023; 16:87. [PMID: 38036955 PMCID: PMC10687916 DOI: 10.1186/s12245-023-00563-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/26/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The use of intravenous fluid therapy in patients with major trauma in prehospital settings is still controversial. We conducted an umbrella review to evaluate which is the best volume expansion in the resuscitation of a hemorrhagic shock to support the development of major trauma guideline recommendations. METHODS We searched PubMed, Embase, and CENTRAL up to September 2022 for systematic reviews (SRs) investigating the use of volume expansion fluid on mortality and/or survival. Quality assessment was performed using AMSTAR 2 and the Certainty of the evidence was assessed with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. RESULTS We included 14 SRs investigating the effects on mortality with the comparisons: use of crystalloids, blood components, and whole blood. Most SRs were judged as critically low with slight overlapping of primary studies and high consistency of results. For crystalloids, inconsistent evidence of effectiveness in 28- to 30-day survival (primary endpoint) was found for the hypertonic saline/dextran group compared with isotonic fluid solutions with moderate certainty of evidence. Pre-hospital blood component infusion seems to reduce mortality, however, as the certainty of evidence ranges from very low to moderate, we are unable to provide evidence to support or reject its use. The blood component ratio was in favor of higher ratios among all comparisons considered with moderate to very low certainty of evidence. Results about the effects of whole blood are very uncertain due to limited and heterogeneous interventions in studies included in SRs. CONCLUSION Hypertonic crystalloid use did not result in superior 28- to 30-day survival. Increasing evidence supports the scientific rationale for early use of high-ratio blood components, but their use requires careful consideration. Preliminary evidence is very uncertain about the effects of whole blood and further high-quality studies are required.
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Affiliation(s)
- Silvia Gianola
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Annalisa Biffi
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Gloria Porcu
- Department of Statistics and Quantitative Methods, National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Statistics and Quantitative Methods, Unit of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Antonello Napoletano
- Centro Nazionale Per L'Eccellenza Clinica, La Qualità E La Sicurezza Delle Cure, Istituto Superiore Di Sanità, Rome, Italy
| | - Daniela Coclite
- Centro Nazionale Per L'Eccellenza Clinica, La Qualità E La Sicurezza Delle Cure, Istituto Superiore Di Sanità, Rome, Italy
| | - Daniela D'Angelo
- Azienda Sanitaria Locale Roma/6, Via Borgo Garibaldi, 12 00041 Albano Laziale, Rome, Italy.
- CECRI Evidence-Based Practice Group for Nursing Scholarship: A JBI Affiliated Group, Rome, Italy.
| | - Marco Di Nitto
- Centro Nazionale Per L'Eccellenza Clinica, La Qualità E La Sicurezza Delle Cure, Istituto Superiore Di Sanità, Rome, Italy
| | - Alice Josephine Fauci
- Centro Nazionale Per L'Eccellenza Clinica, La Qualità E La Sicurezza Delle Cure, Istituto Superiore Di Sanità, Rome, Italy
| | - Ornella Punzo
- Centro Nazionale Per L'Eccellenza Clinica, La Qualità E La Sicurezza Delle Cure, Istituto Superiore Di Sanità, Rome, Italy
| | - Primiano Iannone
- Dipartimento Di Medicina Interna, Azienda USL, Ospedale Maggiore, Largo Nigrisoli 2, 40133, Bologna, Italy
| | - Osvaldo Chiara
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
- General Surgery and Trauma Team, ASST Grande Ospedale Metropolitano Niguarda, University of Milan, Milano, Piazza Ospedale Maggiore, Milan, Italy
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Dresden SM. Optimizing the Care of Persons Living with Dementia in the Emergency Department. Clin Geriatr Med 2023; 39:599-617. [PMID: 37798067 DOI: 10.1016/j.cger.2023.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Emergency department (ED) care for persons living with dementia (PLWD) involves the identification of dementia or cognitive impairment, ED care which is sensitive to the specific needs of PLWD, effective communication with PLWD, their care partners, and outpatient clinicians who the patient and care-partner know and trust, and care-transitions from the emergency department to other health care settings. The recommendations in this article made based on wide-ranging heterogeneous studies of various interventions which have been studied primarily in single-site studies. Future research should work to incorporate promising findings from interventions such as hospital at home, or ED to home Care Transitions Intervention.
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Affiliation(s)
- Scott M Dresden
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Center for Healthcare Studies and Outcomes Research, 211 East Ontario Street, Suite 200, Chicago, IL 60611, USA.
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Xiong L, Le J, Zhao C, Yuan R, Yang M, Shen H. Clinical application of upper limb fracture fixator in emergency treatment of upper limb fracture. Pak J Med Sci 2023; 39:1818-1823. [PMID: 37936728 PMCID: PMC10626112 DOI: 10.12669/pjms.39.6.7097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/15/2023] [Accepted: 08/05/2023] [Indexed: 11/09/2023] Open
Abstract
Objective To compare and analyze the curative effect of fracture upper limb fixator and traditional splint in emergency treatment of upper limb fracture. Methods This is a prospective study. A total of 80 patients with upper limb fractures admitted to the Emergency Department of Sichuan Province Orthopedic Hospital from December 2021 to August 2022 were prospectively selected as subjects. They were divided into two groups according to the random number table method: Patients in the control group were treated with traditional splint, while those in the observation group were treated with medical adjustable upper limb fixator. The clinical efficacy, treatment time, pain, fitness, probability of secondary injury and complications were compared between the two groups. Results After treatment, the excellent and good rate in the observation group (75.00%) was higher than that in the control group(52.50%). There was no statistically significant difference in the treatment time between the two groups. There was no significant difference in the probability of secondary injury between the two group. Statistically significant difference was observed in the comparison of pain conditions between the two groups. The total fitness rate of the observation group (97.50%) was higher than that of the control group (75.00%). The total incidence of complications in the observation group (2.50%) was lower than that in the control group (20.00%), with a statistically significant difference. Conclusion Fracture upper limb fixator shows various benefits in first aid of upper limb fractures, such as improving the clinical efficacy of patients with upper limb fractures, ameliorating pain, improving fitness effect, and reducing the probability of complications.
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Affiliation(s)
- Lianghao Xiong
- Lianghao Xiong, Department of Emergency, Sichuan Province Orthopedics Hospital, Chengdu 610041, Sichuan, China
| | - Jintao Le
- Jintao Le, Department of Emergency, Sichuan Province Orthopedics Hospital, Chengdu 610041, Sichuan, China
| | - Chun Zhao
- Chun Zhao, Department of Emergency, Sichuan Province Orthopedics Hospital, Chengdu 610041, Sichuan, China
| | - Rongxia Yuan
- Rongxia Yuan, Department of Emergency, Sichuan Province Orthopedics Hospital, Chengdu 610041, Sichuan, China
| | - Mai Yang
- Mai Yang, Department of Emergency, Sichuan Province Orthopedics Hospital, Chengdu 610041, Sichuan, China
| | - Hai Shen
- Hai Shen, Department of Emergency, Sichuan Province Orthopedics Hospital, Chengdu 610041, Sichuan, China
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Paratz E, Page GJ, Jennings GL. Defibrillator access across Australia: the first step in avoiding a chain of fatality. Med J Aust 2023; 219:146-148. [PMID: 37517008 DOI: 10.5694/mja2.52041] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 06/15/2023] [Accepted: 06/20/2023] [Indexed: 08/01/2023]
Affiliation(s)
| | | | - Garry Lr Jennings
- Baker Heart and Diabetes Institute, Melbourne, VIC
- University of Sydney, Sydney, NSW
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Ibrahim L, Wilson C, Tham D, Corden M, Jani S, Zhang M, Kochar A, Tan KF, George S, Phillips NT, Buntine P, Robins‐Browne K, Chong V, Georgeson T, Lithgow A, Davidson S, O'Brien S, Tran V, Babl FE. The characteristics of SARS-CoV-2-positive children in Australian hospitals: a PREDICT network study. Med J Aust 2023; 218:460-466. [PMID: 37087105 PMCID: PMC10953026 DOI: 10.5694/mja2.51934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 03/16/2023] [Accepted: 03/16/2023] [Indexed: 04/24/2023]
Abstract
OBJECTIVES To examine the clinical characteristics and short term outcomes for children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections who presented to Australian hospitals during 2020 and 2021. DESIGN, SETTING Retrospective case review study in nineteen hospitals of the Paediatric Research in Emergency Departments International Collaborative (PREDICT) network from all Australian states and territories, including seven major paediatric tertiary centres and eight Victorian hospitals. PARTICIPANTS SARS-CoV-2-positive people under 18 years of age who attended emergency departments or were admitted to hospital during 1 February 2020 - 31 December 2021. MAIN OUTCOME MEASURES Epidemiological and clinical characteristics, by hospital care type (emergency department [ED] or inpatient care). RESULTS A total of 1193 SARS-CoV-2-positive children and adolescents (527 girls, 44%) attended the participating hospitals (107 in 2020, 1086 in 2021). Their median age was 3.8 years (interquartile range [IQR], 0.8-11.4 years); 63 were Aboriginal or Torres Strait Islander people (5%). Other medical conditions were recorded for 293 children (25%), including asthma (86, 7%) and premature birth (68, 6%). Medical interventions were not required during 795 of 1181 ED presentations (67%); children were discharged directly home in 764 cases (65%) and admitted to hospital in 282 (24%; sixteen to intensive care units). The 384 admissions to hospital (including 102 direct admissions) of 341 children (25 infants under one month of age) included 23 to intensive care (6%); the median length of stay was three days (IQR, 1-9 days). Medical interventions were not required during 261 admissions (68%); 44 children received respiratory support (11%) and 21 COVID-19-specific treatments, including antiviral and biologic agents (5%). Being under three months of age (v one year to less than six years: odds ratio [OR], 2.6; 95% confidence interval [CI], 1.7-4.0) and pre-existing medical conditions (OR, 2.5; 95% CI, 1.9-3.2) were the major predictors of hospital admission. Two children died, including one without a known pre-existing medical condition. CONCLUSION During 2020 and 2021, most SARS-CoV-2-positive children and adolescents who presented to participating hospitals could be managed as outpatients. Outcomes were generally good, including for those admitted to hospital.
