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Muscular architecture of the popliteus muscle and the basic science implications.

Muscular architecture of the popliteus muscle and the basic science implications.

Knee. 2020 Jan 15;:

Authors: Wood A, Boren M, Dodgen T, Wagner R, Patterson RM

Abstract
BACKGROUND: The function of the popliteus muscle is largely treated as a static stabilizer and has a lack of basic muscular architectural data to enable study of its dynamic function. A large volume of literature supports its static function and the essential need for reconstruction in the posterolateral knee when injured to restore knee stability.
HYPOTHESIS/PURPOSE: We hypothesize that the popliteus muscle is more significant as a dynamic presence in the knee.
METHODS: A collection of popliteus architectural data was collected from 28 cadaver specimens (mean (SD) 76 years (11)). Physiological cross-sectional area of the popliteus and semimembranosus muscles were calculated from muscle volume and fiber length to power future muscle force prediction models. Posterior knee muscle trajectories were measured with respect to the longitudinal axis of the tibia. A 2-tailed T test was performed.
RESULTS: Significant differences between males and females were found for both the popliteus (p = 1.1E-05) and semimembranosus (p = 2.0E-05) muscle volumes. Significant differences between males and females were also found in PCSA for the popliteus (p = 0.005) and semimembranosus (p = 4.1E-05) muscles. There were no significant differences in fiber length, overall muscle length (with tendon removed), age, and orientation.
CONCLUSION: Further consideration should be given to include the popliteus muscle as a dynamic entity in the knee given its mechanical properties, trajectory, and prior biomechanical evidence showing when and how it is activated. The present study provides data that may shape future directions of research and treatment with regard to posterolateral corner injuries and ligamentous balancing of the knee.

PMID: 31954610 [PubMed - as supplied by publisher]

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

Dahlia Hassani, MD - Sun, 01/19/2020 - 10:08
Related Articles

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

PLoS One. 2020;15(1):e0227752

Authors: Chou EH, Mann S, Hsu TC, Hsu WT, Liu CC, Bhakta T, Hassani DM, Lee CC

Abstract
PURPOSE: To determine the trends of infection sites and outcome of sepsis using a national population-based database.
MATERIALS AND METHODS: Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.
RESULTS: During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).
CONCLUSIONS: The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

PMID: 31929577 [PubMed - in process]

Kinematic Analysis of Combined Suture-Button and Suture Anchor Augment Constructs for Ankle Syndesmosis Injuries.

Related Articles

Kinematic Analysis of Combined Suture-Button and Suture Anchor Augment Constructs for Ankle Syndesmosis Injuries.

Foot Ankle Int. 2020 Jan 15;:1071100719898181

Authors: Wood AR, Arshad SA, Kim H, Stewart D

Abstract
BACKGROUND: Syndesmosis injuries are common, with up to 25% of all ankle injuries being reported to involve an associated syndesmosis injury. These injuries are typically treated with cortical screw fixation or suture-button implants when indicated, but the addition of a suture anchor augment implant has yet to be evaluated. The purpose of this study was to evaluate the ability of a suture anchor augment to add sagittal plane translational and transverse plane rotational constraint to suture-button constructs with syndesmosis injuries. We hypothesized that the suture anchor augment oriented in parallel with the fibers of an injured anterior-inferior tibiofibular ligament (AITFL) in addition to a suture-button construct would achieve physiological motion and stability at the syndesmosis through increased rotational and translational constraint of the fibula.
METHODS: Eleven fresh-frozen cadaver ankles were stressed in external rotation using a custom-made ankle rig. Each ankle had simultaneous recording of ultrasound video, 6 degrees-of-freedom kinematics of the fibula and tibia, and torque as the ankle was stressed by an examiner. The ankles were tested in 6 different states: native uninjured; injured with interosseous ligament and AITFL sectioned; 1× suture button; 2× suture buttons, divergent; 1× suture anchor augment with 2× suture buttons, divergent; and 1× suture anchor augment with 1× suture buttons.
RESULTS: Only the suture anchor augment + 2× suture buttons and suture anchor augment + 1× suture-button constructs were found to be significantly different from the injured state (P = .0003, P = .002) with mean external rotation of the fibula.
CONCLUSION: Overall, the most important finding of this study was that the addition of a suture anchor augment to suture-button constructs provided a mechanism to increase external rotational constraint of the fibula.
CLINICAL RELEVANCE: This study provides a mechanistic understanding of how the combined suture-button and suture anchor augment construct provides an anatomically similar reconstruction of constraints found in the native ankle. However, none of the constructs examined in this study were able to fully restore physiologic motion.

