Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.448
Filtrar
1.
Rev Bras Epidemiol ; 23: e200015, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159626

RESUMO

OBJECTIVE: To study associated factors with loss productivity in people involved road traffic accidents (RTA). METHODS: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. RESULTS: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). CONCLUSION: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Efeitos Psicossociais da Doença , Eficiência , Licença Médica/estatística & dados numéricos , Ferimentos e Lesões/economia , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Licença Médica/economia , Índices de Gravidade do Trauma , Ferimentos e Lesões/etiologia
2.
Medicine (Baltimore) ; 99(9): e19305, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118750

RESUMO

BACKGROUND: Numerous reports in the media have suggested that children could be hurt due to their clothing, yet there are few medical reports that discussed children's clothing-related injuries. This study therefore, aimed to describe the epidemiological characteristics of media-reported injury cases related to children's clothing in Mainland of China. METHODS: This study systematically collected a total of 192 cases of children's clothing-related injuries reported in the news reports and medical literatures published by the Chinese media before December 2017. A content analysis of these cases was conducted to obtain information on the characteristics of these injuries. RESULTS: Cases of clothing-related injuries were most common in children aged 3 to 6 years (54.7%); the ratio of the number of boys to the number of girls in the 192 cases was 1.5: 1. In addition, approximately 51% of the cases occurred in the region of East China. The most common location of the incidents was in the home (35%). Furthermore, the zippers are the most common cause of injuries (15.1%), and the most common injured body part was the genital organs (29.2%). Besides, there were 24 cases reported death related to clothing injuries (13%). Moreover, the locations where the injuries occurred, the reasons for the occurrence of the injuries and the injured body parts differed significantly by gender and age (P < .05). CONCLUSIONS: Our findings suggest that future unintentional injuries could be prevented by implementing 2 major initiatives: improving the promotion of the safety of children clothing design in China and educating consumers on the potential risk associated with children's clothing.


Assuntos
Vestuário/estatística & dados numéricos , Meios de Comunicação de Massa/estatística & dados numéricos , Ferimentos e Lesões/etiologia , Adolescente , Criança , Pré-Escolar , China/epidemiologia , Vestuário/efeitos adversos , Feminino , Humanos , Masculino , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia
3.
Medicine (Baltimore) ; 99(1): e18567, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895799

RESUMO

We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ±â€Š17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ±â€Š89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.


Assuntos
Acidentes de Trânsito/mortalidade , Traumatismos Craniocerebrais/mortalidade , Pedestres/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Adulto , Idoso , Pequim/epidemiologia , Traumatismos Craniocerebrais/etiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/etiologia
4.
Ann R Coll Surg Engl ; 102(1): 36-42, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31660752

RESUMO

INTRODUCTION: The temporal patterns and unit-based distributions of trauma patients requiring surgical intervention are poorly described in the UK. We describe the distribution of trauma patients in the UK and assess whether changes in working patterns could provide greater exposure for operative trauma training. METHODS: We searched the Trauma Audit and Research Network database to identify all patients between 1 January 2014 to 31 December 2016. Operative cases were defined as all patients who underwent laparotomy, thoracotomy or open vascular intervention. We assessed time of arrival, correlations between mechanism of injury and surgery, and the effect of changing shift patterns on exposure to trauma patients by reference to a standard 10-hour shift assuming a dedicated trauma rotation or fellowship. RESULTS: There were 159,719 patients from 194 hospitals submitted to the Network between 2014 and 2016. The busiest 20 centres accounted for 57,568 (36.0%) of cases in total. Of these 2147/57,568 patients (3.7%) required a general surgical operation; 43% of penetrating admissions (925 cases) and 2.2% of blunt admissions (1222 cases). The number of operations correlated more closely with the number of penetrating rather than blunt admissions (r = 0.89 vs r = 0.51). A diurnal pattern in trauma admissions enabled significant increases in trauma exposure with later start times. CONCLUSIONS: Centres with high volume and high penetrating rates are likely to require more general surgical input and should be identified as locations for operative trauma training. It is possible to improve the number of trauma patients seen in a shift by optimising shift start time.


