The influence of stretcher height on the mechanical effectiveness of rowing

The aim of the present study was to determine the effect of varying the height of the foot stretcher on the mechanical effectiveness of rowing. Ten male university level rowers rowed maximally for 3 minutes 30 seconds on a modified Concept 2 rowing ergometer. Each participant completed one trial at three foot stretcher heights. Position 1 was the original Concept 2 stretcher position, with Position 2 being located 5 cm and Position 3 being 10 cm above the original position and in the same orientation. Pull force and velocity were measured, and mean power generated by the rowers was calculated for each stroke. It was shown that in all three stretcher positions, mean power per stroke decreased as a function of time during the trial, confirming the fatiguing effects of the task. Although mean power per stroke did not differ significantly between stretcher positions at the start of the trial, p = 0.082, a significant difference was observed between the original stretcher position and Positions 2 and 3 at the end of the trial, p < 0.05. The lowest decline in mean power occurred in the highest stretcher position. It is suggested that this improvement in effectiveness is due to a reduction in the active downward vertical forces applied to the foot stretchers which does not contribute to forward propulsion, and thus a reduction in energy waste during each stroke. It was hypothesized that further raising the stretchers will continue to lead to an improvement in effectiveness until the optimum stretcher height is reached, above which effectiveness will be reduced.     

Improving the care of patients with major trauma in the accident and emergency department.

OBJECTIVE--To determine whether improvement in the care of victims of major trauma could be made by using the revised trauma score as a triage tool to help junior accident and emergency doctors rapidly identify seriously injured patients and thereby call a senior accident and emergency specialist to supervise their resuscitation. DESIGN--Comparison of results of audit of management of all seriously injured patients before and after these measures were introduced. SETTING--Accident and emergency department in an urban hospital. PATIENTS--All seriously injured patients (injury severity score greater than 15) admitted to the department six months before and one year after introduction of the measures. RESULTS--Management errors were reduced from 58% (21/36) to 30% (16/54) (p less than 0.01). Correct treatment rather than improvement in diagnosis or investigation accounted for almost all the improvement. CONCLUSIONS--The management of seriously injured patients in the accident and emergency department can be improved by introducing two simple measures: using the revised trauma score as a triage tool to help junior doctors in the accident and emergency department rapidly identify seriously injured patients, and calling a senior accident and emergency specialist to supervise the resuscitation of all seriously injured patients. IMPLICATIONS--Care of patients in accident and emergency departments can be improved considerably at no additional expense by introducing two simple measures.     

The periodic health examination: 1. Introduction.

Most cervical spine injuries are due to motor vehicle accidents. Proper extrication of the victims is vital; the ideal device should be easily assembled and applied, should facilitate removal of victims from automobile seats without changing the body''s position, must not hinder airway access or the performance of cardiopulmonary resuscitation, must accommodate all types of patients, including children and obese or pregnant patients, and must completely immobilize the patient, especially if hyperextension is suspected. Current methods of immobilization, such as the use of a soft collar and sandbags, allow neck extension; the short board protects against extension but interferes with airway access. Newer devices are discussed in this article. Injuries of the upper cervical spine are less common but more serious than those of the lower portion and usually involve the vertebral arch. Radiologic examination of the first and second cervical vertebrae and the seventh cervical and first thoracic vertebrae should be emphasized. If lateral and anteroposterior views do not reveal abnormal findings and injury is still suspected, oblique views and computed or conventional tomography should be used. Cervical spinal cord injuries can be minimized or prevented if proper early management is applied.     

Early Management of the Critically Injured

A plan for the early management of the critically injured patient is described with emphasis on the priorities of management of injuries to certain organ-systems. The most important priorities are the establishment and maintenance of adequate ventilation and adequate circulation. The general surgeon is best qualified to assume full responsibility for the proper care of the critically injured, of patients with multiple injuries, and of patients in traumatic shock. He must assume the risk of transfusing unmatched whole blood and of deferring non-essential radiographs. The emergency and radiology departments may have to be by-passed to save the life of the critically injured patient. The measures required to establish a clear airway, to treat complications which can impair ventilation, to manage shock and hemorrhage and the possible complications of massive transfusions of blood are reviewed.     