PMID: 31941352 [PubMed - as supplied by publisher]

Gender differences in diversion among non-medical users of prescription opioids and sedatives.

Gender differences in diversion among non-medical users of prescription opioids and sedatives.

Am J Drug Alcohol Abuse. 2020 Jan 14;:1-8

Authors: Milani SA, Lloyd SL, Serdarevic M, Cottler LB, Striley CW

Abstract
Background: Non-medical use of prescription drugs is a major public health concern in the United States. Prescription opioids and sedatives are among the most widely abused drugs and their combined use can be lethal. Increasingly rigid prescribing guidelines may contribute to the changing context of opioid use and increase drug diversion.Objective: To examine gender differences in diversion of prescription opioids and sedatives among non-medical prescription opioid and sedative polysubstance users. We hypothesize that men will be more likely than women to engage in incoming diversion.Methods: Data from the Prescription Drug Abuse, Misuse, and Dependence Study, a cross-sectional study focused on prescription drug users, were analyzed. Non-medical use was defined as use of a drug that was not prescribed or use in a way other than prescribed. Individuals who reported past 12-month non-medical opioid and sedative use were included; diversion was defined as incoming (obtaining drugs from a source other than a health professional) and outgoing (giving away/selling/trading prescription drugs).Results: Among the 198 polysubstance users, 41.4% were female. Men were 2.85 times as likely as women to report incoming diversion (95% CI: 1.21-6.72). Women were more likely to obtain opioids from a healthcare professional; men were more likely to obtain sedatives from a roommate, coworker, or friend. Over half of men and women reported outgoing diversion opioids or sedatives.Conclusion: Drug diversion highlights an important point of intervention. Current prevention efforts that target prescribers should be expanded to include users and diversion activities; these interventions should be gender-specific.

PMID: 31935131 [PubMed - as supplied by publisher]

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

Related Articles

Incidence, trends, and outcomes of infection sites among hospitalizations of sepsis: A nationwide study.

PLoS One. 2020;15(1):e0227752

Authors: Chou EH, Mann S, Hsu TC, Hsu WT, Liu CC, Bhakta T, Hassani DM, Lee CC

Abstract
PURPOSE: To determine the trends of infection sites and outcome of sepsis using a national population-based database.
MATERIALS AND METHODS: Using the Nationwide Inpatient Sample database of the US, adult sepsis hospitalizations and infection sites were identified using a validated approach that selects admissions with explicit ICD-9-CM codes for sepsis and diagnosis/procedure codes for acute organ dysfunctions. The primary outcome was the trend of incidence and in-hospital mortality of specific infection sites in sepsis patients. The secondary outcome was the impact of specific infection sites on in-hospital mortality.
RESULTS: During the 9-year period, we identified 7,860,687 admissions of adult sepsis. Genitourinary tract infection (36.7%), lower respiratory tract infection (36.6%), and systemic fungal infection (9.2%) were the leading three sites of infection in patients with sepsis. Intra-abdominal infection (30.7%), lower respiratory tract infection (27.7%), and biliary tract infection (25.5%) were associated with highest mortality rate. The incidences of all sites of infections were trending upward. Musculoskeletal infection (annual increase: 34.2%) and skin and skin structure infection (annual increase: 23.0%) had the steepest increase. Mortality from all sites of infection has decreased significantly (trend p<0.001). Skin and skin structure infection had the fastest declining rate (annual decrease: 5.5%) followed by primary bacteremia (annual decrease: 5.3%) and catheter related bloodstream infection (annual decrease: 4.8%).
CONCLUSIONS: The anatomic site of infection does have a differential impact on the mortality of septic patients. Intra-abdominal infection, lower respiratory tract infection, and biliary tract infection are associated with higher mortality in septic patients.

PMID: 31929577 [PubMed - in process]

Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc- A Pilot Study.

Roderick Y. Kim DDS, MD - Sat, 01/11/2020 - 11:42
Related Articles

Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc- A Pilot Study.

