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541. Effect of Physician-Staffed Emergency Medical Services (P-EMS) on the Outcome of Patients with Severe Traumatic Brain Injury: A Review of the Literature. Full Text available with Trip Pro

the neurological outcome were examined. Additionally, data concerning hypotension, hypoxia, length of stay (hospital and intensive care unit) and the number of required early neurosurgical interventions were taken into account.The overall mortality was decreased in three of the fourteen included studies after the implementation of a physician in the prehospital setting. One study found also a decrease in mortality only for patients with a Glasgow Coma Scale of 6-8. Strikingly, two other studies reported higher

2019 Prehospital emergency care

542. Missed foot fractures in multiple trauma patients. Full Text available with Trip Pro

Missed foot fractures in multiple trauma patients. Missed or underestimated injuries are one of the central problems in trauma care. Foot injuries can easily be missed because they lay beyond the regularly screened field of a trauma computer tomography scan (CT scan). During primary and secondary survey a careful examination of the extremities often becomes of secondary interest in the severely injured patient.Thirty-four thousand ninety-one multiple trauma patients of the TraumaRegister DGU® (...) diagnosed foot injuries and 144 patients had initially missed foot injuries. Missed foot injuries were especially found in patients with car accidents or fall from ≥3 m. Patients with higher Abbreviated Injury Scale (AIS) or lower Glasgow Coma Scale (GCS) were not significantly more affected by missed foot injuries. Missing foot injuries was also not caused by injury severity or higher age.Our data highlights the need of careful evaluation of the feet during primary and secondary survey particularly

2019 BMC Musculoskeletal Disorders

543. Role of automated pupillometry in critically ill patients. (Abstract)

Role of automated pupillometry in critically ill patients. Pupillary examination has fundamental diagnostic and prognostic values in clinical practice. However, pupillary assessment was relied until present on manual, qualitative, examination, using manual flash penlights or lamps. Quantitative examination with the use of automated infrared video-pupillometers allows an objective assessment of several pupillary parameters and may be superior to manual subjective examination. The potential (...) for quantitative pupillometry is multiple in the setting of critical care, for the monitoring and detection of secondary cerebral insults and to assess brainstem dysfunction and early coma outcome prognostication, and in the intra-operative anesthesiology setting, to assess analgesia and opioid requirement. Here, we describe the pupillometry technique and review recent critical care and anesthesiology studies that demonstrate the value and potential clinical utility of quantitative pupillometry

2019 Minerva anestesiologica

544. Zones matter: Hemodynamic effects of zone 1 vs zone 3 resuscitative endovascular balloon occlusion of the aorta placement in trauma patients. (Abstract)

Zones matter: Hemodynamic effects of zone 1 vs zone 3 resuscitative endovascular balloon occlusion of the aorta placement in trauma patients. Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as a therapy for hemorrhagic shock to limit ongoing bleeding and support proximal arterial pressures. Current REBOA algorithms recommend zone selection based on suspected anatomic location of injury rather than severity of shock. We examined the effects of Zone 1 versus Zone 3 (...) the study period. Of these, 245 underwent REBOA and 99 patients met inclusion criteria. The initial balloon position was Zone 1 in 55 patients, Zone 3 in 36 patients, and unknown or Zone 2 in 8 patients. The change in proximal SBP was greater after REBOA in the Zone 1 group compared to the Zone 3 group (58 ± 4 mmHg vs 41 ± 4 mmHg, P = 0.008). The zone of occlusion was significantly associated with the change in proximal SBP in a linear regression analysis which included initial SBP, Glasgow Coma Scale

2019 Injury

545. Early risk stratification of in hospital mortality following a ground level fall in geriatric patients with normal physiological parameters. (Abstract)

Early risk stratification of in hospital mortality following a ground level fall in geriatric patients with normal physiological parameters. The purpose of this study was to identify risk factors of mortality for geriatric patients who fell from ground level at home and had a normal physiological examination at the scene.Patients aged 65 and above, who sustained a ground level fall (GLF) with normal scene Glasgow Coma Scale (GCS) score 15, systolic blood pressure (SBP) > 90 and <160 mmHg, heart (...) rate ≥ 60 and ≤100 beats per minute) from the 2012-2014 National Trauma Data Bank (NTDB) data sets were included in the study. Patients' characteristics, existing comorbidities [history of smoking, chronic kidney disease (CKD), cerebrovascular accident (CVA), diabetes mellitus (DM), and hypertension (HTN) requiring medication], injury severity scores (ISS), American College of Surgeons' (ACS) trauma center designation level, and outcomes were examined for each case. Risks factors of mortality were

