98 research outputs found
The ageing population is neglected in research studies of traumatic brain injury
No full textIntroduction: the UK population is ageing with increasing number of elderly patients suffering traumatic brain injury (TBI). The purpose of this study was to identify national TBI admission demographics, analyse the temporal evolution of TBI mortality in a single centre and conduct a systematic review of the literature to identify whether there is an age bias amongst researchers studying TBI.
Methods: National demographics for TBI were obtained from Health Episode Statistics. TBI patients admitted from 2000 to 2011 to Cambridge University Hospitals Neurocritical Care Unit (NCCU) were divided into age groups (<60, 60–74, ≥75 years). Temporal evolution of mortality was analysed using a logistic regression method. A systematic literature review was conducted to identify primary TBI research studies. Patient’s ages were extracted and an average mean age was calculated and compared over time.
Results: from 1998, national TBI admissions have increased with the greatest rise in >60-year age group (p < 0.0001). In a tertiary referral critical care unit (n = 1145), the 60–74 year age group (compared to <60) had a significantly lower improvement in mortality over time (OR: 1.15, 95% CI: 1.02–1.31). A literature review revealed a mean age of 32.73 years (SD ± 12.85) for patients recruited to primary TBI studies.
Conclusion: despite increased admissions of elderly patients following TBI and static mortality (single centre, 60–74 year age group) there is little or no evidence of a corresponding increase in the age of patients recruited for TBI studies. In addition to the difficulties this presents in forming evidence-based decisions for the patient with TBI, it may also represent a wider problem for ICU research in an ever-ageing critical care population. More research needs to be conducted to establish the treatment end points for an ageing population
Teleseismic Travel-Time Delays in the Las Vegas Basin
No full textAbstract A temporary broadband seismic array was deployed in the Las Vegas basin (LVB), home to one of the fastest growing communities in the United States, to investigate structure in this deep (∼5 km) sedimentary basin. To constrain basin velocity structure, we measured the differential travel time of teleseismic P waves by waveform cross correlation relative to a station near the basin’s edge. The range of the travel-time delays is significant (up to 0.5 sec), and the pattern of travel-time delays is independent of the back azimuth of the incoming energy, suggesting that the near-surface structure controls the delay times. Assuming the reported basin geometry of Langenheim et al. (2001), we modeled the average delay times at the basin stations to estimate the average P-wave velocity structure within the basin. The average times can be modeled with relatively fast P-wave velocities (4:5 km=sec) in the deepest part of the basin (below 2 km), which is in agreement with the P-wave velocities of the deep part of the basin from recent seismic refraction profiling (Snelson et al., 2004) and low velocities (1:5 km=sec) in the shallow basin (200 m). We also performed computations based on the fast marching method approach to solve the forwar
A renal clinician's guide to the gut microbiota
No full textIt is increasingly recognized that the gut microbiota plays a role in the progression of chronic diseases and that diet may confer health benefits by altering the gut microbiota composition. This is of particular relevance for chronic kidney disease (CKD), as the gut is a source of uremic retention solutes, which accumulate as a result of impaired kidney function and can exert nephrotoxic and other harmful effects. Kidney dysfunction is also associated with changes in the composition of the gut microbiota and the gastrointestinal tract. Diet modulates the gut microbiota, and there is much interest in the use of prebiotics, probiotics, and synbiotics as dietary therapies in CKD, as well as dietary patterns that beneficially alter the microbiota. This review provides an overview of the gut microbiota and its measurement, its relevance in the context of CKD, and the current state of knowledge regarding dietary manipulation of the microbiota
An integrated lithospheric study of the Rocky Mountain region along the Deep Probe seismic profile
No full textAbstract not availabl
Investigating crustal structure in western Washington and in the Rocky Mountains: Implications for seismic hazards and crustal growth