J Stomatol Oral Maxillofac Surg. 2020 Jan 02;:

Authors: Patel MH, Kim RY, Aronovich S, Skouteris CA

Abstract
BACKGROUND: There is limited data available in the literature describing the utility of acellular dermal matrix (AlloDerm©) in the replacement of the temporomandibular joint disc. Few reports of clinicians using implantable AlloDerm to replace the disc do exist, however, this has been described for reconstruction after surgical resection of the entire temporomandibular joint complex to treat pathology, as opposed to isolated articular disc disorders. Moreover, there is a lack of description in the literature regarding associated perioperative outcomes after such a procedure. We sought to assess the immediate perioperative outcomes in the form of a pilot study, to determine whether this technique warrants further investigation in the form of prospective clinical studies.
METHODS: The study team conducted a retrospective review of medical records for patients who underwent temporomandibular joint discectomy and replacement with AlloDerm© at a single tertiary care center, from 2011 to 2016. Perioperative outcomes of interest including pain levels and range of motion were recorded and descriptive statistics were utilized for statistical analysis.
RESULTS: 15 patients met the inclusion criteria, of which 87% were females and 13% males. The mean age was 47.27 ± 15.93 years. Pre-operatively, 74% of the patients reported severe pain (VAS scores of 7-10); in contrast, 73% of the patients reported only mild pain (VAS scores of 1-3) during the post-operative visits, suggesting an overall reduction in pain intensity. Range of motion also improved from an average of 27.73 ± 13.04 mm, to an average of 38.60 ± 6.08 mm (p<0.01).
CONCLUSIONS: Based on our preliminary data, patients with advanced TMJ articular disc disorders showed clinical improvement from discectomy and replacement with acellular dermal matrix (AlloDerm©). Further longitudinal studies evaluating long-term outcomes need to be conducted to validate this technique, in the form of larger sample sizes with a control group, as well as radiographic assessment of long-term clinical outcomes.

PMID: 31904524 [PubMed - as supplied by publisher]

Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc- A Pilot Study.

Clinical assessment of acellular dermal matrix (AlloDerm©) as an option in the replacement of the temporomandibular joint disc- A Pilot Study.

J Stomatol Oral Maxillofac Surg. 2020 Jan 02;:

Authors: Patel MH, Kim RY, Aronovich S, Skouteris CA

Abstract
BACKGROUND: There is limited data available in the literature describing the utility of acellular dermal matrix (AlloDerm©) in the replacement of the temporomandibular joint disc. Few reports of clinicians using implantable AlloDerm to replace the disc do exist, however, this has been described for reconstruction after surgical resection of the entire temporomandibular joint complex to treat pathology, as opposed to isolated articular disc disorders. Moreover, there is a lack of description in the literature regarding associated perioperative outcomes after such a procedure. We sought to assess the immediate perioperative outcomes in the form of a pilot study, to determine whether this technique warrants further investigation in the form of prospective clinical studies.
METHODS: The study team conducted a retrospective review of medical records for patients who underwent temporomandibular joint discectomy and replacement with AlloDerm© at a single tertiary care center, from 2011 to 2016. Perioperative outcomes of interest including pain levels and range of motion were recorded and descriptive statistics were utilized for statistical analysis.
RESULTS: 15 patients met the inclusion criteria, of which 87% were females and 13% males. The mean age was 47.27 ± 15.93 years. Pre-operatively, 74% of the patients reported severe pain (VAS scores of 7-10); in contrast, 73% of the patients reported only mild pain (VAS scores of 1-3) during the post-operative visits, suggesting an overall reduction in pain intensity. Range of motion also improved from an average of 27.73 ± 13.04 mm, to an average of 38.60 ± 6.08 mm (p<0.01).
CONCLUSIONS: Based on our preliminary data, patients with advanced TMJ articular disc disorders showed clinical improvement from discectomy and replacement with acellular dermal matrix (AlloDerm©). Further longitudinal studies evaluating long-term outcomes need to be conducted to validate this technique, in the form of larger sample sizes with a control group, as well as radiographic assessment of long-term clinical outcomes.

PMID: 31904524 [PubMed - as supplied by publisher]

Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures.

Russell Wagner, MD - Sat, 01/04/2020 - 11:28
Related Articles

Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures.

