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https://www.readbyqxmd.com/read/28340013/implications-of-thoracic-epidural-analgesia-on-hospital-charges-in-rib-fracture-patients
#1
Courtney D Jensen, Jamie T Stark, Lewis E Jacobson, Jan M Powers, Kathy L Leslie, Jeffrey M Kinsella-Shaw, Michael F Joseph, Craig R Denegar
Objective.:  Rib fractures are present in more than 150,000 patients admitted to US trauma centers each year. Those who fracture two or more ribs are typically treated with oral analgesic drugs and are discharged with few complications. The cost of this care generally reflects its brevity. When a patient fractures three or more ribs, there is an elevated risk of complication. In response, treatments are often broadened and their durations prolonged; this affects cost. While health, function, and survival have been widely explored, patient billing has not...
March 7, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/28334590/a-prospective-emergency-department-quality-improvement-project-to-improve-the-treatment-of-vaso-occlusive-crisis-in-sickle-cell-disease-lessons-learned
#2
Paula Tanabe, Caroline E Freiermuth, David M Cline, Susan Silva
BACKGROUND: Guidelines recommend rapid, aggressive management of vaso-occlusive crisis (VOC) for patients with sickle cell disease (SCD). A large prospective research and quality improvement (QI) project was conducted to measure changes in clinical outcomes in two EDs-academic medical centers with emergency medicine residency programs and Level 1 trauma centers-during a 2.5-year time period (October 2011-March 2014). METHODS: A QI team used a Plan-Do-Study-Act approach to modify and implement changes to opioid analgesic protocols for the emergency department (ED) treatment of VOC...
March 2017: Joint Commission Journal on Quality and Patient Safety
https://www.readbyqxmd.com/read/28330797/flexible-intramedullary-nailing-for-treatment-of-proximal-humeral-and-humeral-shaft-fractures-in-children-a-retrospective-series-of-118-cases
#3
Zenon Pogorelić, Sanja Kadić, Klaudio Pjer Milunović, Irena Pintarić, Miro Jukić, Dubravko Furlan
BACKGROUND: The aim of this study was to analyze outcomes of treatment and complications in children treated with flexible intramedullary nailing (FIN) due to humeral fracture. HYPOTHESIS: The FIN for treatment of humeral fractures in children would allow an early functional and cast-free follow-up with a quick pain reduction and low complication rate. PATIENTS AND METHODS: From May 2002 until May 2016 case records of all children who underwent fixation with titanium intramedulary nails because of humeral fracture were retrospectively reviewed...
March 19, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28330737/optimizing-the-assessment-of-pediatric-injury-severity-in-low-resource-settings-consensus-generation-through-a-modified-delphi-analysis
#4
Etienne St-Louis, Dan Leon Deckelbaum, Robert Baird, Tarek Razek
INTRODUCTION: Although a plethora of pediatric injury severity scoring systems is available, many of them present important challenges and limitations in the low resource setting. Our aim is to generate consensus among a group of experts regarding the optimal parameters, outcomes, and methods of estimating injury severity for pediatric trauma patients in low resource settings. MATERIALS AND METHODS: A systematic review of the literature was conducted to identify and compare existing injury scores used in pediatric patients...
March 15, 2017: Injury
https://www.readbyqxmd.com/read/28328732/reliable-method-for-avoiding-malrotation-deformity-after-intramedullary-nailing-of-comminuted-femur-fractures-clinical-validation-of-a-previously-described-technique
#5
Ashoke Sathy, Jonathan C Barnwell, Sean N Shahrestani, Daniel Moore
OBJECTIVES: To evaluate a previously described technique using the inherent anteversion of intramedullary nail (IMN) to avoid malrotation in comminuted femur fractures and describe the use of magnetic resonance imaging (MRI) as an alternative method for assessing postoperative femoral version. DESIGN: Prospective consecutive cohort study. SETTING: Level I trauma center. PATIENT/PARTICIPANTS: Twenty-five consecutive patients with comminuted femur fractures (Winquist III/IV, OTA/AO 32-B/32-C) treated by a single surgeon with IMN between September 1, 2011, and February 28, 2015...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28328731/association-of-ipsilateral-rib-fractures-with-displacement-of-midshaft-clavicle-fractures
#6
Daniel Stahl, Matthew Ellington, Kindyle Brennan, Michael Brennan
OBJECTIVES: To determine whether the presence of ipsilateral rib fractures affects the rate of a clavicle fracture being unstable (>100% displacement). DESIGN: A retrospective review from 2002-2013 performed at a single level 1 trauma center evaluated 243 midshaft clavicle fractures. SETTING: Single Level 1 trauma center. PATIENTS/PARTICIPANTS: These fractures were subdivided into those with ipsilateral rib fractures (CIR; n = 149) and those without ipsilateral rib fractures (CnIR; n = 94)...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28328728/crew-resource-management-in-the-trauma-room-a-prospective-3-year-cohort-study
#7
Marck H T M Haerkens, Matthijs Kox, Pieter M Noe, Johannes G Van Der Hoeven, Peter Pickkers
OBJECTIVE: Human factors account for the majority of adverse events. Human factors awareness training entitled Crew Resource Management (CRM) is associated with improved safety and reduced complications and mortality in critically ill patients. We determined the effects of CRM implementation in the trauma room of an Emergency Department (ED). PATIENTS AND METHODS: A prospective 3-year cohort study was carried out in a level 1 ED, admitting more than 12 000 patients annually (>1500 trauma related)...
