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14%) received ECMO. Extracorporeal membrane oxygenation patients had significantly higher mortality than non-ECMO patients (32% vs. 19%). The standardized rate of ECMO from 2012 to 2016 increased significantly from 75.2 to 179.0 cases per 100,000 severely injured patients undergoing mechanical ventilation. The average annual growth rate was 24%. Of the 82 centers(18%) reporting at least 1 ECMO trauma case, 34 (41%) reported only a single case.

The use of ECMO for trauma, although rare, is rapidly increasing. Two thirds of patients who receive ECMO following traumatic injury survive their hospitalization. These data suggest that ECMO represents a potential treatment strategy for trauma patients with respiratory or cardiopulmonary failure. However, given the rarity of the procedure, there exists an opportunity to develop practice guidelines regarding the indications for, and approach to, ECMO in the setting of trauma.

Therapeutic/care management, level IV.

Therapeutic/care management, level IV.

Renewed interest in whole blood (WB) resuscitation in civilians has emerged following its military use. There is a paucity of data on its role in civilians where balanced component therapy (CT) resuscitation is the standard of care. The aim of this study was to assess nationwide outcomes of using WB as an adjunct to CT versus CT alone in resuscitating civilian trauma patients.

We analyzed the (2015-2016) Trauma Quality Improvement Program. We included adult (age, ≥18 years) trauma patients presenting with hemorrhagic shock and requiring at least 1 U of packed red blood cells (pRBCs) within 4 hours. Patients were stratified into WB-CT versus CT only. Primary outcomes were 24-hour and in-hospital mortality. Secondary outcomes were hospital length of stay and major complications. Hierarchical logistic regression was performed to account for clustering effect within hospitals and adjusting for patient- and hospital-level potential confounding factors.

A total of 8,494 patients were identified, of which 280 erapeutic, level IV.

Therapeutic, level IV.The aim of this study was to describe the radiographic appearance and to evaluate the elbow function with the Mayo elbow performance score (MEPS) in children with medial condyle fracture of the distal humerus (MCFH) who were treated surgically. During the period of 2011-2017, a total of 10 patients (three boys, seven girls) were retrospectively reviewed after obtaining institutional review board approval. All patients underwent open reduction and percutaneous pinning fixation. The average age at the time of injury was 7.7 years (range 4.0-12.5 years), and the mean follow up was 43.9 months (range 8.1-67.1 months). The clinical and radiographic outcomes of medial condyle fracture were retrospectively evaluated. Among 10 patients, half were diagnosed with MCFH initially by the radiograph, four out of 10 patients had their diagnosis confirmed with the aid of MRI, and an intraoperative diagnosis was made in only one individual. The average humeral-ulnar angles of the injured and noninjured sides were 9.7° ± 5.3° and 9.3° ± 4.7°, respectively (P = 0.679). The average MEPSs of the injured and noninjured sides were 95.5 ± 2.8 and 96.5 ± 2.4 points, respectively (P = 0.168). In this retrospectively evaluated cohort submitted to surgical management of medial condyle fracture of the distal humerus, MRI has been proven beneficial assisting the diagnosis and allowing effective joint restoration with mid-term good functional outcome.

The angiotensin receptor and neprilysin inhibitor (ARNI) sacubitril/valsartan (LCZ696) is recommended for the treatment of patients with heart failure in New York Heart Association (NYHA) class II-III and left ventricular ejection fraction (LVEF) 35% or less. We examined the effects of sacubitril/valsartan on cardiac remodeling and their correlation with heart failure duration in patients enrolled in our heart failure clinic from March 2017 to December 2019.

Echocardiographic and clinical/laboratory data were collected at baseline and at 6-month and 12-month follow-up visits in 69 patients (age 67 ± 12 years, disease duration 8.4 ± 5.8 years, 93% men).

At both time points, mean NYHA class, NT-proBNP level, LVEF, LV end-systolic volume, and estimated systolic pulmonary pressure significantly (P < 0.05) improved versus baseline, as did the proportion of patients with diastolic dysfunction grade 3 or functional mitral regurgitation grade 3-4. read more In the subgroup with mean disease duration less than 8.5 years (n = 40), there was a significant improvement in all variables at both time points; in this group, a recovery of right ventricular function was also seen at the 12-month follow-up. On the contrary, patients with heart failure duration of at least 8.5 years (n = 29) showed only a slight improvement in LVEF and mitral regurgitation at 12 months. There were no significant changes in renal function and/or potassium levels in all patients.

In patients with a relatively short disease duration, sacubitril/valsartan was associated with a strong favorable remodeling of the left ventricle and improvement in pulmonary circulation.

In patients with a relatively short disease duration, sacubitril/valsartan was associated with a strong favorable remodeling of the left ventricle and improvement in pulmonary circulation.High workload and unpredictable shift end times can contribute to employee turnover, dissatisfaction, and low staff engagement. The aim of this project was to improve nurse and patient satisfaction within a hospital-based outpatient gastrointestinal endoscopy unit while moving from an existing three-shift procedure staffing model to a two-shift model with defined expectations and predictable shift end times. The shift modification led to an 82% decrease in nurse turnover rates after the first 6 months. There was a 12% decrease in the number of nurses calling in ill to work. Nurse satisfaction, compared to 2 years prior, demonstrated 21% improvement related to "having a sense of achievement"; 39% improvement with "being involved in work unit decisions"; 62% decrease in burnout; and 7% improvement in overall satisfaction. The number of nurses attending and presenting at national, regional, and local conferences increased. Furthermore, overall unit patient satisfaction improved by 1.94% (p = .063) between first-quarter 2014 preimplementation data (n = 183) and first-quarter 2015 postimplementation survey data (n = 140).