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17/01/2018 06:13 PM
Predictive accuracy of medical transport information for in-hospital mortality
Publication date: April 2018
Source:Journal of Critical Care, Volume 44

Author(s): Andrew P. Reimer, Jarrod E. Dalton








17/01/2018 06:13 PM
Safety of long-distance transfers of patients on acute mechanical circulatory support
Publication date: April 2018
Source:Journal of Surgical Research, Volume 224

Author(s): Tae Soo Kang, Byung Soo Ko, Stavros G. Drakos, Josef Stehlik, Steven I. Bott, Antigone Koliopoulou, Joseph E. Tonna, Megan E. Bowen, Kathleen Stoddard, Craig H. Selzman, Stephen H. McKellar

Background Acute mechanical circulatory support (aMCS) can be a lifesaving therapy for patients with refractory cardiogenic shock. As device safety and technology improve, so will the ability to extend aMCS to patients at remote hospitals. The Intermountain West is unique because of the large geographical area, making transport of critically ill patients a logistical challenge. Methods We reviewed our experience of transporting patients in cardiogenic shock over long distances who had already been placed on aMCS: Impella and extracorporeal membrane oxygenator devices. Survival data was compared to international benchmark data published by the Extracorporeal Life Support Organization. Results A total of 11 patients (91% male; mean age 56 ± 5.4 y) were transported via fixed-wing aircraft to our center. The etiology of cardiogenic shock was ST-elevation myocardial infarction (n = 4), acutely decompensated chronic systolic heart failure (n = 4), postcardiotomy shock (n = 2), and acute myocarditis (n = 1). Average transport distance was 364 ± 139 miles (585 ± 264 km) and flight time was 170 ± 29 min. All patients were safely transported with no in-transit adverse events. The average duration of aMCS was 6.4 ± 3.3 d. Six patients (54.5%) survived to device explantation and 3 (27.2%) survived to hospital discharge. For comparison, Extracorporeal Life Support Organization benchmark data for adult cardiogenic shock patients report 56% survival to device explantation and 41% to hospital discharge. Conclusions Patient transport with aMCS over long distances can be done safely without serious adverse events using good protocols and well-trained personnel. Although survival data are slightly below benchmark data, they appear reasonable, given the severity of illness and challenges of transferring critically ill patients to an expert center.






17/01/2018 06:13 PM
Survivability of occupants in commercial passenger aircraft accidents
Publication date: April 2018
Source:Safety Science, Volume 104

Author(s): Simo K. Ekman, Michel Debacker

Globally, the risk of a commercial aircraft accident is low. The fatal accident rate of about 0.65 per million flights at the start of the 1990 s decreased to an average of one per 2.75 million flights for the five-year period 2010–2015. Research related to factors that can impact the health outcomes of occupants and the preparedness and response to aviation mass casualty accidents is rather limited. The aim of the study was to expand this knowledge and to determine the impact of maximum take-off weight (MTOW), flight phases and aircraft damage on the survivability of occupants in commercial passenger aircraft accidents. Two thousand one hundred accidents from the period 1990–2014, included in the accident database of the International Civil Aviation Organization (ICAO), met the inclusion criteria of the study. Results of the study showed that the survivability was lower and the casualty rate and the rate of seriously and fatally injured was higher in accidents that occurred during the approach phase, involving smaller aircrafts and in which the aircraft was destroyed. Approximately two-thirds of the accidents happened at the airport or in its immediate vicinity. Empirical data on the casualty rate, the rate of seriously and fatally injured and the survivability of occupants involved in commercial passenger aircraft accidents can help to optimize the preparedness and response of emergency medical services and hospitals in the accident area.






17/01/2018 06:13 PM
The three betrayals of the medical cannabis growing activist: From multiple victimhood to reconstruction, redemption and activism
Publication date: March 2018
Source:International Journal of Drug Policy, Volume 53

Author(s): Axel Klein, Gary R. Potter

While cannabis has been widely used in the UK for over 50 years, it is only in recent decades that domestic cultivation has become established. Public concern, media reporting and policing policy has emphasised the role of profit motivated criminal organisations often working on a large scale and with coerced labour. However, increasingly, another population are growing for medical reasons, to help themselves and others treat or manage difficult, poorly understood, or incurable conditions. Our study sought to further understand the motives, techniques and interactions of cannabis cultivators through interviews with 48 growers and supplementary ethnographic work. As well as those motivated to grow for personal use, social and commercial supply purposes we identified a cohort growing to provide themselves and others with cannabis used for therapeutic purposes. This paper draws primarily on interviews with a sub-group of sixteen medically-motivated growers who were not only involved in treatment, but also embraced the label “activist”. Rather than develop techniques of deception they were organising to effect a change in legislation. Rejecting the image of criminal perpetrators, they presented themselves as victims of unjust government policy, an indifferent medical establishment, and brutal and immoral criminal markets. Through cultivation, association, self-healing and apomedication, they have found voice and are shifting the debate over the status of growers and of cannabis itself. The ambiguity of their position as both producers and patients challenges the assumptions underlying legal distinctions between suppliers and users, with potentially profound implications for policy.






17/01/2018 06:13 PM
Combining spatial information and optimization for locating emergency medical service stations: A case study for Lower Austria
Publication date: March 2018
Source:International Journal of Medical Informatics, Volume 111

Author(s): Robert Fritze, Anita Graser, Markus Sinnl

Objectives Emergency medical services have been established in many countries all over the world. Good first care improves the outcome of patients in terms of hospital stay duration, chances of full recovery and of treatment costs. In this paper, we present an integrated approach combining spatial information and integer optimization for emergency medical service location planning. The research is motivated by a recent call for bids to restructure the location of emergency medical services in the Austrian federal state of Lower Austria by the local state government. Methods Our framework allows for constraints on the places where an emergency care physician is stationed, accounting for the fact that – for economical reasons – it might not be feasible to arbitrarily place emergency care physicians. We use maximum coverage linear programs to get accurate solutions for the problem instances (depending on the maximum allowed number of emergency care physicians and the constraints of their placement). We optimize for the maximum number of covered residents given certain parameters. The travelling distances are calculated by means of a digital road graph. Moreover we analyze the coverage of the day population as there are significant shifts in the number of persons present at daytime. For every problem instance we have calculated the ten best solutions and examined the variance among them. For the demand point aggregation we have used a cell grid. Results Using our method we can show that with less emergency care physicians more residents can be covered. This is highly applicable to low populated areas where the coverage becomes better. There is little variance from the best to the second best solution: There are only small changes (usually only one cell is shifted) between the best and the second best solution. The coverage of the day population – except for a few problem instances – is always better than the coverage of the residents (reflecting the fact that many residents commute to more densely populated areas). Conclusions In our study, we show that our solutions provide better coverage of residents with fewer emergency care physicians than the current status quo.






17/01/2018 06:13 PM
No Evidence to Support Number of Clinical Hours Necessary for Nursing Competency
Publication date: March–April 2018
Source:Journal of Pediatric Nursing, Volume 39

Author(s): Ann M. Bowling, Rhonda Cooper, Ashley Kellish, Laura Kubin, Tedra Smith

Introduction Direct patient care across the lifespan has been the standard for nursing clinical experiences over the past several years. Recently, the Ohio Board of Nursing ruled that 100% of pediatric clinical hours could be replaced with simulation. Purpose Make a recommendation for the number of direct patient care clinical hours in pediatrics that are needed to meet the pediatric nursing competencies. Method All fifty United States Boards of Nursing prelicensure nursing education requirements were reviewed to identify the number of required clinical hours and definitions for clinical experience. In addition, the Society of Pediatric Nurses members were surveyed to identify the number of direct pediatric clinical hours needed to achieve the Society of Pediatric Nurses pediatric pre-licensure competencies. Results Only ten states outline any requirements regarding the required number of clinical hours for prelicensure nursing education and twenty-six states incorporate language that defines clinical experiences. Conclusion All prelicensure students take the standardized National Council Licensure Examination (NCLEX), therefore, a consensus among the state boards of nursing outlining the minimum number of clinical hours required to reach nursing competency is needed. Practice Implications Based on the survey results of the Society of Pediatric Nurses' members and expert opinion of the pediatric authors, a minimum of 61 to 80 clinical hours in direct care of pediatric patients is necessary for nursing students to meet the Society of Pediatric Nurses' recommended pediatric nursing content, obtain pediatric nursing competency, and be able to care for pediatric patients and their families.






17/01/2018 06:13 PM
Surgical deserts in California: an analysis of access to surgical care
Publication date: March 2018
Source:Journal of Surgical Research, Volume 223

Author(s): Tarsicio Uribe-Leitz, Micaela M. Esquivel, Naomi Y. Garland, Kristan L. Staudenmayer, David A. Spain, Thomas G. Weiser

Background Areas of minimal access to surgical care, often called “surgical deserts”, are of particular concern when considering the need for urgent surgical and anesthesia care. We hypothesized that California would have an appropriate workforce density but that physicians would be concentrated in urban areas, and surgical deserts would exist in rural counties. Methods We used a benchmark of six general surgeons, six orthopedists, and eight anesthesiologists per 100,000 people per county to define a “desert”. The number and location of these providers were obtained from the Medical Board of California for 2015. ArcGIS, version 10.3, was used to geocode the data and were analyzed in Redivis. Results There were a total of 3268 general surgeons, 3188 orthopedists, and 5995 anesthesiologists in California in 2015, yielding a state surgeon-to-population ratio of 7.2, 6.7, and 10.2 per 100,000 people, respectively; however, there was wide geographic variability. Of the 58 counties in California, 18 (31%) have a general surgery desert, 27 (47%) have an orthopedic desert, and 22 (38%) have an anesthesiology desert. These counties account for 15%, 25%, and 13% of the state population, respectively. Five, seven, and nine counties, respectively, have none in the corresponding specialty. Conclusions Overall, California has an adequate ratio of surgical and anesthesia providers to population. However, because of their uneven distribution, significant surgical care deserts exist. Limited access to surgical and anesthesia providers may negatively impact patient outcome in these counties.






