Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents

OBJECTIVE: To compare differences in functional outcomes between urban and rural patients with traumatic brain injury (TBI). DESIGN: A longitudinal, prospective, multicentre study of a 2-year cohort from the Brain Injury Rehabilitation Program (BIRP) for New South Wales, with follow-up at 18 months after injury. PARTICIPANTS: 198 patients (147 urban, 51 rural) with severe TBI from the 11 participating rehabilitation units. MAIN OUTCOME MEASURES: Demographic and injury details collected prospectively using a standardised questionnaire, and measures from five validated instruments (Disability Rating Scale, Mayo-Portland Adaptability Inventory, Sydney Psychosocial Reintegration Scale, Medical Outcomes Study Short Form and the General Health Questionnaire--28-item version) administered at follow-up to document functional, psychosocial, emotional and vocational outcomes. RESULTS: Demographic details, injury severity, lengths of stay in intensive and acute care wards were similar for both rural and urban groups. There were no significant group differences in functional outcomes, including return to work, at follow-up. CONCLUSIONS: Our findings contrast with previous research that has reported poorer outcomes after TBI for rural residents, and suggest that the integrated network of inpatient, outpatient and outreach services provided throughout NSW through the BIRP provides effective rehabilitation for people with severe TBI regardless of where they live.     

创伤性脑损伤的临床研究进展

随着现代经济社会的飞速发展及战争模式的改变,创伤性脑损伤有增无减,已然成为重要的全球公共卫生问题和卫勤保障的重难点.笔者检索并分析了近年国内外创伤性脑损伤的流行病学数据和相关研究进展,对创伤性脑损伤的发病率、病死率、致伤因素及临床诊疗等进行综述,为创伤性脑损伤的研究和平时、战时救治提供参考.     

Changing prevalence of diabetes mellitus amongst rural Malays in Kuala Selangor over a 10-year period

A cross-sectional study was carried out to determine the prevalence of diabetes mellitus and its relationship with age, physical activity, nutritional status and diet amongst rural Malays in Kuala Selangor. By simple random sampling 360 subjects were selected for the study. Besides guided questionnaires, subjects also underwent a 2 hours post prandial (2HPP) test to determine the diabetic status as recommended by WHO. The crude prevalence of diabetes mellitus was 14.6% which increases with age. The prevalence of diabetes adjusted for age was 12.2%. Physical activity status seemed to be a significant risk factor for diabetes. A greater proportion of diabetics was obese and their mean fat intake was higher than normal subjects (p < 0.05). The prevalence of diabetes mellitus in this study was significantly higher compared with data from 1984 (3.9%), representing a marked increment of 212.8 per cent over a 10-year period.     

Epidemiology of hepatitis D virus (delta) infection in Melbourne over a 15-year period

The prevalence of delta infection was studied in 3986 individuals seropositive for hepatitis B surface antigen (HBsAg), who were seen in Melbourne between 1971 and 1985. The group comprised 2004 patients with acute hepatitis B, 1820 asymptomatic HBsAg carriers, 139 HBsAg carriers with evidence of chronic liver disease, and 23 carriers who had suffered more than two separate attacks of acute hepatitis. Markers of delta infection were found almost exclusively among intravenous drug abusers and their close contacts. Studies of stored sera suggest that delta infection was introduced into this group about 1970. In carriers with no evidence of chronic liver disease, the prevalence of delta infection was highest among intravenous drug abusers (19.2%). In carriers with evidence of chronic liver disease, delta markers were present in 20.1% and all 23 carriers with recurrent acute hepatitis had evidence of infection with the delta virus.     

Out-of-hospital cardiac arrest in Victoria: rural and urban outcomes

OBJECTIVE: To compare the survival rate from out-of-hospital cardiac arrest in rural and urban areas of Victoria, and to investigate the factors associated with these differences. DESIGN: Retrospective case series using data from the Victorian Ambulance Cardiac Arrest Registry. SETTING: All out-of-hospital cardiac arrests occurring in Victoria that were attended by Rural Ambulance Victoria or the Metropolitan Ambulance Service. PARTICIPANTS: 1790 people who suffered a bystander-witnessed cardiac arrest between January 2002 and December 2003. RESULTS: Bystander cardiopulmonary resuscitation was more likely in rural (65.7%) than urban areas (48.4%) (P = 0.001). Urban patients with bystander-witnessed cardiac arrest were more likely to arrive at an emergency department with a cardiac output (odds ratio [OR], 2.92; 95% CI, 1.65-5.17; P < 0.001), and to be discharged from hospital alive than rural patients (urban, 125/1685 [7.4%]; rural, 2/105 [1.9%]; OR, 4.13; 95% CI, 1.09-34.91). Major factors associated with survival to hospital admission were distance of cardiac arrest from the closest ambulance branch (OR, 0.87; 95% CI, 0.82-0.92), endotracheal intubation (OR, 3.46; 95% CI, 2.49-4.80), and the presence of asystole (OR, 0.50; 95% CI, 0.38-0.67) or pulseless electrical activity (OR, 0.73; 95% CI, 0.56-0.95) on arrival of the first ambulance crew. CONCLUSIONS: Survival rates differ between urban and rural cardiac arrest patients. This is largely due to a difference in ambulance response time. As it is impractical to substantially decrease response times in rural areas, other strategies that may improve outcome after cardiac arrest require investigation.     

