Retrospective review of image quality of CT in polytrauma patients: comparison of patients scanned using a scoop stretcher and without a scoop stretcher

Increasingly pre-hospital trauma management involves transfer of patients using a scoop stretcher; a number of computed tomography (CT) compatible scoops have recently appeared on the market. We sought to evaluate any differences in image quality in polytrauma patients scanned in a scoop stretcher. CT studies of 234 consecutive patients presenting between December 2011 and August 2012 at our regional level 1 tertiary trauma centre were retrospectively reviewed. Patients were allocated into two groups: those scanned with a scoop stretcher and without. CTs were reviewed by a consultant radiologist and two senior radiology trainees and graded separately for quality/artefact. A scale of 1–5 was employed: 1—uninterpretable, 2—borderline image quality, 3—acceptable, 4—good, 5—excellent. A total of 128 (54.7 %) patients were scanned in a scoop stretcher and 106 (45.3 %) were scanned without, 183 males and 51 females (average age, 46 (16–94)?years; SD, 20). The average quality grading for the patients scanned in the scoop was 4.64 compared to 4.68 in those without the scoop. There was no significant grading difference between the groups, consultant (p?=?0.096) and trainees (p?=?0.782). No artefacts were attributable to the scoop stretcher 0/128 (0 %). Following our experience, the use of scoop stretchers is recommended for efficient, safe and practical management of trauma patients and in terms of imaging, with no detrimental effect on image quality.     

Evaluation of retinopathy of prematurity screening in reverse Kangaroo Mother Care: a pilot study

Purpose

To evaluate retinopathy of prematurity (ROP) screening practice in reverse Kangaroo Mother Care (R-KMC) with respect to stress and pain to the infant.

Methods

In a pilot study we evaluated ROP screening practice in R-KMC in 20 babies at risk of ROP. The R-KMC differed from the conventional KMC with respect to the baby position where the baby lay supine on mother''s chest. With the mother lying supine and the baby in R-KMC position, screening examinations were done with indirect ophthalmoscope. The outcome measures included stress (quantified by pulse, respiration, and oxygen saturation) and pain to the baby by observing facial expression (eye squeezing, crying, and brow bulge). The heart rate, respiratory rate, and SpO2 (%) were compared before and immediately after the procedure using paired t-test.

Result

Mean (±SD) gestational age and birth weight were 30.8±2.3 weeks and 1362.5±253.9 g, respectively. During examination in R- KMC position 8 babies (40%) were completely relaxed (no eye squeezing and crying), 10 (50%) were partially relaxed (no brow bulge) and 2 babies (10%) were not relaxed. A change in heart and respiration rate both by 10 per minute was recorded in 12 (60%) and 10 (50%) babies, respectively. Five babies (25%) had reduction in blood oxygen concentration below 92%. The majority of the mothers (19 of 20) were relaxed.

Conclusion

ROP screening in R-KMC can be a baby friendly screening practice with respect to stress and pain to the infant and needs further evaluation in a larger cohort.     

Ethnic differences in response to lifestyle intervention for the prevention of type 2 diabetes in adults: A systematic review and meta-analysis

The risk of type 2 diabetes mellitus (T2DM) varies by ethnicity, but ethnic differences in response to diabetes prevention interventions remain unclear. This systematic review and meta-analysis assessed ethnic differences in the effects of lifestyle interventions on T2DM incidence, glycemic outcomes (fasting glucose, 2-h glucose, HbA_1c), anthropometric measures (weight, BMI, waist circumference), and lifestyle behaviors (physical activity, energy intake, energy from fat, fiber intake). MEDLINE, EMBASE, and other databases were searched (to June 15, 2020) for randomized and non-randomized controlled trials on lifestyle interventions (diet and/or physical activity) in adults at risk of T2DM. Ethnicity was categorized into European, South Asian, East and Southeast Asian, Middle Eastern, Latin American, and African groups. Forty-four studies were included in meta-analyses. Overall, lifestyle interventions resulted in significant improvement in T2DM incidence, glycemic outcomes, anthropometric measures, physical activity, and energy intake (all P < 0.01). Significant subgroup differences by ethnicity were found for 2-h glucose, weight, BMI, and waist circumference (all P < 0.05) but not for T2DM incidence, fasting glucose, HbA_1c, and physical activity (all P > 0.05). Few studies in non-European groups reported dietary intake. Lifestyle interventions in different ethnic groups may have similar effects in reducing incidence of T2DM although this needs to be confirmed in further studies.     

Nosocomial diarrhoea

Toroviruses have been reported as a new cause of nosocomial viral diarrhoea, and the role of astroviruses has been further elucidated. Polymerase chain reaction methods promise to improve the diagnosis and understanding of the aetiology and control of hospital-acquired viral gastroenteritis. A clearer picture of the impact and extent of Clostridium difficile diarrhoea has emerged, and several control measures have been described. An epidemic Clostridium difficile strain and toxin A-deficient strains have been reported. There is growing evidence that enterotoxin-producing Clostridium perfringens can also cause antibiotic-associated diarrhoea.