Sylvestellis0436

The global drive for improvements in the efficiency and quality of healthcare has led to the development of frameworks to assist in defining and measuring 'good quality care'. However, such frameworks lack a systematic or meaningful definition of what 'good quality care' means from the patients' perspective. The present research provides an in-depth analysis of patients' experiences in a hospital setting from a quality of care perspective. Forty-five adults (aged 16-70) hospitalised in one of four UK NHS trusts following an unintentional injury were interviewed about their experiences of care. The findings show variability in perceived quality of care within the same hospital episode which cannot be meaningfully captured by existing frameworks. The context of trauma care (e.g. distressing nature of injury, patient vulnerability, expectations of hospitalisation and participants' interaction with different service providers) defined the care experience and the value of being 'cared for'. Participants identified; they demonstrate the importance of patient experience in addition to clinical effectiveness and safety as an essential dimension of quality care. In terms of practice, the findings support the need to incorporate knowledge and training of injured adults' psychological needs, and the value of interaction with professionals as a patient defined dimension of the quality of care. INTRODUCTION The management of rectal trauma remains controversial. There are three modalities which have been used to manage these injuries; proximal diversion (PD), washout of the distal rectum (DRW) and presacral drainage (PSD). The EAST group tentatively advocate mandatory proximal diversion for extraperitoneal rectal injuries and omitting DRW or PSD. Other authors have suggested that diversion can be eschewed in patients with an intraperitoneal injury which can be primarily repaired. In light of all these controversies, this project set out to review our experience with rectal injuries over the last seven years with the objective of reviewing our use of PD, PSD and DRW. METHODS Patients aged greater than or equal to 15 years with rectal injuries during December 2012 to July 2019 were included. selleck compound Patient demographics, mechanism of injury, management strategy (operative or non-operative), complications, patient residential status (urban or rural), hospital and intensive care duration of stay, and 30-day mort in a small subset of patients with an intraperitoneal injury, we continue to perform PD for the vast majority of patients with a rectal injury. We do not perform DRW and PSD is used in highly selective cases. We report the case of a 40 year-old male with Staphylococcus aureus osteomyelitis of the proximal humerus after open reduction and internal fixation of a fracture from motor vehicle accident. Removal of the osteosynthesis, extensive debridement and intravenous antibiotics administration was done followed by external fixation stabilization and reconstruction with a combined pedicled flap using the serratus anterior reversed flap and the 6th rib. At the last follow-up, healing of the bone flap was observed; the patient experienced useful motion of his upper extremity without any evidence of recurrent infection. BACKGROUND Although progression of coronary artery calcification (CAC) has been established as an important marker for cardiovascular morbidity, very few studies have studied it in end-stage renal disease patients. Thus we examined and evaluate risk factors of calcification changes in dialysis patients. METHOD Among 28 hemodialysis (HD) patients, CAC was measured in Agatston units at baseline and after five years using the 64 multi-slice ultra-fast CT. The HD patients were classified as progressors or no progressors according to the change in the CAC score across these 2 measurements. RESULTS Over an average 63 months follow-up, participants without CAC at baseline had no incident CAC. The progression of CAC was slow and was found only in 6 patients (21.4%). It was significantly associated with several cardiovascular risk factors, namely, older age (P=0.03), diabetes (P=0.05), male sex (P=0.02), hypercholesterolemia (P=0.05), anemia (P=0.017), inflammation (P=0.05), and hyperphosphataemia (P=0.012). However, calcemia, parathormone levels, dialysis duration, tobacco, high blood pressure and dialysis dose did not seem to influence the progression of CAC in our series. A strong association was found between basal calcification scores and Delta increment at 5 years. CONCLUSIONS Our study suggests that CAC progression in dialysis is a complex phenomenon, associated with several risk factors with special regard to elevated basal scores. This progression can be avoided or slowed with appropriate management, which must begin in the early stages of chronic kidney disease. AIM Electrocardiogram (ECG) is a routine examination in emergency medicine (EM), however the level of resident's interpretations is inhomogeneous and sometimes insufficient. We have developed a support to assist in the interpretation of ECG in emergency situations. Our main objective was to assess whether this new tool improved the rate of good interpretations by residents of EM departments (EMD). The secondary objectives were to assess whether it improved the rate of good triages, the level of certainty of residents, and to study its impact according to the seniority of the resident. PATIENTS AND METHOD Multi-center, before-and-after study, carried out with existing residents in the different EMD dependent of a single university hospital center. The evaluation was conducted in two stages an initial analysis of 17 ECGs without tool and a new analysis using the tool. RESULTS Out of a target population of 68 residents, 41 (60 %) were included. The tool significantly improved the correct reading rate from 46 % without the tool to 68 % (P less then 0.001). The rate of correct triage (56 % vs. 64 %) and diagnostic certainty (54 vs. 66 on a scale of 0 to 100) were also significantly improved (P less then 0.001). The more experienced residents were generally more efficient in pre-testing, but the tool improved results regardless of seniority. CONCLUSION The development of a simple support to assist in the interpretation of ECGs improves the rate of good interpretations among residents in EMD.