Checklistor och »crowdsourcing« för ökad patientsäkerhet på akutmottagningen

Checklists make it easier for the emergency physician. This is the idea behind a website launched this month. The site will contain suggestions for checklists on what information which should be obtained for the assessment of the patient at the emergency department. All emergency staff are invited to participate in the development of the project

A compare between myocardial topical negative pressure levels of -25 mmHg and -50 mmHg in a porcine model

<p>Abstract</p> <p>Background</p> <p>Topical negative pressure (TNP), widely used in wound therapy, is known to stimulate wound edge blood flow, granulation tissue formation, angiogenesis, and revascularization. We have previously shown that application of a TNP of -50 mmHg to the myocardium significantly increases microvascular blood flow in the underlying tissue. We have also shown that a myocardial TNP levels between -75 mmHg and -150 mmHg do not induce microvascular blood flow changes in the underlying myocardium. The present study was designed to elucidate the difference between -25 mmHg and -50 mmHg TNP on microvascular flow in normal and ischemic myocardium.</p> <p>Methods</p> <p>Six pigs underwent median sternotomy. The microvascular blood flow in the myocardium was recorded before and after the application of TNP using laser Doppler flowmetry. Analyses were performed before left anterior descending artery (LAD) occlusion (normal myocardium), and after 20 minutes of LAD occlusion (ischemic myocardium).</p> <p>Results</p> <p>A TNP of -25 mmHg significantly increased microvascular blood flow in both normal (from 263.3 ± 62.8 PU before, to 380.0 ± 80.6 PU after TNP application, * <it>p </it>= 0.03) and ischemic myocardium (from 58.8 ± 17.7 PU before, to 85.8 ± 20.9 PU after TNP application, * <it>p </it>= 0.04). A TNP of -50 mmHg also significantly increased microvascular blood flow in both normal (from 174.2 ± 20.8 PU before, to 240.0 ± 34.4 PU after TNP application, * <it>p </it>= 0.02) and ischemic myocardium (from 44.5 ± 14.0 PU before, to 106.2 ± 26.6 PU after TNP application, ** <it>p </it>= 0.01).</p> <p>Conclusion</p> <p>Topical negative pressure of -25 mmHg and -50 mmHg both induced a significant increase in microvascular blood flow in normal and in ischemic myocardium. The increase in microvascular blood flow was larger when using -25 mmHg on normal myocardium, and was larger when using -50 mmHg on ischemic myocardium; however these differences were not statistically significant.</p

Environmental impact assessment (EIA) on cultivation of the nile tilapia (Oreochromis niloticus) with brackish water in Dashtestan

EIA is a worthy tool for identifying and assessing potential impacts and control them.it compatibles environmental aspects with sustainable development. In order to predict the effects of tilapia culture activities on regional we gathered physical, biological, and social information to quantify the activities effects on them. We addressed 42 impacts consist of 31 positive, and 11 negative. These affect half of social, 33% of physical, and 17 of biological elements. This equivalent with -42, +304, and+36 when puts in the charts.in order to have a good and comprehensive assessment of activities Leopold matrices was employed. Based on summarized values from this we have +380and -82 results +298. This means that this activity has a great positive result especially on socio-economic environment. These kinds of studies are highly recommended for other parts of the Bushehr province e.g Dashtestan county that most of their water resources are brackish and not suitable for agriculture

Personalized diagnosis in suspected myocardial infarction

Background: In suspected myocardial infarction (MI), guidelines recommend using high-sensitivity cardiac troponin (hscTn)- based approaches. These require fixed assay-specific thresholds and timepoints, without directly integrating clinical information. Using machine-learning techniques including hs-cTn and clinical routine variables, we aimed to build a digital tool to directly estimate the individual probability of MI, allowing for numerous hs-cTn assays. Methods: In 2,575 patients presenting to the emergency department with suspected MI, two ensembles of machine-learning models using single or serial concentrations of six different hs-cTn assays were derived to estimate the individual MI probability ( ARTEMIS model). Discriminative performance of the models was assessed using area under the receiver operating characteristic curve (AUC) and logLoss. Model performance was validated in an external cohort with 1688 patients and tested for global generalizability in 13 international cohorts with 23,411 patients. Results: Eleven routinely available variables including age, sex, cardiovascular risk factors, electrocardiography, and hs-cTn were included in the ARTEMIS models. In the validation and generalization cohorts, excellent discriminative performance was confirmed, superior to hs-cTn only. For the serial hs-cTn measurement model, AUC ranged from 0.92 to 0.98. Good calibration was observed. Using a single hs-cTn measurement, the ARTEMIS model allowed direct rule-out of MI with very high and similar safety but up to tripled efficiency compared to the guideline- recommended strategy. Conclusion We developed and validated diagnostic models to accurately estimate the individual probability of MI, which allow for variable hs-cTn use and flexible timing of resampling. Their digital application may provide rapid, safe and efficient personalized patient care

Influenza Vaccination After Myocardial Infarction: A Randomized, Double-Blind, Placebo-Controlled, Multicenter Trial.

