Abstract Background Emergency Medical Services (EMS) has started to embrace the early use of therapeutic hypothermia as standard treatment to improve neurological recovery in out-of hospital cardiac ...arrest (OHCA) survivors. Objective We conducted a systematic review to provide an overall description of the current literature on the use of therapeutic hypothermia in OHCA and to identify possible gaps in the literature. Methods Comprehensive searches of MEDLINE, PubMed, CINAHL, and ISI Web of Science from 1950 to March 2009, and EMBASE from 1988 to March 2009 were performed. Bibliographies of selected articles were hand searched. Two reviewers independently selected studies on the basis of three inclusion criteria. Two additional independent reviewers assessed selected studies for quality. Results Of more than 800 screened citations, a total of 11 published studies were included in the systematic review. Three studies were conducted in the United States, three in Finland, and one each in Australia, France, Germany, Austria, and Norway. Four of the studies were pilot clinical trials that provided prehospital mild therapeutic hypothermia during active cardiopulmonary resuscitation. The remaining seven studies performed cooling after return of spontaneous circulation. Significant differences in research methodology and outcome measures were noted. Eight studies scored poor for quality. Conclusions The use of mild therapeutic hypothermia is gaining acceptance within the EMS community. It seems that hypothermia can be efficiently induced in the prehospital environment. There is a need for more research in this area to understand the effectiveness and timing of early therapeutic hypothermia in the prehospital environment.
Handgrip strength is an important test to evaluate physical fitness and nutritional status. The main objective of this research is to prepare a reference standard applicable to the Spanish population ...of both sexes between 6 and 18 years old. At the same time, to extend our knowledge of normal variation of this characteristic with age, gender, size and body composition.
The sample consisted of 2125 subjects between the 6 and 18 years (1176 boys and 949 girls). The handgrip strength of both hands was taken with a digital adjustable dynamometer. Weight, height, forearm circumference and skin fold thickness were measured mass index, fat free. Body mass, percentage of fat and total, muscle and fat forearm areas were estimated. Ontogenetic and sexual variability of dynamometric force was analysed and a table was produced with the mean, standard deviation and percentile distribution, by hand, age and gender. Multiple correlation analysis was applied to establish the relationship between handgrip dynamometric force, body mass index and body composition variables.
Handgrip strength increases with age and a significant sexual dimorphism from the age of 12 years is observed. Growth charts with normal values obtained in healthy Spanish children and teenagers could be used as a reference pattern. The correlation between hand static force and fat free mass or arm muscle area is stronger than with direct size variables or body mass index.
Abstract Introduction We assessed heart rate as a surrogate measure of psychological response to determine whether high-fidelity simulation reproduces a stressful atmosphere for air medical ...providers. Methods A prospective simulation study of air-medical providers at a level 1 trauma center randomized to adult or pediatric trauma scenarios in an ambulance. Continuous closed circuit video and wireless heart rate monitoring was conducted from the time of initial patient simulator contact to completion of packaging for transport. Results The 19 air-medical providers had the following characteristics: younger than 40 years of age 90%; male 63%; registered nurses (RN) 37%, emergency medical technician–paramedics (EMT-P) 53%; mean time in practice 9 years; mean resting heart rate 71 beats per minute (bpm). Heart rate increased during study intake through start of the scenario, plateaued, and then increased abruptly on scenario completion. “Anticipatory” heart rate (during study intake) and peak heart rate were higher in less versus more experienced providers 106 bpm versus 92 bpm and 132 versus 123 bpm. Conclusion Providers demonstrated increased heart rates when exposed to high-fidelity simulation of critically injured trauma patients. Future studies should determine whether simulation continues to provoke this physiological response, and whether this response occurs during live operations.
