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Emergency Management

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https://www.readbyqxmd.com/read/28938387/critical-sized-bone-defects-sequence-and-planning
#1
Paul Toogood, Theodore Miclau
Bone defects associated with open fractures require a careful approach and planning. At initial presentation, an emergent irrigation and debridement is required. Immediate definitive fixation is frequently safe, with the exception of those injuries that normally require staged management or very severe type IIIB and IIIC injuries. Traumatic wounds that can be approximated primarily should be closed at the time of initial presentation. Wounds that cannot be closed should have a negative pressure wound therapy dressing applied...
October 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28938252/emotional-impact-of-end-of-life-decisions-on-professional-relationships-in-the-icu-an-obstacle-to-collegiality
#2
Alexandra Laurent, Magalie Bonnet, Gilles Capellier, Pierre Aslanian, Paul Hebert
OBJECTIVES: End-of-life decisions are not only common in the ICU but also frequently elicit strong feelings among health professionals. Even though we seek to develop more collegial interprofessional approaches to care and health decision-making, there are many barriers to successfully managing complex decisions. The aim of this study is to better understand how emotions influence the end-of-life decision-making process among professionals working in ICU. DESIGN: Qualitative study with clinical interviews...
September 21, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28938102/self-management-support-at-the-end-of-life-patients-carers-and-professionals-perspectives-on-managing-medicines
#3
N Campling, A Richardson, M Mulvey, M Bennett, B Johnston, S Latter
BACKGROUND: Pain is a frequently reported symptom by patients approaching the end of life and well-established that patients and carers hold fears relating to opioids, and experience side effects related to their use. The management of medicines is intrinsic to achieving effective pain relief. The concept of self-management support whilst well characterised in the context of chronic illness has not been elaborated with respect to end of life care. AIM: To identify patient, carer and professional views on the concept of self-management support at end of life, specifically in relation to analgesia and related medicines (for side-effect management) in order to describe, characterise and explain self-management support in this context...
September 6, 2017: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/28937547/management-of-emergency-electroconvulsive-therapy-in-the-intensive-care-unit-for-life-threatening-psychiatric-conditions-a-case-series
#4
Samuel Bulteau, Edouard-Jules Laforgue, Loïc Chimot, Romain Dumont, Olivier Loutrel, François Etcheverrigaray, Caroline Victorri-Vigneau, Alexandre Massri, Jean-Marie Vanelle, Anne Sauvaget
Catatonia can lead to severe complications and may be lethal but is often underdiagnosed. The clinical presentation can be similar to coma. In these situations, electroconvulsive therapy (ECT) can be used as first-line treatment to enable extubation, recovery of autonomy, and rapid discharge from intensive care. We report 4 cases of patients hospitalized in the intensive care unit with comatose clinical presentation and life-threatening condition caused by catatonia. All patients received ECT sessions, after which the catatonic symptoms partially or fully remitted...
September 20, 2017: Journal of ECT
https://www.readbyqxmd.com/read/28937509/non-ige-mediated-gastrointestinal-food-allergies
#5
Priscille Biermé, Anna Nowak-Wegrzyn, Jean-Christoph Caubet
PURPOSE OF REVIEW: We focus on recent advances regarding the epidemiology, physiopathology, diagnosis and managements of non-IgE-mediated gastrointestinal food allergies (non-IgE-GI-FAs), particularly food protein-induced enterocolitis syndrome (FPIES). RECENT FINDINGS: The first international FPIES diagnostic and management guidelines have been recently published. Although FPIES largely remains a diagnosis of exclusion, it may be more prevalent than previously thought...
September 20, 2017: Current Opinion in Pediatrics
https://www.readbyqxmd.com/read/28937503/patient-burden-of-axial-spondyloarthritis
#6
Vibeke Strand, Jasvinder A Singh
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA...
September 21, 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/28937474/patient-burden-of-axial-spondyloarthritis
#7
Vibeke Strand, Jasvinder A Singh
Axial spondyloarthritis (AxSpA) is an inflammatory spondyloarthritis (SpA) that has significant impact on a patient's life. Symptoms, including fatigue, sleep problems, depression, and sexual dysfunction, can profoundly impact health-related quality of life (HRQoL) and limit work, leisure, and daily activities. Available therapies effectively manage pain and inflammation in early-stage disease, but patients often continue to experience impaired HRQoL. Thus, there remains a need for new therapies with novel mechanisms that can stop disease progression, potentially reverse damage caused by AxSpA and improve HRQoL in patients with AxSpA...
