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https://www.readbyqxmd.com/read/28420688/can-a-partnership-between-general-practitioners-and-ambulance-services-reduce-conveyance-to-emergency-care
#1
Manuel Villarreal, Jonathan Leach, Kandala Ngianga-Bakwin, Jeremy Dale
BACKGROUND: Emergency services are facing increasing workload pressures, and new models of care are needed. We evaluate the impact of a service development involving a partnership between emergency ambulance crews and general practitioners (GPs) on reducing conveyance rates to the Hospital Emergency Department (ED). METHODS: The service model was implemented in the West Midlands of England. Call handlers identified patients with needs that could be addressed by a GP using locally agreed criteria...
April 18, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28416582/relationship-between-oxygen-concentration-and-temperature-in-an-exothermic-warming-device
#2
Ben Brooks, Charles D Deakin
INTRODUCTION: Actively warming hypothermic patients or preventing hypothermia is critical in optimising outcomes in patients with traumatic injuries. Our aim was to investigate the effect of ambient oxygen concentration on the rate and change in temperature of the TechTrade Ready-Heat II exothermic (oxygen-activated) warming blanket, to evaluate safety and ascertain the risk of thermal injury. METHODS: A mannequin covered with an exothermic blanket was placed in a sealed oxygen tent...
April 17, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28405951/posterior-retroperitonoscopic-adrenalectomy-a-back-door-access-with-an-unusually-rapid-learning-curve
#3
Sohail Bakkar, Gabriele Materazzi, Lorenzo Fregoli, Piermarco Papini, Paolo Miccoli
Posterior retroperitonoscopic adrenalectomy (PRA) has become a standard approach to the adrenal gland. The aim of this study was to report an initial experience with the procedure following a proper preparatory phase highlighting the rapidity, safety and effectiveness by which it could be introduced into a surgeon's practice. Between May 2015 and July 2016, 14 PRAs were performed in 14 patients (9 females and 5 males). The average age was 46 years, BMI: 25.5 kg/m(2), and ASA score: 2. Indications included: incidenatloma (n = 5), Conn's adenoma (n = 5), and Cushing's adenoma (n = 4)...
April 12, 2017: Updates in Surgery
https://www.readbyqxmd.com/read/28389230/thick-cement-usage-in-percutaneous-vertebroplasty-for-malignant-vertebral-fractures-at-high-risk-for-cement-leakage
#4
R M Reyad, H Z Ghobrial, S M Hakim, R H Hashem, A Elsaman, M H Shaaban
PURPOSE: To assess the feasibility and safety of transpedicular percutaneous vertebroplasty (PVP) using thick bone cement in patients with intractable metastatic vertebral pain and at high risk for cement leakage. METHODS: Unilateral transpedicular PVP using firm bone cement was performed in 77 patients with intractable pain due to vertebral metastases in the thoracolumbar spine, who had one or more relative contraindication to PVP. Primary outcome measures were the severity of pain as assessed on a 100-mm visual analogue scale and daily morphine consumption...
April 4, 2017: Diagnostic and Interventional Imaging
https://www.readbyqxmd.com/read/28384632/is-reperfusion-useful-in-ischaemic-stroke-patients-presenting-with-a-low-national-institutes-of-health-stroke-scale-and-a-proximal-large-vessel-occlusion-of-the-anterior-circulation
#5
Cyril Dargazanli, Arturo Consoli, Benjamin Gory, Raphaël Blanc, Julien Labreuche, Cristian Preda, Frédéric Bourdain, Jean-Pierre Decroix, Hocine Redjem, Gabriele Ciccio, Mikael Mazighi, Stanislas Smajda, Jean-Philippe Desilles, Roberto Riva, Paul-Emile Labeyrie, Oguzhan Coskun, Georges Rodesch, Francis Turjman, Michel Piotin, Bertrand Lapergue
BACKGROUND: In population-based studies, patients presenting with minor or mild stroke symptoms represent about two-thirds of stroke patients, and almost one-third of these patients are unable to ambulate independently at the time of discharge. Although mechanical thrombectomy (MT) has become the standard of care for acute ischaemic stroke with proximal large vessel occlusion (LVO) in the anterior circulation, the management of patients harbouring proximal occlusion and minor-to-mild stroke symptoms has not yet been determined by recent trials...
