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https://www.readbyqxmd.com/read/28922710/paediatric-mild-head-injury-is-routine-admission-to-a-tertiary-trauma-hospital-necessary
#1
Krishna Tallapragada, Ratna Soundarya Peddada, Mark Dexter
BACKGROUND: Previous studies have shown that children with isolated linear skull fractures have excellent clinical outcomes and low risk of surgery. We wish to identify other injury patterns within the spectrum of paediatric mild head injury, which need only conservative management. Children with low risk of evolving neurosurgical lesions could be safely managed in primary hospitals. METHODS: We retrospectively analysed all children with mild head injury (i.e. admission Glasgow coma score 13-15) and skull fracture or haematoma on a head computed tomography scan admitted to Westmead Children's Hospital, Sydney over the years 2009-2014...
September 18, 2017: ANZ Journal of Surgery
https://www.readbyqxmd.com/read/28921763/implementation-and-preliminary-clinical-outcomes-of-a-pharmacist-managed-venous-thromboembolism-clinic-for-patients-treated-with-rivaroxaban-post-emergency-department-discharge
#2
Baely M DiRenzo, Daren M Beam, Jeffrey A Kline, Karishma S Deodhar, Christina M Davis, Zachary A Weber, Todd A Walroth
OBJECTIVE: To describe the implementation, work flow, and differences in outcomes between a pharmacist-managed clinic for the outpatient treatment of venous thromboembolism (VTE) using rivaroxaban versus care by a primary care provider. INTERVENTIONS: Patients in the studied health system that are diagnosed with low-risk VTE in the emergency department are often discharged without hospital admission. These patients are treated with rivaroxban and follow up either in a pharmacist-managed VTE clinic or with their primary care provider...
September 16, 2017: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/28920131/reversible-causes-in-cardiovascular-collapse-at-the-emergency-department-using-ultrasonography-revive-us
#3
Mui Teng Chua, Gene Wh Chan, Win Sen Kuan
INTRODUCTION: Ultrasonographic evaluation of patients in cardiac arrest is currently not protocolised in the advanced cardiac life support (ACLS) algorithm. Potentially reversible causes may be identified using bedside ultrasonography that is ubiquitous in most emergency departments (EDs). This study aimed to evaluate the incidence of sonographically detectable reversible causes of cardiac arrest by incorporating an ultrasonography protocol into the ACLS algorithm. Secondary objectives include rates of survival to hospital admission, hospital discharge, and 30-day mortality...
August 2017: Annals of the Academy of Medicine, Singapore
https://www.readbyqxmd.com/read/28919067/impact-of-iron-deficiency-diagnosis-using-hepcidin-mass-spectrometry-dosage-methods-on-hospital-stay-and-costs-after-a-prolonged-icu-stay-study-protocol-for-a-multicentre-randomised-single-blinded-medico-economic-trial
#4
Sigismond Lasocki, Hervé Puy, Grégoire Mercier, Sylvain Lehmann
BACKGROUND: Iron deficiency (ID) is frequent but difficult to diagnose in critically ill patients. ID may be responsible for prolonged post-ICU hospital stays, since it results in fatigue, muscle weakness and anaemia. Hepcidin, the key iron metabolism hormone, may be a good marker of ID in these patients. The aim of this study is to determine whether using mass spectrometry hepcidin determination to diagnose (and treat) ID after prolonged ICU stays may reduce patients' subsequent hospital stays and costs in comparison with conventional (ferritin) methods...
September 14, 2017: Anaesthesia, Critical Care & Pain Medicine
https://www.readbyqxmd.com/read/28911287/effect-of-sugammadex-versus-neostigmine-atropine-combination-on-postoperative-cognitive-dysfunction-after-elective-surgery
#5
C Batistaki, M Riga, F Zafeiropoulou, G Lyrakos, G Kostopanagiotou, P Matsota
This study aimed to assess the effects of sugammadex and neostigmine/atropine on postoperative cognitive dysfunction (POCD) in adult patients after elective surgery. A randomised, double-blind controlled trial was carried out on 160 American Society of Anesthesiologists physical status I to III patients who were >40 years. The Mini-Mental State Evaluation, clock-drawing test and the Isaacs Set test were used to assess cognitive function at three timepoints: 1) preoperatively, 2) one hour postoperatively, and 3) at discharge...
