42 research outputs found
Recommended from our members
Management of Liver Injuries: The Panamerican Trauma Society 2018 Consensus Guidelines
No full textRecommended from our members
Discordance in Appendicitis Grading and the Association with Outcomes: A Post-Hoc Analysis of an EAST Multicenter Study
No full textThe American Association for the Surgery of Trauma (AAST) appendicitis severity grading criteria use independent subscales for radiologists (Rad), surgeons (Surg), and pathologists (Path). We reviewed the EAST Multicenter Study of the Treatment of Appendicitis in America: Acute, Perforated, and Gangrenous (MUSTANG) database to determine rates of discordance and clinical consequences of inaccuracy.
A confusion matrix was constructed for pairs among Rad, Surg, and Path. Accuracy was reported using chronologically latest diagnosis as gold standard. "Concordance" (C) was achieved when both agreed on the severity grade and "Discordance"(D) when they disagreed. A composite endpoint("COMP"= 30-d incidence of surgical site infection, abscess, wound complication, Clavien-Dindo complication, secondary intervention, ED[Emergency Department] visit, hospital readmission, and mortality) was compared between C versus D groups via χ
test with Bonferroni correction to define statistical significance(P = 0.05/9 = 0.005).
For each pair and diagnosis, subjects were categorized as C or D and compared for the incidence of COMP. Incidence of COMP for Surg and/or Path in C versus D: 16% versus. 26% (p = 0.006, NS by Bonferroni) for acute (A), 39% versus 33% (p = 0.39) for gangrenous (G), and 48% versus 37% (p = 0.035, NS by Bonferroni) for perforated (P). For Rad and/or Path in C versus. D: 17% versus 42% (p < 0.001) for A, 27% versus 31% (p = 0.95) for G, and 56% versus 48% (p = 0.48) for P. For C versus D: 17% versus 40% (p < 0.001) for A, 36% versus 26% (p = 0.43) for G, and 51% versus 39% (p = 0.29) for P.
In appendicitis treated by appendectomy, surgeons are most accurate at diagnosing acute appendicitis and least accurate at diagnosing gangrenous. Radiologists are less accurate for all categories. When the surgeon is wrong, clinical outcomes are not significantly worse. However, when the radiologist is wrong about acute appendicitis, patients have worse clinical outcomes
Recommended from our members
Acute Care Surgery in the Times of COVID-19 Pandemic: Our Experience at a Large Safety Net Hospital
No full textRecommended from our members
Teduglutide for the treatment of low-output enterocutaneous fistula – A pilot randomized controlled study
No full textPhysical activity in preschoolers
No full textSummary:
The health benefits of physical activity are clearly established. Physical activity is also thought to be
beneficial for children, although morbidity and mortality are established only later in life. One of the
most important benefits of physical activity is maintaining a healthy weight and it thus contributes to
prevent the development of obesity. However, physical activity is also thought to be related to both
aerobic fitness, a strong predictor of cardiovascular disease, and to different motor skills. As there is a
gap on research investigating those relationships in preschool children, cross-sectional and longitudinal
analyses were done to examine children’s physical activity behaviours and their correlates. In addition,
it was analysed if physical activity is associated with socio-cultural characteristics. Finally, the
effects of a physical activity intervention on adiposity and fitness were evaluated, especially in preschoolers
of migrant or low educated families.
This research is based on the Ballabeina Study, a multidimensional lifestyle intervention study aimed
at reducing BMI and increasing fitness in preschool children. The cluster-randomized trial was conducted
in German and French speaking regions in Switzerland with a high prevalence of migrant
populations. The intervention targeted four lifestyle behaviours during one school year: an increase in
physical activity, a balanced nutrition, sufficient sleep and a reduction in media use.
In the cross-sectional analyses, substantial differences in physical activity and in adiposity were found
between the German and French speaking part of Switzerland. On the other hand, parental sociocultural
characteristics (migrant status or educational level) had less impact on physical activity and
adiposity. The cross-sectional analyses also revealed a relationship between physical and body fat,
aerobic fitness and motor skills. The cross-sectional analyses also revealed a relationship between
physical and body fat, aerobic fitness and motor skills. The longitudinal analyses also showed an association
of baseline physical activity with prospective changes in aerobic fitness and in motor skills,
but not in body fat. These findings contribute to the current understanding of the relationships of physical
activity with fitness and adiposity and strengthen the benefits of being active from early childhood.