17/01/2018 06:13 PM
Informal caregiving and metabolic markers in the UK Household Longitudinal Study
Publication date: March 2018
Source:Maturitas, Volume 109

Author(s): Rebecca E. Lacey, Anne McMunn, Elizabeth A. Webb

Objectives Informal caregiving is associated with poorer mental and physical health. Little research has yet focused on objectively measured health risk factors, such as metabolic markers. The aim of this study was to investigate whether informal caregiving was associated with markers of metabolism in a large, representative UK longitudinal study. We also investigated whether more intensive caregiving, as indicated by more caregiving hours, was associated with a less favourable metabolic profile. Study design/outcome measures Using data on 9408 participants aged 16+ from the UK Household Longitudinal Study, we explored the relationship between caregiving and metabolic markers (blood pressure, total and high density lipoprotein cholesterol, glycated haemoglobin and triglycerides). We additionally investigated the importance of caregiving intensity (number of hours spent caregiving per week). Associations between caregiving/caregiving intensity and metabolic markers were tested using gender-stratified linear regression models adjusted for age, household income, education, social class, chronic illness, number of dependent children in the household, body mass index and partnership status. Results Men who were informal caregivers had higher total cholesterol levels than non-caregivers (3.25% higher, 95% CI: 0.07, 6.53). Women caregivers also had higher total cholesterol levels and women providing intensive care (over 20 h per week) had higher triglyceride levels (19.91% higher, 95% CI: 7.22, 34.10) and lower levels of high density lipoprotein cholesterol (8.46% lower, 95% CI: 14.51, 1.99); however, associations for women were attenuated in our final models. Conclusions Informal caregiving is associated with less favourable lipid profiles. This may be one mechanism through which informal caregiving is associated with increased disease risk. The health of informal caregivers should be a priority for public health.






17/01/2018 06:13 PM
Gaussian modelling characteristics changes derived from finger photoplethysmographic pulses during exercise and recovery
Publication date: March 2018
Source:Microvascular Research, Volume 116

Author(s): Anran Wang, Lin Yang, Weimin Wen, Song Zhang, Guanxiong Gu, Dingchang Zheng

Gaussian modelling method has been reported as a useful method to analyze arterial pulse waveform changes. This study aimed to provide scientific evidence on Gaussian modelling characteristics changes derived from the finger photoplethysmographic (PPG) pulses during exercise and recovery. 65 healthy subjects (18 female and 47 male) were recruited. Finger PPG pulses were digitally recorded with 5 different exercise loads (0, 50, 75, 100, 125W) as well as during each of 4minute (min) recovery period. The PPG pulses were normalized in both width and amplitude for each recording, which were decomposed into three independent Gaussian waves with nine parameters determined, including the peak amplitude (H1, H2, H3), peak time position (N1, N2, N3) and half-width (W1, W2, W3) from each Gaussian wave, and four extended parameters determined, including the peak time interval (T1,2, T1,3) and amplitude ratio (R1,2, R1,3) between 1st Gaussian wave and 2nd, 3rd Gaussian waves. These derived parameters were finally compared between different exercise loads and recovery phases. With gradually increased exercise loads, the peak amplitude H2, peak time position N1, N2, N3, and half-width W1, W2 increased, peak amplitude H3 decreased significantly (all P<0.05). The peak time interval T1,2 and T1,3 increased significantly from 10.6±1.2 and 36.0±4.4 at rest to 14.4±2.3 and 45.1±6.5 at 100W exercise load, respectively (both P<0.05). The amplitude ratio R1,2 also increased from 1.07±0.2 at rest to 1.22±0.2 at 100W, and the amplitude ratio R1,3 decreased from 1.10±0.3 at rest to 0.42±0.2 at 125W (all P<0.05). An opposite changing trend of these parameters was observed during recovery phases. In conclusion, this study has quantitatively demonstrated significant changes of Gaussian modelling characteristics derived from finger PPG pulse with exercise and during recovery, providing scientific evidence for the physiological mechanism that exercise increases cardiac ejection and vasodilation, and reduces the total peripheral vascular resistance.






17/01/2018 06:13 PM
Effect of early embryonic deletion of huntingtin from pyramidal neurons on the development and long-term survival of neurons in cerebral cortex and striatum
Publication date: March 2018
Source:Neurobiology of Disease, Volume 111

Author(s): I. Dragatsis, P. Dietrich, H. Ren, Y.P. Deng, N. Del Mar, H.B. Wang, I.M. Johnson, K.R. Jones, A. Reiner

We evaluated the impact of early embryonic deletion of huntingtin (htt) from pyramidal neurons on cortical development, cortical neuron survival and motor behavior, using a cre-loxP strategy to inactivate the mouse htt gene (Hdh) in emx1-expressing cell lineages. Western blot confirmed substantial htt reduction in cerebral cortex of these Emx-httKO mice, with residual cortical htt in all likelihood restricted to cortical interneurons of the subpallial lineage and/or vascular endothelial cells. Despite the loss of htt early in development, cortical lamination was normal, as revealed by layer-specific markers. Cortical volume and neuron abundance were, however, significantly less than normal, and cortical neurons showed reduced brain-derived neurotrophic factor (BDNF) expression and reduced activation of BDNF signaling pathways. Nonetheless, cortical volume and neuron abundance did not show progressive age-related decline in Emx-httKO mice out to 24months. Although striatal neurochemistry was normal, reductions in striatal volume and neuron abundance were seen in Emx-httKO mice, which were again not progressive. Weight maintenance was normal in Emx-httKO mice, but a slight rotarod deficit and persistent hyperactivity were observed throughout the lifespan. Our results show that embryonic deletion of htt from developing pallium does not substantially alter migration of cortical neurons to their correct laminar destinations, but does yield reduced cortical and striatal size and neuron numbers. The Emx-httKO mice were persistently hyperactive, possibly due to defects in corticostriatal development. Importantly, deletion of htt from cortical pyramidal neurons did not yield age-related progressive cortical or striatal pathology.






17/01/2018 06:13 PM
Relationship between childhood trauma and suicide probability in obsessive-compulsive disorder
Publication date: March 2018
Source:Psychiatry Research, Volume 261

Author(s): Rukiye AY, Lale Gonenir Erbay

The aim of this study is to assess the relationship between childhood trauma with the probability of suicide in obsessive compulsive disorders. Sixty-seven patients who were diagnosed with OCD were included in the study out of the patients who were admitted to Malatya Training and Research Hospital psychiatry outpatient clinic. The research data were collected using Yale Brawn Obsessive Compulsive Scale (YBOCS), Beck Depression (BDS) and Beck Anxiety Scales (BAS), Childhood Trauma Questionnaire-28 (CTQ-28), and Suicide Probability Scale (SPS). CTQ was detected as ≥ 35 in 36 of 67 patients who were included in the study. Aggression (p = 0.003), sexual (p = 0.007) and religious (p = 0.023) obsessions and rituelistic (p = 0.000) compulsions were significantly higher in the group with CTQ ≥ 35. Mild correlation was detected between the SPS score and the scores of CTQ. Correlation remained even when the effect of BAS and BDS scores were excluded. At the end of our study, childhood traumas were found to be associated with obsessive symptoms. In the group with childhood trauma, increased suicide probability was detected independently from depression and anxiety.






17/01/2018 06:13 PM
Professional challenges in elite sports medicine and science: Composite vignettes of practitioner emotional labor
Publication date: March 2018
Source:Psychology of Sport and Exercise, Volume 35

Author(s): Rebecca F. Hings, Christopher R.D. Wagstaff, Valerie Anderson, Sarah Gilmore, Richard C. Thelwell

Objectives Our aim was to provide an insight into professional challenges encountered by sports medics and scientists (SMSs) in elite sport organizations and illuminate the emotional labor required to navigate such challenges. Design A semi-structured interview research design was used, and data informed the development of composite vignettes, a form of creative non-fiction. Method Eighteen semi-structured interviews were conducted with sport and exercise psychologists (n = 6), physiotherapists (n = 5), strength and conditioning coaches (n = 5), one sports doctor and one generic sports scientist to facilitate data collection via guided reflection. An interpretive thematic analysis was performed, and key codes and themes were used to develop three composite vignettes. Results The composites were based on participant accounts comprising three professional roles: (a) sport and exercise psychologist, (b) physiotherapist, and (c) strength and conditioning coach. The interplay between the factors affecting emotional labor in the SMS field (e.g., ethics, power, culture), the enactment of emotional labor (e.g., emotion regulation and observable expressions), and the outcomes (e.g., personal and professional) are illuminated in the vignettes. Conclusions These data extend research on professional practice in SMS and emotional labor in three ways: (a) providing a novel theoretical contribution to explain emotional labor in professionally-challenging situations (b) examining the requirements for SMSs to enact emotional labor as part of their professional role and (c) building upon other innovative and rigorous forms of data representation that might be used as a pedagogical tool for reflection with students, trainees, and neophytes.






17/01/2018 06:13 PM
Outcomes of major laparoscopic liver resection for hepatocellular carcinoma
Publication date: March 2018
Source:Surgical Oncology, Volume 27, Issue 1

Author(s): Hanisah Guro, Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, YoungRok Choi, Sungho Kim, Kilhwan Kim, In Gun Hyun

Background To compare the surgical outcomes of major laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC). Methods We retrospectively reviewed the medical records of 177 patients who underwent major liver resection for HCC between January 2004 and June 2015. We divided the 177 patients into two groups according to the type of procedure: major LLR (LLR group; n = 67) and major OLR (OLR group; n = 110). Results Procedures in the LLR group were right hepatectomy (30 patients), right posterior sectionectomy (28), left hepatectomy (11), right anterior sectionectomy (6), extended right hepatectomy (6), and central bisectionectomy (2). Tumor size was greater in the OLR group than in the LLR group (6.3 ± 3.8 vs 4.1 ± 2.4 cm; P = 0.016). The mean indocyanine green retention rate at 15 min (P = 0.698) and serum α-fetoprotein (P = 0.186) were similar in both groups. The mean operation time was longer in the LLR group (416.6 ± 166.9 vs 332.5 ± 105.4 min; P = 0.002). Blood loss (P = 0.319), transfusion rate (P = 0.260), and R0 rate (P = 0.255) were similar in both groups. Hospital stay was shorter (11.3 ± 8.3 vs. 18 ± 21.4 days; P = 0.007) and the complication rate was lower (20.5% vs. 38.7%; P = 0.005) in the LLR group. The 5-year overall survival (77.3% vs 60.2%; P = 0.087) and disease-free survival (50.8% vs 40.1%; P = 0.139) rates were comparable in both groups. Conclusion Major LLR of HCC is feasible and oncologically safe when performed by experienced surgeons. Further refinements of the surgical technique are needed to reduce operation time.






