Epidemiological profile of sports-related knee injuries in northern India: An observational study at a tertiary care centre

BackgroundSports-related knee injuries occur commonly in athletes. However, there is no published epidemiological study from India till date.ObjectivesThe purpose of this study was to identify common injuries sustained by Indian athletes participating in different sports and to study various associated demographic features. A secondary objective was to investigate different factors, which may affect return to sport by the athlete.Study designCross-sectional study (observational study).Study centreSports injury clinic, PGIMER, Chandigarh.MethodsOut of 465 athletes who presented to us with sports-related knee injuries over a 5-year period, 363 athletes (from 24 different sports) with complete records were identified. Data were analysed for demographic features, type of sport, mechanism of injury, injury scenario, athlete's level of play, injury duration at presentation, injury patterns and type of management. Telephonic interviews were conducted with each athlete to enquire about return to sport and time lost in sport due to the knee injury. Factors associated with return to sport were investigated using statistical tests of association.ResultsSoccer was found to be the most common sport associated with knee injuries accounting for 30.6% of the injuries followed by kabaddi (20.9%). The most common mechanism was non-contact injury (64.4%). Competitive injuries were found to be significantly more than practice/training injuries (p < 0.0001). The most common injuries noted were ACL tears (n = 314) followed by meniscus injuries (n = 284) and the most common combination of injuries were an ACL tear with medial meniscus tear (n = 163). Only 39.8% of the athletes returned to sport. Mean duration of time lost in sport among those who returned to sport was 8.84 months. Return to sport was significantly associated with body mass index, level of competitiveness of the athlete and type of management (p = 0.017, 0.045 and <0.0001, respectively).ConclusionKnee injuries take a huge toll on an athlete's career as observed in this study. Prevention of knee injuries is of paramount importance and more focussed epidemiological studies are needed for formulating policies to prevent sports injuries in both professional and amateur athletes.Level of evidenceIV.     

Health visitors' perceptions on their role to assess and manage postpartum depression cases in the community

The present study gives an insight into the health visitors' perceptions on their role in assessing, managing, and supporting mothers with postpartum depression (PPD). The study took place in Cyprus among health visitors of a community Maternity and Child Welfare Clinic using qualitative approach. Data were collected through individual semistructured interviews. The findings showed that although health visitors are able to identify PPD cases, they stress the importance of protocols and evidence‐based care as well as preventive interventions, and they also point out the importance of home visits. Finally, they support the need for education. It is concluded that health visitors can play an important role in women's health and their intervention on the prevention of PPD in the community especially through home visits is very important.     

Different roles of nitric oxide synthase isoforms in cardiopulmonary resuscitation in pigs

The purpose of the present study was to identify the roles of the three nitric oxide synthase (NOS) isoforms on whole body ischemia-reperfusion injury during cardiopulmonary resuscitation (CPR) with periodic acceleration (pGz) in pigs. Thirty-two anesthetized pigs (27.6+/-3.4 kg) were monitored for hemodynamics and selected echocardiographic variables. Twenty minutes after NOS inhibition or placebo administration, ventricular fibrillation (VF) was induced and remained untreated for 3 min, followed by CPR with pGz for 15 min, plus 3 min of manual chest compressions and defibrillation attempt. Four groups were studied: (1) saline control; (2) L-NAME (non-selective NOS inhibitor); (3) aminoguanidine (inducible NOS inhibitor); (4) TRIM (neuronal NOS inhibitor). Return of spontaneous circulation (ROSC) to 180 min occurred in 6/8 controls, 4/8 L-NAME, 7/8 aminoguanidine, and 2/8 TRIM animals. The L-NAME group had significantly lower organ blood flow, impaired cardiac function, but higher vascular tone than control group. The aminoguanidine group had the highest organ blood flows and survival rate. Six out of eight TRIM treated animals had initial return of heartbeat; however, with impaired heart contractility and could not survive more than 20 min of ROSC. This study reveals the differential role of endogenous NO produced from the three NOS isoforms during pGz-CPR. Both endothelial and neuronal NOS derived NO show predominantly protective effects while inducible NOS derived NO plays a detrimental role in pGz-CPR. The present study has shown that cardiac arrest and resuscitation appears to be associated with a different expression of NOS isoforms which appear to affect resuscitation outcomes differently.     