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Affiliation(s)
- Laila Ibrahim
- Royal Children's HospitalMelbourneMelbourneVIC
- Murdoch Children's Research InstituteMelbourneVIC
| | - Catherine Wilson
- Murdoch Children's Research InstituteMelbourneVIC
- PREDICT Research NetworkMelbourneVIC
| | - Doris Tham
- Murdoch Children's Research InstituteMelbourneVIC
- Western HealthMelbourneVIC
| | | | - Shefali Jani
- The Children's Hospital at WestmeadSydneyNSW
- The Children's Hospital at Westmead Clinical Schoolthe University of SydneySydneyNSW
| | - Michael Zhang
- PREDICT Research NetworkMelbourneVIC
- John Hunter HospitalNewcastleNSW
| | | | - Ker Fern Tan
- Auburn HospitalSydneyNSW
- University of Notre DameSydneyNSW
| | - Shane George
- Gold Coast University HospitalGold CoastQLD
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
| | - Natalie T Phillips
- Child Health Research Centrethe University of QueenslandBrisbaneQLD
- Queensland Children's HospitalBrisbaneQLD
| | - Paul Buntine
- Eastern HealthMelbourneVIC
- Eastern Health Clinical SchoolMonash UniversityMelbourneVIC
| | | | | | | | | | | | - Sharon O'Brien
- Perth Children's HospitalPerthWA
- Curtin UniversityPerthWA
| | - Viet Tran
- Royal Hobart HospitalHobartTAS
- Tasmanian School of MedicineUniversity of TasmaniaHobartTAS
| | - Franz E Babl
- Murdoch Children's Research InstituteMelbourneVIC
- The University of MelbourneMelbourneVIC
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Ashok M, Lumsden C, Myers A, Yoon R. Emergency dental treatment among patients waitlisted for the operating room. J Clin Pediatr Dent 2023; 47:54-58. [PMID: 37143421 DOI: 10.22514/jocpd.2023.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 12/09/2022] [Indexed: 05/06/2023] Open
Abstract
This restrospective chart review examined dental emergencies among patients waitlisted for the operating room at an outpatient community dental clinic in a large academic medical center. Dental records of ASA I or II patients, who had dental restorations and/or extractions in the operating room between July 2015 to May 2019 were reviewed. Length of time the patient was waitlisted and number of emergency dental treatments (i.e., therapeutic pulpotomy or a dental extraction due to acute dental pain or infection) completed in the outpatient dental clinic during the wait period were collected. Data were dichotomized as <2 and ≥2 emergency treatments. Kruskal-Wallis test was used to compare the groups. Of 417 charts reviewed, 294 patients met the inclusion criteria. The average time on the waitlist was 228 days. The majority of patients (n = 222; 75.3%) had no emergency dental treatment while waitlisted. Those who had two or more emergency treatments (n = 34; 11.5%) were waitlisted longer than those who had fewer than two (n = 261; 88.5%) (p < 0.05). This study highlights the importance of early intervention (e.g., scheduled periodic follow-ups, interim caries arresting medication) and an ongoing discussion of possible alternatives while waitlisted. Future research identifying predictors of utilization of emergency services while waitlisted is warranted and may help identify those at increased risk of developing acute dental emergencies.
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Affiliation(s)
| | - Christie Lumsden
- Section of Oral, Diagnostic and Rehabilitation Sciences at the College of Dental Medicine, Columbia University Medical Center, 10032 New York, NY, USA
| | - Aaron Myers
- Section of Growth and Development, College of Dental Medicine, Columbia University Medical Center, 10032 New York, NY, USA
| | - Richard Yoon
- Section of Growth and Development, College of Dental Medicine, Columbia University Medical Center, 10032 New York, NY, USA
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Qian Y, Song J, Zheng X. Free fillet flap transplantation using amputated upper limbs for shoulder defect coverage and joint function salvage in emergency treatment-A case report. Int J Surg Case Rep 2023; 106:108176. [PMID: 37058798 PMCID: PMC10123241 DOI: 10.1016/j.ijscr.2023.108176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 04/04/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Severe limb trauma results in mangled extremities, amputation, uncovered wound and delayed healing. The rapid development of flap transplantation concept and technique leads to applications of free flap in the salvage of limb and articular appearance and functions. This report discusses the case of a patient with acute shoulder avulsion and smashed injuries and evaluates the feasibility and safety of free fillet flap transplantation in emergency treatment. CASE PRESENTATION A 44-year-old man presented with acute traumatic severing injury to the left arm. We performed free fillet flap transplantation from the amputated forearms to retain the structure of shoulder joint and coverage of humerus in a patient who suffered from acute shoulder avulsion and smashed injuries. Moreover, we evaluated the long-term outcomes at 2-year follow-up and confirmed the functional adaptivity of proximal stump of the shoulder joint. CLINICAL DISCUSSION The free fillet flap application is an important and advanced technique to cover large areas of skin and soft tissue defects in a mangled upper limb. It requires an experienced microsurgeon to achieve vessel reconnection, flap transfer and wound repair. In such an emergency case like this one, it calls for collaboration between different departments to work out a delicate and comprehensive plan in order to obtain the best possible result for saving patients. CONCLUSION The free fillet flap transfer in this report is feasible and useful for shoulder defect coverage and joint function salvage in emergency treatment.
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Affiliation(s)
- Yun Qian
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jialin Song
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Xianyou Zheng
- Department of Orthopaedics, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Shimpi N, Glurich I, Gabor R, Chyou PH, Nycz G, Acharya A. Impact of Establishing Dental Access for Preventable Infectious Dental Diseases (PIDD) in Medical Settings: Case Study from Rural Wisconsin. Community Dent Health 2023; 40:23-29. [PMID: 36269067 DOI: 10.1922/cdh_00102shimpi07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 09/11/2022] [Indexed: 03/03/2023]
Abstract
OBJECTIVE The frequency of Preventable Infectious Dental Disease (PIDD) visits in medical centers was examined pre and post establishment of expanded dental access and adoption of an integrated medical-dental care delivery model. METHODS A retrospective observational study of patient attributes and frequency of unscheduled PIDD visits between January 1, 1990 and February 29, 2020. Chi-squared tests compared (a) the number of PIDD visits (pre/post dental center establishment), (b) age at first diagnosis, (c) gender, (d) race, (e) primary insurance at the time of PIDD visits and (f) healthcare setting where visit occurred. RESULTS System-wide, 21,957 unique patients were documented with a total of 34,892 PIDD visits as the primary diagnosis. Patients between 18-30 years and patients with Medicaid had the highest frequency of PIDD visits in medical settings. Following the establishment of dental centers, reduced relative risk of PIDD visits was observed for patients with no health insurance or self-pay/other coverage. PIDD visits in primary care settings was 0.87 times as likely as PIDD visits at ED/UCs after dental centers opened. CONCLUSIONS The number of PIDD visits to medical centers increased before the dental infrastructure was established, followed by a decline afterwards, inclusive of disparity populations. Some residual persistence of PIDD visits to primary care settings was identified. This study reinforced importance of dental healthcare access for achieving appropriate PIDD management while reducing PIDD visits to medical settings.
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Affiliation(s)
- N Shimpi
- Center for Clinical Epidemiology and Population Health, Marshfield Clinic Research Institute, USA
| | - I Glurich
- Marshfield Clinic Research Institute, USA
| | - R Gabor
- Office of Research Computing and Analytics, Marshfield Clinic, Research Institute, USA
| | - P-H Chyou
- Office of Research Computing and Analytics, Marshfield Clinic, Research Institute, USA
| | - G Nycz
- Family Health Center for Marshfield Inc, Marshfield Clinic Health System, USA
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Khomvilai S, Pattarajierapan S. Comparison of long-term outcomes of colonic stenting as a "bridge to surgery" and emergency surgery in patients with left-sided malignant colonic obstruction. Ann Coloproctol 2023; 39:17-26. [PMID: 34324803 PMCID: PMC10009074 DOI: 10.3393/ac.2021.00227.0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE Long-term oncologic outcomes of colonic stenting as a "bridge to surgery" in patients with left-sided malignant colonic obstruction (LMCO) are unclear. This study was performed to compare long-term outcomes of self-expandable metal stent (SEMS) insertion as a bridge to surgery and emergency surgery in patients with acute LMCO. METHODS This retrospective cohort study included patients with acute LMCO who underwent SEMS insertion as a bridge to surgery or emergency surgery. The primary outcomes were 5-year disease-free survival (DFS), overall survival (OS), and recurrence rate. Survival outcomes were determined using the Kaplan-Meier method and compared using log-rank tests. RESULTS There was a trend of worsening 5-year OS rate in the SEMS group compared with emergency surgery group (45% vs. 57%, P=0.07). In stage-wise subgroup analyses, a trend of deteriorating 5-year OS rate in the SEMS group with stage III (43% vs. 59%, P=0.06) was observed. The 5-year DFS and recurrence rate were not different between groups. The overall median follow-up time was 58 months. On multivariate analysis, age of ≥65 years and American Joint Committee on Cancer stage of ≥III, and synchronous metastasis were significant poor prognostic factors for OS (hazard ratio [HR], 1.709; 95% confidence interval [CI], 1.007-2.900; P=0.05/HR, 1.988; 95% CI, 1.038-3.809; P=0.04/HR, 2.146; 95% CI, 1.191-3.866; P=0.01; respectively). CONCLUSION SEMS as a bridge to surgery may have adverse oncologic outcomes. Patients in the SEMS group had a trend of worsening 5-year OS rate without higher recurrence.
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Affiliation(s)
- Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Pattarajierapan S, Sukphol N, Junmitsakul K, Khomvilai S. Oncologic safety of colonic stenting as a bridge to surgery in left-sided malignant colonic obstruction: Current evidence and prospects. World J Clin Oncol 2022; 13:943-956. [PMID: 36618077 PMCID: PMC9813833 DOI: 10.5306/wjco.v13.i12.943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/10/2022] [Accepted: 12/08/2022] [Indexed: 12/19/2022] Open
Abstract
Approximately 7%-29% of patients with colorectal cancer present with colonic obstruction. The concept of self-expandable metal stent (SEMS) insertion as a bridge to surgery (BTS) is appealing. However, concerns on colonic stenting possibly impairing oncologic outcomes have been raised. This study aimed to review current evidence on the short- and long-term oncologic outcomes of SEMS insertion as BTS for left-sided malignant colonic obstruction. For short-term outcomes, colonic stenting facilitates a laparoscopic approach, increases the likelihood of primary anastomosis without a stoma, and may decrease postoperative morbidity. However, SEMS-related perforation also increases local recurrence and impairs overall survival. Moreover, colonic stenting may cause negative oncologic outcomes even without perforation. SEMS can induce shear forces on the tumor, leading to increased circulating cancer cells and aggressive pathological characteristics, including perineural and lymphovascular invasion. The conflicting evidence has led to discordant guidelines. Well-designed collaborative studies that integrate both oncologic outcomes and data on basic research (e.g., alteration of circulating tumors) are needed to clarify the actual benefit of colonic stenting as BTS.
