Brogaardhorton6955
This indicates the strategy is well-suited for diverse biological applications, with the requirement of other metal ion cofactors or slightly acidic pH not necessarily being prohibitive.
Medical malpractice during endotracheal intubation can result in catastrophic complications. However, there are no reports on these severe complications in South Korea. We aimed to investigate the severe complications associated with endotracheal intubation occurring in South Korea, via medicolegal analysis.
We retrospectively analyzed the closed judicial precedents regarding complications related to endotracheal intubation lodged between January 1994 and June 2020, using the database of the Supreme Court of Korea. We collected clinical and judicial characteristics from the judgments and analyzed the medical malpractices related to endotracheal intubation.
Of 220 potential cases, 63 were included in the final analysis. The most common event location was the operating room (n = 20, 31.7%). All but 3 cases were associated with significant permanent or more severe injury, including 31 deaths. The most common problems were failed or delayed intubation (n = 56, 88.9%). Supraglottic airway device was used in 5.2% (n = 3) cases of delayed or failed intubation. Fifty-one (81%) cases were ruled in favor of the plaintiff in the claims for damages, with a median payment of Korean Won 133,897,845 (interquartile range 38,000,000-308,538,274). The most common malpractice recognized by the court was that of not attempting an alternative airway technique (n = 32, 50.8%), followed by violation of the duty of explanation (n = 10, 15.9%).
Medical malpractice occurring during endotracheal intubation can lead to catastrophic complications. Our results could increase physicians' awareness of the major complications related to endotracheal intubation and help ensure patient safety.
Medical malpractice occurring during endotracheal intubation can lead to catastrophic complications. Our results could increase physicians' awareness of the major complications related to endotracheal intubation and help ensure patient safety.The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of people and claimed thousands of lives. Starting in China, it is arguably the most precipitous global health calamity of modern times. The entire world has rocked back to fight against the disease and the COVID-19 vaccine is the prime weapon. Even though the conventional vaccine development pipeline usually takes more than a decade, the escalating daily death rates due to COVID-19 infections have resulted in the development of fast-track strategies to bring in the vaccine under a year's time. Governments, companies, and universities have networked to pool resources and have come up with a number of vaccine candidates. Also, international consortia have emerged to address the distribution of successful candidates. Herein, we summarize these unprecedented developments in vaccine science and discuss the types of COVID-19 vaccines, their developmental strategies, and their roles as well as their limitations.
This study compared the independent and combined effects of hemolysis and biotin on cardiac troponin measurements across nine high-sensitivity cardiac troponin (hs-cTn) assays.
Parallel cTn measurements were made in pooled lithium heparin plasma spiked with hemolysate and/or biotin using nine hs-cTn assays Abbott Alinity, Abbott ARCHITECT i2000, Beckman Access 2, Ortho VITROS XT 7600, Siemens Atellica, Siemens Centaur, Siemens Dimension EXL cTnI, and two Roche Cobas e 411 Elecsys Troponin T-hs cTnT assays (outside US versions, with and without increased biotin tolerance). Absolute and percent cTn recovery relative to two baseline concentrations were determined in spiked samples and compared to manufacturer's claims.
All assays except the Ortho VITROS XT 7600 showed hemolysis and biotin interference thresholds equivalent to or greater than manufacturer's claims. While imprecision confounded analysis of Ortho VITROS XT 7600 data, evidence of biotin interference was lacking. Increasing biotin concentration considered in isolation.In many clinical studies, researchers are interested in parsimonious models that simultaneously achieve consistent variable selection and optimal prediction. The resulting parsimonious models will facilitate meaningful biological interpretation and scientific findings. Variable selection via Bayesian inference has been receiving significant advancement in recent years. Despite its increasing popularity, there is limited practical guidance for implementing these Bayesian approaches and evaluating their comparative performance in clinical datasets. In this paper, we review several commonly used Bayesian approaches to variable selection, with emphasis on application and implementation through R software. These approaches can be roughly categorized into four classes namely the Bayesian model selection, spike-and-slab priors, shrinkage priors, and the hybrid of both. To evaluate their variable selection performance under various scenarios, we compare these four classes of approaches using real and simulated datasets. These results provide practical guidance to researchers who are interested in applying Bayesian approaches for the purpose of variable selection.The receiver operating-characteristic (ROC) curve is a well-known graphical tool routinely used for evaluating the discriminatory ability of continuous markers, referring to a binary characteristic. The area under the curve (AUC) has been proposed as a summarized accuracy index. Higher values of the marker are usually associated with higher probabilities of having the characteristic under study. However, there are other situations where both, higher and lower marker scores, are associated with a positive result. The generalized ROC (gROC) curve has been proposed as a proper extension of the ROC curve to fit these situations. Of course, the corresponding area under the gROC curve, gAUC, has also been introduced as a global measure of the classification capacity. In this paper, we study in deep the gAUC properties. The weak convergence of its empirical estimator is provided while deriving an explicit and useful expression for the asymptotic variance. We also obtain the expression for the asymptotic covariance of related gAUCs and propose a non-parametric procedure to compare them. The finite-samples behavior is studied through Monte Carlo simulations under different scenarios, presenting a real-world problem in order to illustrate its practical application. The R code functions implementing the procedures are provided as Supplementary Material.The paramedian forehead flap is considered the gold standard for nasal reconstruction following oncologic surgery. During the 21-day delay in two-stage surgery protocols, many patients report considerably reduced quality of life because of the pedicle. This prospective case series study examined the usefulness of near-infrared (NIR) fluorescence with indocyanine green (ICG) for flap perfusion assessment and identified variables associated with time to flap perfusion. Ten patients (mean age 75.3 ± 11.6 years) with diagnosis of basal cell carcinoma (n = 9) or squamous cell carcinoma (n = 1) underwent intravenous indocyanine injection and NIR fluorescence imaging for assessment of flap vascularisation 2 to 3 weeks after stage 1 surgery. NIR fluorescence imaging showed 90% to 100% perfusion areas in all patients after 14 to 21 days. Early pedicle division occurred in two patients on postoperative days 14 and 16. One minor complication (wound healing disorder) was seen following flap takedown after 14 days. There were no associations between time to flap perfusion and defect size or flap area. NIR fluorescence imaging with ICG dye is a useful method for non-invasive perfusion assessment when used in conjunction with clinical assessment criteria. However, a decision for early pedicle division may raise risk of complications in specific patient groups and must therefore be made with great care.
