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Comparison of the Admission Characteristics and Outcomesof Indian Severe TBI Cohort with Earlier EpidemiologicStudies of Developed Nations 印度重型颅脑损伤队列入院特征和预后与发达国家早期流行病学研究的比较
Pub Date : 2020-01-01 DOI: 10.37421/JTM.2020.9.457
V. Kamal, D. Kumari, P. RavindraMohan, Ey, D. Agrawal, A. Pál
From policymaking and research point of view, our aim is to compare data of patients with severe traumatic brain injury (TBI) with developed settings, where health care facilities are much enhanced as compared to developing settings. In this retrospective study, we described and compared demographic, clinical, secondary insult related characteristics, and outcomes at 6-months (based on Glasgow outcome scale) of our patients with severe TBI; based on emergency department Glasgow coma scale, admitted to neurosurgery Intensive Care Unit at Jai Prakash Narayan Apex Trauma Centre (JPNATC), AIIMS, New Delhi, during May 2010–July 2012; with famous studies from developed settings using descriptive statistics. We found that there is a huge burden of young patients, mostly males with severe TBI in India as compared to developed settings. Follow-up data for 6-months outcome were very much lesser and outcome as death was in high proportion as compared to developed settings. In case of severe TBI, this information can be valuable in formulation of policies and programmes at centre/national/international level, increasing public awareness, developing new action plans.
从政策制定和研究的角度来看,我们的目的是比较严重创伤性脑损伤(TBI)患者与发达国家的数据,这些国家的医疗设施比发展中国家要完善得多。在这项回顾性研究中,我们描述并比较了严重TBI患者6个月时的人口学、临床、继发性损伤相关特征和结局(基于格拉斯哥结局量表);2010年5月至2012年7月,根据急诊科格拉斯哥昏迷量表,在新德里AIIMS的Jai Prakash Narayan顶点创伤中心(JPNATC)的神经外科重症监护室住院;与著名的研究从发达的设置使用描述性统计。我们发现,与发达国家相比,印度的年轻患者负担很大,其中大多数是患有严重脑外伤的男性。与发达国家相比,6个月的随访数据少得多,死亡比例高。在发生严重脑外伤的情况下,这些资料对制订中心/国家/国际一级的政策和方案、提高公众认识、拟订新的行动计划都很有价值。
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引用次数: 0
Brief Editorial Note for Journal of Trauma and Treatment 《创伤与治疗杂志》编辑简注
Pub Date : 2020-01-01 DOI: 10.37421/JTM.2020.9.45
K. Jones
Fifty-two percent of people detained in state jails and 63% of people in government penitentiaries are guardians of minor kids and a large number of them (22% of the offspring of state prisoners and 16% of the offspring of administrative detainees) are younger than 5 years. Exploration has shown that kids who have been presented to capture of a relative are fundamentally bound to have been the casualties of, or observer to, a more extensive scope of brutal and peaceful wrongdoings in their homes including youngster abuse or the utilization/selling of illicit substances.
52%的州立监狱在押人员和63%的政府监狱在押人员是未成年子女的监护人,其中大部分(22%的州立监狱在押人员的子女和16%的行政拘留在押人员的子女)不到5岁。研究表明,那些被介绍去抓亲戚的孩子,从根本上说,必然是家庭中更广泛的残酷和和平的不法行为的受害者或旁观者,包括虐待青少年或使用/出售非法药物。
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引用次数: 0
The Most Effective Method to Instruct Others about youruncommon illness 最有效的方法来指导别人你的不常见的疾病
Pub Date : 2020-01-01 DOI: 10.37421/JTM.2020.9.458
L. Shima
Rare diseases have taken a toll on the health of patients and their families mostly contributing to the shallow knowledge in order to explain the complexity of the situation to the physician; thereby ending up in late diagnosis and misdiagnosis. The aim of this study was to report the training needs in the general public health system within the diagnosis, treatment and monitoring of patients with rare diseases and to create awareness so as to make a better place for such uncommon ailments.
罕见病对病人及其家属的健康造成了损害,这主要是由于人们为了向医生解释情况的复杂性而对罕见病知之甚少;从而导致晚期诊断和误诊。本研究的目的是报告一般公共卫生系统在诊断、治疗和监测罕见疾病患者方面的培训需求,并提高认识,以便为这些罕见疾病创造更好的场所。
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引用次数: 0
Upper Brachial Plexus Palsy (Rucksack Palsy) 上臂丛性麻痹
Pub Date : 2018-03-29 DOI: 10.4172/2167-1222.1000419
S. Nahas, Clarence Yeoh, Hagen Jahnich
Rucksack palsy is an uncommon injury presumably caused by prolonged traction of the straps of a backpack on the brachial plexus. We present a patient with painless weakness and loss of sensation in her arm. Familiarity with the differential diagnosis of insidious, painless shoulder weakness is essential in managing patients with rucksack palsy. These patients should be treated expectantly and monitored closely.
