Jackson, Morgan E.Ludi, Erica K.Reitz, Alexandra C. W.dos Santos, Gustavo Moraes...
8页
查看更多>>摘要：Background: The aim of this study is to assess the efficacy of the TRUE-Bolivia (Trauma Responders Unifying to Empower Communities Bolivia) trauma first responder course at improving participant confidence in first responder abilities and increasing knowledge of trauma response skills. Methods: Participants attended the 4-h TRUE-Bolivia course at the municipal department of urban transportation and universities and medical schools in Santa Cruz, Bolivia and completed a demographic survey and pre- and post-course knowledge assessments. All participants who attended the full course and completed both knowledge assessments were included in the study, with 453 people attending at least one portion of the course and 329 completing the full course and assessments. Results: A majority of participants were men, had completed high school or attended university, and worked or trained in the fields of transportation or medicine. Participant ratings of confidence on a 5-point Likert scale improved from a median of 3 (interquartile range [IQR] 2) before the course to 5 (IQR 1) after the course (P < 0.01). The median number of correct answers on the pre-course nine-question knowledge assessment was 3 (IQR 3), improving to 7 (IQR 3) on the post-course assessment (P < 0.01). All demographic groups demonstrated improvements in scores from the pre- to post-test. Female gender, higher education level, a background in medicine, and prior training in first aid were associated with higher pre- and post-test scores. Conclusions: The TRUE-Bolivia course increased knowledge of first responder skills and improved confidence in these abilities in participants from a variety of backgrounds. Further study is needed to determine the long-term skill utilization by participants and the course's impact on local trauma morbidity and mortality. (c) 2021 Elsevier Inc. All rights reserved.
查看更多>>摘要：Introduction: Electroacupuncture (EA) treatment has been demonstrated to have the potential to prevent sepsis-induced hippocampal injury; however, the mechanisms underlying the protective effects of EA against such injury remain unclear. Herein, to elucidate these mechanisms, we constructed a mouse model of lipopolysaccharide (LPS)-induced hippocampal injury to investigate the protection mechanism of EA and to determine whether heme oxygenase-1 (HO-1)-mediated mitochondrial function is involved in the protective effect of EA. Materials and methods: The sepsis model of hippocampal injury was induced by administering LPS. The Zusanli and Baihui acupoints were stimulated using EA for 30 min once a day, for 5 d before LPS exposure and the first day after administering LPS. Hippocampal injury was investigated by hematoxylin and eosin staining and Nissl staining. HO-1 levels were measured using Western blotting. Mitochondrial metabolism was validated by assessing adenosine triphosphate, superoxide dismutase, malondialdehyde levels, reactive oxygen species production, and mitochondrial respiratory chain activity. Mitochondrial morphology was analyzed by transmission electron microscopy. Results: EA treatment alleviated neuronal injury, impeded oxidative stress, and improved mitochondrial respiratory function, energy metabolism, and mitochondrial morphology in LPS-exposed mice. In addition, HO-1 knockout aggravated LPS-induced hippocampal injury, aggravated oxidative stress, and reduced mitochondrial respiratory function and aggravated mitochondrial swelling, crest relaxation, and vacuole degeneration. Moreover, EA was unable to reverse the hippocampal damage and mitochondrial dysfunction caused by LPS exposure after HO-1 knockout. Conclusions: EA improves LPS-induced hippocampal injury by regulating HO-1-mediated mitochondrial function. Furthermore, HO-1 plays a critical role in maintaining mitochondrial function and resisting oxidative injury. (c) 2021 Elsevier Inc. All rights reserved.
查看更多>>摘要：Background: There is a lack of literature regarding the most effective timing to initiate phys-ical therapy (PT) among traumatically injured patients. We aim to evaluate the association between early PT/mobilization versus delayed or late PT/mobilization and clinical outcomes of trauma patients. Methods: A retrospective cohort analysis of an urban level-I trauma center from 2014 to 2019 was performed. Univariate analyses and multivariable logistic regression were performed with significance defined as P < 0.05. Results: A total of 11,937 patients were analyzed. Among patients without a traumatic brain injury (TBI), late PT initiation times were associated with 60% lower odds of being discharged home without services ( P < 0.05), significantly increased hospital and ICU length of stay (H -LOS, ICU-LOS) ( P < 0.05), and significantly higher odds of complications (VTE, pneumonia, pressure ulcers, ARDS) ( P < 0.001). Among patients with a TBI, late PT initiation time had 76% lower odds of being discharged home without services ( P < 0.05) and significantly longer H-LOS and ICU-LOS ( P < 0.05) however did not experience significantly higher odds of com-plications ( P > 0.05). Conclusions: Among traumatically injured patients, early PT is associated with decreased odds of complications, shorter H-LOS and ICU-LOS, and a favorable discharge disposition to home without services. Adoption of early PT initiation/mobilization protocols and establish-ment of prophylactic measures against complications associated with delayed PT is critical to maximize quality of care and trauma patient outcomes. Multi-center prospective studies are needed to ascertain the impact of PT initiation times in greater detail and to minimize trauma patient morbidity. (c) 2021 Published by Elsevier Inc.
