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Comparative Clinical Outcomes of Trauma Transport: Emergency Medical Services vs. Police Transport, A Systematic Review and Meta-Analysis.
No full textBACKGROUND: In many urban settings, police transport (PT) is increasingly used as an alternative to traditional Emergency Medical Services (EMS). PT follows a scoop and run strategy, aiming to minimize prehospital interventions to rapidly deliver patients to the nearest trauma center. Conversely, EMS teams typically provide stabilizing medical care on site before transport.
OBJECTIVES: This study aimed to compare outcomes, specifically rates of surgical intervention and mortality, for patients transported by police vs. EMS.
METHODS: PubMed, Scopus, and Cochrane databases were searched from inception to January 1, 2025 for studies meeting inclusion criteria. A random-effects meta-analysis was performed to assess the primary outcome of mortality for PT vs. EMS, and the secondary outcome of surgical intervention in penetrating injuries. Study quality was evaluated using the Newcastle-Ottawa Scale; heterogeneity was assessed with Q-statistics and I² values.
RESULTS: Ten studies met criteria, totaling 112,570 patients: 100,716 (89%) transported via EMS and 11,854 (11%) by police. All-cause mortality was 13% (12,742/100,716) for EMS patients vs. 25% (2922/11,854) for PT patients. Police transport was associated with a 1.5-fold higher mortality rate (odds ratio 1.50, 95% confidence interval 1.34-1.69, p \u3c 0.001). No statistically significant difference was found in surgical intervention rates for penetrating injuries (odds ratio 1.19, 95% confidence interval 0.98-1.45, p = 0.082). Heterogeneity was significant for both mortality (I
CONCLUSION: Police transport was associated with higher odds of all-cause mortality compared with EMS, with no difference in surgical intervention rates. Prospective, methodologically robust studies are needed to guide future practice
Ethnic disparities in stroke outcomes within a large tele-stroke network: a retrospective cohort study
No full textRECIST Responses to Radiation in Retroperitoneal Soft Tissue Sarcoma: When and How Often Do They Occur?
No full textINTRODUCTION: Retroperitoneal sarcoma (RPS) is a rare mesenchymal tumor where complete resection is often difficult due to size and invasion of adjacent organs. This analysis aimed to explore the association between neoadjuvant radiation and downsizing of RPS prior to surgical resection.
METHODS: Retrospective review of adult, nonmetastatic patients undergoing curative-intent treatment at a single National Cancer Institute (NCI)-designated center between January 1, 2000, and December 31, 2020, was conducted. Patients with incomplete records were excluded. Imaging obtained preradiation/postradiation was reviewed by study radiologists to quantify the following: (1) absolute and relative change in tumor size and (2) RECIST response prior to resection. Subgroup analyses were performed by RECIST response.
RESULTS: The cohort (n = 22) was 60% female, with a mean age of diagnosis at 60.8 years. Liposarcoma (n = 13, 59.1%) and leiomyosarcoma (N = 6, 27.3%) were most common. Intensity-modulated radiation therapy was most frequently utilized (median dose 5000 cGy). Among tumors that decreased in size (N = 14, 63.6%), the mean relative decrease was 7.1%. There was one partial RECIST response observed, no change in organ abutment posttreatment, and no alterations to planned multivisceral resection. In contrast, 8 tumors (36.4%) remained unchanged or increased in size (mean relative increase 21.9%). By RECIST criteria, the majority exhibited stable disease (N = 17, 77.3%). Tumors demonstrating progressive disease (N = 4, 18.2%) exhibited a mean relative size increase of 38%.
CONCLUSIONS: Favorable RECIST responses with neoadjuvant radiation are rare for RPS, with a significant proportion increasing in size on therapy. These trends caution use of neoadjuvant radiation for RPS for the purpose of downsizing or altering the operative plan
Research Communication: Prevalence of Asymptomatic Premalignant Oesophageal Lesions in Patients With Fanconi Anaemia.
No full textFanconi anaemia (FA), a rare genetic disorder of DNA repair, predisposes to squamous cell carcinomas of head, neck and oesophagus. We assessed the value of screening esophagogastroduodenoscopy (EGD) in 20 asymptomatic adults (median age 23.5, 65% female) with FA, compared to age-and sex-matched non-FA patients enrolled at a 3:1 ratio. Among 11 FA patients with abnormal oesophageal mucosa, 15% had low-grade dysplasia, nodular high-grade dysplasia or squamous carcinoma in situ, 10% had non-dysplastic Barrett\u27s oesophagus and 30% had columnar epithelium without goblet cells, compared to none in the controls (p \u3c 0.001). Our findings support routine EGD screening of asymptomatic FA patients
International expert consensus on metric-based characterization of robot-assisted total laparoscopic hysterectomy (RATLH).
No full textSTUDY OBJECTIVE: The study aimed to develop procedural performance metrics for robot-assisted total laparoscopic hysterectomy (RATLH) and to establish face and content validity through a Delphi consensus meeting.
DESIGN: A core metrics team comprising three highly experienced gynaecologists in RATLH and a behavioural scientist developed the metrics.
SETTING: Two modified Delphi consensus meetings took place as a face-to-face and online.
