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1.
Thomas W. Clements Michael Dunham Andrew Kirkpatrick Ruphus Rajakumar Carolyn Gratton Rohan Lall Paul McBeth Chad G. Ball 《American journal of surgery》2018,215(5):843-846
Background
Evidence for repeat computed tomography (CT) in minor traumatic brain injury (mTBI) patients with intracranial pathology is scarce. The aim of this study was to investigate the utility of clinical cognitive assessment (COG) in defining the need for repeat imaging.Methods
COG performance was compared with findings on subsequent CT, and need for neurosurgery in mTBI patients (GCS 13–15 and positive CT findings).Results
Of 152 patients, 65.8% received a COG (53.0% passed). Patients with passed COG underwent fewer repeat CT (43.4% vs. 78.7%; p?=?.001) and had shorter LOS (8.7 vs. 19.5; p?<?.05). Only 1 patient required neurosurgery after a passed COG. The negative predictive value of a normal COG was 90.6% (95%CI?=?81.8%–95.4%).Conclusion
mTBI patients with an abnormal index CT who pass COG are less likely to undergo repeat CT head, and rarely require neurosurgery. The COG warrants further investigation to determine its role in omitting repeat head CT. 相似文献2.
H. Abe M. Sumitani K. Uchida T. Ikeda H. Matsui K. Fushimi H. Yasunaga Y. Yamada 《British journal of anaesthesia》2018,120(4):779-789
Background
Although the incidence of maternal mortality during Caesarean delivery remains very low, the rate of severe maternal morbidity is increasing. Improvements in obstetric anaesthetic practice have resulted in a dramatic reduction in the risk of maternal death from general anaesthesia. Less clear is whether the risk of severe maternal morbidity differs according to mode of anaesthesia for women undergoing Caesarean delivery. We analysed the association between the mode of anaesthesia and severe maternal morbidity during Caesarean delivery using a nationally representative inpatient database.Methods
We identified 89 225 women undergoing scheduled Caesarean delivery from the Diagnosis Procedure Combination database in Japan, 2010–2013. We defined severe maternal morbidity as the presence of any life-threatening complications and identified women with severe maternal morbidity from the database. Propensity score-matched analysis was carried out to compare the odds of severe maternal morbidity between women who underwent general vs neuraxial anaesthesia.Results
Of 89 225 women, 10 058 received general anaesthesia and 79 167 received neuraxial anaesthesia. In the propensity score-matched analysis with 10 046 pairs, a higher incidence of severe maternal morbidity was observed among patients receiving general (2.00%) rather than neuraxial anaesthesia (0.76%). The odds ratio of severe maternal morbidity was 2.68 (95% CI, 1.97–3.64) among women receiving general compared with neuraxial anaesthesia.Conclusions
For scheduled Caesarean delivery, general anaesthesia compared with neuraxial anaesthesia is associated with greater odds for severe maternal morbidity. However, we should be cautious with interpretation of these findings because they may be explained by confounding indications. 相似文献3.
4.
Alex Gu Adam J. Michalak Jordan S. Cohen Neil D. Almeida Alexander S. McLawhorn Peter K. Sculco 《The Journal of arthroplasty》2018,33(5):1598-1605
Background
Knee stiffness following primary total knee arthroplasty can lead to unsatisfactory patient outcomes secondary to persistent pain and loss of function. Manipulation under anesthesia (MUA) remains a viable option for treatment of post-operative stiffness. However, the optimal timing and clinical efficacy of manipulation of anesthesia remains unknown.Methods
A systematic review of the literature was performed to identify studies that reported clinical outcomes for patients who underwent MUA for post-operative stiffness treatment. Repeat MUA procedures were included in the study but were analyzed separately.Results
Twenty-two studies (1488 patients) reported on range of motion (ROM) after MUA, and 4 studies (81 patients) reported ROM after repeat MUA. All studies reported pre-MUA motion of less than 90°, while mean ROM at last follow-up exceeded 90° in all studies except 2. For studies reporting ROM improvement following repeat MUA, the mean pre-manipulation ROM was 80° and the mean post-manipulation ROM was 100.6°.Conclusion
MUA remains an efficacious, minimally invasive treatment option for post-operative stiffness following TKA. MUA provides clinically significant improvement in ROM for most patients, with the best outcomes occurring in patients treated within 12 weeks post-operatively.Prospero Registration Number
CRD42016052215. 相似文献5.
