Does an assessment aid improve Glasgow Coma Scale scoring by helicopter rescuers in Hong Kong: A randomised controlled trial.

BACKGROUND: Glasgow Coma Scale (GCS) is one of the most commonly used patient assessment tools. This study aimed to determine whether an assessment aid can improve the GCS scoring accuracy by helicopter rescuers in Hong Kong. METHODS: In this randomised controlled trial, Air Crewman Officers (ACMOs) of Government Flying Service in Hong Kong were randomised into two groups, with and without assessment aid. The group with the assessment aid was provided a printed copy of the GCS scoring table while watching the patient simulated videos. Ten videos with GCS scores ranging from 3 to 15 were used to test the performance of total GCS (tGCS) and motor component of GCS (mGCS) scoring. RESULTS: 78% (n=25/32) of ACMOs participated in the study. By comparing the groups with and without an assessment aid, there was no significant difference in the accuracy of tGCS score (60% versus 60%; p=0.85) or mGCS score (80% versus 80%; p=0.75). Overall, mGCS has a higher accuracy than tGCS (p<0.001). The accuracy of mGCS was better than tGCS in mild and moderate brain injury scenarios. CONCLUSION: The use of an assessment aid did not improve GCS scoring by helicopter rescuers. The assessing of mGCS was more accurate than tGCS, further supporting the use of mGCS for prehospital conscious level assessment.

Molecular defects of the dystonia-causing torsinA mutation.

The DeltaGAG deletion mutation in DYT1, causing a loss of a glutamic acid near the carboxyl terminus of torsinA protein (torsinADeltaE), is dominantly inherited and tends to result in a severe generalized form of dystonia with childhood onset. We have used a yeast two-hybrid interaction assay to examine torsinA and its mutant torsinADeltaE interactions. Our data showed that torsinA monomers are capable of interacting with themselves and that mutant torsinADeltaE fails to interact with itself or with torsinA. We also demonstrated that purified torsinA protein is an ATPase, which forms a multimeric complex in vitro and that the DeltaGAG mutation disrupts the formation of multimeric complex and decreases torsinA's ATPase activity.

Randomized double-blind trial comparing oral paracetamol and oral nonsteroidal antiinflammatory drugs for treating pain after musculoskeletal injury.

STUDY OBJECTIVE: We investigate the efficacy and safety of oral paracetamol compared with oral nonsteroidal antiinflammatory drugs or combination therapy in relieving pain after blunt limb injury in an emergency department (ED). METHODS: This was a double-blind, randomized, controlled study in an ED of a university hospital in the New Territories of Hong Kong. Three hundred adult patients with painful isolated limb injuries were enrolled. Primary outcome measures were pain relief at rest and with limb movement, adverse events, and patient satisfaction. RESULTS: There was no statistical difference in the mean reduction in pain score between any of the combinations at any point, although combination therapy was the first to reach a clinically significant reduction in pain score (<13 mm), and diclofenac-paracetamol combinations consistently produced a greater reduction in mean pain score than either nonsteroidal antiinflammatory drugs or paracetamol alone. All combinations appeared to be safe, although more patients receiving diclofenac-paracetamol combination complained of abdominal pain. The median patient satisfaction scores were poor. CONCLUSION: In the doses, frequencies, and routes of administration used for this study, any analgesic benefit of oral paracetamol-nonsteroidal antiinflammatory drug combinations over single nonsteroidal antiinflammatory drugs or paracetamol treatment is small and of doubtful clinical significance. Nonsteroidal antiinflammatory drugs, paracetamol, and diclofenac-paracetamol combinations appeared equally safe in the management of musculoskeletal pain.