Assuntos
Educação de Pós-Graduação em Medicina/métodos , Cirurgia Geral/educação , Admissão do Paciente/estatística & dados numéricos , Traumatologia/educação , Ferimentos e Lesões/etiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra , Feminino , Hospitais com Alto Volume de Atendimentos , Humanos , Irlanda , Masculino , Pessoa de Meia-Idade , Admissão e Escalonamento de Pessoal/organização & administração , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Estudos Retrospectivos , Jornada de Trabalho em Turnos/estatística & dados numéricos , Fatores de Tempo , Centros de Traumatologia/organização & administração , Centros de Traumatologia/estatística & dados numéricos , País de Gales , Local de Trabalho/organização & administração , Local de Trabalho/estatística & dados numéricos , Ferimentos e Lesões/cirurgia
5.
Accid Anal Prev ; 134: 105336, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31704640

RESUMO

Electric two-wheelers (E2Ws) have become newly popular transportation tools with the associated growing traffic safety concerns. E2W riders and bicyclists behave similarly as vulnerable road users (VRUs), while exhibited dissimilarities in riding postures and interactions with the two-wheelers. Existing epidemiology reveals prominent differences in injury risks between E2W riders and other vulnerable road users in collisions with motor vehicles. The objective of this study is to investigate the factors influencing kinematics and head injury risks of two-wheeler rides in two-wheeler-vehicle collisions and compare between E2W-vehicle and bicycle-vehicle collisions. Via multi-body modeling of two two-wheeler types, two vehicle types, and three rider statures in MADYMO, twelve collision scenarios were developed. A simulation matrix considering a range of impact velocities and relative positions was performed for each scenario. A subsequent parametric analysis was conducted with focus on the kinematics and head injury risks of two-wheeler riders. Results show that the head injury risk increased with vehicle moving velocity, while the two-wheeler velocity and relative location between rider and vehicle prior to the collision exhibited highly non-linear influence on the kinematical response. The rider with larger stature had higher possibilities to miss head impact on the vehicle. In collisions with the sedan, E2W riders would sustain lower head injury risks with lower contacting velocity on the windshield than bicyclists. While in collisions with the SUV, E2W riders would sustain increasing head injury risks due to the higher structural stiffness at contact, and the risk level was about the same as bicyclists. The findings revealed the loading mechanisms behind the different head injury risks between E2W riders and bicyclists.


Assuntos
Acidentes de Trânsito , Ciclismo/lesões , Motocicletas , Ferimentos e Lesões/etiologia , Fenômenos Biomecânicos , Simulação por Computador , Feminino , Humanos , Masculino , Medição de Risco , Segurança , Ferimentos e Lesões/prevenção & controle
6.
Pan Afr Med J ; 33: 215, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692769

RESUMO

Introduction: Pediatric traumatic injury is a major public health concern that is poorly documented in lower and middle-income countries. This study analyzed data on pediatric injuries from a unique hospital trauma registry in Abuja, Nigeria. Methods: Data were analyzed on 220 traumatically injured patients aged 21 years/less to describe injury characteristics and to determine the association between mechanism of injury and pediatric head injuries in Abuja, Nigeria, between 2014 and 2015. Bivariate analysis using Pearson's chi-square and adjusted logistic regression were conducted to characterize the population and identify risk factors for head injury. P-values<0.05 were considered statistically significant. All statistical analyses were performed using STATA v.15.1. Results: The majority of patients were male (60.9%) with a mean age (SD) of 12.5±6.9 years. Head injuries were most common (49.6%), followed by chest (14.1%), abdomen (12.3%) and back (7.7%). The mechanism of injury was statistically significantly associated with head injury (p=0.027) with 63% of children in a motor vehicle accident sustaining a head injury. After adjusting for covariates, the odds of head injury were 3.8 times higher for children injured in a motor vehicle accidents (MVA) compared to those with falls (95%CI 1.40-10.40). Conclusion: This analysis reveals that motor vehicle accident is a risk factor for traumatic head injury among children in Nigeria. Therefore, efforts should be made to address motor vehicle accidents involving children. These data will help to inform age-related prevention and treatment strategies. The results of this study highlight the importance of collecting pediatric trauma data in developing countries.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Acidentes de Trânsito/estatística & dados numéricos , Traumatismos Craniocerebrais/epidemiologia , Ferimentos e Lesões/epidemiologia , Adolescente , Criança , Pré-Escolar , Traumatismos Craniocerebrais/etiologia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Nigéria/epidemiologia , Sistema de Registros , Fatores de Risco , Ferimentos e Lesões/etiologia , Adulto Jovem
7.
Wilderness Environ Med ; 30(4): 362-368, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31668938

