Current Issue : July - September Volume : 2019 Issue Number : 3 Articles : 7 Articles
Purpose. To measure fidelity with which a group seizure first aid training intervention was delivered within a pilot randomized\ncontrolled trial underway in the UK for adults with epilepsy who visit emergency departments (ED) and informal carers.\nEstimates of its effects, including on ED use, will be produced by the trial. Whilst hardly ever reported for trials of epilepsy\nInterventions- only one publication on this topic exists-this study provides the information on treatment fidelity necessary to\nallow the trialâ??s estimates to be accurately interpreted. This rare worked example of how fidelity can be assessed could also\nprovide guidance sought by neurology trialists on how to assess fidelity. Methods. 53 patients who had visited ED on less than equal to 2\noccasions in prior year were recruited for the trial; 26 were randomized to the intervention. 7 intervention courses were\ndelivered for them by one facilitator. Using audio recordings, treatment â??adherenceâ? and â??competenceâ? were assessed.\nAdherence was assessed by a checklist of the items comprising the intervention. Using computer software, competence was\nmeasured by calculating facilitator speech during the intervention (didacticism). Interrater reliability was evaluated by two\nindependent raters assessing each course using the measures and their ratings being compared. Results. The fidelity measures\nwere found to be reliable. For the adherence instrument, raters agreed 96% of the time, PABAK-OS kappa 0.91. For didacticism,\nratersâ?? scores had an intraclass coefficient of 0.96. In terms of treatment fidelity, not only were courses found to have been\ndelivered with excellent adherence (88% of its items were fully delivered) but also as intended they were highly interactive, with\nthe facilitator speaking for, on average, 55% of course time. Conclusions. The fidelity measures used were reliable and showed\nthat the intervention was delivered as attended. Therefore, any estimates of intervention effect will not be influenced by poor\nimplementation fidelity....
Introduction. A Bosworth fracture-dislocation is a rare lesion resulting in a fixed dislocation of the distal fibula behind the posterior\ntibial tubercle. Only few cases have been reported showing an associated consequent fracture, namely, a pilon or a medial malleolus\nfracture. Case Report. We present a case report of a patient with an unusual combination of a Bosworth injury with a pilon fracture\nand an open multifragmentary talus fracture and our approach for open reduction and internal fixation. At one year postoperative,\nthe patient developed an invalidating tibiotalar and subtalar arthrosis that eventually required an ankle-hindfoot arthrodesis. A\nBosworth injury is an infrequent entity and is even rarer when associated with other fractures. Careful preoperative planning is\nnecessary, as the combination of these fractures is a surgical challenge. Special care must be taken to preserve the neurovascular\nbundle. Discussion. The present case highlights a Bosworth injury involving a severity that has never been described before and\nsuggests adding an eighth stage to the classification presented by Perry et al....
Background: Hyperventilation-induced hypocapnia (HV) reduces elevated intracranial pressure (ICP), a dangerous\nand potentially fatal complication of traumatic brain injury (TBI). HV decreases the arteriolar diameter of intracranial\nvessels, raising the risk of cerebral ischemia. The aim of this study was to characterize the effects of moderate shortterm\nHV in patients with severe TBI by using concomitant monitoring of cerebral metabolism, brain tissue oxygen\ntension (PbrO2), and cerebral hemodynamics with transcranial color-coded duplex sonography (TCCD).\nMethods: This prospective trial was conducted between May 2014 and May 2017 in the surgical intensive care unit\n(ICU) at the University Hospital of Zurich. Patients with nonpenetrating TBI older than 18 years of age with a\nGlasgow Coma Scale (GCS) score < 9 at presentation and with ICP monitoring, PbrO2, and/or microdialysis (MD)\nprobes during ICU admission within 36 h after injury were included in our study. Data collection and TCCD\nmeasurements were performed at baseline (A), at the beginning of moderate HV (C), after 50 min of moderate HV\n(D), and after return to baseline (E). Moderate HV was defined as arterial partial pressure of carbon dioxide 4-4.7 kPa.\nRepeated measures analysis of variance was used to compare variables at the different time points, followed by\npost hoc analysis with Bonferroni adjustment as appropriate.\nResults: Eleven patients (64% males, mean age................
In recent years, with the increase of natural disasters, wars, and terrorist incidents,\netc., there are more and more researches on post-traumatic stress disorder\n(PTSD). This paper bases on the definition, pathogenic mechanism and\nrelated gene research of post-traumatic stress disorder. Mechanism, reviews\nthe research status of post-traumatic stress disorder to improve peopleâ??s understanding\nof post-traumatic stress disorder, and prospect for future research....