17/01/2018 06:13 PM
Symptomatic orthostatic hypotension in Parkinson's disease patients: Prevalence, associated factors and its impact on balance confidence
Publication date: 15 February 2018
Source:Journal of the Neurological Sciences, Volume 385

Author(s): Siranan Klanbut, Siripan Phattanarudee, Supakit Wongwiwatthananukit, Chuthamanee Suthisisang, Roongroj Bhidayasiri

Background Orthostatic hypotension (OH) is a commonly reported sign of the cardiovascular autonomic dysfunctions associated with Parkinson's disease (PD). Patients might suffer from a variety of the clinical symptoms of OH, including dizziness, lightheadedness, or problems with vision and fatigue. Objectives To determine the prevalence of, and factors associated with, symptomatic orthostatic hypotension (OH) in Parkinson's disease (PD) and to identify any relationships between the clinical symptoms of OH and balance confidence in this patient population. Methods Symptomatic OH was defined as a systolic or diastolic BP fall of ≥20 or ≥10mmHg respectively, within 3min of standing and an Orthostatic Hypotension Questionnaire (OHQ) score of more than zero. Factors related to symptomatic OH were identified from a multivariate logistic regression analysis. Pearson's correlation test was used to reveal any relationships between the clinical symptoms of OH and a patient's confidence in their ability to balance, assessed using the Activities-specific Balance Confidence (ABC) scale. Results 100 Thai PD patients were consecutively recruited into this study. The prevalence of symptomatic OH was 18%, asymptomatic OH was 4%, while 78% were patients without OH. Factors associated with symptomatic OH were age (OR, 95%CI: 1.06, 1.003–1.115, p=0.038) and hypertension (OR, 95%CI: 6.16, 1.171–32.440, p=0.032). A significant and negative correlation (r=0.229, p=0.022) between OHQ composite scores and item 3 of the ABC scale (picking up slippers from floor), one of the movements in a vertical orientation, was found. Conclusion Elderly PD patients and with a co-morbidity of essential hypertension should be closely evaluated for the presence of symptomatic OH. In addition, they should be advised to change positions slowly, especially those in a vertical orientation.






17/01/2018 06:13 PM
Neurocognitive Dysfunction in Hematopoietic Cell Transplant Recipients: Expert Review from the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and Complications and Quality of Life Working Party of the European Society for Blood and Marrow Transplantation
Publication date: February 2018
Source:Biology of Blood and Marrow Transplantation, Volume 24, Issue 2

Author(s): Debra Lynch Kelly, David Buchbinder, Rafael F. Duarte, Jeffrey J. Auletta, Neel Bhatt, Michael Byrne, Zachariah DeFilipp, Melissa Gabriel, Anuj Mahindra, Maxim Norkin, Helene Schoemans, Ami J. Shah, Ibrahim Ahmed, Yoshiko Atsuta, Grzegorz W. Basak, Sara Beattie, Sita Bhella, Christopher Bredeson, Nancy Bunin, Jignesh Dalal, Andrew Daly, James Gajewski, Robert Peter Gale, John Galvin, Mehdi Hamadani, Robert J. Hayashi, Kehinde Adekola, Jason Law, Catherine J. Lee, Jane Liesveld, Adriana K. Malone, Arnon Nagler, Seema Naik, Taiga Nishihori, Susan K. Parsons, Angela Scherwath, Hannah-Lise Schofield, Robert Soiffer, Jeff Szer, Ida Twist, Anne Warwick, Baldeep M. Wirk, Jean Yi, Minoo Battiwalla, Mary E. Flowers, Bipin Savani, Bronwen E. Shaw

Hematopoietic cell transplantation (HCT) is a potentially curative treatment for children and adults with malignant and nonmalignant diseases. Despite increasing survival rates, long-term morbidity after HCT is substantial. Neurocognitive dysfunction is a serious cause of morbidity, yet little is known about neurocognitive dysfunction after HCT. To address this gap, collaborative efforts of the Center for International Blood and Marrow Transplant Research and the European Society for Blood and Marrow Transplantation undertook an expert review of neurocognitive dysfunction after HCT. In this review we define what constitutes neurocognitive dysfunction, characterize its risk factors and sequelae, describe tools and methods to assess neurocognitive function in HCT recipients, and discuss possible interventions for HCT patients with this condition. This review aims to help clinicians understand the scope of this health-related problem, highlight its impact on well-being of survivors, and help determine factors that may improve identification of patients at risk for declines in cognitive functioning after HCT. In particular, we review strategies for preventing and treating neurocognitive dysfunction in HCT patients. Finally, we highlight the need for well-designed studies to develop and test interventions aimed at preventing and improving neurocognitive dysfunction and its sequelae after HCT.






17/01/2018 06:13 PM
Effect of olfactory stimulation with essential oils on cardiovascular reactivity during the moving beans task in stroke patients with anxiety
Publication date: February 2018
Source:Complementary Therapies in Medicine, Volume 36

Author(s): Kazuaki Iokawa, Masahiro Kohzuki, Toshimasa Sone, Satoru Ebihara

Objective To investigate the effect of olfactory stimulation with essential oils on cardiovascular reactivity during the “moving beans” rehabilitation task in stroke patients with anxiety. Methods Twenty-eight stroke patients participated in this study. Blood pressure and heart rate were measured before and after finger movement tasks (e.g., moving beans and the Purdue pegboard test). Olfactory stimulation with lavender oil, grapefruit oil, and distilled water were conducted during finger tasks. Anxiety was assessed using the State Trait Anxiety Inventory (STAI)-Y2 before the finger movement tasks. Results There were no significant changes in blood pressure or heart rate activity in both finger movement tasks when stimulation of lavender oil, grapefruit oil, and distilled water was applied. However, the change values of Δ diastolic blood pressure (DBP) associated with the moving beans task indicated a significant interaction between olfactory stimulations and the groups of STAI-Y2 scores (high vs low) (p =0.03), without main effects in the olfactory stimulations and the groups of STAI-Y2 scores. Conclusion Olfactory stimulation with lavender and grapefruit oil may repress the exaggerated DBP response during the moving beans task in stroke patients with higher levels of trait anxiety symptoms.






17/01/2018 06:13 PM
Contributors
Publication date: February 2018
Source:Emergency Medicine Clinics of North America, Volume 36, Issue 1










17/01/2018 06:13 PM
Major Trauma Outside a Trauma Center
Publication date: February 2018
Source:Emergency Medicine Clinics of North America, Volume 36, Issue 1

Author(s): Preston J. Fedor, Brian Burns, Michael Lauria, Clare Richmond



Teaser

Care of the critically injured begins well before the patient arrives at a large academic trauma center. It is important to understand the continuum of care from the point of injury in the prehospital environment, through the local hospital and retrieval, until arrival at a trauma center capable of definitive care. This article highlights the important aspects of trauma assessment and management outside of tertiary or quaternary care hospitals. Key elements of each phase of care are reviewed, including management pearls and institutional strategies to facilitate effective and efficient treatment of trauma patients from the point of injury forward.




17/01/2018 06:13 PM
Ivabradine improves left ventricular twist and untwist during chronic hypertension
Publication date: 1 February 2018
Source:International Journal of Cardiology, Volume 252

Author(s): Mathieu Jozwiak, Jonathan Melka, Mario Rienzo, Alain Bizé, Lucien Sambin, Luc Hittinger, Alain Berdeaux, Jin Bo Su, Belaid Bouhemad, Bijan Ghaleh

Background Left ventricular (LV) dysfunction develops during LV hypertrophy and particularly during tachycardia. Thus we investigated the effects of heart rate (HR) reduction with ivabradine, an I f -channel blocker, on LV twist and untwist which represents myocardial deformation occurring during the overall systole and diastole and therefore provide valuable evaluation of global LV systolic and diastolic function. Methods Eight chronically instrumented pigs receiving continuous angiotensin II infusion during 28days to induce chronic hypertension and LV hypertrophy. Measurements were performed at Days 0 and 28 after stopping angiotensin II infusion in the presence and absence of ivabradine. Results At Day 0, reducing HR from 75±3 to 55±2beats/min with ivabradine did not affect LV twist but slowed LV untwist along with an increase in LV end-diastolic pressure. At Day 28, LV posterior and septal wall thickness as well as the estimated LV mass increased, indicating LV hypertrophy. LV twist and untwist were significantly reduced by 33±4% from 16±1° and 32±6% from −154±9°/s, respectively, showing global LV systolic and diastolic dysfunction. In this context, ivabradine decreased HR by 25% from 86±5beats/min and significantly improved LV twist from 11±1 to 14±1° and LV untwist from −104±8 to −146±5°/s. Conclusions Administration of ivabradine during chronic hypertension and LV hypertrophy improved LV twist and untwist. This further supports the beneficial effect of this drug on both LV systolic and diastolic function during the development of LV hypertrophy.






