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https://www.readbyqxmd.com/read/28328670/the-trauma-ecosystem-the-impact-and-economics-of-new-trauma-centers-on-a-mature-statewide-trauma-system
#1
David J Ciesla, Etienne E Pracht, Pablo T Leitz, David A Spain, Joseph J Tepas, Kristan L Staudenmayer
INTRODUCTION: Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened along side 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patient profiles. METHODS: A statewide dataset was queried for all injury related discharges from adult acute care hospitals using ICD-9 codes for 2010 and 2014. The dataset, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida department of health in its trauma registry...
March 20, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28322534/indicators-for-monitoring-screening-programs-with-primary-hpv-test
#2
Manuel Zorzi, Paolo Giorgi Rossi
BACKGROUND: following scientific evidence produced in numerous studies, as well as national and international guidelines, organized cervical cancer screening programs in Italy have gradually introduced the HPV test as primary screening test, replacing cytology. As public health interventions, screening programs must ensure equity, improvement in quality of life, and adequate information for the population involved with regards to benefits and possible risks; therefore, it is essential for quality to be constantly checked at every phase of the project...
January 2017: Epidemiologia e Prevenzione
https://www.readbyqxmd.com/read/28314417/an-algorithmic-approach-to-triaging-facial-trauma-on-the-sidelines
#3
REVIEW
Kristi Colbenson
On-the-field evaluation of facial trauma requires a focused initial assessment of the patient's airway and breathing with a knowledge of the critical associated injuries. The initial triage in facial trauma involves assessing and protecting the athlete's airway, breathing, and cervical spine. The algorithm then requires a repeat evaluation for subtle causes of airway obstruction and aspiration risks. Final steps include control of hemorrhage, recognition of neurologic and ophthalmologic disability, and complete exposure of the athlete to examine for other associated injury...
April 2017: Clinics in Sports Medicine
https://www.readbyqxmd.com/read/28266033/first-international-consensus-report-on-adnexal-masses-management-recommendations
#4
Phyllis Glanc, Beryl Benacerraf, Tom Bourne, Douglas Brown, Beverly G Coleman, Christopher Crum, Jason Dodge, Deborah Levine, Edward Pavlik, Dirk Timmerman, Frederick R Ueland, Wendy Wolfman, Steven R Goldstein
The First International Consensus Conference on Adnexal Masses was convened to thoroughly examine the state of the science and to formulate recommendations for clinical assessment and management. The panel included representatives of societies in the fields of gynecology, gynecologic oncology, radiology, and pathology and clinicians from Europe, Canada, and the United States. In the United States, there are approximately 9.1 surgeries per malignancy compared to the European International Ovarian Tumor Analysis center trials, with only 2...
March 7, 2017: Journal of Ultrasound in Medicine: Official Journal of the American Institute of Ultrasound in Medicine
https://www.readbyqxmd.com/read/28264831/head-to-head-comparison-of-procalcitonin-and-presepsin-for-the-diagnosis-of-sepsis-in-critically-ill-adult-patients-a-protocol-for-a-systematic-review-and-meta-analysis
#5
Kei Hayashida, Yutaka Kondo, Yoshitaka Hara, Morio Aihara, Kazuma Yamakawa
INTRODUCTION: Early diagnosis and immediate therapeutic intervention, including appropriate antibiotic therapy and goal-directed resuscitation, are necessary to reduce mortality in patients with sepsis. However, a single clinical or biological marker indicative of sepsis has not been adopted unanimously. Although procalcitonin and presepsin are promising biomarkers that can effectively differentiate between sepsis/infection and systemic inflammatory response syndrome of non-infectious origin, little is known about which marker is superior...