A large proportion of individuals with an at-risk mental state (ARMS) live at home and are supported by their families. Recommended treatment includes family intervention (FI), and therefore, understanding relationships between individuals with an ARMS and their family members is key. This study aimed to provide a more holistic exploration of relationships within families of individuals with an ARMS by reporting the perceived impact of the condition on other family members including sibling and romantic relationships.
Fourteen semi-structured interviews with family members were analysed using thematic analysis.
Parents wanted to maintain a safe family environment for all family members. This can result in spending less time with siblings who impacted on siblings' relationships with the service user and other family members. Romantic relationships were negatively impacted when there was unclear communication between the couple, as well as the partner's response and understanding of the ARMS condition. Clear communication across sibling and romantic relationships facilitated helpful family/carer's behaviour and understanding of the individuals' mental distress.
FI should explore and support families with changes in sibling and romantic relationships. More research is needed to understand siblings' perspectives in families with individuals experiencing an ARMS and to develop resources to support partners and families in changes within their sexual and romantic relationships.
FI should explore and support families with changes in sibling and romantic relationships. More research is needed to understand siblings' perspectives in families with individuals experiencing an ARMS and to develop resources to support partners and families in changes within their sexual and romantic relationships.
To examine the structure of the Prodromal Questionnaire (PQ-16) in a non-help-seeking population through exploratory factor analysis and confirmatory factor analysis. Previous studies have not looked at the structure of this self-report measure outside clinical settings.
Participants (n = 1045) were recruited through Amazon's Mechanical Turk (MTurk), and then completed the PQ-16. The data set was split randomly in two, one being used for exploratory factor analysis (EFA) and the other for confirmatory factor analysis (CFA). A polychoric correlation matrix was created and EFA was used to explore the factor structure of the PQ-16. Four models were tested through CFA to determine best fit one, two, three and four-factor models were all analysed.
EFA indicated a two-factor structure in the PQ-16 in a non-help-seeking population (with a mean age = 29.7 years). Factor 1 represented perceptual abnormalities/hallucinations and factor 2 general symptoms associated with psychosis-risk. CFA indicated that all the proposed models were suitable fits for the dataset. Fit indices for the three-factor model (factor 1 representing perceptual abnormalities/hallucinations, factor 2 unusual thought content, and factor 3 negative symptom) indicated that it appeared to be a better fit for the data than the one, two, and four factor models.
This study suggests that a three-factor model of the PQ-16 is a better fit than other proposed models in a non-help-seeking population. Future research of the structure of the PQ-16 in this population may benefit from recruiting subjects with a lower mean age than the current study.