2019 American Journal of Emergency Medicine

546. A nomogram to predict cognitive impairment after supratentorial spontaneous intracranial hematoma in adult patients: A retrospective cohort study. Full Text available with Trip Pro

in this study. They were divided into development (n = 92) and validation (n = 35) dataset according to their admission time. Mini-mental State Examination (MMSE) was conducted between the third and the sixth month after the onset of stroke. MMSE ≤ 24 was considered as cognitive impairment. Univariate and multivariate logistic regression was used to screen for independent risk factors which correlate with cognitive impairment on the development dataset. A nomogram was built based on Akaike Information (...) Criterion (AIC). Receiver operating characteristic (ROC) curve and calibration curve on development and validation dataset was drawn with each area under the curves (AUC) calculated. The decision curve analysis was also conducted with the development dataset.The bleeding volume, Glasgow Coma Scale (GCS), and intraventricular hemorrhage (IVH) are the most significant risk factors which may cause cognitive impairment both in the univariate and multivariate analysis. The finial model performed good

2019 Medicine

547. Acute diffuse edematous-hemorrhagic Epstein-Barr virus meningoencephalitis: A case report. Full Text available with Trip Pro

Acute diffuse edematous-hemorrhagic Epstein-Barr virus meningoencephalitis: A case report. In this study, we presented a rare case of Epstein-Barr virus (EBV) meningoencephalitis presented with meningoencephalitis-like symptoms and diffuse edematous hemorrhage.A 77-year-old male patient was admitted to our hospital with fever, headache, confusion, and unconsciousness for 7 days. Physical examination revealed unconsciousness and stiffness of the neck.The final diagnosis was EBV (...) meningoencephalitis.Ganciclovir (two times 350 mg/day, 21 days), methylprednisolone sodium succinate (120 mg, 5 days), and IV immunoglobulins (IV Ig) (0.4 g/kg, 5 days) were given to this patient.But the patient's clinical symptoms did not improve, and he was still in a coma. His family refused to be further diagnosed and discharged. After discharge for 2 months, the patient was in a coma. Four months later, the patient died of complications of pulmonary infection.The patient is an adult, and imaging was dominated

2019 Medicine

548. Intracranial haemorrhage detected by cerebral computed tomography after falls in hospital acute medical wards. Full Text available with Trip Pro

and potential risk factors for intracranial haemorrhage.We identified inpatient falls in acute medical wards at Monash Health, a large hospital network in the southeast region of Melbourne in Australia, from the incident reporting system during a 32 month period. We examined the post-fall medical assessment form, neurological observation chart and the diagnostic imaging system for details of the fall and brain CT findings. We used survival analysis to evaluate the timeliness of brain imaging and determined (...) was 0.9%. The factors associated with intracranial haemorrhage were head strike, anticoagulation, loss of consciousness or amnesia, drop in Glasgow Coma Scale and advanced chronic kidney disease.The incidence of intracranial haemorrhage was low as most inpatient falls were at low risk for head injury. Research is needed to determine if guidelines specific for hospital inpatients may reduce unnecessary scans without compromising case detection, and improve timeliness of urgent scans.

2019 BMC health services research

549. Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial. Full Text available with Trip Pro

Effect of Dexmedetomidine on Mortality and Ventilator-Free Days in Patients Requiring Mechanical Ventilation With Sepsis: A Randomized Clinical Trial. Dexmedetomidine provides sedation for patients undergoing ventilation; however, its effects on mortality and ventilator-free days have not been well studied among patients with sepsis.To examine whether a sedation strategy with dexmedetomidine can improve clinical outcomes in patients with sepsis undergoing ventilation.Open-label, multicenter (...) duration). Sequential Organ Failure Assessment score (days 1, 2, 4, 6, 8), sedation control, occurrence of delirium and coma, intensive care unit stay duration, renal function, inflammation, and nutrition state were assessed as secondary outcomes.Of the 203 screened patients, 201 were randomized. The mean age was 69 years (SD, 14 years); 63% were male. Mortality at 28 days was not significantly different in the dexmedetomidine group vs the control group (19 patients [22.8%] vs 28 patients [30.8

2017 JAMA Controlled trial quality: predicted high

550. Early Heart Rate Variability and Electroencephalographic Abnormalities in Acutely Brain-Injured Children Who Progress to Brain Death. Full Text available with Trip Pro

is an early indicator of autonomic system failure, and it predicts progression to brain death. We additionally explored the association between heart rate variability and markers of brain dysfunction such as electroencephalogram and neurologic examination between brain-injured children who progressed to brain death and those who survived.Retrospective case-control study.PICU, single institution.Children up to 18 years with a Glasgow Coma Scale score of less than 8 admitted between August of 2016