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Affiliation(s)
- Sukit Pattarajierapan
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nattapanee Sukphol
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Karuna Junmitsakul
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Supakij Khomvilai
- Surgical Endoscopy Colorectal Division, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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22
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Thate S, Volmerg JS, Leenderts F, Majeed R, Grabenhenrich L, Röhrig R, Seeger I. [Use of emergency services for suicide attempts during the SARS-CoV-2 pandemic-a prevalence study]. Notf Rett Med 2022:1-10. [PMID: 36567955 PMCID: PMC9764311 DOI: 10.1007/s10049-022-01107-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Background The pandemic has caused several changes in the emergency care system. The deployment figures in emergency medical services have shown atypical fluctuations. This has also been explained by changes in behavior and an increased sense of stress among the population. Existing research provides hints for the increased incidence of mental health symptoms in emergency care during ongoing pandemics. Objective In this context, this paper examines the occurrence of emergency medical services calls related to the keyword suicide in relation to total calls. Methods This is a retrospective cross-sectional study based on routine documentation from a fire and rescue dispatch center with descriptive and exploratory data analyses. The data are divided by settlement-structural county types and compared with incidences and pandemic phases. Results Phase 1 and 2a show a decrease in the number of dispatches during the pandemic. In addition, there is a shift in the number of dispatch cases with a context of suicide by structure types in phase 3. A decreased dispatch rate in the sparsely populated rural county is offset by an increase in the metropolitan area. Changes made to the control center system resulted in an increase in the number of dispatch cases in the context of suicide. Conclusion Continuous mental health surveillance, including data collected by emergency medical services, can provide valuable insight. The study also highlights the need for standardization of emergency dispatch center data.
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Affiliation(s)
- Stefan Thate
- Stadt Oldenburg – Feuerwehr, 26105 Oldenburg, Deutschland
- Oldenburger Forschungsnetzwerk Notfall und Intensivmedizin (OFNI), Carl von Ossietzky Universität, Oldenburg, Deutschland
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - Julia S. Volmerg
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | | | - Raphael Majeed
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - Linus Grabenhenrich
- Methodenentwicklung und Forschungsinfrastruktur, Robert Koch-Institut, Berlin, Deutschland
- Charité – Universitätsmedizin, Berlin, Deutschland
| | - Rainer Röhrig
- Institut für Medizinische Informatik, Medizinische Fakultät, RWTH Aachen, Aachen, Deutschland
| | - Insa Seeger
- Oldenburger Forschungsnetzwerk Notfall und Intensivmedizin (OFNI), Carl von Ossietzky Universität, Oldenburg, Deutschland
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Kim YE, Lee HY. The effects of an emergency department length-of-stay management system on severely ill patients' treatment outcomes. BMC Emerg Med 2022; 22:204. [PMID: 36513973 PMCID: PMC9745968 DOI: 10.1186/s12873-022-00760-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 11/30/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE This study aimed to compare the length of stay (LOS) and treatment outcomes based on the application and achievement of a newly developed emergency department (ED) LOS management system for severely ill patients. METHODS Data were retrospectively collected from electronic medical records (EMRs) for the system evaluation and research purpose. The study subjects are severely ill patients whose diagnosis codes are designated by the Ministry of Health and Welfare and who visited the ED of a tertiary hospital from January to December 2019. The control group (Group 1) refers to those who have neither applied nor achieved the goal (5 hours or less) of the ED LOS management system even after it was applied, and the experimental group (Group 2) refers to those who have achieved the 5-hour goal after applying the system. RESULTS A total of 2034 severely ill patients applied the ED LOS management system. Group 1 included 837 patients and Group 2 included 1197 patients. Thirty days in-hospital mortality corresponded to 10.6% in Group 1 and 6.6% in Group 2 (χ2 = 10.58, p = .001). The total duration of hospitalization was 14.66 ± 18.26 days in Group 1 and 10.19 ± 16.00 days in Group 2 (t = 9.03, p < .001). Six hundred forty-two patients (76.6%) in Group 1 were discharged to their home (normal discharge) and 979 patients (81.7%) were discharged to their home in Group 2, but the discharge-as-death rate was 14.1% in Group 1 and 7.5% in Group 2 (χ2 = 29.80, p < .001). CONCLUSION With the application and attainment of the ED LOS management system for severely ill patients, we have concluded the new system produced a lower LOS in the ED, 30 days in-hospital mortality, length of the hospitalization, mortality rate, and a higher rate of normal discharge.
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Affiliation(s)
- Young Eun Kim
- grid.414966.80000 0004 0647 5752Department of Emergency Medicine, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul, 06591 South Korea
| | - Hyang Yuol Lee
- grid.411947.e0000 0004 0470 4224College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591 Republic of Korea
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Brockmann C, Dillinger D, Mpotsaris A, Spreer A, Maus V, Waldeck S, Othman AE, Altmann S, Ringel F, Kerz T, Brockmann MA. Safety Profile and Complication Rates in Emergency Off-label Use of Tirofiban in Interventional Neuroradiology : An Observational Dual Center Study. Clin Neuroradiol 2022; 33:427-433. [PMID: 36269346 DOI: 10.1007/s00062-022-01223-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/18/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Tirofiban has been approved for the treatment of acute coronary syndrome. Meanwhile, tirofiban is frequently applied in emergency situations in interventional neuroradiology (INR). The objective of this study was to analyze the risk profile for the off-label use of tirofiban in INR patients. METHODS Data of 86 patients, who underwent neurointerventional therapy and were treated with tirofiban at 2 neuroendovascular centers between January 2016 and July 2017 were retrospectively analyzed. Despite off-label use, recent stroke (< 30 days), recent hemorrhage, thrombocytopenia (< 150,000/µl), activated partial thromboplastin time (aPTT) > 1.3-fold, internation normalised ratio (INR) < 1.5, severe liver insufficiency (Child-Pugh C), and preceding intravenous thrombolysis were considered as contraindications. RESULTS Median patient age was 62 years (range 26-88 years). Patients received tirofiban for extracranial (n = 35) or intracranial stenting (n = 35), coiling of ruptured cerebral aneurysms (n = 6), continuous intra-arterial nimodipine infusion via microcatheters for subarachnoid hemorrhage (SAH)-related vasospasm (n = 5), or thrombotic complications during neuroendovascular procedures (n = 5). The desired effect of preventing thrombotic complications when applying tirofiban off-label was achieved in 81 of 86 patients (94.2%). Relevant tirofiban-associated complications occurred in 14 patients (16.3%), of which 9 patients received i.v. thrombolysis for treatment of acute ischemic stroke shortly before starting therapy with tirofiban. Of the 86 patients 12 died, while the overall tirofiban-related mortality was 2.3% (2 patients died due to ICH). Logistic regression analysis revealed age to be the only parameter significantly associated with development of tirofiban-associated complications (p = 0.026). CONCLUSION Whereas the safety profile of tirofiban when applied off-label in INR is acceptable, the highest risk for relevant tirofiban-associated complications is observed in older patients treated by emergency stenting for acute stroke.
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Affiliation(s)
- Carolin Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Daniel Dillinger
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Anastasios Mpotsaris
- Department of Neuroradiology, Munich Klinik, Thalkirchner Str. 48, 80337, Munich, Germany
| | - Annette Spreer
- Department of Neurology, Klinikum Braunschweig, Salzdahlumer Straße 90, 38126, Braunschweig, Germany
- Department of Neurology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Volker Maus
- Department of Radiology, Neuroradiology and Nuclear Medicine, Universitätsklinikum Knappschaftskrankenhaus Bochum, In der Schornau 23-25, 44892, Bochum, Germany
| | - Stephan Waldeck
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology and Neuroradiology, Bundeswehr Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany
| | - Ahmed E Othman
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Sebastian Altmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Florian Ringel
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Thomas Kerz
- Department of Neurosurgery, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Marc A Brockmann
- Department of Neuroradiology, University Medical Center Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
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Mølgaard C, Bro F, Mygind A. What GPs do to meet accreditation standards - implementation activities and perceived improvements attributed to general practice accreditation. BMC Prim Care 2022; 23:265. [PMID: 36243686 PMCID: PMC9571477 DOI: 10.1186/s12875-022-01864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 09/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Healthcare accreditation is a widely implemented tool used to enhance the quality of care and underpin quality control. However, research is sparse on the accreditation process in general practice. The aim of this study was to explore how team-based implementation activities preceding accreditation were associated with self-perceived improvements in emergency preparedness (preparedness for urgent disease and cardiac arrest) and handling of prescription renewals in Danish general practice. METHODS GPs (general practitioners) completed a questionnaire exploring practice-team activities conducted to implement two specific accreditation standards and the related improvements as perceived by the GPs. The following implementation activities were selected, inspired by Normalization Process Theory: Common understanding (obtaining a common understanding of the purpose of implementing changes according to the accreditation standard), key person (assigning a key person responsible for working with the standard), and easy integration (finding it easy to integrate changes into existing working procedures). Data were analysed with logistic regression, and adjusted analyses included practice type, number of GP partners, number of staff, training site for junior GPs and administrative region. RESULTS The total response rate was 74% (n = 920). Around 80% of the clinics reported having conducted team-based implementation activities. Almost half of the clinics (48%) reported perceived improvements in the emergency preparedness, and 30% reported perceived improvements in the handling of prescription renewals. Obtaining a common understanding was found to have a strong, significant association with perceived improvements in the emergency preparedness (OR = 5.07 (3.06-8.40)) and handling of prescription renewals (OR = 3.66 (2.07-6.46)). Easy integration of changes was also significantly associated with improvements in both emergency preparedness (OR = 1.88 (1.24-2.85)) and handling of prescription renewals (OR = 2.34 (1.44-3.79)), whereas assigning a key person was only significantly associated with improved emergency preparedness (OR = 1.95 (1.19-3.19)). CONCLUSION Clinical quality initiatives that involve collaboration within a practice team are more likely to cause improvements if specific team-based implementation activities are conducted. It is particularly important to facilitate a common understanding of the purpose of the initiative. Therefore, external support for quality initiatives aiming at the practice level in general practice should facilitate such team-based activities.