Factors increasing life threat in patients with lesions of the spinal cord]

Mortality of spinal cord trauma has been analysed. An analysis included 3,486 patients treated early after spinal trauma in 1965-1989. Life threat in patients, who underwent trauma to the spinal cord embraces several factors. The most important is are: the level and degree of the lesion to the spinal cord, certain causes precipitating severe lesions to the nervous system, advanced age, and--to some degree--accompanying lesions, way of therapy, advances in medical technology, and intensive treatment technics. Available data indicate that the life of patients admitted to the hospital with symptoms of complete interruption of the cervical segment of the spinal cord is threatened to the highest degree. Falls from heights (scaffolding, roofs etc.), and certain road accidents are particularly dangerous. A special group of accidents is fall from the horse carriage in which advanced age of the victims plays the most important role. Mortality rate in the elderly is about tenfold higher, than in the group of subjects under 20 years with the same degree of lesions to the spine.     

Spinal metastases: From conventional fractionated radiotherapy to single-dose SBRT

AimTo review the recent evolution of spine SBRT with emphasis on single dose treatments.BackgroundRadiation treatment of spine metastases represents a challenging problem in clinical oncology, because of the high risk of inflicting damage to the spinal cord. While conventional fractionated radiation therapy still constitutes the most commonly used modality for palliative treatment, notwithstanding its efficacy in terms of palliation of pain, local tumor control has been approximately 60%. This limited effectiveness is due to previous lack of technology to precisely target the tumor while avoiding the radiosensitive spinal cord, which constitutes a dose-limiting barrier to tumor cure.Materials and methodsA thorough review of the available literature on spine SBRT has been carried out and critically assessed.ResultsStereotactic body radiotherapy (SBRT) emerges as an alternative, non-invasive high-precision approach, which allows escalation of tumor dose, while effectively sparing adjacent uninvolved organs at risk. Engaging technological advances, such as on-line Cone Beam Computed Tomography (CBCT), coupled with Dynamic Multi-Leaf Collimation (DMLC) and rapid intensity-modulated (IMRT) beam delivery, have promoted an interactive image-guided (IGRT) approach that precisely conforms treatment onto a defined target volume with a rapid dose fall-off to collateral non-target tissues, such as the spinal cord. Recent technological developments allow the use of the high-dose per fraction mode of hypofractionated SBRT for spinal oligometastatic cancer, even if only a few millimeters away from the tumor.ConclusionSingle-dose spine SBRT, now increasingly implemented, yields unprecedented outcomes of local tumor ablation and safety, provided that advanced technology is employed.     

急诊脑卒中识别评分量表在院前急救中筛选价值的探讨

目的:探讨急诊脑卒中识别评分量表(ROSIER)在院前急救筛选中的应用价值。方法:收集2013年1月至2014年1月期间,我院急诊科收治的可疑脑卒中病例114例,在院前急救中应用ROSIER量表筛查,并以辛辛那提院前脑卒中识别评分量表(CPSS)作为对照,以头颅CT或MRI检查、神经专科医师意见作为最终诊断,比较ROSIER与CPSS的对于脑卒中的筛选价值。结果:ROSIER对脑卒中的特异度、阳性似然比依次为83.67%、4.80,均显著高于CPSS的67.35%、2.36(P0.05);假阳性为16.33%,显著低于CPSS的32.65%;ROSIER的Kappa值为0.621,显著高于CPSS的0.462,差异具有统计学意义(P0.05);两组的敏感度、假阴性率及阴性拟然比无明显差异(P0.05)。结论:ROSIER应用于脑卒中筛查具有较高的敏感度和特异度,对于脑卒中的院前筛查以及院前急救具有重要指导意义。     

Thrombolysis in Acute Ischemic Stroke: A Simulation Study to Improve Pre- and in-Hospital Delays in Community Hospitals

Background

Various studies demonstrate better patient outcome and higher thrombolysis rates achieved by centralized stroke care compared to decentralized care, i.e. community hospitals. It remains largely unclear how to improve thrombolysis rate in decentralized care. The aim of this simulation study was to assess the impact of previously identified success factors in a central model on thrombolysis rates and patient outcome when implemented for a decentral model.