Background
De novo gastric cancer is a rare complication of liver transplantation.Methods
Surgical treatments of 16 cases with different outcomes were reported in the English literature.Results
De novo gastric cancer (stage II) was diagnosed as the result of epi-gastric discomfort in a recipient 10 years after liver transplantation. The patient received chemotherapy alone and remained well for 26 months.Conclusions
De novo gastric cancer of liver transplantation recipients is a severe complication; early detection and relevant intervention will benefit these recipients. 相似文献6.
7.
M.H. Kuizenga P.J. Colin K.M.E.M. Reyntjens D.J. Touw H. Nalbat F.H. Knotnerus H.E.M. Vereecke M.M.R.F. Struys 《British journal of anaesthesia》2018,120(3):525-536
Background
Neural inertia is defined as the tendency of the central nervous system to resist transitions between arousal states. This phenomenon has been observed in mice and Drosophila anaesthetized with volatile anaesthetics: the effect-site concentration required to induce anaesthesia in 50% of the population (C50) was significantly higher than the effect-site concentration for 50% of the population to recover from anaesthesia. We evaluated this phenomenon in humans using propofol or sevoflurane (both with or without remifentanil) as anaesthetic agents.Methods
Thirty-six healthy volunteers received four sessions of anaesthesia with different drug combinations in a step-up/step-down design. Propofol or sevoflurane was administered with or without remifentanil. Serum concentrations of propofol and remifentanil were measured from arterial blood samples. Loss and return of responsiveness (LOR-ROR), response to pain (PAIN), Patient State Index (PSI) and spectral edge frequency (SEF) were modeled with NONMEM®.Results
For propofol, the C50 for induction and recovery of anaesthesia was not significantly different across the different endpoints. For sevoflurane, for all endpoints except SEF, significant differences were found. For some endpoints (LOR and PAIN) the difference was significant only when sevoflurane was combined with remifentanil.Conclusions
Our results nuance earlier findings with volatile anaesthetics in mice and Drosophila. Methodological aspects of the study, such as the measured endpoint, influence the detection of neural inertia. A more thorough definition of neural inertia, with a robust methodological framework for clinical studies is required to advance our knowledge of this phenomenon.Clinical trial registration
NCT 02043938. 相似文献8.
Background
The global rise in infectious disease has led the Center for Disease Control and Prevention and the World Health Organization to release new guidelines for the prevention of surgical site infection.Methods
In this article, we summarize current recommendations based on level of evidence, review unresolved and unaddressed issues, and supplement them with new literature.Results
Although the guidelines discuss major issues in reducing surgical site infection, many questions remain unanswered.Conclusion
These guidelines will hopefully help in setting a standard of care based on best evidence available and focus investigators on areas where evidence is lacking. 相似文献9.
Study Design
Case series.Introduction
Hand injuries are the most common injury observed in hurling although compliance in wearing protective gloves is reportedly low.Purpose of the Study
To devise a glove that offers comfort, protection and freedom of movement, using the bespoke capabilities of 3-dimensional (3D) printing.Methods
Each player's “catching” hand was imaged using a 3D scanner to produce a bespoke glove that they later trialed and provided feedback.Results
Nine players provided feedback. On average, the players favorably rated the glove for the protection offered. The average response on comfort was poor, and no players reported that glove aided performance during play.Discussion
This feasibility study explores the versatility of 3D printing as a potential avenue to improve player compliance in wearing protective sportswear. Feedback will help refine glove design for future prototypes.Conclusions
Hurling is the primary focus in this study, but knowledge gains should be transferable to other sports that have a high incidence of hand injury.Level of Evidence
4. 相似文献10.
Background
Heart-lung transplantation is a well-established therapeutic modality for concomitant end-stage heart and lung failure. With growing organ scarcity, the rates of these transplants are declining, and center experience is waning.Methods
With over 35 years of experience performing heart-lung transplantation, we describe our procurement protocol herein, as well as offer suggestions to avoid potential pitfalls in order to ensure technical excellence in harvesting these valuable grafts.Results
Procurement issues most commonly arise with organ preservation and inadvertent damage to structures that are difficult to fully visualize.Conclusions
En-bloc heart-lung procurement can be taught effectively and safely to trainees with an emphasis on avoiding common pitfalls that may compromise graft function. 相似文献11.