This study suggests that a three-factor model of the PQ-16 is a better fit than other proposed models in a non-help-seeking population. Future research of the structure of the PQ-16 in this population may benefit from recruiting subjects with a lower mean age than the current study.Retinal diseases are a leading cause of impaired vision and blindness but some lack effective treatments. New therapies are required urgently to better manage retinal diseases. Natural pentacyclic triterpenoids and their derivatives have a wide range of activities, including antioxidative, anti-inflammatory, cytoprotective, neuroprotective, and antiangiogenic properties. Pentacyclic triterpenoids have great potential in preventing and/or treating retinal pathologies. The pharmacological effects of pentacyclic triterpenoids are often mediated through the modulation of signalling pathways, including nuclear factor erythroid-2 related factor 2, high-mobility group box protein 1, 11β-hydroxysteroid dehydrogenase type 1, and Src homology region 2 domain-containing phosphatase-1. This review summarizes recent in vitro and in vivo evidence for the pharmacological potential of pentacyclic triterpenoids in the prevention and treatment of retinal diseases. The present literature supports the further development of pentacyclic triterpenoids. Future research should now attempt to improve the efficacy and pharmacokinetic behaviour of the agents, possibly by the use of medicinal chemistry and targeted drug delivery strategies.Machine perfusion of donor livers is currently regarded as the most important innovation in transplant surgery to address the continuing shortage of organs in liver transplantation. Hypothermic machine perfusion (HMP) is safe to use and appears to reduce the risk of biliary complications and improve the long-term survival of transplanted organs following preservation by cold static storage - even in donors after cardiac death. A potential functional test of donor organs during HMP uses flavin mononucleotide and is still under clinical investigation. Normothermic machine perfusion (NMP) has a greater risk of technical problems, but functional testing using conventional laboratory parameters during NMP allows significant expansion of the donor pool, even though no prospective randomised study has been able to demonstrate a survival advantage for transplanted organs after NMP. In addition, the preservation time of the donor organs can be significantly extended with the help of NMP, which is particularly advantageous for complex recipient operations and/or logistics. Both methods could be applied for various scenarios in transplantation medicine - theoretically also in combination. The majority of German transplant centres regard machine perfusion as an important innovation and already actively perform perfusions or are in preparation for doing so. However, the overall practical experience in Germany is still relatively low, with only 2 centres having performed more than 20 perfusions. In the coming years, multi-centre efforts to conduct clinical trials and to develop national guidelines on machine perfusion will therefore be indispensable in order to define the potential of these technological developments objectively and to exploit it optimally for the field of transplantation medicine.
The SARS-CoV-2 pandemic has led to profound limitations in patient care and student teaching at the University Hospitals of Otorhinolaryngology (ORL). In contrast, the impact on research has been variable. To classify the pandemic-related effect on research, the development of the number of scientific publications of the German ORL university hospitals before and during the pandemic was analyzed.
The publication performance between 2015 and 2020 of the 39 current chairmen was surveyed using a literature search (Pubmed). All entries relating to the chairmen of the university hospital as first, last or co-author were included. The absolute and relative development of each author's publication performance was determined and evaluated using nonparametric statistical methods.
A total of 2420 publications could be documented. From 2015 to 2019, an average of 368 publications were published per year. In 2020, this number increased by 57.9 % to 581 publications. While the number of monthly publications remainedly, free time capacities enabled this increased publication output. Our results confirm the great scientific potential of the ORL university hospitals, which has been successfully implemented despite the pandemic.
Patients with hereditary hemorrhagic Telangiectasia (HHT) suffer from a rare and systemic disease which is characterized by vascular malformations leading to a variety of different symptoms.
A retrospective review of patients who were referred to our new HHT Center of Excellence (HHT COE) for evaluation and treatment between April 2014 and August 2019 was performed.
235 patients were treated at the West German HHT Center. 83 % of these were diagnosed with definite HHT (235/282, 83 %) and 9 % with possible HHT (26/282). The average latency between first manifestation and definite diagnosis of HHT was 18 years. Several initial symptoms were direct or indirect signs of bleeding (224/241, 93 %). In 83 % of the patients HHT was reported having caused their degree of disability. Older, female patients and those with severe epistaxis suffered from chronic iron deficiency anemia, took iron preparations (148/261, 57 %) and received 9 blood transfusions on average (± standard deviation 41, minimum - maximum 0-400, number of patients 218). 10 % of all patients tolerated anticoagulant or antiplatelet agents. 74 % of patients with HHT used nasal creams/sprays/oils (177/238) and reported fewer bleedings compared to patients without nasal care (ESS T-Test 3.193; p = 0.003; anemia Chi-square 5.173; p = 0.023).
The diagnostic latency of HHT was almost two decades. Patients with HHT particularly suffered from recurrent epistaxis, which was mostly treated with nasal care and coagulative therapies. Antiplatelet or anticoagulant agents can be used in patients with HHT with caution if indicated.
The diagnostic latency of HHT was almost two decades. Patients with HHT particularly suffered from recurrent epistaxis, which was mostly treated with nasal care and coagulative therapies. Antiplatelet or anticoagulant agents can be used in patients with HHT with caution if indicated.
Though frequently used in practice, research studies have shown inconclusive benefits of homeopathy in the treatment of warts. We aimed to assess the feasibility of a future definitive trial, with preliminary assessment of differences between effects of individualized homeopathic (IH) medicines and placebos in treatment of cutaneous warts.
A double-blind, randomized, placebo-controlled trial (
= 60) was conducted at the dermatology outpatient department of D.N. De Homoeopathic Medical College and Hospital, West Bengal. Patients were randomized to receive either IH (
= 30) or identical-looking placebo (
= 30). Primary outcome measures were numbers and sizes of the warts; secondary outcome was the Dermatology Life Quality Index (DLQI) questionnaire measured at baseline, and every month up to 3 months. Group differences and effect sizes were calculated on the intention-to-treat sample.