查看更多>>摘要：Background: Emergency department resuscitative thoracotomy (ED-RT) or prehospital resuscitative thoracotomy (PH-RT) is performed for trauma patients with impending or full cardiovascular collapse. This systematic review and meta-analysis analyze outcomes in patients with thoracic trauma receiving PH-RT and ED-RT. Methods: PubMed, JAMA Network, and CINAHL electronic databases were searched to identify studies published on ED-RT or PH-RT between 2000-2020. Patients were grouped by location of procedure and type of thoracic injury (blunt versus penetrating). Results: A total of 49 studies met the criteria for qualitative analysis, and 43 for quantitative analysis. 43 studies evaluated ED-RT and 5 evaluated PH-RT. Time from arrival on scene to PH-RT > 5 min was associated with increased neurological complications and time from the initial encounter to PH-RT or ED-RT > 10 min was associated with increased mortality. ISS > 25 and absent signs of life were also associated with increased mortality. There was higher mortality in all PH-RT (93.5%) versus all ED-RT (81.8%) ( P = 0.02). Among ED-RTs, a significant difference was found in mortality rate between patients with blunt (92.8%) versus penetrating (78.7%) injuries ( P < 0.001). When considering only blunt or penetrating injury types, no significant difference in RT mortality rate was found between ED-RT and PH-RT ( P = 0.65 and P = 0.95, respectively). Conclusions: ED-RT and PH-RT are potentially life-saving procedures for patients with penetrating thoracic injuries in extremis and with signs of life. The efficacy of this procedure is time sensitive. Moreover, there appears to be a greater mortality risk for patients with thoracic trauma receiving RT in the PH setting compared to the ED setting. More studies are needed to determine the significance of PH-RT mortality. (c) 2021 Published by Elsevier Inc.
查看更多>>摘要：Background: The care of patients with congenital diaphragmatic hernia (CDH) is expensive, yet little is known about variability in cost-of-care for these patients. The purpose of this study was to examine the cost-effectiveness of CDH treatment, comparing high- versus low-volume centers. Methods: This is a retrospective study of neonatal patients with CDH at U.S. hospitals using data from the Pediatric Health Information System database (2015-2018). Centers were considered high-volume if they had >10 patients with CDH for > 2 y. Cost-effectiveness analysis was performed with cost per survivor as the outcome measure, and probabilistic sensitivity analysis was performed. Results: A total of 1687 patients were included in the study. Overall mortality was 24.4%. Patients at high-volume centers had a longer mean length of stay (64 d versus 48 d for lowvolume centers, P = 0.0001) and higher extracorporeal life support (ECLS) rates (32% versus 24%, P = 0.002). Risk-adjusted mortality did not differ between high- and low-volume centers (23.9% versus 25.9%, P = 0.39), except when ECLS was involved (42% versus 56%, P = 0.011). Costs were significantly higher at high-volume centers ($395,291 +/- 508,351 versus $255,074 +/- 308,802, P < 0.0001). Survival status, ECLS use, operative repair, length of stay, high-volume status, and gestational age were identified as independent drivers of cost. On cost-effectiveness analysis, low-volume hospitals were more cost-effective in 95% of simulations. Conclusions: High-volume centers have substantially higher costs without an associated survival benefit and are less cost-effective than low-volume centers. Standardization of care is necessary to minimize the delivery of low-value care. (c) 2021 Elsevier Inc. All rights reserved.
查看更多>>摘要：Background: Low- and middle-income countries (LMICs) bear the bulk of the global burden of traumatic injury, yet many lack adequate prehospital trauma care systems. The Stop the Bleed (STB) course, designed to equip bystanders with bleeding control skills, is infrequently offered in LMICs, and its impact in these settings is unknown. To examine the frequency and effectiveness of STB interventions in LMICs, we quantified nursing student trainees' encounters with bleeding victims after STB training in rural Sierra Leone. Methods: Local providers and volunteers from a US-based surgical nongovernmental organization taught an STB course to nursing students in Kabala, Sierra Leone. One month and 1 year after the course, trainees completed follow-up surveys describing encounters with traumatic hemorrhage victims since the course. Results: Of 121 total STB trainees, 82 completed the 1-month follow-up survey, with 75% reporting at least one encounter with a bleeding victim. This increased to 98% at 12 months (100 responses, average 2 +/- 2 encounters). Injuries were most commonly sustained on victims' legs (32%) and most often precipitated by motorcycle crashes (31%). Respondents intervened in 99% of encounters, and 97% of patients receiving intervention survived. Although only 20% of respondents used a tourniquet, this technique produced the highest survival rate (100%). Conclusions: Nearly all respondents had encounters with victims of traumatic hemorrhage within 1 year of the STB course, and trainees effectively applied bleeding control techniques, leading to 97% survival among victims receiving intervention. These findings indicate the lifesaving impact of STB training in one rural LMIC setting. (C) 2021 Elsevier Inc. All rights reserved.
