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排序方式: 共有491条查询结果,搜索用时 187 毫秒
1.
Alexander Becker Kobi Peleg Joseph Dubose Yaakov Daskal Adi Givon Boris Kessel 《Journal of pediatric surgery》2019,54(4):780-782
Background
Penetrating stab wounds in children are relatively rare and no clear recommendations for the optimal evaluation have been devised. An acceptable traditional approach to the patient with an abdominal stab wound who does not require urgent surgery is selective nonoperative management and serial exams. The use of routine computed tomography remains an actively utilized investigation for these patients at many institutions.Purpose
We hypothesize that the approach to pediatric stab wound victims should be distinctly different than that of adult counterparts in order to minimize radiation exposure.Methods
A retrospective cohort study involving abdominal stab wounds among pediatric trauma patients (age < 14) compared with adults between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry.Results
A total of 92 children and 4444 adults were identified from the registry for inclusion. Among the children 20 (21.7%) patients had intraabdominal injury compared to 1730 (38.9%) among adult counterparts. Four children were hemodynamically unstable, two of them were referred directly to operating room and two others were treated without surgery. Among the remaining 88 children there was no observed mortality.Conclusions
The majority of pediatric stab wounds trauma victims have minor abdominal injuries. We do not recommend the routine utilization of abdominal CT scan in the evaluation of abdominal stab wounds. Observation with serial exams and minimization of radiation exposure from CT are warranted in this unique population.Type of study
Retrospective comparative study.Level of evidence
3. 相似文献2.
Eytan M. Debbi Benjamin Bernfeld Amir Herman Moshe Salai Yocheved Laufer Alon Wolf 《The Journal of arthroplasty》2019,34(1):47-55
Background
Biomechanics after total knee arthroplasty (TKA) often remain abnormal and may lead to prolonged postoperative recovery. The purpose of this study is to assess a biomechanical therapy after TKA.Methods
This is a randomized controlled trial of 50 patients after unilateral TKA. One group underwent a biomechanical therapy in which participants followed a walking protocol while wearing a foot-worn biomechanical device that modifies knee biomechanics and the control group followed a similar walking protocol while wearing a foot-worn sham device. All patients had standard physical therapy postoperatively as well. Patients were evaluated throughout the first postoperative year with clinical measures and gait analysis.Results
Improved outcomes were seen in the biomechanical therapy group compared to the control group in pain scores (88% vs 38%, P = .011), function (86% vs 21%, P = .001), knee scores (83% vs 38%, P = .001), and walking distance (109% vs 47%, P = .001) at 1 year. The therapy group showed healthier biomechanical gait patterns in both the sagittal and coronal planes at 1 year.Conclusion
A postoperative biomechanical therapy improves outcomes following TKA and should be considered as an additional therapy postoperatively. 相似文献3.
《Pain Management Nursing》2020,21(2):201-206
BackgroundPrevious studies support the role of both auditory and visual stimuli in the evocation of empathy, but no research to date has explored the relative effectiveness of each on any type of empathy.AimsThe present study compared how auditory and visual presentation influence somatic empathic arousal and perceived pain level.DesignExposure to auditory and/or visual information about an individual in pain was manipulated between groups of participants.MethodsStudents (N = 125) in several classes were randomly assigned in groups to one of three conditions—audio-only, video-only, or audio-video—each portraying an elderly man suffering from a painful kidney stone. Participants indicated his perceived pain and level of danger and relevant physical sensations and completed an empathy status scale.ResultsConsistent with the hypothesis, the results indicated that participants who were presented with an auditory stimulus (audio-only and audio-video conditions) estimated higher and more accurate pain and danger level for the patient compared with those in the visual-only group. Participants in the audio groups also reported experiencing physical sensations, whereas the visual-only group had no such report.ConclusionsThe study found that auditory information is more impactful in eliciting perceptions of pain in others compared with visual information. Experiences of clinical empathy and patient care may be improved by focusing on patients’ auditory pain communications. 相似文献
4.