October 2017: Journal of Clinical Rheumatology: Practical Reports on Rheumatic & Musculoskeletal Diseases
https://www.readbyqxmd.com/read/28936756/clinical-utility-of-mri-brain-in-children-with-non-traumatic-coma
#8
Jatinder Khipal, Naveen Sankhyan, Sunit C Singhi, Pratibha Singhi, Niranjan Khandelwal
OBJECTIVES: To determine characteristics that help identify children with acute encephalopathy who benefit from an MRI (magnetic resonance imaging) of the brain. The secondary objective was to determine the adverse events associated with the MRI procedure. METHODS: In this single center, prospective, observational study. Children (2 mo - 12 y) presenting with impaired consciousness were screened. Those with acute non-traumatic encephalopathy (Glasgow Coma Score of 12 or less) undergoing their first in-patient MRI brain were included...
September 22, 2017: Indian Journal of Pediatrics
https://www.readbyqxmd.com/read/28936627/the-accuracy-of-emergency-weight-estimation-systems-in-children-a-systematic-review-and-meta-analysis
#9
REVIEW
Mike Wells, Lara Nicole Goldstein, Alison Bentley
The safe and effective administration of fluids and medications during the management of medical emergencies in children depends on an appropriately determined dose, based on body weight. Weight can often not be measured in these circumstances and a convenient, quick and accurate method of weight estimation is required. Most methods in current use are not accurate enough, but the newer length-based, habitus-modified (two-dimensional) systems have shown significantly higher accuracy. This meta-analysis evaluated the accuracy of weight estimation systems in children...
September 21, 2017: International Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28936486/the-burden-and-social-determinants-of-asthma-for-adults-in-the-state-of-georgia
#10
Mark Ebell, Christian Marchello, Jean O'Connor
BACKGROUND: Asthma is a serious chronic health condition, and social determinants may affect its prevalence. METHODS: Data from the Behavioral Risk Factors Surveillance Survey (BRFSS), the Georgia Asthma Call-back Survey (ACBS), and the Georgia hospital and emergency department survey for patients with a diagnosis of asthma were used. All data were from the years 2011 through 2014. SAS and SUDAAN software were used to calculate weighted prevalence estimates and to perform univariate and multivariate analyses of the association between social determinants, other risk factors, and asthma outcomes...
2017: Journal of the Georgia Public Health Association
https://www.readbyqxmd.com/read/28936143/assessment-of-readiness-of-academic-emergency-departments-in-the-central-region-of-saudi-arabia-to-receive-a-sick-child
#11
Fahad Saleh Alhajjaj, Abdullah Saleh Aldamigh
OBJECTIVE: We sought to assess the readiness of general emergency departments (EDs) in academic hospitals in the central region of the Kingdom of Saudi Arabia (KSA) to manage pediatric patients using an international tool: The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association guidelines, which include facilities, personnel, safety, and other components. METHODS: We assessed eligible centers during multiple visits from January 2016 to May 2016 in which we inspected the EDs and conducted interviews with their respective leadership in which we independently recorded our observations...
July 2017: International Journal of Health Sciences
https://www.readbyqxmd.com/read/28936069/prehospital-management-of-acute-stroke-in-rural-versus-urban-responders
#12
Gregory Hansen, Simerpreet Bal, Kerri Lynn Schellenberg, Susan Alcock, Esseddeeg Ghrooda
OBJECTIVE: Stroke guideline compliance of rural Canadian prehospital emergency medical services (EMS) care in acute stroke is unknown. In this quality assurance study, we sought to compare rural and urban care by prehospital EMS evaluation/management indicators from patients assessed at an urban Canadian stroke center. MATERIALS AND METHODS: One hundred adult patients were randomly selected from the stroke registry. Patients were transported through Rural EMS bypass protocols or urban EMS protocols (both bypass and direct) to our stroke center between January and December 2013...
August 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28936065/high-frequency-of-depressive-symptoms-among-adults-with-epilepsy-results-from-a-hospital-based-study
#13
Syam C Chandrasekharan, Vikas Menon, Vaibhav Wadwekar, Pradeep Pankajakshan Nair
CONTEXT: Assessment of comorbid burden of depression and associated factors among adult people living with epilepsy (PWE) has the potential to inform clinical evaluation and management to improve outcomes. AIM: The aim of this study is to determine frequency of depressive symptoms and factors associated with it among PWE attending a tertiary care hospital. SETTING AND DESIGN: This was a cross-sectional observational study conducted in the outpatient clinic of a tertiary care center...