专科护理门诊个案管理对永久性起搏器植入患者的影响

目的 探讨专科护理门诊个案管理对永久性起搏器植入患者复诊及服药依从的影响。方法 将首次植入永久起搏器患者134例采用随机数字表法分为对照组和干预组各67例。对照组给予微信或电话方式进行常规随访,干预组实施专科护理门诊个案管理,即通过线上及专科护理门诊方式对患者进行随访与个性化健康教育。比较两组出院后1、3、6个月的复诊率、服药依从性。结果 出院后1、3、6个月干预组复诊率、服药依从性显著高于对照组(P<0.05,P<0.01)。结论 对永久性起搏器植入患者实施专科护理门诊个案管理,促进患者出院后专业化护理的延续和全程管理,可以显著提高其术后复诊率、服药依从性。     

院内外团队协作入户对产妇实施母乳喂养与产褥期照护支持研究

目的 通过实施院内外联动母乳喂养与产褥期照护支持,了解母婴产褥期健康问题,总结入户访视经验,为完善产褥期健康管理提供依据。方法由医院指导团队对社区入户指导团队4名成员进行培训和一对一对接指导,协助制订入户照护方案,由入户指导团队对102名存在母乳喂养问题的产妇行入户访视服务,包括母乳喂养与产褥期照护支持。结果共完成118人次入户访视服务。最常见的产妇问题为哺乳姿势问题,占73.7%;最常见的婴儿问题为喂养遇到的难题,占65.2%。产妇对访视服务的满意度为100%,未发生事故和投诉。结论院内外团队协作入户对产妇行母乳喂养与产褥期照护支持,能帮助产妇解决母乳喂养遇到的问题,提高产妇满意度。在实施前应构建访视团队以及相应的指导团队,加强入户指导质量把控,提高院内外联动性、对指导者进行一对一指导以提高服务质量。     

Predictors of postoperative emergency department visits after laparoscopic bariatric surgery

BackgroundPostoperative emergency department (ED) visits are a quality metric for bariatric surgical programs. Predictive factors of ED visits that do not result in readmission are not clear.ObjectivesWe aimed to identify predictors of ED visits in patients without readmission after laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass (LRYGB).SettingThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) database.MethodsThe MBSAQIP database was queried for patients who underwent LSG and LRYGB from 2015 through 2017. Patients were grouped by those who presented to the ED (ED group) and those who did not. ED visits analyzed included only those that did not result in readmission. Multivariable forward selection logistic regression was used to report adjusted odds ratios (AORs) with 95% CIs for ED visits.ResultsOf 276,073 patients, 257,985 (93.4%) were in the group who did not present to the ED, and 18,088 (6.6%) were in the ED group. Most underwent LSG (71.9%) versus LRYGB (28.1%). Multivariable forward logistic regression identified outpatient treatment for dehydration (AOR, 22.26; 95% CI, 21.30–23.27; P < .001) as the most predictive factor of an ED visit, followed by urinary tract infection (AOR, 7.25; 95% CI, 6.22–8.46; P < .001), wound disruption (AOR, 4.63; 95% CI, 3.09–6.96; P < .001), and surgical site infection (AOR, 3.80; 95% CI, 3.38–4.28; P < .001).ConclusionsPostoperative complications were the strongest predictors of ED visits after laparoscopic bariatric surgery. Quality improvement initiatives should target these variables to decrease postoperative ED visits.     

某医院病房药房退药原因分析及对策

目的：分析某医院病房药房退药原因,提出解决对策,减少患者用药隐患。方法对某医院病房2013年7月～12月的退药品种和原因进行统计和分析。结果每个科室都有退药,其中退药平均每月3万元以上的科室依次是ICU、普外科、神经内科、呼吸科、肝胆外科,占本科用药的比例前5名的依次为ICU6.82%、消化科3.62%、呼吸科3.02%、心内科2.97%、肾内科2.68%。结论各种原因导致退药,有些原因如医嘱录入错误等为主观原因,可通过加强责任心和增加复核等减小出现频率;部分原因如患者死亡、过敏等为客观原因,是无法避免的。     

Development of an inter-professional clinical practice guideline for vocational evaluation following severe burn

Purpose

To develop an inter-professional clinical practice guideline for vocational evaluation following severe burn.