BACKGROUND: Observational and small, randomized studies suggest that influenza vaccine may reduce future cardiovascular events in patients with cardiovascular disease. METHODS: We conducted an investigator-initiated, randomized, double-blind trial to compare inactivated influenza vaccine with saline placebo administered shortly after myocardial infarction (MI; 99.7% of patients) or high-risk stable coronary heart disease (0.3%). The primary end point was the composite of all-cause death, MI, or stent thrombosis at 12 months. A hierarchical testing strategy was used for the key secondary end points: all-cause death, cardiovascular death, MI, and stent thrombosis. RESULTS: Because of the COVID-19 pandemic, the data safety and monitoring board recommended to halt the trial before attaining the prespecified sample size. Between October 1, 2016, and March 1, 2020, 2571 participants were randomized at 30 centers across 8 countries. Participants assigned to influenza vaccine totaled 1290 and individuals assigned to placebo equaled 1281; of these, 2532 received the study treatment (1272 influenza vaccine and 1260 placebo) and were included in the modified intention to treat analysis. Over the 12-month follow-up, the primary outcome occurred in 67 participants (5.3%) assigned influenza vaccine and 91 participants (7.2%) assigned placebo (hazard ratio, 0.72 [95% CI, 0.52-0.99]; P=0.040). Rates of all-cause death were 2.9% and 4.9% (hazard ratio, 0.59 [95% CI, 0.39-0.89]; P=0.010), rates of cardiovascular death were 2.7% and 4.5%, (hazard ratio, 0.59 [95% CI, 0.39-0.90]; P=0.014), and rates of MI were 2.0% and 2.4% (hazard ratio, 0.86 [95% CI, 0.50-1.46]; P=0.57) in the influenza vaccine and placebo groups, respectively. CONCLUSIONS: Influenza vaccination early after an MI or in high-risk coronary heart disease resulted in a lower risk of a composite of all-cause death, MI, or stent thrombosis, and a lower risk of all-cause death and cardiovascular death, as well, at 12 months compared with placebo. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02831608

Global, regional, and national burden of colorectal cancer and its risk factors, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019

Funding: F Carvalho and E Fernandes acknowledge support from Fundação para a Ciência e a Tecnologia, I.P. (FCT), in the scope of the project UIDP/04378/2020 and UIDB/04378/2020 of the Research Unit on Applied Molecular Biosciences UCIBIO and the project LA/P/0140/2020 of the Associate Laboratory Institute for Health and Bioeconomy i4HB; FCT/MCTES through the project UIDB/50006/2020. J Conde acknowledges the European Research Council Starting Grant (ERC-StG-2019-848325). V M Costa acknowledges the grant SFRH/BHD/110001/2015, received by Portuguese national funds through Fundação para a Ciência e Tecnologia (FCT), IP, under the Norma Transitória DL57/2016/CP1334/CT0006.proofepub_ahead_of_prin

Vacuum-Assisted Closure Therapy after Cardiac Surgery. Sternal Stability, Cost of Care, Learning Curve and Hemodynamic Outcome

Deep sternal wound infection (DSWI) following cardiothoracic surgery is a rare but potentially life-threatening complication with high morbidity and mortality. DSWI is associated with a significant increase in the length of hospital stay and the cost of hospitalization. The socioeconomic impact of DSWI is considerable. Conventional treatment includes reexploration, surgical debridement, mediastinal antibiotic irrigation-suction, primary or delayed sternal closure, and reconstructive procedures with vascularized tissue flaps. Despite these efforts, patients with DSWI have poor long-term outcome following conventional treatment. Vacuum-assisted closure (VAC) therapy is a new modality for the treatment of problematic chest wound healing. This technique can be performed with less surgical trauma and has been adopted as the standard treatment for DSWI because of its excellent clinical outcome. However, many questions remain concerning VAC therapy, such as the optimal subatmospheric pressure, cost-effectiveness, learning curve effects, survival and changes in hemodynamics. The aims of this work were: (1) to evaluate sternal stability at different negative pressures during VAC therapy; (2) to investigate whether high negative pressures increase the rate of organ rupture (e.g. heart and lungs); (3) to calculate the cost of VAC treatment in patients with DSWI after cardiac surgery; (4) to ascertain whether there is any correlation between the preoperative EuroSCORE and the cost of DSWI therapy; (5) to identify possible effects of the learning curve on survival during the introduction of VAC therapy in patients with DSWI and predictors of late mortality; and finally (6) to investigate changes in the hemodynamics during the application of negative pressure therapy. We found that low negative pressures (–50 to –100 mmHg) stabilize the sternum just as efficiently as high negative pressures (–150 to –200 mmHg). No failure of the foam dressings or organ ruptures were seen following the application of low negative pressures in combination with high lateral forces (above 200 N). VAC therapy in patients with DSWI following cardiac surgery seems to be cost-effective and no correlations were found between the preoperative EuroSCORE and the cost of DSWI therapy after CABG surgery. VAC therapy is thus an excellent adjunct for wound healing in DSWI without significant learning curve effects on early or late mortality. Late diagnosis and prolonged wound therapy were identified as predictors of late mortality. With a suitable foam application technique, a pressure of –75 mmHg can be applied without compromising the central hemodynamics