Ita Suzana Mat Jais Kai Li Chan Mun Kitt Austin Loke Saleem Abdul Rahim Shian Chao Tay 《Journal of hand therapy》2018,31(1):122-128
Study Design
Cross-sectional study for clinical measurement.Introduction
Most daily tasks require individuals to exert grip strength with torque, which can be challenging for elderly as their strength diminishes with age. We postulate that to assess the functional capacity of an individual, it is important to evaluate the functional grip strength instead of the maximal static grip strength.Purpose of the Study
The objective of this cross-sectional study is to establish normative data for the functional grip strength of elderly aged 60 years and older in the Singapore population.Methods
In this study, 233 healthy subjects aged 60 years and older were recruited. Using a custom-made hand strength measurement device, the following measurements were recorded: grip strength at neutral position, grip strength with resistive pronation torque, and grip strength with resistive supination torque.Results
Grip strengths measured for both genders decreased by 13% and 16% for males and females respectively, when pronation torque was exerted, and with supination torque, the strength decreased by 18% and 17% for males and females respectively.Conclusion
Normative data for the elderly population in Singapore had been established. The findings from this study can complement the existing ergonomic hand data in designing better assistive tools to improve the independent living of elderly.Level of Evidence
NA. 相似文献12.
Harvey Mathews Addie Middleton Lindsey Boan Madison Jacks Lindsey Riddick Jessica Shepherd Jay Patel Antonia McNeal Stacy Fritz 《Journal of hand therapy》2018,31(4):554-561
Study Design
Clinical measurement.Introduction
Individuals with carpal tunnel syndrome (CTS) sometimes exhibit weakness of palmar abduction strength (TAS). Reliable assessment of this strength in both subjects with and without CTS with the commonly available Microfet 2 is not known.Purpose of the Study
The purpose of this study was to determine the intrarater and interrater reliabilities of a handheld dynamometric (HHD) method to assess TAS in individuals with and without CTS using the commercially available MicroFET2 and to examine the association between TAS in individuals with CTS and the Carpal Tunnel Symptom Questionnaire (CTSQ) scores.Methods
In 2 different study phases, individuals with and without CTS were assessed for TAS by 2 different examiners. The CTSQ was administered to the individuals with CTS.Results
Intrarater and interrater reliability coefficients (0.89-0.93 and 0.82-0.90, respectively) were excellent in individuals with and without CTS. Weak negative correlations were found between TAS and overall CTSQ and symptom severity subscale scores, and a moderate negative correlation was found between TAS and functional Status Subscale score.Discussion
This HHD method of reliably assessing TAS better quantifies deficits and progress than traditional manual muscle testing for muscle grades greater than 3/5.Conclusion
This method of HHD reliably quantifies TAS but is more reliable with the same than different raters. 相似文献13.
Monti Khatod 《The Journal of arthroplasty》2018,33(6):1649-1651
Background
Total joint arthroplasty is a successful operation with increasing prevalence in the United States. Kaiser Permanente has been using multiple tools to optimize patient outcomes while keeping health-care expenditures in check.Methods
We describe the patient, surgeon, and hospital perspective toward the delivery of sustainable arthroplasty care for a growing elderly population. Quality metrics for each stakeholder are presented.Results
Kaiser Permanente optimizes value for the patient, surgeon, and hospital with the use of evidence-based integrated care pathways and a national joint arthroplasty registry.Conclusion
A continued focus on value-driven care will provide continued efficiency in a time of growth with maintenance of excellent outcomes. 相似文献14.
Objective
The objective of this study was to introduce a new framework, called IDEAL (idea, development, exploration, assessment, and long-term study), to guide physicians, investigators, and regulatory agencies through the life cycle of device development and procedural refinement.Methods
This review describes the IDEAL framework and illustrates its application for treatment of uncomplicated type B dissection (uTBD) as an example of this process.Results
Components of IDEAL are summarized and applied to devices used to treat uTBD. Treatment of uTBD is currently in the exploration phase, with concurrent assessment and long-term study being facilitated by detailed registries.Conclusions
The application of IDEAL to the development and monitoring of technologies standardizes the nomenclature, facilitates evidence-based practice, and enhances the innovation process. 相似文献15.