Attrition rate was 11.6% (IH, 3; placebo, 4). Intra-group changes were significantly greater (all
< 0.05, Friedman tests) in IH than placebo. Inter-group differences were statistically non-significant (all
> 0.05, Mann-Whitney
tests) with small effect sizes-both in the primary outcomes (number of warts after 3 months IH median [inter-quartile range; IQR] 1 [1, 3] vs. placebo 1 [1, 2];
= 0.741; size of warts after 3 months IH 5.6 mm [2.6, 40.2] vs. placebo 6.3 [0.8, 16.7];
= 0.515) and in the secondary outcomes (DLQI total after 3 months IH 4.5 [2, 6.2] vs. placebo 4.5 [2.5, 8];
= 0.935).
(28.3%),
(10%) and
(8.3%) were the most frequently prescribed medicines. No harms, homeopathic aggravations, or serious adverse events were reported.
As regards efficacy, the preliminary study was inconclusive, with a statistically non-significant direction of effect favoring homeopathy. The trial succeeded in showing that an adequately powered definitive trial is both feasible and warranted.
CTRI/2019/10/021659; UTN U1111-1241-7340.
CTRI/2019/10/021659; UTN U1111-1241-7340.
Rapid deployment aortic valve replacement (RDAVR) and transcatheter aortic valve implantation (TAVI) have emerged as increasingly used alternatives to conventional aortic valve replacement to treat patients at higher surgical risk. Therefore, in this single-center study, we retrospectively compared clinical outcomes and hemodynamic performance of two self-expanding biological prostheses, the sutureless and rapid deployment valve (RDV) Perceval-S (PER) and the transcatheter heart valve (THV) ACURATE
/TF (NEO) in a 11 propensity-score-matching (PSM) patient cohort.
A total of 332 consecutive patients with symptomatic aortic valve stenosis underwent either singular RDAVR with PER (119) or TAVI with NEO (213) at our institutions between 2012 and 2017. To compare the unequal patient groups, a 11 PSM for preoperative data and comorbidities was conducted. Afterward, 59 patient pairs were compared with regard to relevant hemodynamic parameter, relevant paravalvular leak (PVL), permanent postoperative pacemakeBoth self-expanding bioprostheses, the RDV-PER and THV-NEO provide a feasible option in elderly and patients with elevated perioperative risk. However, the discussed PER collective showed more postoperative short-term complications with regard to 30-day all-cause mortality and cerebrovascular events, whereas the NEO showed higher rates of PVL.
Third-generation transcatheter heart valves (THV) are predominantly implanted through a percutaneous, transfemoral access. To reduce vascular complications, we selectively performed surgical vascular access (cutdown) in patients with particular calcified or small femoral arteries. We aim to review our experience with this approach.
All patients who underwent transfemoral transcatheter aortic valve replacement (TAVR) with a third-generation THV at our institution between March 2014 and April 2019 were included in the study. All available computerized tomography studies were reassessed for access vessel diameter and visual graduation of calcifications. Vascular complications are reported according to Valve Academic Research Consortium-2 criteria.
A total of 944 patients were included. Among them, 879 patients underwent a percutaneous access and 65 patients underwent surgical cutdown. Also, 459 Evolut R/PRO and 420 Sapien 3/ultra were implanted percutaneously and 40 Evolut R/PRO and 25 Sapien 3 were implanted with a surgical cutdown. Patients with surgical cutdown were older (80.0 ± 7.5 vs. 83.8 ± 7.5 years,
< 0.001), had smaller femoral arteries (8.0 ± 1.6 vs. 7.6 ± 1.6 mm,
= 0.034) and more severe vessel calcifications (17.5 vs. 1.0%,
< 0.001). Procedure time was similar for cutdown and percutaneous access (64.0 vs. 64.5 minutes,
= 0.879). With percutaneous access, 80 major vascular complications (10%) occurred, whereas with surgical cutdown, no major vascular complications occurred (
< 0.005). No wound infection occurred after surgical cutdown. The mean length of stay was 8 days in both groups.
Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.
Surgical cutdown for vascular access avoids vascular complications in patients with small or severely calcified femoral arteries.This Yale Aortic Institute lecture provides "tips and pitfalls" regarding echocardiographic assessment of the aorta.
In blunt trauma patients, injury of the thoracic aorta is the second most common cause of death after head injury. In recent years, thoracic endovascular aortic repair (TEVAR) has largely replaced open repair as the primary treatment modality, and delayed repair of stable aortic injuries has been shown to improve mortality. In light of these major advancements, we present a 10-year institutional experience from a tertiary cardiovascular surgery center.
Records of patients who underwent endovascular or open repair of the ascending, arch or descending thoracic aorta between January 2009 and December 2018 were retrospectively analyzed. Patients without blunt traumatic etiology were excluded. Perioperative data were retrospectively collected from patient charts. Long-term follow-up was performed via data from follow-up visits and phone calls.