背包麻痹是一种罕见的损伤,可能是由臂丛神经上背包带的长期牵引引起的。我们介绍了一位患者,她手臂出现无痛性无力和感觉丧失。熟悉隐性无痛性肩部无力的鉴别诊断对于治疗帆布背包麻痹患者至关重要。这些患者应得到预期的治疗并密切监测。
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引用次数: 0
Relationship between work-related musculoskeletal disorders among intensive care unit nurses 重症监护室护士与工作相关肌肉骨骼疾病的关系
Pub Date : 2018-03-09 DOI: 10.4172/2167-1222-C1-007
R. Anabtawi
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引用次数: 0
Transarterial Embolization Affects Recovery in Nonoperative Management of Severe Blunt Hepatic Injuries: A Retrospective Study 经动脉栓塞影响非手术治疗严重钝性肝损伤的恢复:一项回顾性研究
Pub Date : 2018-02-12 DOI: 10.4172/2167-1222.1000411
K. Sekine, S. Matsumoto, T. Funabiki, Y. Sugawara, J. Sasaki, Mitsuhide Kitano
Introduction: Transarterial embolization (TAE) has been used as an essential technique in the nonoperative management (NOM) of severe blunt hepatic injuries (BHI) but has a possible risk of tissue ischemia and necrosis, which may affect hepatic recovery. The injured liver tissue gets encapsulated and absorbed by intact liver tissue; therefore, the healing process requires the formation of a wall surrounding the injured tissue. In this study, we determined the impact of TAE on the hepatic healing process.Patients and methods: We reviewed hemodynamically stable patients (n=35; males, 23; females, 12; mean age, 32 years), admitted to our hospitals over a 10-year period, who underwent NOM of severe BHI (American Association for the Surgery of Trauma Organ Injury Scale, grades IV and V). Data collected included demographic information, serial CT findings, severity of hepatic injuries showing lacerations (Couinaud's liver segment classification), TAE performed for active hepatic bleeding, and the amount of hemoperitoneum. Extrahepatic factors were evaluated using the Abbreviated Injury Scale for injuries to the head, face, thorax, and extremities. Time taken by injured segments to encapsulate was individually obtained from serial CTs. Cox regression and Kaplan-Meier analyses were used to identify risk factors associated with delayed healing among the hepatic and extrahepatic factors mentioned above.Results: Risk factors were independently and significantly associated with TAE (odds ratio, 2.45; 95% confidence interval, 1.01-5.92; p=0.047). Multivariate analysis indicated that patients who underwent TAE took 2.45-times longer time to attain liver encapsulation than those who did not undergo TAE and that extrahepatic factors did not correlate with the time to encapsulation.Conclusion: TAE for active liver hemorrhage resulted in a delayed recovery from BHI, regardless of extrahepatic factors.
