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Trauma care

Logan Boles, Christopher Alexander, Leslie Pace, Warren Haggard, Joel Bumgardner, Jessica Jennings
Complex open musculoskeletal wounds are a leading cause of morbidity worldwide, partially due to a high risk of bacterial contamination. Local delivery systems may be used as adjunctive therapies to prevent infection, but they may be nondegradable, possess inadequate wound coverage, or migrate from the wound site. To address this issue, a thermo-responsive, injectable chitosan paste was fabricated by incorporating beta-glycerophosphate. The efficacy of thermo-paste as an adjunctive infection prevention tool was evaluated in terms of cytocompatibility, degradation, antibacterial, injectability, and inflammation properties...
October 12, 2018: Journal of Functional Biomaterials
Joon-Myoung Kwon, Youngnam Lee, Yeha Lee, Seungwoo Lee, Hyunho Park, Jinsik Park
AIM: Triage is important in identifying high-risk patients amongst many less urgent patients as emergency department (ED) overcrowding has become a national crisis recently. This study aims to validate that a Deep-learning-based Triage and Acuity Score (DTAS) identifies high-risk patients more accurately than existing triage and acuity scores using a large national dataset. METHODS: We conducted a retrospective observational cohort study using data from the Korean National Emergency Department Information System (NEDIS), which collected data on visits in real time from 151 EDs...
2018: PloS One
Stephanie A Sundborg
OBJECTIVE: Organizations are identifying trauma-informed care (TIC) as a priority yet implementation is slow. Research suggests commitment to a change effort is an important predictor for change behavior; however, there is little theoretical or empirical evidence exploring commitment to TIC. This study examines the variables that predict affective commitment to TIC including foundational knowledge, principal support, self-efficacy, and beliefs about trauma. Does foundational knowledge independently predict affective commitment to TIC or is this relationship mediated by other variables? METHOD: Data were collected from 118 participants working in human services, using cross-sectional survey design...
October 15, 2018: Psychological Trauma: Theory, Research, Practice and Policy
V Van Gansbeke
Introduced at the end of the '50s, ultrasound has widely developed and spread since then. Not limited to morphological information, sonography more and more includes elements of functional imaging. The new technological developments of ultrasound, and the main fields of application of sonography are reviewed, as well as the management of the so-called ultrasound incidentaloma. The triangular relationship between the patient, the ultrasound machine, and the operator are reviewed, with a special attention to those parameters affecting the final results of an ultrasound examination...
2018: Revue Médicale de Bruxelles
Ítalo de Macedo Bernardino, Lorena Marques da Nóbrega, José Régis Cordeiro da Silva, Carmen Lúcia Soares Gomes de Medeiros, Ricardo Alves de Olinda, Sérgio d'Ávila
OBJECTIVES: To investigate the spatial and spatial-temporal distribution of oral and maxillofacial injuries caused by urban violence, as well as to identify underlying disparities at regional level through a geostatistical approach. METHODS: This was a historical ecological cohort study of trauma cases caused by urban violence using aggregate data from victims assisted in a Brazilian medical-forensic service between January 2012 and December 2015. The longitudinal patterns of change observed in each geographic area (neighbourhoods) were evaluated using the finite mixture model (FMM)...
October 15, 2018: Community Dentistry and Oral Epidemiology
Tarandeep Oberai, Maggie Killington, Kate Laver, Maria Crotty, Ruurd Jaarsma
ABSTRACTBackground:Delirium is a complex clinical syndrome characterized by disturbed consciousness, cognitive function, or perception and associated with serious adverse outcomes such as death, dementia, and the need for long-term care. However, recognition and management of delirium is poorly prioritized even though it is the most frequent complication among patients undergoing surgery following hip fracture. The aim of this study was to understand clinicians' from orthopedic speciality perceptions in relation to recognition, diagnosis, and management of delirium...
October 15, 2018: International Psychogeriatrics
Tiago R Velho, Hugo Duarte Ferreira, Catarina Carvalheiro, André Sena, Nádia Juqueira, Nuno Guerra, Javier Gallego, Ângelo Nobre
BACKGROUND: Aortic valve disease is the most common valvular heart disease. Surgical aortic valve replacement remains the gold-standard of treatment. Recently, minimally invasive approaches have been developed to reduce surgical trauma and to compete with percutaneous treatment of valvular heart disease. Minimally invasive approaches are associated with reduced perioperative morbidity and mortality. METHODS: Single-center retrospective study comparing clinical data of patients submitted to surgical treatment of aortic stenosis by limited sternotomy versus conventional sternotomy between January 2014 and August 2016...