August 2017: Journal of Neurosciences in Rural Practice
https://www.readbyqxmd.com/read/28935873/whole-genome-sequencing-molecular-typing-and-in-vivo-virulence-of-oxa-48-producing-escherichia-coli-isolates-including-st131-h30-rx-h22-and-h41-subclones
#14
María de Toro, Javier Fernández, Vanesa García, Azucena Mora, Jorge Blanco, Fernando de la Cruz, M Rosario Rodicio
Carbapenem-resistant Enterobacteriaceae, including the increasingly reported OXA-48 Escherichia coli producers, are an emerging public health threat worldwide. Due to their alarming detection in our healthcare setting and their possible presence in the community, seven OXA-48-producing, extraintestinal pathogenic E. coli were analysed by whole genome sequencing as well as conventional tools, and tested for in vivo virulence. As a result, five E. coli OXA-48-producing subclones were detected (O25:H4-ST131/PST43-fimH30-virotype E; O25:H4-ST131/PST9-fimH22-virotype D5, O16:H5-ST131/PST506-fimH41; O25:H5-ST83/PST207 and O9:H25-ST58/PST24)...
September 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28935618/social-communication-coaching-smartglasses-well-tolerated-in-a-diverse-sample-of-children-and-adults-with-autism
#15
Neha U Keshav, Joseph P Salisbury, Arshya Vahabzadeh, Ned T Sahin
BACKGROUND: Augmented reality (AR) smartglasses are an emerging technology that is under investigation as a social communication aid for children and adults with autism spectrum disorder (ASD) and as a research tool to aid with digital phenotyping. Tolerability of this wearable technology in people with ASD is an important area for research, especially as these individuals may experience sensory, cognitive, and attentional challenges. OBJECTIVE: The aim of this study was to assess the tolerability and usability of a novel smartglasses system that has been designed as a social communication aid for children and adults with autism (the Brain Power Autism System [BPAS])...
September 21, 2017: JMIR MHealth and UHealth
https://www.readbyqxmd.com/read/28935231/pandemic-legislation-in-the-european-union-fit-for-purpose-the-need-for-a-systematic-comparison-of-national-laws
#16
Elizabeth M Speakman, Scott Burris, Richard Coker
Sound governance is central to effective pandemic management. Key international legal instruments governing pandemic management in the European Union (EU): the International Health Regulations (2005) and Decision 1082/13 require EU Member States to develop national plans and invite them to establish national legal frameworks to support compliance with this international legislation. Although Member States may design the legal framework as they choose, the strongest instrument of pandemic governance is national legislation...
September 1, 2017: Health Policy
https://www.readbyqxmd.com/read/28934985/factors-influencing-on-scene-time-in-a-rural-norwegian-helicopter-emergency-medical-service-a-retrospective-observational-study
#17
Øyvind Østerås, Jon-Kenneth Heltne, Bjørn-Christian Vikenes, Jörg Assmus, Guttorm Brattebø
BACKGROUND: Critically ill patients need to be immediately identified, properly managed, and rapidly transported to definitive care. Extensive prehospital times may increase mortality in selected patient groups. The on-scene time is a part of the prehospital interval that can be decreased, as transport times are determined mostly by the distance to the hospital. Identifying factors that affect on-scene time can improve training, protocols, and decision making. Our objectives were to assess on-scene time in the Helicopter Emergency Medical Service (HEMS) in our region and selected factors that may affect it in specific and severe conditions...
September 21, 2017: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
https://www.readbyqxmd.com/read/28934765/qualitative-study-the-experience-and-impact-of-living-with-behcet-s-syndrome
#18
Vicky Tai, Karen Lindsay, Joanne L Sims, Fiona M McQueen
AIM: Behcet's syndrome is a rare chronic multisystemic vasculitis of unknown aetiology, is unpredictable and can cause life-threatening complications. This qualitative study aims to explore the experiences of patients living with Behcet's syndrome in New Zealand. METHODS: Eight English-speaking patients participated in in-depth semi-structured interviews about their experiences of living with Behcet's syndrome. Interviews were recorded and transcribed. Data were analysed using a general inductive thematic approach...
September 22, 2017: New Zealand Medical Journal
https://www.readbyqxmd.com/read/28934705/vitamin-c-the-next-step-in-sepsis-management
#19
REVIEW
J Teng, A Pourmand, M Mazer-Amirshahi
Sepsis is a life-threatening medical condition, affecting approximately 26 million people worldwide every year. The disease is a continuum, marked by dysregulated inflammation and hemodynamic instability leading to shock, multi-system organ dysfunction, and death. Over the past decades, there has been a focus on the early identification and treatment of sepsis primarily with bundled and goal directed therapy. Despite these advances, morbidity and mortality has remained high, prompting investigation into novel therapies...
September 18, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28934258/reports-of-unintended-consequences-of-financial-incentives-to-improve-management-of-hypertension
#20
Sylvia J Hysong, Richard SoRelle, Kristen Broussard Smitham, Laura A Petersen
BACKGROUND: Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives...
2017: PloS One
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