引言:经动脉栓塞(TAE)已被用作严重钝性肝损伤(BHI)的非手术治疗(NOM)的一项重要技术,但可能存在组织缺血和坏死的风险,这可能会影响肝脏的恢复。损伤的肝组织被完整的肝组织包裹并吸收;因此,愈合过程需要在受伤组织周围形成一个壁。在本研究中,我们确定了TAE对肝脏愈合过程的影响。患者和方法:我们回顾了在10年内入住我们医院的血液动力学稳定的患者(n=35;男性,23;女性,12;平均年龄,32岁),他们接受了严重BHI的NOM(美国创伤器官损伤外科协会量表,IV和V级)。收集的数据包括人口统计学信息、系列CT检查结果、显示裂伤的肝损伤严重程度(Couinaud肝段分类)、活动性肝出血的TAE检查以及腹腔积血量。使用头部、面部、胸部和四肢损伤的简易损伤量表评估肝外因素。损伤节段封装所花费的时间是从连续CT中单独获得的。Cox回归和Kaplan-Meier分析用于确定上述肝外因素中与延迟愈合相关的风险因素。结果:危险因素与TAE独立且显著相关(比值比2.45;95%置信区间1.01-5.92;p=0.047)。多因素分析表明,接受TAE的患者获得肝包膜的时间是未接受TAE患者的2.45倍,肝外因素与包膜的时间无关。结论:无论肝外因素如何,TAE治疗活动性肝出血可延迟BHI的恢复。
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引用次数: 0
Initial Experience Using a Novel Reticulated Open Cell Foam Dressing with Through Holes during Negative Pressure Wound Therapy with Instillation for Management of Pressure Ulcers 新型网状开孔泡沫敷料在负压创面灌注治疗压疮中的初步经验
Pub Date : 2017-12-23 DOI: 10.4172/2167-1222.1000410
Luis G. Fernández, C. Ellman, Patricia Jackson
Several published reviews and recommendations exist for the use of negative pressure wound therapy (NPWT) with instillation and a dwell time (NPWTi-d) in acute and chronic wounds. Specific dressings for use with NPWTi-d have also been developed, including a reticulated open cell foam dressing with through holes (ROCF-CC) that assists in removing thick wound exudate and infectious materials. ROCF-CC is especially helpful for wound cleansing when debridement is not possible or appropriate in patients. We report our initial experiences in using NPWTi-d with ROCF-CC in patients with pressure ulcers. An algorithmic approach was used to determine appropriate treatment to reach the goals of therapy (i.e., wound bed preparation, granulation tissue formation, and removal of infectious materials). Previous therapies included honey and gauze soaked in Dakin’s solution. All patients received antibiotics and debridement when possible. Five patients (3 females and 2 males) received NPWTi-d with ROCF-CC (instillation of saline or a hypochlorous solution with a dwell time of 10 minutes, followed by 2-3 hours of -125 mmHg NPWT). Patient comorbidities included obesity, diabetes mellitus, hypertension, and peripheral artery disease. Mean age of patients was 65.2 years (range: 50-82 years). After an average of 6 days of therapy (range 2-9 days), all wounds treated with NPWTi-d with ROCFCC showed rapid granulation tissue formation. We also noted improved removal of devitalized tissue and subsequent granulation tissue formation in patients receiving hypochlorous solution compared to patients receiving saline during NPWTi-d with ROCF-CC. All patients were eventually transferred to a skilled nursing facility. In our clinical practice, NPWTi-d with ROCF-CC provided effective and rapid removal of the thick exudate and infectious materials and promoted excellent development of underlying granulation tissue.
关于在急性和慢性伤口中使用带有滴注和停留时间(NPWTi-d)的负压伤口治疗(NPWT),存在一些已发表的综述和建议。还开发了用于NPWTi-d的特定敷料,包括具有通孔的网状开孔泡沫敷料(ROCF-CC),该敷料有助于去除厚的伤口渗出物和感染性物质。当清创术不可能或不适合患者时,ROCF-CC特别有助于伤口清洁。我们报告了我们在压疮患者中使用NPWTi-d和ROCF-CC的初步经验。使用算法方法来确定适当的治疗方法,以达到治疗目标(即伤口床准备、肉芽组织形成和感染性物质的去除)。以前的治疗方法包括蜂蜜和浸泡在Dakin溶液中的纱布。所有患者在可能的情况下接受抗生素和清创术。5名患者(3名女性和2名男性)接受了含有ROCF-CC的NPWTi-d(滴注生理盐水或次氯溶液,停留时间为10分钟,然后滴注2-3小时-125 mmHg的NPWT)。患者合并症包括肥胖、糖尿病、高血压和外周动脉疾病。患者的平均年龄为65.2岁(范围:50-82岁)。在平均6天的治疗(范围2-9天)后,所有用NPWTi-d和ROCFCC治疗的伤口都显示出快速的肉芽组织形成。我们还注意到,与使用ROCF-CC的NPWTi-d期间接受盐水的患者相比,接受次氯溶液的患者的失活组织去除和随后的肉芽组织形成有所改善。所有患者最终都被转移到一个熟练的护理机构。在我们的临床实践中,NPWTi-d联合ROCF-CC有效快速地去除了粘稠的渗出物和感染性物质,并促进了底层肉芽组织的良好发育。
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引用次数: 10
Crisis Perceptibility of People Requiring Assistance and Special Care: A Case Report 需要帮助和特殊照顾的人的危机感知:一个案例报告
Pub Date : 2017-11-22 DOI: 10.4172/2167-1222.1000407
Dai Noguchi, T. Fujioka
A major problem during a disaster relates to people requiring assistance. Very few studies have investigated the difficulties people requiring assistance during an actual disaster experience. We examined the situations and behavior of those with intellectual, developmental, and psychiatric disorders during the Great East Japan Earthquake through semi-structured interviews of eight supporters. In essence, the study aimed to elucidate crisis perceptibility of people who require assistance and special care during disaster evacuation. Results revealed that immediately after the disaster occurred, people requiring assistance and special care during evacuation did not exhibit any signs of panic or unexpected reactions. We assumed that the factor that accounted for the finding was the presence of supporters who understood them. There was also the possibility that different cognitive function profiles of people requiring assistance and special care affected their behavior during a disaster.