March 21, 2017: European Journal of Emergency Medicine: Official Journal of the European Society for Emergency Medicine
https://www.readbyqxmd.com/read/28328710/fatty-acid-saturation-of-albumin-used-in-resuscitation-fluids-modulates-cell-damage-in-shock-in-vitro-results-using-a-novel-technique-to-measure-fatty-acid-binding-capacity
#8
Alexander H Penn, Michael A Dubick, Ivo P Torres Filho
The use of albumin for resuscitation has not proven as beneficial in human trials as expected from numerous animal studies. One explanation could be the practice of adding fatty acid (FA) during manufacture of pharmaceutical albumin. During ischemia, unbound free FAs (FFA) in the circulation could potentially induce cellular damage. We hypothesized that albumins with higher available binding capacities (ABC) for FFAs may prevent that damage. Therefore, we developed a technique to measure ABC, determined if pharmaceutical human serum albumin (HSA) has decreased ABC compared to FA-free bovine serum albumin (BSA), and if binding capacity would affect hemolysis when blood is mixed with exogenous FFA at levels similar to those observed in shock...
March 21, 2017: Shock
https://www.readbyqxmd.com/read/28328679/results-of-a-multicenter-prospective-pivotal-trial-of-the-first-inline-continuous-glucose-monitor-in-critically-ill-patients
#9
Grant V Bochicchio, Stan Nasraway, Laura Moore, Anthony Furnary, Eden Nohra, Kelly Bochicchio
INTRODUCTION: We have previously demonstrated that tight glycemic control (80-120 mg/dl) improves outcome in critically injured patients. However, many centers have gotten away from aggressive glucose control due to the workload and risk of hypoglycemia. The objective of this pivotal trial is to evaluate the first in human continuous inline glucose monitor (OptiScanner) in critically ill patients. METHODS: A multicenter pivotal trial was conducted over a 1 year period (2014-2015) at 4 major academic centers in 200 critically ill patients...
March 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28328676/correlation-between-factor-f-xia-fixa-and-tissue-factor-and-trauma-severity
#10
Shannon M Prior, Mitchell J Cohen, Amanda S Conroy, Mary F Nelson, Lucy Z Kornblith, Benjamin M Howard, Saulius Butenas
BACKGROUND: It has been observed that trauma patients often display elevated procoagulant activity that could be caused, in part, by tissue factor (TF). We previously observed that trauma patients with thermal, blunt and penetrating injuries have active FIXa and FXIa in their plasma. In the current study we evaluated the effect of injury severity, with or without accompanying shock, on the frequency and concentration of TF, FIXa and FXIa in plasma from trauma patients. METHODS: Eighty trauma patients were enrolled and divided equally into 4 groups based on their injury severity score (ISS) and base deficit (BD):Group 1: Non-severe injury, no shockGroup 2: Non-severe injury, with shockGroup 3: Severe injury, no shockGroup 4: Severe injury, with shockBlood was collected at a 0 time-point (first blood draw upon arrival at hospital) and citrate plasma was prepared, frozen and stored at -80C...
