e-Bug Games for Children: Teaching Hygiene and Prudent Antibiotics Use using Web Games

Technology enhanced education has been recently established as a new approach for all stages of education. However, among these new IT media it is computer games playing the central role in delivering education in particular to children and teenagers, however, real world sound evaluation is often given little attention. The EU funded e-Bug project developed web games aimed at children to teach basic principles of pru- dent antibiotics use, hand and respiratory hygiene and aims to reinforces an awareness of microbes, hand and respiratory hygiene among junior and senior school children in 10 countries in Europe. An educational pack implemented in schools across Europe is complemented by Internet web games for two age groups teaching a set of learning objectives (LOs) using a fast and interactive platform game design for junior children and investigate detective games based on PBL principles for senior children. In this paper, we present the design of e-Bug junior and senior games and evaluation results

Have changes in computerised tomography guidance positively impacted detection of cervical spine injury in children? A review of the Trauma Audit and Research Network data

Background Clinically significant damage to the cervical spine in children is uncommon, but missing this can be life-changing for patients. The balance between rarity and severity leads to inconsistent scanning, with both resource and radiation implications. In 2014, the United Kingdom’s National Institute for Health and Care Excellence updated their computerised tomography neck imaging guidance in children. The aim of this study was to assess if the change in guidance had resulted in a change in diagnosis or imaging rates. Methods A retrospective review of the national Trauma Audit and Research Network’s data for computerised tomography spine imaging in children in 2012–2013 was compared to the same data sample collected in 2015–2016. Results The percentage of children presenting with neck trauma who were imaged reduced from 15.5 to 14.1% with an increase in confirmed cervical spine injury from 1.6 to 2.3% between the two time periods. The specificity of computerised tomography scanning increased from 10 to 16.4%. There was variation in scan rates, with major trauma centres scanning a greater percentage of children of all ages and with all injury scores, than trauma units. Discussion This study suggests national guidance can impact clinical care in a relatively short timeframe. Variation in how guidance is applied, with major trauma centres scanning proportionately more children with a lower yield, could be because scanning is more readily available, or because trauma protocols encourage more scans. Twenty per cent of injuries were not found on the initial computerised tomography, in keeping with previously reported data, because the injuries were ligamentous or cord contusion. This suggests a role for early magnetic resonance imaging in children with suspected spinal injury

How did a Quality Premium financial incentive influence antibiotic prescribing in primary care? Views of Clinical Commissioning Group and general practice professionals

Background: The Quality Premium (QP) was introduced for Clinical Commissioning Groups (CCGs) in England to optimize antibiotic prescribing, but it remains unclear how it was implemented. Objectives: To understand responses to the QP and how it was perceived to influence antibiotic prescribing. Methods: Semi-structured telephone interviews were conducted with 22 CCG and 19 general practice professionals. Interviews were analysed thematically. Results: The findings were organized into four categories. (i) Communication: this was perceived as unstructured and infrequent, and CCG professionals were unsure whether they received QP funding. (ii) Implementation: this was influenced by available local resources and competing priorities, with multifaceted and tailored strategies seen as most helpful for engaging general practices. Many antimicrobial stewardship (AMS) strategies were implemented independently from the QP, motivated by quality improvement. (iii) Mechanisms: the QP raised the priority of AMS nationally and locally, and provided prescribing targets to aim for and benchmark against, but money was not seen as reinvested into AMS. (iv) Impact and sustainability: the QP was perceived as successful, but targets were considered challenging for a minority of CCGs and practices due to contextual factors (e.g. deprivation, understaffing). CCG professionals were concerned with potential discontinuation of the QP and prescribing rates levelling off. Conclusions: CCG and practice professionals expressed positive views of the QP and associated prescribing targets and feedback. The QP helped influence change mainly by raising the priority of AMS and defining change targets rather than providing additional funding. To maximize impact, behavioural mechanisms of financial incentives should be considered pre-implementation

Predicting need for hospital admission in patients with traumatic brain injury or skull fractures identified on CT imaging : a machine learning approach