The intervention led to improvements in aerobic fitness, but not in BMI, the two primary outcomes. It
also led to improvements in body fat and agility. In view of the substantial decrease in children’s fitness
and the increase in obesity over the last 20 years, the improvements in aerobic fitness and in
body fat in favor of the intervention group are most relevant. Moreover, children of migrant or low educated
parents benefitted equally from the intervention compared to their respective counterparts.
These results are encouraging, as these children have been less accessible in previous interventions.
Thus, using strategies to target a multicultural population might represent a promising approach to
reduce body fat and increase fitness in these high-risk groups. In conclusion, Ballabeina is an intensive
intervention, but offers an effective school-based intervention program to reduce body fat and
increase fitness in preschool children.
Physical activity in preschoolers. ---------- Zusammenfassung:
Der gesundheitliche Nutzen von körperlicher Aktivität ist unbestritten. Dies gilt auch für Kinder, auch
wenn sich die positiven Effekte meist erst im späteren Leben zeigen. Körperliche Aktivität ist wichtig,
um ein gesundes Körpergewicht zu halten und dadurch einen Beitrag zur Übergewichtsprävention zu
leisten. Körperliche Aktivität scheint aber auch mit aerober Ausdauer, einem wichtigen Einflusswert für
kardiovaskuläre Krankheiten, und mit motorischen Fertigkeiten assoziiert zu sein. Da diese Zusammenhänge
im Vorschulalter noch nicht ausreichend untersucht worden sind, haben wir die körperliche
Aktivität von Vorschulkindern und dessen Wechselbeziehungen mit Adipositas und Fitness genauer
unter die Lupe genommen. Zudem haben wir untersucht, inwiefern körperliche Aktivität und Adipositas
mit sozio-kulturellen Faktoren assoziiert sind. Schlussendlich haben wir auch die Effekte einer schulbasierten
Intervention in Bezug auf Adipositas und Fitness evaluiert, speziell bei Kindern aus Familien
mit Migrationshintergrund oder tiefem Bildungsniveau.
Die Grundlage dieser Forschungsarbeit bildet die Ballabeina Studie, eine in der Schweiz durchgeführte
Interventionsstudie bei Kindergartenkindern. Diese cluster-randomisierte Studie wurde in Regionen
mit einem hohen Ausländeranteil in der Deutschschweiz sowie in der Romandie durchgeführt. Ziel der
Studie war, den BMI zu senken und die aerobe Fitness zu verbessern. Die vier wichtigsten Elemente
der Intervention waren: eine Erhöhung der täglichen Aktivität, eine ausgewogene Ernährung, genügend
Schlaf und eine Reduktion des Medienkonsums.
Die Querschnittuntersuchungen zeigten, dass körperliche Aktivität mit Körperfett, Ausdauer und motorischen
Fertigkeiten assoziiert war. Dabei stellten wir bedeutende Unterschiede in Bezug auf körperliche
Aktivität und Adipositas zwischen der Deutschen und Französischen Schweiz fest. Auf der anderen
Seite schienen elterliche Merkmale wie Migrationshintergrund oder Bildungsniveau weniger Einfluss
auf diese Parameter zu haben. In den Längsschnittuntersuchungen konnten wir einen Zusammenhang
zwischen körperlicher Aktivität und Verbesserungen in der Fitness aufzeigen, jedoch nicht
beim Körperfett. Diese Erkenntnisse entsprechen früher gefundenen Zusammenhänge von körperlicher
Aktivität, Adipositas und Fitness und unterstreichen somit die Wichtigkeit, bereits im frühen Kindesalter
körperlich aktiv zu sein.
