共查询到20条相似文献，搜索用时 31 毫秒
1.
Sandra Cristina Pillon Kelly Graziani Giacchero Vedana Jessica Adrielle Teixeira Leonardo Afonso dos Santos Roberto Molina de Souza Alessandra Diehl Goolam Hussein Rassool Adriana Inocenti Miasso 《Archives of Psychiatric Nursing》2019,33(1):70-76
Aim
To investigate the prevalence of depressive symptoms, psychological problems, suicidal behaviour and their associations in substance users in treatment.Methods
A cross-sectional study, with 307 substance users in an out-patient treatment facility, was undertaken. Socio-demographic data, psychoactive substances used, depressive symptoms, and suicide information were obtained.Results
70% of participants were depressed; of those, 8.1% were either under the influence of drugs or in withdrawal. Suicidal ideation was found to be present in those who had anxiety, were nervous, had depressive symptoms, or were under drug influence or in withdrawal.Conclusion
It is important to identify potential suicidal risk factors and implement the management of these conditions in substance users. 相似文献2.
Yosuke Homma Takashi Shiga Hiraku Funakoshi Dai Miyazaki Atsushi Sakurai Yoshio Tahara Ken Nagao Naohiro Yonemoto Arino Yaguchi Naoto Morimura 《The American journal of emergency medicine》2019,37(2):241-248
Objective
This study assessed the association between the timing of first epinephrine administration (EA) and the neurological outcomes following out-of-hospital cardiac arrests (OHCAs) with both initial shockable and non-shockable rhythms.Methods
This was a post-hoc analysis of a multicenter prospective cohort study (SOS-KANTO 2012), which registered OHCA patients in the Kanto region of Japan from January 2012 to March 2013. We included consecutive adult OHCA patients who received epinephrine. The primary result included 1-month favorable neurological outcomes defined as cerebral performance category (CPC) 1 or 2. Secondary results included 1-month survival and return of spontaneous circulation (ROSC) after arrival at the hospital. Multivariable logistic regression analysis determined the association between delay per minute of the time from call to first EA in both pre- or in-hospital settings and outcomes.Results
Of the 16,452 patients, 9344 were eligible for our analyses. In univariable analysis, the delay in EA was associated with decreased favorable neurological outcomes only when the initial rhythm was a non-shockable rhythm. In multivariable analyses, delay in EA was associated with decreased ROSC (adjusted odds ratio [OR] for one minute delay, 0.97; 95% confidence interval [CI], 0.96–0.98) and 1-month survival (adjusted OR, 0.95; 95% CI, 0.92–0.97) when the initial rhythm was a non-shockable rhythm, whereas during a shockable rhythm, delay in EA was not associated with decreased ROSC and 1-month survival.Conclusions
While assessing the effectiveness of epinephrine for OHCA, we should consider the time-limited effects of epinephrine. Additionally, consideration of early EA based on the pathophysiology is needed. 相似文献3.
Hannah Kempton Ruan Vlok Christopher Thang Thomas Melhuish Leigh White 《The American journal of emergency medicine》2019,37(3):511-517
Introduction
Out of hospital cardiac arrest (OHCA) is a time critical and heterogeneous presentation. The most appropriate management strategies remain an issue for debate. The aim of this systematic review and meta-analysis was to determine the association of epinephrine versus placebo with return of spontaneous circulation, survival to hospital admission, survival to hospital discharge and neurological outcomes in out of hospital cardiac arrest.Methods
A systematic review of five databases was performed from inception to August 2018. Only randomised controlled trials were considered eligible for inclusion. The primary outcome was survival to hospital discharge. Secondary outcomes were ROSC, survival to hospital admission, neurological function on discharge and three-month survival. All studies were assessed for level of evidence and risk of bias.Results
Five randomised controlled trials with 17,635 patients were identified for inclusion. Use of epinephrine was associated with increased ROSC (OR?=?3.10; 95% CI?=?2.16 to 4.45; I2?=?74%; p?<?0.0001) and increased survival to hospital admission OR?=?2.52; 95% CI?=?1.63 to 3.88; I2?=?94%; p?<?0.0001). However, epinephrine was not associated with increased survival to discharge (OR?=?1.09; 95% CI?=?0.48 to 2.47; I2?=?77%; p?=?0.84) or differences in neurological outcomes (OR?=?0.81; 95% CI?=?0.34 to 1.96).Discussion
This study was a systematic review and meta-analysis of epinephrine versus placebo in OHCA. The use of epinephrine was associated with improved ROSC and survival to hospital admission. However, use of epinephrine was not associated with a significant difference in survival to hospital discharge, neurological outcomes or survival to 3?months. Further research is required to control for the confounders during inpatient management. 相似文献4.
