Assessing the discharge instructing in the emergency department : Patient perspective

Objective: The objective of the study is to assess how well the emergency department (ED) personnel succeed in instructing the patient at discharge. Methods: In November and December 2016 at Peijas Hospital ED, Finland, a structured questionnaire was conducted during a phone interview on patients the day after discharge. Results: A total of 132 patients interviewed. Ninety percent had received discharge instructions from the ED staff, most of them (75%) about medication. Almost half of the patients (45%) were satisfied with the communication at discharge, those not satisfied (47%) felt that the staff did not know enough of their background to give discharge instructions. Of the patients, 20% thought that they did not have the opportunity to ask questions during the guidance session, and 41% thought that the session was too short and restricted. Some patients (20%) felt that the instructions were ambiguous, but 63% (83/132) felt they were able to follow them well or very well. Conclusion: The pace of care in the ED is fast and duration of the stay is short. The patients must be able to take responsibility of their self-care. Failure to follow medical discharge instructions could lead to non-compliance. Attention should be paid to enhancing the quality of discharge instructing and the instructions provided by the ED personnel, as recurring visits and inquiry calls add to the ED workload.Peer reviewe

Physiological Profile of Male Competitive and Recreational Surfers

Surfing consists of both high- and low-intensity paddling of varying durations, using both the aerobic and anaerobic systems. Surf-specific physiological studies lack adequate group sample sizes, and V[Combining Dot Above]O2peak values are yet to determine the differences between competitive and recreational surfers. The purpose of this study was therefore to provide a comprehensive physiological profile of both recreational and competitive surfers. This multisite study involved 62 male surfers, recreational (n = 47) and competitive (n = 15). Anthropometric measurements were conducted followed by dual-energy x-ray absorptiometry, anaerobic testing and finally aerobic testing. V[Combining Dot Above]O2peak was significantly greater in competitive surfers than in recreational surfers (M = 40.71 ± 3.28 vs. 31.25 ± 6.31 ml·kg·min, p \u3c 0.001). This was also paralleled for anaerobic power (M = 303.93 vs. 264.58 W) for competitive surfers. Arm span and lean total muscle mass was significantly (p ≤ 0.01) correlated with key performance variables (V[Combining Dot Above]O2peak and anaerobic power). No significant (p ≥ 0.05) correlations were revealed between season rank and each of the variables of interest (V[Combining Dot Above]O2peak and anaerobic power). Key performance variables (V[Combining Dot Above]O2peak and anaerobic power) are significantly higher in competitive surfers, indicating that this is both an adaptation and requirement in this cohort. This battery of physiological tests could be used as a screening tool to identify an athlete\u27s weaknesses or strengths. Coaches and clinicians could then select appropriate training regimes to address weaknesses

Theory of Transmission through disordered superlattices

We derive a theory for transmission through disordered finite superlattices in which the interface roughness scattering is treated by disorder averaging. This procedure permits efficient calculation of the transmission thr ough samples with large cross-sections. These calculations can be performed utilizing either the Keldysh or the Landauer-B\"uttiker transmission formalisms, both of which yield identical equations. For energies close to the lowest miniband, we demonstrate the accuracy of the computationally efficient Wannier-function approximation. Our calculations indicate that the transmission is strongly affected by interface roughness and that information about scale and size of the imperfections can be obtained from transmission data.Comment: 12 pages, 6 Figures included into the text. Final version with minor changes. Accepted by Physical Review

Relapsing macrophage activating syndrome in a 15-year-old girl with Still's disease: a case report

<p>Abstract</p> <p>Introduction</p> <p>Macrophage activating syndrome is a severe, potentially life-threatening condition that may accompany Still's disease. It is characterized by fever, hepatosplenomegaly, lymphadenopathy, severe cytopenia, serious liver dysfunction, coagulopathy and neurologic involvement. The principal treatment for patients with this syndrome includes etoposide 150 mg/2 M twice a week for two weeks, dexamethasone 10 mg/2 M for two weeks and cyclosporine 3 mg/kg to 5 mg/kg for a longer period. Cases of relapse of macrophage activating syndrome are relatively rare.</p> <p>Case presentation</p> <p>We describe the case of a 15-year-old Iraqi girl with Still's disease who developed macrophage activating syndrome with acute respiratory distress syndrome that required resuscitation and mechanical ventilation. Following intensive treatment, including high dose steroids and cyclosporine, the patient improved significantly. Two weeks after cyclosporine was discontinued, however, she was readmitted with an acute relapse of macrophage activating syndrome manifested by spiking fever, arthralgias, maculopapular rash and leukocytosis. This time the patient recovered following the reintroduction of treatment with cyclosporine and the addition of mycophenolate mofetil (Cellcept).</p> <p>Conclusion</p> <p>We believe that cyclosporine is a cornerstone for the treatment of Still's disease. We recommend continuing this medication for several weeks following the patient's clinical recovery in order to prevent macrophage activating syndrome relapses.</p

Linear-Time Arguments with Sublinear Verification from Tensor Codes

Minimizing the computational cost of the prover is a central goal in the area of succinct arguments. In particular, it remains a challenging open problem to construct a succinct argument where the prover runs in linear time and the verifier runs in polylogarithmic time. We make progress towards this goal by presenting a new linear-time probabilistic proof. For any fixed $\epsilon > 0$, we construct an interactive oracle proof (IOP) that, when used for the satisfiability of an $N$-gate arithmetic circuit, has a prover that uses $O(N)$ field operations and a verifier that uses $O(N^{\epsilon})$ field operations. The sublinear verifier time is achieved in the holographic setting for every circuit (the verifier has oracle access to a linear-size encoding of the circuit that is computable in linear time). When combined with a linear-time collision-resistant hash function, our IOP immediately leads to an argument system where the prover performs $O(N)$ field operations and hash computations, and the verifier performs $O(N^{\epsilon})$ field operations and hash computations (given a short digest of the $N$-gate circuit)

Stented ureterovesical anastomosis in renal transplantation: does it influence the rate of urinary tract infections?

