Alcohol consumption, blood alcohol concentration level and guideline compliance in hospital referred patients with minimal, mild and moderate head injuries

<p>Abstract</p> <p>Background</p> <p>In 2000 the Scandinavian Neurotrauma Committee published guidelines for safe and cost-effective management of minimal, mild and moderate head injured patients.</p> <p>The aims of this study were to investigate to what extent the head injury population is under the influence of alcohol, and to evaluate whether the physicians' compliance to the guidelines is affected when patients are influenced by alcohol.</p> <p>Methods</p> <p>This study included adult patients (≥15 years) referred to a Norwegian University Hospital with minimal, mild and moderate head injuries classified according to the Head Injury Severity Scale (HISS). Information on alcohol consumption was recorded, and in most of these patients blood alcohol concentration (BAC) was measured. Compliance with the abovementioned guidelines was registered.</p> <p>Results</p> <p>The study includes 860 patients. 35.8% of the patients had consumed alcohol, and 92.1% of these patients had a BAC ≥ 1.00‰. Young age, male gender, trauma occurring during the weekends, mild and moderate head injuries were independent factors significantly associated with being under the influence of alcohol. Guideline compliance was 60.5%, and over-triage was the main violation. The guideline compliance showed no significant correlation to alcohol consumption or to BAC-level.</p> <p>Conclusions</p> <p>This study confirms that alcohol consumption is common among patients with head injuries. The physicians' guideline compliance was not affected by the patients' alcohol consumption, and alcohol influence could therefore not explain the low guideline compliance.</p

An observational study of compliance with the Scandinavian guidelines for management of minimal, mild and moderate head injury

<p>Abstract</p> <p>Background</p> <p>The Scandinavian guidelines for management of minimal, mild and moderate head injuries were developed to provide safe and cost effective assessment of head injured patients. In a previous study conducted one year after publication and implementation of the guidelines (2003), we showed low compliance, involving over-triage with computed tomography (CT) and hospital admissions. The aim of the present study was to investigate guideline compliance after an educational intervention.</p> <p>Methods</p> <p>We evaluated guideline compliance in the management of head injured patients referred to the University Hospital of Stavanger, Norway. The findings from the previous study in 2003 were communicated to the hospitals physicians, and a feed-back loop training program for guideline implementation was conducted. All patients managed during the months January through June in the years 2005, 2007 and 2009 were then identified with an electronic search in the hospitals patient administrative database, and the patient files were reviewed. Patients were classified according to the Head Injury Severity Scale, and the management was classified as compliant or not with the guideline.</p> <p>Results</p> <p>The 1 180 patients were 759 (64%) males and 421 (36%) females with a mean age of 31.5 (range 0-97) years. Over all, 738 (63%) patients were managed in accordance with the guidelines and 442 (37%) were not. Compliance was not significantly different between minimal (56%) and mild (59%) injuries, while most moderate (93%) injuries were managed in accordance with the guidelines (p < 0.05). Noncompliance was caused by overtriage in 362 cases (30%) and undertriage in 80 (7%). Guideline compliance was 54% in 2005, 71% in 2007, and 64% in 2009.</p> <p>Conclusions</p> <p>This study shows higher guideline compliance after an educational intervention involving feed-back on performance. A substantial number of patients are exposed to over-triage, involving unnecessary radiation from CT examinations, and unnecessary costs from hospital admissions.</p

The microscopic structure of normal human synovial tissue

Microscopic study of normal synovial tissue from 16 humans of varying age disclosed an architectural pattern which did not vary significantly with age, sex or intra-articular location. Except for fibrous synovium, the tissue samples were similar in vascularity, number of surface cell layers and in the differential composition of the surface cells. Histochemical procedures delineated a pericellular surface reticulin network but failed to establish the locus of hyaluronic acid synthesis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/37688/1/1780030205_ftp.pd

Treatment of irritable bowel syndrome with diarrhoea using titrated ondansetron (TRITON): study protocol for a randomised controlled trial

Background: Irritable bowel syndrome with diarrhoea (IBS-D) affects up to 4% of the general population. Symptoms include frequent, loose, or watery stools with associated urgency, resulting in marked reduction of quality of life and loss of work productivity. Ondansetron, a 5HT3 receptor antagonist, has had an excellent safety record for over 20 years as an antiemetic, yet is not widely used in the treatment of IBS-D. It has, however, been shown to slow colonic transit and in a small randomised, placebo-controlled, cross-over pilot study, benefited patients with IBS-D. Methods: This trial is a phase III, parallel group, randomised, double-blind, multi-centre, placebo-controlled trial, with embedded mechanistic studies. Participants (n = 400) meeting Rome IV criteria for IBS-D will be recruited from outpatient and primary care clinics and by social media to receive either ondansetron (dose titrated up to 24 mg daily) or placebo for 12 weeks. Throughout the trial, participants will record their worst abdominal pain, worst urgency, stool frequency, and stool consistency on a daily basis. The primary endpoint is the proportion of “responders” in each group, using Food and Drug Administration (FDA) recommendations. Secondary endpoints include pain intensity, stool consistency, frequency, and urgency. Mood and quality of life will also be assessed. Mechanistic assessments will include whole gut transit, faecal tryptase and faecal bile acid concentrations at baseline and between weeks 8 and 11. A subgroup of participants will also undergo assessment of sensitivity (n = 80) using the barostat, and/or high-resolution colonic manometry (n = 40) to assess motor patterns in the left colon and the impact of ondansetron. Discussion: The TRITON trial aims to assess the effect of ondansetron across multiple centres. By defining ondansetron’s mechanisms of action we hope to better identify patients with IBS-D who are likely to respond

Vaktpostlymfeknuteoperasjon ved brystkreft

Sentinel Lymph Node Biopsy in Breast Cancer Ellen Schlichting, Marianne Efskind Harr, Torill Sauer, Almira Babovic, Rolf Kåresen Background Sentinel lymph node (SN) biopsy is a highly accurate technique for identifying axillary metastases from a primary breast carcinoma. Material and methods Between 2000 and 2005, SN biopsy was performed in 1409 patients with breast carcinoma or ductal carcinoma in situ grade 3. Peritumoral radiocolloid (60-80 MBq 99 Tc-Nanocoll) was injected the day before operation and blue dye was injected around the tumor peroperatively. Results SN was detected in 90,2% of the operations. Training of the individual surgeon influenced the detection rate. Metastases to SN were detected in 25% of the patients. Of the 319 patients with a positive SN, 51,7% had no further positive nodes in the axilla. Patients with a tumor less than 20 mm had metastases in 21,6% of the SN, while tumors larger than 20 mm were positive in 31,8% of the patients. Age below 50 years was associated with a positive SN in 35,3%, while age above 50 years reduced the incidence of positive SN to 21,9%. Mean age was 58 years. The mean tumor size was 16,6 mm. Tumors were located in the upper, outer quadrant in 59%. There were three patients with local recurrence in the axilla early in the series. Ductal carcinoma in situ grade 3 was diagnosed preoperatively in 109 patients (cytology), 88 had this diagnosis after histology (the rest had combinations with cancer or in situ lesions with another grade). Axillary metastases were found in 4.8% of these patients. Two out of 19 patients had metastases to parasternal SN. Interpretation SN biopsy has a proven valid in the staging of the axilla in patients with breast cancer and have replaced routine axillary clearance. The method should also be considered in patients with high-grade DCIS