Objectives This study sought to compare the in-hospital prognostic values of the original and updated GRACE (Global Registry of Acute Coronary Events) risk score (RS) and the AR-G (ACTION Acute ...Coronary Treatment and Intervention Outcomes Network Registry and the GWTG Get With the Guidelines Database) RS in acute coronary syndromes (ACS). To evaluate the utility of recalculating risk after percutaneous coronary intervention (PCI) with newer RS models (NCDR National Cardiovascular Data Registry and EHS EuroHeart Score RS). Background Defined in 2003, GRACE is among the most popular systems of risk stratification in ACS. An updated version of GRACE has since appeared and new RS have been developed, aiming to improve risk prediction. Methods From 2004 to 2010, 4,497 consecutive patients admitted to a single center in Spain with an ACS were included (32.1% ST-segment elevation myocardial infarction, 19.2% unstable angina). Discrimination (C-statistic) and calibration (Hosmer-Lemeshow HL) indexes were used to assess performance of each RS. A comparative analysis of RS designed to predict post-PCI mortality NCDR and EHS RS versus the GRACE and AR-G RS was performed in a subgroup of 1,113 consecutive patients included in the study. Results There were 265 in-hospital deaths (5.9%). Original and updated GRACE RS and the AR-G RS all demonstrated good discrimination for in-hospital death (C-statistics: 0.91, 0.90 and 0.90, respectively) with optimal calibration (HL p: 0.42, 0.50, and 0.47, respectively) in all spectra of ACS, according to different managements (PCI vs. conservative) and without significant differences between the 3 different RS. In patients undergoing PCI, EHS and NCDR RS (C-statistic = 0.80 and 0.84, respectively) were not superior to GRACE RS (C-statistic = 0.91), albeit in the subgroup of patients undergoing PCI who were categorized as high risk using the GRACE RS, both EHS and NCDR have contributed to decrease the false positive rate generated by using the GRACE RS. Conclusions Despite having been developed over 8 years ago, the GRACE RS still maintains its excellent performance for predicting in-hospital risk of death among ACS patients.
Abstract Background Crashes are a small but regular feature of elite motorcycle racing. These crashes provide a novel opportunity to benchmark and analyze motorcycle crash mechanics, crash types and ...associated injuries at high speeds in a cohort of riders who are well protected and in a controlled environment. Purpose To benchmark the prevalence of injuries, categorize crash subtypes, and determine associated injury patterns. Methods IRB approved, prospective observational cohort study of Moto GP riders for one racing season in 3 venues. Accident type was determined by race-marshal report and visual analysis of race footage for each crash. Accident types were defined as lowside (falling toward the inside of the turn), highside (falling over and toward the outside of the turn) and topside (going over the handlebars of the motorcycle). Specific injuries and hospital admission data were collected using a standardized data collection form. Basic descriptive statistics were performed on all categorical variables. We used the exact binomial test examine the association between accident type and retirement from race, transport to medical building, transport to hospital and injuries sustained. Results Crash prevalence was 9.7 per hundred rider hours. There were 78 crashes. 58 lowsides; 13 highsides; 2 topsides and 5 indeterminate. In the lowside group (n = 58), 19 (95% CI: 0.21–0.46) riders retired, 0 required emergent transportation to the track facility or to the hospital, and 1 (95% CI: <0.1–0.9) significant injury was noted. In the highside group (n = 13), 10 (95% CI: 0.46–0.95) retired; 9 (95% CI: 0.39–0.91) were transported to the track medical facility, and 3 (95% CI: 0.05–0.54) were admitted to the hospital. In the highside group there were 7 (95% CI: 0.25–0.81) significant injuries. In the topside group, both riders were retired with one hospital admission. Lowside crashes had a lower rate of retirement from race, emergent transport, and significant injuries compared to highside crashes. Conclusions Lowside crashes are lower risk than highside crashes. Most highside crashes are caused by oversteering to prevent an impending lowside crash. Strategies to reduce oversteering to prevent a lowside crash may reduce highside crashes, enhance the safety for riders in Moto GP racing, and be applicable to recreational motorcycle riding.
Objetivo: Evaluar si los Ensayos Clínicos Aleatorizados (ECAS) realizados por enfermeras en los últimos siete años, cumplen con la rigurosidad metodológica establecida por los criterios de la ...Declaración CONSORT.