Arthroplast Today. 2019 Dec;5(4):421-426

Authors: Neal DC, Sambhariya V, Rahman SK, Tran A, Wagner RA

Abstract
We present a patient with bilateral Rorabeck II/Su III periprosthetic distal femur fractures treated successfully with bilateral single stage flexible intramedullary fixation. Flexible intramedullary fixation of Rorabeck II/Su III periprosthetic distal femur fractures provides the benefits of shorter operative time, lower blood loss, and preservation of bone stock compared to plate fixation and distal femur replacement. We suggest that for patients with similar injuries flexible intramedullary fixation can be a viable treatment option.

PMID: 31886383 [PubMed]

Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism.

Related Articles

Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism.

Trauma Surg Acute Care Open. 2019;4(1):e000367

Authors: Walker PF, Schobel S, Caruso JD, Rodriguez CJ, Bradley MJ, Elster EA, Oh JS

Abstract
Introduction: Clinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE. The purpose of this study was to evaluate the utility of TESS in predicting VTE in military trauma patients.
Methods: A retrospective cohort study of 549 combat casualties from October 2010 to November 2012 admitted to a military treatment facility in the USA was performed. TESS scores were calculated through data obtained from the Department of Defense Trauma Registry and chart reviews. Univariate analysis and multivariate logistic regression were performed to evaluate risk factors for VTE. Receiver operating characteristic (ROC) curve analysis of TESS in military trauma patients was also performed.
Results: The incidence of VTE was 21.7% (119/549). The median TESS for patients without VTE was 8 (IQR 4-9), and the median TESS for those with VTE was 10 (IQR 9-11). On multivariate analysis, Injury Severity Score (ISS) (OR 1.03, p=0.007), ventilator days (OR 1.05, p=0.02), and administration of tranexamic acid (TXA) (OR 1.89, p=0.03) were found to be independent risk factors for development of VTE. On ROC analysis, an optimal high-risk cut-off value for TESS was ≥7 with a sensitivity of 0.92 and a specificity of 0.53 (area under the curve 0.76, 95% CI 0.72 to 0.80, p<0.0001).
Conclusions: When used to predict VTE in military trauma, TESS shows moderate discrimination and is well calibrated. An optimal high-risk cut-off value of ≥7 demonstrates high sensitivity in predicting VTE. In addition to ISS and ventilator days, TXA administration is an independent risk factor for VTE development.
Level of evidence: Level III.

PMID: 31897437 [PubMed]

Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures.

Related Articles

Single stage bilateral flexible intramedullary fixation of periprosthetic distal femur fractures.

Arthroplast Today. 2019 Dec;5(4):421-426

Authors: Neal DC, Sambhariya V, Rahman SK, Tran A, Wagner RA

Abstract
We present a patient with bilateral Rorabeck II/Su III periprosthetic distal femur fractures treated successfully with bilateral single stage flexible intramedullary fixation. Flexible intramedullary fixation of Rorabeck II/Su III periprosthetic distal femur fractures provides the benefits of shorter operative time, lower blood loss, and preservation of bone stock compared to plate fixation and distal femur replacement. We suggest that for patients with similar injuries flexible intramedullary fixation can be a viable treatment option.

PMID: 31886383 [PubMed]

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Richard Robinson, MD - Sat, 12/21/2019 - 08:22
Related Articles

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Am J Emerg Med. 2019 04;37(4):579-584

Authors: Singh N, Robinson RD, Duane TM, Kirby JJ, Lyell C, Buca S, Gandhi R, Mann SM, Zenarosa NR, Wang H

Abstract
OBJECTIVE: Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care.
METHODS: This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016-Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events.
RESULTS: Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10-12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17-2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression.
CONCLUSION: Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care.

PMID: 30139579 [PubMed - indexed for MEDLINE]

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Hao Wang, MD - Sat, 12/21/2019 - 08:22
Related Articles

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Am J Emerg Med. 2019 04;37(4):579-584

Authors: Singh N, Robinson RD, Duane TM, Kirby JJ, Lyell C, Buca S, Gandhi R, Mann SM, Zenarosa NR, Wang H

Abstract
OBJECTIVE: Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care.
METHODS: This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016-Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events.
RESULTS: Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10-12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17-2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression.
CONCLUSION: Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care.

PMID: 30139579 [PubMed - indexed for MEDLINE]

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Related Articles

Role of ED crowding relative to trauma quality care in a Level 1 Trauma Center.