精神病专科医院3年医院感染分析

目的:分析精神病专科医院3年医院感染情况,为精神病专科医院医院管理工作提供资料与依据.方法:回顾性调查精神科2004～2006年住院患者医院感染资料,分析医院感染流行病学特点.结果:3年内有5 875例精神科住院患者,发生医院感染393例,感染率6.72%;感染部位依次为上呼吸道、下呼吸道、胃肠道感染,构成比依次为41.32%、17.36%、14.05%.上、下呼吸道感染多发生于全年,尤以冬季为甚;胃肠道感染以夏季为高发季节.结论:精神病院医院感染的发生与疾病特殊性有关,应采取针对性措施,切实做好精神病专科医院医院感染预防和控制工作.     

Radioactive iodine (131I) therapy for thyrotoxicosis at Groote Schuur Hospital over a 6-year period

The case records of 262 patients who received 131I therapy during a 6-year period were analysed retrospectively. These included seventy-eight patients who received more than one therapeutic dose. The major indication for 131I therapy was thyrotoxicosis occurring in patients aged 40 years and over. The racial incidence in this series is striking. The effects on thyroid function of two low-dose schedules (4 mCi and 6 mCi) were compared. The major complication encountered was hypothyroidism. 4 mCi appears to be as effective as 6 mCi with the added advantage of producing less hypothyroidism.     

Oncology research in Saudi Arabia over a 10-year period: A synopsis

Objectives:To assess the quality and quantity of Saudi publications in oncology over a 10-year period.Methods:A systematic PubMed search was conducted between January 2008 and December 2017 to retrieve all Saudi oncology publications. Data about the articles was collected. The level of evidence (LOE) was independently assessed by 2 authors. Two 5-year periods (2008-2012 and 2013-2017) were compared using the relevant parameters. Clinicaltrials.gov was also searched for all oncology trials registered in Saudi Arabia.Results:A total of 839 publications met our inclusion criteria. The most common type of research was case series, totaling 32% of all publications. Clinical trials formed less than 2% of the total. The LOE was I, II, III, and IV in 0.3%, 2.1%, 58.4%, and 39.3% of the included publications, respectively. The LOE was the same in the 2 periods. There were more publications in international journals (p=0.004), more international collaborations (p=0.001), and higher journal impact factors (p=0.037) in 2013-2017 than in 2008-2012. Only 76 registered clinical trials were found in the Clinicaltrials.gov registry.Conclusion:Despite an increase in the number of Saudi publications in the field of oncology over time, the LOE did not change. There were, however, some improvements in the international collaboration and journal impact factor, as well as an increase in the number of studies published in international journals. These observations call for a national strategy to improve oncology research in Saudi Arabia.     

Discharge of patients to long-term care from a large acute hospital over a 12-year period

Background

Several factors may be important in determining the discharge of patients to long-term care from the acute hospital.

Aims

We aimed to look at factors associated with discharge to long-term care from St. James’s Hospital, Dublin between 1997 and 2008.

Methods

Data obtained from a long-term care database within the geriatric service were analysed. This service is responsible for assessing and listing all patients for long-term care within the hospital.

Results

3,107 patients were listed and 2,520 discharged to long-term care during the period. Mean age was 81.7 ± 7.3 years and 64.1 % were female. The number listed increased since 1997, but there was no change in age or gender. Median time to discharge was 52 days, but varied by year and was longer for public versus private facilities (mean difference = 18 days, P = 0.006). Mortality of those awaiting long-term care was 17.0 %, but varied significantly by year and ranged form 9.3–29.0 %. Mortality was higher in males, in those of older age and during the winter months.

Conclusions

Variation in the time to discharge appears to be associated with changes in the provision of publicly funded private nursing home beds.     

Reperfusion strategy for ST-segment elevation myocardial infarction: trend over a 10-year period