2019 Pediatric Critical Care Medicine

551. Management of perinatal mood disorders

The majority cluster around 10% to 15% with one meta-analysis giving a prevalence of 13%. 23 There is some evidence that, while the overall prevalence of postnatal depression is not significantly different from that of depression at other times, there is an increased risk of depression occurring in the early postnatal period (threefold in the first five postnatal weeks). 22,24 A smaller body of literature has examined the prevalence of antenatal depression, but the findings also suggest little difference (...) history In a UK study examining the influence of family history, women with bipolar disorder who had a family history of postpartum psychosis were at more than a sixfold greater risk of suffering an episode of postpartum psychosis (odds ratio (oR) 6.54, 95% CI 2.55 to 16.76) than parous women with bipolar disorder who had no such family history. 51 In a Danish cohort study of first time mothers with no previous history of mental disorders, family psychopathology was a risk factor for onset

2012 SIGN

552. Treatment of obesity in patients with type 2 diabetes mellitus - Guideline synopsis and supplementary search for and assessment of systematic reviews

and the Cochrane Database of Systematic Reviews (Cochrane Reviews), the Database of Abstracts of Reviews of Effects (Other Reviews) and the Health Technology Assessment Database (Technology Assessments). The literature search covered the period up to 28.09.2011. Systematic reviews published in German, English or French, based on randomized controlled trials (RCTs) with a minimum duration of 24 weeks in adult patients with type 2 diabetes and concurrent obesity, were included. The interventions to be examined (...) : all-cause mortality, cardiac morbidity and mortality, cerebral morbidity and mortality, vascular-related non-cardiac and non-cerebral morbidity and mortality, blindness or its precursor states, end-stage renal failure with the need for dialysis, amputation (major and minor), hyperosmolar or ketoacidotic coma, symptoms caused by chronic hyperglycaemia, hypoglycaemia, especially severe hypoglycaemia, adverse events of the interventions, health-related quality of life and diabetes remission

2012 Institute for Quality and Efficiency in Healthcare (IQWiG)

553. Ryzodeg (insulin degludec (genetical recombination) / insulin aspart (genetical recombination))

should be reported to the Pharmaceutical Affairs Department of the Pharmaceutical Affairs and Food Sanitation Council. The product is not classified as a biological product or a specified biological product and its re- examination period should be until September 27, 2020 so that it is in line with the re-examination period for an approved product containing Insulin Degludec (Genetical Recombination), one of the active ingredients of the product. The drug substance and the drug product are both (...) were mild in severity except for left thigh haematoma (moderate) and a causal relationship to trial product was denied for all events. No hypoglycaemic symptoms or injection site reactions were reported. No deaths, severe adverse events (SAEs), or adverse events (AEs) leading to withdrawal were reported. 22 No clinically significant changes in vital signs, ECG, laboratory parameters, or physical examination were observed. 4.(ii).A.(1).2) IDegAsp multiple-dose trial in Japanese healthy adult

2012 Pharmaceuticals and Medical Devices Agency, Japan

554. How Useful are Clinical Findings in Patients With Blunt Abdominal Trauma?

of Emergency Medicine Grand Rapids Medical Education Partners/Michigan State University College of Human Medicine Grand Rapids, MI Results Table 1. Likelihood ratios for useful examination and diagnostic tests in blunt abdominal trauma. Finding (nNo. of Studies) Positive LR (95% CI) Negative LR (95% CI) Examination ?ndings Seat belt sign (n2) 5.6–9.9 0.53–0.55 Rebound tenderness (n1) 6.5 (1.8–24) 0.96 (0.91–1.0) Hypotension (systolic blood pressure90 mm Hg) (n1) 5.2 (3.5–7.5) 0.90 (0.87–0.94) Laboratory (...) testing Base de?cit6 mEq/L (n1) 18 (11–30) 0.12 (0.06–0.24) AST or ALT130 (n1) 5.2 (3.5–7.9) 0.46 (0.33–0.65) Ultrasonography Abnormal FAST (adjusted for publication bias) (n22) 30 (20–46) 0.26 (0.19–0.34) AST, aspartate aminotransferase; ALT, alanine aminotransferase. Table 2. Less useful ?ndings (both LR less than 5 and LR– greater than 0.2). Examination Type Findings (nNo. of Studies) Clinical examination Abdominal pain as a symptom (n1) Abdominal tenderness to palpation (n5) Costal margin

2013 Annals of Emergency Medicine Systematic Review Snapshots

555. The Use of Spine Boards in the Pre-Hospital Setting for the Stabilization of Patients Following Trauma

for pre-hospital spinal cord immobilization. 5 The National Association of EMS Physicians and the American College of Surgeons Committee on Trauma stated that, “patients for whom spinal immobilization has not been deemed necessary include those with all of the following: normal level of consciousness (Glasgow Coma Score [GCS] 15), no spine tenderness or anatomic abnormality, no neurologic findings or complaints, no distracting injury, and no intoxication.” 6 Spinal immobilization has also been (...) for exclusion included inappropriate populations (mixed populations of healthy volunteers and trauma patients), inappropriate outcomes (examining pre-hospital assessments of SCI, rather than spinal board effectiveness), and inappropriate comparators (cervical spinal collars). A PRISMA diagram demonstrating the study selection process is presented in APPENDIX 1. Additional references that did not meet the inclusion criteria but may be of potential interest are provided in the APPENDIX 2. CONCLUSIONS