Am J Emerg Med. 2019 04;37(4):579-584

Authors: Singh N, Robinson RD, Duane TM, Kirby JJ, Lyell C, Buca S, Gandhi R, Mann SM, Zenarosa NR, Wang H

Abstract
OBJECTIVE: Trauma Quality Improvement Program participation among all trauma centers has shown to improve patient outcomes. We aim to identify trauma quality events occurring during the Emergency Department (ED) phase of care.
METHODS: This is a single-center observational study using consecutively registered data in local trauma registry (Jan 1, 2016-Jun 30, 2017). Four ED crowding scores as determined by four different crowding estimation tools were assigned to each enrolled patient upon arrival to the ED. Patient related (age, gender, race, severity of illness, ED disposition), system related (crowding, night shift, ED LOS), and provider related risk factors were analyzed in a multivariate logistic regression model to determine associations relative to ED quality events.
RESULTS: Total 5160 cases were enrolled among which, 605 cases were deemed ED quality improvement (QI) cases and 457 cases were ED provider related. Similar percentages of ED QI cases (10-12%) occurred across the ED crowding status range. No significant difference was appreciated in terms of predictability of ED QI cases relative to different crowding status after adjustment for potential confounders. However, an adjusted odds ratio of 1.64 (95% CI, 1.17-2.30, p < 0.01) regarding ED LOS ≥2 h predictive of ED related quality issues was noted when analyzed using multivariate logistic regression.
CONCLUSION: Provider related issues are a common contributor to undesirable outcomes in trauma care. ED crowding lacks significant association with poor trauma quality care. Prolonged ED LOS (≥2 h) appears to be linked with unfavorable outcomes in ED trauma care.

PMID: 30139579 [PubMed - indexed for MEDLINE]

Relationship Between Duration of Targeted Temperature Management, Ischemic Interval, and Good Functional Outcome From Out-of-Hospital Cardiac Arrest.

Veer Vithalani, MD - Sat, 12/14/2019 - 05:19
Related Articles

Relationship Between Duration of Targeted Temperature Management, Ischemic Interval, and Good Functional Outcome From Out-of-Hospital Cardiac Arrest.

Crit Care Med. 2019 Dec 10;:

Authors: Sawyer KN, Humbert A, Leroux BG, Nichol G, Kudenchuk PJ, Daya MR, Grunau B, Wang HE, Ornato JP, Rittenberger JC, Aufderheide TP, Wittwer L, Colella MR, Austin M, Kawano T, Egan D, Richmond N, Vithalani VD, Scales D, Baker AJ, Morrison LJ, Vilke GM, Kurz MC, Resuscitation Outcomes Consortium

Abstract
OBJECTIVES: Tailoring hypothermia duration to ischemia duration may improve outcome from out-of-hospital cardiac arrest. We investigated the association between the hypothermia/ischemia ratio and functional outcome in a secondary analysis of data from the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study trial.
DESIGN: Cohort study of out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study.
SETTING: Multicenter study across North America.
PATIENTS: Adult, nontraumatic, out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study who survived to hospital admission and received targeted temperature management between May 2012 and October 2015.
INTERVENTIONS: Targeted temperature management in comatose survivors of out-of-hospital cardiac arrest. We defined hypothermia/ischemia ratio as total targeted temperature management time (initiation through rewarming) divided by calculated total ischemia time (approximate time of arrest [9-1-1 call or emergency medical services-witnessed] to return of spontaneous circulation).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital survival with good functional status (modified Rankin Score, 0-3) at hospital discharge. We fitted logistic regression models to estimate the association between hypothermia/ischemia ratio and the primary outcome, adjusting for demographics, arrest characteristics, and Resuscitation Outcomes Consortium enrolling site. A total of 3,429 patients were eligible for inclusion, of whom 36.2% were discharged with good functional outcome. Patients had a mean age of 62.0 years (SD, 15.8), with 69.7% male, and 58.0% receiving lay-rescuer cardiopulmonary resuscitation. Median time to return of spontaneous circulation was 21.1 minutes (interquartile range, 16.1-26.9), and median duration of targeted temperature management was 32.9 hours (interquartile range, 23.7-37.8). A total of 2,579 had complete data and were included in adjusted regression analyses. After adjustment for patient characteristics and Resuscitation Outcomes Consortium site, a greater hypothermia/ischemia ratio was associated with increased survival with good functional outcome (odds ratio, 2.01; 95% CI, 1.82-2.23). This relationship, however, appears to be primarily driven by time to return of spontaneous circulation in this patient cohort.
CONCLUSIONS: Although a larger hypothermia/ischemia ratio was associated with good functional outcome after out-of-hospital cardiac arrest in this cohort, this association is primarily driven by duration of time to return of spontaneous circulation. Tailoring duration of targeted temperature management based on duration of time to return of spontaneous circulation or patient characteristics requires prospective study.