查看更多>>摘要：Introduction: Ultrasound is the gold standard for workup of cholecystitis in the emergency department, and findings heavily influence clinical decision-making. Patients with negative imaging for acute cholecystitis may be inappropriately sent home. The purpose of our study was to review the pathology and outcomes of patients presenting with biliary pain and negative ultrasound findings of acute cholecystitis. Materials and methods: Emergency department patients who underwent laparoscopic cholecystectomy between January 2015 and February 2019 were reviewed retrospectively. Only patients with negative or equivocal imaging were included. The primary outcome was the incidence of cholecystitis on final pathology. Results: Two hundred fifty-seven patients underwent laparoscopic cholecystectomy. Pathology demonstrated cholecystitis in 84% of patients. Only 15% of patients had cholelithiasis without cholecystitis on pathology. The incidence of cholecystitis was similar in negative and equivocal imaging groups (84% versus 83%; P = 0.960). The median time from admission to the operating room was 12.1 h (interquartile range 7.1-18.3 h), and hospital length of stay was 1.2 d (interquartile range 0.8-1.7 d). Conclusions: This study found that patients with negative or equivocal imaging had cholecystitis on pathology. On review of patient outcomes, those patients who underwent surgical intervention had a low rate of complications and short hospital stay. (C) 2021 Elsevier Inc. All rights reserved.
查看更多>>摘要：Introduction: Upper gastrointestinal (UGI) pathologies are common in adolescents with obesity. This study aims to determine the prevalence of UGI inflammation on preoperative esophagogastroduodenoscopy (EGD) in adolescents undergoing sleeve gastrectomy (SG) and to assess weight loss outcomes. Methods: This is a retrospective analysis of pathology reports from EGD biopsies performed prior to SG from September 2017 to August 2020. Percentage weight loss was measured at 3, 6, and 12 mo after surgery. Percent total body weight loss (TBWL) was compared between patients with and without UGI inflammation. Results: Thirty adolescents underwent laparoscopic SG. Mean TBWL was 22% of total body weight 12 mo after surgery. Preoperative EGD identified 9 (30%) patients with esophagitis, 10 (33%) with gastritis, and 9 (30%) with duodenitis. Twenty-one patients (70%) had inflammation of at least one area, 5 (17%) were Helicobacter pylori positive, and 1 (3%) had a gastric ulcer that delayed surgery. Five (17%) patients were taking antacids prior to EGD. Patients with preoperative gastric or duodenal inflammation had significantly less TBWL 12 mo after SG compared to patients without gastric (24.6% versus 16.7%, P = 0.04) or duodenal inflammation (25.7% versus 14.1%, P = 0.02). Conclusions: There is a high prevalence of UGI inflammation in adolescents undergoing SG. Gastric and duodenal inflammation is associated with less TBWL after SG.
查看更多>>摘要：Introduction: The Surgical Skills and Technology Elective Program (SSTEP) is a bootcamp for preclinical medical students that uses simulation learning methodology to provide expo-sure to procedural specialties and enhance surgical skills. Despite the widespread adoption of similar bootcamps, evidence is lacking regarding their impact on students' decision to pursue surgical/procedural careers. Methods: This exploratory analysis consisted of a retrospective, cross-sectional assessment of SSTEP involving a survey examining engagement during clerkship rotations and career decision-making was sent to all SSTEP participants since the program's inception (n = 184). In addition, publicly available data through the Canadian Resident Matching Service (CaRMS) were used to compare match data between all SSTEP participants who have participated in the CaRMS match (n = 144) and students in corresponding years who did not participate in SSTEP (n = 351). Results: Seventy-four SSTEP participants (40.2%) responded to the survey. Of the re-spondents, the majority agreed or strongly agreed that SSTEP influenced participants to engage in more procedural opportunities during clerkship (73%) and that they felt more confident performing procedural tasks during clerkship because of SSTEP (92%). Fifty percent of participants agreed that their anxiety decreased regarding clinical specialty decision. Thirty percent of participants indicated that SSTEP influenced them to pursue a procedural career. Examination of CaRMS data showed that 42% of SSTEP participants matched into direct-entry procedural specialties compared with 32% of non-SSTEP grad-uating medical students at our institution (P = 0.048). Conclusions: Our analysis supports the utility of preclerkship surgical bootcamps. By providing early exposure to procedural skills, SSTEP promoted engagement with proce-dural skills during clerkship. Participation in SSTEP influenced student career choice, which may have contributed to the increased match rate into procedural specialties for SSTEP participants. (c) 2021 Elsevier Inc. All rights reserved.
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