March 21, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28327433/sonographic-prediction-of-outcome-of-vacuum-deliveries-a-multicenter-prospective-cohort-study
#11
Birgitte H Kahrs, Sana Usman, Tullio Ghi, Aly Youssef, Erik A Torkildsen, Elsa Lindtjørn, Tilde B Østborg, Sigurlaug Benediktsdottir, Lis Brooks, Lotte Harmsen, Pål R Romundstad, Kjell Å Salvesen, Christoph C Lees, Torbjørn M Eggebø
BACKGROUND: Safe management of the second stage of labor is of great importance. Unnecessary interventions should be avoided and correct timing of interventions focused. Ultrasound assessment of fetal position and station has a potential to improve the precision in diagnosing and managing prolonged or arrested labors. The decision to perform vacuum delivery is traditionally based on subjective assessment by digital vaginal examination and clinical expertise and there is currently no method of objectively quantifying the likelihood of successful delivery...
March 18, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28326453/violent-trauma-recidivism-does-all-violence-escalate
#12
R M Nygaard, A P Marek, S R Daly, J M Van Camp
PURPOSE: Rates of trauma patients presenting with history of prior trauma range from 25 to 44%. Outcomes involving recidivists in the setting of intentional trauma, especially penetrating trauma, are conflicting. We hypothesized that if violence does escalate with successive incidence, then injuries due to successive violence should escalate or become increasingly severe with successive admissions. METHODS: The trauma registry from an urban level I adult and pediatric trauma center was queried for injuries due to blunt assault, stabbing, and firearm injury...
March 22, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28323807/the-trauma-collaborative-care-study-tccs
#13
Stephen T Wegener, Andrew N Pollak, Katherine P Frey, Robert A Hymes, Kristin R Archer, Clifford B Jones, Rachel B Seymour, Robert V OʼToole, Renan C Castillo, Yanjie Huang, Daniel O Scharfstein, Ellen J MacKenzie
Previous research suggests that the care provided to trauma patients could be improved by including early screening and management of emotional distress and psychological comorbidity. The Trauma Collaborative Care (TCC) program, which is based on the principles of well-established models of collaborative care, was designed to address this gap in trauma center care. This article describes the TCC program and the design of a multicenter study to evaluate its effectiveness for improving patient outcomes after major, high-energy orthopaedic trauma at level 1 trauma centers...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323788/traumatic-colon-injury-in-damage-control-laparotomy-a-multicenter-trial-is-it-safe-to-do-a-delayed-anastomosis
#14
Leah Carey Tatebe, Andrew Jennings, Ken Tatebe, Alexandra Handy, Purvi Prajapati, Michael Smith, Tai Do, Gerald O Ogola, Rajesh R Gandhi, Therese M Duane, Stephen Luk, Laura Bruce Petrey
BACKGROUND: Delayed colonic anastomosis after damage control laparotomy (DCL) is an alternative to colostomies during a single laparotomy (SL) in high-risk patients. However, literature suggests increased colonic leak rates up to 27% with DCL, and various reported risk factors. We evaluated our regional experience to determine if delayed colonic anastomosis was associated with worse outcomes. METHODS: A multicenter retrospective cohort study was performed across three Level I trauma centers encompassing traumatic colon injuries from January 2006 through June 2014...
April 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28323763/prospective-randomized-clinical-trial-investigating-the-effect-of-the-reamer-irrigator-aspirator-on-the-volume-of-embolic-load-and-respiratory-function-during-intramedullary-nailing-of-femoral-shaft-fractures
#15
Jeremy A Hall, Michael D McKee, Milena R Vicente, Zachary A Morison, Niloofar Dehghan, Christine E Schemitsch, Hans J Kreder, Brad Petrisor, Emil H Schemitsch
OBJECTIVES: We sought to determine whether the use of the Reamer-Irrigator-Aspirator (RIA) device resulted in a decreased amount of fat emboli compared with standard reaming (SR) when performing intramedullary (IM) nailing of femoral shaft fractures. DESIGN: Prospective randomized clinical trial. SETTING: Multi-centered trial, level I trauma centers. PATIENTS/PARTICIPANTS: All eligible patients who presented to participating institutions with an isolated femoral shaft fracture amenable to fixation with antegrade IM nailing...