J. Raper J.C. De Biasio K.L. Murphy M.C. Alvarado M.G. Baxter 《British journal of anaesthesia》2018,120(4):761-767
Background
Socio-emotional development is the expression and management of emotions, which in non-human primates can be examined using responses toward increasing levels of threat. Damage to the limbic system alters socio-emotional development in primates. Thus, neuronal and glial cell loss caused by exposure to general anaesthesia early in infancy might also impact socio-emotional development. We recently reported that repeated sevoflurane exposure in the first month of life alters emotional behaviours at 6 months of age and impairs visual recognition memory after the first year of life in rhesus monkeys. The present study evaluated socio-emotional behaviour at 1 and 2 yr of age in those same monkeys to determine the persistence of altered emotional behaviour.Methods
Rhesus monkeys of both sexes were exposed to sevoflurane anaesthesia three times for 4 h each time in the first 6 weeks of life. At 1 and 2 yr of age, they were tested on the human intruder task, a well-established mild acute social stressor.Results
Monkeys exposed to sevoflurane as infants exhibited normal fear and hostile responses, but exaggerated self-directed (displacement) behaviours, a general indicator of stress and anxiety in non-human primates.Conclusions
Early repeated sevoflurane exposure in infant non-human primates results in an anxious phenotype that was first detected at 6 months, and persists for at least 2 yr of age. This is the first demonstration of such a prolonged impact of early anaesthesia exposure on emotional reactivity. 相似文献16.
S. Ceruti L. Anselmi B. Minotti D. Franceschini J. Aguirre A. Borgeat A. Saporito 《British journal of anaesthesia》2018,120(1):101-108
Background
Significant hypotension is frequent after spinal anaesthesia and fluid administration as therapy is usually empirical. Inferior vena cava (IVC) ultrasound (US) is effective to assess fluid responsiveness in critical care patients. The aim of this study was to evaluate the IVCUS-guided volume optimization to prevent post-spinal hypotension.Methods
In this prospective, randomized, cohort study, 160 patients scheduled for surgery under spinal anaesthesia were randomized into a study group (IVCUS-group), consisting of an IVCUS analysis before spinal anaesthesia with IVCUS-guided volume management and a control group (group C) with no IVCUS assessment. The primary outcome was a relative risk reduction in the incidence of hypotension between the groups; secondary outcomes were the need for vasoactive drugs and the amounts of fluids required after spinal anaesthesia. We also tested the hypothesis of a correlation between IVC collapsibility index and hypotension after spinal anaesthesia.Results
The relative risk reduction of hypotension between the groups was 35% (IVCUS-group 27.5%, Group C 42.5%, P=0.044, CI=95%). The need for vasoactive drugs in the IVCUS-group was significantly lower compared to the C-group (P=0.015), while the total amount of fluids was significantly superior higher in the IVCUS group (P<0.0001) compared to Group C. IVC collapsibility index was correlated with the amount of fluid administered (r2=0.32), but could not be used to predict postspinal anaesthesia hypotension.Conclusions
IVCUS is an effective method to prevent postspinal anaesthesia hypotension by IVCUS-guided fluid administration before spinal anaesthesia.17.
Joachim Gülke Barbara Leopold Daniel Grözinger Björn Drews Stephan Paschke Nikolaus J. Wachter 《Journal of hand therapy》2018,31(1):20-28
Study Design
Prospective cohort randomized controlled trial.Purpose of the Study
Is either a home exercise (HE) program or traditional physical therapy (PT) more effective in the postoperative management of metacarpal fractures?Methods
Sixty patients suffering from nonthumb metacarpal fractures who received mobilization-stable open reduction and internal fixation were included. All patients were prospectively randomized into either the PT group or the HE group. Follow-up examinations at 2, 6 and 12 weeks postoperatively.Results
After 2 weeks, the range of motion (ROM) in both groups was still severely reduced. Twelve weeks after surgery the ROM improved to 245° (PT) and 256° (HE). Grip strength after 6 weeks was 68% (PT) and 71% (HE) when compared to the non-injured hand, improving to 91% (PT) and 93% (HE) after 12 weeks.Conclusion
Study results show that both HE program and traditional PT are effective in the postoperative management of metacarpal fractures.Level of Evidence
II. 相似文献18.
Background
Average costs associated with common procedures can vary by surgeon without a corresponding variation in outcome or case complexity.Methods
De-identified cost and equipment utilization data were collected from our hospital for elective laparoscopic cholecystectomy performed by 17 different surgeons over a 6-month period. A group of surgeons used this data to design a standardized equipment pick list that became optional (not mandated) for laparoscopic cholecystectomy. Cost and consumable surgical supply utilization data were collected for six months prior to and following the creation of the standardized pick-list.Results
280 elective laparoscopic cholecystectomies were performed during the study interval. In the 6 months after standardized pick list creation, the cost of disposable supplies utilized per case decreased by 32%.Conclusions
Surgical cost savings can be achieved with standardized procedure pick lists and attention to the cost of consumable surgical supplies. 相似文献19.
20.
L. Cornelissen S.E. Kim J.M. Lee E.N. Brown P.L. Purdon C.B. Berde 《British journal of anaesthesia》2018,120(6):1274-1286