Die Intervention führte zu einer Verbesserung der aeroben Fitness, nicht aber zu einer Reduktion des
BMI’s. Zusätzlich erzielten wir eine Abnahme des Körperfetts und eine Verbesserung bei den motorischen
Fertigkeiten. Da die Fitness bei Kindern über die letzten 20 Jahren stetig abgenommen und das
Übergewicht stetig zugenommen hat, sind diese positiven Resultate besonders wichtig. Darüber hinaus
konnten Kinder aus Familien mit Migrationshintergrund oder tiefem Bildungsniveau ebenso viel
von der Intervention profitieren wie alle anderen Kindern. Dies ist besonders betonenswert, da diese
Kinder in früheren Interventionen weniger erreicht werden konnten. Der Ansatz, eine multikulturelle
Population einzubeziehen, stellt einen vielversprechenden Lösungsansatz dar, um Übergewicht und
Fitness auch bei benachteiligten Kindern zu verbessern. Schlussfolgernd kann gesagt werden, dass
Ballabeina ein intensives, aber erfolgreiches schulbasiertes Interventionsprogramm darstellt, mit welchem
Körperfett und Fitness von Kindergartenkindern verbessert werden kann
Variable Association of Ridesharing Application Implementation with Total and Alcohol-Related Driving Crashes in Florida
No full textHidden Costs of Hospitalization After Firearm Injury
No full textTo compare the risk factors and costs associated with readmission after firearm injury nationally, including different hospitals.
No national studies capture readmission to different hospitals after firearm injury.
The 2013 to 2014 Nationwide Readmissions Database was queried for patients admitted after firearm injury. Logistic regression identified risk factors for 30-day same and different hospital readmission. Cost was calculated. Survey weights were used for national estimates.
There were 45,462 patients admitted for firearm injury during the study period. The readmission rate was 7.6%, and among those, 16.8% were readmitted to a different hospital. Admission cost was 131 million. Sixty-four per cent of those injured by firearms were publicly insured or uninsured. Readmission predictors included: length of stay >7 days [odds ratio (OR) 1.43, P 15 (OR 1.41, P < 0.01), and requiring an operation (OR 1.40, P < 0.01). Private insurance was a predictor against readmission (OR 0.81, P < 0.01). Predictors of readmission to a different hospital were unique and included: initial admission to a for-profit hospital (OR 1.52, P < 0.01) and median household income ≥791 million yearly, with the largest fraction paid by the public. This has implications for policy, benchmarking, quality, and resource allocation
Recommended from our members
Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention
No full textThe Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention.
We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes.
630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention.
Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock
Recommended from our members
Association Between Child Access Prevention and State Firearm Laws With Pediatric Firearm-Related Deaths
No full textWe aim to study the association between state child access prevention (CAP) and overall firearm laws with pediatric firearm-related mortality.
The Centers for Disease Control and Prevention Web-based Injury Statistics Query and Reporting System was queried for pediatric (aged < 18 y) all-intent (accidental, suicide, and homicide) firearm-related crude death rates (CDRs) among the 50 states from 1999 to 2019. States were into three groups: Always CAP (throughout the 20-year period), Never CAP, and New CAP (enacted CAP during study period). We used the Giffords Law Center Annual Gun Law Scorecard (A, B, C, D, F) to group states into strict (A, B) and lenient (C, D, F) firearm laws. A scatter plot was constructed to display state CDR based on CAP laws by year. The top 10 states by CDR per year were tabulated based on CAP law status. Wilcoxon rank-sum was used to compare CDR between strict and lenient scorecard states in 2019.
There were 12 Always CAP, 21 Never CAP, and 17 New CAP states from 1999 to 2019. No states changed from CAP laws to no CAP laws. Never CAP and New CAP states dominated the high outliers in CDR compared to Always CAP. The top 10 states with the highest CDR per year were most commonly Never CAP. Strict firearm laws states had lower median CDR in 2019 than lenient states (0.79 [0-1.67] versus 2.59 [1.66-3.53], P = 0.007).
Stricter overall gun laws are associated with three-fold lower all-intent pediatric firearm-related deaths. For 2 decades, the 10 states with the highest CDR were almost universally those without CAP laws. Our findings support the RAND Gun Policy in America initiative's claims on the importance of CAP laws in reducing suicide, unintentional deaths, and violent crime among children, but more research is needed.
[Display omitted