Background: Emergency department utilization has increased tremendously over the past years, which is\naccompanied by an increased necessity for emergency medicine research to support clinical practice. Important\nsources of evidence are systematic reviews (SRs) and meta-analyses (MAs), but these can only be informative\nprovided their quality is sufficiently high, which can only be assessed if reporting is adequate. The purpose of this\nstudy was to assess the quality of reporting of SRs and MAs in emergency medicine using the PRISMA statement.\nMethods: The top five emergency medicine related journals were selected using the 5-year impact factor of the ISI\nWeb of Knowledge of 2015. All SRs and MAs published in these journals between 2015 and 2016 were extracted\nand assessed independently by two reviewers on compliance with each item of the PRISMA statement.\nResults: The included reviews (n = 112) reported a mean of.................
Background: Double lumen intubation and one-lung ventilation should be applied without delay in cases of\ntraumatic main bronchial rupture. In most cases, when the patientsâ?? vital signs have been stabilized, the repair can\nbe performed. However, when one-lung ventilation is complicated by traumatic wet lung, the mortality rate is likely\nto be much higher.\nCase presentation: In this case, the patient experienced a left main bronchial rupture, bilateral traumatic wet lung,\nand acute respiratory distress syndrome (ARDS) because of severe thoracic trauma. Though the patient was treated\nwith intubation and mechanical ventilation (MV), his oxygenation was still not stable. Thus, veno-venous\nextracorporeal membrane oxygenation (V-V ECMO) was initiated; upon improvement of oxygenation, the patient\nreceived an exploratory thoracotomy. Unfortunately, the rupture proved to be irreparable, resulting in a total left\npneumonectomy. As there was severe ARDS caused by trauma, ECMO and ultra-low tidal volume (VT) MV strategy\n(3 ml/kg) were utilized for lung protection post-op. ECMO was sustained up to the 10th day, and MV until the 20th\nday, post-operation. With the support of MV, ECMO and other comprehensive measures, the patient made a\nrecovery.\nConclusion: V-V ECMO and ultra-low VT MV helped this thoracic trauma patient survive the lung edema period and\nprevented ventilator associated pneumonia (VAP). In extreme situations, with the support of ECMO, the tidal\nvolume may be lowered to 3 ml/kg....
Background: There is a lack of validated tools to assess potential disease progression and hospitalisation decisions\nin patients presenting to the emergency department (ED) with a suspected infection. This study aimed to identify\nsuitable blood biomarkers (MR-proADM, PCT, lactate and CRP) or clinical scores (SIRS, SOFA, qSOFA, NEWS and CRB-\n65) to fulfil this unmet clinical need.\nMethods: An observational derivation patient cohort validated by an independent secondary analysis across nine\nEDs. Logistic and Cox regression, area under the receiver operating characteristic (AUROC) and Kaplan-Meier curves\nwere used to assess performance. Disease progression was identified using a composite endpoint of 28-day mortality, ICU\nadmission and hospitalisation > 10 days.\nResults: One thousand one hundred seventy-five derivation and 896 validation patients were analysed with respective\n28-day mortality rates of 7.1% and 5.0%, and hospitalisation rates of 77.9% and 76.2%. MR-proADM showed greatest\naccuracy in predicting 28-day mortality and hospitalisation requirement across both cohorts. Patient subgroups with high\nMR-proADM concentrations (less than equal to 1.54 nmol/L) and low biomarker (PCT < 0.25 ng/mL, lactate < 2.0mmol/L or CRP < 67 mg/\nL) or clinical score (SOFA < 2 points, qSOFA < 2 points, NEWS < 4 points or CRB-65 < 2 points) values were characterised\nby a significantly longer length of hospitalisation (p < 0.001), rate of ICU admission (p < 0.001), elevated mortality risk (e.g.\nSOFA, qSOFA and NEWS HR [95%CI], 45.5 [10.0-207.6], 23.4 [11.1-49.3] and 32.6 [9.4-113.6], respectively) and a greater\nnumber of disease progression events (p < 0.001), compared to similar subgroups with low MR-proADM concentrations\n(< 1.54 nmol/L). Increased out-patient treatment across both cohorts could be facilitated using a derivation-derived MRproADM\ncut-off of < 0.87 nmol/L (15.0% and 16.6%), with decreased readmission rates and no mortalities....
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