September 2017: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/28903871/prevalence-and-risk-factors-for-transition-period-diseases-in-grazing-dairy-cows-in-brazil
#6
Rolnei R Daros, Maria J Hötzel, Jose A Bran, Stephen J LeBlanc, Marina A G von Keyserlingk
The aim of this cross-sectional study was to describe the incidence risk of dystocia, retained placenta (RP), pathological recumbence (down cow), the prevalence of metritis and subclinical ketosis (SCK), and the risk factors for SCK, metritis, and RP in grazing dairy herds in Southern Brazil. Fifty-three herds were visited 2-6 times from February to October of 2015. Body condition score (BCS), breed, days in milk (DIM), parity and disease status were recorded for each cow that was between 3 and 21 DIM at the time of the visits...
September 15, 2017: Preventive Veterinary Medicine
https://www.readbyqxmd.com/read/28901631/equine-behavioral-enrichment-toys-as-tools-for-non-invasive-recovery-of-viral-and-host-dna
#7
Peter A Seeber, Sanatana E Soilemetzidou, Marion L East, Chris Walzer, Alex D Greenwood
Direct collection of samples from wildlife can be difficult and sometimes impossible. Non-invasive remote sampling for the purpose of DNA extraction is a potential tool for monitoring the presence of wildlife at the individual level, and for identifying the pathogens shed by wildlife. Equine herpesviruses (EHV) are common pathogens of equids that can be fatal if transmitted to other mammals. Transmission usually occurs by nasal aerosol discharge from virus-shedding individuals. The aim of this study was to validate a simple, non-invasive method to track EHV shedding in zebras and to establish an efficient protocol for genotyping individual zebras from environmental DNA (eDNA)...
September 12, 2017: Zoo Biology
https://www.readbyqxmd.com/read/28900890/high-level-of-venous-thromboembolism-in-critically-ill-trauma-patients-despite-early-and-well-driven-thromboprophylaxis-protocol
#8
S R Hamada, C Espina, T Guedj, R Buaron, A Harrois, S Figueiredo, J Duranteau
BACKGROUND: Venous thromboembolism (VTE) is one of the most common preventable causes of in-hospital death in trauma patients surviving their injuries. We assessed the prevalence, incidence and risk factors for deep venous thrombosis (DVT) and pulmonary embolism (PE) in critically ill trauma patients, in the setting of a mature and early mechanical and pharmacological thromboprophylaxis protocol. METHODS: This was a prospective observational study on a cohort of patients from a surgical intensive care unit of a university level 1 trauma centre...
September 12, 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28891451/fibrinolytic-and-anticoagulation-therapy-in-patients-undergoing-ultrasound-assisted-catheter-directed-thrombolysis-for-pulmonary-embolism
#9
Kimberly Terry, Leo F Buckley, Ahmed Aldemerdash, John Fanikos, Heather Dell Orfano
BACKGROUND: Ultrasound-assisted, catheter-directed thrombolysis (UA-CDT) relieves right ventricular stress without a significant increase in the risk of bleeding compared to systemic thrombolysis. Although concomitant anticoagulation is provided to prevent thrombus expansion, the optimal anticoagulation regimen in patients receiving UA-CDT remains unknown. OBJECTIVE: We sought to describe anticoagulation practices for patients receiving UA-CDT. METHODS: Patients receiving UA-CDT for acute pulmonary embolism (PE) between Jan 1, 2013 to Sept 30, 2014 at a single center were analyzed...
September 7, 2017: Cardiovascular & Hematological Disorders Drug Targets
https://www.readbyqxmd.com/read/28890380/risk-of-exclusion-from-stroke-rehabilitation-in-the-oldest-old
#10
Paola Forti, Fabiola Maioli, Elisabetta Magni, Letizia Regazzoni, Roberto Piperno, Marco Zoli, Maura Coveri, Gaetano Procaccianti
OBJECTIVE: To investigate whether oldest-old age (≥85 yr) is an independent predictor of exclusion from stroke rehabilitation. DESIGN: Retrospective cohort study. SETTING: Stroke Unit (SU) of an Italian tertiary hospital. PARTICIPANTS: 1055 elderly patients (age 65-74 yr, n=230; age, 75-84 yr, n=432; age ≥ 85 yr, n=393), who, between 2009 and 2012, were admitted to SU with acute stroke and evaluated by a multiprofessional team for access to rehabilitation...