No full textThis dissertation consists of two seismic studies, one in western Washington State and one in the Rocky Mountains. The study in western Washington State is one component of the SHIPS (Seismic Hazards Investigations of Puget Sound) experiments, a continuing effort to define Cenozoic basin and fault geometry beneath the densely populated Puget Lowland. In September 1999, the U.S. Geological Survey and a number of university collaborators collected the “Dry” SHIPS seismic profile across the Seattle basin of western Washington State. The objectives of the “Dry” SHIPS study were to define the geometry of the Seattle basin in an E-W direction and to determine the structure of the eastern and western boundaries of the basin. In addition, the experiment was designed to test the hypothesis that N-S trending faults lie beneath Puget Sound or the adjacent Lowland. One of these faults may form the eastern boundary of the Siletz terrane. The “Dry” SHIPS data are characterized by travel time advances associated with the Siletz terrane to the west and the Cascades to the east and by delays of as much as 2 s in the Seattle basin. The study in the Rocky Mountains is one component of the Continental Dynamics-Rocky Mountains Project (CD-RoM \u2799), a collaborative interdisciplinary study involving 14 American universities and the University of Karlsruhe, Germany that focuses on Precambrian features and their effects on Phanerozoic deformation. One of the major field efforts in the CD-RoM project took place during August, 1999. The University of Texas at El Paso and the University of Karlsruhe, with the assistance of several other institutions, collected data along a ∼950 km long seismic refraction/wide-angle reflection profile extending from Fort Sumner, New Mexico to the Gas Hills, Wyoming. Station spacing was nominally 800 m using ∼600 instruments during two deployments. Eleven shots were fired ranging in size from 167.2–4540.9 kg and were nominally spaced at ∼100 km intervals along the profile. The profile crosses major structural features of the continent including the Jemez lineament, the Colorado mineral belt, and the Cheyenne belt (a prominent Proterozoic suture). (Abstract shortened by UMI.
MAPPING THE STATE OF STRESS FROM THE PLATE- TO RESERVOIR-SCALE: IMPLICATIONS AND CHALLENGES
No full text
Analgesia of Patients with Multiple Rib Fractures in Critical Care:A Survey of Healthcare Professionals in the UK
No full textIntroduction: Good analgesia has been shown to reduce the risk of pneumonia, chronic pain, and mortality in patients with multiple rib fractures (MRFs). This survey explores the current analgesic practice in the UK, protocol use, barriers to provision, and physician preferences.Materials and methods: A web-based survey was distributed nationally to an enriched cohort of clinicians working in UK trauma units with an interest in MRF management.Results: Seventy-nine healthcare professionals responded. A third (31.4%) reported that their department had a rib fracture pain protocol, 52.9% did not, and 15.7% were unsure. Significantly more respondents reported adequate pain control when a hospital protocol was present compared to when not (χ2, p < 0.01). Inadequate analgesia, a poor cough, and inability to breathe deeply were the commonest complications reported by 81.4, 78.6, and 65.7%, respectively. Patient-controlled analgesia (PCA) was the most commonly used form of analgesia (38.6%) followed by thoracic epidural (TEA) (30.0%) and continuous opioid infusion (18.6%). However, TEA was the preferred method of analgesia among respondents (37.1%) followed by serratus block (21.4%), paravertebral block (17.1%), and PCA (14.3%).Discussion: There is considerable variation among physicians in their current use of analgesic modalities, with opiate-based methods predominating despite a physician preference for regional techniques. Thoracic epidurals are preferred by physicians but of limited use as a result of contraindications, time pressures, and staff skill mix. Pain control is reported to be better handled when protocols are present. Further research focusing on currently utilized regional techniques is required in order to produce a validated standardized national protocol that is informed by the current practice, the evidence base, and limitations to service provision.Key messages: There is considerable variation among physicians in their current use of analgesic modalities. Opiate-based methods dominate for thoracic trauma despite a physician preference for regional techniques, which can be challenging in this cohort due to contraindications, staff skill mix, and time pressures. Inadequate analgesia is common but is better managed when pain management protocols are available.How to cite this article: Beard L, Holt B, Snelson C, Parcha C, Smith FG, Veenith T. Analgesia of Patients with Multiple Rib Fractures in Critical Care: A Survey of Healthcare Professionals in the UK. Indian J Crit Care Med 2020;24(3):184-189.</p
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