A total of 1,667 patients underwent 1,740 thoracic aortic procedures (172 TEVAR and 1,568 open repair). There were 13 patients (12 males) with a diagnosis of blunt thoracic aortic injury. Mean patient age was 43.6 years (range, 16-80 years). Ten (77%) patients underwent TEVAR, two (15.4%) underwent open repair, and one (7.7%) was treated nonoperatively. Procedure-related stroke was observed in one (7.7%) case. Procedure-related paraplegia did not occur in any patients. Left subclavian artery origin was covered in seven patients. None developed arm ischemia. Hospital survivors were followed-up for an average of 60.2 months (range, 4-115 months) without any late mortality, endoleak, stent migration, arm ischemia, or reintervention.
Blunt thoracic aortic injury is a rare but highly fatal condition. TEVAR offers good early and midterm results. Left subclavian artery coverage can be performed without major complications.
Blunt thoracic aortic injury is a rare but highly fatal condition. TEVAR offers good early and midterm results. Left subclavian artery coverage can be performed without major complications.The article presents an unusual cause of sepsis happening several weeks after heart transplant (infected iliofemoral junction false aneurysm) requiring iliofemoral reconstruction with arterial homograft by both retroperitoneal and inguinal approaches combined with Sartorius myoplasty.We describe a patient with contained aortic rupture due to perforation from a protruding lumbar osteophyte, who was treated by open surgery. This case underlines that less common aortic pathologies are possible, which require a high suspicion index to be diagnosed.We report the case of a 12-year-old girl with balanced double aortic arch with coarctation of the aorta presenting with symptoms of respiratory and swallowing difficulty. On investigation, the patient had a double aortic arch with coarctation and clinically nonsignificant disease in the infrarenal aorta. Division of the nondominant aortic arch was done through a left thoracotomy, along with resection of the coarctation segment and placement of an interposition Dacron tube graft.Giant aortoiliac aneurysm is a rare nosological entity. Owing to the increased diameter, the risk of rupture is extremely high and, similarly, the repair is extremely challenging. In this article, open surgical repair of a ruptured giant aortoiliac aneurysm in a 72-year-old male is described. A bifurcated Dacron graft was used with left internal iliac artery revascularization, while the contralateral internal iliac artery was ligated. The patient had an uneventful recovery.A 68-year-old man who had undergone descending thoracic aortic replacement was referred to our hospital with a thoracoabdominal aortic aneurysm. During the original surgery, the Adamkiewicz artery was directly reconstructed. However, multidetector row computed tomography showed occlusion of the reconstructed artery at its orifice, with supply by a collateral vessel from the left lateral thoracic artery. With careful incision to avoid damage to the collateral vessel, no postoperative neurological deficit was observed.We present a unique case of late diagnosis of coarctation of the aorta in an adult, presenting with congestive heart failure associated with severe aortic and mitral valve insufficiency. To minimize operative risk, staged endovascular repair of the coarctation was initially performed, followed by aortic valve replacement and mitral valve repair. Six months postoperatively, the 41-year-old patient remains completely asymptomatic.
There are only limited data on the extent to which children and adolescents with the need of integrative assistance (KiJu-PflEh) are considered for outreach dental care service. Aim The aim of this study was to evaluate accounting data from the Kassenzahnärztliche Bundesvereinigung (KZBV) on the use of dental care by KiJU-PflEh. Material and Methods Based on six specific BEMA items (accounting year 2019), the KZBV performed a filtering of GKV-insured persons (0-17 years). The generated data sets of the study group (KiJu-PflEh) and the control group (all KiJu) were made the UW/H available in anonymized form for further analyses.
The study group comprised 1602 KiJu-PflEh (mean age 11.6 years). The gender ratio from ♂ to ♀ was 21. 56.0% of the KiJu-PflEh underwent diagnostic dental examination. The use of individual prophylactic (IP) measures was as follows oral hygiene status assessment - IP1 (47.5%), oral health promotion - IP2 (46.1%), fluoridation of the teeth - IP4 (63.1%), fissure sealing per tooth - Is the KiJu-PflEh group has a high risk of caries. Medical information is also necessary to implement targeted prevention measures for all KiJu-PflEh. For this purpose, the introduction of a central database, which enables dental and general medical networking, should be driven forward. Furthermore, there is a need for more research to obtain primary data on the epidemiology of caries in KiJu-PflEh to verify the findings of the present pilot study.
Das Projekt "Gesunde Südstadt" hat den Schwerpunkt Gesundheitsförderung in der Lebenswelt Kommune. Es wurde im Rahmen des "Präventionsgesetzes" (SGB V §20a) initiiert und zielt ab auf die Verringerung der gesundheitlichen Ungleichheit in der Stadt Nürnberg. Die Maßnahmen der kommunalen Gesundheitsförderung im Handlungsfeld Ernährung wurden durch eine externe multiperspektivische, multimethodische Prozess- und Ergebnisevaluation begleitend untersucht.
55 Maßnahmenberichte, 8 Interviews mit Teilnehmenden sowie 3 Interviews mit Maßnahmendurchführenden wurden mit qualitativer Inhaltsanalyse ausgewertet. Eine Teilnehmendenbefragung (n=35) mittels Fragebögen wurde quantitativ-statistisch ausgewertet.
