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1.
Injury ; 2021 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-34749909

RESUMO

INTRODUCTION: Transfusion strategy for trauma patients with massive haemorrhage is often incorporated in massive transfusion protocols (MTP). Albeit correct MTP use results in better patient outcome, research regarding the state of MTP knowledge is scarce. The objective of this study is therefore to assess knowledge of local MTP and massive transfusion strategy in the level 1 trauma centres in the Netherlands. Our hypothesis is that actual MTP knowledge is low and transfusion strategy differs. MATERIALS AND METHODS: Surveys were sent out in January 2020 to all trauma and vascular surgeons, anaesthesiologists, emergency department physicians of the largest level 1 trauma centre (locally, n = 113) and to one trauma surgeon, emergency physician and anaesthesiologist in each of the nine other governmentally assigned level 1 trauma centres in the Netherlands (nationally, n = 27). The respondents were subdivided into a frequent user group (MTP usage ≥ 4 times in 2019) and a non-frequent user group (MTP usage < 4 in 2019). Data are expressed as numbers and percentages. RESULTS: Response rate was (n = 48; 42%) for the local survey and (n = 14; 52%) for the national survey. Locally, (n = 23; 48%) and (n = 25; 52%) respondents were defined frequent and non-frequent users respectively and national respondents all as frequent users. In total, (n = 13; 27%) of local respondents were aware of the current local composition of the MTP. Respondents indicated to transfuse erythrocytes first, followed by plasma and platelets (local non-frequent users n = 23; 92%, local frequent users n = 21; 91% and national frequent users n = 13; 93%). The indication for platelet transfusion was units erythrocytes transfused (local non-frequent users n = 10; 40% frequent users locally n = 11; 48% and nationally n = 5; 36%) and clinical view (local non-frequent users n = 9; 36%, frequent users locally n = 8; 35% and n<5 nationally. Whereas few respondents claimed (n = 5; 21% non-frequent users locally and n <5 nationally) to transfuse platelets based on platelet counts. Viscoelastic haemostatic assays were performed during MTP, but only by frequent users. CONCLUSION: The majority of physicians dealing with massive transfusion in trauma patients were not aware of the exact composition of the MTP and consensus regarding transfusion strategy and indication for platelet transfusion was low.

2.
Adv Skin Wound Care ; 34(9): 498-501, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34415255

RESUMO

ABSTRACT: This article describes a series of four patients for whom a Reverdin graft was performed. The Reverdin graft, also known as a pinch graft, is a method to promote epithelialization for superficial wounds. The intervention is minimally invasive with a short learning curve. The procedure and its advantages and disadvantages are discussed in this case series. This pinch graft is a widely accepted, minimally invasive intervention to accelerate the epithelialization of wounds.


Assuntos
Procedimentos Cirúrgicos Reconstrutivos/métodos , Transplante de Pele/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Transplante de Pele/normas , Transplante de Pele/estatística & dados numéricos
3.
J Trauma Acute Care Surg ; 91(4): 759-771, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34225351

RESUMO

BACKGROUND: Platelet transfusion during major hemorrhage is important and often embedded in massive transfusion protocols. However, the optimal ratio of platelets to erythrocytes (platelet-rich plasma [PLT]/red blood cell [RBC] ratio) remains unclear. We hypothesized that high PLT/RBC ratios, as compared with low PLT/RBC ratios, are associated with improved survival in patients requiring massive transfusion. METHODS: Four databases (Pubmed, CINAHL, EMBASE, and Cochrane) were systematically screened for literatures published until January 21, 2021, to determine the effect of PLT/RBC ratio on the primary outcome measure mortality at 1 hour to 6 hours and 24 hours and at 28 days to 30 days. Studies comparing various PLT/RBC ratios were included in the meta-analysis. Secondary outcomes included intensive care unit length of stay and in-hospital length of stay and total blood component use. The study protocol was registered in PROSPERO under number CRD42020165648. RESULTS: The search identified a total of 8903 records. After removing the duplicates and second screening of title, abstract, and full text, a total of 59 articles were included in the analysis. Of these articles, 12 were included in the meta-analysis. Mortality at 1 hour to 6 hours, 24 hours, and 28 days to 30 days was significantly lower for high PLT/RBC ratios as compared with low PLT/RBC ratios. CONCLUSION: Higher PLT/RBC ratios are associated with significantly lower 1-hour to 6-hour, 24-hour, 28-day to 30-day mortalities as compared with lower PLT/RBC ratios. The optimal PLT/RBC ratio for massive transfusion in trauma patients is approximately 1:1. LEVEL OF EVIDENCE: Systematic review and meta-analysis, therapeutic Level III.