Background: Patients with mild traumatic brain injury on CT scan are routinely admitted for inpatient observation. Only a small proportion of patients require clinical intervention. We recently developed a decision rule using traditional statistical techniques that found neurologically intact patients with isolated simple skull fractures or single bleeds <5 mm with no preinjury antiplatelet or anticoagulant use may be safely discharged from the emergency department. The decision rule achieved a sensitivity of 99.5% (95% CI 98.1% to 99.9%) and specificity of 7.4% (95% CI 6.0% to 9.1%) to clinical deterioration. We aimed to transparently report a machine learning approach to assess if predictive accuracy could be improved. Methods: We used data from the same retrospective cohort of 1699 initial Glasgow Coma Scale (GCS) 13–15 patients with injuries identified by CT who presented to three English Major Trauma Centres between 2010 and 2017 as in our original study. We assessed the ability of machine learning to predict the same composite outcome measure of deterioration (indicating need for hospital admission). Predictive models were built using gradient boosted decision trees which consisted of an ensemble of decision trees to optimise model performance. Results: The final algorithm reported a mean positive predictive value of 29%, mean negative predictive value of 94%, mean area under the curve (C-statistic) of 0.75, mean sensitivity of 99% and mean specificity of 7%. As with logistic regression, GCS, severity and number of brain injuries were found to be important predictors of deterioration. Conclusion: We found no clear advantages over the traditional prediction methods, although the models were, effectively, developed using a smaller data set, due to the need to divide it into training, calibration and validation sets. Future research should focus on developing models that provide clear advantages over existing classical techniques in predicting outcomes in this population

Letter in Response to 'Classification of Traumatic Brain Injury Severity Using Informed Data Reduction in a Series of Binary Classifier Algorithms'

This paper is a comment to the paper "Classification of Traumatic Brain Injury Severity Using Informed Data Reduction in a Series of Binary Classifier Algorithms" by Bloom et al. The authors inform the editors that they have conducted a similar study on behalf of, and funded BrainScope Company, Inc. and that the method used to acquire the QEEG data suffer from a technical fault. Same methods seem to have been used by Bloom et. al. It is noted that the authors do not refer to this technical fault even though it arose months before the publication of the papers

Performance of the Hull Salford Cambridge Decision Rule (HSC DR) for early discharge of patients with findings on CT scan of the brain : a CENTER-TBI validation study

Background: There is international variation in hospital admission practices for patients with mild traumatic brain injury (TBI) and injuries on CT scan. Only a small proportion of patients require neurosurgical intervention, while many guidelines recommend routine admission of all patients. We aim to validate the Hull Salford Cambridge Decision Rule (HSC DR) and the Brain Injury Guidelines (BIG) criteria to select low-risk patients for discharge from the emergency department. Method: A cohort from 18 countries of Glasgow Coma Scale 13–15 patients with injuries on CT imaging was identified from the multicentre Collaborative European NeuroTrauma Effectiveness Research in TBI (CENTER-TBI) Study (conducted from 2014 to 2017) for secondary analysis. A composite outcome measure encompassing need for ongoing hospital admission was used, including seizure activity, death, intubation, neurosurgical intervention and neurological deterioration. We assessed the performance of our previously derived prognostic model, the HSC DR and the BIG criteria at predicting deterioration in this validation cohort. Results: Among 1047 patients meeting the inclusion criteria, 267 (26%) deteriorated. Our prognostic model achieved a C-statistic of 0.81 (95% CI: 0.78 to 0.84). The HSC DR achieved a sensitivity of 100% (95% CI: 97% to 100%) and specificity of only 4.7% (95% CI: 3.3% to 6.5%) for deterioration. Using the BIG criteria for discharge from the ED achieved a higher specificity (13.3%, 95% CI: 10.9% to 16.1%) and lower sensitivity (94.6%, 95% CI: 90.5% to 97%), with 12/105 patients recommended for discharge subsequently deteriorating, compared with 0/34 with the HSC DR. Conclusion: Our decision rule would have allowed 3.5% of patients to be discharged, none of whom would have deteriorated. Use of the BIG criteria may select patients for discharge who have too high a risk of subsequent deterioration to be used clinically. Further validation and implementation studies are required to support use in clinical practice