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Affiliation(s)
- Cecilie Mølgaard
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark ,Grangårdsvej 58, 9530 Støvring, Denmark
| | - Flemming Bro
- grid.7048.b0000 0001 1956 2722Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C, Denmark ,grid.5254.60000 0001 0674 042XResearch Unit for General Practice, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
| | - Anna Mygind
- grid.5254.60000 0001 0674 042XResearch Unit for General Practice, Bartholins Allé 2, DK-8000 Aarhus C, Denmark
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Chu K, Kelly A, Kinnear F, Keijzers G, Kamona S. Primary headache drug treatment in emergency departments in Australia and New Zealand. Med J Aust 2022; 217:366-367. [PMID: 35916121 PMCID: PMC9804343 DOI: 10.5694/mja2.51670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Kevin Chu
- The University of QueenslandBrisbaneQLD,Royal Brisbane and Women's HospitalBrisbaneQLD
| | - Anne‐Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western HealthMelbourneVIC
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Liu B, Gao Y, Ye K, Yang Z, Hou G, Zhang Z, Ji H, Zhou F, Tian Y. Cervical Spine Fracture Prediction by Simple Plain X-Ray in Ankylosing Spondylitis Patients after Low-Energy Trauma. Orthop Surg 2022; 14:2939-2946. [PMID: 36178011 PMCID: PMC9627076 DOI: 10.1111/os.13423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022] Open
Abstract
Objective Timely diagnosis is essential in the management of cervical spine fracture (CSF) in ankylosing spondylitis (AS) patients. However, the value of simple plain X‐ray in the early management of ASCSF has not been well‐studied. This study aimed to explore the prediction ability of simple plain X‐ray for CSF in AS patients who suffer from low‐energy trauma (LET). Methods From January 2010 to December 2020, AS patients who experienced LET were retrospectively reviewed. Clinical data including gender, age, body mass index, time interval between AS diagnosis and trauma, smoking or not, and a presence of continuous bony bridge between anterior margin of C1 and C2 body or not were collected. Morphological features including atlanto‐occipital gap, Pavlov ratio of C2–7, Angle A–D, Borden's index, and Harrison's value were measured by the lateral cervical X‐ray. All data was compared between patients who had CSF and those who did not. Binary logistic regression analysis and receiver operator characteristic (ROC) curves were applied to discriminate and assess the predictive parameters. Results A total of 129 AS patients were divided into Fracture group (41 cases) and Non‐fracture group (88 cases) based on whether CSF existed. Twelve parameters showed significant differences between two groups (p < 0.05). According to the binary logistic regression model, four of the 12 parameters showed a further correlation with the occurrence of CSF, namely, mean Pavlov ratio (p < 0.001, OR = 0.067, 95% CI: 0.023 to 0.194), Angle D (p = 0.031, OR = 1.057, 95% CI: 1.005 to 1.112), Borden's index (p = 0.042, OR = 1.131, 95% CI: 0.994 to 1.287), the time interval between the AS diagnosis and the trauma (p < 0.020, OR = 0.935, 95% CI: 0.883 to 0.990). The ROC curve further revealed the mean Pavlov ratio had the largest AUC (0.793) with the cut‐off of 0.72. While the optimal cut‐off value was 45.65° for Angle D (sensitivity = 61.0%, specificity = 78.4%), 9.79 for Borden's index (sensitivity = 87.8%, specificity = 37.5%), 15.50 years for the time interval between AS diagnosis and trauma (sensitivity = 70.7%, specificity = 56.8%). Conclusions The time interval between the AS diagnosis and the trauma, mean Pavlov ratio, Angle D, and Borden's index showed predictive ability for the occurrence of CSF in AS patients who encounter LET. Surgeons should consider measuring these parameters in the management of AS patient.
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Affiliation(s)
- Bingchuan Liu
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Yitian Gao
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Kaifeng Ye
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Zhongwei Yang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Guojin Hou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Zhishan Zhang
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Hongquan Ji
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
| | - Yun Tian
- Department of Orthopedics, Peking University Third Hospital, Beijing, China.,Beijing Key Laboratory of Spinal Disease Research, Peking University Third Hospital, Beijing, China
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Vielsmeier V, Hackenberg S, Schelzig H, Knapsis A. [Update on neck trauma]. HNO 2022; 70:724-735. [PMID: 36066623 DOI: 10.1007/s00106-022-01214-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Important organs and structures are located in the cervical region. In case of blunt and penetrating trauma, emergency situations may arise. OBJECTIVE Emergency management as well as diagnostic and therapeutic steps pertaining to neck injuries are presented. CONCLUSION Shock therapy and airway management are essential, fast management of neck injuries highly relevant.
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Affiliation(s)
- V Vielsmeier
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Universitätsklinikum Regensburg, Regensburg, Deutschland.
| | - S Hackenberg
- Klinik für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie, Uniklinik RWTH Aachen, Aachen, Deutschland
| | - H Schelzig
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - A Knapsis
- Klinik für Gefäß- und Endovaskularchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
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Wang J, Zhao MS, Yan HL, Ma HW. [Association of organizational climate perception withwork-related acceptance actions and work engagement among nurses in emergency department]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:573-577. [PMID: 36052585 DOI: 10.3760/cma.j.cn121094-20211011-00497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To understand the current situation of emergency department nurses' work engagement, and analyze the relationship between emergency department nurses' organizational climate perception, work-related acceptance actions and work engagement. Methods: In May 2021, 273 emergency department nurses from 6 class Ⅲ class a general hospitals in Tianjin were selected as the research objects by using the convenient sampling method, and the general information questionnaire, work input scale, nurses' organizational climate perception scale and work-related acceptance action questionnaire were used for questionnaire survey. The correlation between job involvement and nurses' organizational climate perception and job-related acceptance action was analyzed by pearson correlation, and the influencing factors of job involvement were analyzed by multiple linear regression. Results: The average score of job involvement was (3.57±0.45) , the average score of nurses' organizational climate perception was (3.29±0.69) , and the score of work-related acceptance action was 35.00 (29.00, 47.00) . The results of correlation analysis showed that there was a positive correlation between nurses' organizational climate perception, job acceptance action and job involvement in emergency department (r=0.435, 0.518, P<0.05) . Multiple stepwise regression analysis showed that job acceptance, nurses' perception of organizational climate, health status, specialist nurses, education and emergency work years were the influencing factors of emergency department nurses' job involvement (P<0.05) , accounting for 41.9% of the total variation. Conclusion: We should create a good organizational atmosphere, improve the acceptance of emergency department nurses to nursing work, and improve the level of nurses' work input.
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Affiliation(s)
- J Wang
- Tianjin People's Hospital, Tianjin 300122, China
| | - M S Zhao
- Tianjin People's Hospital, Tianjin 300122, China
| | - H L Yan
- Tianjin People's Hospital, Tianjin 300122, China
| | - H W Ma
- Tianjin People's Hospital, Tianjin 300122, China
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Paily VP, Raj G R, Sidhik A, Sudhamma A, Neelankavil JJ, Usha MG, George R, Cheriyan S, Ramakrishnan S, John TE, Vishnu D, Pradeep M. Arresting post-partum hemorrhage using the novel trans-vaginal uterine artery clamp. Eur J Obstet Gynecol Reprod Biol 2022; 272:6-15. [PMID: 35276445 DOI: 10.1016/j.ejogrb.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/28/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Post-partum hemorrhage (PPH) continues to be the leading cause of maternal mortality in low-resource settings. The commonest variant - Atonic PPH, is managed by additional pharmacological measures which may fail. Additional surgical interventions for hemostasis take time and are not universally available. Immediate arrest of bleeding was deemed essential and a novel Transvaginal Uterine Artery Clamp (TVUAC) was explored for its effectiveness in achieving immediate hemostasis in atonic and mixed post-partum hemorrhage. STUDY DESIGN A retrospective chart review was performed for all patients, who underwent vaginal delivery and developed immediate post-partum atonic PPH, in a tertiary care center in South India, between 1st April 2015 and 31st December 2020. As soon as excess bleeding was observed, two TVUACs were applied trans-vaginally at 3' and 9'o clock position of the cervix to occlude the uterine arteries where it joins the isthmus of the uterus. RESULTS Of 3999 vaginal deliveries, there were 251 patients who developed primary atonic PPH during the study period, of which 89 were managed by medical measures alone. Out of the remaining 162 patients, in 153 (94.4%) TVUAC helped to achieve hemostasis; with TVUAC alone in 120 patients (78.43%) and with an additional second line surgical intervention in 33 patients. In nine patients, TVUAC was not readily available and hence second line interventions alone were used. None required any third line surgical interventions (laparotomies) for hemostasis nor were there any incident of maternal mortality or consumptive coagulopathy. TVUAC was applied for a mean duration of 25 ± 10 min. Only 11.6% (29/251, 95% C.I 7.9-16.1%) of the patients required a blood transfusion with a median of 2 (1-4) units of packed RBC. No procedure related complications were reported up to a scheduled 6th week in-person follow-up. CONCLUSION The novel TVUAC shows potential in limiting third line interventions, maternal morbidity and mortality. Its effectiveness and safety may be further explored as a first line surgical adjunct to medical measures, in PPH protocols in low-resource settings.
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Wang Z, Liang T, Song G, Lin J, Xiao Y, Wang F, Zhang K, Zhang J, Xu Y, Fu Q, Song L. The effects of primary realignment or suprapubic cystostomy on prostatic displacement in patients with pelvic fracture urethral injury: a clinical study based on MR urethrography. Injury 2022; 53:534-538. [PMID: 34645564 DOI: 10.1016/j.injury.2021.09.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 05/16/2021] [Accepted: 09/26/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND To provide direct evidence of whether primary realignment (PR) or suprapubic cystostomy (SPC) had different effects on the prostatic displacement and prognosis in patients with pelvic fracture urethral injury who needed delay anastomotic urethroplasty based on Magnetic Resonance (MR) urethrography. METHODS We screened the urethral stenosis database of our single institution from January 2016 to June 2020. Patients who underwent delayed anastomotic urethroplasty with a preoperative MR urethrography and no treatment history of urethra were included. We compared the urethral gap length and prostatic displacement between the PR and SPC group based on MR urethrography. The terminal outcomes such as stenosis-free rate, urinary continence and erectile function were also analyzed between two groups. RESULTS 66 patients were included in this retrospective study in which 36 were in PR group and 30 in SPC group. Mean follow-up time was 15.1 months (3-38 months). One and two patients experienced recurrence of stenosis after urethroplasty in two groups (p = 1.000). No difference of erectile dysfunction and urinary incontinence was found between two groups. Based on MR urethrography, the urethral gap length was 17.4 mm and 23.3 mm (p = 0.008) which presented a significant decrease in PR group. The superior prostatic displacement was similar in two groups (9.8 mm vs. 13.8 mm, p = 0.081). The numbers and distance of displacement on lateral aspect showed no difference, either. However, PR group had less anterior-posterior prostatic displacement (p = 0.005). Besides, the erectile function was significantly related to the lateral prostatic displacement (p = 0.030/0.047). CONCLUSIONS Based on MR urethrography, patients in PR group showed shorter urethral gap distance and slighter anterior-posterior prostatic displacement without extra erectile dysfunction or incontinence. Besides, patients' erectile function might be significantly related to the lateral prostatic displacement.