17/01/2018 06:13 PM
Spatial methods for evaluating critical care and trauma transport: A scoping review
Publication date: February 2018
Source:Journal of Critical Care, Volume 43

Author(s): Katia Vasilyeva, Michael J. Widener, Samuel M. Galvagno, Zachary Ginsberg

Purpose The objective of this scoping review is to inform future applications of spatial research regarding transportation of critically ill patients. We hypothesized that this review would reveal gaps and limitations in the current research regarding use of spatial methods for critical care and trauma transport research. Materials and methods Four online databases, Ovid Medline, PubMed, Embase and Scopus, were searched. Studies were selected if they used geospatial methods to analyze a patient transports dataset. 12 studies were included in this review. Results Majority of the studies employed spatial methods only to calculate travel time or distance even though methods and tools for more complex spatial analyses are widely available. Half of the studies were found to focus on hospital bypass, 2 studies focused on transportation (air or ground) mode selection, 2 studies compared predicted versus actual travel times, and 2 studies used spatial modeling to understand spatial variation in travel times. Conclusions There is a gap between the availability of spatial tools and their usage for analyzing and improving medical transportation. The adoption of geospatially guided transport decisions can meaningfully impact healthcare expenditures, especially in healthcare systems looking to strategically control expenditures with minimum impact on patient outcomes.






17/01/2018 06:13 PM
Effects of potentially modifiable risk factors on the health of adults in the Eastern Province of KSA
Publication date: February 2018
Source:Journal of Taibah University Medical Sciences, Volume 13, Issue 1

Author(s): Mohammed T. Al-Hariri, Ahmed M. Elkilany, Shaea A. Alkahtani

Objectives The purpose of this study was to investigate the association between selected major modifiable risk factors including life style habits, household income and smoking on health. Methods This cross-sectional study was conducted during 2015–2016 among 104 healthy men aged 38 ± 8 years. The data were collected using a self-administered questionnaire that enquired about clinical information about blood pressure and body mass index. Venous blood samples were taken to assess the fasting blood glucose (FBG), lipid profile, high density lipoprotein and triglyceride. Results Current smoking status and consumed energy drinks were significantly positive risk factors for increased systolic blood pressure and FBG, respectively. Participants with monthly income of more than 10,000 Saudi Riyals showed significantly lower diastolic pressure than those with lower income. However, there was a significant decrease in body weight among those who consumed vegetables. Conclusion This study highlights the effect of major modifiable risk factors on health. There is a great need for improving and enhancing a healthy lifestyle behaviour.






17/01/2018 06:13 PM
Prevalence of hypertension and prehypertension among a coastal population in south India: baseline findings from a population-based health registry project in Kerala
Publication date: February 2018
Source:Public Health, Volume 155

Author(s): T.N. Anand, M. Shaffi, M. Pillai A, A. Lathika Rajendrakumar, L.S. Sreemathy, K. Rajasekharan Nayar, J. Lordson, M. Abraham, P. Rajeev, A. Marthanda Pillai, A. Kumar, C. Grace A, J. Jacob








17/01/2018 06:13 PM
The quality of the post academic course ‘management of safety, health and environment (MoSHE) of Delft University of Technology
Publication date: February 2018
Source:Safety Science, Volume 102

Author(s): Paul Swuste, Simone Sillem

Objective This article discusses the rise of European postgraduate courses in safety science and the content and quality of the Management of Safety Health and Environment (MoSHE) course of Delft University of Technology. Materials and methods Literature search, document analysis, interviews. Results The different MoSHE years show a varied picture of this post academic program. In the Netherlands the course is unique with a central focus on risk management and sustainability, supported by scientific developments in the areas of safety, health, environment, organizational science and psychology. In all year-groups the quality of the course was assessed with a short questionnaire, collecting opinions of course members on individual presentations and the course as a whole. Quality of the course was regularly discussed through the contacts of the course coordinator with module leaders, and at meetings of course committees, and leading to changes in content of modules. After MoSHE 1 (1989), 14 (2008), and 17 (2012) the courses’ structure, organization and content was changed radically. Only, the quality system of the course remained implicit. Using the model of the European Foundation for Quality Management a first set-up for a quality system is presented. Over the years the academic nature of the program has changed substantially. This is one of the challenges for the future to find a balance between the domains taught and between an academic approach and practical skills. The course could benefit from a greater input of process safety and safety in high-tech-high-hazard sectors.






17/01/2018 06:13 PM
Resilience engineering: Current status of the research and future challenges
Publication date: February 2018
Source:Safety Science, Volume 102

Author(s): Riccardo Patriarca, Johan Bergström, Giulio Di Gravio, Francesco Costantino

This paper offers an extensive literature review on the field of Resilience Engineering (RE), encompassing 472 contributions, including journal articles, conference proceedings and book chapters. Adopting the numbers of co-citations as a metric of conceptual proximity, this paper details the application of Factor Analysis and Multi-Dimensional Scaling, as groundbreaking means to extract relevant research factors. A temporal analysis in a multi-variate two-dimensional space confirms the significance and relevance of the identified research factors. An in-depth analysis of the five research factors, labeled as the need of RE, RE for modelling, defining and exploring RE, reflecting on RE, RE and improvisation, guides the definition of future research paths and open research questions within the field and across several domains, suggesting the need for multi-disciplinary future studies.






17/01/2018 06:13 PM
The essence of the first 2.5 h in the treatment of generalized convulsive status epilepticus
Publication date: February 2018
Source:Seizure, Volume 55

Author(s): Leena Kämppi, Harri Mustonen, Kaisa Kotisaari, Seppo Soinila

Purpose This study was designed to find realistic cut-offs of the delays predicting outcome after generalized convulsive status epilepticus (GCSE) and serving protocol streamlining of GCSE patients. Method This retrospective study includes all consecutive adult (>16 years) patients (N = 70) diagnosed with GCSE in Helsinki University Central Hospital emergency department over 2 years. We defined ten specific delay parameters in the management of GCSE and determined functional outcome and mortality at hospital discharge. Functional outcome was assessed with Glasgow Outcome Scale (GOS1-3 for poor outcome, GOS > 3 for good outcome) and also defined as condition relative to baseline (worse-than-baseline vs. baseline). Univariate and multivariate regression models were used to analyze the relations between delays and outcome. Delay cut-offs predicting outcome were determined using ROC-Curves. Results In univariate analysis long onset-to-tertiary-hospital time (p = 0.034) was a significant risk factor for worse-than-baseline condition. Long delays in onset-to-diagnosis (p = 0.032), onset-to-second-stage-medication (p = 0.023), onset-to-consciousness (p = 0.027) and long total-anesthesia-time (0 = 0.043) were risk factors for low GOS score (1–3). Short delay in onset-to-initial-treatment (p = 0.047), long onset-to-anesthesia (p = 0.003) and onset-to-consciousness (p = 0.008) times were risk factors for in-hospital mortality. Multivariate analysis showed no significant factors. Cut-offs for increased risk of poor outcome were onset-to-diagnosis 2.4 h (p = 0.011), onset-to-second-stage-medication 2.5 h (p = 0.001), onset-to-consciousness 41.5 h (p = 0.009) times and total-anesthesia-time 45.5 h (p = 0.003). The delay over 2.1 h in onset-to-tertiary-hospital time increased the risk of worse-than-baseline condition (p = 0.028). Conclusions GCSE treatment is a dynamic process, where every delay component needs to be optimized. We suggest that GCSE patients should be handled with high priority and transported directly to hospital ED with neurological expertise. Critical steps in the treatment, such as diagnosing GCSE and starting progressive antiepileptic medication on stages 1 through 3, if needed, should be accomplished within 2.5 h.






17/01/2018 06:13 PM
Redundant Angiogenic Signaling and Tumor Drug Resistance
Publication date: Available online 17 January 2018
Source:Drug Resistance Updates

Author(s): Rajesh N. Gacche, Yehuda G. Assaraf

Angiogenesis research in the past two decades has contributed significantly towards understanding the molecular pathophysiology of cancer progression and inspired target-oriented research and pharma industry for the development of novel anti-angiogenic agents. Currently, over eleven drugs targeting angiogenesis have been approved by the FDA for the treatment of various malignancies. Of the registered anti-angiogenic clinical trials until the end of 2017 (ClinicalTrials.gov), over 47% were completed, 10% were terminated, 3% withdrawn, over 0.5% were suspended and only 4 trials have culminated in FDA approval for marketing. On the one hand, the clinical benefits of anti-angiogenic drugs prompted the development of novel anti-angiogenic agents. On the other hand, however, a plethora of recent studies demonstrated the emergence of tumor drug resistance towards currently used anti-angiogenic therapeutics. Series of preclinical and clinical studies have highlighted the enigma of drug resistance with functional bypass pathways, and identified compensatory or alternative angiogenic mechanisms assuring tumor growth in the midst of an anti-angiogenic stress environment. In the present review the classical literature of such redundant angiogenic pathways in concert with the key angiogenic factors and specialized cells involved in anti-angiogenic escape mechanisms is described. A strategic discourse regarding increasing tumor drug resistance and future modalities for anti-angiogenic therapy is also discussed in view of recent advances.






17/01/2018 06:13 PM
Vitreoretinal Complications and Outcomes in 92 Eyes Undergoing Surgery for Modified Osteo-Odonto-Keratoprosthesis
Publication date: Available online 17 January 2018
Source:Ophthalmology

Author(s): Pukhraj Rishi, Ekta Rishi, Vishvesh Agarwal, Sridevi Nair, Geetha Iyer, Bhaskar Srinivasan, Shweta Agarwal

Purpose To analyze vitreoretinal (VR) complications and treatment outcomes in eyes undergoing modified osteo-odonto-keratoprosthesis (OOKP) surgery. Design Retrospective case series. Participants All patients who underwent modified OOKP (mOOKP) surgery at a tertiary eye-care center from March 2003 to February 2013 were included. Methods Medical records were reviewed for relevant medical history, best-corrected visual acuity (BCVA), slit-lamp examination, ultrasound scan, oral examination findings, and VR complications. Main Outcome Measures The BCVA at the last visit. Optimal anatomic outcome was attached retina with a normal intraocular pressure at the last visit. Results A total of 92 eyes of 90 patients were included. Indications for OOKP included Stevens–Johnson syndrome (n = 53), chemical injury (n = 36), and ocular cicatricial pemphigoid (n = 3). A total of 41 eyes of 39 patients developed VR complications, including vitritis (n = 21), retinal detachment (RD) (n = 12; primary RD = 5), retroprosthetic membrane (RPM) (n = 10; primary RPM = 2), endophthalmitis (n = 8), vitreous hemorrhage (VH) (n = 5; primary VH = 1), serous choroidal detachment (n = 5), hemorrhagic choroidal detachment (n = 2), and leak-related hypotony (n = 1). Mean interval from mOOKP surgery to occurrence of VR complication(s) was 43.8 months (median, 41.9 months; range, 0.2–95.5 months). After treatment of VR complication, visual improvement was seen in 17 eyes (42%) (mean improvement = 1.2 logarithm of the minimum angle of resolution [logMAR]; median, 0.8 logMAR; range, 0.1–2.5 logMAR), visual decline in 7 eyes (14%) (mean decline in BCVA = 0.6 logMAR; median, 0.4 logMAR; range, 0.3–1.8 logMAR), and no change in BCVA in 17 eyes (42%). However, BCVA ≥6/60 was retained in 19 eyes and ≥6/18 was retained in 9 eyes after final VR treatment. Conclusions Vitreoretinal complications constitute a significant cause of visual morbidity in eyes undergoing mOOKP surgery and pose a challenging situation to manage. However, appropriate and timely intervention can achieve encouraging results.