Assuntos
Transfusão de Eritrócitos/estatística & dados numéricos , Hemorragia/terapia , Transfusão de Plaquetas/estatística & dados numéricos , Plasma Rico em Plaquetas , Ferimentos e Lesões/terapia , Hemorragia/etiologia , Hemorragia/mortalidade , Mortalidade Hospitalar , Humanos , Tempo de Internação , Índices de Gravidade do Trauma , Resultado do Tratamento , Ferimentos e Lesões/complicações , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/mortalidade
4.
Int J Sports Med ; 42(6): 559-565, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33176383

RESUMO

The aim of this nonrandomized cohort study was to compare the clinical effectiveness of an elective fasciotomy with conservative treatment for chronic exertional compartment syndrome of the leg. Patients diagnosed with chronic exertional compartment syndrome who opted for surgery (n=188) completed a preoperative questionnaire and a 12-month postoperative questionnaire. Patients who continued conservative treatments (n=23) served as controls. Gender, age, sports activity or affected compartments were comparable, but intensity of pain was higher in the surgical group (at rest: 2.5±0.1 vs. 2.0±0.2, during exercise: 4.2±0.1 vs. 3.8±0.2; both p<0.05). Following treatment, surgical patients demonstrated a larger drop in intensity levels of pain (surgery 1.6±0.1, conservative 0.9±0.2, p=0.01) and tightness (surgery 1.4±0.1, conservative 0.4±0.3, p=0.00) during exercise. Success (good or excellent treatment effect) was attained in 42% of the surgical group compared to only 17% in the conservatively treated group (p=0.02). However, previous activity level was achieved in a mere 26% in the surgical treatment group and 35% in the conservative treatment group (p=0.33). A fasciotomy for chronic exertional compartment syndrome in the leg results in significantly decreased levels of pain and tightness and better satisfaction compared to patients who continued a conservative treatment regimen.


Assuntos
Síndrome Compartimental Crônica do Esforço/terapia , Tratamento Conservador , Procedimentos Cirúrgicos Eletivos/métodos , Fasciotomia/métodos , Perna (Membro) , Adulto , Síndrome Compartimental Crônica do Esforço/cirurgia , Estudos de Coortes , Tratamento Conservador/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Exercício Físico/fisiologia , Fasciotomia/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Medição da Dor , Satisfação do Paciente , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento
5.
Surgery ; 169(5): 1182-1187, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33257036

RESUMO

BACKGROUND: Owing to improved quality of computed tomography, a new category of complicated acute diverticulitis, including patients with pericolic air but without abscess formation, can be defined (Hinchey 1a). Recent studies question whether this new category of acute diverticulitis could be treated as uncomplicated cases. The aim of our study is to report on the clinical course of acute diverticulitis Hinchey 1a in current clinical practice. METHODS: For this multicenter retrospective cohort study, patients presenting at the emergency department with Hinchey 1a acute diverticulitis as demonstrated by computed tomography scan, were identified. The primary outcome measure was successful conservative treatment with observation alone, antibiotics, and/or hospital admission. Readmissions, percutaneous drainage of abscesses, and emergency operations were considered as failure. RESULTS: Between October 2016 and October 2018, 1,199 patients were clinically suspected for acute diverticulitis, of whom 101 (8.4%) were radiologically diagnosed to have type 1a acute diverticulitis (average age 57 (±13) years, 45% female) and started with conservative treatment. This was successful in 86 (85%) patients. One of the 15 unsuccessfully treated patients (1%) received percutaneous drainage of an abdominal abscess. Surgery was required in 9 cases (9%) after a median time of 6 days (range, 3 to 69 days). Although a difference in the volume of extraluminal air on computed tomography scan was found, this was not shown to be a risk factor for the clinical course. CONCLUSION: Patients with type 1a acute diverticulitis can be treated successfully by conservative therapy in the majority of cases (85%). More research is required to define predictive factors for successful conservative management.