PMID: 31821187 [PubMed - as supplied by publisher]

Relationship Between Duration of Targeted Temperature Management, Ischemic Interval, and Good Functional Outcome From Out-of-Hospital Cardiac Arrest.

Neal Richmond, MD - Sat, 12/14/2019 - 05:19
Related Articles

Relationship Between Duration of Targeted Temperature Management, Ischemic Interval, and Good Functional Outcome From Out-of-Hospital Cardiac Arrest.

Crit Care Med. 2019 Dec 10;:

Authors: Sawyer KN, Humbert A, Leroux BG, Nichol G, Kudenchuk PJ, Daya MR, Grunau B, Wang HE, Ornato JP, Rittenberger JC, Aufderheide TP, Wittwer L, Colella MR, Austin M, Kawano T, Egan D, Richmond N, Vithalani VD, Scales D, Baker AJ, Morrison LJ, Vilke GM, Kurz MC, Resuscitation Outcomes Consortium

Abstract
OBJECTIVES: Tailoring hypothermia duration to ischemia duration may improve outcome from out-of-hospital cardiac arrest. We investigated the association between the hypothermia/ischemia ratio and functional outcome in a secondary analysis of data from the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study trial.
DESIGN: Cohort study of out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study.
SETTING: Multicenter study across North America.
PATIENTS: Adult, nontraumatic, out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study who survived to hospital admission and received targeted temperature management between May 2012 and October 2015.
INTERVENTIONS: Targeted temperature management in comatose survivors of out-of-hospital cardiac arrest. We defined hypothermia/ischemia ratio as total targeted temperature management time (initiation through rewarming) divided by calculated total ischemia time (approximate time of arrest [9-1-1 call or emergency medical services-witnessed] to return of spontaneous circulation).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital survival with good functional status (modified Rankin Score, 0-3) at hospital discharge. We fitted logistic regression models to estimate the association between hypothermia/ischemia ratio and the primary outcome, adjusting for demographics, arrest characteristics, and Resuscitation Outcomes Consortium enrolling site. A total of 3,429 patients were eligible for inclusion, of whom 36.2% were discharged with good functional outcome. Patients had a mean age of 62.0 years (SD, 15.8), with 69.7% male, and 58.0% receiving lay-rescuer cardiopulmonary resuscitation. Median time to return of spontaneous circulation was 21.1 minutes (interquartile range, 16.1-26.9), and median duration of targeted temperature management was 32.9 hours (interquartile range, 23.7-37.8). A total of 2,579 had complete data and were included in adjusted regression analyses. After adjustment for patient characteristics and Resuscitation Outcomes Consortium site, a greater hypothermia/ischemia ratio was associated with increased survival with good functional outcome (odds ratio, 2.01; 95% CI, 1.82-2.23). This relationship, however, appears to be primarily driven by time to return of spontaneous circulation in this patient cohort.
CONCLUSIONS: Although a larger hypothermia/ischemia ratio was associated with good functional outcome after out-of-hospital cardiac arrest in this cohort, this association is primarily driven by duration of time to return of spontaneous circulation. Tailoring duration of targeted temperature management based on duration of time to return of spontaneous circulation or patient characteristics requires prospective study.

PMID: 31821187 [PubMed - as supplied by publisher]

Relationship Between Duration of Targeted Temperature Management, Ischemic Interval, and Good Functional Outcome From Out-of-Hospital Cardiac Arrest.

Relationship Between Duration of Targeted Temperature Management, Ischemic Interval, and Good Functional Outcome From Out-of-Hospital Cardiac Arrest.