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Affiliation(s)
- Zeyu Wang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Tao Liang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Guoping Song
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Jiahao Lin
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Yunfeng Xiao
- Department of Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China.
| | - Feixiang Wang
- Shanghai Key Laboratory of Forensic Medicine, Academy of Forensic Science, Shanghai, 200063, China.
| | - Kaile Zhang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Jiong Zhang
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Yuemin Xu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Qiang Fu
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
| | - Lujie Song
- Department of Urology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; Shanghai Eastern Institute of Urologic Reconstruction, Shanghai, 200233, China.
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Gao Y, Liao LP, Chen P, Wang K, Huang C, Chen Y, Mou SY. Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury. World J Clin Cases 2021; 9:11265-11275. [PMID: 35071557 PMCID: PMC8717492 DOI: 10.12998/wjcc.v9.i36.11265] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/17/2021] [Accepted: 11/15/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Severe craniocerebral injury (STBI) is a critical physical trauma caused by a sudden external force acting on the head. The condition is complex and changeable, and disability and mortality rates are high. Although the life of STBI patients can be saved through treatment, the sequelae of consciousness, speech, cognitive impairment, stiffness, spasm, pain and abnormal behavior in the early rehabilitation stage can be a heavy burden to a family. In the past, routine nursing was often used to treat/manage STBI; however, problems, such as improper cooperation and untimely communication, reduced therapeutic effectiveness.
AIM To investigate the effect of a proposed care bundle to optimize the first aid process and assess its effectiveness on the early rehabilitation nursing of patients with STBI.
METHODS From January 2019 to December 2020, 126 STBI patients were admitted to the emergency department of Chongqing Emergency Medical Center. These patients were retrospectively selected as the research participants in the current study. The study participants were then divided into a control group (61 cases) and a study group (65 cases). The control group was treated with routine nursing. The study group adopted the proposed care bundle. The National Institutes of Health Stroke Scale/Score and Glasgow Coma Scale (GCS) were used to evaluate neurological function before and after emergency treatment. After 3 mo of rehabilitation, experimental outcomes were assessed. These included the GCS, Barthel Index, complication rate, muscle strength grade and satisfaction.
RESULTS There was no significant difference in gender, age, cause of injury and GCS between the two groups. After emergency, the National Institutes of Health Stroke Scale/Score of the study group (10.23 ± 3.26) was lower than that of the control group (14.79 ± 3.14). The GCS score of the study group (12.48 ± 2.38) was higher than that of the control group (9.32 ± 2.01). The arrival time of consultation in the study group was 20.56 ± 19.12, and the retention time in the emergency room was 45.12 ± 10.21, which were significantly shorter than those in the control group. After 3 mo of rehabilitation management, the GCS and Barthel Index of the study group were 14.56 ± 3.75 and 58.14 ± 12.14, respectively, which were significantly higher than those of the control group. The incidence of complications in the study group (15.38%) was significantly lower than that in the control group (32.79%). The proportion of muscle strength ≥ grade III in the study group (89.23%) was significantly higher than that in the control group (50.82%). The satisfaction of patients in the study group was significantly higher than that in the control group.
CONCLUSION Care bundles are used to optimize the nursing process. During first-aid, care bundles can effectively improve the rescue effect and improve neurological function of STBI patients as well as shorten the treatment time. In early rehabilitation, they can effectively improve the consciousness of STBI patients, improve the activities of daily living, reduce the risk of complications, accelerate the recovery of muscle strength and improve their satisfaction.
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Affiliation(s)
- Ying Gao
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Li-Ping Liao
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Peng Chen
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ke Wang
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Cui Huang
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Ying Chen
- Department of Neurosurgery, Chongqing Emergency Medical Center, Chongqing 400014, China
| | - Shao-Yu Mou
- School of Nursing, Chongqing Medical University, Chongqing 400016, China
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Osman AD, Howell J, Smithies L, Wilson D, Lam L, Moran J, Jones D, Taylor DM. Assessment of emergency department staff awareness, access and utilisation of advance care directives and goals of care: A cross-sectional survey. Australas Emerg Care 2021; 25:235-240. [PMID: 34906442 DOI: 10.1016/j.auec.2021.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/06/2021] [Accepted: 12/06/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Emergency department staff awareness, access and implementation of advance care directives and goals of care documents and the related patient consent processes are important but not well understood. METHODS A cross-sectional survey using purposive sampling was undertaken at a tertiary hospital's Emergency Department from 15th March to 26th April 2021. Participants were recruited through online platforms. Pre-validated questionnaires were distributed by email or as QR codes on bulletin boards. Data collected included staff: demographics, knowledge, access and implementation of advance care directives and goals of care documentation. RESULTS One hundred thirty-four (28%) of 476 targeted participants responded with nursing forming largest group. Results showed that previous attendance of advance care planning education was low at 20%. Familiarity with advance care directive documentations was only 19% while with goals of care document was average. 61 (48%) respondents reported ease of accessing electronic documents and 21 (19%) reported feeling very comfortable discussing and setting goals of care with patients (p = <0.01). CONCLUSIONS Staff awareness of advance care directive was poor, while awareness of goals of care was average. There was no association between advance care directives awareness and staff age group, gender, length of: - professional practice, practice at the study site.
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Affiliation(s)
- Abdi D Osman
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; School of Health, Federation University Australia, Victoria, Australia.
| | - Jocelyn Howell
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Lisa Smithies
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; Faculty of Arts, University of Melbourne, Parkville, Victoria, Australia
| | - Damian Wilson
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia
| | - Louisa Lam
- School of Health, Federation University Australia, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Juli Moran
- Department of Palliative Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - Daryl Jones
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia; Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia
| | - David M Taylor
- Emergency Department, Austin Hospital, Heidelberg, Victoria, Australia; Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
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Sigari C, Biberthaler P. Medical drones: Disruptive technology makes the future happen. Unfallchirurg 2021; 124:974-976. [PMID: 34714357 PMCID: PMC8554499 DOI: 10.1007/s00113-021-01095-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 11/21/2022]
Abstract
Trauma surgery has always been driven forward by innovative technological advancements. The recent appearance of “advanced air mobility” (AAM) represents one of the next steps in these technological developments. These innovative flying systems have major implications for all of the various healthcare stages in trauma surgery: Unmanned aircraft systems, or drones, can deliver critical supplies on demand, just in time, without physical contact, within the “last mile delivery” concept, such as AEDs, critical medication, blood for transfusion etc. Electric vertical take-off and landing (eVTOL) devices add new horizons for healthcare thanks to the smallest take-off and landing areas. These eVTOLs are not only new aircraft but, thanks to the autonomous flying options, they are flying computers with novel technological opportunities on board. With these new, flying operation systems, the whole rescue chain will be completely revolutionized by much faster response intervals, patient transportation times, telemedical applications, optimized emergency medical services, laboratory transportation etc. Hence, this article aims to provide a tentative overview of these new exciting technological developments in the field of trauma surgery for the benefit of our patients.
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Affiliation(s)
| | - Peter Biberthaler
- Klinik und Poliklinik für Unfallchirurgie, Klinikum rechts der Isar, TU München, Ismaninger Str. 22, 81675, München, Germany.
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Yousefifard M, Madani Neishaboori A, Rafiei Alavi SN, Toloui A, Gubari MIM, Zareie Shab Khaneh A, Karimi Ghahfarokhi M, Hosseini M. Active and Passive Immunization with Myelin Basic Protein as a Method for Early Treatment of Traumatic Spinal Cord Injury; a Meta-Analysis. Arch Acad Emerg Med 2021; 9:e57. [PMID: 34580655 PMCID: PMC8464018 DOI: 10.22037/aaem.v9i1.1316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Introduction: Traumatic spinal cord injury (SCI), as a dangerous central nervous system damage, continues to threaten communities by imposing various disabilities and costs. Early adjustment of the immune system response using Myelin Basic Protein (MBP) immunization may prevent the SCI-related secondary damages. As a result, the current study is designed to review and analyse the evidence on active and passive immunization with MBP for treatment of traumatic SCI. Methods: Medline, Embase, Scopus, and Web of Science databases were systematically searched until the end of 2020. Criteria for inclusion in the current study included pre-clinical studies, which performed passive (injection of MBP-activated T cells) or active (administration of MBP or MBP-modified peptides) immunization with MBP after traumatic SCI. Exclusion criteria was defined as lack of a non-treated SCI group, lack of evaluation of locomotion, review studies, and combination therapy. Finally, analyses were conducted using STATA software, and a standardized mean difference (SMD) with a 95% confidence interval (CI) were reported. Results: Data from 17 papers were included in the present study. Finally, analysis of these data showed that passive immunization (SMD=0.87; 95%CI: 0.19-1.55; p=0.012) and active immunization (SMD=2.08, 95%CI: 1.42-2.73; p<0.001) for/with MBP both have good efficacy in improving locomotion following traumatic SCI. However, significant heterogeneity was observed in both of them. The most important sources of heterogeneity in active immunization were differences in SCI models, route of administration, time interval between SCI and transplantation, and type of vaccine used. In passive immunization, however, these sources were the model of SCI and the time interval between SCI and transplantation. Although, there was substantial heterogeneity among studies, subgroup analysis showed that active immunization improved locomotion after traumatic SCI in all tested conditions (with differences in injury model, severity of injury, method of administration, different time interval between SCI to vaccination, etc.). Conclusion: The results of the present study demonstrated that immunization with MBP, especially in its active form, could significantly improve motor function following SCI in rats and mice. Therefore, it could be considered as a potential treatment in acute settings such as emergency departments. However, the safety of this method is still under debate. Therefore, it is recommended for future research to focus on the investigation of safety of MBP immunization in animal studies, before conducting human clinical trials.
