First impressions last… A survey of knowledge of first aid in burn-related injuries amongst hospital workers

Rationale

The administration of first aid in burns has been shown to have a significant influence on the ultimate severity of the burn. We wanted to assess in-hospital healthcare (HCW), and non-healthcare workers’ (nHCW) knowledge of first aid in burns.

Methods

A purpose-designed questionnaire, including information about previous attendance at a first aid course and four clinical scenarios of burns, was distributed to HCWs in the local hospitals and non-medical students in the Universities of Leeds and Sheffield.

Results

697 questionnaires were completed – 397 (57%) from HCW and 300 (43%) from nHCW. 59% of HCW had attended a first aid course, 68% of these courses included teaching on first aid in burns.HCW who had completed a first aid course generally did better than those who had not. Only 16% of HCW achieved correct answers in all questions compared to 30% nHCW.

Conclusions

We show that the knowledge of first aid in burns is relatively poor amongst HCW and that attendance at a burns first aid course improves knowledge (although perhaps not as much as one might hope). We recommend that the burns content of first aid courses be reviewed, and that there is a requirement for ALL hospital healthcare workers to undertake a first aid course, which includes appropriate burns first aid.     

Adjuvant Hepatic Intra-arterial Iodine-131-Lipiodol Following Curative Resection of Hepatocellular Carcinoma: A Prospective Randomized Trial

Background

The purpose of the present study was to determine whether intrahepatic injection of ¹³¹I-lipiodol (Lipiodol) is effective against recurrence of surgically resected hepatocellular carcinoma (HCC).

Methods

From June 2001 through March 2007, this nationwide multi-center prospective randomized controlled trial enrolled 103 patients 4–6 weeks after curative resection of HCC with complete recovery (52: Lipiodol, 51: Control). Follow-up was every 3 months for 1 year, then every 6 months. Primary and secondary endpoints were recurrence-free survival (RFS) and overall survival (OS), respectively, both of which were evaluated by the Kaplan–Meier technique and summarized by the hazard ratio (HR). The design was based on information obtained from a similar trial that had been conducted in Hong Kong.

Results

The Lipiodol group showed a small, and nonsignificant, improvement over control in RFS (HR = 0.75; 95 % confidence interval [95 % CI] 0.46–1.23; p = 0.25) and OS (HR = 0.88; 95 % CI 0.51–1.51; p = 0.64). Only two serious adverse events were reported, both with hypothyroidism caused by ¹³¹I-lipiodol and hepatic artery dissection during angiography.

Conclusions

The randomized trial provides insufficient evidence to recommend the routine use of ¹³¹I-lipiodol in these patients.     

Chicken bone perforation of an irreducible inguinal hernia: a case report and review of the literature

Foreign bodies causing perforation of hernias are extremely uncommon with only a few cases reported in the literature. Here, we present a case of a patient with ingestion of a foreign body, which was initially managed expectantly but developed a perforation due to the foreign body impacting and causing perforation of an irreducible inguinal hernia. Management of this condition usually involves resection of the involved loop of bowel with repair of the hernia defect at the time of surgery. Patients with ingested foreign bodies who have irreducible hernias have altered anatomy and should be considered for early surgical intervention to prevent complications.     

Standardization of definitions in focal therapy of prostate cancer: report from a Delphi consensus project

Purpose

To reach standardized terminology in focal therapy (FT) for prostate cancer (PCa).

Methods

A four-stage modified Delphi consensus project was undertaken among a panel of international experts in the field of FT for PCa. Data on terminology in FT was collected from the panel by three rounds of online questionnaires. During a face-to-face meeting on June 21, 2015, attended by 38 experts, all data from the online rounds were reviewed and recommendations for definitions were formulated.