Assuntos
Tratamento Conservador/estatística & dados numéricos , Doença Diverticular do Colo/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Eur J Trauma Emerg Surg ; 47(1): 57-69, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32472443

RESUMO

PURPOSE: Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as adjunct for temporary hemorrhage control in patients with exsanguinating torso hemorrhage is increasing. Characteristics of aortic occlusion balloons (AOB) are diverse and evolving as efforts are made to improve the technology. It is important to select a device that fits the requirements of the medical situation to minimize the risk of failure and complications. The aim of this study is to appraise guidance in the choice of an AOB in a specific situation. METHODS: We assessed 29 AOB for differences and outline possible advantages and disadvantages of each. Bending stiffness was measured with a three-point bending device. RESULTS: Diameter of the AOB ranged from 6 (ER-REBOA™) to 10 (Coda®-46) French. However, some need large-bore access sheaths up to 22 French (Fogarty®-45 and LeMaitre®-45) or even insertion via cut-down (Equalizer™-40). Bending stiffness varied from 0.08 N/mm (± 0.008 SD; Coda®-32) to 0.72 N/mm (± 0.024 SD; Russian prototype). Rescue Balloon™ showed kinking of the shaft at low bending pressures. The only non-compliant AOB is REBOA Balloon®. ER-REBOA™, Fogarty®, LeMaitre®, REBOA Balloon®, and Rescue Balloon™ are provided with external length marks to assist blind positioning. CONCLUSION: In resource-limited settings, a guidewire- and fluoroscopy-free, rather stiff device, such as ER-REBOA™, Fogarty®, and LeMaitre®, is warranted. Of these devices, ER-REBOA™ is the only catheter compatible with seven French sheaths and specifically designed for emergency hemorrhage control. Of the over-the-wire devices, Q50® has several features that facilitate use and reduce the risk of malplacement or vessel damage.


Assuntos
Aorta/cirurgia , Oclusão com Balão/instrumentação , Procedimentos Endovasculares/instrumentação , Hemorragia/cirurgia , Ressuscitação/instrumentação , Desenho de Equipamento , Humanos
7.
Int J Low Extrem Wounds ; : 1534734620965815, 2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33084448

RESUMO

Estimates regarding the prevalence of chronic wounds in the Netherlands vary from 350 000 to 500 000. The cross-sectional multicenter study presented here provides evidence for the incidence and prevalence of wounds and chronic wounds. The primary aim of the present study was to provide evidence for incidence and prevalence of (chronic) wounds outside the hospital. The secondary aim was to optimize the organization for chronic wounds care within our region. From January 2017 until January 2018, information was prospectively collected of patients with new onset of wounds in 2 general practitioner practices to which 19 100 patients are enrolled. For the patients with new onset of wounds the "fast track protocol" was used and outcomes including etiology and wound healing were measured. This protocol included a structured treatment protocol and predetermined triage moments. The Alrijne Wound Centre database 2014 was used as a control group (469 records). The incidence of new onset of wounds was 364/19 100 (1.9%). The prevalence of wounds was 405/19 100 (2.1%). The prevalence of chronic wounds, that is, wounds that did not show a sufficient healing rate after 4 to 6 weeks, was 78/19 100 (0.4%). Time to referral to a wound physician (the triage moment) was 5 weeks versus 19 weeks in 2014 (P < .001). Unnecessary referrals to the hospital was reduced by 17.4% (P = .007). In conclusion, the prevalence of the chronic wounds was 4 per 1000 patients. The use of the "fast track" protocol optimizes wound care, wounds heal faster, and unnecessary referrals decrease significantly.