<p>Abstract</p> <p>Objective</p> <p>Our objective was to evaluate the impact of routine use of double-J stents on the incidence of urinary tract infection after renal transplantation.</p> <p>Methods</p> <p>We conducted a retrospective-comparative single-centre study in 310 consecutive adult deceased donor kidney recipients transplanted from 2002 to 2006. Patients were divided in two groups, with or without urinary stent implantation. To evaluate the predictive factors for UTI, donor and recipients pre- and post-transplantation data were analysed. Early urological complications and renal function within 12 months of transplantation were included as well.</p> <p>Results</p> <p>A total of 157 patients were enrolled to a stent (ST) and 153 patients to a no-stent (NST) group. The rate of urinary tract infection at three months was similar between the two groups (43.3% ST vs. 40.1% NST, p = 0.65). Of the identified pathogens Enterococcus and Escherichia coli were the most common species. In multivariate analysis neither age nor immunosuppressive agents, BMI or diabetes seemed to have influence on the rate of UTI. When compared to males, females had a significantly higher risk for UTI (54.0% vs. 33.5%).</p> <p>Conclusion</p> <p>Prophylactic stenting of the ureterovesical anastomosis does not increase the risk of urinary tract infection in the early postoperative period.</p

Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments: Study protocol for a randomized controlled trial

BACKGROUND: Pain is the most common reason that patients present to an emergency department (ED) and is often inadequately managed. Evidence suggests that acupuncture is effective for pain relief, yet it is rarely practiced in the ED. The current study aims to assess the efficacy of acupuncture for providing effective analgesia to patients presenting with acute low back pain, migraine and ankle sprain at the EDs of four hospitals in Melbourne, Australia. METHOD: The study is a multi-site, randomized, assessor-blinded, controlled trial of acupuncture analgesia in patients who present to an ED with low back pain, migraine or ankle sprain. Patients will be block randomized to receive either acupuncture alone, acupuncture as an adjunct to pharmacotherapy or pharmacotherapy alone. Acupuncture will be applied according to Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA). Pain after one hour, measured using a visual analogue scale (VAS), is the primary outcome. Secondary outcomes measures include the following instruments; the Oswestry low back pain disability questionnaire, 24-hour Migraine Quality of Life questionnaire and Patient's Global Assessment of Ankle Injury Scale. These measures will be recorded at baseline, 1 hour after intervention, each hour until discharge and 48±12 hours of ED discharge. Data will also be collected on the safety and acceptability of acupuncture and health resource utilization. DISCUSSION: The results of this study will determine if acupuncture, alone or as an adjunct to pharmacotherapy provides effective, safe and acceptable pain relief for patients presenting to EDs with acute back pain, migraine or ankle sprain. The results will also identify the impact that acupuncture treatment may have upon health resource utilisation in the ED setting. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12609000989246

Neck circumference is associated with adipose tissue content in thigh skeletal muscle in overweight and obese premenopausal women

Neck circumference (NC) has been proposed as a simple and practical tool, independently associated with cardiometabolic risk factors. However, the association of NC with inter-muscular adipose tissue (IMAT) is still to be determined. We aimed to examine the association of NC with thigh IMAT, and visceral adipose tissue (VAT) measured with computed tomography (CT) in overweight/obese women. 142 premenopausal overweight and obese Caucasian women participated in this crosssectional study. NC was measured with an inextensible metallic tape above the thyroid cartilage according to International Society for Advancement of Kinanthropometry protocol. Thigh IMAT and VAT volumes were measured with a single cross-sectional CT. Regarding the covariates, fat mass (FM) was assessed with dual-energy x-ray absorptiometry and physical activity was objectively measured with accelerometry. NC was positively associated with thigh IMAT and VAT volumes (standardized β coefcient: β=0.45, P-value= ≤0.001, β=0.60, P=≤0.001; respectively), which persisted after adjusting for age, height, overall FM or moderate-to-vigorous physical activity. Our fndings show that NC is associated with thigh IMAT volume in overweight and obese premenopausal Caucasian women, regardless of the amount of lower-body fatness. These results suggest underscoring the relevance of NC as a marker of adipose tissue content in thigh skeletal muscle.Portuguese Foundation for Science and Technology Sapiens 358007/99Oeiras City CouncilBecel PortugalRoche Pharmaceuticals PortugalCompal PortugalUniversity of Granada Plan Propio de Investigacion 2016 -Excellence actions: Unit of Excellence on Exercise and Health (UCEES)Junta de AndaluciaEuropean Union (EU) SOMM17/6107/UGRFundacion Carolina C.201657496