17/01/2018 06:13 PM
¿Qué hemos aprendido de la notificación de incidentes de seguridad en el Bloque Quirúrgico?: estudio descriptivo transversal de 2 años de actividad de un grupo analizador multidisciplinar
Publication date: Available online 17 January 2018
Source:Revista Española de Anestesiología y Reanimación

Author(s): F. Caba Barrientos, A. Rodríguez Morillo, R. Galisteo Domínguez, M. del Nozal Nalda, C.V. Almeida González, M. Echevarría Moreno

Antecedentes y objetivos Los sistemas de notificación de incidentes (SNI) se consideran una herramienta que facilita el aprendizaje y la cultura de seguridad. Utilizando la experiencia adquirida con SENSAR, evaluamos la viabilidad y la actividad de un grupo multidisciplinar analizador de incidentes en el paciente quirúrgico notificados a un sistema general comunitario, el del Observatorio para la Seguridad del Paciente (OSP). Material y método Estudio observacional descriptivo transversal planificado a 2 años. Previa formación en el análisis, se crea un grupo multidisciplinar en cuanto a especialidades y categorías profesionales, que analizarían los incidentes en el paciente quirúrgico notificados al OSP. Se clasifican los incidentes y se analizan sus circunstancias. Resultados Entre los meses de marzo de 2015 y 2017 se notificaron 95 incidentes (4 por no profesionales). Los facultativos notificaron más que la enfermería, 54 (56,8%) vs. 37 (38,9%). La unidad que más notificó fue Anestesia con 46 (48,4%) (p=0,025). Los tipos de incidentes se relacionaron principalmente con el procedimiento asistencial (30,5%); el momento, con el preoperatorio (42,1%) y el lugar, con el área quirúrgica (48,4%), detectándose diferencias significativas en función de la filiación del notificante (p=0,03). No daño, o morbilidad menor, presentaron el 88% de los incidentes. Se identificaron errores en el 79%. El análisis de los incidentes dirigió las medidas a tomar. Conclusiones La actividad que mantuvo el grupo multidisciplinar de análisis durante el periodo de estudio propició el conocimiento del sistema entre los profesionales y permitió identificar elementos de mejora en el Bloque Quirúrgico a diferentes niveles. Background and objectives Incident Reporting Systems (IRS) are considered a tool that facilitates learning and safety culture. Using the experience gained with SENSAR, we evaluated the feasibility and the activity of a multidisciplinary group analyzing incidents in the surgical patient notified to a general community system, that of the Observatory for Patient Safety (OPS). Material and method Cross-sectional observational study planned for two years. After training in the analysis, a multidisciplinary group was created in terms of specialties and professional categories, which would analyze the incidents in the surgical patient notified to the OPS. Incidents are classified and their circumstances analyzed. Results Between March 2015 and 2017, 95 incidents were reported (4 by non-professionals). Doctors reported more than nurses, at 54 (56.84%) vs. 37 (38.94%). The anaesthesia unit reported most at 46 (48.42%) (P =.025). The types of incidents mainly related to the care procedure (30.52%); to the preoperative period (42.10%); and to the place, the surgical area (48.42%). Significant differences were detected according to the origin of the notifier (P =.03). No harm, or minor morbidity, constituted 88% of the incidents. Errors were identified in 79%. The analysis of the incidents directed the measures to be taken. Conclusions The activity undertaken by the multidisciplinary analytical group during the period of study facilitated knowledge of the system among the professionals and enabled the identification of areas for improvement in the Surgical Block at different levels.






17/01/2018 06:13 PM
An Effective Treatment in the Austere Environment? A Critical Appraisal into the Use of Intra-Articular Local Anesthetic to Facilitate Reduction in Acute Shoulder Dislocation
Publication date: Available online 17 January 2018
Source:Wilderness & Environmental Medicine

Author(s): Fraser John Gould

Acute shoulder dislocation is a common injury in the outdoor environment. The objective of this systematic review of the literature was to determine if intra-articular local anesthetic (IAL) is an effective treatment that could have prehospital application. A methodical search of MEDLINE, PubMed, and EMBASE databases targeted publications from January 1, 1990 until January 1, 2017. Eligible articles compared IAL with other analgesic techniques in patients 16 years or older experiencing acute glenohumeral dislocation. Reduction success, complications, and patient-reported outcome measures underwent comparison. All identified publications originated from the hospital setting. Procedural success rates ranged widely among randomized control trials comparing IAL with intravenous analgesia and sedation (IAL 48–100%, intravenous analgesia and sedation 44–100%). A pooled risk ratio [RR] favored intravenous analgesia and sedation (RR 0.91, 95% confidence interval [CI] 0.84–0.98), but there was significant inconsistency within the analysis (I2 = 75%). IAL provided lower complication rates (4/170, 2%) than intravenous analgesia and sedation (20/150, 13%) (RR 1.11, 95% CI 1.04–1.19, I2 = 63%). One trial found a clinically relevant reduction in visual analogue pain scores when comparing IAL against no additional analgesia in the first minute (IAL 21±13 mm; control 49±15 mm; P<0.001) and fifth minute (IAL 10±10 mm; control 40±14 mm, P<0.001) after reduction. The results suggest that IAL is an effective intervention for acute anterior shoulder dislocation that would have a place in the repertoire of the remote physician. Further research might be beneficial in determining the outcomes of performing IAL in the prehospital setting.






17/01/2018 06:13 PM
Cutaneous Vascular Responses of the Hands and Feet to Cooling, Rewarming, and Hypoxia in Humans
Publication date: Available online 17 January 2018
Source:Wilderness & Environmental Medicine

Author(s): Heather C. Massey, James R. House, Michael J. Tipton

Introduction This study investigated skin vasomotor responses in the fingers and toes during cooling and rewarming with and without normobaric hypoxia. Methods Fourteen volunteers (8 males and 6 females) were exposed to gradual air cooling (mean±SD: −0.4±0.1oC·min−1) followed by rewarming (+0.5±0.1oC·min−1) while breathing normoxic air (FIO2 0.21 at 761±3 mm Hg) or hypoxic gas (FIO2 0.12, at 761±3 mm Hg, equivalent to ~5000 m above sea level). Throughout the gradual cooling and rewarming phases, rectal temperature was measured, and skin temperatures and laser Doppler skin blood flow were measured on the thumb, little finger, and great and little toe pads. Results During gradual cooling, skin temperature but not deep body temperature decreased. No differences in cutaneous vascular conductance were found for the toes or thumb (P=0.169 great toe; P=0.289 little toe; P=0.422 thumb). Cutaneous vascular conductance was reduced in the little finger to a greater extent at the same mean skin temperatures (34.5–33.5oC) in the hypoxic compared with normoxic conditions (P=0.047). The onset of vasoconstriction and release of vasoconstriction in the thumb and little finger occurred at higher mean skin temperatures in hypoxia compared with normoxia (P<0.05). The onset of vasoconstriction and release of vasoconstriction in the toes occurred at similar skin temperatures (P=0.181 and P=0.132, respectively). Conclusion The earlier vasoconstrictor response and later release of vasoconstriction in the finger during hypoxic conditions may result in a greater dose of cold to that digit, taking longer to rewarm following the release of vasoconstriction.






17/01/2018 06:13 PM
Differential effects of brachial and central blood pressures on circulating levels of high-sensitivity cardiac troponin I in the general population
Publication date: Available online 16 January 2018
Source:Atherosclerosis

Author(s): Tomonori Sugiura, Yasuaki Dohi, Hiroyuki Takase, Atsushi Ito, Satoshi Fujii, Nobuyuki Ohte

Background and aims Severe cardiac load increases circulating concentrations of high-sensitivity cardiac troponin I (hs-cTnI) through non-ischemic mechanisms. The present study was designed to investigate the effect of central blood pressure (BP), which reflects cardiac load rather than peripheral BP, on serum concentrations of hs-cTnI in subjects with or without increased arterial stiffness. Methods We enrolled 1210 participants taking part in a yearly health checkup program. Laboratory measurements included serum concentrations of hs-cTnI and derivative reactive oxygen metabolites (d-ROM), as well as plasma concentrations of B-type natriuretic peptide (BNP). Central BP and the radial augmentation index (rAI) were evaluated non-invasively using an automated device. Results Univariate and multivariable regression analysis showed that both brachial and central BP were significantly associated with hs-cTnI. When subjects were divided into two groups according to mean rAI value, those with higher rAI had higher hs-cTnI concentrations than those with lower rAI. In subgroup analyses, in those with lower rAI, brachial but not central systolic BP was independently associated with hs-cTnI, whereas in those with higher rAI, central but not brachial systolic BP was independently associated with hs-cTnI. These associations remained significant after further adjustment for BNP and/or d-ROM concentrations. Conclusions Circulating levels of hs-cTnI increase with increasing brachial and central BP, but the effect of central BP was greater in subjects with higher rAI. This indicates that central BP may have a strong effect on silent myocardial damage, assessed as increased circulating hs-cTnI, particularly in subjects with increased arterial stiffness.






