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41.
Jonathan E. Slutzman Lisa A. ArvoldJoshua S. Rempell MD Michael B. StoneHeidi H. Kimberly MD 《The Journal of emergency medicine》2014
Background
The focused assessment with sonography in trauma (FAST) examination is an important screening tool in the evaluation of blunt trauma patients.Objectives
To describe a case of a hemodynamically unstable polytrauma patient with positive FAST due to fluid resuscitation after blunt trauma.Case Report
We describe a case of a hemodynamically unstable polytrauma patient who underwent massive volume resuscitation prior to transfer from a community hospital to a trauma center. On arrival at the receiving institution, the FAST examination was positive for free intraperitoneal fluid, but no hemoperitoneum or significant intra-abdominal injuries were found during laparotomy. In this case, it is postulated that transudative intraperitoneal fluid secondary to massive volume resuscitation resulted in a positive FAST examination.Conclusion
This case highlights potential issues specific to resuscitated trauma patients with prolonged transport times. Further study is likely needed to assess what changes, if any, should be made in algorithms to address the effect of prior resuscitative efforts on the test characteristics of the FAST examination. 相似文献42.
43.
Feasibility and repeatability of localized 31P‐MRS four‐angle saturation transfer (FAST) of the human gastrocnemius muscle using a surface coil at 7 T 下载免费PDF全文
Marjeta Tušek Jelenc Marek Chmelík Wolfgang Bogner Martin Krššák Siegfried Trattnig Ladislav Valkovič 《NMR in biomedicine》2016,29(1):57-65
Phosphorus (31P) MRS, combined with saturation transfer (ST), provides non‐invasive insight into muscle energy metabolism. However, even at 7 T, the standard ST method with T1app measured by inversion recovery takes about 10 min, making it impractical for dynamic examinations. An alternative method, i.e. four‐angle saturation transfer (FAST), can shorten the examination time. The aim of this study was to test the feasibility, repeatability, and possible time resolution of the localized FAST technique measurement on an ultra‐high‐field MR system, to accelerate the measurement of both Pi‐to‐ATP and PCr‐to‐ATP reaction rates in the human gastrocnemius muscle and to test the feasibility of using the FAST method for dynamic measurements. We measured the exchange rates and metabolic fluxes in the gastrocnemius muscle of eight healthy subjects at 7 T with the depth‐resolved surface coil MRS (DRESS)‐localized FAST method. For comparison, a standard ST localized method was also used. The measurement time for the localized FAST experiment was 3.5 min compared with the 10 min for the standard localized ST experiment. In addition, in five healthy volunteers, Pi‐to‐ATP and PCr‐to‐ATP metabolic fluxes were measured in the gastrocnemius muscle at rest and during plantar flexion by the DRESS‐localized FAST method. The repeatability of PCr‐to‐ATP and Pi‐to‐ATP exchange rate constants, determined by the slab‐selective localized FAST method at 7 T, is high, as the coefficients of variation remained below 20%, and the results of the exchange rates measured with the FAST method are comparable to those measured with standard ST. During physical activity, the PCr‐to‐ATP metabolic flux decreased (from FCK = 8.21 ± 1.15 mM s?1 to FCK = 3.86 ± 1.38 mM s?1) and the Pi‐to‐ATP flux increased (from FATP = 0.43 ± 0.14 mM s?1 to FATP = 0.74 ± 0.13 mM s?1). In conclusion, we could demonstrate that measurements in the gastrocnemius muscle are feasible at rest and are short enough to be used during exercise with the DRESS‐localized FAST method at 7 T. © 2015 The Authors. NMR in Biomedicine published by John Wiley & Sons Ltd. 相似文献
44.
Aims To examine (1) the prevalence of alcohol use disorders in adult general hospital inpatients; (2) the accuracy of documentation
in relation to alcohol use.
Methods A total of 210 random patients were interviewed out of 1,448 consecutive new admissions to CUH over 7 days. Case notes were
reviewed for 206 (98%). Alcohol consumption was assessed using the Fast Alcohol Screening Test (FAST) and weekly drinking
diary. FAST-positive (and a random sample of FAST-negative) patients then had a standardized interview.
Results A total of 82% admitted for drinking alcohol. Among them 22% were drinking in excess of guidelines, 9% had DSM-IV Alcohol
Abuse and 7% dependence. The sensitivity and specificity of the FAST for detecting those drinking above guidelines were 89
and 94% and for detecting a DSM-IV diagnosis was 100 and 73%. The majority of case notes contained inadequate information
about alcohol intake.
Conclusion Alcohol use disorders are common and often undetected in the general hospital setting. 相似文献
45.