8.
Transfusion ; 60(8): 1846-1855, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692441

RESUMO

BACKGROUND: Early plasma transfusion is important in the treatment of patients with major hemorrhage. Prolonged shelf life of AB type frozen -80°C and cold-stored (4°C) deep frozen plasma (DFP) will improve strategic stock management, minimize need for resupply, and make pre-hospital implementation more feasible. METHODS AND MATERIALS: Plasma products type AB of different age and origin (-30°C Fresh Frozen [(FFP], -80°C DFP [short (±1 year) and long (±7 year)] stored) were thawed (Day 0), stored at 4°C, and sampled on Days 7 and 14. Additionally, samples of plasma containing blood products (Octaplas LG®, whole blood and platelets) were compared for coagulation factor activity, phospholipid clotting time (PPL), and kaolin TEG during 4°C or 22°C storage. RESULTS: Coagulation profiles of FFP, short- and long-stored -80°C DFP were not significantly different after thaw. Cold storage did not affect fibrinogen, Protein C, and Antithrombin III activities whereas factor V, VII, VIII, and Protein S decreased in all blood products. After 14 days DFP still meets the guidelines for clinical use, except for Protein S (0.4 IU/mL). With exception of Octaplas LG®, phospholipid activity and TEG coagulation were similar between plasma containing blood components during storage. CONCLUSION: AB DFP quality was unaffected by almost 7 years of frozen storage. Quality of thawed 14-day stored AB DFP met, with exception of Protein S, all minimal guidelines which implies that its quality is sufficient for use in the (pre)-hospital (military) environment for treatment of major hemorrhage.


Assuntos
Transfusão de Componentes Sanguíneos , Preservação de Sangue , Congelamento , Plasma/química , Plasma/metabolismo , Humanos , Fatores de Tempo
9.
Scand J Med Sci Sports ; 30(10): 1827-1845, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32526086

RESUMO

OBJECTIVE: Surgery is the gold standard in the management of chronic exertional compartment syndrome (CECS) of the lower extremity, although recent studies also reported success following gait retraining. Outcome parameters are diverse, and reporting is not standardized. The aim of this systematic review was to analyze the current evidence regarding treatment outcome of CECS in the lower leg. MATERIAL AND METHODS: A literature search and systematic analysis were performed according to the PRISMA criteria. Studies reporting on outcome following treatment of lower leg CECS were included. RESULTS: A total of 68 reports fulfilled study criteria (n =; 3783; age range 12-70 year; 7:4 male-to-female ratio). Conservative interventions such as gait retraining (n =; 2) and botulinum injection (n =; 1) decreased ICP ( x -  =; 68 mm Hg to x -  =; 32 mm Hg) and resulted in a 47% (±42%) rate of satisfaction and a 50% (±45%) rate of return to physical activity. Fasciotomy significantly decreased ICP ( x -  =; 76 mm Hg to x -  =; 24 mm Hg) and was associated with an 85% (±13%) rate of satisfaction and an 80% (±17%) rate of return to activity. Return to activity was significantly more often achieved (P < .01) in surgically treated patients, except in one study favoring gait retraining in army personnel. CONCLUSION: Surgical treatment of CECS in the lower leg results in higher rates of satisfaction and return to activity, compared to conservative treatment. However, the number of studies is limited and the level of evidence is low. Randomized controlled trials with multiple treatment arms and standardized outcome parameters are needed.


Assuntos
Síndrome Compartimental Crônica do Esforço/terapia , Perna (Membro) , Adolescente , Adulto , Idoso , Toxinas Botulínicas Tipo A/administração & dosagem , Criança , Tratamento Conservador/métodos , Fasciotomia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fármacos Neuromusculares/administração & dosagem , Satisfação do Paciente , Pressão , Volta ao Esporte , Resultado do Tratamento , Adulto Jovem
10.
Transfusion ; 60(9): 2079-2089, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32592423