Die Ergebnisse zeigen, dass die Gesundheitsförderungsmaßnahmen durch die Teilnehmenden eine hohe Akzeptanz erfuhren und ein ausgeprägtes Maß an Partizipation ermöglicht wurde. Weiterhin zeigen die Ergebnisse, dass die Maßnahmen die interaktive sowie die funktionale Gesundheitskompetenz förderten. Ein empirisches interventions on participants. The project "Gesunde Südstadt" thus represents a systematic, relevant and low-threshold approach to health promotion in a communal setting. Methodological limitations such as the cross-sectional design are discussed.
Taking into consideration and addressing patients' psychosocial problems is one of the characteristics of good clinical practice; this applies to IBD-patients as well. Since 2014, such patients have been offered an online questionnaire-based problem assessment linked to care recommendations. The primary aim of our data analysis was to carry out a comparative description of socio-demographic and disease-related characteristics of users of the free service.
For a retrospective data analysis, the online sample (OG) comprising 2156 CD and UC patients was compared with 852 individuals who participated in 2 IBD health services research studies (CG). Besides descriptive statistics, regression and covariance analyses were carried out.
The OG differed from CG in a highly significant and partly clinically relevant way. One in 3 of the OG was younger than 30 years of age (CG 19%); 45% had completed high school (CG 36%). In the OG, fewer were in disease remission (OG 34%; CG 59%). Even controlling for these differences, the OG reported more often greater burden in 12 of 17 psychosocial problem areas and expressed a greater need for information on 5 of 9 disease-related topic areas.
The internet-based assessment of psychosocial problems is used primarily by younger, better educated, and physically as well as psychosocially more burdened IBD patients with comparatively high information needs. The assessment may help them to actively participate in their care. Our data sheds further light on the peculiarities of internet-based study groups.
The internet-based assessment of psychosocial problems is used primarily by younger, better educated, and physically as well as psychosocially more burdened IBD patients with comparatively high information needs. The assessment may help them to actively participate in their care. Our data sheds further light on the peculiarities of internet-based study groups.Pulmonary barotrauma may occur in diving and can result in a spectrum of injuries referred to as pulmonary over-inflation syndrome (POIS). Pneumomediastinum is a part of the POIS spectrum and only rarely results in respiratory symptoms. We present a case of a civilian diver who developed pneumomediastinum with respiratory symptoms which did not respond to normobaric 100% oxygen. After investigation for pneumothorax, he underwent hyperbaric oxygen treatment which resulted in significant alleviation of his symptoms. This is a novel case example of this treatment algorithm.
This report describes the use of hyperbaric oxygen treatment (HBOT) to treat a case of colorectal anastomosis ischaemia following colorectal surgery.
A 47-year-old man developed post-operative colorectal anastomosis ischaemia with leak after laparoscopic low anterior resection for T3N0 adenocarcinoma of the rectum. The leak with concomitant ischaemia presented 17 days after surgery. HBOT was administrated in 11 sessions over three weeks and the patient followed endoscopically and radiologically for two months. At two months the anastomosis showed both endoscopic and radiological healing; therefore the ileostomy was closed. Anal function was satisfactory with no incontinence or evidence of sepsis.
Intra-operative or late leak with concomitant ischaemia of a colorectal anastomosis is a challenging event in colorectal surgery. HBOT may be beneficial in promoting healing in selected patients. Further studies are needed to evaluate conservative treatments and the role of HBOT.
Intra-operative or late leak with concomitant ischaemia of a colorectal anastomosis is a challenging event in colorectal surgery. HBOT may be beneficial in promoting healing in selected patients. Further studies are needed to evaluate conservative treatments and the role of HBOT.A diver returned to diving, 15 months after an episode of neuro-spinal decompression sickness (DCS) with relapse, after which she had been found to have a moderate to large provoked shunt across a persistent (patent) foramen ovale (PFO), which was not closed. She performed a single highly conservative dive in line with the recommendations contained in the 2015 position statement on PFO and diving published jointly by the South Pacific Underwater Medicine Society and the United Kingdom Sports Diving Medical Committee. An accidental Valsalva manoeuvre shortly after surfacing may have provoked initial symptoms which later progressed to DCS. Her symptoms and signs were milder but closely mirrored her previous episode of DCS and she required multiple hyperbaric oxygen treatments over several days, with residua on discharge. Although guidance in the joint statement was mostly followed, the outcome from this case indicates that there may be a subgroup of divers with an unclosed PFO, who have had a previous episode of serious DCS, who may not be safe to dive, even within conservative limits.A broad spectrum of conditions including neuropathic pain, complex regional pain syndrome (CRPS) and fibromyalgia, have been implicated as causes of chronic pain. There is a need for new and effective treatments that patients can tolerate without significant adverse effects. One potential intervention is hyperbaric oxygen treatment (HBOT). The case reported here is unique in describing repeated HBOT in a patient who developed recurrent post-traumatic CRPS of the lower as well as the upper limbs. In the first event, two months after distortion and abruption of the external right ankle, the patient suffered leg pain, oedema formation, mild hyperaemia, limited mobility of the ankle and CRPS Type 1. In the second event, the same patient suffered fracture-dislocation of the distal radius 1.5 years after the first injury. After the plaster cast was removed the patient developed pain, warmth, colour changes, oedema formation and limited wrist mobility with CRPS Type 1. Pharmacological treatment as well as HBOT were used with significant improvement of functional outcome in both cases. Some studies