Crit Care Med. 2019 Dec 10;:

Authors: Sawyer KN, Humbert A, Leroux BG, Nichol G, Kudenchuk PJ, Daya MR, Grunau B, Wang HE, Ornato JP, Rittenberger JC, Aufderheide TP, Wittwer L, Colella MR, Austin M, Kawano T, Egan D, Richmond N, Vithalani VD, Scales D, Baker AJ, Morrison LJ, Vilke GM, Kurz MC, Resuscitation Outcomes Consortium

Abstract
OBJECTIVES: Tailoring hypothermia duration to ischemia duration may improve outcome from out-of-hospital cardiac arrest. We investigated the association between the hypothermia/ischemia ratio and functional outcome in a secondary analysis of data from the Resuscitation Outcomes Consortium Amiodarone, Lidocaine, or Placebo Study trial.
DESIGN: Cohort study of out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study.
SETTING: Multicenter study across North America.
PATIENTS: Adult, nontraumatic, out-of-hospital cardiac arrest patients screened for Resuscitation Outcomes Consortium-Amiodarone, Lidocaine, or Placebo Study who survived to hospital admission and received targeted temperature management between May 2012 and October 2015.
INTERVENTIONS: Targeted temperature management in comatose survivors of out-of-hospital cardiac arrest. We defined hypothermia/ischemia ratio as total targeted temperature management time (initiation through rewarming) divided by calculated total ischemia time (approximate time of arrest [9-1-1 call or emergency medical services-witnessed] to return of spontaneous circulation).
MEASUREMENTS AND MAIN RESULTS: The primary outcome was hospital survival with good functional status (modified Rankin Score, 0-3) at hospital discharge. We fitted logistic regression models to estimate the association between hypothermia/ischemia ratio and the primary outcome, adjusting for demographics, arrest characteristics, and Resuscitation Outcomes Consortium enrolling site. A total of 3,429 patients were eligible for inclusion, of whom 36.2% were discharged with good functional outcome. Patients had a mean age of 62.0 years (SD, 15.8), with 69.7% male, and 58.0% receiving lay-rescuer cardiopulmonary resuscitation. Median time to return of spontaneous circulation was 21.1 minutes (interquartile range, 16.1-26.9), and median duration of targeted temperature management was 32.9 hours (interquartile range, 23.7-37.8). A total of 2,579 had complete data and were included in adjusted regression analyses. After adjustment for patient characteristics and Resuscitation Outcomes Consortium site, a greater hypothermia/ischemia ratio was associated with increased survival with good functional outcome (odds ratio, 2.01; 95% CI, 1.82-2.23). This relationship, however, appears to be primarily driven by time to return of spontaneous circulation in this patient cohort.
CONCLUSIONS: Although a larger hypothermia/ischemia ratio was associated with good functional outcome after out-of-hospital cardiac arrest in this cohort, this association is primarily driven by duration of time to return of spontaneous circulation. Tailoring duration of targeted temperature management based on duration of time to return of spontaneous circulation or patient characteristics requires prospective study.

PMID: 31821187 [PubMed - as supplied by publisher]

Patient selection, education, and cannulation of percutaneous arteriovenous fistulae: An ASDIN White Paper.

Saravanan Balamuthusamy, MD - Sat, 12/07/2019 - 04:09
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Patient selection, education, and cannulation of percutaneous arteriovenous fistulae: An ASDIN White Paper.

J Vasc Access. 2019 Nov 29;:1129729819889793

Authors: Wasse H, Alvarez AC, Brouwer-Maier D, Hull JE, Balamuthusamy S, Litchfield TF, Cooper RI, Rajan DK, Niyyar VD, Agarwal AK, Abreo K, Lok CE, Jennings WC

Abstract
End-stage kidney disease patients who are candidates for surgical arteriovenous fistula creation commonly experience obstacles to a functional surgical arteriovenous fistula, including protracted wait time for creation, poor maturation, and surgical arteriovenous fistula dysfunction that can result in significant patient morbidity. The recent approval of two endovascular devices designed to create a percutaneous arteriovenous fistula enables arteriovenous fistula creation to be placed in the hands of interventionalists, thereby increasing the number of arteriovenous fistula providers, reducing wait times, and allowing the patient to avoid surgery. Moreover, current studies demonstrate that patients with percutaneous arteriovenous fistula experience improved time to arteriovenous fistula maturation. Yet, in order to realize the potential advantages of percutaneous arteriovenous fistula creation within our hemodialysis patient population, it is critical to select appropriate patients, ensure adequate patient and dialysis unit education, and provide sufficient instruction in percutaneous arteriovenous fistula cannulation and monitoring. In this White Paper by the American Society of Diagnostic and Interventional Nephrology, experts in interventional nephrology, surgery, and interventional radiology convened and provide recommendations on the aforementioned elements that are fundamental to a functional percutaneous arteriovenous fistula.