RESUMO

BACKGROUND: Cryopreserved platelet products can be stored for years and are mainly used in military settings. Following thawing, cryopreserved platelets are activated, resulting in faster clot formation but reduced aggregation in vitro, rendering their efficacy in bleeding unknown. Also, concerns remain on the safety of these products. The aim was to investigate the efficacy and safety of cryopreserved platelets in a rat model of traumatic hemorrhage. STUDY DESIGN AND METHODS: After 1 hour of shock, rats (n = 13/group) were randomized to receive a balanced transfusion pack (1:1:1 red blood cell:plasma:platelet) made from syngeneic rat blood, containing either liquid stored platelets or cryopreserved platelets. Primary outcome was the transfusion volume required to obtain a mean arterial pressure (MAP) of 60 mmHg. Secondary outcomes were coagulation as assessed by thromboelastometry (ROTEM®) and organ failure as assessed by biochemistry and histopathology. RESULTS: The transfusion volume to obtain a MAP of 60 mmHg was lower in animals receiving cryopreserved platelets (5.4 [4.1-7.1] mL/kg) compared to those receiving liquid stored platelets (7.5 [6.4-8.5] mL/kg, p < 0.05). ROTEM® clotting times were shorter (45 [41-48] vs. 49 [45-53]sec, p < 0.05), while maximum clot firmness was slightly lower (68 [67-68] vs. 69 [69-71]mm, p < 0.01). Organ failure was similar in both groups. CONCLUSIONS: Use of cryopreserved platelets required less transfusion volume to reach a targeted MAP compared to liquid stored platelets, while organ injury was similar. These results provide a rationale for clinical trials with cryopreserved platelets in (traumatic) bleeding.


Assuntos
Plaquetas , Preservação de Sangue , Criopreservação , Hemorragia , Transfusão de Plaquetas , Ferimentos e Lesões , Animais , Plaquetas/citologia , Plaquetas/metabolismo , Modelos Animais de Doenças , Hemorragia/sangue , Hemorragia/etiologia , Hemorragia/terapia , Masculino , Ratos , Ferimentos e Lesões/sangue , Ferimentos e Lesões/complicações , Ferimentos e Lesões/terapia
11.
World J Surg ; 44(8): 2622-2637, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32377860

RESUMO

BACKGROUND: The Acute Care Surgery (ACS) model was developed as a dedicated service for the provision of 24/7 nontrauma emergency surgical care. This systematic review investigated which components are essential in an ACS model and the state of implementation of ACS models worldwide. METHODS: A literature search was conducted using PubMed, MEDLINE, EMBASE, Cochrane library, and Web of Science databases. All relevant data of ACS models were extracted from included articles. RESULTS: The search identified 62 articles describing ACS models in 13 countries. The majority consist of a dedicated nontrauma emergency surgical service, with daytime on-site attending coverage (cleared from elective duties), and 24/7 in-house resident coverage. Emergency department coverage and operating room access varied widely. Critical care is fully embedded in the original US model as part of the acute care chain (ACC), but is still a separate unit in most other countries. While in most European countries, ACS is not a recognized specialty yet, there is a tendency toward more structured acute care. CONCLUSIONS: Large national and international heterogeneity exists in the structure and components of the ACS model. Critical care is still a separate component in most systems, although it is an essential part of the ACC to provide the best pre-, intra- and postoperative care of the physiologically deranged patient. Universal acceptance of one global ACS model seems challenging; however, a global consensus on essential components would benefit any healthcare system.


Assuntos
Cuidados Críticos/organização & administração , Atenção à Saúde/organização & administração , Modelos Organizacionais , Centro Cirúrgico Hospitalar/organização & administração , Emergências , Serviços Médicos de Emergência/organização & administração , Serviço Hospitalar de Emergência , Europa (Continente) , Humanos , Estados Unidos
12.
Transfus Apher Sci ; 59(3): 102789, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32340813

RESUMO

The Dutch military uses frozen blood products for the treatment of bleeding trauma patients during military deployments. With -80 °C frozen blood products it is possible to follow operational demand while reducing the number of resupply transports and loss of products due to expiration. In this paper lessons learned are described on efficient blood management with -80 °C deep-frozen erythrocytes (DEC).


Assuntos
Bancos de Sangue/normas , Preservação de Sangue/métodos , Criopreservação/métodos , Eritrócitos/metabolismo , Humanos , Militares , Países Baixos
13.
Diving Hyperb Med ; 50(1): 2-7, 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32187611