September 7, 2017: Archives of Physical Medicine and Rehabilitation
https://www.readbyqxmd.com/read/28888267/sex-based-differences-in-quality-of-care-and-outcomes-in-a-health-system-using-a-standardized-stemi-protocol
#11
Janet Wei, Puja K Mehta, Elizabeth Grey, Ross F Garberich, Robert Hauser, C Noel Bairey Merz, Timothy D Henry
BACKGROUND: Recent data from the National Cardiovascular Data Registry indicate that women with ST-segment-elevation myocardial infarction (STEMI) continue to have higher mortality and reported delays in treatment compared with men. We aimed to determine whether the sex difference in mortality exists when treatment disparities are reduced. METHODS: Using a prospective regional percutaneous coronary intervention (PCI)-based STEMI system database with a standardized STEMI protocol, we evaluated baseline characteristics, treatment, and clinical outcomes of STEMI patients stratified by sex...
September 2017: American Heart Journal
https://www.readbyqxmd.com/read/28884212/routine-sildenafil-does-not-improve-clinical-outcomes-after-fontan-operation
#12
J Leslie Gaddis Collins, Mark A Law, Santiago Borasino, W Clinton Erwin, David C Cleveland, Jeffrey A Alten
Fontan operation can be complicated by persistent chest tube output (CTO) leading to prolonged hospital length of stay (LOS). Postoperative sildenafil administration has been shown to improve clinical outcomes in selected patients after Fontan. We initiated a practice change utilizing intravenous (IV) sildenafil in early postoperative period in all patients undergoing Fontan operation with aim to decrease LOS and CTO. Nineteen patients (February 2014-May 2016) received 0.35 mg/kg sildenafil IV (three doses) followed by enteral, 1 mg/kg every eight hours until hospital discharge...
September 7, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28882721/clinical-presentation-of-neurocysticercosis-related-epilepsy
#13
REVIEW
Kevin R Duque, Jorge G Burneo
Neurocysticercosis (NCC) is the most common parasitic infection of the central nervous system and a major risk factor for seizures and epilepsy. Seizure types in NCC vary largely across studies and seizure semiology is poorly understood. We discuss here the studies regarding seizure types and seizure semiology in NCC, and examine the clinical presentation in patients with NCC and drug-resistant epilepsy. We also provide evidence of the role of MRI and EEG in the diagnosis of NCC-related epilepsy. Focal seizures are reported in 60-90% of patients with NCC-related epilepsy, and around 90% of all seizures registered prospectively are focal not evolving to bilateral tonic-clonic seizures...
September 4, 2017: Epilepsy & Behavior: E&B
https://www.readbyqxmd.com/read/28880108/reduced-length-of-uninterrupted-institutional-stay-after-implementing-a-fast-track-protocol-for-primary-total-hip-replacement
#14
Konsta J Pamilo, Paulus Torkki, Mikko Peltola, Maija Pesola, Ville Remes, Juha Paloneva
Background and purpose - Fast-track protocols have been successfully implemented in many hospitals as they have been shown to result in shorter length of stay (LOS) without compromising results. We evaluated the effect of fast-track implementation on the use of institutional care and results after total hip replacement (THR). Patients and methods - 3,193 THRs performed in 4 hospitals between 2009-2010 and 2012-2013 were identified from the Finnish Hospital Discharge Register and the Finnish Arthroplasty Register...
September 7, 2017: Acta Orthopaedica
https://www.readbyqxmd.com/read/28875046/ganglioneuroma-of-the-external-auditory-canal-and-middle-ear
#15
Hesham Saleh Almofada, Michael Steven Timms, M Anas Dababo
OBJECTIVE: We report an extremely rare case of ganglioneuroma involving the external auditory canal and middle ear. CASE REPORT: Ganglioneuromas are rare benign mature tumors thought to originate from sympathetic ganglions, with the highest incidence in the retroperitoneum, adrenal medulla, and posterior mediastinum. We present a case of ganglioneuroma of the external auditory canal and middle ear. At the age of 12 months, the patient was diagnosed with neuroblastoma stage IV with metastasis to the squamous temporal bone, bone marrow, and skull base...
