An increasing number of abdominal gunshot and stab wounds are being treated without the need for unnecessary operations.
Researchers from The Johns Hopkins School of Medicine, USA, and the Aga Khan University in Pakistan reviewed nearly 26,000 patients with penetrating abdominal gunshot or stab injuries from the American College of Surgeons’ National Trauma Data Bank.
They focused on patients aged 16 years plus who survived long enough to be admitted to one of the 378 level one or two trauma centres for at least 24 hours. Just over half of the 25,737 patients (51%) had stab wounds and the remainder had gunshot wounds.
The study found that just over 22% of the gunshot wounds were treated using selective non-operative management (SNOM), together with just under 34% of stab wounds. The remainder of the surviving patients received laparotomy surgery.
‘SNOM rates for stab wounds increased by 50% between 2002 and 2008 and rates for gunshot injuries increased by 28%’ says co-author Dr Adil H Haider, associate professor of surgery and co-director of the Center for Surgery, Trials and Outcomes Research at Johns Hopkins. ‘This correlated with a decrease in the number of non-therapeutic laparotomies (NTL).
‘In most instances, failed SNOM was associated with increased death rates, underlining the importance of careful patient selection and protocols to reduce failure rates. However, it is important to point out that failure rates fell for both injuries during the seven-year study period and that successful SNOM was associated with shorter hospital stays.’
Key findings of the study included:
Gunshot wounds
Photoacoustic device finds cancer cells before they become tumours
, /in E-News /by 3wmediaEarly detection of melanoma, the most aggressive skin cancer, is critical because melanoma will spread rapidly throughout the body. Now, University of Missouri researchers are one step closer to melanoma cancer detection at the cellular level, long before tumours have a chance to form. Commercial production of a device that measures melanoma using photoacoustics, or laser-induced ultrasound, will soon be available to scientists and academia for cancer studies. The commercial device also will be tested in clinical trials to provide the data required to obtain U.S. Food and Drug Administration approval for early diagnosis of metastatic melanoma and other cancers.
‘Using a small blood sample, our device and method will provide an earlier diagnosis for aggressive melanoma cancers,’ said John Viator, associate professor of biomedical engineering and dermatology in the Christopher S. Bond Life Sciences Center. ‘We compare the detection method to watching an eight-lane highway full of white compact cars. In our tests, the cancer cells look like a black 18-wheeler.’
Currently, physicians use CT or MRI scans for melanoma cancer detection, costing thousands of dollars. Viator
Focusing on family helps mothers of technology-dependent children function
, /in E-News /by 3wmediaNormal everyday life for parents requires organisation. Parents of children who require ventilators, oxygen, IVs and other tools to live, those day-to-day tasks can be time-consuming, difficult and stressful on the family. But researchers from Case Western Reserve University found that mothers who successfully integrate the care of the technology-dependent child into family life have families that function better.
‘It
Trauma centres increase use of non-surgical options for abdominal gunshot and stab wounds
, /in E-News /by 3wmediaAn increasing number of abdominal gunshot and stab wounds are being treated without the need for unnecessary operations.
Researchers from The Johns Hopkins School of Medicine, USA, and the Aga Khan University in Pakistan reviewed nearly 26,000 patients with penetrating abdominal gunshot or stab injuries from the American College of Surgeons’ National Trauma Data Bank.
They focused on patients aged 16 years plus who survived long enough to be admitted to one of the 378 level one or two trauma centres for at least 24 hours. Just over half of the 25,737 patients (51%) had stab wounds and the remainder had gunshot wounds.
The study found that just over 22% of the gunshot wounds were treated using selective non-operative management (SNOM), together with just under 34% of stab wounds. The remainder of the surviving patients received laparotomy surgery.
‘SNOM rates for stab wounds increased by 50% between 2002 and 2008 and rates for gunshot injuries increased by 28%’ says co-author Dr Adil H Haider, associate professor of surgery and co-director of the Center for Surgery, Trials and Outcomes Research at Johns Hopkins. ‘This correlated with a decrease in the number of non-therapeutic laparotomies (NTL).
‘In most instances, failed SNOM was associated with increased death rates, underlining the importance of careful patient selection and protocols to reduce failure rates. However, it is important to point out that failure rates fell for both injuries during the seven-year study period and that successful SNOM was associated with shorter hospital stays.’
Key findings of the study included:
Gunshot wounds
Clostridium difficile lengthens hospital stays by six days on average
, /in E-News /by 3wmediaC. difficile is the most common cause of infectious diarrhoea in hospital, and it is estimated that 10% of patients who become infected in hospital will die. Researchers used The Ottawa Hospital Data Warehouse, Canada to analyse data on 136 877 admissions to The Ottawa Hospital between July 1, 2002 and March 31, 2009. A total of 1393 patients acquired C. difficile in hospital during this time, and these patients spent 34 days in hospital compared with eight days for patients who did not have C. difficile. However, the researchers also found that patients who became infected with C. difficile tended to have more serious illnesses and would have been more likely to stay longer in hospital anyway. When the researchers controlled for the level of illness using a mathematical model, they found that hospital-acquired C. difficile increased the length of stay in hospital by six days. The researchers believe that the study provides the most accurate measure yet of the impact of hospital-acquired C. difficile on length of hospital stay. C. difficile is a very serious problem for patients and for healthcare systems, however the good news is that tools such as this can provide more accurate information about C. difficile infection, helping to improve infection prevention efforts and also analyse their cost-effectiveness.
