3600 Gaston Ave #550
Dallas TX 75246
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License #: J6812
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Characteristics and outcomes of patients administered blood in the prehospital environment by a road based trauma response team. - Emergency medicine journal : EMJ
OBJECTIVE: To describe the characteristics, clinical interventions and the outcomes of patients administered packed red blood cells (pRBCs) by a metropolitan, road based, doctor-paramedic trauma response team (TRT). METHODS: A retrospective cohort study examining 18 months of historical data collated by the Queensland Ambulance Service TRT, the Pathology Queensland Central Transfusion Laboratory, the Royal Brisbane and Women's Hospital and the Princess Alexandra Hospital Trauma Services was undertaken. RESULTS: Over an 18-month period (1 January 2011 to 30 June 2012), 71 trauma patients were administered pRBCs by the TRT. Seven patients (9.9%) died on scene and 39 of the 64 patients (60.9%) transported to hospital survived to hospital discharge. 57 (89.1%) of the transported patients had an Injury Severity Score (ISS) >â€‰15, with a mean ISS, Revised Trauma Score (RTS) and Trauma-Injury Severity Score of 32.11, 4.70 and 0.57, respectively. No patients with an RTS <â€‰2 survived to hospital discharge. 53 patients (82.8%) received additional pRBCs in hospital with 17 patients (26.6%) requiring greater than 10 units pRBCs in the first 24 h. 47 patients (73.4%) required surgical or interventional radiological procedures in the first 24 h. CONCLUSIONS: There is a potential role for prehospital pRBC transfusions in an integrated civilian trauma system. The RTS calculated using the initial set of observations may be a useful tool in determining in which patients the administration of prehospital pRBC transfusions would be futile.
The feasibility of civilian prehospital trauma teams carrying and administering packed red blood cells. - Emergency medicine journal : EMJ
To evaluate the feasibility, limitations and costs involved in providing prehospital trauma teams with packed red blood cells (pRBCs) for use in the prehospital setting.A retrospective cohort study, examining 18 months of historical data collated by the Queensland Ambulance Service Trauma Response Team (TRT) and the Pathology Queensland Central Transfusion Laboratory was undertaken.Over an 18-month period (1 January 2011-30 June 2012), of 500 pRBC units provided to the TRT, 130 (26%) were administered to patients in the prehospital environment. Of the non-transfused units, 97.8% were returned to a hospital blood bank and were available for reissue. No instances of equipment failure directly contributed to wastage of pRBCs. The cost of providing pRBCs for prehospital use was $A551 (Â£361) for each unit transfused.It is feasible and practical to provide prehospital trauma teams with pRBCs for use in the field. Use of pRBCs in the prehospital setting is associated with similar rates of pRBC wastage to that reported in emergency departments.
Fatal toxic leukoencephalopathy secondary to overdose of a new psychoactive designer drug 2C-E ("Europa"). - Proceedings (Baylor University. Medical Center)
We present a case of a fatal toxic leukoencephalopathy following ingestion of a new psychoactive designer drug known as 2C-E or "Europa." Recreational drugs, particularly hallucinogenic substances, appear to be growing in popularity, with increasing amounts of information available via the Internet to entice potential users. In addition, some newer "designer" psychoactive substances are available for purchase online without adverse legal consequences, therefore adding to their popularity. We describe magnetic resonance imaging (MRI) findings to include selective diffuse toxic injury of the cerebral white matter with sparing of the cortex and most of the deep gray nuclei. To our knowledge, this is the first reported description of cerebral findings on MRI that are likely related to a lethal ingestion of 2C-E.