Guillaume Gantois Erika Parmentier-Decrucq Thibault Duburcq Raphaël Favory Daniel Mathieu Julien Poissy 《The American journal of emergency medicine》2017,35(11):1672-1676
Introduction
Patients surviving a self-attempted hanging have a total neurological recovery in 57–77% of cases at hospital discharge, but no long-term data are available.Methods
In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12 months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2 + 3 + 4 (bad recovery) vs. CPC1 (good recovery).Results
Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12 months were obtained in 97 of the 136 surviving patients. At 6 months, in the CA group (n = 9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n = 88), 79 patients had normal neurological status at 6 months and 78 at 12 months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6 months were a CA at the hanging site (P = 0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P = 0.04), a lower initial Glasgow score (4 vs. 5; P = 0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P < 0.001).Conclusion
Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists. 相似文献5.
Joshua K. Johnson Bryan Lohse Haley A. Bento Christopher S. Noren Robin L. Marcus Joseph E. Tonna 《Archives of physical medicine and rehabilitation》2019,100(2):270-277.e1
Objective
To examine the effect of increasing physical therapy (PT) staff in a cardiovascular intensive care unit (CVICU) on temporal measures of PT interventions and on outcomes important to patients and hospitals.Design
Retrospective pre/post subgroup analysis from a quality improvement initiative.Setting
Academic medical center.Participants
Cardiovascular patients in either a baseline (N=52) or quality improvement period (N=62) with a CVICU length of stay (LOS) ≥7 days and use of any one of the following: mechanical ventilation, continuous renal replacement therapy, or mechanical circulatory support.Interventions
The 6-month quality improvement initiative increased CVICU-dedicated PT staff from 2 to 4.Main Outcome Measures
Changes in physical therapy delivery were examined using the frequency and daily duration of PT intervention. Post-CVICU LOS was the primary outcome. CVICU LOS, mobility change, and discharge level of care were secondary outcomes. A secondary analysis of hospital survivors was also conducted.Results
Compared to those in the baseline period, cardiovascular patients in the quality improvement period participated in PT for an additional 9.6 minutes (95% confidence interval [CI]: 1.9, 17.2) per day for all patients and 15.1 minutes (95% CI: 7.6, 22.6) for survivors. Post-CVICU LOS decreased 2.2 (95% CI: -6.0, 1.0) days for all patients and 2.6 days (95% CI: -5.3, 0.0) for survivors. CVICU LOS decreased 3.6 days (95% CI: -6.4, -0.8) for all patients and 3.1 days (95% CI: -6.4, -0.9) for survivors. Differences in mobility change and discharge level of care were not significant.Conclusions
Additional CVICU-dedicated PT staff was associated with increased PT treatment and reductions in CVICU and post-CVICU LOS. The effects of each were greatest for hospital survivors. 相似文献6.
Ting-ting Yeh Ku-chou Chang Ching-yi Wu 《Archives of physical medicine and rehabilitation》2019,100(5):821-827
Objective
To investigate the efficacy of a sequential combination of aerobic exercise and cognitive training on cognitive function and other health-related outcomes in stroke survivors with cognitive decline.Design
Intervention study and randomized controlled trial.Setting
Hospital-based rehabilitation units.Participants
Survivors of stroke with cognitive decline (N=30) were randomized to sequential combination training (SEQ) (n=15) or an active control (n=15) group.Interventions
The SEQ group received 30 minutes of aerobic exercise, followed by 30 minutes of computerized cognitive training. The control group received 30 minutes of nonaerobic physical exercise, followed by 30 minutes of unstructured mental activities.Main Outcome Measures
The primary outcome measure was cognitive function. Secondary outcome measures included physical function, social participation, and quality of life.Results
Compared with the control group, the SEQ group had significantly improved Montreal Cognitive Assessment scores (P=.03) and Wechsler Memory Scale span scores (P=.012) after training. The endurance and mobility level measured by the 6-minute walk test (P=.25) was also enhanced in the SEQ group relative to the control group. However, the transfer of sequential training to social participation (Community Integration Questionnaire) and quality of life (EuroQoL questionnaire) was limited (P>.05 for both).Conclusions
Aerobic exercise combined with computerized cognitive training has better effects on the cognitive functional status of survivors of stroke than an active control. The cognitive functional status of stroke survivors was better after participation in aerobic exercise combined with computerized training than after active control therapy, demonstrating the clinical significance of this combination therapy. 相似文献7.