Methods

The Canadian Medical Association's (CMA) handbook on clinical practice guideline and the appraisal of guidelines for research and evaluation (AGREE) were used to develop the guideline. The following steps from the CMA handbook were followed: (1) identifying the guideline's objective and questions; (2) systematic literature review; (3) study selection and quality appraisal and (4) development of clear recommendations by key stakeholders. The international classification of function and disability was used as a guiding theoretical framework.

Results

The guideline includes recommendations within seven domains: (1) establishing evaluation purpose and consent; (2) history taking and information gathering; (3) assessment of functional systems: body systems and structures; (4) assessment of functional systems: activity limitations and participation restrictions; (5) identification of key personal and environmental factors; (6) analysis and synthesis; (7) development of evaluation recommendations.

Conclusions

This guideline insures that vocational evaluators use an evidence-based approach to systematically assess elements within the individual, the work, workplace, personal and environmental facilitators and barriers to work participation. The guideline may be useful to clinicians, healthcare teams, employers and individuals with severe burns. Future steps will include guideline pilot testing and endorsement.     

Facilitating surgical decisions for patients who are uncertain: a pilot surgical option process within an interdisciplinary functional restoration program

Background contextFor chronic pain patients, recovery may be slowed by indecisiveness over optional surgery. These patients may be delayed from participating in interdisciplinary functional restoration (FR), pending resolution of the surgical decision. Uncertainty about surgery or rehabilitation leads to delayed recovery. A surgical option process (SOP) was developed to permit patients with chronic disabling occupational musculoskeletal disorders to enter FR, make a final determination halfway through treatment, and return to complete rehabilitation after surgery, if surgery was elected.PurposeThis study assessed the frequency with which an FR program can resolve an uncertain surgical option. It also assessed program completion rate and 1-year post-program outcomes for subgroups that decline surgery, request and receive surgery, or request surgery but are denied by surgeon or insurance carrier.Study designRetrospective study of a consecutive cohort.Patient sampleA cohort of 44 consecutively treated chronic disabling occupational musculoskeletal disorder patients were admitted to an FR program and identified as candidates for a surgical procedure but were either ambivalent about undergoing surgery, had a difference of opinion by two or more surgeons, or were denied a surgical request by an insurance carrier. Patients attended half (10 full day visits) of an FR program before making their own final determination to pursue a request or decline surgery.Outcome measuresPatients were assessed on surgical requests and whether surgery was ultimately performed, program completion status after the surgical determination, demographic variables, and 1-year outcomes on work status, additional surgery, and other health utilization measures.MethodsPatients became part of the SOP on program entry and were included in the study if they participated in a surgical-decision interview halfway through the program. Those who elected to decline surgery (DS) completed the program without delay, but those requesting surgery were placed on hold from the program while consultation and preauthorization steps took place. Those requesting surgery, but denied (RSD), and those undergoing surgery (US) were given the opportunity to complete FR following postoperative physical therapy or resolution of the surgical re-evaluation process.ResultsThere were 32 DS patients (73%), indicating that a large majority of patients declined the surgery that was still being considered when offered participation in the SOP. Of the 12 patients wanting a surgery, there were four US patients who received surgery previously denied (9% of cohort), and eight RSD patients (18% of cohort). Patients from the DS group completed the FR program at an 88% rate, as did 75% of US patients. However, despite an opportunity to re-enter and complete rehab, only 50% of RSD patients completed the FR option. Overall, patients who persistently sought surgery, contrary to the recommendations of a surgeon, had poorer outcomes. These 1-year post-FR outcomes included lower return-to-work and work retention rates, with higher rates of treatment seeking from new providers (resulting in higher rates of post-discharge surgery) and higher rates of recurrent injury claims after work return.ConclusionsA SOP tied to participation in an interdisciplinary FR program resolves uncertainty regarding surgical options in a high proportion of cases, resulting in a large majority declining surgery and completing the FR program. Timely surgery is also promoted decisively when needed. Findings suggest that patients who persistently seek surgery, contrary to the recommendations of a surgeon, frequently fail to complete FR and have poorer outcomes overall.