January 2018: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
Siddhant K Mehta, Wood W Dale, Michael D Dedwylder, Patrick F Bergin, Clay A Spitler
PURPOSE: The purpose of this study is to evaluate the incidence of neurovascular injuries, compartment syndrome, early postoperative infection as well as the injury factors predictive of neurovascular injury following ballistic fractures of the radius and ulna. METHODS: A retrospective review was performed to identify all ballistic fractures of the radius and ulna in skeletally mature patients over a 5-year period at a single level-1 trauma center. Chart and radiographic review was performed to identify patient and injury demographics, associated neurologic or vascular injuries, and fracture characteristics...
October 6, 2018: Injury
Mitsuhiro Kamiyoshihara, Ryohei Yoshikawa, Hitoshi Igai, Fumi Ohsawa, Tomohiro Yazawa
A 35-year-old male was transferred because of bruising on the chest. A computed tomography scan revealed a pulmonary pseudocyst. Although the pulmonary pseudocyst remained unchanged it accumulated fluid. Based on our concern regarding hemoptysis, the patient underwent S6 segmentectomy of the right lower lobe. The postoperative pathological examination revealed a cystic lesion, including a white mass on the cystic wall. Unexpectedly, the mass was composed of papillary adenocarcinoma. Acute care surgeons should be alert to the possible presence of tumor in trauma patients...
October 10, 2018: Annals of Thoracic Surgery
Ran Nivy, Alina Kaplanov, Sharon Kuzi, Michal Mazaki-Tovi, Einat Yas, Gilad Segev, Jennifer Ben-Oz, Eran Lavy, Itamar Aroch
BACKGROUND: Pancreatitis in cats (FP) has been increasingly diagnosed in recent years, but clinical studies of large numbers of affected cats are scarce. OBJECTIVES: To describe a large cohort of cats with FP requiring hospitalization. ANIMALS: One hundred and fifty-seven client-owned cats. METHODS: Retrospective study, including cats diagnosed with pancreatitis based on sonographic evidence, positive SNAP feline pancreatic lipase immunoreactivity test results, increased 1,2-o-dilauryl-rac-glycerol-glutaric Acid-(6'-methylresorufin ester)-lipase activity, histopathology, or some combination of these...
October 13, 2018: Journal of Veterinary Internal Medicine
Ting Hway Wong, Yu Jie Wong, Zheng Yi Lau, Nivedita Nadkarni, Gek Hsiang Lim, Dennis Chuen Chai Seow, Marcus Eng Hock Ong, Kelvin Bryan Tan, Hai V Nguyen, Chek Hooi Wong
OBJECTIVES: Readmission after acute care is a significant contributor to health care costs, and has been proposed as a quality indicator. Our earlier studies showed that patients aged ≥55 years who are injured by falls from heights of ≤0.5 m were at increased risk for long-term mortality, compared to patients by high-velocity blunt trauma (higher fall heights, road injuries, and other blunt trauma). We hypothesized that these patients are also at higher risk of readmission, compared to patients injured by high-velocity mechanisms...
October 9, 2018: Journal of the American Medical Directors Association
S Rafael Arceo, Robert P Runner, Tony D Huynh, Michael B Gottschalk, Mara L Schenker, Thomas J Moore
OBJECTIVES: To describe differences in follow-up compliance and emergency department (ED) visits between ballistic and non-ballistic operative lower extremity fracture patients. DESIGN: Retrospective study. SETTING: Urban level 1 trauma center. PATIENTS/PARTICIPANTS: Patients age ≥18 years with ≥1 tibia or femur fractures treated with ORIF or intramedullary nailing (IMN) between September 1, 2013 and August 31, 2015...
October 4, 2018: Injury
Magandhree Naidoo, Shenuka Singh
BACKGROUND: Echoing the sentiments of the Sixty-seventh World Health Assembly of May 2014, mandating the all-inclusive and synchronized efforts for the management of autism spectrum disorder (ASD), the aim of this current study was to investigate the oral health status of children with ASD aged between 7 to 14 years in KwaZulu-Natal, South Africa. METHODS: An investigative cross-sectional quantitative design employing non-probability purposeful sampling was conducted on 149 children with ASD attending special needs schools in KwaZulu-Natal...