17/01/2018 06:13 PM
Association between Reduced Trunk Flexibility in Children and Lumbar Stress Fractures
Publication date: Available online 16 January 2018
Source:Journal of Orthopaedics

Author(s): Masahiko Kemmochi, Shigeru Sasaki, Shoichi Ichimura

Background We noticed that most of active sports children with low back pain (LBP) have muscle tightness around the pelvis and reduced trunk flexibility. Abnormalities in short-time inversion recovery (STIR) images on magnetic resonance imaging (MRI) can show stress fracture. Therefore, we investigated the associations among LBP, trunk flexibility, and lumbar stress fractures. Methods A total of 130 patients under the age of 18 years complained of LBP were investigated in STIR MRI images. Among these 130 patients, 65 cases of lumbar stress fracture were diagnosed and 65 cases were not diagnosed as a lumbar stress fracture. We compared between a group suspected of stress fracture (suspected group) and a group of stress fracture(stress fracture group)about their trunk flexibility. These groups were investigated about their initial trunk flexibility about below items; Finger floor distance (FFD), Heel to buttock distance (HBD), straight leg raising (SLR). Results Significant differences were observed between suspected group and stress fracture group about every items; SLR (P < 0.001), FFD (P < 0.01), HBD (P < 0.002). Most cases of stress fracture group had reduced trunk flexibility, and low flexibility in pelvic area muscles was observed in 93.8% (61/65) of cases at the initial examination. Otherwise, that of suspected group was 73.8%(48/65). Conclusions Most patients of lumbar stress fracture had reduced trunk flexibility, and their reduced trunk flexibility might not be caused by LBP. In the early diagnosis of lumbar stress fractures using STIR MRI images, there were indicated that reduced trunk flexibility was one of helpful item for lumbar stress fracture.






17/01/2018 06:13 PM
Carotid-femoral pulse wave velocity in a healthy adult sample: The ELSA-Brasil study
Publication date: 15 January 2018
Source:International Journal of Cardiology, Volume 251

Author(s): Marcelo Perim Baldo, Roberto S. Cunha, Maria del Carmen B. Molina, Dora Chór, Rosane H. Griep, Bruce B. Duncan, Maria Inês Schmidt, Antonio L.P. Ribeiro, Sandhi M. Barreto, Paulo A. Lotufo, Isabela M. Bensenor, Alexandre C. Pereira, José Geraldo Mill

Background Aging declines essential physiological functions, and the vascular system is strongly affected by artery stiffening. We intended to define the age- and sex-specific reference values for carotid-to-femoral pulse wave velocity (cf-PWV) in a sample free of major risk factors. Methods and results The ELSA-Brasil study enrolled 15,105 participants aged 35–74years. The healthy sample was achieved by excluding diabetics, those over the optimal and normal blood pressure levels, body mass index ≤18.5 or ≥25kg/m2, current and former smokers, and those with self-report of previous cardiovascular disease. After exclusions, the sample consisted of 2158 healthy adults (1412 women). Although cf-PWV predictors were similar between sex (age, mean arterial pressure (MAP) and heart rate), cf-PWV was higher in men (8.74±1.15 vs. 8.31±1.13m/s; adjusted for age and MAP, P <0.001) for all age intervals. When divided by MAP categories, cf-PWV was significantly higher in those which MAP ≥85mmHg, regardless of sex, and for all age intervals. Risk factors for arterial stiffening in the entire ELSA-Brasil population (n =15,105) increased by twice the age-related slope of cf-PWV growth, regardless of sex (0.0919±0.182 vs. 0.0504±0.153m/s per year for men, 0.0960±0.173 vs. 0.0606±0.139m/s per year for women). Conclusions cf-PWV is different between men and women and even in an optimal and normal range of MAP and free of other classical risk factors for arterial stiffness, reference values for cf-PWV should take into account MAP levels. Also, the presence of major risk factors in the general population doubles the age-related rise in cf-PWV.






17/01/2018 06:13 PM
Effect of Serum Albumin Concentration on Neurological Outcome After Out-of-Hospital Cardiac Arrest (from the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] Study in Osaka, Japan)
Publication date: 15 January 2018
Source:The American Journal of Cardiology, Volume 121, Issue 2

Author(s): Tasuku Matsuyama, Taku Iwami, Tomoki Yamada, Koichi Hayakawa, Kazuhisa Yoshiya, Taro Irisawa, Yoshio Abe, Tetsuro Nishimura, Toshifumi Uejima, Yasuo Ohishi, Takeyuki Kiguchi, Masashi Kishi, Masafumi Kishimoto, Shota Nakao, Yasuyuki Hayashi, Taku Sogabe, Takaya Morooka, Junichi Izawa, Tomonari Shimamoto, Toshihiro Hatakeyama, Tomoko Fujii, Junya Sado, Takeshi Shimazu, Takashi Kawamura, Tetsuhisa Kitamura

The aim of this study was to assess whether serum albumin concentration upon hospital arrival had prognostic indications on out-of-hospital cardiac arrest (OHCA). This prospective, multicenter observational study conducted in Osaka, Japan (the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] study), enrolled all patients with consecutive OHCA transported to 14 participating institutions. We included adult patients aged ≥18 years with nontraumatic OHCA who achieved return of spontaneous circulation and whose serum albumin concentration was available from July 2012 to December 2014. Based on the serum albumin concentration upon hospital arrival, patients were divided into quartiles (Q1 to Q4), namely, Q1 (<2.7 g/dl), Q2 (2.7 to 3.1 g/dl), Q3 (3.1 to 3.6 g/dl), and Q4 (≥3.6 g/dl). The primary outcome was 1-month survival with favorable neurological outcome (cerebral performance category scale 1 or 2). During the study period, a total of 1,269 patients with OHCA were eligible for our analyses. The highest proportion of favorable neurological outcome was 33.5% (109 of 325) in the Q4 group, followed by 13.2% (48 of 365), 5.0% (13 of 261), and 3.5% (11 of 318) in the Q3, Q2, and Q1 groups, respectively. In the multivariable logistic regression analysis, the proportion of favorable neurological outcome in the Q4 group was significantly higher, compared with that in the Q1 group (adjusted odds ratio 8.61; 95% confidence interval 4.28 to 17.33). The adjusted proportion of favorable neurological outcome increased in a stepwise manner across increasing quartiles (p for trend <0.001). Higher serum albumin concentration was significantly and independently associated with favorable neurological outcome in a dose-dependent manner.






17/01/2018 06:13 PM
Canceled to Be Called Back: A Retrospective Cohort Study of Canceled Helicopter Emergency Medical Service Scene Calls That are Later Transferred to a Trauma Center
Publication date: Available online 12 January 2018
Source:Air Medical Journal

Author(s): Brodie Nolan, Alun Ackery, Avery Nathens, Bruce Sawadsky, Homer Tien

Introduction In our trauma system, helicopter emergency medical services (HEMS) can be requested to attend a scene call for an injured patient before arrival by land paramedics. Land paramedics can cancel this response if they deem it unnecessary. The purpose of this study is to describe the frequency of canceled HEMS scene calls that were subsequently transferred to 2 trauma centers and to assess for any impact on morbidity and mortality. Methods Probabilistic matching was used to identify canceled HEMS scene call patients who were later transported to 2 trauma centers over a 48-month period. Registry data were used to compare canceled scene call patients with direct from scene patients. Results There were 290 requests for HEMS scene calls, of which 35.2% were canceled. Of those canceled, 24.5% were later transported to our trauma centers. Canceled scene call patients were more likely to be older and to be discharged home from the trauma center without being admitted. Conclusion There is a significant amount of undertriage of patients for whom an HEMS response was canceled and later transported to a trauma center. These patients face similar morbidity and mortality as patients who are brought directly from scene to a trauma center.






17/01/2018 06:13 PM
Systolic Blood Pressure Threshold for HEMS-Witnessed Arrests
Publication date: Available online 12 January 2018
Source:Air Medical Journal

Author(s): Aurore Richard, Jared Johns, Allen Wolfe, David Olvera, Alin Gragossian, Eliana Vaezazizi, Daniel Davis

Objective Defining vital sign thresholds has focused on mortality, which may be delayed for hours, days, or weeks after injury. This limits the immediate clinical significance in guiding therapy to avoid arrest. The aim of this study was to identify a systolic blood pressure (SBP) threshold indicating imminent cardiopulmonary arrest. Methods This was a retrospective, observational study analyzing physiological data from air medical patients suffering witnessed arrest. We limited the analysis to a subgroup of adult (> 14 years) patients with hypoperfusion-related arrest. Prearrest SBP values were plotted over time, with arrest defined as “time zero.” Multiple linear regression was used to define a best fit curve to identify an inflection point beyond which arrest was imminent. Results A total of 53 eligible patients were identified; 33 (62%) were trauma victims. A fifth-degree equation showed appropriate goodness of fit (r = −.66, P < .0001). An inflection point was identified at an SBP of 78 mm Hg, with arrest occurring approximately 3 minutes later. Conclusion An inflection point below SBP 80 mm Hg was identified, suggesting a predictable physiological pattern for perfusion-related deterioration. This may help guide therapy to reverse deterioration and prevent arrest.






17/01/2018 06:13 PM
Air Medical Simulation Training: A Retrospective Review of Cost and Effectiveness
Publication date: Available online 12 January 2018
Source:Air Medical Journal

Author(s): Marc P. Dotson, Mark L. Gustafson, Alfred Tager, Leslie M. Peterson

Objective Simulation training is an integral part of the training of medical personnel. However, there are limited data on the use of simulation in the training of helicopter emergency medical services (HEMS). Methods In this study, we retrospectively compared the number of orientation flights needed to be released to a full crewmember and the cost of training in an air medical flight academy before and after implementation of a high-fidelity air medical simulator. A total of 13 participants in the air medical services flight academy were analyzed. Four of these participants went through the standard academy. Nine participants went through the standard academy but had additional training using the simulator. Results There was no statistical difference in the number of orientation flights before release from training (P = .35). Also, although there was a trend that the simulator decreased the overall cost of training, there was no significant difference between the groups (P = .16). Conclusion This study found that the use of a high-fidelity simulator when training HEMS personnel does not significantly reduce the number of orientation flights needed to become a full crewmember. There was a trend toward a significant reduction in the total cost of training.