March 6, 2017: BMJ Open
https://www.readbyqxmd.com/read/28238499/out-of-hospital-triage-of-older-adults-with-head-injury-a-retrospective-study-of-the-effect-of-adding-anticoagulation-or-antiplatelet-medication-use-as-a-criterion
#6
Daniel K Nishijima, Samuel D Gaona, Trent Waechter, Ric Maloney, Troy Bair, Adam Blitz, Andrew R Elms, Roel D Farrales, Calvin Howard, James Montoya, Jeneita M Bell, Mark Faul, David R Vinson, Hernando Garzon, James F Holmes, Dustin W Ballard
STUDY OBJECTIVE: Field triage guidelines recommend that emergency medical services (EMS) providers consider transport of head-injured older adults with anticoagulation use to trauma centers. However, the triage patterns and the incidence of intracranial hemorrhage or neurosurgery in these patients are unknown. Our objective is to describe the characteristics and outcomes of older adults with head trauma who are transported by EMS, particularly for patients who do not meet physiologic, anatomic, or mechanism-of-injury (steps 1 to 3) field triage criteria but are receiving anticoagulant or antiplatelet medications...
February 23, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28195686/diagnosis-of-anaplastic-lymphoma-kinase-rearrangement-in-cytological-samples-through-a-fluorescence-in-situ-hybridization-based-assay-cytological-smears-versus-cell-blocks
#7
Federica Zito Marino, Giulio Rossi, Matteo Brunelli, Maria Gabriella Malzone, Giuseppina Liguori, Giuseppe Bogina, Alessandro Morabito, Gaetano Rocco, Renato Franco, Gerardo Botti
Anaplastic lymphoma kinase (ALK) status analysis of lung cytological specimens should be successfully encouraged in routine practice because biopsy specimens are not always available. To date, the US Food and Drug Administration has approved both fluorescence in situ hybridization (FISH) and immunohistochemistry (IHC) as diagnostic tests for identifying ALK-positive patients eligible for treatment with crizotinib. Although ALK IHC is an optimal diagnostic tool, FISH becomes mandatory in equivocal cases. ALK FISH of paraffin-embedded tissue material is still the gold standard, whereas the cytological specimen assay has not yet been completely standardized...
February 14, 2017: Cancer
https://www.readbyqxmd.com/read/28156460/developing-and-piloting-an-electronic-telephone-triage-application
#8
Christine Carlisle, Colleen F Ford, Jan Hartman, Peggy Nikolajski, Carol Reidmiller, Justin S Rushford, Leslie Stewart, Amanda Barry, Melinda Krebs
68 Background: Telephone triage is a vital part of today's oncology practice and is often not standardized and measured to allow for quality improvement. UPMC CancerCenter (UPMC) has 31 outpatient clinics and is in need of a tool to streamline the current telephone triage process. UPMC and Via Oncology collaborated to develop and pilot a prototype of an electronic telephone triage application. The key components of the prototype were defined as decision support, EHR integration, reporting and workflow management...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28089112/predictive-utility-of-the-total-glasgow-coma-scale-versus-the-motor-component-of-the-glasgow-coma-scale-for-identification-of-patients-with-serious-traumatic-injuries
#9
REVIEW
Roger Chou, Annette M Totten, Nancy Carney, Spencer Dandy, Rongwei Fu, Sara Grusing, Miranda Pappas, Ngoc Wasson, Craig D Newgard
STUDY OBJECTIVE: The motor component of the Glasgow Coma Scale (mGCS) has been proposed as an easier-to-use alternative to the total GCS (tGCS) for field assessment of trauma patients by emergency medical services. We perform a systematic review and meta-analysis to compare the predictive utility of the tGCS versus the mGCS or Simplified Motor Scale in field triage of trauma for identifying patients with adverse outcomes (inhospital mortality or severe brain injury) or who underwent procedures (neurosurgical intervention or emergency intubation) indicating need for high-level trauma care...
January 11, 2017: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/28055239/the-evolving-role-of-pathology-in-new-developments-classification-terminology-and-diagnosis-of-pancreatobiliary-neoplasms
#10
REVIEW
Michelle D Reid, Melinda M Lewis, Field F Willingham, N Volkan Adsay
Pancreatobiliary tract lesions are increasingly being discovered because of more sensitive imaging modalities. Magnetic resonance imaging has identified incidental pancreatic cysts in 13.5% of patients of progressively increasing age. Pancreatobiliary tissue is more accessible through endoscopic ultrasound and magnetic resonance imaging-guided biopsy procedures, and is now an integral part of pathologists' routine practice. Accordingly, several new tumor categories have been recently recognized, including intraductal tubulopapillary neoplasm, a new addition to tumoral intraepithelial neoplasms...