October 12, 2018: BMC Oral Health
Woo Jong Kim, Hong Seop Lee, Sung Hun Won, Yong Cheol Hong, Dhong Won Lee, Ji-Hye Lee, Chang Hyun Kim
RATIONALE: The Morel-Lavallée lesion (MLL) is a closed degloving injury developing when shear force acts between the muscle fascia and the subcutaneous layer. MLLs develop principally in the trochanteric area or the pelvis; lesions in the proximal calf are rare. Acute lesions can be treated conservatively, but chronic lesions are best treated surgically because of a high rate of recurrence. To the best of our knowledge, this is a rare case of successful treatment of an MLL in the proximal calf associated with tibio-fibular shaft fracture...
October 2018: Medicine (Baltimore)
Thalita Molinos Campos, Maria Aparecida Dos Santos Traverzim, Ana Paula Taboada Sobral, Sandra Kalil Bussadori, Kristianne Santos Porta Fernandes, Lara Jansiski Motta, Sergio Makabe
INTRODUCTION: Poor positioning of the child in relation to the breast and improper suckling are the main causes of nipple fissure. Treatment options for nipple fissures include drug therapy with antifungal and antibiotics, topical applications of lanolin, glycerin gel, creams and lotions, the milk itself, hot compresses, and silicone nipple shields. Studies involving light-emitting diode (LED) therapy have demonstrated anti-inflammatory properties, the enhancement of the wound repair process, and the control of pain...
October 2018: Medicine (Baltimore)
Joshua Loewenstern, Remi A Kessler, John Caridi
PURPOSE: Thoracic vertebral fracture repair after a traumatic injury can be associated with significant risk for postoperative complications. Surgical outcomes are further complicated by patient comorbidity, particularly diabetes mellitus. The present study compared outcomes and complication rates for traumatic thoracic vertebral fracture repair in a matched sample of diabetic patients and non-diabetic controls. METHODS: Patients with a surgical repair of a trauma-induced thoracic vertebral fracture treated from 2010-2015 were identified from the Trauma Quality Improvement Program (TQIP) database yielding 5,557 cases...
October 9, 2018: World Neurosurgery
Christopher W Snyder, Jeremy D Kauffman, Etienne E Pracht, Paul D Danielson, David J Ciesla, Nicole M Chandler
BACKGROUND: Effective and sustainable pediatric trauma care requires systems of regionalization and interfacility transfer. Avoidable transfer, also known as secondary overtriage, occurs when a patient is transferred to a regional trauma center after initial evaluation at another facility that is capable of providing definitive care. The purpose of this study was to identify risk factors for avoidable transfer among pediatric trauma patients in southwest Florida. METHODS: All pediatric trauma patients two years and older transferred from outlying hospitals to the emergency department (ED) of a single state-designated pediatric trauma center between 2009 and 2017 were obtained from the institutional registry...
October 11, 2018: Journal of Trauma and Acute Care Surgery
Priyanka Anand, Keith Kranker, Arnold Y Chen
OBJECTIVE: To estimate the additional hospital costs associated with inpatient medical harms occurring during an index inpatient admission and costs from subsequent readmissions within 90 days. DATA SOURCE: 2009 to 2011 Healthcare Cost and Utilization Project's State Inpatient Databases from 12 states. STUDY DESIGN: We compare hospital costs incurred by patients experiencing a specific harm during their hospital stay to the costs incurred by similar patients who did not experience that harm...
October 11, 2018: Health Services Research
Wei Yuan, Ernest Beng Kee Kwek
PURPOSE: Recent literature on hip fractures has focussed on the optimal environment for best outcomes. One factor that has not been studied is the managing surgeon's training background. Our study aims to examine if hip fracture patients managed by fellowship-trained orthopaedic trauma surgeons have better outcomes compared to non-trauma trained general orthopaedic surgeons. METHODS: This is a retrospective study performed at a tertiary hospital with an established orthogeriatric co-managed hip fracture care pathway...
October 11, 2018: Archives of Orthopaedic and Trauma Surgery
Beverley J Hunt, Matthew D Neal, Jakob Stensballe
Andexanet alfa, a reversing agent for anticoagulants which inhibit factor Xa, has recently been licensed in the USA. We discuss the impact of this on current practice and review in detail the problems of a neglected and growing clinical area, that of reversing the anticoagulation effect of factor Xa inhibitors in bleeding trauma patients. We identify areas of practice that need research so that care of bleeding trauma patients receiving direct factor Xa inhibitors can be improved.
October 11, 2018: Blood
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