PATIENTS: The final metrics were discussed by 28 experts in RATLH from 13 different countries.
INTERVENTIONS: The core metrics team performed a detailed task deconstruction of the RATLH procedure. To ensure a comprehensive representation of technique and clinical practice across both the US and Europe, a consensus meeting was also conducted with European clinicians.
MEASUREMENTS AND MAIN RESULTS: Initially, performance metrics consisting of 20 Phases, 110 steps, 119 errors, and 54 critical errors were identified to characterize the RATLH procedure. During the Delphi meetings, these were discussed and modified. The outcome of the meeting was consensus on 20 Phases of the procedure, with 116 Steps (8 added, 2 deleted), 134 Errors (19 were added and 4 were deleted), and 56 Critical Errors (2 added). A total number of 41 general edits were performed with 100% consensus.
CONCLUSIONS: This study presents the first comprehensive metric-based characterization of a standardized approach to RATLH, validated by expert consensus using a structured methodology that comprises operative procedure Steps, Errors, and Critical Errors. The next phase will evaluate reliability and the construct validity of the agreed metrics
Otitis Media With Effusion in Patients With Cleft Palate.
No full textThis article reviews otitis media with effusion (OME) in children with cleft palate (CP), the current evidence and recommendations regarding management of OME in cleft palate with a focus on interdisciplinary communication, and the impact this condition has on patients and caregivers. OME is nearly ubiquitous in children with CP due to the anatomical variation of the palatal musculature and resultant Eustachian tube dysfunction. If untreated, OME can negatively affect hearing, speech development, cognitive development, and social integration. Patients with CP have the potential to be negatively impacted by the otologic, cognitive, and psychosocial consequences of untreated chronic OME if not actively managed for this condition. Multidisciplinary management, appropriate intervention, shared decision-making, and appropriate surveillance optimize the wellbeing, cognitive development, and social progression of CP patients with OME
Reproductive health knowledge and preferences in adolescent rheumatology patients: a convergent mixed methods study.
No full textBACKGROUND: Sexual and reproductive health (SRH) guidelines exist for adults with rheumatic diseases (RDs), but not for their adolescent counterparts. SRH discussions are regarded as important areas of discussion by pediatric rheumatology providers. However, adolescents with RDs have unique needs that are not well elucidated. The purpose of this study was to explore SRH knowledge and information sources among female adolescents with systemic lupus erythematosus (SLE), undifferentiated connective tissue disease (UCTD), mixed connective tissue disease (MCTD), or an overlap disease given their increased risk for SRH-related adverse outcomes.
METHODS: This convergent mixed methods study sought to survey and interview participants from a healthcare system in central Pennsylvania. Eligibility included: (1) being 15-21 years old, (2) having SLE, UCTD, MCTD, or an overlap disease, (3) receiving care from a pediatric rheumatologist, (4) being assigned female at birth, and (5) having access to a computer or phone. Quantitatively, descriptive statistics and the Mann-Whitney U test were used for data presentation and assessment. Qualitatively, a semi-structured interview guide was developed, and thematic analysis was conducted. Quantitative and qualitative findings were assessed for convergence and presented using a joint display.
RESULTS: Sixteen participants completed the survey, and ten also completed an individual interview. Limited understanding of SRH concepts, the impact of pregnancy, and medication safety were noted in both the survey and interview results. Participants with teratogenic medication use had lower general (2.4 vs. 2.7) and lupus-specific (3.3 vs. 4.4) SRH knowledge scores compared to their counterparts with no teratogenic medication use. Qualitatively, participants voiced concern about the interplay between their disease and pregnancy, reported differences in their information sources, and discussed trustworthy sources of SRH information.
CONCLUSIONS: This study identified gaps in SRH knowledge among female adolescents with susceptible RDs. Many participants are receiving SRH information from non-health care sources, but desire to have discussions on SRH with their provider. These findings signal a need for additional research in this area with expansion to other RDs and males. Clinicians and researchers can work alongside this population to develop tools and inform SRH guidelines to address patient concerns and improve overall outcomes
The Role of Previous History of Muscle Wasting in Burn Outcomes-A Burn Care Quality Platform Study.
No full textBACKGROUND: Burn patients can suffer prolonged hospital stays, infections, and wound breakdown. Given the complexity of burns, it is often difficult to determine which underlying factors contribute to complications. The Burn Care Quality Platform (BCQP) is the largest database of burn patients globally available, and it accounts for underlying or coinciding disease conditions present in burn patients. Muscle wasting conditions, such as sarcopenia, cachexia, and protein malnutrition, are suspected of causing worse outcomes. Prior analysis of BCQP data (2000-2017) demonstrated that patients with muscle wasting had prolonged hospitalization and adverse outcomes.
METHODS: Building on our previous work, we extended logistic regression analysis to BCPQ data through 2022 to assess whether reporting and outcomes had changed.
RESULTS: Updated BCQP data demonstrated a statistically significant increase in mortality in cachexia vs. non-muscle wasting patients (Odds Ratio [OR]: 2.2 [95% Confidence Interval (CI): 1.3-3.7],
CONCLUSIONS: Burn care could be augmented by better diagnosis of underlying conditions that predispose to muscle wasting