Métodos: Revisión integrativa de la literatura de revistas de enfermería, se analizaron 66 ECAS realizados por enfermeras y publicados en 11 revistas indizadas en bases de datos reconocidas, en cuyo título, palabras clave o diseño se reconocieran como un ensayo clínico aleatorio. Se realizó un instrumento de 48 ítems para evaluar las características de los 66 ECAS publicados. Dicho instrumento está dividido en dos segmentos: el primero evalúa información general de los artículos y el segundo incluye las características de la Declaración CONSORT.
Resultados: El 57.6% de los ECAS utilizaron grupo control equivalente, 87.9% utilizó muestreo aleatorio, 28.8% enmascaramiento, 54.5% presentaron diagrama de flujo, 83% realizaron aleatorización, 57.6% describen las intervenciones empleadas a los grupos de estudio.
Conclusiones: De forma general, los ECAS publicados por enfermería en los últimos siete años no cumplen con los criterios de la Declaración CONSORT. Estos hallazgos representan un área de oportunidad para que editores de revistas de enfermería soliciten a los autores mayor apego a la rigurosidad metodológica en sus artículos de acuerdo a los criterios de la Declaración CONSORT.
Porous 3-D scaffolds consisting of gelatine and Si-doped hydroxyapatite were fabricated at room temperature by rapid prototyping. Microscopic characterization revealed a highly homogeneous structure, ...showing the pre-designed porosity (macroporosity) and a lesser in-rod porosity (microporosity). The mechanical properties of such scaffolds are close to those of trabecular bone of the same density. The biological behavior of these hybrid scaffolds is greater than that of pure ceramic scaffolds without gelatine, increasing pre-osteoblastic MC3T3-E1 cell differentiation (matrix mineralization and gene expression). Since the fabrication process of these structures was carried out at mild conditions, an antibiotic (vancomycin) was incorporated in the slurry before the extrusion of the structures. The release profile of this antibiotic was measured in phosphate-buffered saline solution by high-performance liquid chromatography and was adjusted to a first-order release kinetics. Vancomycin released from the material was also shown to inhibit bacterial growth in vitro. The implications of these results for bone tissue engineering applications are discussed.
The United States is currently experiencing a public health crisis of opioid overdoses. To determine where resources may be most needed, many public health officials utilize naloxone administration ...by EMS as an easily-measured surrogate marker for opioid overdoses in a community. Our objective was to evaluate whether naloxone administration by EMS accurately represents EMS calls for opioid overdose. We hypothesize that naloxone administration underestimates opioid overdose.
We conducted a chart review of suspected overdose patients and any patients administered naloxone in Wake County, North Carolina, from January 2013 to December 2015. Patient care report narratives and other relevant data were extracted from electronic patient care records and the resultant database was analyzed by two EMS physicians. Cases were divided into categories including "known opioid use," "presumed opioid use," "no known opioid," "altered mental status," "cardiac arrest with known opioid use," "cardiac arrest with no known opioid use," or "suspected alcohol intoxication," and then further separated based on whether naloxone was administered. Patient categories were compared by patient demographics and incident year. Using the chart review classification as the gold standard, we calculated the sensitivity and positive predictive value (PPV) of naloxone administration for opioid overdose.
A total of 4,758 overdose cases from years 2013-15 were identified. During the same period, 1,351 patients were administered naloxone. Of the 1,431 patients with known or presumed opioid use, 57% (810 patients) received naloxone and 43% (621 patients) did not. The sensitivity of naloxone administration for the identification of patients with known or presumed opioid use was 57% (95% CI: 54%-59%) and the PPV was 60% (95% CI: 57%-63%).
Among patients receiving care in this large urban EMS system in the United States, the overall sensitivity and positive predictive value for naloxone administration for identifying opioid overdoses was low. Better methods of identifying opioid overdose trends are needed to accurately characterize the burden of opioid overdose within and among communities.
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