suggest that patients with a history of CRPS are more likely to develop secondary CRPS compared to the rates reported in the literature among the general population. Patients with a history of CRPS should be counselled that they may be at risk for developing secondary CRPS if they undergo surgery or sustain trauma to another extremity.Medical personnel in hyperbaric treatment centres are at occupational risk for decompression sickness (DCS) while attending patients inside the multiplace hyperbaric chamber (MHC). A 51-year-old male hyperbaric physician, also an experienced diver, was working as an inside attendant during a standard hyperbaric oxygen therapy (HBOT) session (70 minutes at 253.3 kPa [2.5 atmospheres absolute, 15 metres' seawater equivalent]) in a large walk-in MHC. Within 10 minutes after the end of the session, symptoms of spinal DCS occurred. Recompression started within 90 minutes with an infusion of lignocaine and hydration. All neurological symptoms resolved within 10 minutes breathing 100% oxygen at 283.6 kPa (2.8 atmospheres absolute) and a standard US Navy Treatment Table 6 was completed. He returned to regular hyperbaric work after four weeks of avoiding hyperbaric exposures. Transoesophageal echocardiography with a bubble study was performed 18 months after the event without any sign of a persistent (patent) foramen ovale. Any hyperbaric exposure, even within no-decompression limits, is an essential occupational risk for decompression sickness in internal hyperbaric attendants, especially considering the additional risk factors typical for medical personnel (age, dehydration, tiredness, non-optimal physical capabilities and frequent problems with the lower back).The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.In the offshore oil industry, Multipurpose Support Vessels with extensive diving capability are used for inspection, maintenance and repair of subsea pipelines. The diving industry has developed systemic safety checks and strict regulatory control after a number of fatal accidents in early years. However, accidents do continue to occur and, when involving divers in the water, are often fatal. Hydrogen sulphide (H2S), called 'sour gas' in an oil field, is produced by the action of anaerobic bacteria on sulphate containing organic matter. A highly toxic gas, it remains a constant danger for offshore oil industry workers who must remain vigilant. Crude oil and gas produced in these oilfields is called 'sour crude' and pipelines carry this crude with varying content of dissolved H2S to shore for processing. Divers are routinely called to attend to leaking pipelines and come in contact with this crude. Their hot water suits and umbilical lines are often covered with crude containing dissolved H2S. There is always a possibility that these may enter and contaminate the bell environment. Such a case leading to fatality is reported here.
Resistant bacterial infections following brain and spine surgery and spontaneous mucormycosis with central nervous system (CNS) involvement represent a serious treatment challenge and more efficient therapeutic approaches ought to be considered. Hyperbaric oxygen treatment (HBOT) has shown promise as a complementary therapy. This case series evaluated whether HBOT contributed to infection resolution in seven patients with refractory CNS infectious conditions.
Clinical results for seven patients referred for HBOT between 2010 to 2018 to treat refractory postoperative brain and spine infections or spontaneously developing mucormycosis were retrospectively analysed. The patients' clinical files and follow-up consultations were reviewed to assess evolution and outcome.
Seven patients were referred with a median age of 56 years. The median follow-up was 20 months. Four patients had postoperative infections and three had rhino-orbital-cerebral mucormycosis (ROCM). HBOT was used as an adjunctive treatment to antimicrobial therapy in all patients. Prior to HBOT, all patients had undergone an average of four operations due to infection refractoriness and had completed an average of five months of antimicrobial therapy. After HBOT, infection resolution was obtained in six patients without additional operations, while one patient with ROCM stopped HBOT after the third session due to intolerance. Three patients stopped antimicrobial therapy while four were maintained on prophylactic treatment.
Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.
Infection resolution was reached in the six patients that completed HBOT as prescribed. HBOT may serve as an effective complementary treatment in CNS refractory postoperative and spontaneous infections.Although relatively safe, hypoxia exposure is a mandatory training requirement for aircrew that carries the risk of decompression sickness (DCS). Usually DCS affects only one individual at a time. Here, a cluster of three simultaneous cases is reported. Since these numbers were well in excess of the usually encountered incidence rate, the purpose of this work was to identify the most likely reasons using the epidemic DCS investigation framework which involves four main considerations time; place; population; and environment. Based on time and place observations, this cluster clearly falls into the individual-based classification, where the environment is a primary concern. Indeed, equipment analysis allowed us to identify the most likely reason for two out of three cases (perforations in the oro-nasal oxygen masks worn during training). It led to replacement of damaged equipment and modification of teaching to prevent such damage. It is recommended that this investigative template may be used for any future occurrences of DCS in clusters.The experience of managing a critically ill severe carbon monoxide poisoning patient suspected of possibly also suffering COVID-19 and requiring emergency hyperbaric oxygen treatment is described. Strategies used to minimise infection risk, modifications to practice and lessons learnt are described. All aerosol generating procedures such as endotracheal tube manipulation and suctioning should be undertaken in a negative pressure room. In the absence of in-chamber aerosol generating procedures, an intubated patient presents less risk than that of a non-intubated, symptomatically coughing patient. Strict infection control practices, contact precautions, hospital workflows and teamwork are required for the successful HBOT administration to an intubated COVID-19 suspect patient.