April 7, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28316464/peritoneal-nebulization-of-ropivacaine-during-laparoscopic-cholecystectomy-dose-finding-and-pharmacokinetic-study
#6
Massimo Allegri, Martina Ornaghi, Catherine E Ferland, Dario Bugada, Yash Meghani, Serena Calcinati, Manuela De Gregori, Federica Lovisari, Krishnaprabha Radhakrishnan, Maria Cusato, Stefano Scalia Catenacci, Marta Somaini, Guido Fanelli, Pablo Ingelmo
Background. Intraperitoneal nebulization of ropivacaine reduces postoperative pain and morphine consumption after laparoscopic surgery. The aim of this multicenter double-blind randomized controlled trial was to assess the efficacy of different doses and dose-related absorption of ropivacaine when nebulized in the peritoneal cavity during laparoscopic cholecystectomy. Methods. Patients were randomized to receive 50, 100, or 150 mg of ropivacaine 1% by peritoneal nebulization through a nebulizer. Morphine consumption, pain intensity in the abdomen, wound and shoulder, time to unassisted ambulation, discharge time, and adverse effects were collected during the first 48 hours after surgery...
2017: Pain Research & Management: the Journal of the Canadian Pain Society
https://www.readbyqxmd.com/read/28303670/a-randomized-comparison-of-modified-subcutaneous-z-stitch-versus-manual-compression-to-achieve-hemostasis-after-large-caliber-femoral-venous-sheath-removal
#7
Radoslaw Pracon, Sripal Bangalore, Jan Henzel, Iwona Cendrowska-Demkow, Barbara Pregowska-Chwala, Agnieszka Tarnowska, Zofia Dzielinska, Zbigniew Chmielak, Adam Witkowski, Marcin Demkow
OBJECTIVES: To compare subcutaneous "Z"-stitch versus manual compression in attaining hemostasis after large bore femoral venous access, and to assess its impact on venous patency. BACKGROUND: Structural interventions increasingly require large caliber venous access, for which convenient, safe, and effective method of postprocedural hemostasis is needed. "Z"-stitch has been introduced for this purpose in some centers but systematic data on its performance is limited...
March 17, 2017: Catheterization and Cardiovascular Interventions
https://www.readbyqxmd.com/read/28299203/outcomes-of-bariatric-surgery-in-morbidly-obese-patients-with-multiple-sclerosis
#8
Kalman Bencsath, Adham Jammoul, Ali Aminian, Hideharu Shimizu, Carolyn J Fisher, Philip R Schauer, Alexander Rae-Grant, Stacy A Brethauer
Obesity is common in patients with multiple sclerosis (MS); however, safety and efficacy of bariatric surgery in this population remain unclear. A database of 2,918 was retrospectively reviewed, yielding 22 (0.75%) severely obese patients with MS who underwent bariatric surgery. Sixteen surgical patients with complete follow-up data were matched to a nonsurgical control group of MS patients, based on age, BMI, MS subtype, and length of follow-up. MS relapse rates and trends in the timed twenty-five foot walk test (T25FW) were compared...
2017: Journal of Obesity
https://www.readbyqxmd.com/read/28284983/systemic-aav-mediated-%C3%AE-sarcoglycan-delivery-targeting-cardiac-and-skeletal-muscle-ameliorates-histological-and-functional-deficits-in-lgmd2e-mice
#9
Eric R Pozsgai, Danielle A Griffin, Kristin N Heller, Jerry R Mendell, Louise R Rodino-Klapac
Limb-girdle muscular dystrophy type 2E (LGMD2E), resulting from mutations in β-sarcoglycan (SGCB), is a progressive dystrophy with deteriorating muscle function, respiratory failure, and cardiomyopathy in 50% or more of LGMD2E patients. SGCB knockout mice share many of the phenotypic deficiencies of LGMD2E patients. To investigate systemic SGCB gene transfer to treat skeletal and cardiac muscle deficits, we designed a self-complementary AAVrh74 vector containing a codon-optimized human SGCB transgene driven by a muscle-specific promoter...