RESUMO

INTRODUCTION: With the growing enthusiasm from people of all ages about rock climbing and bouldering, adaptions and medical conditions of the older athlete have become increasingly important. We aimed to analyze injury demographics, distribution, and severity for the older rock-climbing athlete. METHODS: During a 3-y period, we performed a single-center injury surveillance in athletes ≥35 y of age presenting with rock climbing-related injuries or complaints. A standard questionnaire and examination protocol were conducted. RESULTS: A total of 198 patients (age 44.2±7.1 [35-77] y) (mean±SD, with range) with 275 independent injuries were recorded. Ninety percent of all injuries affected the upper extremity, 6% the lower extremity, and 4% other body regions. The Union Internationale des Associations d'Alpinisme injury scores were 2.0±0.3 (1-4), and no fatalities occurred. Acute injuries were observed in 32% and overuse injuries in 68% of all injuries. Among the overuse injuries, 47% were classified as degenerative overuse conditions. Athlete age did not significantly correlate with the development of overuse injuries and UIAA injury score, but subgroup analysis showed a weak correlation of the climber age with the development of degenerative conditions (P<0.05). The leading diagnosis of degenerative conditions was subacromial impingement syndrome of the shoulder. CONCLUSIONS: Compared to younger athletes, older rock climbers demonstrate a higher proportion of overuse injuries, especially degenerative conditions. Profound knowledge of climbing injuries patterns and conditions in older rock climbers is crucial to prevent injuries among all age groups and to decrease the number of degenerative injuries.


Assuntos
Traumatismos em Atletas/etiologia , Extremidade Inferior/lesões , Recreação , Extremidade Superior/lesões , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/patologia , Adulto , Humanos , Masculino , Pessoa de Meia-Idade , Pelve/lesões , Traumatismos da Coluna Vertebral/patologia
9.
Braz J Med Biol Res ; 52(11): e8567, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31721905

RESUMO

The aim of this study was to explore the analgesic effect of local application of compound lidocaine/prilocaine cream on cancer wounds during wound care in order to reduce the amount of morphine intake or completely replace the systemic morphine administration and optimize the protocol for cancer wound pain management. All patients were enrolled with a visual analog scale (VAS) pain score ≥4. Before wound care, 60 patients were randomly divided into 2 groups of 30 each: morphine group (10 mg tablet); topical 5% compound lidocaine cream group (0.2 g/cm2). VAS scores, heart rate, and Kolcaba comfort level were recorded for the two groups 10 min before and 10, 15, 20, and 25 min after wound care and data were analyzed statistically. The means for the pain score and heart rate of the topical lidocaine/prilocaine cream group were lower than those of the morphine group (P<0.01) and the Kolcaba comfort level was higher (P<0.01). Local dermal application of the compound lidocaine cream can be used as an alternative to the systemic morphine administration in cancer wound care for its safety and effectiveness. In addition, it can improve the patients' comfort and quality of life.


Assuntos
Anestésicos Combinados/administração & dosagem , Combinação Lidocaína e Prilocaína/administração & dosagem , Neoplasias/complicações , Manejo da Dor/métodos , Ferimentos e Lesões/tratamento farmacológico , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Qualidade de Vida , Resultado do Tratamento , Ferimentos e Lesões/etiologia
11.
Am Surg ; 85(11): 1281-1287, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775972

RESUMO

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study (P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group (P = 0.0002); motorized recreational vehicle (P = 0.028), violent (P = 0.009), and other (P = 0.0374) mechanism of injury categories; ambulance (P = 0.0124), fixed wing (P = 0.0028), and personal-owned vehicle (P = 0.0112) modes of transportation. Decreased public injuries (P = 0.0071) and advanced life support ambulance transportation (P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.