Gloria McKee-Lopez Leslie Robbins Elias Provencio-Vasquez Hector Olvera 《Journal of Professional Nursing》2019,35(2):112-119
Background
Research evidence strongly suggests that Adverse Childhood Experiences (ACEs) predispose individuals to development of an increased sensitivity to stress and negative physical and mental health outcomes in adulthood.Purpose
To determine if there was a relationship between the number of ACEs reported by first semester BSN students and their reported level of Burnout and Depression.Methods
211 students enrolled in the first semester of upper division courses of their BSN program completed self-report questionnaires which measured the number of ACEs, the level of Depression and the level of Burnout.Results
The number of reported ACEs by participants had a significant relationship on the levels of burnout and severity of depressive symptoms. Female students with a higher number of ACEs were more likely to report higher levels of Burnout A (Emotional Exhaustion) and Burnout B (Depersonalization), and higher depression severity scores compared to males.Conclusion
Nursing programs should educate faculty concerning the frequency and range of adverse experiences that students may have had prior to admission to the nursing program, and the possible relationship with Burnout and Depression. Faculty can provide early information on counseling and support services. 相似文献8.
Mollie E. Aleshire Alexandra Dampier Leslie Woltenberg 《Journal of Professional Nursing》2019,35(1):37-43
Background
Nursing students' attitudes related to health care teams in the context of interprofessional education (IPE) and the impact of these attitudes on IPE and future practice are not fully understood.Purpose
The current study assesses baccalaureate nursing students' attitudes toward health care teams and evaluates if these attitudes have changed after completion of a nursing course focusing on health care systems from an interprofessional perspective.Method
A convenience sample of 116 undergraduate nursing students in a required interprofessionally-focused course was invited to participate. The Attitudes Toward Health Care Teams Scale Quality of Care subscale (ATHCT-QC) and Team Understanding Scale (TUS) were employed via a pretest-posttest design. Paired samples t-tests were conducted to compare mean scores.Results
Ninety-five respondents (81.8%) voluntarily participated at the beginning and conclusion of the course.Conclusions
There were no significant differences between pretest-posttest attitudes toward interprofessional health care teams. Nurse educators must create and evaluate innovative IPE interventions to enhance students' preparedness to be effective interprofessional health care team members. 相似文献9.
Marine Paul Wulfran Bougouin Stéphane Legriel Julien Charpentier Jean-Paul Mira Claudio Sandroni Alain Cariou 《Intensive care medicine》2016,42(7):1128-1136
Purpose
Although prolonged unconsciousness after cardiac arrest (CA) is a sign of poor neurological outcome, limited evidence shows that a late recovery may occur in a minority of patients. We investigated the prevalence and the predictive factors of delayed awakening in comatose CA survivors treated with targeted temperature management (TTM).Methods
Retrospective analysis of the Parisian Region Out-of-Hospital CA Registry (2008–2013). In adult comatose CA survivors treated with TTM, sedated with midazolam and fentanyl, time to awakening was measured starting from discontinuation of sedation at the end of rewarming. Awakening was defined as delayed when it occurred after more than 48 h.Results
A total of 326 patients (71 % male, mean age 59 ± 16 years) were included, among whom 194 awoke. Delayed awakening occurred in 56/194 (29 %) patients, at a median time of 93 h (IQR 70–117) from discontinuation of sedation. In 5/56 (9 %) late awakeners, pupillary reflex and motor response were both absent 48 h after sedation discontinuation. In multivariate analysis, age over 59 years (OR 2.1, 95 % CI 1.0–4.3), post-resuscitation shock (OR 2.6 [1.3–5.2]), and renal insufficiency at admission (OR 3.1 [1.4–6.8]) were associated with significantly higher rates of delayed awakening.Conclusions
Delayed awakening is common among patients recovering from coma after CA. Renal insufficiency, older age, and post-resuscitation shock were independent predictors of delayed awakening. Presence of unfavorable neurological signs at 48 h after rewarming from TTM and discontinuation of sedation did not rule out recovery of consciousness in late awakeners.10.