灾难期间的一个主要问题与需要援助的人有关。很少有研究调查人们在实际的灾难经历中需要援助的困难。我们通过对8位支持者的半结构化访谈,研究了东日本大地震期间智力、发育和精神障碍患者的情况和行为。从本质上讲,本研究旨在阐明在灾害疏散过程中需要援助和特殊照顾的人的危机感知能力。结果显示,灾难发生后,在疏散过程中需要帮助和特殊照顾的人没有表现出任何恐慌或意外反应的迹象。我们认为,造成这一结果的因素是有理解他们的支持者在场。还有一种可能性是,需要帮助和特殊照顾的人的不同认知功能概况影响了他们在灾难中的行为。
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引用次数: 0
Is There a Role for Second Generation Antipsychotics in the Treatment of PTSD 第二代抗精神病药物在治疗创伤后应激障碍中有作用吗
Pub Date : 2017-11-22 DOI: 10.4172/2167-1222.1000406
G. Villarreal
Posttraumatic Stress Disorder (PTSD) is common in civilians and veterans and is often chronic and disabling [1&2]. The Selective Serotonin Reuptake Inhibitors (SSRIs) and venlafaxine are considered first line treatment for PTSD although only sertraline and paroxetine have FDA approval [3]. These medications have been shown to improve most PTSD symptoms and in particular, irritability [4&5]. However, they have little effect on insomnia [4&5] which is serious problem in PTSD patients [6]. Military veterans tend to have little or no response to antidepressant medications [7-10]. Second Generation Antipsychotics (SGAs) are often used in the treatment of PTSD, particularly for insomnia [11]. A review of SGAs randomized trials in the treatment of PTSD found the most evidence of benefit from quetiapine and risperidone, particularly for re-experiencing and hyperarousal symptoms [12].
创伤后应激障碍(PTSD)常见于平民和退伍军人,通常是慢性和致残的[1&2]。选择性血清素再摄取抑制剂(SSRIs)和文拉法辛被认为是治疗PTSD的一线药物,尽管只有舍曲林和帕罗西汀获得了FDA的批准。这些药物已被证明可以改善大多数PTSD症状,特别是易怒[4&5]。然而,它们对失眠几乎没有作用[4&5],而失眠是PTSD患者的严重问题[10]。退伍军人往往对抗抑郁药物很少或没有反应[7-10]。第二代抗精神病药物(SGAs)常用于治疗创伤后应激障碍,特别是失眠。对SGAs治疗创伤后应激障碍的随机试验的回顾发现,喹硫平和利培酮的益处最明显,特别是对再经历和高唤醒症状[12]。
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引用次数: 0
A Single Case Report of a Patient with Bipolar I Disorder: Focusing on EMDR 单例双相I型患者报告:关注EMDR
Pub Date : 2017-11-17 DOI: 10.4172/2167-1222.1000405
Jae Woo Park
Objective: The aim of this study was to investigate the effects of Eye Movement Desensitization and Reprocessing (EMDR) on the residual symptoms of bipolar disorder through a single case AB design. Method: A single-case experimental AB design was carried out using an EMDR intervention with a patient with bipolar I disorder. Result: Beck Depression Inventory and Young Mania Rating Scale scores for the single patient with bipolar I disorder decreased rapidly during the intervention (A phase), but slightly increased during the intervention withdrawal (B phase). Conclusion: The single-case experimental design results demonstrated that EMDR reduced residual depressive and manic symptoms in a patient with bipolar I disorder.
目的:本研究通过单例AB设计,探讨眼动脱敏和再加工(EMDR)对双相情感障碍残留症状的影响。方法:采用EMDR干预对1例双相情感障碍患者进行单例实验AB设计。结果:单例双相I型患者Beck抑郁量表和Young躁狂症评定量表得分在干预期间(A期)迅速下降,但在干预退出期间(B期)略有上升。结论:单例实验设计结果表明,EMDR减轻了双相I型患者残留的抑郁和躁狂症状。
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引用次数: 0
期刊
Journal of trauma & treatment
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