Assuntos
Escala de Gravidade do Ferimento , Centros de Cuidados de Saúde Secundários/normas , Centros de Traumatologia/normas , Ferimentos e Lesões/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , North Dakota/epidemiologia , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Distribuição por Sexo , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/etiologia
12.
Rev Esp Salud Publica ; 932019 Nov 15.
Artigo em Espanhol | MEDLINE | ID: mdl-31719516

RESUMO

OBJECTIVE: Traffic accidents constitute a public health problem and are the leading cause of accidental death in the world. Analyze if the type of accident, the age of the victim or the attention provided by the emergency medicalized units (UME) are related to the morbidity and mortality due to traffic accidents in Extremadura (Spain) during the years 2012, 2013, 2014 and 2015. METHODS: Descriptive study of the information in the records of the emergency response coordination center 112. A multivariate analysis was carried out. The prognostic status was introduced as a dependent variable and the type of accident, the age of the accident. RESULTS: The type of accident [odds ratio (OR)=1.745; 95% confidence interval (95% CI=1.488-2.045), the victim's age (OR=1.016; 95% CI=1.013-1.020), UME 4-3 (OR=4.304; 95% CI=2.158-8.587), UME 4-1 (OR=2.463; 95% CI=1.414-4.291) and UME 1-4 (OR=1.990; 95% CI=1.052-3.762) are related to the prognostic status of the victims. CONCLUSIONS: Inter-urban traffic accidents, the victim's age and three UME influence the prognostic status of the victims.


Assuntos
Acidentes de Trânsito/mortalidade , Ferimentos e Lesões/etiologia , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Espanha/epidemiologia , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
13.
Rev Esp Salud Publica ; 932019 Nov 15.
Artigo em Espanhol | MEDLINE | ID: mdl-31719517

RESUMO

OBJECTIVE: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain. METHODS: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads. RESULTS: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks. CONCLUSIONS: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers.


Assuntos
Acidentes de Trânsito/economia , Redução de Custos/estatística & dados numéricos , Saúde da População Urbana/economia , Ferimentos e Lesões/economia , Prevenção de Acidentes/economia , Prevenção de Acidentes/métodos , Acidentes de Trânsito/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Condução de Veículo/estatística & dados numéricos , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Fatores de Risco , Espanha/epidemiologia , Saúde da População Urbana/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto Jovem
14.
Nursing ; 49(10): 32-39, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31568079

RESUMO

The clinical nurse may be the first caregiver to assess changes in a patient's skin and initiate wound care. This article provides practical guidelines that any nurse can implement.


Assuntos
Guias de Prática Clínica como Assunto , Higiene da Pele/enfermagem , Ferimentos e Lesões/enfermagem , Administração Tópica , Humanos , Avaliação em Enfermagem , Ferimentos e Lesões/etiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-31569612

RESUMO

Although comorbidities are prevalent in older people experiencing falls, there is a lack of studies examining their influence on health-related quality of life (HRQOL) in this population. This study examines the prevalence of comorbidities and associations between comorbidities and HRQOL in older patients after falls in Vietnamese hospitals. A cross-sectional design was employed among 405 older patients admitted to seven hospitals due to fall injuries in Thai Binh province, Vietnam. The EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) was used to measure HRQOL. Socio-demographic characteristics were collected using a structured questionnaire, while comorbidities and other clinical characteristics were examined by physicians and extracted from medical records. Multivariate Tobit regression was used to determine the associations between comorbidities and HRQOL. Among 405 patients, 75.6% had comorbidities, of which hypertension and osteoarthritis were the most common. Lumbar spine/cervical spine diseases (Coefficient (Coef.) = -0.10; 95%CI = -0.18; 0.03) and stroke (Coef. = -0.36; 95%CI = -0.61; -0.10) were found to be associated with a significantly decreased EQ-5D index. Participants with three comorbidities had EQ-5D indexes 0.20 points lower (Coef. = -0.20; 95%CI = -0.31; -0.09) in comparison with those without comorbidities. This study underlined a significantly high proportion of comorbidities in older patients hospitalized due to fall injuries in Vietnam. In addition, the existence of comorbidities was associated with deteriorating HRQOL. Frequent monitoring and screening comorbidities are critical to determining which individuals are most in need of HRQOL enhancement.