RESUMO

INTRODUCTION: The Netherlands Maritime Special Operations Forces use closed circuit oxygen rebreathers (O2-CCR), which can cause pulmonary oxygen toxicity (POT). Recent studies demonstrated that volatile organic compounds (VOCs) can be used to detect POT in laboratory conditions. It is unclear if similar VOCs can be identified outside the laboratory. This study hypothesised that similar VOCs can be identified after O2-CCR diving in operational settings. METHODS: Scenario one: 4 h O2-CCR dive to 3 metres' seawater (msw) with rested divers. Scenario two: 3 h O2-CCR dive to 3 msw following a 5 day physically straining operational scenario. Exhaled breath samples were collected 30 min before and 30 min and 2 h after diving under field conditions and analysed using gas chromatography-mass spectrometry (GC-MS) to reconstruct VOCs, whose levels were tested longitudinally using a Kruskal-Wallis test. RESULTS: Eleven divers were included: four in scenario one and seven in scenario two. The 2 h post-dive sample could not be obtained in scenario two; therefore, 26 samples were collected. GC-MS analysis identified three relevant VOCs: cyclohexane, 2,4-dimethylhexane and 3-methylnonane. The intensities of 2,4-dimethylhexane and 3-methylnonane were significantly (P = 0.048 and P = 0.016, respectively) increased post-dive relative to baseline (range: 212-461%) in both scenarios. Cyclohexane was increased not significantly (P = 0.178) post-dive (range: 87-433%). CONCLUSIONS: VOCs similar to those associated with POT in laboratory conditions were identified after operational O2-CCR dives using GC-MS. Post-dive intensities were higher than in previous studies, and it remains to be determined if this is attributable to different dive profiles, diving equipment or other environmental factors.


Assuntos
Pulmão , Adulto , Mergulho , Humanos , Hiperóxia , Países Baixos , Oxigênio
14.
J Spec Oper Med ; 20(1): 81-86, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32203611

RESUMO

BACKGROUND: Early hemorrhage control using resuscitative endovascular balloon occlusion of the aorta (REBOA) can save lives. This study was designed to evaluate the ability to train Quick Response Team Fire Fighters (QRT-FF) to gain percutaneous femoral artery access and place a REBOA catheter in a model, using a comprehensive theoretical and practical training program. METHODS: Six QRT-FF participated in the training. SOF medics from a previous training served as the control group. A formalized training curriculum included basic anatomy and endovascular materials for percutaneous access and REBOA placement. Key skills included (1) preparation of an endovascular toolkit, (2) achieving vascular access in the model, and (3) placement and positioning of REBOA. RESULTS: QRT-FF had significantly better scores compared with medics using endovascular materials (P = .003) and performing the procedure without unnecessary attempts (P = .032). Basic surgical anatomy scores for QRT-FF were significantly better than SOF medics (P = .048). QRT-FF subjects demonstrated a significantly higher overall technical skills point score than medics (P = .030). QRT-FF had a median total time from start of the procedure to REBOA inflation of 3:23 minutes, and medics, 5:05 minutes. All six QRT-FF subjects improved their procedure times-as did four of the five medics. CONCLUSIONS: Our training program using a task training model can be utilized for percutaneous femoral access and REBOA placement training of QRT-FF without prior ultrasound or endovascular experience. Training the use of advanced bleeding control options such as REBOA, as a secondary occupational task, has the potential to improve outcomes for severely bleeding casualties in the field.


Assuntos
Bombeiros/educação , Hemorragia/prevenção & controle , Aorta , Oclusão com Balão , Cateterismo Periférico , Procedimentos Endovasculares , Estudos de Viabilidade , Artéria Femoral , Humanos , Avaliação de Programas e Projetos de Saúde , Ressuscitação
16.
Injury ; 51(4): 892-896, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32093945

RESUMO

BACKGROUND: Optimal health is demanded for service members in military operations. However, the strains of deployment can result in a deterioration, moreover when combat-related injuries are sustained, affecting level of participation and health related quality of life (HRQOL). Secondary health conditions may occur in time, however existing studies measure coping, level of activity and participation and HRQOL at one point in time. AIM: To assess the change over time concerning coping, mobility, level of participation and HRQOL in Dutch service members with combat-related injuries sustained during operation Task Force Uruzgan (TFU). METHODS: The lower extremity functional scale (LEFS), the cognitive emotion regulation questionnaire (CERQ), the assessment of life habits short version (LIFE-H) and the EuroQol-5D (EQ-5D), measuring HRQOL, were administered in 2010 and 2014. Change of scores between the two time points was tested with the Wilcoxon signed rank test. RESULTS: The response rate was 53% (28/53). The score on the coping strategy self-blame showed a significant increase over time with low scores on both occasions. The coping strategies positive reappraisal and acceptance showed the highest scores. No significant change is shown in mobility, the level of participation or HRQOL. CONCLUSION: service members with combat-related injuries remain stable in level of activity and participation and HRQOL in time and they use adaptive coping strategies.