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Affiliation(s)
- Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.,First and second authors have equally contributed to this work
| | - Arian Madani Neishaboori
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.,First and second authors have equally contributed to this work
| | | | - Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammed I M Gubari
- Community Medicine, College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Amirali Zareie Shab Khaneh
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Karimi Ghahfarokhi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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O'Neill C, Najjar Z, Ingleton A, Edwards A, Dawson A, Gupta L. Methaemoglobinaemia associated with the atypical use of sodium nitrite as a food additive. Med J Aust 2021; 215:256-257.e1. [PMID: 34458998 DOI: 10.5694/mja2.51233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/27/2020] [Accepted: 09/01/2020] [Indexed: 11/17/2022]
Affiliation(s)
- Caitlin O'Neill
- Public Health Unit, Sydney Local Health District, Sydney, NSW
| | - Zeina Najjar
- Public Health Unit, Sydney Local Health District, Sydney, NSW
| | - Andrew Ingleton
- Public Health Unit, Sydney Local Health District, Sydney, NSW
| | - Alan Edwards
- Biosecurity and Food Safety, NSW Department of Primary Industries, Sydney, NSW
| | - Andrew Dawson
- NSW Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW
| | - Leena Gupta
- Public Health Unit, Sydney Local Health District, Sydney, NSW.,University of Sydney, Sydney, NSW
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Innes GD, Teichman JMH, Scheuermeyer FX, McRae AD, Grafstein E, Andruchow J, Cheng L, Law MR. Does early intervention improve outcomes for patients with acute ureteral colic? CAN J EMERG MED 2021; 23:679-686. [PMID: 34491558 DOI: 10.1007/s43678-020-00016-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 08/26/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Early surgical intervention is increasingly employed for patients with ureteral colic, but guidelines and current practice are variable. We compared 60-day outcomes for matched patients undergoing early intervention vs. spontaneous passage. METHODS This multicentre propensity-matched cohort analysis used administrative data and chart review to study all eligible emergency department (ED) patients with confirmed 2.0-9.9 mm ureteral stones. Those having planned stone intervention within 5 days comprised the intervention cohort. Controls attempting spontaneous passage were matched to intervention patients based on age, sex, stone width, stone location, hydronephrosis, ED site, ambulance arrival and acuity level. The primary outcome was treatment failure, defined as rescue intervention or hospitalization within 60 days, using a time to event analysis. Secondary outcome was ED revisit rate. RESULTS Among 1154 matched patients, early intervention did not reduce the risk of treatment failure (adjusted hazard ratio 0.94; P = 0.61). By 60 days, 21.8% of patients in both groups experienced the composite primary outcome (difference 0.0%; 95% confidence interval - 4.8 to 4.8%). Intervention patients required more hospitalizations (20.1% vs. 12.8%; difference 7.3%; 95% CI 3.0-11.5%) and ED revisits (36.1% vs. 25.5%; difference 10.6%; 95% CI 5.3-15.9%), but (insignificantly) fewer rescue interventions (18.9% vs. 21.3%; difference - 2.4%; 95% CI - 7.0 to 2.2%). CONCLUSIONS In matched patients with 2.0-9.9 mm ureteral stones, early intervention was associated with similar rates of treatment failure but greater patient morbidity, evidenced by hospitalizations and emergency revisits. Physicians should adopt a selective approach to interventional referral and consider that spontaneous passage probably provides better outcomes for many low-risk patients.
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Affiliation(s)
- Grant D Innes
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada.
| | - Joel M H Teichman
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Frank X Scheuermeyer
- Department of Emergency Medicine and Center for Healthcare Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Andrew D McRae
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Eric Grafstein
- Department of Emergency Medicine and Center for Healthcare Evaluation and Outcome Sciences, St Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - James Andruchow
- Department of Emergency Medicine and Department of Community Health Sciences, University of Calgary, Room C231, Foothills Medical Centre, 1403, 29 Street NW, Calgary, AB, T2N 2T9, Canada
| | - Lucy Cheng
- Centre for Health Services and Policy Research, School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Michael R Law
- Centre for Health Services and Policy Research, School for Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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McLeod KE, Xavier J, Okhowat A, Williams S, Korchinski M, Young P, Papamihali K, Martin RE, Monaghan A, Sharifi N, Buxton JA. Knowledge of the Good Samaritan Drug Overdose Act and possession of a naloxone kit among people recently released from prison. Int J Prison Health 2021; 18:43-54. [PMID: 34633774 DOI: 10.1108/ijph-04-2021-0033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE This study aims to describe knowledge of Canada's Good Samaritan Drug Overdose Act (GSDOA) and take home naloxone (THN) training and kit possession among people being released from provincial correctional facilities in British Columbia. DESIGN/METHODOLOGY/APPROACH The authors conducted surveys with clients of the Unlocking the Gates Peer Health Mentoring program on their release. The authors compared the characteristics of people who had and had not heard of the GSDOA and who were in possession of a THN kit. FINDINGS In this study, 71% people had heard of the GSDOA, and 55.6% were in possession of a THN kit. This study found that 99% of people who had heard of the GSDOA indicated that they would call 911 if they saw an overdose. Among people who perceived themselves to be at risk of overdose, 28.3% did not have a THN kit. Only half (52%) of participants had a mobile phone, but 100% of those with a phone said they would call 911 if they witnessed an overdose. ORIGINALITY/VALUE The authors found that people with knowledge of the GSDOA were likely to report that they would call 911 for help with an overdose. Education about the GSDOA should be a standard component of naloxone training in correctional facilities. More than one in four people at risk of overdose were released without a naloxone kit, highlighting opportunities for training and distribution. Access to a cellphone is important in enabling calls to 911 and should be included in discharge planning.
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Affiliation(s)
- Katherine E McLeod
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | | | - Ali Okhowat
- Faculty of Medicine, The University of British Columbia, Vancouver, Canada
| | | | - Mo Korchinski
- School of Nursing, The University of British Columbia, Vancouver Canada and Unlocking the Gates Services Society, Maple Ridge, Canada
| | - Pamela Young
- School of Nursing, The University of British Columbia, Vancouver Canada and Unlocking the Gates Services Society, Maple Ridge, Canada
| | | | - Ruth Elwood Martin
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Angus Monaghan
- Correctional Health Services, Provincial Health Services Authority, Vancouver, Canada
| | - Nader Sharifi
- Correctional Health Services, Provincial Health Services Authority, Vancouver, Canada
| | - Jane A Buxton
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada and BC Centre for Disease Control, Vancouver, Canada
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Lee HJ, Kim KH, Lee SC, Song S. Prognostic Factors of Patients with Stercoral Perforation of the Colon. Korean J Gastroenterol 2021; 76:191-198. [PMID: 33100314 DOI: 10.4166/kjg.2020.76.4.191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/04/2020] [Accepted: 09/19/2020] [Indexed: 12/14/2022]
Abstract
Background/Aims The incidence of stercoral perforation of the colon (SPC) is expected to rise, given the increased life expectancy and the aging population. On the other hand, the prognostic factors of mortality after surgery for SPC remain unclear. This study examined the prognostic factors of patients with SPC after surgery. Methods The medical records of 145 patients who underwent surgery for colonic perforation between April 2010 and May 2019 were reviewed retrospectively. In 145 patients, 22 patients who underwent SPC surgery were categorized into the following two groups according to in-hospital survival after surgery: alive (group A, n=15) and dead (group B, n=7). Results In all enrolled patients, the mean age was 75.7±9.0 years, with a female predominance (female patients, n=19, 86.4%). Sixteen patients (72.7%) had chronic constipation with medications, and five patients (22.7%) were bedridden. The rate of preoperative bedridden status was significantly higher in group B than group A (6.7% vs. 57.1%; p=0.021). Univariate analysis revealed immobility, a sequential organ failure assessment (SOFA) score, and lactate levels of more than 2.0 mmol/L to be factors associated with increased mortality rates in the postoperative period. Multivariate analysis revealed abnormal lactate levels to be the only factor related to mortality (hazard ratio 16.50, 95% CI 1.48-183.07, p=0.022). Conclusions Preoperative abnormal serum lactate levels may be a risk factor for mortality after surgery in patients with stercoral perforation. Further research will be needed to identify the postoperative prognostic SPC factors.
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Affiliation(s)
- Hyung Jin Lee
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Kil Hwan Kim
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Sung Chul Lee
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
| | - Sanghyun Song
- Department of Surgery, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea
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Abstract
INTRODUCTION Trauma resuscitation at dedicated trauma centers typically consist of ad-hoc teams performing critical tasks in a time-limited manner. This creates a high stakes environment apt or avoidable errors. Reporting of errors in trauma resuscitation is generally center-dependent and lacks common terminology. METHODS We conducted a systematic review by searching Ovid Medline, Scopus and Embase from inception to February 24, 2021 for errors in adult trauma resuscitation. English studies published after 2001 were included. Studies were assessed by two independent reviewers for meeting inclusion/exclusion criteria. Errors were characterized from the included studies and a summary table was developed. Our review was prospectively registered with the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42020152875). RESULTS The literature search retrieved 4658 articles with 26 meeting eligibility criteria. Errors were identified by morbidity and mortality rounds or other committee in 62%, missed injuries on tertiary assessment or radiology review in 12%, deviations from algorithmic guidelines in 12% or predefined for chest tube complications, critical incident reporting, aspiration or delays in care. In total there were 39 unique error types identified and divided into 9 categories including Emergency Medical Services handover, airway, assessment of injuries, patient monitoring and access, transfusion/blood related, management of injuries, team communication/dynamics, procedure error and disposition. CONCLUSIONS Overall, our systematic review identified 39 unique error types in trauma resuscitation. Identifying these errors is imperative in developing systems for improvement of trauma care.