Assuntos
Acidentes por Quedas , Doença Crônica/epidemiologia , Qualidade de Vida , Ferimentos e Lesões/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Estudos Transversais , Feminino , Indicadores Básicos de Saúde , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Vietnã/epidemiologia , Ferimentos e Lesões/etiologia
16.
BMC Surg ; 19(1): 136, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519173

RESUMO

OBJECTIVES: The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. We also provide an algorithm for the selection of these flap variants for sternoclavicular defect reconstruction. METHODS: EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to August of 2019. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures. RESULTS: The study included 6 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the thoracoacromial artery (type 3a) or the deltoid branch of the thoracoacromial artery (type 3b). CONCLUSION: There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system, the Opoku Classification will help surgeons select the appropriate configuration of the pectoralis major flap for sternoclavicular joint defect reconstruction based on size of defect, the status of the vascular anatomy, and acceptability of upper extremity disability. It will also help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.


Assuntos
Músculos Peitorais/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Ferimentos e Lesões/cirurgia , Algoritmos , Clavícula/cirurgia , Humanos , Osteomielite/cirurgia , Músculos Peitorais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/classificação , Esterno/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Parede Torácica/cirurgia , Ferimentos e Lesões/etiologia
17.
Fa Yi Xue Za Zhi ; 35(4): 433-436, 2019 Aug.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-31532152

RESUMO

Abstract: Objective To investigate the characteristics and patterns of factors such as victims' information, injury tools and time of occurrence of intentional injury cases in southwest China. Methods One thousand three hundred and forty intentional injury cases from several places in southwest China from 2014 to 2016 assessed as minor injury level Ⅱ and above had been randomly selected. Data on victims' information, motives, injury tools, sites of occurrence, time of occurrence, injured parts and degrees of injury were classified and gathered, and then association analyses of motives and types of injury tools as well as degrees of injury and injury tools were made. Results Most of the victims were young adults between 20-50 years (65.2%), male (82.3%), rural household registration (62.8%); the motives were mainly dispute (45.8%). Injury tools were mostly blunt (54.6%) or sharp (36.0%). Specifically, injuries were mostly made bare-handed (36.9%) and by cutting tools (33.2%); the cases mainly occurred in public areas (59.0%). Cases occurred more frequently in January (11.3%), February (13.1%), March (11.6%) and from 22:00 to 01:00 every night. Injuries mainly involved the craniofacial region. The wounds were mainly assessed as minor injury level Ⅱ (61.6%). There was statistical significance in the difference of types of injury tools among cases with different motives (P<0.05). There was statistical significance in the difference of the distribution of injury tools among cases with different degrees of injury (P<0.05). Conclusion The occurrence of intentional injury cases in southwest China has potential patterns and relevant influencing factors. Prevention and analysis of such cases need to be comprehensively considered from the aspects such as victims' information, injury tools and time of occurrence.


Assuntos
Motivação , Violência , Ferimentos e Lesões/etiologia , Adulto , Distribuição por Idade , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Distribuição por Sexo , Ferimentos e Lesões/diagnóstico , Adulto Jovem
18.
BMJ Case Rep ; 12(9)2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511266

RESUMO

Splenic rupture secondary to colonoscopy is a rare but potentially fatal complication. Given the disparity between the small number of case reports with the incidence reported by some investigators, we contend that the former is not representative of the true extent of this sequela. We present a case report of postcolonoscopy splenic rupture, where the patient had a bizarre initial presentation of chest pain and collapse; and only developed haemodynamic instability and abdominal pain on day 2 postprocedure. Diagnosis was made with a CT scan, and resolution of symptoms was achieved with a splenectomy.