Aykut Sarıtaş Burcu Acar Çinleti Çiler Zincircioğlu Uğur Uzun Işıl Köse Nimet Şenoğlu 《The American journal of emergency medicine》2018,36(12):2236-2241
Purpose
The aim of our study is to research the role and efficacy of cerebral oximetry in predicting neurologic prognosis when applied during TTM to patients experiencing coma after CA.Methods
This study was performed on surviving adult comatose patients after CA treated with TTM. The average scores of rSO2 was measured at 6 h intervals for the first 2 days and once a day for the following 3 days with a NIRS device during TTM. The CPC scale was used to define the neurologic outcomes of patients. We compared the correlations of rSO2 values between good (CPC 1–2) and poor (CPC 3–5) neurologic outcomes in CA patients.Results
There was no statistically significant difference identified between the prognosis groups in terms of rSO2, CPR durations, hemoglobin values and admission body temperature (p > 0.05). When the variation in rSO2 values over time is investigated, though there was no significant difference between the good and poor prognosis groups, it appeared to fall in the first 6 h in both prognosis groups. The median NT-proBNP and lactate values were observed to be higher in the poor prognosis group.Conclusion
There is no significant correlation between rSO2 values and neurologic outcomes. Multimodal monitoring methods may be useful and further studies with a larger patient population are necessary in this area. 相似文献11.
12.
Rachael W. Duncan Karen L. Smith Michelle Maguire Donald E. Stader 《The American journal of emergency medicine》2019,37(1):38-44
Objective
The objective of this study was to assess opioid use in an emergency department following the development and implementation of an alternative to opioids (ALTO)-first approach to pain management. The study also assessed how implementation affected patient satisfaction scores.Methods
This study compared data collected from October to December of 2015 (prior to implementation) to data collected between October and December of 2016 (after the intervention had been implemented). Emergency department visits during the study timeframe were included. Opioid reduction was measured in morphine equivalents (ME) administered per visit. Secondary outcomes on patient satisfaction were gathered using the Press Ganey survey.Results
Intravenous (IV) opioid administration during the study period decreased by >20%. The predicted mean ME use in 2016 was 0.25 ME less when compared to 2015 (95% CI ?0.27 to ?0.23). Estimated use for patients in the pre-implementation period was 1.45 ME mgs (SD 0.88), and 1.13 ME mg (SD 0.69) for patients in the post-implementation period. Patient satisfaction scores using the Press Ganey Scale also were assessed. There was no significant difference in the scores between 2015 and 2016 when patients were asked “How well was you pain controlled?” (?0.94, 95% CI ?5.29 to 3.4) and “How likely are you to recommend this emergency department?” (?1.55, 95% CI ?5.26 to 2.14).Conclusion
In conclusion, by using an ALTO-first, multimodal treatment approach to pain management, participating clinicians were able to significantly decrease the use of IV opioids in the emergency department. Patient satisfaction scores remained unchanged following implementation. 相似文献13.
Nancy Hoffart Thomas P. McCoy Lynne P. Lewallen Shemeka Thorpe 《Journal of Professional Nursing》2019,35(2):93-100
Background
The New Careers in Nursing (NCIN) program provided scholarships and other supports to accelerated degree students at 130 nursing schools and collected data from the scholars at three time-points.Purpose
The NCIN database was analyzed to identify gender-based differences in scholars' profile characteristics, program experiences, and post-graduation outcomes.Method
An adaptation of Jeffreys's Nursing Universal Retention and Success Model guided the analysis. Gender differences were assessed after multiplicity adjustments for false positive rates.Results
Differences based on gender were found for profile characteristics, student affective factors, academic factors, professional integration factors, environmental factors, as well as academic, psychological and NCIN program outcomes. Results suggest that males were influenced by economic factors more than females when choosing nursing as a career. They had fewer concerns about financial aspects associated with being a student again yet secured employment sooner after graduation than female scholars. They did not view support services as important as did female students. They expressed confidence in their leadership competence more than their female counterparts.Conclusion
Efforts are needed to better understand and address the nuanced gender-based perceptions and needs of nursing students who are male. 相似文献14.