PMID: 31782685 [PubMed - as supplied by publisher]

Role of Free Tissue Transfer in Facial Trauma.

Roderick Y. Kim DDS, MD - Sat, 12/07/2019 - 04:09
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Role of Free Tissue Transfer in Facial Trauma.

Facial Plast Surg. 2019 Dec;35(6):584-589

Authors: Kim RY, Sokoya M, Williams FC, Shokri T, Ducic Y

Abstract
For large composite traumatic defects of the head and neck, free tissue transfer presents a reconstructive allowing for the reconstitution of both form and function. Furthermore, the ability to provide bulk, soft, and hard tissue, as well as immediate dental rehabilitation, makes free tissue transfer an efficient and attractive option for head and neck reconstruction. Herein, we discuss the utility of free tissue transfer in facial trauma, its problems, complications, and controversies.

PMID: 31783413 [PubMed - in process]

Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, Multicenter American Association for the Surgery of Trauma Study.

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Presumptive antibiotics in tube thoracostomy for traumatic hemopneumothorax: a prospective, Multicenter American Association for the Surgery of Trauma Study.

Trauma Surg Acute Care Open. 2019;4(1):e000356

Authors: Cook A, Hu C, Ward J, Schultz S, Moore Iii FO, Funk G, Juern J, Turay D, Ahmad S, Pieri P, Allen S, Berne J, AAST Antibiotics in Tube Thoracostomy Study Group

Abstract
Background: Thoracic injuries are common in trauma. Approximately one-third will develop a pneumothorax, hemothorax, or hemopneumothorax (HPTX), usually with concomitant rib fractures. Tube thoracostomy (TT) is the standard of care for these conditions, though TTs expose the patient to the risk of infectious complications. The controversy regarding antibiotic prophylaxis at the time of TT placement remains unresolved. This multicenter study sought to reconcile divergent evidence regarding the effectiveness of antibiotics given as prophylaxis with TT placement.
Methods: The primary outcome measures of in-hospital empyema and pneumonia were evaluated in this prospective, observational, and American Association for the Surgery of Trauma multicenter study. Patients were grouped according to treatment status (ABX and NoABX). A 1:1 nearest neighbor method matched the ABX patients with NoABX controls. Multilevel models with random effects for matched pairs and trauma centers were fit for binary and count outcomes using logistic and negative binomial regression models, respectively.
Results: TTs for HPTX were placed in 1887 patients among 23 trauma centers. The ABX and NoABX groups accounted for 14% and 86% of the patients, respectively. Cefazolin was the most frequent of 14 antibiotics prescribed. No difference in the incidence of pneumonia and empyema was observed between groups (2.2% vs 1.5%, p=0.75). Antibiotic treatment demonstrated a positive but non-significant association with risk of pneumonia (OR 1.61; 95% CI: 0.86~3.03; p=0.14) or empyema (OR 1.51; 95% CI: 0.42~5.42; p=0.53).
Conclusion: There is no evidence to support the routine use of presumptive antibiotics for post-traumatic TT to decrease the incidence of pneumonia or empyema. More investigation is necessary to balance optimal patient outcomes and antibiotic stewardship.
Level of evidence: II Prospective comparative study.

PMID: 31799417 [PubMed]

Role of Free Tissue Transfer in Facial Trauma.

Fayette C. Williams, DDS, MD, FACS - Sat, 11/30/2019 - 06:46
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Role of Free Tissue Transfer in Facial Trauma.

Facial Plast Surg. 2019 Dec;35(6):584-589

Authors: Kim RY, Sokoya M, Williams FC, Shokri T, Ducic Y

Abstract
For large composite traumatic defects of the head and neck, free tissue transfer presents a reconstructive allowing for the reconstitution of both form and function. Furthermore, the ability to provide bulk, soft, and hard tissue, as well as immediate dental rehabilitation, makes free tissue transfer an efficient and attractive option for head and neck reconstruction. Herein, we discuss the utility of free tissue transfer in facial trauma, its problems, complications, and controversies.

PMID: 31783413 [PubMed - in process]

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