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Affiliation(s)
- Anton Nikouline
- Division of Emergency Medicine, Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Room 304, Toronto, ON, M5S 3H2, Canada.
| | - Andrew Quirion
- Division of Emergency Medicine, Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Room 304, Toronto, ON, M5S 3H2, Canada
| | - James J Jung
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- International Centre for Surgical Safety, St. Michael's Hospital, Toronto, ON, Canada
| | - Brodie Nolan
- Division of Emergency Medicine, Department of Medicine, University of Toronto, C. David Naylor Building, 6 Queen's Park Crescent West, Third Floor, Room 304, Toronto, ON, M5S 3H2, Canada
- International Centre for Surgical Safety, St. Michael's Hospital, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Emergency Medicine, St. Michael's Hospital, Toronto, ON, Canada
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Wachira BW, Mwai M. A baseline review of the ability of hospitals in Kenya to provide emergency and critical care services for COVID-19 patients. Afr J Emerg Med 2021; 11:213-217. [PMID: 33495726 PMCID: PMC7816953 DOI: 10.1016/j.afjem.2021.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/23/2020] [Accepted: 01/06/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction As the Coronavirus Disease 2019 (COVID-19) cases in Kenya begin to rise, the number of severe and critical COVID-19 patients has the potential to quickly overload the local healthcare system beyond its capacity to treat people. Objective The purpose of this study was to gather information about the ability of hospitals in Kenya to provide emergency and critical care services and to identify priority actions for use by policymakers and other stakeholders as a roadmap toward strengthening the COVID-19 response in the country. Methods This was a comprehensive review of the published and grey literature on emergency and critical care services in Kenya published in the last three years through April 2020. Screening of articles was conducted independently by the authors and the final decision for inclusion was made collaboratively. A total of 15 papers and documents were included in the review. Key recommendations There is an urgent need to strengthen prehospital emergency care in Kenya by establishing a single toll-free ambulance access number and an integrated public Emergency Medical Services (EMS) system to respond to severe and critical COVID-19 patients in the community and other emergency cases. Functional 24-h emergency centres (ECs) need to be established in all the level 4, 5 and 6 hospitals in the country to ensure these patients receive immediate lifesaving emergency care when they arrive at the hospitals. The ECs should be equipped with pulse oximeters and functioning oxygen systems and have the necessary resources and skills to perform endotracheal intubation to manage COVID-19-induced respiratory distress and hypoxia. Additional intensive care unit (ICU) beds and ventilators are also needed to ensure continuity of care for the critically ill patients seen in the EC. Appropriate practical interventions should be instituted to limit the spread of COVID-19 to healthcare personnel and other patients within the healthcare system. Further research with individual facility levels of assessment around infrastructure and service provision is necessary to more narrowly define areas with significant shortfalls in emergency and critical care services as the number of COVID-19 cases in the country increase.
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Cozzi D, Moroni C, Cavigli E, Bindi A, Caviglioli C, Nazerian P, Vanni S, Miele V, Bartolucci M. Prognostic value of CT pulmonary angiography parameters in acute pulmonary embolism. Radiol Med 2021; 126:1030-1036. [PMID: 33961187 DOI: 10.1007/s11547-021-01364-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 04/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Computed tomographic pulmonary angiography (CTPA) is the first-line test in acute pulmonary embolism (APE) diagnostic algorithm, but its correlation with short-term outcome remains not clear at all. The aim is to determine whether CTPA findings can predict 30-day mortality of patients with APE in Emergency Department. METHODS This retrospective monocentric study involved 780 patients with APE diagnosed at the Emergency Department of our institution (period 2010-2019). These CTPA findings were evaluated: embolic obstruction burden score (Qanadli score), common pulmonary artery trunk diameter, right-to-left ventricular ratio, azygos vein and coronary sinus diameters. Comorbidities and fatal/nonfatal adverse outcomes within 30 days were recorded. Troponin I values were correlated with angiographic parameters with multiple logistic regression analysis. RESULTS The all-cause and APE-related 30-day mortality rates were 5.9% and 3.6%, respectively. Patients who died within 30 days were older with higher prevalence rates of malignancy. Qanadli score and all CTPA parameters correlate with Troponin I level and the presence of RVD at echocardiography (p values < 0.0001). Instead, RV/LV ratio and coronary sinus diameter correlate with 30-day mortality (p values < 0.05). At the multivariate logistic regression analysis, only coronary sinus and RVD remained significant with an HR = 2.5 (95% CI 1.1-5.6) and HR = 1.9 (95% CI 0.95-3.7), respectively. CONCLUSION CTPA quantification of right ventricular strain is an accurate predictor of 30-day mortality. In particular, it seems that a dilated coronary sinus (>9 mm) has an additional prognostic value in association with echocardiographic signs of right-heart disfunction and high Troponin I levels.
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Affiliation(s)
- Diletta Cozzi
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy.
| | - Chiara Moroni
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Edoardo Cavigli
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Alessandra Bindi
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
| | - Cosimo Caviglioli
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Florence, Italy
| | - Simone Vanni
- Department of Emergency Medicine, San Giuseppe Hospital, Empoli, Italy
| | - Vittorio Miele
- Department of Emergency Radiology, Careggi University Hospital, L.go Brambilla 3, 50134, Florence, Italy
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Luo W, Limb R, Aslam A, Kattimani R, Karthikappallil D, Paramasivan A, Waseem M. COVID-19 pandemic did not affect emergency theatre patient demographic and length of stay in the first phase of UK countrywide lockdown in a district general hospital. Ann R Coll Surg Engl 2021; 103:404-411. [PMID: 33955242 DOI: 10.1308/rcsann.2021.0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION We aim to identify any changes in outcome for patients undergoing nonelective surgery at the start of the UK pandemic in our district general hospital. This was a single-centre retrospective cohort review of a UK district general hospital serving a population of over 250,000 people. METHODS Participants were all patients undergoing a surgical procedure in the acute theatre list between 23 March to 11 May in both 2019 and 2020. Primary outcome was 90-day postoperative mortality. Secondary outcomes include time to surgical intervention and length of inpatient stay. RESULTS A total of 132 patients (2020) versus 141 (2019) patients were included. Although overall 90-day postoperative mortality was higher in 2020 (9.8%) compared with 2019 (5.7%), this difference was not statistically significant (p=0.196). In 2020, eight patients tested positive for COVID-19 either as an inpatient or within 2 weeks of discharge, of whom five patients died. Time to surgical intervention was significantly faster for NCEPOD (National Confidential Enquiry into Patient Outcome and Death) code 3 patients in 2020 than in 2019 (p=0.027). There were no significant differences in mean length of inpatient stay. CONCLUSIONS We found that patients were appropriately prioritised using NCEPOD classification, with no statistically significant differences in 90-day postoperative mortality and length of inpatient stay compared with the 2019 period. A study on a larger scale would further elucidate the profile and outcomes of patients requiring acute surgery to generate statistical significance.
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Affiliation(s)
- W Luo
- Macclesfield District General Hospital, UK
| | - R Limb
- Macclesfield District General Hospital, UK
| | - A Aslam
- University of Cambridge School of Clinical Medicine, UK
| | | | | | - A Paramasivan
- Countess of Chester Hospital NHS Foundation Trust, UK
| | - M Waseem
- Macclesfield District General Hospital, UK
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Portinari M, Bianchi L, De Troia A, Valpiani G, Spadaro S, Fogagnolo A, Acciarri P, Soliani G, Carcoforo P. Non-traumatic emergency abdominal surgery in nonagenarian patients: a retrospective study. Eur J Trauma Emerg Surg 2021; 48:1205-1216. [PMID: 33742224 DOI: 10.1007/s00068-021-01646-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/11/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE The primary aim of this study was to evaluate the 30-day survival of nonagenarian patients who underwent non-traumatic emergency abdominal surgery. Other aims were: 90-day and 12-month survival rates, the postoperative complications rate, the impact of the emergency operation on postoperative functional status, the accuracy of the P-POSSUM in predicting 30-day postoperative mortality and changes in care services after surgery. METHODS This was a retrospective cohort study of nonagenarian patients who underwent non-traumatic emergency abdominal surgery between January 2010 and June 2017. Patients were divided in two groups according to the 30-day survival status to compare the distribution of patients' characteristics and postoperative outcomes. Overall survival was estimated using the Kaplan-Meier method. To assess the accuracy of P-POSSUM to predict 30-day mortality, a receiver operating characteristic curve and the Hosmer-Lemeshow goodness of fit test were used. RESULTS 85 nonagenarian patients were enrolled in this study; of these, 27 (31.8%) died within 30 days. The Kaplan-Meier curve showed a rapid decline in survival over the first 30 postoperative days, followed by a more gradual reduction during the rest of the first year. The majority of patients (92.6%) who died within 30 days experienced a medical complication, with a preponderance of respiratory failure (48.2%) and multiple organ failure (33.3%). In the surviving patients, the postoperative functional status had worsened, and 64.2% of patients did not return to their original housing situation or were institutionalized. The accuracy of P-POSSUM in predicting 30-day mortality in nonagenarian patients was poor. CONCLUSIONS This study may help doctors convey the postoperative risks of morbidity and mortality, and also to adequately inform relatives about the possible adverse discharge destination of surviving nonagenarian patients with a consequent increase in care needs.
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Affiliation(s)
- Mattia Portinari
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy. .,Dipartimento di Morfologia, Chirurgia e Medicina Sperimentale, Università di Ferrara, Ferrara, Italia. .,Dipartimento Chirurgico, Azienda Ospedaliero-Universitaria, Arcispedale S. Anna di Ferrara, Via Aldo Moro, 8
- Stanza 2 34 39 (1C2), 44124, Ferrara, Cona, Italia.
| | - Lara Bianchi
- Department of Internal Medicine, University Hospital of Ferrara, Ferrara, Italy
| | - Alessandro De Troia
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, University Hospital of Ferrara, Ferrara, Italy
| | - Savino Spadaro
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Alberto Fogagnolo
- Department of Morphology, Surgery and Experimental Medicine, Section of Anesthesiology and Intensive Care, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Pierfilippo Acciarri
- Department of Surgery, Unit of Vascular Surgery, University Hospital of Ferrara, Ferrara, Italy
| | - Giorgio Soliani
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara, University of Ferrara, Ferrara, Italy
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Wang L, Chen XH, Ling WH, Wang LG, Chen HF, Sun ZJ, Yang P, Xu F. Application of trauma time axis management in the treatment of severe trauma patients. Chin J Traumatol 2021; 24:39-44. [PMID: 33342607 DOI: 10.1016/j.cjtee.2020.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 11/17/2020] [Accepted: 11/29/2020] [Indexed: 02/04/2023] Open
Abstract
PURPOSE This study aimed at exploring the application of trauma time axis management in the treatment of severe trauma patients by using the Medicalsystem trauma system. METHODS We performed a retrospective cohort study involving patients with severe trauma. Patients who were admitted before the application of the Medicalsystem trauma system were divided into before system group; patients who were admitted after the application of the system were divided into after system group. Comparison was made between the two groups. For normally distributed data, means were reported along with standard deviation, and comparisons were made using the independent samples t test. Categorical data were compared using the Chi-square test. The Mann-Whitney U test was used to compare nonparametric variables. RESULTS There were 528 patients admitted to the study during the study period. There was no significant statistical difference in the time from the start of trauma team to arrive at the resuscitation room between the two groups. The time from arrival at hospital to endotracheal intubation, to ventilator therapy, to blood transfusion, to completion of CT scan, to completion of closed thoracic drainage, to the start of operation, as well as the length of stay in resuscitation room and hospital were significantly lower after the application of the Medicalsystem trauma system. The mortality was decreased by 8.6% in the after system group compared with that in the before system group, but there was no statistical difference. CONCLUSION The Medicalsystem trauma system can optimize diagnosis and treatment process for trauma patients, and accordingly improve the treatment efficiency and shorten the treatment time. Therefore, the Medicalsystem trauma system deserves further popularization and promotion.