17/01/2018 06:13 PM
Analysis of the new code stroke protocol in Asturias after one year. Experience at one hospital
Publication date: Available online 12 January 2018
Source:Neurología (English Edition)

Author(s): C. García-Cabo, L. Benavente, J. Martínez-Ramos, Á. Pérez-Álvarez, A. Trigo, S. Calleja

Introduction Prehospital code stroke (CS) systems have been proved effective for improving access to specialised medical care in acute stroke cases. They also improve the prognosis of this disease, which is one of the leading causes of death and disability in our setting. The aim of this study is to analyse results one year after implementation of the new code stroke protocol at one hospital in Asturias. Patients and methods We prospectively included patients who were admitted to our tertiary care centre as per the code stroke protocol for the period of one year. Results We analysed 363 patients. Mean age was 69 years and 54% of the cases were men. During the same period in the previous year, there were 236 non-hospital CS activations. One hundred forty-seven recanalisation treatments were performed (66 fibrinolysis and 81 mechanical thrombectomies or combined treatments), representing a 25% increase with regard to the previous year. Conclusions Recent advances in the management of acute stroke call for coordinated code stroke protocols that are adapted to the needs of each specific region. This may result in an increased number of patients receiving early care, as well as revascularisation treatments.






17/01/2018 06:13 PM
Prehospital Emergencies in Illegal Gold Mining Sites in French Guiana
Publication date: Available online 12 January 2018
Source:Wilderness & Environmental Medicine

Author(s): Gérald Egmann, Pierre Tattevin, Renaud Palancade, Matthieu Nacher

Introduction Illegal gold mining is flourishing in French Guiana, existing outside the law due to both the high cost of gold mining permits and the challenges of law enforcement within the Amazon forest. We report the characteristics of, and the medical responses to, medical emergencies in illegal gold mining sites. Methods We performed a retrospective study of all medical emergencies reported from illegal gold mining sites to the centralized call office of SAMU 973 from 1998 through 2000 and from 2008 through 2010. According to the national health care system, any medical emergency within the territory is handled by the prehospital emergency medical service (SAMU 973), irrespective of the patients’ legal status. Data were extracted from the SAMU 973 notebook registry (1998–2000) or the SAMU 973 computerized database (2008–2010) and werre collected using a standardized questionnaire. Results Of 71,932 calls for medical emergencies in French Guiana during the study periods, 340 (0.5%) originated from illegal gold mining sites. Of these, 196 (58%) led to medical evacuation by helicopter, whereas the overall rate of evacuation by helicopter after placing a call to SAMU 973 was only 4% (3020/71,932; P<0.0001 for comparison with illegal gold mining sites). Medical emergencies were classified as illness (48%, mostly infectious), trauma (44%, mostly weapon wounds), and miscellaneous (8%). Conclusions Medical emergencies at illegal gold mining sites in the Amazon forest mostly include infectious diseases, followed by trauma, and often require medical evacuation by helicopter. Our study suggests that implementation of preventive medicine within gold mining sites, irrespective of their legal status, could be cost-effective and reduce morbidity.






17/01/2018 06:13 PM
Prevalence of noncommunicable disease risk factors among the Kani tribe in Thiruvananthapuram district, Kerala
Publication date: Available online 11 January 2018
Source:Indian Heart Journal

Author(s): Priyanka Sajeev, Biju Soman








17/01/2018 06:13 PM
Efecto de la acupuntura en el control de la hipertensión arterial. Protocolo del estudio y resultados
Publication date: Available online 10 January 2018
Source:Revista Internacional de Acupuntura

Author(s): Providencia Garcia-Fresneda Segura, Antoni Collado Cuco, M. del Mar Caparrós Granados, Yolanda Herranz Pinilla, Montserrat Salvadó Gispert, Guillermina Medina Martín

El objetivo del estudio es comprobar la eficacia de la acupuntura en el control de la hipertensión arterial en pacientes ya diagnosticados de hipertensión y que actualmente están con tratamiento farmacológico en el Centro de Atención Primaria de Montbrió del Camp de octubre a diciembre de 2016. Se ha realizado un estudio de intervención experimental con selección aleatoria con un total de 11 pacientes sometidos a una valoración energética y posterior tratamiento con acupuntura durante 8 semanas. La intervención ha consistido en realizar acupuntura corporal juntamente con auriculoterapia con frecuencia semanal durante 8 semanas consecutivas. Se puncionaron los puntos mediante agujas durante 20min y se colocaron semillas de Vaccaria en la oreja al finalizar la sesión, para que el paciente las presionara 2 veces al día hasta la visita siguiente. Los puntos tratados han sido en función a la valoración energética y posterior diagnóstico según los criterios de los 5 elementos de la Medicina Tradicional China, tratándose puntos de Fuego, Madera y Agua. Se han añadido más puntos a todos los participantes en función del diagnóstico energético según la teoría de los 5 elementos (Wu Xing). Los puntos de auriculoterapia tratados han sido Shen Men y Corazón, y se ha tenido en cuenta la presencia del surco diagonal en el lóbulo de la oreja. En el presente estudio, la acupuntura ha demostrado ser efectiva en la reducción de los valores de presión arterial en pacientes que ya recibían terapia farmacológica. Esta reducción se produce durante las 3 primeras semanas y se mantiene posteriormente hasta, como mínimo, 8 semanas. The aim of the study was to evaluate the efficacy of acupuncture in the control of arterial hypertension in patients already diagnosed with hypertension and who were currently on pharmacological treatment in the Montbrió del Camp Primary Care Area from October to December 2016. An experimental intervention study was conducted using random selection. A total of 11 patients were subjected to an energetic evaluation, and then treated with acupuncture for 8 weeks. The treatment consisted of performing body acupuncture together with auriculotherapy weekly for 8 consecutive weeks. The points were punctured using needles for 20minutes and then vaccaria seeds were placed in the ear at the end of each session, so that the patient could press them twice a day until the next visit. The points treated depended on the energetic evaluation and subsequent diagnosis according to the criteria of the five elements of Traditional Chinese Medicine, with the fire, wood, and water points being treated. More points were added to all the participants depending on the energetic diagnosis according to Wu. Xing theory. The points treated in the auriculotherapy were Shen Men and Heart, as well as taking into account the presence of the diagonal groove in the earlobe. In the present study, acupuncture was shown to be effective in reducing the blood pressure levels in patients who were already receiving pharmacological treatment. This reduction is produced in the first three weeks and is subsequently maintained for a minimum of eight weeks.






17/01/2018 06:13 PM
A Novel Difficult-Airway Prediction Tool for Emergency Airway Management: Validation of the HEAVEN Criteria in a Large Air Medical Cohort
Publication date: Available online 10 January 2018
Source:The Journal of Emergency Medicine

Author(s): Edward Kuzmack, Travis Inglis, David Olvera, Allen Wolfe, Kona Seng, Daniel Davis

Background Difficult-airway prediction tools help identify optimal airway techniques, but were derived in elective surgery patients and may not be applicable to emergency rapid sequence intubation (RSI). The HEAVEN criteria (Hypoxemia, Extremes of size, Anatomic abnormalities, Vomit/blood/fluid, Exsanguination, Neck mobility issues) may be more relevant to emergency RSI patients. Objective To validate the HEAVEN criteria for difficult-airway prediction in emergency RSI using a large air medical cohort. Methods This was a retrospective analysis using a large air medical airway registry using data from 160 bases over a 1-year period. Standard test characteristics (sensitivity, specificity, positive predictive value, negative predictive value [NPV]) for the HEAVEN criteria were calculated for overall intubation success, first-attempt success, and first-attempt success without desaturation. In addition, multivariable logistic regression was used to quantify the independent association between each of the HEAVEN criteria, as well as the total number of criteria present and intubation success after adjusting for age, gender, and clinical category (burn, medical, trauma, nontraumatic shock). Results A total of 2419 patients undergoing air medical RSI were included. Excellent NPV was observed (97% for each of the HEAVEN criteria except “Exsanguination,” which had an NPV of 87% but specificity of 99%). First-attempt success was lower for each of the HEAVEN criteria, with an inverse relationship observed between total HEAVEN criteria and intubation success (first-attempt success with no criteria = 94% and with 5 + criteria = 43%). Multivariable logistic regression revealed independent associations between each of the HEAVEN criteria, as well as total number of criteria and intubation success. Conclusions The HEAVEN criteria seem to be a useful tool to predict difficult airways in emergency RSI.






17/01/2018 06:13 PM
Elevation 3 mm: A Case of a Cardiac Emergency and Rescue on Mount Monadnock
Publication date: Available online 10 January 2018
Source:Wilderness & Environmental Medicine

Author(s): Benjamin J. Church, Nicholas J. Daniel








17/01/2018 06:13 PM
Helicopter Mountain Rescue in Slovenia from 2011 to 2015
Publication date: Available online 10 January 2018
Source:Wilderness & Environmental Medicine

Author(s): Janina Golob Deeb, Nicholas Walter, Caroline Carrico, Miha Gašperin, George R. Deeb

Introduction The popularity of adventure recreation in wilderness areas across the world continues to increase. Nevertheless, the risk of injury and illness remains significant. The purpose of this study is to analyze the mountain rescue operations performed in Slovenia between 2011 and 2015. Methods This retrospective study reports mountain rescue operations documented by the Slovenian National Mountain Rescue Association. The annual number of ground-based and helicopter-based rescues were identified and compared. For 2015, the indication for rescue and the severity of injury were also analyzed, specifically for interventions requiring the use of a helicopter. Results From 2011 through 2015, the number of rescues remained consistent with an annual average of 413 (SD ±15; range, 393–434) rescues. However, the percentage of ground-based rescues varied significantly year by year (P=0.016), with highest rate in 2014 (68%) and the lowest in 2015 (56%). In 2015, 434 mountain rescue operations were reported in Slovenia. Injury accounted for 44%, illness for 10%, and fatality for 9% of the rescues. In 37%, no illness or injury was reported. Helicopter rescue was used in 190 (44%) of all interventions. Among the 190 helicopter rescues, 49% of patients had nonfatal injuries, 29% required no medical treatment, 15% had illness, and 7% had fatal injuries. Conclusions A significant number of mountain rescue operations were conducted in Slovenia from 2011 through 2015. Most of these were needed for injured, ill, or deceased persons. A notable number of rescues in 2015 required a helicopter.