2017: Case Reports in Otolaryngology
https://www.readbyqxmd.com/read/28874950/appropriateness-of-bolus-antihypertensive-therapy-for-elevated-blood-pressure-in-the-emergency-department
#16
Joseph B Miller, Andrew Arter, Suprat S Wilson, Alexander T Janke, Aaron Brody, Brian P Reed, Phillip D Levy
INTRODUCTION: While moderate to severely elevated blood pressure (BP) is present in nearly half of all emergency department (ED) patients, the incidence of true hypertensive emergencies in ED patients is low. Administration of bolus intravenous (IV) antihypertensive treatment to lower BP in patients without a true hypertensive emergency is a wasteful practice that is discouraged by hypertension experts; however, anecdotal evidence suggests this occurs with relatively high frequency. Accordingly, we sought to assess the frequency of inappropriate IV antihypertensive treatment in ED patients with elevated BP absent a hypertensive emergency...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28874939/rapid-primary-care-follow-up-from-the-ed-to-reduce-avoidable-hospital-admissions
#17
Amanda S Carmel, Peter Steel, Robert Tanouye, Aleksey Novikov, Sunday Clark, Sanjai Sinha, Judy Tung
INTRODUCTION: Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center...
August 2017: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28871523/a-personalized-diagnostic-and-treatment-approach-for-macrophage-activation-syndrome-and-secondary-hemophagocytic-lymphohistiocytosis-in-adults
#18
Bharat Kumar, Sohaib Aleem, Hana Saleh, Jennifer Petts, Zuhair K Ballas
OBJECTIVE: We assessed the clinical features and outcomes based on therapeutic options adopted during hospital stay for adult patients with macrophage activation syndrome and secondary hemophagocytic lymphohistiocytosis (MAS/sHLH). METHODS: We conducted a retrospective chart review of all adult patients (age ≥ 18 years) diagnosed with MAS/sHLH at our center between 2010 and 2015. Inclusion criteria for patients were diagnosis of MAS/sHLH during admission and patients meeting at least 5 out of 8 of Henter's criteria or at least 4 out of 6 of the criteria that were tested...
September 4, 2017: Journal of Clinical Immunology
https://www.readbyqxmd.com/read/28871439/one-normal-void-and-residual-following-mus-surgery-is-all-that-is-necessary-in-most-patients
#19
Paul Ballard, Sami Shawer, Colette Anderson, Aethele Khunda
INTRODUCTION AND HYPOTHESIS: There is considerable variation worldwide on how the assessment of voiding function is performed following midurethral sling (MUS) surgery. There is potentially a financial cost, and reduction in efficiency when patient discharge is delayed. Using our current practice of two normal void and residual (V&R) readings before discharge, the aim of this retrospective study was to evaluate the likelihood of an abnormal second V&R test if the first V&R test was normal in order to determine if a policy of discharge after only one satisfactory V&R test is reasonable...
September 4, 2017: International Urogynecology Journal
https://www.readbyqxmd.com/read/28870263/effect-of-maternal-vitamin-d3-supplementation-on-maternal-health-birth-outcomes-and-infant-growth-among-hiv-infected-tanzanian-pregnant-women-study-protocol-for-a-randomized-controlled-trial
#20
Christopher R Sudfeld, Karim P Manji, Christopher P Duggan, Said Aboud, Alfa Muhihi, David M Sando, Fadhlun M Alwy Al-Beity, Molin Wang, Wafaie W Fawzi
BACKGROUND: Vitamin D has significant immunomodulatory effects on both adaptive and innate immune responses. Observational studies indicate that adults infected with HIV with low vitamin D status may be at increased risk of mortality, pulmonary tuberculosis, and HIV disease progression. Growing observational evidence also suggests that low vitamin D status in pregnancy may increase the risk of adverse birth and infant health outcomes. As a result, antiretroviral therapy (ART) adjunct vitamin D3 supplementation may improve the health of HIV-infected pregnant women and their children...
September 4, 2017: Trials
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