《International journal of antimicrobial agents》2020,55(2):105847
This study aimed to evaluate risk factors for 30-day mortality among hospitalised patients with Pseudomonas aeruginosa bacteraemia, a highly fatal condition. A retrospective study was conducted between 1 January 2009 and 31 October 2015 in 25 centres (9 countries) including 2396 patients. Univariable and multivariable analyses of risk factors were conducted for the entire cohort and for patients surviving ≥48 h. A propensity score for predictors of appropriate empirical therapy was introduced into the analysis. Of the 2396 patients, 636 (26.5%) died within 30 days. Significant predictors (odds ratio and 95% confidence interval) of mortality in the multivariable analysis included patient-related factors: age (1.02, 1.01–1.03); female sex (1.34, 1.03–1.77); bedridden functional capacity (1.99, 1.24–3.21); recent hospitalisation (1.43, 1.07–1.92); concomitant corticosteroids (1.33, 1.02–1.73); and Charlson comorbidity index (1.05, 1.01–1.93). Infection-related factors were multidrug-resistant Pseudomonas (1.52, 1.15–2.1), non-urinary source (2.44, 1.54–3.85) and Sequential Organ Failure Assessment (SOFA) score (1.27, 1.18–1.36). Inappropriate empirical therapy was not associated with increased mortality (0.81, 0.49–1.33). Among 2135 patients surviving ≥48 h, hospital-acquired infection (1.59, 1.21–2.09), baseline endotracheal tube (1.63, 1.13–2.36) and ICU admission (1.53, 1.02–2.28) were additional risk factors. Risk factors for mortality among patients with P. aeruginosa were mostly irreversible. Early appropriate empirical therapy was not associated with reduced mortality. Further research should be conducted to explore subgroups that may not benefit from broad-spectrum antipseudomonal empirical therapy. Efforts should focus on prevention of infection, mainly hospital-acquired infection and multidrug-resistant pseudomonal infection. 相似文献
5.
Nail Puncture Wound Through a Rubber-Soled Shoe: Should We Take Every Patient to the Operating Room?
《The Journal of foot and ankle surgery》2022,61(3):479-481
Nail puncture wounds through rubber-soled shoes, when presenting acutely, have a deceivingly benign appearance. High index of suspicion for a retained rubber piece should be maintained by the physician. This study investigates whether preoperative ultrasound examination can rule out a foreign body and reduce the need for surgery. It is a retrospective cohort of 125 patients with deep nail puncture wounds through a rubber-soled shoe, who underwent surgical exploration between 2008 and 2018. All patients had a preoperative ultrasound examination for detection of a rubber foreign body. The patients’ median age was 29, and 112 (89.6%) were males. Median time of presentation was 1 day, but there were patients who presented up to 90 days after injury (mean 5.1 ± 15.6 days). Foreign bodies, ranging 1 to 4 mm in diameter, were surgically removed in 37 (29.6%) patients. Only 16 of these patients had a positive preoperative ultrasound examination, corresponding to sensitivity of 43.2%. Specificity of the ultrasound examination was 95%. Ultrasound examination has low sensitivity for detection of foreign bodies following a puncture wound of the foot. This is attributable to the small size of the foreign bodies in this scenario and to the complexity of sonography in this location. We conclude that ultrasound cannot be used to rule out foreign body in the foot, and should not be relied on when deciding to avoid surgery. Nevertheless, it can be a helpful adjunct preoperatively, as an assessment of the foreign body size and location. 相似文献
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Alexander Becker Ori Yaslowitz Joseph Dubose Kobi Peleg Yaakov Daskal Adi Givon Israel Trauma Group Boris Kessel 《中华创伤杂志(英文版)》2020,23(3):181-184
Purpose: Pelvic fracture evaluation with abdominopelvic computed tomography (CT) and formal CT cystography for rule out of urine bladder injury have been commonly employed in pediatric trauma patients. The additional delayed imaging required to obtain optimal CT cystography is, however, associated with increased doses of ionizing radiation to pelvic organs and represent a significant risk in the pediatric population for future carcinogenic risk. We hypothesized that avoidance of routine CT cystography among pediatric pelvic fracture victims would not result in an appreciable rate of missed bladder injuries and would aid in mitigating the radiation exposure risk associated with these additional
images.
Methods: A retrospective cohort study involving blunt trauma pelvic fractures among pediatric trauma patients (age<14) between the years 1997 and 2016 was conducted utilizing the Israeli National Trauma Registry. Statistical analysis was performed using SAS statistical software version 9.4 via the tests of Chisquare test and two-sided Fisher''s exact test. A p value of less than 0.05 was considered statistically significant.
Results: A total of 1072 children were identified from the registry for inclusion. Mean age of patients was 7.7 years (range 0-14) and 713 (66.5%) were male. Overall mortality in this population was 4.1% (44/1072). Only 2.1% (23) of pediatric patients with pelvic fractures had bladder injury identified, with just 9 children having intraperitoneal bladder rupture (0.8% of all the patients).
Conclusion: The vast majority of blunt pediatric trauma victims with pelvic fractures do not have urine bladder injuries. Based on our study results we do not recommend the routine utilization of CT cystography in this unique population. 相似文献