17/01/2018 06:13 PM
Legume consumption and risk of all-cause, cardiovascular, and cancer mortality in the PREDIMED study
Publication date: Available online 9 January 2018
Source:Clinical Nutrition

Author(s): Christopher Papandreou, Nerea Becerra-Tomás, Mònica Bulló, Miguel Ángel Martínez-González, Dolores Corella, Ramon Estruch, Emilio Ros, Fernando Arós, Helmut Schroder, Montserrat Fitó, Lluís Serra-Majem, José Lapetra, Miquel Fiol, Miguel Ruiz-Canela, Jose V. Sorli, Jordi Salas-Salvadó

Background & aims Limited prospective studies have examined the association between legumes consumption and mortality, whereas scarce, if at all, previous studies have evaluated such associations taking into consideration specific grain legumes. We aimed to investigate the association between total legumes consumption and grain legumes species (dry beans, chickpeas, lentils, and fresh peas) with all-cause, cardiovascular disease (CVD), cancer and other-cause mortality among elderly Mediterranean individuals at high CVD risk. Methods We prospectively assessed 7,216 participants from the PREvención con DIeta MEDiterránea study. Dietary intake was assessed at baseline and yearly during follow-up by using a validated food frequency questionnaire. Results During a median follow-up of 6.0 years, 425 total deaths, 103 CVD deaths, 169 cancer deaths and 153 due to other-causes deaths occurred. Hazard ratios (HRs) [95% confidence interval (CI)] of CVD mortality were 1.52 (1.02-2.89) (P-trend= 0.034) and 2.23 (1.32-3.78) (P-trend= 0.002) for the 3rd tertile of total legumes and dry beans consumption, respectively, compared with the 1st tertile. When comparing extreme tertiles, higher total legumes and lentils consumption was associated with 49% (HR: 0.51; 95% CI: 0.31-0.84; P-trend= 0.009) and 37% (HR: 0.63; 95% CI: 0.40-0.98; P-trend= 0.049) lower risk of cancer mortality. Similar associations were observed for CVD death in males and for cancer death in males, obese and diabetic participants. Conclusions These findings support the benefits of legumes consumption for cancer mortality prevention which may be counterbalanced by their higher risk for CVD mortality. Trial registration The trial is registered at http://www.controlled-trials.com (ISRCTN35739639). Registration date: 5th October 2005.






17/01/2018 06:13 PM
Sex-specific associations between extreme sleep duration and prevalence of cardio-cerebral vascular disease: a community-based cross-sectional study
Publication date: Available online 9 January 2018
Source:Sleep Medicine

Author(s): Juzhong Ke, Xianfeng Zhou, Hua Qiu, Siyu Yu, Kang Wu, Xinyi Rui, Xiaonan Wang, Xiaolin Liu, Tao Lin, Xiaonan Ruan

Background Most previous studies on sleep duration and cardio-cerebral vascular disease (CCVD) association have not adequately controlled for many confounders. The current study prospectively examined the association of sleep duration with CCVD prevalence in a Chinese community population; cardiovascular risk factors, chronic diseases, and sleep quality were taken into consideration. Methods A cross-sectional study conducted in Pudong New Area of Shanghai, China. Through three-stage sampling, 10,657 adults aged ≥15 years were randomly selected. Self-reported sleep duration and CCVD prevalence were obtained using a structured questionnaire. Medical records of the subjects were reviewed by investigators for further confirmation. Relationships between sleep duration and CCVD prevalence were examined using logistic regression models. Results Compared to midrange sleep duration (7 hours), the multivariate-adjusted OR of CCVD prevalence was 1.550 (95% CI 1.192-2.017) for sleeping 5 hours, 1.427 (95% CI 0.983-2.072) for sleeping <5 hours. A similar situation also prevailed in coronary heart disease (CHD) prevalence: the multivariate-adjusted OR of stroke prevalence was 2.130 (95% CI 1.338-3.389) for sleeping >9 hours. In an analysis stratified by sex, participants with a long sleep duration (>9 hours) demonstrated significantly increased prevalence (OR = 3.623, 95% CI 1.862-7.052) for stroke only in men. Conclusions The relationship between extreme sleep durations and CCVD were influenced by sex in a Chinese community population. Further studies are needed to investigate the mechanisms of the association between extreme sleep duration and CCVD, as well as sex-specificity in the relationship.






17/01/2018 06:13 PM
Liste des présidents, secrétaires généraux et trésoriers de la Société Médico-Psychologique depuis sa fondation, 1852–2017
Publication date: Available online 8 January 2018
Source:Annales Médico-psychologiques, revue psychiatrique










17/01/2018 06:13 PM
Supporting patient education using schema theory: A discourse analysis
Publication date: Available online 8 January 2018
Source:Collegian

Author(s): Tonia Crawford, Peter Roger, Sally Candlin

Background While patient education has long been an important part of nurses’ roles in patient care, research has found difficulties with providing patient education. Sound subject matter knowledge is not enough to give effective and meaningful instruction; pedagogical knowledge is also needed, with an understanding of different aspects of learning processes to inform our teaching methods Despite the importance of patient education, many nurses do not necessarily have pedagogical knowledge regarding how to teach, how to support patient’s learning and how to consciously implement strategies into patient education. Aim By understanding theories that explain how people learn better, and awareness of the consequences of different approaches to giving patient education, nurses can be better informed about how to structure their information-giving in ways that will support patient learning. Methods Discourse analysis from an interactional sociolinguistic perspective is used to examine authentic nurse-patient health information encounters, mapped against cognitive learning theories, schema theory in particular. Findings The interactional consequences, when elements drawn from learning theories are implemented, are observable in the data. Discussion Strategies that support patients’ learning include linking information to the patients’ prior experience/knowledge, providing information that is relevant to them, and chunking information into unified themes while encouraging patients’ active involvement through questioning and clarification of information. Conclusion Awareness of learning theories and strategies outlined in this paper can strengthen communication skills and assist health professionals to structure patient education in ways that support patients’ learning, thereby enhancing patient safety.






17/01/2018 06:13 PM
Can persistent organic pollutants distinguish between two opposite metabolic phenotypes in lean Koreans?
Publication date: Available online 6 January 2018
Source:Diabetes & Metabolism

Author(s): K. Hwa-Ha, S.A. Kim, Y.M. Lee, D. Jung-Kim, D.H. Lee

Aims This study investigated the association of persistent organic pollutants (POPs), an emerging new risk factor for type 2 diabetes and the metabolic syndrome, with the presence of opposite phenotypes of glucose and lipid metabolism among normal-weight Koreans of similar body composition. Methods Fifty subjects, randomly selected from an ongoing community-based cohort study, from two opposite phenotype groups — metabolically unhealthy normal weight (MUHNW) and metabolically healthy normal weight (MHNW) — were matched for waist circumference, visceral fat mass and demographic variables, then compared for serum concentrations of POPs. Results Most POPs (10 out of 13 compounds) were present in higher serum concentrations in the MUHNW than in the MHNW. In particular, serum concentrations of all compounds of the organochlorine pesticide class were 2.2 to 4.7 times higher in cases than in controls. Compared with the lowest tertile of summary measures of POPs, ORs (95% CIs) for the second and third tertiles were 7.4 (1.9–29.4) and 10.4 (2.6–41.2), respectively. Adjusting for possible confounders did not change the results. Conclusion Taken altogether, these findings from the present and previous studies suggest that increased serum POP concentrations may play an important role in the development of unhealthy metabolic phenotypes in lean people.






17/01/2018 06:13 PM
Use of a Parabolic Microphone to Detect Hidden Subjects in Search and Rescue
Publication date: Available online 6 January 2018
Source:Wilderness & Environmental Medicine

Author(s): Nathaniel L. Bowditch, Stanley K. Searing, Jeffrey A. Thomas, Peggy K. Thompson, Jacqueline N. Tubis, Sylvia P. Bowditch

Introduction This study compares a parabolic microphone to unaided hearing in detecting and comprehending hidden callers at ranges of 322 to 2510 m. Methods Eight subjects were placed 322 to 2510 m away from a central listening point. The subjects were concealed, and their calling volume was calibrated. In random order, subjects were asked to call the name of a state for 5 minutes. Listeners with parabolic microphones and others with unaided hearing recorded the direction of the call (detection) and name of the state (comprehension). Results The parabolic microphone was superior to unaided hearing in both detecting subjects and comprehending their calls, with an effect size (Cohen’s d) of 1.58 for detection and 1.55 for comprehension. For each of the 8 hidden subjects, there were 24 detection attempts with the parabolic microphone and 54 to 60 attempts by unaided listeners. At the longer distances (1529–2510 m), the parabolic microphone was better at detecting callers (83% vs 51%; P<0.00001 by χ2) and comprehension (57% vs 12%; P<0.00001). At the shorter distances (322–1190 m), the parabolic microphone offered advantages in detection (100% vs 83%; P=0.000023) and comprehension (86% vs 51%; P<0.00001), although not as pronounced as at the longer distances. Conclusions Use of a 66-cm (26-inch) parabolic microphone significantly improved detection and comprehension of hidden calling subjects at distances between 322 and 2510 m when compared with unaided hearing. This study supports the use of a parabolic microphone in search and rescue to locate responsive subjects in favorable weather and terrain.