March 2017: Archives of Pathology & Laboratory Medicine
https://www.readbyqxmd.com/read/28041758/emergency-medical-services-ems-versus-non-ems-transport-among-injured-children-in-the-united-states
#11
Michelle M Corrado, Junxin Shi, Krista K Wheeler, Jin Peng, Brian Kenney, Sarah Johnson, Huiyun Xiang
OBJECTIVES: This study aimed to assess the proportions of injured children transported to trauma centers by different transportation modes and evaluate the effect of transportation mode on inter-facility transfer rates using the US national trauma registry. METHODS: We analyzed data from the 2007-2012 National Trauma Data Bank (NTDB) to study trends of EMS versus non-EMS transport. Multivariable logistic regression was used to evaluate the association between transport mode and inter-facility transfer...
March 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27992953/age-related-disparities-in-trauma-center-access-for-severe-head-injuries-following-the-release-of-the-updated-field-triage-guidelines
#12
Thomas J Flottemesch, Susan Raetzman, Kevin C Heslin, Katie Fingar, Rosanna Coffey, Marguerite Barrett, Ernest Moy
OBJECTIVE: In 2006, the American College of Surgeons' Committee on Trauma and the Center for Disease Control released field triage guidelines with special consideration for older adults. Additional considerations for direct transport to a Level I or II trauma center (TC) were added in 2011, reflecting perceived undertriage to TCs for older adults. We examined whether age-based disparities in TC care for severe head injury decreased following introduction of the 2011 revisions. METHODS: A pre-post design analyzing the 2009 and 2012 Healthcare Cost and Utilization Project State Emergency Department Databases (SEDD) and State Inpatient Databases (SID) with multivariable logistic regressions considered changes in (1) the trauma designation of the emergency department where treatment was initiated and (2) transfer to a TC following initial treatment at a non-TC...
December 19, 2016: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
https://www.readbyqxmd.com/read/27982665/building-health-it-capacity-to-improve-hiv-infection-health-outcomes
#13
Hannah Rettler, Monina Klevens, Gillian Haney, Liisa Randall, Alfred DeMaria, Johanna Goderre
Eighty-six percent of those engaged in HIV medical care in Massachusetts achieved viral suppression, making Massachusetts's long-term goal of eliminating new infections of HIV a real possibility. In order to achieve this goal, Massachusetts is working to engage all individuals living with HIV/AIDS in HIV medical care, keep them retained in care, and render their viral load non-detectable. Currently, in Massachusetts, the data elements necessary to monitor the HIV care continuum are documented in siloed health information systems that do not communicate with each other...
December 2016: American Journal of Managed Care
https://www.readbyqxmd.com/read/27965331/understanding-attention-deficit-hyperactivity-disorder-as-a-continuum
#14
REVIEW
John D McLennan
OBJECTIVE: To review research findings that consider whether attention deficit hyperactivity disorder (ADHD) is a discrete entity or whether it is more consistent with an extreme end-of-trait distribution in the population and to then grapple with the potential clinical implications. QUALITY OF EVIDENCE: Peer-reviewed publications in the past 5 years, drawing from diverse fields (taxonomy, epidemiology, genetics, neurobiology, and neuropsychology), were identified through searches in MEDLINE and PsycINFO...
December 2016: Canadian Family Physician Médecin de Famille Canadien
https://www.readbyqxmd.com/read/27941470/simbu-ptosis-an-outreach-approach-to-myogenic-ptosis-in-eastern-highlands-of-papua-new-guinea-experience-and-results-from-a-high-volume-oculoplastic-surgical-camp
#15
Anna G Gushchin, Alison V Crum, Ben B Limbu, Edward P Quigley, Michael S Seward, Geoffrey C Tabin
PURPOSE: To present the results of a high-volume oculoplastic surgical outreach in a remote region of Simbu Province in the Eastern Highlands of Papua New Guinea. The authors describe the clinical features and evaluation and treatment of a novel ptosis syndrome found in this area. DESIGN: A team of 4 international ophthalmologists and 3 local doctors and 3 local nurses involved in a high-volume field intervention for all patients presenting with a bilateral ptosis to Mingende Rural Hospital...
