Kragrosenkilde0412

Older trauma patients are reported to receive lower levels of care than younger adults. Differences in clinical management between adult and older trauma patients hold important information about potential trauma system improvement targets. The aim of this study was to compare prehospital and early in-hospital management of adult and older trauma patients, focusing on time-critical interventions and radiological examinations.

Retrospective analysis of the Norwegian Trauma Registry for 2015 through 2018. Trauma patients 16 years or older met by a trauma team and with New Injury Severity Score of 9 or greater were included, dichotomized into age groups 16 years to 64 years and 65 years or older. Prehospital and emergency department clinical management, advanced airway management, chest decompression, and admission radiological examinations was compared between groups applying descriptive statistics and appropriate statistical tests.

There were 9543 patients included, of which 28% (n = 2711) were 65 years erventions and radiological examinations. Improved dispatch of doctor/paramedic teams to older adults and assessment of the impact the observed differences have on outcome are future research priorities.

Therapeutic/Care Management; Level III.

Therapeutic/Care Management; Level III.

Traumatic rib fractures (TRFs) are common with a 10% incidence in all trauma patients and are associated with significant morbidity and mortality. Adequate analgesia is paramount for preventing pulmonary complications and death. Evidence exists for intravenous (IV) lidocaine's effectiveness and safety in postoperative thoracic and abdominal surgery, and we hypothesized that it would be effective in patients with TRFs.

We conducted a single-center, double-blind, randomized control trial comparing IV lidocaine plus usual analgesics to placebo infusion plus usual analgesics for 72 hours to 96 hours. Participants were adult trauma patients diagnosed with two or more TRFs requiring hospital admission. The primary outcome was mean pain score at rest and with movement, as measured on the visual analog scale. Secondary outcomes included patient satisfaction and opioid requirements (standardized total morphine equivalents). The study was powered to detect a 20% reduction in pain scores, which has been deemed clinint important consequences of inadequate analgesia.

Therapeutic/Care Management; Level II.

Therapeutic/Care Management; Level II.

We investigated whether surveillance imaging had an impact on post-relapse survival in patients with rhabdomyosarcoma (RMS). We hypothesized that relapse detected by imaging (group IM) would be associated with longer survival compared with relapse detected with a clinical sign or symptom (group SS).

We performed an observational multi-institutional study in 127 patients with relapsed RMS comparing overall survival (OS) after relapse using Kaplan-Meier and Cox proportional hazards analyses.

Relapse was detected in 60 (47%) group IM and 67 (53%) SS patients. Median follow-up in survivors was 4 years (range 1.0 to 16.7 y). Four-year OS rates were similar between group IM (28%, 95% confidence interval [CI] 14%-40%) and SS (21%, 95% CI 11%-31%) ( P =0.14). In multivariable analyses accounting for institution, age at diagnosis, time to relapse, risk group at diagnosis, and primary site, not receiving chemotherapy (hazard ratio [HR] 6.8, 95% CI 2.8-16.6), radiation (HR 3, 95% CI 1.7-5.3), or surgery (HR 2.8, 95% CI 1.6-4.8) after relapse were independently associated with poor OS.

These results on whether surveillance imaging provides survival benefit in patients with relapsed RMS are inconclusive. Larger studies are needed to justify current surveillance recommendations. Chemotherapy, radiotherapy and surgery to treat recurrence prolong OS.

These results on whether surveillance imaging provides survival benefit in patients with relapsed RMS are inconclusive. Larger studies are needed to justify current surveillance recommendations. Chemotherapy, radiotherapy and surgery to treat recurrence prolong OS.

The Centers for Disease Control and Prevention (CDC) recommend screening men who have sex with men who are living with HIV for sexually transmitted infections at appropriate extragenital contact sites for bacterial sexually transmitted infections. In an effort to increase provider adherence to CDC recommended guidelines at a Ryan White Clinic, microlearning educational sessions were used. A quality improvement project was designed to determine the rate of provider adherence to CDC guidelines pre/post microlearning sessions. Student t-test was used to compare the number of patients who received urine and extragenital screening to those who received urine-only screening, to before and after the microlearning sessions. The rate of extragenital screening significantly increased after the microlearning sessions (4/460 vs. 70/507, p < .0001). The rate of urine screening remained unchanged (p = 1). Although extragenital screening significantly increased, it remained low. A decision tree in the electronic medica, it remained low. A decision tree in the electronic medical record to prompt providers to screen was developed.

Although studies have examined the relationship between HIV-related stigma and HIV testing among men who have sex with men (MSM) in China, there is still a lack of knowledge regarding whether sexual minority stigma and HIV testing are associated. The purpose of this study was to identify the association between sexual minority- and HIV-related stigmas with HIV-testing behavior. A cross-sectional study was conducted in the Hunan Province of China. After controlling for covariates, the multivariate analyses showed that high internalized sexual minority stigma was negatively associated with HIV testing behavior in the previous year. However, anticipated sexual minority- and HIV-related stigmas were not associated with HIV-testing behavior. Findings suggest that internalized sexual minority stigma should be addressed in health care settings to encourage MSM to seek HIV testing services, especially considering the continuing HIV epidemic among MSM in China.

Although studies have examined the relationship between HIV-related stigma and HIV testing among men who have sex with men (MSM) in China, there is still a lack of knowledge regarding whether sexual minority stigma and HIV testing are associated. The purpose of this study was to identify the association between sexual minority- and HIV-related stigmas with HIV-testing behavior. A cross-sectional study was conducted in the Hunan Province of China. www.selleckchem.com/btk.html After controlling for covariates, the multivariate analyses showed that high internalized sexual minority stigma was negatively associated with HIV testing behavior in the previous year. However, anticipated sexual minority- and HIV-related stigmas were not associated with HIV-testing behavior. Findings suggest that internalized sexual minority stigma should be addressed in health care settings to encourage MSM to seek HIV testing services, especially considering the continuing HIV epidemic among MSM in China.Current nursing professional development programs include online education related to caring for COVID-19-positive patients. However, these resources failed to attract significant uptake of knowledge acquisition mainly because of poorly structured web pages. This discussion paper presents a unique perspective to designing professional development programs for frontline nurses working during the COVID-19 pandemic and beyond through the use of interactive digital content (IDC). An overview of IDC is provided, followed by strategies for transforming existing nursing professional development education into IDC.

Sexual assault nurse examiners (SANEs) conduct medical forensic examinations for persons who have been sexually assaulted. Positive psychological effects, high prosecution rates, and increased victim self-efficacy to seek resources for recovery were reported among sexual assault victims who received forensic care from SANEs. However, such endeavors may be very challenging to achieve because of the severe shortage of certified SANEs. This article will describe how one institution located in a medically underserved U.S.-Mexico border town built a SANE program to increase the capacity of SANEs in the region through 3-year grant funding. The lessons learned, challenges faced during implementation, and sustainability plans including integrating SANEs into the local medicolegal system to seek justice for sexual assault victims are critically addressed in this article.

Sexual assault nurse examiners (SANEs) conduct medical forensic examinations for persons who have been sexually assaulted. Positive psychological effects, high prosecution rates, and increased victim self-efficacy to seek resources for recovery were reported among sexual assault victims who received forensic care from SANEs. However, such endeavors may be very challenging to achieve because of the severe shortage of certified SANEs. This article will describe how one institution located in a medically underserved U.S.-Mexico border town built a SANE program to increase the capacity of SANEs in the region through 3-year grant funding. The lessons learned, challenges faced during implementation, and sustainability plans including integrating SANEs into the local medicolegal system to seek justice for sexual assault victims are critically addressed in this article.

Sexual assault nurse examiners (SANEs) play a critical role in providing quality care to patients who have experienced sexual violence. Recent national legislative initiatives have been launched both to better explore state-specific needs in regard to training SANE nurses as well as pilot programs that will establish evidence-based methods of expanding SANE training to remote, rural, and underserved communities.A scoping literature review was conducted to identify best practices in SANE training as well as implications for delivering this education to rural and underserved communities. This review analyzed the scientific strengths and weaknesses of existing research, provided an overview of findings within the literature, and identified areas where further research could be directed to inform local, state, and national strategy on SANE education.Blended learning programs that pair online education with simulated clinical experiences are promising alternatives to the traditional classroom experience; howeverrams that pair online education with simulated clinical experiences are promising alternatives to the traditional classroom experience; however, more research is needed to know how to enhance retention and engagement of nurses utilizing these methods to obtain preliminary SANE training.

This review discusses recent findings in surgical management of glaucoma, focusing on trabeculectomy and minimally invasive glaucoma surgery (MIGS). We discuss how the role these procedures play in conjunction with phacoemulsification.

New findings of the Primary Trab Vs Tube study and findings regarding the Hydrus, Xen 45, Kahook dual blade, Ab-interno Canaloplasty and head-to-head MIGS studies are summarized.

Patients with glaucoma greatly benefit from combining cataract surgery with a MIGS procedure that can be tailored to disease severity and medication use. Certain MIGS combined with phacoemulsification in severe and refractory glaucoma can potentially delay incisional glaucoma, although trabeculectomy- mitomycin C (MMC) still remains the best option in certain patient populations. We provide an update in the MIGS treatment paradigm based on newer, stronger evidence.

Patients with glaucoma greatly benefit from combining cataract surgery with a MIGS procedure that can be tailored to disease severity and medication use.