http://tinyurl.com/c5ynk5eImproved technology may obviate need for drug when assessing patients for a coronary stent
, /in E-News /by 3wmediaA new method for measuring narrowing in the coronary arteries may allow patients to be assessed for a stent without having to take a drug with unpleasant side effects. Currently fractional flow reserve (FFR) involves inserting a wire into the artery to measure changes in blood pressure. This is sometimes used in addition to an angiogram to give a more clinically accurate measurement to help make the decision to insert a stent. However, FFR requires the patient to be given a drug such as adenosine to dilate blood vessels, which can cause unpleasant side effects including facial flushing and shortness of breath. Although there is good evidence that FFR is useful, it is done in only 5-10 per cent of cardiac stenting procedures because it is costly, time-consuming and some patients cannot receive adenosine, such as patients with certain heart conduction diseases. Now, researchers at Imperial College London, UK have developed a way to measure narrowings in the arteries instantaneously, using the same instruments as FFR but without the need for a drug. The new investigational method, termed the instant wave-Free Ratio could benefit patients by making it easier to determine whether a stent is the best option.Like FFR, iFR works by inserting a wire into the coronary artery to measure blood pressure on either side of the narrowing. However it is possible to obtain a measurement during a particular time in the heart
Probiotics reduce infections for patients in intensive care
, /in E-News /by 3wmediaTraumatic brain injury is associated with a profound suppression of the patient
An easy-to-use cleaning solution to control resistant bacteria in hospitals
, /in E-News /by 3wmediaAccording to the WHO, antibiotic-resistant bacteria are one of the top three threats to human health; patients in hospitals are especially at risk. Now researchers at Tel Aviv University
Drug side-effects are so bad women end treatment and risk return of cancer
, /in E-News /by 3wmediaWhy do so many postmenopausal women who are treated for oestrogen-sensitive breast cancer stop using aromatase inhibitors that help prevent the disease from recurring? The first study to actually ask the women themselves, as well as the largest, most scientifically rigorous study to examine the question, carried out at Northwestern University, USA reports that 36 percent of women stop treatment early because of the medications
Software for analysing digital pathology images proving its usefulness
, /in E-News /by 3wmediaIn a new study, a program known as Spatially Invariant Vector Quantisation (SIVQ) was able to separate malignancy from background tissue in digital slides of micropapillary urothelial carcinoma, a type of bladder cancer whose features can vary widely from case to case and that presents diagnostic challenges even for experts.
‘Being able to pick out cancer from background tissue is a key test for this type of software tool,’ says U-M informatics fellow Jason Hipp, M.D., Ph.D., who shares lead authorship of the paper with resident Steven Christopher Smith, M.D., Ph.D. ‘This is the type of validation that has to happen before digital pathology tools can be widely used in a clinical setting.’
To test the software
Predicting the value of indexing symptoms for ovarian cancer
, /in E-News /by 3wmediaThe use of symptom indices to identify patients with symptoms associated with ovarian cancer who may need further screening is increasing in both the UK and the US in an attempt to promote earlier diagnosis, but they may need to be reassessed in order to help better detect cancer.
Ovarian cancer is a disease which is perceived to rarely produce symptoms until the disease has spread to other organs of the body, allowing the disease to reach an advanced stage before it is caught. Some evidence suggests patient-reported symptoms may help detect the cancer early on, and in fact, the Goff index, which uses questionnaire data, has been reported to be effective in identifying women who are at a low to moderate risk of ovarian cancer. However, symptom assessment may greatly influence index performance.
To determine the effectiveness of the symptom indices, Anita Wey Wey Lim of the Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, at Queen Mary University of London and associates looked at data from 194 women who had recently been diagnosed with ovarian cancer and 268 control subjects who underwent ovarian cancer screenings. The symptom data was assessed through questionnaires, telephone interviews, and general practitioner notes. The sensitivity of the symptoms reported within a few months of the diagnosis was also determined by comparing two 12 month periods (0-11 and 3-14 months before diagnosis).
The researchers found that the results were similar to those found in previous reports on the Goff index and that the sensitivity of the symptoms were stronger in late- vs early-stage disease. The assessment also shows that there is only a slight variation in the symptoms reported by women with early- vs late-stage disease.
The authors note that a strong point in the study comes from a comparison of multiple data sources, which had never been done before. Even so, they write that, ‘The small differences between the three indices indicate that there is little to gain from deriving new symptom indices.’ They also suggest that while a symptom index could advance the diagnosis of ovarian cancer, the benefits of such are greatly overemphasised, given that most symptoms of the disease emerge within three months before diagnosis. They write, ‘At best, a symptom index might advance diagnosis of ovarian cancer by 3 months or more in two-thirds of women. For a more specific index, the sensitivity would be approximately one-third.’
In an accompanying editorial, Patricia Hartge, ScD, at National Cancer Institute’s Division of Cancer Epidemiology and Genetics, and James L. Speyer, MD, from the NYU Langone Cancer Center, write that symptom indices such as the Goff index and two novel indices described in the study are viewed as good for detecting early-stage ovarian cancer with the assumption that an early detection and therapy can achieve a better patient outcome. While this can be true, they caution that these indices were not highly specific and that the screeners found the cancer symptoms close to the time in which the patient was diagnosed. ‘The study design permits no calculation of years of life that might have been saved or lost if screeners actually were used