Methods

Based on a prospectively collected dataset of 1084 ischemic stroke patients, simulation was used to replicate current practice and estimate the effect of re-organizing decentralized stroke care to resemble a centralized model. Factors simulated included symptom onset call to help, emergency medical services transportation, and in-hospital diagnostic workup delays. Primary outcome was proportion of patients treated with thrombolysis; secondary endpoints were good functional outcome at 90 days, Onset-Treatment-Time (OTT), and OTT intervals, respectively.

Results

Combining all factors might increase thrombolysis rate by 7.9%, of which 6.6% ascribed to pre-hospital and 1.3% to in-hospital factors. Good functional outcome increased by 11.4%, 8.7% ascribed to pre-hospital and 2.7% to in-hospital factors. The OTT decreased 17 minutes, 7 minutes ascribed to pre-hospital and 10 minutes to in-hospital factors. An increase was observed in the proportion thrombolyzed within 1.5 hours; increasing by 14.1%, of which 5.6% ascribed to pre-hospital and 8.5% to in-hospital factors.

Conclusions

Simulation technique may target opportunities for improving thrombolysis rates in acute stroke. Pre-hospital factors proved to be the most promising for improving thrombolysis rates in an implementation study.     

2014-2015 年乌鲁木齐市院前急救老年患者疾病谱分析

目的：了解乌鲁木齐市院前急救老年患者疾病谱变化,提高老年人救治效率。方法：回顾性收集2014 年1 月1 日-2015 年 12 月31 日乌鲁木齐市120院前急救调度指挥中心数据库中40823 例老年（≥ 60 岁）患者病例信息,并进行疾病谱分析。结果： 40823 例老年患者中男性22284 例,女性18539 例,平均年龄（75.25 8.49）岁;其中汉族35018 例,维吾尔族3608 例,回族1698 例,其他民族499 例。院前急救老年患者疾病谱以心脑血管疾病、呼吸系统疾病、损伤、消化系统疾病、神经系统疾病为主,且心脑 血管疾病接诊率最高。院前急救老年患者接诊高峰月份为每年3-5 月,9-10 月,12-1 月;呼叫高峰时段为每日8:00-12:00,其次为 每日12:00-16:00;高发区域集中在新市区与沙依巴克区。结论：随着院前急救老年患者接诊数量的增多,应加强院前医护人员的 相关培训。根据院前急救老年患者的高发地区、月份及时段,合理配置院前急救资源。     

Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group.

In light of recent publications relating to resuscitation and pre-hospital treatment of patients suffering acute myocardial infarction of British Heart Foundation convened a working group to prepare guidelines outlining the responsibilities of general practitioners, ambulance services, and admitting hospitals. The guidelines emphasise the importance of the rapid provision of basic and advanced life support; adequate analgesia; accurate diagnosis; and, when indicted, thrombolytic treatment. The working group developed a standard whereby patients with acute myocardial infarction should receive thrombolysis, when appropriate, within 90 minutes of alerting the medical or ambulance service--the call to needle time. Depending on local circumstances, achieving this standard may involve direct admissions to coronary care units, "fast track" assessments in emergency departments, or pre-hospital thrombolytic treatment started by properly equipped and trained general practitioners.     

Development of Korean spine database and ontology for realizing e-Spine

By 2026, Korea is expected to surpass the UNs definition of an aged society and reach the level of a super-aged society. As a result, degenerative spinal disease and the related surgical procedures will increase exponentially. To prevent unnecessary spinal surgery and support scientific diagnosis of spinal disease and systematic prediction of treatment effects, we have been developing e-Spine which is a computerized simulation model of human spines. In this paper, we present the Korean spine database and ontology that are used as a background data for realizing e-Spine. Generally, Korean physical function is different from foreign physical function. For example, ossification of posterior longitudinal ligament is only occurred in Asians. However, developed countries are currently constructing digital human data to improve the medical and biomedical researches, while the digital human data for Korean are inadequate. Therefore, we constructed Korean spine database on Korean with normal spine or degenerative spinal diseases. To date, we have collected spine data from 72 cadavers and 298 patients. The spine data consists of 2D images such as CT, MRI, or X-ray, 3D shapes, geometry data and property data. The volume and quality of Korean spine database are now the worlds highest. Also, we constructed spinal ontology to provide a wealth of information related to spine. The spinal ontology contains anatomy of spine, method of treatment, cause, classification information related to spine. Finally, we implemented a management service for efficiently searching and managing the data. As a result, our database and ontology will offer great value and utility in the diagnosis, treatment, and rehabilitation of patients suffering from spinal diseases.     

