Safety and Efficacy of Erythropoietin in Traumatic Brain Injury Patients: A Pilot Randomized Trial

Background. Erythropoietin (EPO) is a neuroprotective agent utilized in stroke patients. This pilot study represents the first randomized trial of EPO in traumatic brain injury (TBI) patients. Methods. Adult, blunt trauma patients with evidence of TBI were randomized to EPO or placebo within 6 hours of injury. Baseline and daily serum S-100B and Neuron Specific Enolase (NSE) levels were measured. Results. TBI was worse in the EPO (n = 11) group compared to placebo patients (n = 5). The use of EPO did not impact NSE (P = .89) or S100 B (P = .53) levels compared to placebo. Conclusions. At the dose used, EPO did not reduce neuronal cell death compared to placebo; however, TBI severity was worse in the EPO group while levels of NSE and S100-B were similar to the less injured placebo group making it difficult to rule out a treatment effect. A larger, balanced study is necessary to confirm a potential treatment effect

Metabolic Effects of Cyclic Parenteral Nutrition Infusion in Adults and Children

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/141574/1/ncp0277.pd

A review of patients who suddenly deteriorate in the presence of paramedics

<p>Abstract</p> <p>Background</p> <p>The report of the Ministerial Review of Trauma and Emergency Services in Victoria, Australia, recommended that paramedics be permitted to divert to the closest hospital in incidences of life threatening situations prior to and during transport. An audit of patients that suddenly deteriorated in paramedic care was recommended by the Ministerial Review. The objective of the study was to identify the number and outcome of patients who suddenly deteriorated in the presence of paramedics.</p> <p>Methods</p> <p>A retrospective cohort study of trauma patients who suddenly deteriorated in the presence of paramedics during 2002. As there was no standard definition, sudden deterioration was defined using a predetermined set of physiological criteria. Patient care record data of patients who suddenly deteriorated were compared with the State Trauma Registry to determine those who sustained hospital defined major trauma. Patient care records where hospital bypass was undertaken were identified and analysed. Ethics committee approval was obtained.</p> <p>Results</p> <p>There were 2,893 patients that suddenly deteriorated according to predefined criteria. 2,687 (5.1% of the total trauma patients for 2002) were suitable for further analysis. The majority of patients had a sudden decrease in BP (n = 2,463) with 4.3% having hospital defined major trauma. For patients with a sudden decrease in conscious state or a total GCS score of less than 13 (n = 77), 37.7% had hospital defined major trauma; and a sudden increase/decrease in pulse rate and sudden decrease in BP (n = 65), 26.2% had hospital defined major trauma. Only 28 documented incidents of hospital bypass were identified.</p> <p>Conclusion</p> <p>This study suggests that the incidents of patients suddenly deteriorating in the presence of paramedics are low and the incidence of hospital bypass is not well documented.</p

Predicting the Potential Worldwide Distribution of the Red Palm Weevil Rhynchophorus ferrugineus (Olivier) (Coleoptera: Curculionidae) using Ecological Niche Modeling

This is the publisher's version, also available electronically from http://www.bioone.org/doi/abs/10.1653/024.095.0317.The red palm weevil (RPW), Rhynchophorus ferrugineus (Olivier) (Coleoptera: Curculionidae), ranks among the most important pests of various palm species. The pest originates from South and Southeast Asia, but has expanded its range dramatically since the 1980s. We used ecological niche modeling (ENM) approaches to explore its likely geographic potential. Two techniques, the Genetic Algorithm for Rule-set Prediction (GARP) and a maximum entropy approach (MaxEnt), were used. However, MaxEnt provided more significant results, with all 5 random replicate subsamples having P < 0.002 while GARP models failed to achieve statistical significance in 3 of 5 cases, in which predictions achieved probabilities of 0.07 < P < 0.10. The MaxEnt models predicted successfully the known distribution, including the single North American occurrence point of Laguna Beach, California, and various areas where the pest has been reported in North Africa, southern Europe, Middle East and South and Southeastern Asia. In addition, areas where the pest has not been yet reported were found to be suitable for invasion by RPW in sub-Saharan Africa, southern, central and northern America, Asia, Europe, and Oceania. Highly suitable areas in the United States of America were limited mostly to coastal California and southern Florida, while all Caribbean islands were found highly suitable for establishment and spread of the pest

Regionalisation of trauma care in England

Aims We aimed to determine whether there is evidence of improved patient outcomes in Major Trauma Centres following the regionalisation of trauma care in England. Patients and Methods An observational study was undertaken using the Trauma Audit and Research Network (TARN), Hospital Episode Statistics (HES) and national death registrations. The outcome measures were indicators of the quality of trauma care, such as treatment by a senior doctor and clinical outcomes, such as mortality in hospital. Results and Conclusion A total of 20 181 major trauma cases were reported to TARN during the study period, which was 270 days before and after each hospital became a Major Trauma Centre. Following regionalisation of trauma services, all indicators of the quality of care improved, fewer patients required secondary transfer between hospitals and a greater proportion were discharged with a Glasgow Outcome Score of “good recovery”. In this early post-implementation analysis, there were a number of apparent process improvements (e.g. time to CT) but no differences in either crude or adjusted mortality. The overall number of deaths following trauma in England did not change following the national reconfiguration of trauma services. Evidence from other countries that have regionalised trauma services suggests that further benefits may become apparent after a period of maturing of the trauma system