Evidence-Based Nursing Care for Spinal Nursing Immobilization: A Systematic Review

IntroductionA high degree of suspicion for spinal injury after trauma is commonplace in an emergency department, and spinal immobilization is considered an accepted intervention to prevent the progression of a potential injury. This systematic review was conducted to gain insight into the best research evidence related to nursing interventions for patients with trauma presenting with a suspected spinal injury.MethodsA systematic search of online databases was conducted in April 2019 for relevant research using specific search terms. The studies were selected on the basis of pre-established eligibility criteria, and the quality was appraised using the Critical Appraisal Skills Programme tool.ResultsNineteen included articles were synthesized thematically on the basis of the outcomes from interventions directed at a suspected spinal injury. The main findings were that spinal immobilization may compromise pulmonary function and airway management, cause pain and pressure ulcers, and be inappropriate with penetrating trauma. Furthermore, there was insufficient evidence to support the safety and efficacy of the hard neck collar and long backboard.DiscussionPatients would benefit from a more selective and cautious approach to spinal immobilization. Emergency nurses should use the evidence to facilitate informed decision-making in balancing the benefits of spinal immobilization against harm when considering the needs and values of the patient.     

Exercise handout and one-on-one hand therapy for management of stiffness after plaster cast immobilization of simple phalangeal and metacarpal fractures in children: A randomized,noninferiority trial

Study DesignThis is a noninferior, single-blind, randomized controlled trial.IntroductionJoint stiffness is common after plaster cast immobilization for simple phalanx and metacarpal fractures in children. The limited literature suggests this joint stiffness in children resolves without one-on-one therapy; however, without robust studies confirming that there is no detrimental effect from withdrawing treatment, many children are still referred.Purpose of the StudyThe purpose of this study was to determine if an educational handout for self-management of stiffness is noninferior to one-on-one hand therapy for achieving full range of motion (ROM).MethodsParticipants were randomly assigned to group one who received the handout or group two who received hand therapy in addition to the handout. The ROM was measured by composite flexion and total active motion (TAM). The noninferiority margin was 10% difference between the two groups in the proportion of participants who achieved full ROM at two weeks after cast removal.ResultsSixty participants in each group completed the study. Group difference for composite flexion was 1.7% (95% CI: −3.9% to 7.2%), demonstrating noninferiority. Group difference for TAM was inconclusive at 8.3% (95% CI: −2.1% to 18.7%). Sensitivity analysis adjusting for participants with full composite flexion at the baseline resulted in the group difference for composite flexion of 3.1% (95% CI: −3.6% to 9.8%), maintaining noninferiority, but group difference for TAM at 10.4% (95% CI: 0.0% to 20.9%), was inconclusive with the handout group significantly worse.ConclusionAn educational handout is noninferior to hand therapy for achieving full ROM in composite flexion but not TAM. This needs to be taken into consideration for changing clinical practise.     

发际内头皮冠状切口在颧骨颧弓骨折治疗中的应用

目的:观察头皮冠状切口在颧骨颧弓骨折中重建骨骼形态的效果。方法:应用发际内头皮冠状切口进路对21例颧骨颧弓骨折病例进行复位和固定,分析其治疗方法的优越性、效果、并发症及预防措施。结果:21例患者术后面型和功能恢复良好。结论:头皮冠状切口对颧骨颧弓三维结构的重建具有手术视野暴露好,操作方便,复位精确,面部不遗留疤痕等优点。     

正畸钢丝冠内固定治疗磨牙纵折的应用

目的:改进磨牙纵折保留治疗的固定方法.方法:对56颗磨牙纵折采用正畸钢丝冠内固定、牙体牙髓治疗加全冠修复的综合治疗,保留患牙.结果:56颗磨牙纵折成功49颗,失败7颗,有效率为87.5%.结论:在磨牙纵折的保留治疗中,正畸钢丝冠内固定是一种较佳的固定方法.     