Improving attendance for cardiovascular risk assessment in Australian general practice: an RCT of a monetary incentive for patients. - BMC family practice
Preventive health care is an important part of general practice however uptake of activities by patients is variable. Monetary incentives for doctors have been used in the UK and Australia to improve rates of screening and immunisation. Few studies have focussed on incentives for patients to attend preventive health care examinations. Our objective was to investigate the use of a monetary incentive to increase patient attendance with their general practitioner for a cardiovascular risk assessment (CVRA).A pragmatic RCT was conducted in two Australian general practices. Participating GPs underwent academic detailing for cardiovascular risk assessment. 301 patients aged 40-74, who did not have cardiovascular disease, were independently randomised to receive a letter inviting them to a no cost cardiovascular risk assessment with their GP, or the same letter plus an offer of a $25 shopping voucher if they attended. An audit of patient medical records was also undertaken and a patient questionnaire administered to a sub sample of participants. Our main outcome measure was attendance for cardiovascular risk assessment.In the RCT, 56/301(18.6%) patients attended for cardiovascular risk assessment, 29/182 (15.9%) in the control group and 27/119 (22.7%) in the intervention group. The estimated difference of 6.8% (95% CI: -2.5% to 16.0%) was not statistically significant, Pâ€‰=â€‰0.15. The audit showed that GPs may underestimate patients' absolute cardiovascular risk and the questionnaire that mailed invitations from GPs for a CVRA may encourage patients to attend.A small monetary incentive does not improve attendance for cardiovascular risk assessment. Further research should be undertaken to determine if there are other incentives that may increase attendance for preventive activities in the general practice setting.ACTRN12608000183381.
Patient-reported outcomes one year after primary hip replacement in a European Collaborative Cohort. - Arthritis care & research
To identify whether patients have symptomatic improvement 12 months following total hip replacement (THR) surgery.The European Collaborative Database of Cost and Practice Patterns of Total Hip Replacement study consists of 1,327 patients receiving primary THR for osteoarthritis (OA) across 20 European orthopedic centers. The primary outcome was the difference in Western Ontario and McMaster Universities OA Index (WOMAC) score between preoperative and 12-month postoperative measurements. To classify whether patients responded to THR at 12 months, we used return to normal, Outcome Measures in Rheumatology Clinical Trials (OMERACT)-OA Research Society International (OARSI) criteria, minimum important difference (MID), and minimum clinically important difference. Exposures were age, sex, obesity, employment, educational attainment, American Society of Anesthesiologists status, and radiographs.On average, there was a large improvement in WOMAC scores 12 months after surgery, but whereas some patients improved, others got worse. The OMERACT-OARSI method classified 85.7% of patients as responders, MID 70.1%, and return to normal 64.1%. In general, each approach classified the same groups of patients as responding to THR. Based on total WOMAC score, patients who were younger, morbidly obese, employed, and better educated were more likely to respond to THR, but the effects were attenuated after adjustment for confounding, with only the effect of education remaining important.The overall average response to THR was good, but approximately 14-36% of patients did not improve, or were worse, 12 months postsurgery. Although the OMERACT-OARSI criteria were originally designed for use in clinical drug trials, they performed well in classifying patient response 12 months post-THR. Further research is required to understand the determinants of patient outcomes following THR.
Maternal separation anxiety in Hispanic and Euro-American mothers. - Psychological reports
Maternal separation anxiety, that is, anxiety experienced by mothers when separated from their infants, was compared for 24 Hispanic and 41 Euro-American mothers. Compared to Euro-American mothers, Hispanic mothers reported more sadness and guilt when separated from their child. However, college education emerged as the sole significant predictor of maternal separation anxiety within the sample.
Trauma reception and resuscitation in Sri Lanka: the Health for the South Capacity-Building project. - Emergency medicine Australasia : EMA
In response to the Indian Ocean tsunami of 2004, the Health for the South project, Capacity-Building programme was implemented in Galle, Sri Lanka. The objectives of the Capacity-Building programme were to develop the emergency and trauma service capability at Teaching Hospital Karapitiya in Galle. Over 15 months, ED clinicians, from the Alfred Hospital and Royal Children's Hospital in Melbourne, provided training in the Emergency Treatment Unit of the main referral hospital for the south of Sri Lanka. This programme, completed in June 2008, significantly improved the hospital's ability to conduct trauma resuscitation, and to attain an increased level of disaster preparedness. In addition, valuable lessons were noted that will guide future initiatives in trauma care training in similar contexts.