April 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28323710/does-sagittal-spinopelvic-configuration-influence-vertebral-fracture-type-or-localization-in-trauma-patients-a-retrospective-radiologic-analysis
#16
Samy Bouaicha, Marc Cunier, Max J Scheyerer, Guido A Wanner, Hans-Peter Simmen, Clément M L Werner
STUDY DESIGN: Retrospective data analysis. OBJECTIVE: The aim of this study was to analyze correlations between spinopelvic configuration and fracture pattern or location in traumatic vertebral fractures. SUMMARY OF BACKGROUND DATA: The spinopelvic configuration represented by the pelvic incidence (PI) angle showed to have a strong correlation with the occurrence of degenerative diseases of the thoracolumbar spine. No data are available on whether there is an influence of the PI angle on traumatic vertebral lesions as well...
April 2017: Clinical Spine Surgery
https://www.readbyqxmd.com/read/28323627/effects-of-xuebijing-injection-for-patients-with-sepsis-induced-acute-kidney-injury-after-wenchuan-earthquake
#17
Qin Yuxi, Hanlai Zhang, Yu Baili, Shihua Shi
Context • Earthquakes are devastating disasters that have claimed countless lives in the past, partially owing to the danger of direct and indirect injuries to vital organs. In the deadly earthquake that occurred in Sichuan Province of China on May 12, 2008, some victims suffered from severe damage to multiple organs and tissue and developed sepsis, a systematic inflammatory reaction resulting from infection and trauma. Xuebijing injection (CCXG) could beneficial for improvement of clinical symptoms in those patients, but no research has yet examined its potential...
March 2017: Alternative Therapies in Health and Medicine
https://www.readbyqxmd.com/read/28323248/accuracy-and-reproducibility-of-preoperative-three-dimensional-planning-for-total-hip-arthroplasty-using-biplanar-low-dose-radiographs-a-pilot-study
#18
Didier Mainard, Olivier Barbier, Yohann Knafo, Rémi Belleville, Laurence Mainard-Simard, Jean-Baptiste Gross
BACKGROUND: In total hip arthroplasty (THA), the acetabular cup and femoral stem must be correctly sized and positioned to avoid intraoperative and postoperative complications, achieve good functional outcomes and ensure long-term survival. Current two-dimensional (2D) techniques do not provide sufficient accuracy, while low-dose biplanar X-rays (EOS) had not been assessed in this indication. Therefore we performed a case-control study to: 1) evaluate the prediction of stem and cup size for a new 3D planning technique (stereoradiographic imaging plus 3D modeling) in comparison to 2D templating on film radiographs and 2) evaluate the accuracy and reproducibility of this 3D technique for preoperative THA planning...
March 16, 2017: Orthopaedics & Traumatology, Surgery & Research: OTSR
https://www.readbyqxmd.com/read/28322249/the-protective-effects-of-shikonin-on-hepatic-ischemia-reperfusion-injury-are-mediated-by-the-activation-of-the-pi3k-akt-pathway
#19
Tong Liu, QingHui Zhang, Wenhui Mo, Qiang Yu, Shizan Xu, Jingjing Li, Sainan Li, Jiao Feng, Liwei Wu, Xiya Lu, Rong Zhang, Linqiang Li, Keran Cheng, Yuqing Zhou, Shunfeng Zhou, Rui Kong, Fan Wang, Weiqi Dai, Kan Chen, Yujing Xia, Jie Lu, Yingqun Zhou, Yan Zhao, Chuanyong Guo
Hepatic ischemia/reperfusion (I/R) injury, which can result in severe liver injury and dysfunction, occurs in a variety of conditions such as liver transplantation, shock, and trauma. Cell death in hepatic I/R injury has been linked to apoptosis and autophagy. Shikonin plays a significant protective role in ischemia/reperfusion injury. The purpose of the present study was to investigate the protective effect of shikonin on hepatic I/R injury and explore the underlying mechanism. Mice were subjected to segmental (70%) hepatic warm ischemia to induce hepatic I/R injury...
March 21, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28321507/the-relationship-between-cumulative-lifetime-ultraviolet-radiation-exposure-bone-mineral-density-falls-risk-and-fractures-in-older-adults
#20
M J W Thompson, D A Aitken, P Otahal, J Cicolini, T M Winzenberg, G Jones
Data linking cumulative lifetime vitamin D status with skeletal outcomes are lacking. We show that increasing cumulative sun exposure was associated with higher bone mineral density in younger males and protective against fractures in females independent of current vitamin D. This supports the concept that cumulative sun exposure is an important contributor to skeletal health. INTRODUCTION: While low 25-hydroxyvitamin D levels are associated with increased fracture risk, this reflects only recent sun exposure...
March 20, 2017: Osteoporosis International
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