Assuntos
Colonoscopia/efeitos adversos , Baço/lesões , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Idoso , Humanos , Incidência , Masculino , Ferimentos e Lesões/diagnóstico
19.
Accid Anal Prev ; 132: 105287, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31514085

RESUMO

BACKGROUND: Rollover crashes of buses occur less frequently than do those involving passenger cars; however, they are associated with higher fatality rates. During rollover crashes, a vehicle experiences multidirectional acceleration and multiple impacts, yielding a complex interaction between structural components and its occupants. A better understanding of vehicle and occupant's motion, structural deformation, and vehicle and road interactions are necessary to improve the safety of the occupants during this event. One of the key factors in rollover crashworthiness assessment is to investigate the relationship between the strength of the vehicle's structure and the risk of injury outcomes. However, rollover crashes involving buses have received less research attention than have those involving passenger cars. Experimental studies in bus rollover safety have mainly focused on the structural integrity of the passenger compartment without considering the occupant responses. The main goal of this research is to evaluate the rollover mechanism and associated injury risk during two experimental rollover tests for a paratransit cutaway bus that is commonly used by transit agencies. METHODS: The modified dolly rollover (MDR) and tilt table (TT) tests were conducted using a similar bus and anthropomorphic test device (ATD) configurations. In each test, a 2-point and 3-point belted Hybrid III 50th percent male ATDs were used to quantify the kinematics of the occupants. The deformation index (DI), accelerations and angular velocities of the bus's CG were measured as vehicle responses. The collected data were then calibrated and filtered to assess the effects of the test procedure on kinematic responses of the vehicle and occupants. Next, the effectiveness of the 2-point vs 3-point seatbelt to reduce or prevent the injuries, the vulnerable body regions and corresponded injury risk were evaluated. RESULTS: The residual space remained intact (DI < 1) during both rollover tests, however, the ATD responses were quite different. The results of the injury assessment indicate that the risk of the injuries in the MDR test was significantly higher than the TT test. The highest risk of injuries was identified for the head, neck, and shoulder of 2-point belted ATD during the MDR test. Also, the main source of injuries during the MDR test was partial ejection due to the shattered side window, whereas for the TT test impacts between the ATDs and the side window and/or window frame were the injury causes. From the vehicle point of view, the total energy produced in the MDR was 3.5 times higher than the TT test, but the overall structural deformation in the TT test was higher than MDR test. Overall, the tilt table test provides a more severe scenario compared to the MDR test for the assessment of structural strength. Considering the limited real-world injury data in rollover crashes of buses, the MDR test presented the more realistic occupant responses.


Assuntos
Acidentes de Trânsito/prevenção & controle , Veículos Automotores , Ferimentos e Lesões/etiologia , Acidentes de Trânsito/estatística & dados numéricos , Humanos , Medição de Risco , Cintos de Segurança/estatística & dados numéricos , Ferimentos e Lesões/prevenção & controle
20.
Br J Community Nurs ; 24(Sup9): S19-S23, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31479334

RESUMO

Malignant wounds are a complication of cancer, and usually occur in those individuals with advanced disease. When healing ceases to be the goal, treatment is centred around symptom control and improving quality of life. Caring for individuals with malignant wounds presents challenges for patients, their families and nurses alike. This article discusses the holistic management of malignant wounds, with an emphasis on the control of both physical and psychosocial symptoms of wound management, as well as the impact that this may have on all those involved. Common physical symptoms of malignant wounds include malodour, bleeding, pain, exudate and pruritis. Psychosocial symptoms may result in social isolation and depression. All these symptoms have a huge impact, not only on patients and their families, but also on healthcare professionals both during and after care. Managing these symptoms requires a multidisciplinary approach to facilitate the best possible outcomes for patients and their caregivers.


Assuntos
Saúde Holística , Enfermagem de Cuidados Paliativos na Terminalidade da Vida/métodos , Neoplasias/enfermagem , Manejo da Dor/métodos , Ferimentos e Lesões/enfermagem , Carvão Vegetal , Depressão/psicologia , Exsudatos e Transudatos , Hemorragia/etiologia , Hemorragia/enfermagem , Humanos , Neoplasias/complicações , Odorantes , Dor/enfermagem , Prurido/etiologia , Prurido/enfermagem , Qualidade de Vida , Isolamento Social/psicologia , Ferimentos e Lesões/etiologia , Ferimentos e Lesões/psicologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA