INFORMED CONSENT FOR TRAUMA PATIENTS: AN EXPERIMENT TO IMPROVE TAIWANESE PATIENT KNOWLEDGE AND SATISFACTION AFTER INFORMED CONSENT FOR DEBRIDEMENT OF COMPLICATED WOUNDS

Background: Valid informed consent is an ethical fundamental element and a prerequisite of law and regulation for clinical treatment. Trauma patients with physical pain and emotional stress under an environment of time constraint in emergency settings usually have difficulty in understanding the information presented to them. It is vital that physicians convey any complicated treatment information to patients, and patients need to have adequate knowledge about the treatment to facilitate individual choice. Aims: The study has three aims. The first aim is to explore what the current state of art for informed consent is, and how we can improve the quality of the informed consent process for trauma patients in the emergency department. The second aim is to develop an audiovisual video containing the information for the informed consent process in trauma patients undergoing the surgery, and to develop and validate a knowledge measure instrument to quantify the understanding of trauma patients for informed consent to surgery. The third aim is to compare the understanding and satisfaction of trauma patients between video and routine informed consent groups. Methods: To address the first aim, a systematic review is conducted to identify relevant articles. To address the second aim, an audiovisual video including information about the surgical procedure, benefits, risks, and alternatives is developed. One panel of experts is invited to develop the script for the video based upon the consensus from the modified Delphi technique. Furthermore, the development of the knowledge measure instrument is based on the literature and the consensus of experts. To address the third aim, a prospective randomized controlled trial is conducted in the emergency department, and a convenience sample of targeted trauma patients is enrolled. Findings: From the literature, it is found that trauma patients have poor recall of risks and complications, while written information, pamphlets or video have positive effect on patients’ understanding and satisfaction. Modified Delphi technique is a useful method to collect and reach experts’ consensus to develop the contents of informed consent. Moreover, the audiovisual video containing information about informed consent to surgery for trauma patients was developed and pilot-tested as well as the knowledge measure instrument for evaluating the understanding of trauma patients. Furthermore, by using the educational video, patients were found to have better information, more understanding and higher satisfaction. The video-assisted method is, accordingly, a good vehicle for improving the informed consent process for trauma patients in the emergency department. Conclusion: The content of informed consent should be developed by integrating a variety of experts’ opinions, especially patients. Using educational videos is a good tool for improving informed consent process for the surgery in trauma patients. Future studies should be conducted to develop a structured and standardized informed consent process and evaluate the effectiveness in combination with healthcare providers, patients, and informed consent experts. Institutions should give top priority to ensure patient-centered health care and improved quality of care for trauma patients

Pancreatic Tail Cancer with Sole Manifestation of Left Flank Pain: A Very Rare Presentation

Pancreatic cancer is sometimes called a “silent disease” because it often causes no symptoms in the early stage. The symptoms can be quite vague and various depending on the location of cancer in the pancreas. The anatomic site distribution is 78% in the head of the pancreas, 11% in the body, and 11% in the tail. Pancreatic cancer is rarely detected in the early stage, and it is very uncommon to diagnose pancreatic tail cancer during an emergency department visit. The manifestation of pancreatic tail cancer as left flank pain is very rare and has seldom been identified in the literature. We present a case of pancreatic tail cancer with the sole manifestation of dull left flank pain. Having negative findings on an ultrasound study initially, this female patient was misdiagnosed as having possible acute gastritis, urolithiasis or muscle strain after she received gastroendoscopy and colonofiberscopy. Her symptoms persisted for several months and she visited our emergency department due to an acute exacerbation of a persistent dull pain in the left flank area. Radiographic evaluation with computed tomography was performed, and pancreatic tail tumor with multiple metastases was found unexpectedly. We review the literature and discuss this rare presentation of pancreatic tail cancer

Bis[2-(2H-benzotriazol-2-yl)-4-methylphenolato]palladium(II)

In the title complex, [Pd(C13H10N3O)2], the PdII atom is tetra­coordinated by two N atoms and two O atoms from two bidentate 2-(2H-benzotriazol-2-yl)-4-methylphenolate ligands, forming a square-planar environment. The asymmetric unit contains one half mol­ecule in which the Pd atom lies on a centre of symmetry

Use of sodium bicarbonate for acute dizziness after minor head injury

AbstractObjectiveDizziness after minor head injury (mHI) is common. In some eastern countries, it is treated with 7% sodium bicarbonate solution (SB). This prospective study evaluated the clinical efficacy of SB compared with normal saline (NS).Material and methodsFrom April 2009 to April 2010, we performed a prospective observational study on 228 patients (68% female, 32% male) with acute dizziness after mHI. At the emergency physician’s discretion, intravenous SB (1 mL/kg) in NS (250 mL) or NS (250 mL) was administered to 166 patients and 62 patients, respectively, as empiric antidizziness therapy. Outcome measures were severity of dizziness and treatment response, which were measured by a visual analog scale. Various characteristics were compared between treatment groups. Any continued dizziness of the patients during follow-up was also compared with their pre-injury condition, such as prior psychiatric disorders and the presence of vertigo.ResultsThe SB group had their visual analog scale scores reduced by 25.4% compared with 24.6% in the NS group. Both groups showed a statistically significant reduction in dizziness (p < 0.001); however, the dizziness improvement did not differ significantly between the two treatment groups (p = 0.699). Sixty-four patients (28.1%) suffered from continued dizziness during follow-up (mean period, 22.4 ± 28.9 days). The prevalence of continued dizziness was higher in patients with prior psychiatric disorders, although this was not statistically significant (40% vs. 27.2%, p = 0.276), whereas patients with prior vertigo did not experience a higher dizziness relapse rate (27% vs. 28.2%).ConclusionsSB and NS administrations are both effective individually when treating patients with acute dizziness from mHI; however, both results may be attributable to the placebo effect. Therefore more research is necessary to understand the complex conditions that determine the effects of SB on this disorder

In situ reconstruction of septic aortic pseudoaneurysm due to Salmonella or Streptococcus microbial aortitis: long-term follow-up

AbstractObjectiveThis study was undertaken to illustrate the safety of in situ reconstruction of septic aortic pseudoaneurysm (SAP) secondary to microbial aortitis, with or without long-term antibiotic treatment.MethodsData for patients with SAP (11 abdominal, 4 thoracic) operated on between 1993 and 1999 were reviewed. Computed tomography and aortography showed septic pseudoaneurysm in all patients before surgery. After diagnosis of SAP, all patients underwent aneurysm resection and extensive debridement, with in situ prosthetic grafting or patch repair angioplasty. The graft in 10 of the 11 patients with abdominal SAP was also wrapped with an omental pedicle. In vitro active parenteral antibiotic therapy was prescribed for all patients for at least 2 to 8 weeks after surgery.ResultsAll 15 patients had positive preoperative blood cultures or intraoperative tissue cultures for Salmonella spp (n = 12), viridans Streptococcus (n = 1), group G Streptococcus (n = 1), or Streptococcus pneumoniae (n = 1). There were two perioperative deaths (13.3%), one 6 days after surgery and the other 19 days after surgery, and two late deaths, at 8 and 10 months after surgery, neither of which was related to aortic repair. One patient was unavailable for follow-up. The other 10 patients have been regularly followed up with abdominal ultrasound or computed tomography (mean, 84 months; range, 47-118 months). To date, there has been no graft infection, thrombosis, false aneurysm, or subsequent aortic surgery in these 10 patients.ConclusionSAP due to Salmonella and streptococcal microbial arortitis can be successfully treated with resection of the aneurysm and extensive debridement, followed by in situ prosthetic graft interposition or patch repair aortoplasty. This is a safe and effective treatment that may result in complete remission of SAP. Postoperative parenteral antibiotic therapy should be continued for 2 to 8 weeks. Although usually recommended, lifelong suppressive antibiotic therapy appears to be nonessential with this approach

Melanogenesis Inhibitor(s) from Phyla nodiflora

Overexpression of tyrosinase can cause excessive production of melanin and lead to hyperpigmentation disorders, including melasma and freckles. Recently, agents obtained from plants are being used as alternative medicines to downregulate tyrosinase synthesis and decrease melanin production. Phyla nodiflora Greene (Verbenaceae) is used as a folk medicine in Taiwanese for treating and preventing inflammatory diseases such as hepatitis and dermatitis. However, the antimelanogenesis activity and molecular biological mechanism underlying the activity of the methanolic extract of P. nodiflora (PNM) have not been investigated to date. Our results showed that PNM treatment was not cytotoxic and significantly reduced the cellular melanin content and tyrosinase activity in a dose-dependent manner (P<0.05). Further, PNM exhibited a significant antimelanogenesis effect (P<0.05) by reducing the levels of phospho-cAMP response element-binding protein and microphthalmia-associated transcription factor (MITF), inhibiting the synthesis of tyrosinase, tyrosinase-related protein-1 (TRP-1), and TRP-2, and decreasing the cellular melanin content. Moreover, PNM significantly activated the phosphorylation of mitogen-activated protein kinases, including phospho-extracellular signal-regulated kinase, c-Jun N-terminal kinase, and phospho-p38, and inhibited the synthesis of MITF, thus decreasing melanogenesis. These properties suggest that PNM could be used as a clinical and cosmetic skin-whitening agent to cure and/or prevent hyperpigmentation

THE EFFECT OF COUNTER MOVEMENT JUMP PERFORMANCE IN MIDDLEAGED ELDERLY PRACTICING TAI-CHI EXERCISE

The purpose of this study was to investigate biomechanical effects of Tal-Chi exercise on the lower-extremity in middle-aged elders during counter-movement jump. Twelve middle-aged elders with regular Tai Chi exercise experience and twelve healthy middle-aged elders participated in this study. Ten Vicon Motion System cameras, two Kistler force plates were used simultaneously to capture the kinematic and dynamlc parameters of standing vertical jumps. Independent samples &test was performed for statistical analysis ( u = .05 ). Since the jump height of Tai Chi group was significantly higher ( p c .05 ). It showed that practicing Tai Chi exercise could effectively slow down the degeneration of the moment and power at the hip Joint. Therefore, middle-aged elders were recommended to engage in long-term Tai Chi exercise