Mast cell-nerve interactions in children with functional dyspepsia. - Journal of pediatric gastroenterology and nutrition
Functional dyspepsia in childhood is commonly triggered by food allergen in sensitised individuals. We investigated the topography of eosinophils and mast cells in gastric antral lamina propria, the interaction of mast cell products with mucosal nerve fibres, and changes in gastric antral muscle slow wave activity in children with atopy and non-atopy-related functional dyspepsia.Open label study of gastric mucosal cow's milk challenge in 10 atopic and 6 nonatopic children (ages 2-12 years) investigated consecutively with gastroscopy for functional dyspepsia. Simultaneous surface electrogastrography and milk challenge were undertaken and laser scanning fluorescence microscopy used to examine the association of mast cell tryptase with mucosal nerves in the gastric mucosa before and after challenge.Eosinophils and mast cells within the lamina propria were increased in number in children with atopic functional dyspepsia and degranulated rapidly after cow's milk challenge in the atopic group. For degranulating eosinophils, median = 13.0% (interquartile range = 3.7-31.0) premilk versus 32.0% (12.0-42.0) after milk biopsies (P < 0.05); for degranulating mast cells, 5.35% (2.7-10.9) premilk biopsies versus 18.75% (12.9-22.1) after milk biopsies (P < 0.05). No such differences were seen in nonatopic patients. Mast cells were closely associated with mucosal nerve fibres and released tryptase, which colocalised with proteinase-activated receptors on mucosal nerve fibres. The gastric antral slow wave became abnormal within 2 minutes of antigen challenge in atopics with an increase in dominant frequency instability coefficient (P < 0.005), decrease in 3 cycles per minute myoelectrical activity (P < 0.01), and increase in bradygastria (P < 0.01).Early-onset neuroimmune interactions induced by cow's milk in the gastric mucosa of atopic children are associated with rapid disturbance of gastric myoelectrical activity and dyspeptic symptoms.
Glomerular expression of monocyte chemoattractant protein-1 is predictive of poor renal prognosis in pediatric lupus nephritis. - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Monocyte chemoattractant protein-1 (MCP-1) is upregulated and it recruits and activates inflammatory cells in murine lupus nephritis (LN).Clinical outcomes of children with LN were examined in relation to glomerular expression of MCP-1 and macrophage infiltration, as determined by immunohistochemical staining of renal biopsy sections with MCP-1 and CD68. Sections were analysed using a modified histological score (H-score; maximum of 300) based on both percentage of positively stained cells and intensity of staining.Renal biopsies were examined from 34 children [27 (79%) female] aged 7.7-17.3 (median 13.7) years with 50% ISN/RPS Class IV LN. Renal dysfunction and proteinuria at follow-up of 2.2-15.4 (median 6.5) years were analysed with estimated glomerular filtration rates (eGFR) of 11.2-124.1 (median 93.6) ml/min/1.73 m(2) and urine albumin:creatinine ratios of 1-535 (median 63) mg/mmol. There was a correlation between glomerular expression of MCP-1 and CD68 (r = 0.98, P = 0.04; median modified H-score of 219.7 and 230.8, respectively). Patients with Class III and IV LN had increased glomerular expression of both MCP-1 and PGM1 compared to the other classes (P = 0.01) with Class IV-G LN patients having the most glomerular expression of MCP-1 (median of 227.3) and PGM1 (median of 237.5) and the worst renal prognosis (with proteinuria and reduced eGFR).There is a correlation between glomerular expression of MCP-1 and PGM1 and worsening renal prognosis in paediatric LN. Larger prospective studies of paediatric LN are required to further evaluate MCP-1 and other markers of disease progression.
In the wake of Sri Lanka's tsunami: the health for the south capacity-building project. - Emergency medicine Australasia : EMA
In response to the Indian Ocean tsunami of December 2004, the Health for the South Project was developed for Sri Lanka. The capacity-building component of this project involves the provision of trauma and emergency care training to the staff of Teaching Hospital Karapitiya (THK) in Galle, Sri Lanka. A principal objective of this training for THK is an increased capacity to respond to future disasters in the south of Sri Lanka. Key elements of the capacity-building programme include the on-site emergency care training by teams of Australian emergency physicians and emergency nurses, working alongside the staff of the Emergency Treatment Unit in THK. It is expected that the programme will continue for at least 2 years, during which time a new Emergency and Trauma Centre will be constructed.
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