Objectives
Diagnostic tests are widely used for patients with syncope in the emergency department (ED). This study aimed to determine the diagnostic yield of neuroimaging in patients with syncope without high-risk symptoms.Methods
Adult patients who presented to the ED with syncope in 2016 were screened retrospectively. Patients who suffered from mild head trauma due to syncope were also included. Patients with neurological examination findings (confusion, amnesia, focal neurological deficit, severe headache, dizziness, nausea and vomiting), patients on anticoagulants, patients with known intracranial malignancies and those whose loss of consciousness was attributed to reasons other than syncope were excluded from the study.Results
A total of 1114 patients were included in the study. The median age was 48?years (IQR?=?34–66?years) and 576 (51.7%) of the patients were male. The neuroimaging tests performed were cranial computerized tomography (CT) in 694 (62.3%) cases and magnetic resonance imaging (MRI) in 114 (10.2%) cases. Mild head trauma due to syncope was observed in 116 (10.4%) patients. None of the neuroimaging studies revealed any clinically significant findings.Conclusion
Neuroimaging is not beneficial in patients whose medical history and physical examination do not indicate neurogenic syncope, even if the patient has mild head trauma. 相似文献15.
W. C. Lin A. C. Westphalen G. E. Silva S. Chodraui Filho R. B. Reis V. F. Muglia 《Abdominal imaging》2016,41(11):2209-2217
Purpose
The purpose of this study was to compare the PI-RADS V2 scores, ADC histogram-derived parameters, and their combination for the diagnosis of clinically significant peripheral zone prostate cancer (PCa).Materials and Methods
The IRB approved this retrospective study of 47 men who underwent 1.5 Tesla endorectal prostate magnetic resonance imaging (MRI). Informed consent was waived. Two readers identified and scored MRI lesions using PI-RADS V2. Their mean, median, 10th, 25th, 75th percentile ADC values, and normalized ratio were also calculated. Multilevel logistic regression and receiver-operating characteristic (ROC) curve analyses assessed their diagnostic performance. Clinically significant PCa was defined as tumor volume over 0.5 cc and Gleason grade of 4 or 5 on prostatectomy.Results
The area under the ROC curve (A z) of the overall and diffusion-weighted imaging (DWI) PI-RADS V2 scores were 0.69 and 0.84 (reader-1), and 0.68 and 0.73 (reader-2). The A z of ADC parameters ranged from 0.68 to 0.75 for both readers. Compared to other predictors, DWI PI-RADS V2 yielded the highest A z for identification of significant cancer; but, except for reader-1 75th percentile ADC, the differences were not statistically significant (P > 0.05). Adding ADC parameters to PI-RADS V2 scores did not improve their diagnostic ability.Conclusion
DWI PI-RADS V2 score may a better predictor of clinically significant PCa than the overall PI-RADS V2 score, but its diagnostic performance was not significantly improved by the addition of objective ADC value measurements.16.
Laurie Malia V. Matt Laurich Jesse J. Sturm 《The American journal of emergency medicine》2019,37(1):85-88
Purpose
Procedural sedation is commonly performed in the emergency department (ED). Having safe and fast means of providing sedation and anxiolysis to children is important for the child's tolerance of the procedure, parent satisfaction and efficient patient flow in the ED.Objective
To evaluate fasting times associated with the administration of intranasal midazolam (INM) and associated complications. Secondary objectives included assessing provider and caregiver satisfaction scores.Methods
A prospective observational study was conducted in children presenting to an urban pediatric emergency department who received INM for anxiolysis for a procedure or imaging. Data collected included last solid and liquid intake, procedure performed, sedation depth, adverse events and parent and provider satisfaction.Results
112 patients were enrolled. The mean age was 3.8?years. There were no adverse events experienced by any patients. Laceration repair was the most common reason for INM use. The median depth of sedation was 2.0 (cooperative/tranquil). The median liquid NPO time was 172.5?min and the median NPO time for solids was 194.0?min. 29.8% were NPO for liquids ≤2?h and 62.5% were NPO for solids ≤2?h. Parent and provider satisfaction was high: 90.4% of parents' and 88.4% of providers' satisfaction scores were a 4 or 5 on a 5 point Likert scale.Conclusion
Our data suggest that short NPO of both solids and liquids are safe for the use of INM. Additionally, parent and provider satisfaction scores were high with the use of INM. 相似文献17.