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Wu MT, Wells M. Pediatric weight estimation: validation of the PAWPER XL tape and the PAWPER XL tape mid-arm circumference method in a South African hospital. Clin Exp Emerg Med 2021; 7:290-301. [PMID: 33440107 PMCID: PMC7808830 DOI: 10.15441/ceem.19.082] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/13/2019] [Indexed: 11/24/2022] Open
Abstract
Objective The primary aim of this study was to prospectively compare the performance of the Broselow tape, Mercy method, pediatric advanced weight prediction in the emergency room extra-long (PAWPER XL) tape, and PAWPER XL mid-arm circumference (MAC) method in estimating the weight of children from a low-income setting. The secondary aim was to analyze the time taken to perform each method. Methods This analyzed a convenience study sample of 300 children aged 0 to 18 years at the Baragwanath Hospital in South Africa. Weight estimations were obtained using each of the weight estimation systems on each child. These weight estimations were then compared against the actual weight to determine bias, precision, and accuracy of the estimation methods. Results The PAWPER XL tape and PAWPER XL-MAC methods performed the best and provided estimated weights within 10% of the actual weight in 62.7% and 67.3% of cases, respectively, followed by the Mercy method (56.5%) and Broselow tape (43.9%). The use of MAC improved the accuracy of estimation, especially in heavier and taller children. The median times taken to perform measurements using the Broselow tape, Mercy method, PAWPER XL tape, and PAWPER XL-MAC method were 11.3 seconds, 34.7 seconds, 9.3 seconds, and 33.9 seconds respectively. Conclusion The PAWPER XL tape and PAWPER XL-MAC methods were the most accurate methods of estimating weight in this group of children. These methods may be considered in preference to the Broselow tape or the Mercy method for emergency weight estimation in low socioeconomic status populations.
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Affiliation(s)
- Ming-Tung Wu
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mike Wells
- Division of Emergency Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Wu C, Li Q. Characteristics of organic matter removed from highly saline mature landfill leachate by an emergency disk tube-reverse osmosis treatment system. Chemosphere 2021; 263:128347. [PMID: 33297272 DOI: 10.1016/j.chemosphere.2020.128347] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/10/2020] [Accepted: 09/12/2020] [Indexed: 06/12/2023]
Abstract
Some sanitary landfills in China are required to treat aging landfill leachate that is highly saline. In this study, the effectiveness of an emergency disk tube-reverse osmosis (DTRO) treatment system for such a refractory mature landfill leachate was evaluated. A molecular-level analysis was then applied to reveal the changes of the characteristics of leachate organic matter (OM). The DTRO system achieved >83% water recovery rate, reduced the electrical conductivity of effluent to 0.15-0.22 ms/cm, and reduced carbonaceous and nitrogenous pollutants to a level suitable for discharge. Furthermore, the vast majority of salts (e.g., chloride and sulfate ions), as well as refractory OM (e.g., humic- and fulvic-like substances), were effectively removed. The DTRO system can effectively remove a large number of macromolecular dissolved organic compounds with carbon number >23, as well as highly unsaturated compounds with DBE >12. Additionally, > 80% of the molecules assigned to the dissolved OM (DOM) were removed; even CHONS compounds with complex molecular structures were completely removed. The constitution of DOM in the DTRO effluent was simple, mainly comprising anti-sludge agents (e.g., small molecule alcohol and alkyl benzene sulfonic acid, etc.). However, the DOM in the resulting membrane concentrates was very similar to that in raw landfill leachate and the concentration was much higher. Therefore, an effective and feasible method should be developed to treat DTRO membrane concentrates because they pose high environmental risk.
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Affiliation(s)
- Chuanwei Wu
- Faculty of Geosciences and Environmental Engineering, Southwest Jiaotong University, Chengdu, 611756, China
| | - Qibin Li
- Faculty of Geosciences and Environmental Engineering, Southwest Jiaotong University, Chengdu, 611756, China.
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48
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Hoyer C, Ebert A, Szabo K, Platten M, Meyer-Lindenberg A, Kranaster L. Decreased utilization of mental health emergency service during the COVID-19 pandemic. Eur Arch Psychiatry Clin Neurosci 2021; 271:377-379. [PMID: 32519205 PMCID: PMC7282463 DOI: 10.1007/s00406-020-01151-w] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 06/04/2020] [Indexed: 11/25/2022]
Abstract
During the rapid rise of the COVID-19 pandemic, a reduction of the numbers of patients presenting to emergency departments has been observed. We present an early study from a German psychiatric hospital to assess the dynamics of mental health emergency service utilization rates during the COVID-19 pandemic. Our results show that the numbers of emergency presentations decreased, and a positive correlation between these numbers and mobility of the general public suggests an impact of extended measures of social distancing. This finding underscores the necessity of raising and sustaining awareness regarding the threat to mental health in the context of the pandemic.
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Affiliation(s)
- Carolin Hoyer
- grid.7700.00000 0001 2190 4373Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Anne Ebert
- grid.7700.00000 0001 2190 4373Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Kristina Szabo
- grid.7700.00000 0001 2190 4373Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Michael Platten
- grid.7700.00000 0001 2190 4373Department of Neurology, Medical Faculty Mannheim and Mannheim Center for Translational Neurosciences (MCTN), Heidelberg University, Mannheim, Germany
| | - Andreas Meyer-Lindenberg
- grid.7700.00000 0001 2190 4373Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Laura Kranaster
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
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Csonka P, Tapiainen T, Mäkelä MJ, Lehtimäki L. Optimal administration of bronchodilators with valved holding chambers in preschool children: a review of literature. Eur J Pediatr 2021; 180:3101-3109. [PMID: 33877400 PMCID: PMC8055476 DOI: 10.1007/s00431-021-04074-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/06/2021] [Accepted: 04/08/2021] [Indexed: 11/30/2022]
Abstract
Our aim was to synthesize the published literature on factors that potentially affect the delivery of bronchodilators using valved holding chambers (VHC) in preschool children. We also aimed to identify those attributes that are not yet incorporated or clearly stated in the guidelines and those topics that are still lacking sufficient data. There is strong evidence supporting several recommendations in current guidelines. Based on present knowledge, bronchodilators should be delivered by VHC administering each puff separately. Face mask should be omitted as soon as the child can hold the mouthpiece of the VHC tightly between the lips and teeth. Based on the review, we suggest adding a specific note to current guidelines about the effect of chamber volume and the impact of co-operation during drug administration. Calming the child and securing a tight face-to-mask seal is critical for successful drug delivery. There is not enough evidence to make specific recommendations on the most reliable VHC and face mask for children. There is an urgent need for studies that evaluate and compare the effectiveness of VHCs in various clinical settings in wide age-groups and respiratory patterns. In addition, there is insufficient data on ideal chamber volume, material, and effective antistatic treatment. What is Known: • Valved holding chambers (VHC) should not be considered interchangeable when used with pressurized metered dose inhalers (pMDI). • Drug delivery is influenced by VHC volume, aerodynamic and electrostatic properties; mask fit; respiratory pattern and co-operation during inhalation; and the number of puffs actuated. What is New: • The impact of co-operation, VHC volume, and good mask-to-face fit during drug inhalation is not stressed enough in the guidelines. • Studies are urgently needed to evaluate the effectiveness of different VHCs in various clinical settings focusing on VHC electrostatic properties, respiratory patters, face masks, and ideal pMDI+VHC combinations.
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Affiliation(s)
- Péter Csonka
- Centre for Child Health Research, Tampere University and Tampere University Hospital, Kalevantie 4, 33014 Tampereen yliopisto, Tampere, Finland. .,Terveystalo Healthcare, Tampere, Finland.
| | - Terhi Tapiainen
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital and PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Mika J. Mäkelä
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland ,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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50
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Gäble A, AlMatter M, Armbruster M, Berndt M, Kuršumovic A, Mühlmann M, Kimmig H, Kumle B, Ritz R, Russo S, Schmid F, Wanner G, Wirth S. [Resuscitation room diagnostics]. Radiologe 2020; 60:642-651. [PMID: 32507969 DOI: 10.1007/s00117-020-00704-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
CLINICAL PROBLEM The indication for resuscitation room care is an acute (potentially) life-threatening patient condition. Typical causes for this are polytrauma, acute neurological symptoms, acute chest and abdominal pain or the cause remains unclear at first. The care is always provided in a suitably composed interdisciplinary team. This requires cause-specific standards tailored to the care facility and requires a mutual understanding of the partners involved with regard to specialist interests and care processes. STANDARD RADIOLOGICAL METHODS Whole-body CT is established for polytrauma imaging and usually each institution has already defined an institutional standard. For the other causes, first imaging with CT is just as common, but the protocols and procedures to be used are often not as clear as in the case of polytrauma. METHODICAL INNOVATION AND EVALUATION For polytrauma service, ATLS and procedures according to ABCDE already serve as a largely standardized framework in the resuscitation room. For every other group of causes, comparable concepts should be developed and institutionally strive for objectification of continuous improvement. This refers not only to the resuscitation room stay but also to the interfaces before and after resuscitation room service. PRACTICAL RECOMMENDATIONS After the patient has arrived, it has to be determined whether the assessment of a vital risk is retained. If so, institutionally defined care standards must be followed for the various causes. This concerns the interface logistics, the definition of a team leader including associated tasks, the supply processes including the CT examination protocols as well as the close communication.
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Affiliation(s)
- Alexander Gäble
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.
| | - Muhammad AlMatter
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland
| | - Marco Armbruster
- Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland
| | - Maria Berndt
- Abteilung für Diagnostische und Interventionelle Neuroradiologie, Klinikum rechts der Isar, Technische Universität München, München, Deutschland
| | - Adisa Kuršumovic
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.,Klinik für Neurochirurgie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Marc Mühlmann
- Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland
| | - Hubert Kimmig
- Klinik für Neurologie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Bernhard Kumle
- Zentrale Notaufnahme und Aufnahmestation, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Rainer Ritz
- Klinik für Neurochirurgie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Sebastian Russo
- Klinik für Anästhesiologie, Intensiv‑, Notfall- und Schmerzmedizin, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Frank Schmid
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland
| | - Guido Wanner
- Klinik für Unfallchirurgie und Orthopädie, Schwarzwald-Baar-Klinikum, Villingen Schwenningen, Deutschland
| | - Stefan Wirth
- Institut für Radiologie und Nuklearmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen Schwenningen, Deutschland.,Klinik und Poliklinik für Radiologie, Klinikum der LMU, München, Deutschland.,European Society of Emergency Radiology, Wien, Österreich
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