April 5, 2017: Molecular Therapy: the Journal of the American Society of Gene Therapy
https://www.readbyqxmd.com/read/28229894/mobile-stroke-units-for-prehospital-thrombolysis-triage-and-beyond-benefits-and-challenges
#10
REVIEW
Klaus Fassbender, James C Grotta, Silke Walter, Iris Q Grunwald, Andreas Ragoschke-Schumm, Jeffrey L Saver
In acute stroke management, time is brain. Bringing swift treatment to the patient, instead of the conventional approach of awaiting the patient's arrival at the hospital for treatment, is a potential strategy to improve clinical outcomes after stroke. This strategy is based on the use of an ambulance (mobile stroke unit) equipped with an imaging system, a point-of-care laboratory, a telemedicine connection to the hospital, and appropriate medication. Studies of prehospital stroke treatment consistently report a reduction in delays before thrombolysis and cause-based triage in regard to the appropriate target hospital (eg, primary vs comprehensive stroke centre)...
March 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28214486/robotic-inferior-vena-cava-surgery
#11
Victor J Davila, Cristine S Velazco, William M Stone, Richard J Fowl, Haidar M Abdul-Muhsin, Erik P Castle, Samuel R Money
OBJECTIVE: Inferior vena cava (IVC) surgery is uncommon and has traditionally been performed through open surgical approaches. Renal cell carcinoma with IVC extension generally requires vena cavotomy and reconstruction. Open removal of malpositioned IVC filters (IVCF) is occasionally required after endovascular retrieval attempts have failed. As our experience with robotic surgery has advanced, we have applied this technology to surgery of the IVC. We reviewed our institution's experience with robotic surgical procedures involving the IVC to determine its safety and efficacy...
March 2017: Journal of Vascular Surgery. Venous and Lymphatic Disorders
https://www.readbyqxmd.com/read/28185289/effect-of-epidural-compared-to-patient-controlled-intravenous-analgesia-on-outcomes-for-patients-undergoing-liver-resection-for-neoplastic-disease
#12
Shelby Allen, Amy DeRoche, Lu Adams, Karen Valerie Slocum, Clancy J Clark, Nora F Fino, Perry Shen
BACKGROUND: Epidural analgesia is routinely used for postoperative pain control following abdominal surgeries, yet data regarding the safety and efficacy of epidural analgesia is controversial. METHODS: Pain-related and clinical perioperative data were extracted and correlated with baseline clinicopathologic data and method of analgesia (epidural vs. intravenous patient-controlled analgesia) in patients who underwent hepatectomy from 2012 to 2014. Chronic pain was defined by specific narcotic requirements preoperatively...
March 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28134063/the-use-of-emergency-lights-and-sirens-by-ambulances-and-their-effect-on-patient-outcomes-and-public-safety-a-comprehensive-review-of-the-literature
#13
Brett Murray, Ricky Kue
The benefits of emergency lights and sirens (L&S) use as warning devices by ambulances continue to be a debated topic in Emergency Medical Services (EMS). While the most widely studied aspect of L&S use has been related to their effect on ambulance response and transport times, the literature suggests minimal time savings with more questionable impact on actual patient outcomes. As L&S use has been shown to increase the risk for vehicle crashes, the secondary concern of ambulance design and safety also becomes an important aspect on potential design recommendations that could mitigate the effects of a crash on patients, EMS providers, and the general public...
January 30, 2017: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/28127376/safety-and-efficacy-of-mini-open-transforaminal-lumbar-interbody-fusion
#14
Mohamed M Mohi Eldin, Ehab M Eissa, Haitham M Elmorsy
OBJECTIVE: Mini-transforaminal lumbar interbody fusion (Mini-TLIF) and other minimally invasive approaches introduced for the purpose of treating lumbar degenerative disc disease and instability are achieving high success and safety rates as the conventional approaches. Moreover, it has less soft tissue damage, minimal blood loss, and less hospital stay. METHODS: A prospective study was conducted from 2012 to 2014 on 28 patients who were subjected to Mini-open TLIF combined with transpedicular screw fixation for spondylolisthesis and degenerative disc disease...
December 2016: Korean Journal of Spine
https://www.readbyqxmd.com/read/28118817/multiple-triangulation-and-collaborative-research-using-qualitative-methods-to-explore-decision-making-in-pre-hospital-emergency-care
#15
Maxine Johnson, Rachel O'Hara, Enid Hirst, Andrew Weyman, Janette Turner, Suzanne Mason, Tom Quinn, Jane Shewan, A Niroshan Siriwardena
BACKGROUND: Paramedics make important and increasingly complex decisions at scene about patient care. Patient safety implications of influences on decision making in the pre-hospital setting were previously under-researched. Cutting edge perspectives advocate exploring the whole system rather than individual influences on patient safety. Ethnography (the study of people and cultures) has been acknowledged as a suitable method for identifying health care issues as they occur within the natural context...