Etienne St-Louis Marcus Oosenbrug Tara Landry Robert Baird 《Journal of pediatric surgery》2018,53(5):879-884
Background
Pediatric surgical randomized clinical trials (RCTs) are labor-intensive and costly. This systematic review investigated patient accrual and estimates of study duration in RCTs by interrogating enrollment and registration practices.Methods
We performed a peer-review search of multiple databases from 2000 to 2016 evaluating RCTs salient to the field with inclusion mandated that a self-identified pediatric surgeon be listed as an author. Trial registries were also searched. RCTs were appraised, and predictors of success were evaluated using multivariate logistic regression, with success defined as achievement of recruitment objectives.Results
After screening, 137 RCTs were analyzed. Mean Jadad score was 1.80 (median = 2). CONSORT scores ranged between 17% and 97% (median = 58%). Sixty-seven studies described sample-size determination, 49 reported projected enrollment, and 26 were successful. Among 26 registered RCTs, 15 disclosed their expected completion date, which was achieved by 8. On average, protocols underwent 3.42 iterations. 9% of trials were terminated before completion, most commonly owing to poor recruitment. Trial registration and urgent cases significantly predicted success on multivariable analysis (p < 0.05).Conclusion
Overall quality of reporting in pediatric surgical trials is poor. Sample-size calculation and patient accrual are frequently poorly performed or underestimated, resulting in trial overrun and/or premature termination. These data may help inform subsequent study design and facilitate successful completion.Level of Evidence
Level III—Systematic Review and Observational (Case–Control) Analysis. 相似文献46.
Time required for bathing-related care for nursing home residents with various stages of severe dementia were observed. Time required for each resident, including guiding to the bathroom, undressing, and dressing were plotted in graphs in order to make comparisons. The situations and conversations observed for the instances when additional time was needed were analyzed. Stage of dementia affected the amount of time required for the task of guiding to the bathroom, but did not appear to affect time required for dressing or undressing. For dressing and undressing, additional time was required when caregivers failed to keep to a specific routine. 相似文献
47.
Bedside emergency ultrasonographic diagnosis of diaphragmatic rupture in blunt abdominal trauma 总被引:4,自引:0,他引:4
Blaivas M Brannam L Hawkins M Lyon M Sriram K 《The American journal of emergency medicine》2004,22(7):933-604
Abdominal injury from significant blunt trauma can include injury to bowel, kidneys, liver, and spleen. In approximately 5% of all injuries one of the diaphragms is ruptured. Diaphragmatic rupture may not be easily detected and this can lead to significant morbidity and even mortality. Rupture may be suggested on chest X-ray film especially with abnormal nasogastric tube location but the accuracy of this method is modest only. Abdominal computed tomography is not accurate and magnetic resonance imaging, although very sensitive and specific, is not feasible in most trauma situations. Surgeons have often resorted to exploratory laparotomy or laparoscopy to make the diagnosis. Although not typically part of the basic Focused Abdominal Sonography for Trauma (FAST) examination, ultrasonographic diagnosis of diaphragmatic rupture is possible with little added time to the examination. We present 3 cases of diaphragmatic rupture discovered shortly after the patients' arrival, on initial trauma evaluation with the FAST. A discussion of previous literature and ultrasound technique for diagnosis follows the cases. 相似文献
48.
49.
Purpose
The aim of this study was to facilitate attainment of Critical Care Ultrasonography (CCUS) competence.Materials and Methods
We developed a Web-based learning program followed by simulation-based hands-on training in noncardiac CCUS for novice learners. We administered knowledge and skills tests before and after the workshop and conducted surveys on confidence levels using a 10-point Likert scale. Knowledge tests were conducted online, and skills tests were video-captured for evaluation.Results
Sixteen physicians participated in a 4-hour combined vascular and thoracic CCUS workshop, and 23 in a 2-hour abdominal CCUS workshop. In the combined vascular and thoracic workshop, the mean (SD) pre-workshop and post-workshop knowledge scores were 24 (4) and 33 (5), respectively, out of 43 (P < .001). The pre-workshop and post-workshop skill scores were 15 (5) and 23 (2), out of 28 (P < .001). In the abdominal workshop, the pre-workshop and post-workshop knowledge scores were 11 (3) and 18 (2), out of 20 (P < .001). The pre-workshop and post-workshop skill scores were 6 (3) and 15 (2), out of 16 (P < .001). Learners' confidence increased significantly in both workshops (P < .001).Conclusions
Our novel hybrid educational workshop on general CCUS significantly improved knowledge, skills, and confidence levels. Our flexibly scheduled module can be a practical option for the busy intensivist. 相似文献50.