Results

Consensus was attained on 23 of 27 topics; Targeted FT was defined as a lesion-based treatment strategy, treating all identified significant cancer foci; FT was generically defined as an anatomy-based (zonal) treatment strategy. Treatment failure due to the ablative energy inadequately destroying treated tissue is defined as ablation failure. In targeting failure the energy is not adequately applied to the tumor spatially and selection failure occurs when a patient was wrongfully selected for FT. No definition of biochemical recurrence can be recommended based on the current data. Important definitions for outcome measures are potency (minimum IIEF-5 score of 21), incontinence (new need for pads or leakage) and deterioration in urinary function (increase in IPSS >5 points). No agreement on the best quality of life tool was established, but UCLA-EPIC and EORTC-QLQ-30 were most commonly supported by the experts. A complete overview of statements is presented in the text.

Conclusion

Focal therapy is an emerging field of PCa therapeutics. Standardization of definitions helps to create comparable research results and facilitate clear communication in clinical practice.

     

Increased risk of strontium ranelate-related SJS/TEN is associated with HLA

Summary

Severe adverse drug reactions (ADR) of Stevens-Johnson syndrome and toxic epidermal necrolysis (SJS/TEN) in some patients receiving strontium ranelate have been reported, but the risk factors are unclear. We show that HLA-A*33:03 and B*58:01 are significantly associated with patients who developed SJS/TEN; and provide the first evidence that genetic risk factors are involved in strontium ranelate-associated SJS/TEN.

Introduction

In this study, HLA as a genetic risk factor was assessed among osteoporotic patients prescribed with strontium ranelate that developed severe cutaneous adverse drug reactions (SCARs) compared with those who were tolerant.

Methods

Genomic DNA isolated from peripheral blood mononuclear cells (PBMCs) of patients was HLA typed using sequencing-based typing method to determine their HLA profiles.

Results

Osteoporotic patients who are currently on strontium ranelate were enrolled in the study (n?=?76). Tolerant controls were defined as patients who received strontium ranelate for a minimum of 3 months (range 3 months to 8 years) with no reports of any cutaneous reactions as these reactions usually occur within the first 12 weeks after starting treatment. Retrospective cases of SJS/TEN were also identified (n?=?5). The majority of the accrued samples were of Han Chinese descent: controls (n?=?72) and cases (n?=?4). All cases and controls were genotyped at four HLA genes, namely HLA-A, HLA-B, HLA-C, and HLA-DRB1. In comparing the samples of Han Chinese descent (72 controls and 4 cases), we found significant associations with HLA-A*33:03 (p?=?0.002) and HLA-B*58:01 (p?=?0.023). There was no significant association with any HLA-C or HLA-DRB1 alleles.

Conclusions

This study reveals that the occurrence of SJS/TEN in Han Chinese patients receiving strontium ranelate is HLA associated. This has important clinical implications for understanding the underlying mechanisms for this ADR as well as evaluating the potential role of genetic pre-screening for osteoporotic patients who may be prescribed strontium ranelate.

     

Effect of post-retained composite restoration of MOD preparations on the fracture resistance of endodontically treated teeth

PURPOSE: The present study aimed to compare the fracture resistance and failure patterns of endodontically treated premolars with MOD preparations restored using different material combinations. The null hypothesis postulated that there was no association between the fracture resistance of endodontically treated premolars and the resin composite materials or the post-and-core system used to build up the restorations. MATERIALS AND METHODS: Eighty single-rooted maxillary premolars were used. After endodontic treatment and preparation of MOD preparations, 8 groups of 10 samples each were created, using the following material combinations: group 1 (control), flowable and microhybrid resin composites; group 2, flowable A; group 3, flowable B; group 4, microhybrid resin A; group 5, microhybrid resin B; group 6, flowable B + microhybrid resin B; group 7, flowable A + microhybrid resin A + post A; group 8, flowable B + microhybrid resin B + post B. Mechanical static fracture tests were performed loading the specimens till fracture. RESULTS: The mean failure loads (N) were 502 (control), 470 (group 7), 445 (group 8), 441 (group 6), 405 (group 5), 364 (group 4), 317 (group 2), and 302 (group 3). Statistically significant differences were found between groups 1 vs 2, 1 vs 3, and 3 vs 7 (p < 0.05). CONCLUSION: The fracture resistance of endodontically treated premolars with MOD preparations was enhanced by the use of the sandwich technique. The samples restored with posts predominantly showed restorable fractures, while teeth restored without posts mostly displayed unrestorable failures.