OBJECTIVES. To review the 10-year trend of reperfusion strategies in patients with ST-segment elevation myocardial infarction, and the adoption rate of percutaneous coronary interventions as opposed to thrombolytic therapy. Also to explore why some patients did not receive reperfusion therapy, and document changes in reperfusion strategies after the introduction of primary percutaneous coronary intervention programmes. DESIGN. Case series. SETTING. A regional hospital, Hong Kong. PATIENTS. All patients with ST-segment elevation myocardial infarction from January 2000 to December 2009. RESULTS. There were 1835 patients with ST-segment elevation myocardial infarction in that period, of which 1179 (64.3%) received reperfusion therapy (thrombolytic therapy, 46.0%; primary percutaneous coronary intervention, 17.5%; emergency coronary artery bypass graft, 0.7%). After introduction of the primary percutaneous coronary intervention programme, significantly more ST-segment elevation myocardial infarction cases underwent that particular intervention (1.6% in 2000 increasing to 30.6% in 2009), while the proportion receiving thrombolytic therapy declined (57.4% in 2000 decreasing to 35.0% in 2009). Seven reasons for no reperfusion therapy were identified. The commonest ones were delayed presentation (45.1%), succumbed before reperfusion (16.0%), multiple medical co-morbidities (15.2%), and contra-indication to thrombolytic therapy (14.8%). The proportion without reperfusion therapy due to a contra-indication to thrombolytic therapy declined (22.7% in 2000 decreasing to 4.9% to 2009), whilst an increasing proportion received primary percutaneous coronary interventions. CONCLUSIONS. Primary percutaneous coronary intervention is increasingly used as the reperfusion therapy in ST-segment elevation myocardial infarction and is replacing thrombolytic therapy, though the latter still remains a mainstay of therapy. A significant proportion of ST-segment elevation myocardial infarction cases received no reperfusion due to various reasons.     

城乡社区自杀死亡率前瞻性观察

目的：研究城乡社区人群的自杀死亡率及其在不同人群中的分布特征，探讨自杀死亡原因和自杀方式。方法：采用分层整群抽样方法，选择城乡8个观察区，自1988年至1992年对其自杀死亡状况进行5年前瞻性观察。结果：观察区5年间≥15岁人群中共自杀死亡423例，5年的逐年自杀死亡率分别为10万分之17．75，27．29，25．26，18．31和22．96。年平均自杀死亡率为10万分之22．32，主要自杀原因为家庭纠纷，失恋和精神疾病，主要自杀方式为服毒和自缢。结论：本观察区中的自杀死亡率，自杀原因和自杀方式与国内同类研究结果基本一致，与国外资料相比本观察区自杀死亡率处于中等或中等以上水平。     

城乡社区自杀死亡率前瞻性观察

目的研究城乡社区人群的自杀死亡率及其在不同人群中的分布特征,探讨自杀死亡原因和自杀方式.方法采用分层整群抽样方法,选择城乡8个观察区,自1988年至1992年对其自杀死亡状况进行5年前瞻性观察.结果观察区5年间≥15岁人群中共自杀死亡423例,5年的逐年自杀死亡率分别为10万分之17.75、27.29、25.26、18.31和22.96.年平均自杀死亡率为10万分之22.32.主要自杀原因为家庭纠纷、失恋和精神疾病,主要自杀方式为服毒和自缢.结论本观察区中的自杀死亡率、自杀原因和自杀方式与国内同类研究结果基本一致,与国外资料相比本观察区自杀死亡率处于中等或中等以上水平.     

Correlation between cerebral co-oximetry (rSO2) and outcomes in traumatic brain injury cases: A prospective,observational study

BackgroundTraumatic brain injury (TBI) is known to be an important reason for the increase in disabilities and deaths worldwide. Studies have demonstrated that brain tissue oxygen (PO2) monitoring reduces mortality significantly but is a invasive method of monitoring. Therefore, there is a need to monitor cerebral ischemia in TBI by noninvasive methods. The study aims to correlate cerebral co-oximetry and possible outcomes in patients with TBI.MethodsThe study included 78 patients with TBI admitted in intensive care unit (ICU) with glascow coma scale (GCS) of 8 or less than 8. Near-infrared spectroscopy monitor is applied to the patients immediately after admission to ICU; readings are noted every 4 hours up to first 48 hours, and outcomes studied as survival or neurological deficit are noted at 28 days.ResultsA total of 12 (15.4%) deaths were seen in this study. Survived patients were further divided into good recovery 33 (42.3%), moderate disability 21(26.9%), major disability 8 (10.3%), and persistent vegetative state 4 (5.1%). The rSO2 values in surviving patients were ranging from mean of 60.74% (standard deviation [SD] 4.38) to a mean of 64.98% (SD 5.01), and the mean rSO2 values in patients who died were ranging from a mean of 52.17% (SD 4.11) to a mean of 37.17% (SD 12.48). Lower rSO2 values were correlating significantly with worse neurological outcome or death by using two independent sample t-test (p < 0.001).ConclusionCerebral co-oximetry is a simple noninvasive method for predicting the outcomes in TBI and can be used to guide the management of these patients.     

Incidence of neural tube defects in liveborn and stillborn infants in British Columbia over a 10-year period

Reports of an apparent decline in the incidence of neural tube defects (NTDs) have come from various parts of the world. If these findings are consistent they would have an important impact on prenatal diagnosis and on screening programs. The incidence of NTDs over a 10-year period was examined in British Columbia, a province that has a population-based health surveillance registry through which there is virtually complete ascertainment of liveborn infants with NTDs. The results showed a significant decrease in incidence only for stillborn infants with anencephaly. The increased use of ultrasonography and the subsequent termination of pregnancies in which the fetus has been found to have anencephaly may explain this observation.