March 2017: Ophthalmic Plastic and Reconstructive Surgery
https://www.readbyqxmd.com/read/27928226/achieving-timely-percutaneous-reperfusion-for-rural-st-elevation-myocardial-infarction-patients-by-direct-transport-to-an-urban-pci-hospital
#16
Charles-Lwanga K Bennin, Saif Ibrahim, Farah Al-Saffar, Lyndon C Box, Joel A Strom
BACKGROUNDS: ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol...
October 2016: Journal of Geriatric Cardiology: JGC
https://www.readbyqxmd.com/read/27918864/comparison-of-emergency-medical-services-and-trauma-care-systems-among-pan-asian-countries-an-international-multicenter-population-based-survey
#17
Kyong Min Sun, Kyoung Jun Song, Sang Do Shin, Hideharu Tanaka, Goh E Shaun, Wen-Chu Chiang, Kentaro Kajino, Sabariah Faizah Jamaluddin, Akio Kimura, Young Sun Ro, Dae Han Wi, Ju Ok Park, Sung Woo Moon, Young Hee Jung, Min Jung Kim, James F Holmes
OBJECTIVE: Knowledge on the current trauma systems in Asian countries is limited. The objective of this study was to describe the emergency medical services (EMS) and trauma care systems among countries participating in the Pan-Asian Trauma Outcomes Study (PATOS) Clinical Research Network. METHODS: The PATOS network consists of 33 participating sites from 14 countries. Standardized data was collected from each site using an EMS survey form and included general information (population, population density, urbanization, EMS service fee, etc...
March 2017: Prehospital Emergency Care
https://www.readbyqxmd.com/read/27886997/using-stable-free-radicals-to-obtain-unique-and-clinically-useful-data-in-vivo-in-human-subjects
#18
Harold M Swartz
This paper attempts to: (1) provide a critical overview of the challenges and opportunities to extend electron paramagnetic resonance (EPR) into practical applications in human subjects, based on EPR measurements made in vivo; (2) summarize the clinical applications of EPR for improving treatments in cancer, wound healing and diabetic care, emphasizing EPR's unique capability to measure tissue oxygen repeatedly and with particular sensitivity to hypoxia and (3) summarize the capabilities of in vivo EPR to measure radiation dose for triage and medical guidance after a large-scale radiation exposure...
December 2016: Radiation Protection Dosimetry
https://www.readbyqxmd.com/read/27833674/alternative-destination-transport-the-role-of-paramedics-in-optimal-use-of-the-emergency-department
#19
Michael M Neeki, Fanglong Dong, Leigh Avera, Tan Than, Rodney Borger, Joe Powell, Reza Vaezazizi, Richard Pitts
INTRODUCTION: Alternative destination transportation by emergency medical services (EMS) is a subject of hot debate between those favoring all patients being evaluated by an emergency physician (EP) and those recognizing the need to reduce emergency department (ED) crowding. This study aimed to determine whether paramedics could accurately assess a patient's acuity level to determine the need to transport to an ED. METHODS: We performed a prospective double-blinded analysis of responses recorded by paramedics and EPs of arriving patients' acuity level in a large Level II trauma center between April 2015 and November 2015...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27797986/ambulance-smartphone-tool-for-field-triage-of-ruptured-aortic-aneurysms-filtr-study-protocol-for-a-prospective-observational-validation-of-diagnostic-accuracy
#20
Thomas L Lewis, Rachael T Fothergill, Alan Karthikesalingam
INTRODUCTION: Rupture of an abdominal aortic aneurysm (rAAA) carries a considerable mortality rate and is often fatal. rAAA can be treated through open or endovascular surgical intervention and it is possible that more rapid access to definitive intervention might be a key aspect of improving mortality for rAAA. Diagnosis is not always straightforward with up to 42% of rAAA initially misdiagnosed, introducing potentially harmful delay. There is a need for an effective clinical decision support tool for accurate prehospital diagnosis and triage to enable transfer to an appropriate centre...
October 24, 2016: BMJ Open
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