This paper presents a quantitative and qualitative study exploring patients' knowledge and experience of hyperbaric oxygen treatment (HBOT).
Participants included 29 patients with appropriate indications who were undertaking HBOT at facilities in two different locations Hobart, Australia, and Plymouth, United Kingdom. Participants completed surveys prior to commencing HBOT, after five sessions, and on completion of HBOT. Semi-structured one-to-one interviews were conducted with each individual on conclusion of their course. Data were analysed using descriptive statistics and interpretive description.
Prior to referral, 15/29 (52%) of participants knew HBOT was used to treat divers, and of these, 9/15 (60%) were familiar with its use for non-divers. Only one third sought additional information about the process between referral for HBOT and attending their medical assessment. Anxiety was a pre-treatment concern amongst participants. However, when re-measured after five sessions and upon completion of thet, such as finances or logistics, a minor inconvenience. These results highlight the need for psychosocial support during treatment by identifying gaps in patient preparation for HBOT.
Idiopathic sudden sensorineural hearing loss (ISSHL) is an otolaryngologic emergency. The Undersea and Hyperbaric Medicine Society (UHMS) revised practice guidelines in 2014 adding ISSHL to approved indications. This study investigated whether the UHMS guidelines influenced referral and practice in Australia and New Zealand.
Retrospective review of 319 patient referrals in two time periods (five years prior to addition of ISSHL to indications (T-PRE) and three years post (T-POST)).
Seven of eight participating hyperbaric facilities provided data down to the level of the indication for HBOT for analysis. In T-PRE 136 patients were treated with HBOT for ISSHL, representing between 0% and 18% of the total cases to each facility. In the T-POST period 183 patients were treated for ISSHL, representing from 0.35% to 24.8% of the total patients in each facility. Comparison between the two periods shows the proportion of patients treated with ISSHL among all indications increased from 3.2% to 12.1% (P < 0.0009). One facility accounted for 74% (101/136) of ISSHL patients receiving HBOT in T-PRE and 63% (116/183) in T-POST. ISSHL case load at that facility increased from 18% to 24.8% (P = 0.009) after the UHMS guideline publication. Three of the seven units had a significant increase in referrals after the guideline change.
There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue.
There remains equipoise regarding HBOT in the management of ISSHL. Only three out of seven units had a significant increase in ISSHL patients after the UHMS guidelines publication. Without well controlled RCTs to develop guidelines based on good evidence this is unlikely to change and practice variation will continue.
Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited.
Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS.
Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140-2,200) before closure, and 4,708 dives (median 413, range 11-2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile.
Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.
Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.
This study identified characteristics and diving practices of victims of fatal surface supplied breathing apparatus (SSBA) incidents in Australia from 1965-2019 to determine underlying factors and risks associated with these activities, better educate the diving community and prevent such deaths.
A hand search was made of 'Project Stickybeak' reports from 1965-2000 and SSBA fatality data were compared to the Australasian Diving Safety Foundation fatality database. The National Coronial Information System was searched to identify SSBA diving deaths for 2001-2019. Extracted data were collated and analysed using descriptive statistics and Poisson Regression. A chain of events analysis was used to determine the likely sequence of events.
There were 84 identified SSBA-related deaths during the study period. Most victims were relatively young, healthy males (median age 33 years). At least 50% of victims were undertaking work-related diving, and 37% were recreational diving. Equipment issues, mainly compressord education, and, failing this, regulatory oversight. The increase in health-related incidents in older participants may be controlled to some extent by greater medical oversight, especially in recreational and non-certified occupational divers who should be encouraged to undergo regular diving medical assessments.
Middle ear barotrauma (MEBt) is the most common medical complication in diving, posing a serious risk to dive safety. Given this prevalence and the continuing growth of the diving industry, a comprehensive overview of the condition is warranted.
This was a survey study. An anonymous, electronic questionnaire was distributed to 7,060 recipients professional divers of the Finnish Border Guard, the Finnish Rescue Services, and the Finnish Heritage agency; and recreational divers registered as members of the Finnish Divers' Association reachable by e-mail (roughly two-thirds of all members and recreational divers in Finland). Primary outcomes were self-reported prevalence, clinical characteristics, and health effects of MEBt while diving. Secondary outcomes were adjusted odds ratios (OR) for frequency of MEBt with respect to possible risk factors.
A total of 1,881 respondents participated in the study (response rate 27%). In total, 81% of the respondents had experienced MEBt while diving. Of those affected, 38% had used medications and 1% had undergone otorhinolaryngology-related surgical procedures due to MEBt.