Sensitivity of serum concentration of cartilage biomarkers to 21‐days of bed rest

The objective of the study was to test the hypothesis that serum levels of cartilage oligomeric matrix protein (COMP) would decrease and serum levels of tumor‐necrosis factor alpha (TNF‐α) and selected matrix metalloproteinases (MMPs) would increase in response to bed rest (BR) and that these changes are unaffected by the intake of potassium bicarbonate or whey protein. Seven and nine healthy male subjects participated in two 21‐day 6° head down tilt crossover BR‐studies with nutrition interventions. Serum samples were taken before, during, and after BR and biomarker concentrations were measured using commercial enzyme‐linked immunosorbent assays. MMP‐3 during BR was significantly lower than at baseline (reduction greater 20%; p < 0.001). MMP‐3 increased significantly from 14 to 21 days of BR (+7%; p = 0.049). COMP during BR was significantly lower than at baseline (reduction greater 20%; p < 0.001). MMP‐3 and COMP returned to baseline within 1 day after BR. MMP‐9 on day 3 of BR was significantly lower than at baseline (?31%; p < 0.033) and on days 3, 5, and 14 of BR significantly lower than at the end of and after BR (reduction greater 35%; p < 0.030). The nutritional countermeasures did not affect these results. The observed changes in cartilage biomarkers may be caused by altered cartilage metabolism in response to the lack of mechanical stimulus during BR and inflammatory biomarkers may play a role in changes in biomarker levels. Clinical relevance: Immobilization independently from injury can cause altered cartilage biomarker concentration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1465–1471, 2018.

     

Effective Enzyme Coimmobilization and Synergistic Catalysis on Hierarchically Porous Inorganic/Organic Hybrid Microbeads Fabricated Via Droplet‐Based Microfluidics

In this paper, a novel and robust droplet‐based microfluidic method to fabricate poly(ε‐caprolactone)/silica (PCL/SiO₂) hybrid microbeads with hierarchically porous architecture is described and their performance as multienzyme carriers for cascade catalysis is further investigated in detail. In addition to the precise control on size and monodispersity of PCL/SiO₂ microbeads enabled by the microfluidic method, the presence of ammonia as a catalyst for the hydrolysis and condensation of tetraethylorthosilicate makes it possible to manipulate the competition between sol–gel process and solvent extraction and thus adjust the surface porosity of hybrid microbeads, which eliminates the use of porogens/templates and also the complicated post‐treatment. Isothiocyanate‐immunoglobulin G/cyanine 3‐bovine serum albumin (FITC‐IgG/Cy3‐BSA) and superoxide dismutase/chloramphenicol acetyltransferase (SOD/CAT) are coimmobilized, respectively onto hierarchically porous PCL/SiO₂ hybrid microbeads via either physical adsorption or covalent binding. Fluorescence intensity of coimmobilized FITC‐IgG/Cy3‐BSA proves that the proteins/enzymes immobilization amount via covalent binding is much higher than physical adsorption. The enhanced enzymatic activity, total antioxidant capacity, and reusability assay reveal that coimmobilized SOD/CAT exhibits better performance compared with the mono‐immobilized ones, mainly due to their mutual synergistic effect. The excellent results achieved in the work indicate that hierarchically porous PCL/SiO₂ hybrid microbeads are very promising carriers for multienzymatic catalysis.     

Community Implementation of a Prehospital Spinal Immobilization Guideline

Objective: The purpose of this study was to qualitatively describe the underpinnings of the successful implementation of a collaborative prehospital spinal immobilization guideline throughout the emergency medical services (EMS) community in two counties in Colorado. We also describe lessons learned that may be beneficial to other communities considering similar initiatives. Methods: Qualitative data were collected from key informants who were directly involved in the implementation of a new prehospital spinal immobilization guideline among four community hospitals in two different hospital systems and the associated EMS providers within the two counties. We interviewed a purposively selected sample of emergency department (ED) physicians and other ED staff, hospital decision makers, EMS educators as well as fire department and EMS medical directors. Data were collected and reviewed until saturation was achieved. We conducted qualitative analysis to summarize and synthesize themes. Results: Ten key informants were interviewed, at which point saturation was achieved and several clear themes emerged. Participants described successful community-wide guideline implementation despite a history of competition, isolation, and conflict between the various EMS organizations and hospitals on past EMS and trauma initiatives. Factors related to success included the nearly universal perception that the initiative was “cutting edge” and thus an important paradigm shift in care for the community, as a whole. Participants reported the ability of community stakeholders to jointly assure a collaborative approach, characterized by intensive education for EMS personnel and others involved, and the ability of the community to together secure the new equipment required for success. Conclusions: Key informants described a convergence of factors as leading to the successful implementation of a prehospital spinal immobilization guideline. Lessons learned regarding how to overcome a tradition of competition and isolation to allow for success may be useful to other communities considering similar initiatives.