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991.
992.
Maha Alfaqawi Yousef Abuowda Abdalrahman Alqedra Ahmad Alborno Hisham Abuamro Bettina Böttcher 《Lancet》2019
Background
The WHO trauma checklist reduces morbidity and mortality. This study evaluates adherence of three hospitals in Gaza to the basic WHO checklist standards in order to promote set standards of care.Methods
A multi-centre clinical audit was conducted at the three major hospitals in Gaza (Nasser Hospital, European Gaza Hospital, and Alshifa Hospital), which we refer to as hospitals A, B, and C. A prospective observational study was carried out to assess current trauma care practice and to compare this with the WHO trauma care checklist, which was used as a data collection sheet. A team member selected the sample prospectively and randomly from patients with trauma in the emergency department of each of the hospitals over a 3-month period (June to September 2017), and data were analysed using SPSS.Findings
In each hospital, 50 patients were included, with mean ages of 9·5 years (SD 4·1 years), 21·3 years (7 years), and 13 years (9 years) in hospitals A, B, and C, respectively. The majority of these patients were male; 38 out of 50 patients (76%) in hospital A, 44 of 50 patients (88%) in hospital B, and 37 of 50 patients (74%) in hospital C. Road traffic accidents were the most common cause of trauma in hospitals A and C, whereas falling from a height of 2 m or greater was the most common in hospital B. All patients reached the emergency room within 30 min, mainly by ambulance in hospital A (28 of 50 patients; 56%), whereas private cars were the most frequent type of transportation to hospital B (28 of 50 patients; 56%) and hospital C (30 of 50 patients; 60%). Pre-hospital care was provided by non-trained first responders in all cases. In the emergency room, airway devices and chest drains were provided in all cases when indicated, but intravenous fluids and oximeters were not always used. Intravenous fluids were used in 32%, 34%, and 60% of indicated cases in hospitals A, B, and C, respectively. Oximeters were used in 72%, 74%, and 76% of indicated cases in hospitals A, B, and C, respectively. All patients were checked for internal and external bleeding and pelvic fractures, with immobilisation when indicated. In hospitals A and B, urinary catheters were used in some cases despite no appropriate indication (for 8% and 16% of patients with no indication in hospitals A and B, respectively). In hospital C, urinary catheters were only used when indicated. The broader treatment plan was discussed with patients' families, with good communication with units to which the patients were referred after the emergency room. In the majority of cases (126 of 150 patients), the treatment plan was not documented on the patient's trauma chart.Interpretation
The findings show that adherence to trauma care standards and emergency room care provision vary by hospital. Areas requiring improvement include pre-hospital care and documentation on the patient's trauma chart. Universal use of the WHO checklist, a simple adaptable tool, should facilitate the necessary improvements, and a re-audit should be carried out after this improvement are made.Funding
None. 相似文献993.
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Heng Chi Pauline Arends Jurriën G P Reijnders Ivana Carey Ashley Brown Massimo Fasano David Mutimer Katja Deterding Ye H Oo Jrg Petersen Florian van Bommel Robert J de Knegt Teresa A Santantonio Thomas Berg Tania M Welzel Heiner Wedemeyer Maria Buti Pierre Pradat Fabien Zoulim Bettina E Hansen Harry L A Janssen 《Journal of gastroenterology and hepatology》2016,31(11):1882-1887
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The introduction of BCR-ABL-tyrosine kinase inhibitors (TKI) for treatment of hematologic malignancies has made a significant impact on patient outcome. Contingent upon their targeted and off-target activity, therapy-associated infectious complications may occur. We present a case of cytomegalovirus pneumonitis and a case of adenovirus hemorrhagic cystitis in two patients with Philadelphia chromosome-positive acute lymphoblastic leukemia on BCR-ABL TKI treatment and review the literature to summarize the infectious complications based on clinical data. As life-threatening infections may occur, treating physicians should maintain a heightened awareness in patients treated with BCR-ABL TKIs. Based on the frequent reports of hepatitis B virus (HBV) reactivation under the treatment BCR-ABL TKIs, screening for and prophylactic therapy of chronic HBV infection should be considered. Similarly, patients would benefit from screening for and treatment of latent tuberculosis. 相似文献
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Sturchio Andrea Dwivedi Alok K. Gastaldi Matteo Grimberg Maria Barbara Businaro Pietro Duque Kevin R. Vizcarra Joaquin A. Abdelghany Elhusseini Balint Bettina Marsili Luca Espay Alberto J. 《Journal of neurology》2022,269(7):3511-3521
Journal of Neurology - Movement disorders can be associated with anti-neuronal antibodies. We conducted a systematic review of cases with documented anti-neuronal antibodies in serum and/or... 相似文献