Taking the pressure off in the Emergency Department: evaluation of the prophylactic application of a low shear,soft silicon sacral dressing on high risk medical patients

Pressure injuries are key clinical indicators of care standard. In Australia, pressure injuries increase length of hospital stay by 4·31 and cost $285 million annually. This pilot study examined the effectiveness of sacral dressing in reducing the prevalence of pressure injuries in older, high‐risk patients. A non randomised one‐sample experimental design was used in this study comprising of four phases. Of the 51 patients recruited to the study, one patient developed a sacral pressure injury compared to six patients identified in a known group with similar demographics who were not approached to participate in the study. The results indicated that patients in the known group were 5·4 times more likely to develop a pressure injury than the intervention group. Findings suggest that applying a protective sacral dressing with a low shear backing as part of a simple standardised prevention injury prevention regime commencing in the Emergency Department was beneficial in the prevention of pressure injury in older ‘at high risk’ medical patients.     

Thyroid Hormones and Cardiovascular Function and Diseases

Thyroid hormone (TH) receptors are present in the myocardium and vascular tissue, and minor alterations in TH concentration can affect cardiovascular (CV) physiology. The potential mechanisms that link CV disease with thyroid dysfunction are endothelial dysfunction, changes in blood pressure, myocardial systolic and diastolic dysfunction, and dyslipidemia. In addition, cardiac disease itself may lead to alterations in TH concentrations (notably, low triiodothyronine syndrome) that are associated with higher morbidity and mortality. Experimental data and small clinical trials have suggested a beneficial role of TH in ameliorating CV disease. The aim of this review is to provide clinicians dealing with CV conditions with an overview of the current knowledge of TH perturbations in CV disease.     

Transparency and credibility of industry-sponsored clinical trial publications: a survey of journal editors

Objective: To examine how medical journal editors perceive changes in transparency and credibility of industry-sponsored clinical trial publications over a 5 year period (2010 to 2015).

Methods: From July to September 2015, a survey link was emailed to journal editors identified from the Thomson Reuters registry. Editors ranked their perception of: a) change in transparency and credibility of industry-sponsored clinical trial publications; b) 8 “Publication Best Practices” and the impact of each on transparency; and c) the importance and adoption of the previously published “10 Recommendations for Closing the Credibility Gap in Reporting Industry-Sponsored Clinical Research”.

Results: Of 510 editors who opened the survey, the analysis pool comprised a total of 293 editors. The majority of respondents reported their location as the US (46%) or EU (45%) and most commonly reported editorial titles were deputy/assistant editor (36%), editor-in-chief (35%) and section editor (24%). More editors reported improved versus worsened transparency (63.5% vs. 6.1%) and credibility (53.2% vs. 10.4%). Best practices that contributed most to improved transparency were “disclosure of the study sponsor” and “registration and posting of trial results”. Respondents ranked the importance of nine recommendations as moderate or extremely important, and adoption of all recommendations was ranked minimal to moderate.

Conclusions: The 293 editors who responded perceived an improvement in the transparency and credibility of industry-sponsored publications from 2010 to 2015. Confirmation of the importance of 9/10 recommendations by the respondents was encouraging. Yet, low adoption rates suggest that additional work is required by all stakeholders to improve best practices, transparency and credibility.     

Interprofessionelle Ausbildungsansätze in der Medizin

Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz - Der gesellschaftliche Wandel und die daraus folgende zunehmende Komplexität der Patientenversorgung stellen alle Akteure des...     

Effectiveness of cast immobilization in comparison to the gold-standard self-removal orthotic intervention for closed mallet fingers: A randomized clinical trial

Study designRandomized clinical trial.IntroductionAlthough orthotic immobilization has become the preferable treatment choice for closed mallet injuries, it is unclear whether orthosis self-removal has an impact on the final outcome.PurposeTo evaluate the treatment efficacy of cast immobilization of closed mallet fingers using Quickcast^® (QC) compared to a removable, lever-type thermoplastic orthosis (LTTP).Methods57 subjects were randomized in 2 groups. DIPj extensor lag and the Gaberman success scale were used as primary outcomes.ResultsLTTP subjects resulted in greater extensor lag than QC subjects (x = 5°; p = 0.05) at 12 weeks from baseline, and high edema and older age negatively affected DIPj extensor lag. No other differences were found between groups.ConclusionCast immobilization seems to be slightly more effective than the traditional approach probably for its greater capacity to reduce edema.Level of evidence1B.     

R v Stone [1999] 2 SCR 290

The recent Canadian Supreme Court decision in R v Stone [1999] 2 SCR 290 goes some way toward clarifying the factors that need to be taken into account in distinguishing between mental disorder and non‐mental disorder automatism. A majority of five judges to four held that the burdon of proof in relation to both types of automatism is on the accussed to prove on the balance of probabilities. This is a radical departure from previous case law and part of the decision is criticised on a number of grounds.