Assuntos
Adaptação Psicológica , Militares/psicologia , Qualidade de Vida/psicologia , Ferimentos e Lesões/psicologia , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Países Baixos , Inquéritos e Questionários , Guerra/psicologia , Ferimentos e Lesões/reabilitação , Adulto Jovem
17.
J Vasc Surg ; 71(2): 682-692.e1, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32040434

RESUMO

BACKGROUND: Diabetic foot ulcers (DFUs) are frequently associated with peripheral arterial occlusive disease (PAOD) and may ultimately lead to amputations of the lower extremity. Adjuvant hyperbaric oxygen treatment (HBOT) might foster better wound healing and lower amputation rates in patients with DFU and PAOD. A systematic review was conducted to assess the effects of HBOT as an adjunctive therapy to standard treatment for patients with DFUs with PAOD. METHODS: Systematic review using the MEDLINE, EMBASE, and Cochrane CENTRAL databases (from inception to October 2018). All original, comparative studies on the effect of HBOT on DFUs with PAOD were eligible. The primary outcome measures were amputation rate, amputation-free survival, complete ulcer healing, and mortality. RESULTS: Eleven studies, totaling 729 patients, were included for analysis, including 7 randomized clinical trials, 2 controlled clinical trials, and 2 retrospective cohorts. Four were used for quantitative synthesis. Meta-analysis showed a significantly fewer major amputations in the HBOT group (10.7% vs 26.0%; risk difference, -15%; 95% confidence interval [CI], -25 to -6; P = .002; number needed to treat, 7; 95% CI, 4-20). No difference was found for minor amputations (risk difference, 8%; 95% CI, -13 to 30; P = .46). Three studies reporting on complete wound healing showed contrasting results. No significant difference was found for mortality or amputation-free survival. CONCLUSIONS: Current evidence shows that adjuvant HBOT improves major amputation rate, but not wound healing, in patients with DFUs and PAOD. Given the wide range of patients included in the trials, better patient selection may help define which patients with DFUs and PAOD benefit most from HBOT as standard adjunctive treatment.


Assuntos
Arteriopatias Oclusivas/complicações , Pé Diabético/complicações , Pé Diabético/terapia , Oxigenação Hiperbárica , Doença Arterial Periférica/complicações , Humanos
18.
Injury ; 51(1): 70-75, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31400810

RESUMO

BACKGROUND: Recent terrorist attacks and mass shooting incidents in major European and North American cities have shown the unexpected influx of large volumes of patients with complex multi-system injuries. The rise of subspecialisation and the low violence-related penetrating injuries among European cities, show the reality that most surgical programs are unable to provide sufficient exposure to penetrating and blast injuries. The aim of this study is to describe and create a collaborative program between a major South African trauma service and a NATO country military medical service, with synergistic effect on both partners. This program includes comprehensive cross-disciplinary training & teaching, and scientific research. METHODS: This is a retrospective descriptive study. The Pietermaritzburg hospital and Netherlands military trauma register databases were used for analysing patient data: Pietermaritzburg between September 2015 and August 2016, Iraq between May and July 2018 and Afghanistan from 2006 to 2010. Interviews were held to analyse the mutual benefits of the program. RESULTS: From the Pietermaritzburg study, mutual benefits focus on social responsibility, exchange of knowledge and experience and further mutual exploration. The comparison showed the numbers of surgical procedures over a one-month period performed in Iraq 12.7, in Afghanistan 68.8 and in Pietermaritzburg 152. CONCLUSION: This study has shown a significant volume of penetrating trauma in South Africa, that can provide substantial exposure over a relatively short period. This help to prepare civilian and military surgeons and deployable military medical personnel for casualties with blast - and/or penetrating injuries. The aforementioned findings and the willingness to shape the mutual benefits, create a platform for trauma electives, research, education and training.