Acute lower limb compartment syndrome after Cesarean section: a case report

Abstract: Introduction Acute compartment syndrome of the lower limb is a rare but severe intra- and post-partum complication. Prompt diagnosis is essential to avoid permanent functional restriction or even the loss of the affected limb. Clinical signs and symptoms might be nonspecific, especially in the early stages; therefore, knowledge of predisposing risk factors can be helpful. Case presentation We present the case of a 32-year-old Caucasian woman with acute post-partum compartment syndrome. Conclusion: Acute compartment syndrome is an important differential diagnosis for the sudden onset of intra- or post-partum lower-limb pain. Predisposing factors for the manifestation of acute compartment syndrome in an obstetric environment are augmented intra-partum blood loss, prolonged hypotensive episodes and the use of oxytocin to support or induce labor because of its vasoconstrictive properties. Treatment is prompt surgical decompression by performing fasciotomy in any affected muscular compartments

Survey of major trauma centre preparedness for mass casualty incidents in Australia, Canada, England and New Zealand

Background: Mass casualty incidents (MCIs) are increasing. Trauma centres play a key role in MCIs due to their readiness and expansive multidisciplinary expertise for injury management. Previous studies have shown deficiencies in trauma centre disaster preparedness. The aim of this study was to describe the current disaster preparedness of Major Trauma Centres (MTCs) in Australia, Canada, England and New Zealand. Methods: A cross-sectional survey of all (n = 82) MTCs was undertaken. The anonymous survey collected data about disaster preparedness in nine key areas. Respondents were encouraged to consult appropriately at their centre to provide an accurate representation of their centre’s preparedness. Findings: Responses were received from 69 (84%) centres; 61 completed all questions. 91% had a disaster preparedness committee and 80% had an all-hazards emergency plan. 79% had held an MCI drill in the past 2 years. 54% reported a system in place to calculate maximum capacity, but testing of surge capacity was uncommon. 55% reported the presence of stored resources for an MCI and 58% had a database of staff trained in Emergency Management. 74% had a training and education plan available for staff involved in an MCI and a plan for professional debriefing of staff post-MCI, while 62% had a post-disaster employee assistance programme. Most centres had appropriate back-up communication, safety and security plans. Interpretation: The disaster preparedness of MTCs was high for communication, safety and security but there was clear need for improvement in other areas including surge capacity, human resources and post-disaster recovery

Sport-related major trauma incidence in young people and adults in England and Wales: a national registry-based study

Objectives Data on sport and physical activity (PA) injury risk can guide intervention and prevention efforts. However, there are limited national-level data, and no estimates for England or Wales. This study sought to estimate sport and PA-related major trauma incidence in England and Wales. Methods Nationwide, hospital registry-based cohort study between January 2012 and December 2017. Following Trauma Audit and Research Network Registry Research Committee approval, data were extracted in April 2018 for people ≥16 years of age, admitted following sport or PA-related injury in England and Wales. The population-based Active Lives Survey was used to estimate national sport and PA participation (ie, running, cycling, fitness activities). The cumulative injury incidence rate was estimated for each activity. Injury severity was described by Injury Severity Score (ISS) >15. Results 11 702 trauma incidents occurred (mean age 41.2±16.2 years, 59.0% male), with an ISS >15 for 28.0% of cases, and 1.3% were fatal. The overall annual injury incidence rate was 5.40 injuries per 100 000 participants. The incidence rate was higher in men (6.44 per 100 000) than women (3.34 per 100 000), and for sporting activities (9.88 per 100 000) than cycling (2.81 per 100 000), fitness (0.21 per 100 000) or walking (0.03 per 100 000). The highest annual incidence rate activities were motorsports (532.31 per 100 000), equestrian (235.28 per 100 000) and gliding (190.81 per 100 000). Conclusion Injury incidence was higher in motorsports, equestrian activity and gliding. Targeted prevention in high-risk activities may reduce admissions and their associated burden, facilitating safer sport and PA participation