集束化管理模式在急诊危重患者院内转运的应用及效果评价

目的 探讨集束化管理模式在急诊危重患者院内转运中的应用效果.方法 选取2019年9月 ～2020年4月我院急诊科就诊的324例急诊危重患者为研究对象,按转运方式不同分为观察组和对照组各162例.观察组采用集束化管理模式转运危重患者,对照组采用传统模式转运危重患者,比较两组患者的院内转运时间、投诉率、转运意外发生率(包括...     

Experimental flexion/extension data corridors for validation of finite element models of the young, normal cervical spine

Finite element (FE) modeling is an important tool for studying the cervical spine in normal, injured and diseased conditions. To understand the role of mechanical changes on the spine as it goes from a normal to a diseased or injured state, experimental studies are needed to establish the external response of young, normal cervical spinal segments compared to injured or degenerated cervical spinal segments under physiologic loading. It is important to differentiate injured or degenerated specimens from young, normal specimens to provide accurate experimental results necessary for the validation of FE models. This study used seven young, normal fresh adult cadaver cervical spine segments C2-T1 ranging in age from 20 to 51 years. Prior to testing, the spines were graded in three ways: specimen quality, facet degeneration and disc degeneration. Spine segments were tested in flexion/extension, and the range of loads applied to the specimens was 0.33, 0.5, 1.0, 1.5 and 2.0 Nm. These loads resulted in rotations in the direction of loading as the primary response to loading. In general, results for young, normal specimens showed greater flexibility in flexion and less flexibility in extension than results previously reported in the literature. The flexion/extension curves are asymmetric with a greater magnitude in flexion than in extension. These experimental results will be used to validate FE models of young, normal cervical spines.     

Molecular targets for therapeutic intervention after spinal cord injury

In an effort to develop therapies for promoting neurological recovery after spinal cord injury, much work has been done to identify the cellular and molecular factors that control axonal regeneration within the injured central nervous system. This review summarizes the current understanding of a number of the elements within the spinal cord environment that inhibit axonal growth and outlines the factors that influence the neuron's ability to regenerate its axon after injury. Recent insights in these areas have identified important molecular pathways that are potential targets for therapeutic intervention, raising hope for victims of spinal cord injury.     

Technical means for objectification of medical treatments in the area of the deep stabilisation spinal system

Information regarding two versions of an instrument called a muscle dynamometer, which enables detailed information about muscle activity in the deep stabilisation spinal system (DSSS), presented in this article. The MD01 (muscle dynamometer ver. 01) is a simple electromechanical instrument that allows measurement of muscle activity in two areas of the lumbar spine region. Measurements on patients have confirmed the usefulness of quantifying the initial state of a patient before rehabilitation as well as monitoring rehabilitation treatment; the MD01 is a suitable device for obtaining these measurements. However, a new and improved version of the MD01, the MD02, has been developed. The MD02 allows measurements in four different body regions and now has a PC interface, which allows achieving of patient information and data export for use with statistical software.     