2013 Canadian Agency for Drugs and Technologies in Health - Rapid Review

556. Safety and quality issues associated with the care of patients with cognitive impairment in acute care settings

Drawing Test (CDT) are less sensitive and specific than the Mini-Mental State Examination (MMSE) for the detection of CI. 56 The Mini-Mental State Examination 57 is one of the most widely used and studied instruments for screening for CI, including in the inpatient setting. 56 Although it has some limitations, it is suggested as a screening test in the hospital setting by the Royal College of Psychiatrists. 47 The Rowland Universal Dementia Assessment Scale (RUDAS) 58 is a culture fair test

2013 Sax Institute Evidence Check

557. Depression (PDQ®): Health Professional Version

. One study conducted in a group of 86 mostly late-stage cancer patients suggested that maladaptive coping styles and higher levels of depressive symptoms are potential predictors of the timing of disease progression.[ ] Another study examining coping strategies in women with breast cancer (n = 138) concluded that patients with better coping skills such as positive self-statements have lower levels of depressive and anxiety symptoms.[ ] The same study found racial differences in the use of coping (...) BK, Nanda JP, Campbell L, et al.: Examining the influence of coping with pain on depression, anxiety, and fatigue among women with breast cancer. J Psychosoc Oncol 23 (2-3): 137-57, 2005. [ ] Beresford TP, Alfers J, Mangum L, et al.: Cancer survival probability as a function of ego defense (adaptive) mechanisms versus depressive symptoms. Psychosomatics 47 (3): 247-53, 2006 May-Jun. [ ] Nelson CJ, Rosenfeld B, Breitbart W, et al.: Spirituality, religion, and depression in the terminally ill

2017 PDQ - NCI's Comprehensive Cancer Database

558. Telavancin (Vibativ)

not identify a respiratory pathogen (or if baseline respiratory cultures were not available), then an organism known to cause pneumonia that was identified from baseline blood cultures would qualify a patient for the MAT population. Adequacy of respiratory specimens: The Applicant provided criteria for a uniform examination of sputum and endotracheal aspirates. A reliable sputum specimen was defined as having > 25 white blood cells and 2 days. A patient was defined as having received potentially effective

2013 FDA - Drug Approval Package

559. Selincro - nalmefene

the “complete or partial reversal of opioid effects, including natural or synthetic opioid-induced respiratory depression” or for “known or suspected opioid overdose or poisoning, first aid awaking, acute brain and spinal cord injury, cerebral ischaemia, cerebral infarction and other neurological dysfunction disease, coma, shock, postoperative wake-up anaesthesia, alcoholism, and drug treatment relapse after release” in Mexico and China, respectively. 1.2. Manufacturers H. Lundbeck A/S Ottiliavej 9 DK-2500 (...) , conducted in 1993 in order to examine the influence of Selincro CHMP assessment report Page 22/73 hepatic impairment after 2 mg i.v. bolus administration of NMF. Selincro is contraindicated in patients with severe renal impairment. Based on the available data, differentiated dose recommendations or warning notes for various degrees of renal impairment could not be formulated. This is reflected in Sections 4.2 and 4.4 of the SmPC. Hepatic impairment The impact of hepatic impairment was examined in Study

2013 European Medicines Agency - EPARs

560. Severity Assessment Tools for Patients With Community-Acquired Pneumonia

Health Literature (CINAHL), the Wiley Cochrane Library, and the Centre for Reviews and Dissemination database, for studies published from January 1, 2008, until June 24, 2013. Abstracts were reviewed by a single reviewer and, for those studies meeting the eligibility criteria, full-text articles were obtained. Reference lists were also examined for any additional relevant studies not identified through the search. Inclusion Criteria ? English-language full reports ? published between January 1, 2008 (...) . Community-acquired pneumonia requiring admission to an intensive care unit: a descriptive study. Medicine (Baltimore) 2007; 86(2):103-111. (33) Renaud B, Coma E, Labarere J, Hayon J, Roy PM, Boureaux H et al. Routine use of the Pneumonia Severity Index for guiding the site-of-treatment decision of patients with pneumonia in the emergency department: a multicenter, prospective, observational, controlled cohort study. Clin Infect Dis 2007; 44(1):41-49. (34) Renaud B, Coma E, Hayon J, Gurgui M, Longo C

2013 Health Quality Ontario

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