Assuntos
Medicina Militar/educação , Militares , Traumatismo Múltiplo/cirurgia , Cirurgiões/educação , Traumatologia/educação , Ferimentos Penetrantes/cirurgia , Europa (Continente) , Humanos , Incidência , Traumatismo Múltiplo/epidemiologia , Estudos Retrospectivos , África do Sul/epidemiologia , Ferimentos Penetrantes/epidemiologia
19.
Wound Repair Regen ; 28(2): 266-275, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31667898

RESUMO

Diabetic foot ulcers are a common complication of diabetes, which affects 25% of patients and may ultimately lead to amputation of affected limbs. Research suggests hyperbaric oxygen therapy improves healing of these ulcers. However, this has not been reflected in previous reviews, possibly because they did not differentiate between patients with and without peripheral arterial occlusive disease. Therefore, we performed a systematic review of published literature in the MEDLINE, Embase, and Cochrane CENTRAL databases on nonischemic diabetic foot ulcers with outcome measures including complete ulcer healing, amputation rate (major and minor), and mortality. Seven studies were included, of which two were randomized clinical trials. Two studies found no difference in major amputation rate, whereas one large retrospective study found 2% more major amputations in the hyperbaric oxygen group. However, this study did not correct for baseline differences. Two studies showed no significant difference in minor amputation rate. Five studies reporting on complete wound healing showed no significant differences. In conclusion, the current evidence suggests that hyperbaric oxygen therapy does not accelerate wound healing and does not prevent major or minor amputations in patients with a diabetic foot ulcer without peripheral arterial occlusive disease. Based on the available evidence, routine clinical use of this therapy cannot be recommended. However, the available research for this specific subgroup of patients is scarce, and physicians should counsel patients on expected risks and benefits. Additional research, focusing especially on patient selection criteria, is needed to better identify patients that might profit from this therapy modality.


Assuntos
Pé Diabético/terapia , Oxigenação Hiperbárica , Cicatrização , Amputação , Pé Diabético/complicações , Pé Diabético/fisiopatologia , Humanos , Isquemia/complicações , Isquemia/fisiopatologia , Doença Arterial Periférica/complicações , Doença Arterial Periférica/fisiopatologia , Resultado do Tratamento
20.
Emerg Med J ; 37(2): 65-72, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31831587

RESUMO

OBJECTIVES: Massive transfusion protocols (MTPs) may improve survival in patients with uncontrolled haemorrhage. An MTP was introduced into the Dutch transfusion guidelines in 2011, the ninth edition of the advanced trauma life support course in 2012 and the third version of the European guideline in 2013. This is the first survey of MTPs in Dutch trauma centres. METHODS: The aim of the study was to compare MTP strategies in level 1 trauma centres in The Netherlands, and with (inter)national guidelines. A contact in each government assigned level 1 trauma centre in The Netherlands and the Dutch Ministry of Defence was approached to share their MTPs and elucidate their protocol in a survey and oral follow-up interview. RESULTS: All 11 level 1 trauma centres responded. The content of the packages and transfusion ratios (red blood cells/plasma/platelets) were 3:3:1, 5:5:1, 5:3:1, 2:3:1, 4:4:1, 5:2:1, 2:2:1 and 4:3:1. Tranexamic acid was used in all centres and an additional dose was administered in eight centres. Fibrinogen was given directly (n=4), with persistent bleeding (n=3), based on Clauss fibrinogen (n=3) or rotational thromboelastometry (n=1). All centres used additional medication in patients in the form of anticoagulants, but their use was ambiguous. CONCLUSION: MTPs differed between institutes and guidelines. The discrepancies in transfusion ratios can be explained by (inter)national differences in preparation and volume of blood components and/or interpretation of the '1:1:1' guideline. We recommend updating MTPs every year using the latest guidelines and evaluating the level of evidence for treatment during massive transfusion.


Assuntos
Transfusão de Sangue/métodos , Protocolos Clínicos/normas , Adulto , Transfusão de Sangue/instrumentação , Feminino , Hemorragia/terapia , Humanos , Masculino , Países Baixos , Ressuscitação/métodos , Inquéritos e Questionários
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