10 research outputs found
Management of children visiting the emergency department during out-of-office hours: An observational study
Background The aim was to study the characteristics
and management of children visiting the emergency
department (ED) during out-of-office hours.
Methods We analysed electronic health record data from
119 204 children visiting one of five EDs in four European
countries. Patient characteristics and management
(diagnostic tests, treatment, hospital admission and
paediatric intensive care unit admission) were compared
between children visiting during office hours and evening
shifts, night shifts and weekend day shifts. Analyses were
corrected for age, gender, Manchester Triage System
urgency, abnormal vital signs, presenting problems and
hospital.
Results Patients presenting at night were younger
(median (IQR) age: 3.7 (1.4–8.2) years vs 4.8 (1.8–9.9)),
more often classified as high urgent (16.3% vs 9.9%) and
more often had ≥2 abnormal vital signs (22.8% vs 18.1%)
compared with office hours. After correcting for disease
severity, laboratory and radiological tests were less likely
to be requested (adjusted OR (aOR): 0.82, 95% CI 0.78–
0.86 and aOR: 0.64, 95% CI 0.60–0.67, respectively);
treatment
Biomechanical analysis of drop and countermovement jumps
For 13 subjects the performance of drop jumps from a height of 40 cm (DJ) and of countermovement jumps (CMJ) was analysed and compared. From force plate and cine data biomechanical variables including forces, moments, power output and amount of work done were calculated for hip, knee and ankle joints. In addition, electromyograms were recorded from five muscles in the lower extremity. The results obtained for DJ appeared to depend on jumping style. In a subgroup of subjects making a movement of large amplitude (i. e. bending their hips and knees considerably before pushing off) the push-off phase of DJ closely resembled that of CMJ. In a subgroup of subjects making a movement of small amplitude, however, the duration of the push-off phase was shorter, values for moments and mean power output at the knees and ankles were larger, and the mean EMG activity of m. gastrocnemius was higher in DJ than in CMJ. The findings are attributed to the influences of the rapid pre-stretch of knee extensors and plantar flexors after touch-down in DJ. In both subgroups, larger peak resultant reaction forces were found at the knee and ankle joints, and larger peak forces were calculated for the Achilles tendon in DJ than in CMJ
HLA associations in narcolepsy type 1 persist after the 2009 H1N1 pandemic
We aimed to compare HLA-DQB1-associations in narcolepsy type 1 (NT1) patients with disease onset before and after the 2009 H1N1 pandemic in a large Dutch cohort 525 NT1 patients and 1272 HLA-DQB1*06:02-positive healthy controls were included. Because of the discussion that has arisen on the existence of sporadic and post-H1N1 NT1, HLA-DQB1-associations in pre- and post-H1N1 NT1 patients were compared. The associations between HLA-DQB1 alleles and NT1 were not significantly different between pre- and post-H1N1 NT1 patients. Both HLA-DQB1-associations with pre- and -post H1N1 NT1 reported in recent smaller studies were replicated. Our findings combine the results of studies in pre- and post-H1N1 NT1 and argue against considering post-H1N1 NT1 as a different entity
Skin temperature as a predictor of on-the-road driving performance in people with central disorders of hypersomnolence
Excessive daytime sleepiness is the core symptom of central disorders of hypersomnolence (CDH) and can directly impair driving performance. Sleepiness is reflected in relative alterations in distal and proximal skin temperature. Therefore, we examined the predictive value of skin temperature on driving performance. Distal and proximal skin temperature and their gradient (DPG) were continuously measured in 44 participants with narcolepsy type 1, narcolepsy type 2 or idiopathic hypersomnia during a standardised 1-h driving test. Driving performance was defined as the standard deviation of lateral position (SDLP) per 5?km segment (equivalent to 3?min of driving). Distal and proximal skin temperature and DPG measurements were averaged over each segment and changes over segments were calculated. Mixed-effect model analyses showed a strong, quadratic association between proximal skin temperature and SDLP (p?<?0.001) and a linear association between DPG and SDLP (p?<?0.021). Proximal skin temperature changes over 3 to 15?min were predictive for SDLP. Moreover, SDLP increased over time (0.34?cm/segment, p?<?0.001) and was higher in men than in women (3.50?cm, p?=?0.012). We conclude that proximal skin temperature is a promising predictor for real-time assessment of driving performance in people with CDH