胸腰段骨折外科治疗的研究进展

胸腰椎骨折是骨科临床工作中常见的损伤。胸腰段骨折往往伴发不同程度的脊髓损伤,很大程度上影响患者的生活质量。准确把握其分型,并制定恰当、及时、有效的治疗方案,对伤员进行救治,恢复椎体的高度、序列与曲度,解除神经压迫,重建脊柱稳定性,减少近远期并发症,改善预后有着深远的意义。本文通过对胸腰段骨折的分类、手术入路、手术方式、不同类型骨折的治疗等四个方面的国内外近期研究成果作一综述。     

MEWS系统在指导院前急性脑血管意外急救的临床应用

目的 探讨应用改良早期预警（MEWS）评分指导急性脑血管意外院前急救的临床价值.方法 将院前急救中临床诊断为急性脑血管意外的患者分为常规病情评估急救组（对照组）和进行现场MEWS评分指导急救组（实验组）,并比较两组患者的病死率及好转出院率.结果 对照组病死率为17.23%,好转出院率为82.77%;实验组病死率为8.76%,好转出院率为91.24%.两组比较,差异有统计学意义（P＜0.05）.结论 急性脑血管意外患者院前应用MEWS评分进行病情评估和指导急救,能降低患者的病死率及提高好转出院率,具有较好的应用价值,值得在院前脑血管意外急救中推广应用.     

Pathways to Care for Critically Ill or Injured Children: A Cohort Study from First Presentation to Healthcare Services through to Admission to Intensive Care or Death

Purpose

Critically ill or injured children require prompt identification, rapid referral and quality emergency management. We undertook a study to evaluate the care pathway of critically ill or injured children to identify preventable failures in the care provided.

Methods

A year-long cohort study of critically ill and injured children was performed in Cape Town, South Africa, from first presentation to healthcare services until paediatric intensive care unit (PICU) admission or emergency department death, using expert panel review of medical records and caregiver interview. Main outcomes were expert assessment of overall quality of care; avoidability of severity of illness and PICU admission or death and the identification of modifiable factors.

Results

The study enrolled 282 children, 252 emergency PICU admissions, and 30 deaths. Global quality of care was graded good in 10% of cases, with half having at least one major impact modifiable factor. Key modifiable factors related to access to care and identification of the critically ill, assessment of severity, inadequate resuscitation, and delays in decision making and referral. Children were transferred with median time from first presentation to PICU admission of 12.3 hours. There was potentially avoidable severity of illness in 185 (74%) of children, and death prior to PICU admission was avoidable in 17/30 (56.7%) of children.

Conclusions

The study presents a novel methodology, examining quality of care across an entire system, and highlighting the complexity of the pathway and the modifiable events amenable to interventions, that could reduce mortality and morbidity, and optimize utilization of scarce critical care resources; as well as demonstrating the importance of continuity and quality of care.     

Three-dimensional static modeling of the lumbar spine

This paper presents three-dimensional static modeling of the human lumbar spine to be used in the formation of anatomically-correct movement patterns for a fully cable-actuated robotic lumbar spine which can mimic in vivo human lumbar spine movements to provide better hands-on training for medical students. The mathematical model incorporates five lumbar vertebrae between the first lumbar vertebra and the sacrum, with dimensions of an average adult human spine. The vertebrae are connected to each other by elastic elements, torsional springs and a spherical joint located at the inferoposterior corner in the mid-sagittal plane of the vertebral body. Elastic elements represent the ligaments that surround the facet joints and the torsional springs represent the collective effect of intervertebral disc which plays a major role in balancing torsional load during upper body motion and the remaining ligaments that support the spinal column. The elastic elements and torsional springs are considered to be nonlinear. The nonlinear stiffness constants for six motion types were solved using a multiobjective optimization technique. The quantitative comparison between the angles of rotations predicted by the proposed model and in the experimental data confirmed that the model yields angles of rotation close to the experimental data. The main contribution is that the new model can be used for all motions while the experimental data was only obtained at discrete measurement points.     

Tympanic thermometry in heat stroke: is it justifiable?

Heat stroke is a medical emergency. Quick diagnosis, and sorting of victims for severity is very important for positive prognosis. Tympanic membrane thermometry was introduced as a good index for core body temperature. Therefore, we have used a sheep model for heat stroke, to study the reliability of measuring body temperature at the tympanic membrane, as a diagnostic index in heat stroke management. This was compared to measuring body temperature at the skin and the rectum. We have observed no major superiority of tympanic over rectal thermometry in regard to its ability to sort out heat stroke cases according to severity. On the other hand, skin thermometry was found not to be a reliable index in this regard.