Ruan Vlok Gun Hee An Matthew Binks Thomas Melhuish Leigh White 《The American journal of emergency medicine》2019,37(3):381-386
Intro
Buprenorphine is a potent analgesic agent with several unique and favourable features such as its sublingual formulation. The aim of this study is to compare the effectiveness of sublingual versus intramuscular and intravenous buprenorphine in acute pain.Methods
Five major databases were systematically searched until April 2018. All randomized control trials comparing sublingual buprenorphine with intravenous or intramuscular morphine in acute pain were included in this review. These studies were assessed for level of evidence and risk of bias. The data was then analyzed both qualitatively and where appropriate by meta-analysis. The primary outcomes were analgesic effect up to six hours and rescue analgesia requirement. The secondary outcomes were incidence of respiratory depression, nausea, vomiting, dizziness and hypotension.Results
Nine studies comparing sublingual and intramuscular or intravenous buprenorphine were identified and included 826 patients. There was no difference in pain at any time point before six hours or need for rescue analgesia between the two agents. There was no difference in secondary outcomes between the two agents.Discussion
Sublingual buprenorphine offers an effective alternative to intravenous or intramuscular analgesia in acute pain. Sublingual buprenorphine appears to be a viable option in patients where intravenous access is difficult or not favourable. 相似文献18.
Objective
To assess whether robot-assisted reach training (RART) with an active assistant protocol can improve upper extremity function and kinematic performance in chronic stroke survivors.Design
This study was conducted as a randomized controlled trial.Setting
National rehabilitation center.Participants
Chronic stroke survivors (N=38) were randomized into 2 groups: a robot-assisted reach training with assist-as-needed (RT-AAN) group and a robot-assisted reach training with guidance force (RT-G) group.Intervention
The RT-AAN group received robot-assisted reach training with an assist-as-needed mode for 40 minutes per day, 3 times per week over a 6-week period, and the RT-G group participated in the RART with a guidance mode for 40 minutes per day, 3 times per week over a 6-week period.Main Outcome Measures
Upper extremity functions were measured with Fugl–Meyer Assessment (FMA), Action Research Arm Test (ARAT), and Box and Block Test. In addition, movement velocities were measured as an index for upper extremity kinematic performances in 6 directions.Results
Both groups showed significant improvements in FMA, ARAT, and kinematics (movement velocity) in all directions (targets 1-6, P<.05). However, the RT-AAN group showed significantly more improvement than the RT-G group in FMA and ARAT (P<.05).Conclusions
RART with an active assistant protocol showed improvements of upper extremity function and kinematic performance in chronic stroke survivors. In particular, assist-as-needed robot control was effective for upper extremity rehabilitation. Therefore robot-assisted training may be suggested as an effective intervention to improve upper extremity function in chronic stroke survivors. 相似文献19.
Comparison of cosmetic appearances after facial lacerations repaired by junior residents and experts
Jin Hong Min Yeon Ho You Yong Chul Cho Won Joon Jeong Jung Soo Park Se Kwang Oh Sung Uk Cho Yong Nam In Chi Hwan Kwack In Sool Yoo 《The American journal of emergency medicine》2019,37(5):817-822
Purpose
The technical factors which improve cosmetic outcomes and which need to be emphasized in education of junior residents have yet to be described. We compared cases in which suturing was performed by either junior emergency medicine residents or experts, in order to determine the focus of future education and training.Methods
Wound registry data was reviewed and retrospectively analyzed from September 2015 to February 2016. Only patients who visited the emergency room with facial lacerations were enrolled, and their wound registry data sheets were reviewed. Practitioners were divided into junior resident and expert groups. We assessed the progress using the Stony Brook Scar Evaluation Scale (SBSES) 5–10?days following suturing.Results
Sixty-six patients were enrolled; 43 (65.2%) were men. The median (interquartile range) cosmetic scores (SBSES scale) for suturing performed by junior residents or experts were 3 (2–4) and 5 (4–5), respectively (p?=?0.001). The percentage of maximum scores for each SBSES category was significantly lower in the junior resident group than in the expert group for width (68% vs. 86%), hatch marks (68% vs. 93%), and overall appearance (41% vs. 80%) (all p?<?0.001).Conclusions
There were significant differences in scar widths and hatch marks, which were attributable to the skill level of the practitioner who performed the suturing of facial lacerations. Junior residents should be educated about maintenance of proper tension, atraumatic technique, and performing appropriate trimming or debridement. 相似文献20.
Trauma team activation criteria and outcomes of geriatric trauma: 10 year single centre cohort study
Kevin Kei-ching Hung Janice H.H. Yeung Catherine S.K. Cheung Ling-yan Leung Raymond C.H. Cheng N.K. Cheung Colin A. Graham 《The American journal of emergency medicine》2019,37(3):450-456