January 24, 2017: BMC Medical Research Methodology
https://www.readbyqxmd.com/read/28117724/ubiquitous-emergency-medical-service-system-based-on-wireless-biosensors-traffic-information-and-wireless-communication-technologies-development-and-evaluation
#16
Tan-Hsu Tan, Munkhjargal Gochoo, Yung-Fu Chen, Jin-Jia Hu, John Y Chiang, Ching-Su Chang, Ming-Huei Lee, Yung-Nian Hsu, Jiin-Chyr Hsu
This study presents a new ubiquitous emergency medical service system (UEMS) that consists of a ubiquitous tele-diagnosis interface and a traffic guiding subsystem. The UEMS addresses unresolved issues of emergency medical services by managing the sensor wires for eliminating inconvenience for both patients and paramedics in an ambulance, providing ubiquitous accessibility of patients' biosignals in remote areas where the ambulance cannot arrive directly, and offering availability of real-time traffic information which can make the ambulance reach the destination within the shortest time...
January 21, 2017: Sensors
https://www.readbyqxmd.com/read/28110861/safety-of-early-ambulation-in-patients-undergoing-ultrasound-guided-femoral-low-angle-arterial-access-technique-flat
#17
P A Shukla, M K Kolber, A Kumar, R I Patel
PURPOSE: To evaluate the safety of early ambulation in patients undergoing transfemoral arterial interventions via ultrasound-guided femoral low angle arterial access technique (FLAT). MATERIALS AND METHODS: A total of 58 patients undergoing 72 transfemoral arterial procedures that underwent an attempt at FLAT for femoral artery cannulation at our institution from November 2014 to July 2015 were retrospectively identified. Technical success was defined as obtaining less than a 35-degree angle of entry through the anterior wall of the common femoral artery...
January 16, 2017: Diagnostic and Interventional Imaging
https://www.readbyqxmd.com/read/28105624/-clinical-research-of-delta-shaped-anastomosis-technology-in-laparoscopic-distal-gastrectomy-and-digestive-tract-reconstruction
#18
Bo Gao, Qingxing Huang, Jianhong Dong
OBJECTIVE: To evaluate the feasibility and safety of the delta-shaped anastomosis in laparoscopic distal gastrectomy and digestive tract reconstruction. METHODS: Clinical data of 34 gastric cancer patients undergoing laparoscopic distal gastrectomy with the delta-shaped anastomosis for digestive tract reconstruction (delta-shaped group) and 83 gastric cancer patients undergoing laparoscopic distal gastrectomy with Billroth I( for digestive tract reconstruction (Billroth group) by same surgeon team from July 2013 to July 2015 at the Department of Digestive Surgery, Affiliated Tumor Hospital of Shanxi Medical University were retrospectively analyzed...
January 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28104260/robot-guided-ankle-sensorimotor-rehabilitation-of-patients-with-multiple-sclerosis
#19
Yunju Lee, Kai Chen, Yupeng Ren, Jongsang Son, Bruce A Cohen, James A Sliwa, Li-Qun Zhang
BACKGROUND: People with multiple sclerosis (MS) often develop symptoms including muscle weakness, spasticity, imbalance, and sensory loss in the lower limbs, especially at the ankle, which result in impaired balance and locomotion and increased risk of falls. Rehabilitation strategies that improve ankle function may improve mobility and safety of ambulation in patients with MS. This pilot study investigated effectiveness of a robot-guided ankle passive-active movement training in reducing motor and sensory impairments and improving balance and gait functions...
January 2017: Multiple Sclerosis and related Disorders
https://www.readbyqxmd.com/read/28072708/life-threatening-motor-vehicle-crashes-in-bright-sunlight
#20
Donald A Redelmeier, Sheharyar Raza
Bright sunlight may create visual illusions that lead to driver error, including fallible distance judgment from aerial perspective. We tested whether the risk of a life-threatening motor vehicle crash was increased when driving in bright sunlight.This longitudinal, case-only, paired-comparison analysis evaluated patients hospitalized because of a motor vehicle crash between January 1, 1995 and December 31, 2014. The relative risk of a crash associated with bright sunlight was estimated by evaluating the prevailing weather at the time and place of the crash compared with the weather at the same hour and location on control days a week earlier and a week later...
January 2017: Medicine (Baltimore)
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