bluuebunny/crossref_metadata_2025_split huggingface dataset:
A DESCRIPTIVE PARADIGM OF ESCALATING ENDOVASCULAR INTERVENTION FOR THE MANAGEMENT OF TRAUMATIC CARDIAC ARREST IN A SWINE MODEL OF NON-COMPRESSIBLE TORSO HAEMORRHAGE
Authors: Barnard EB , Smith JE , Manning JE , Rall JM , Cox JM , Bebarta VS , Ross JD 
Published: November 2016

Objectives & BackgroundResuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) aims to improve trauma survival by controlling torso haemorrhage. Selective Aortic Arch Perfusion (SAAP) is an experimental resuscitative technique that, in addition to controlling torso haemorrhage, allows infusion of oxygenated blood into the proximal aorta - theoretically providing coronary perfusion pressures adequate for return of spontaneous circulation (ROSC) in cardiac arrest (figure 1). Prolonged cardiac support can subsequently be achieved by converting the SAAP blood supply from exogenous to autologous via a central venous catheter–an extra-corporeal life support circuit (SAAP-ECLS).Hypotheses–1. Swine in haemorrhage-induced traumatic cardiac arrest that do not achieve a ROSC with initial therapy (REBOA), will have ROSC with more advanced therapy (SAAP). 2. Animals that do not achieve ROSC with REBOA and subsequent SAAP will achieve ROSC with SAAP-ECLS.Methods70–90 kg swine underwent a combination of non-compressible torso and arterial haemorrhage. Arrest was defined as a systolic blood pressure (SBP) <10 mm Hg, together with an inappropriate bradycardia. All animals initially received REBOA (inflation of zone 1 REBOA and four units of intravenous blood). Those that did not achieve ROSC (defined as SBP >50 mm Hg) subsequently received SAAP (800 ml/minute of intra-aortic oxygenated blood, up to 4000 ml). Animals that did not have a ROSC after SAAP received continuous SAAP-ECLS (at 800 ml/minute). The protocol end-point was 60 minutes from the start of the REBOA intervention. Data are descriptive, and presented as mean (+/−standard deviation) and number (percent).ResultsEight animals were included; weight 75.0 kg (+/−3.6); time from the start of the injury to onset of arrest was 9.9 minutes (+/−1.4). Two (25.0%) animals had a ROSC with REBOA, and out of the remaining six a further two (25.0%) had a ROSC with SAAP. The four remaining animals, that had not achieved ROSC with REBOA and subsequent SAAP, all had a ROSC with SAAP-ECLS (figure 2).ConclusionA step-wise approach of more complex endovascular intervention in haemorrhage-induced traumatic cardiac arrest may be an effective clinical paradigm – in this swine model all animals had short-term survival following escalating intervention: REBOA, followed by SAAP, followed SAAP-ECLS as required.Figure 1Figure 2
EXIT INTERVIEWS FOR JUNIOR DRS- WHAT CAN WE LEARN? THE POPE-I PROJECT
Authors: Turner C , Lee-Shrewsbury V , Hill N 
Published: November 2016

Objectives & BackgroundOrganisations which conduct exit interviews are known to create more promoters in people who leave than organisations that do not. Despite this and the valuable feedback gained, exit interviews are uncommon in medicine.Our objectives were to develop an exit interview programme which was brief, gave the opportunity to say positives and negatives and guaranteed anonymity. Further to this we wished to evaluate the information that we received and how useful it was felt to be by those taking part.MethodsFollowing a pilot study we developed a peer on peer, time restricted, anonymous, semi structured interview process which was delivered by our junior medical tier to each other.Specific questions related to good experiences, bad experiences, the overall educational experience, ease of the interview process and any members of staff that the interviewees might wish to thank. Staff were given the questions in advance to allow them some time to consider their answers.At the end of the interview the responses were reflected back to the interviewee to check for accuracy.Completed interviews were thematically analysed and coded by the research team.ResultsAt the time of submission we have >30 interviews completed.All respondents found having an exit interview useful or very useful.The paperwork was regarded as being user friendly by the staff delivering and receiving the interviews.The most appreciated part of the job was consistently felt to be the consultant contact and patient diversity.Areas of frustration differed to the information we had received from junior Drs forum, which would seem to imply this process adds value.Amongst other issues, the junior medical staff wish more exposure to resus (trauma in particular) and more teaching in minors.On direct questioning there was an exact 50:50 split between those who were more and those who were less likely to follow a career in EM after doing the job.ConclusionThe process was appreciated by those who took part.If the evidence from the business community is replicated in healthcare then we should create more positivity about the EM job by using this process. Even if we do not create more promoters of the department, we have received much very useful feedback (both positive and negative) that we can work on.We feel we can recommend this method of feedback as safe, personalised, anonymous and valuable.
IDENTIFYING TRAUMA CENTRE NEED (TCN) IN ADULTS SUSTAINING INJURY: A NARRATIVE REVIEW
Authors: Follows A , Phillips R , Vassallo J 
Published: November 2016

Objectives & BackgroundField triage is the process of identifying patients who, sustaining trauma, are in need of treatment at a trauma centre (TCN – trauma centre need). This is acheived by Emergency Medical Service (EMS) personnel employing a field-triage algorithm to enable them to make this decision; within the UK there is considerable variation between algorithms, dependent on the region. In common, is a four tier approach looking at a patient's physiological derangement, their likely anatomical injury, mechanism of injury and other special considerations in turn to determine whether TCN is indicated. Optimum triage is desired as both under and over triage have been proven to have a negative impact on patient morbidity and mortality. Guidelines within the USA suggest that the performance of field triage algorithms be sufficient to limit under and over triage to <10% and <50% respectively. The objective of this study was to review the literature to determine the evidence base and the ability of mechanism of injury, anatomical injury and/or physiological derangement at predicting TCN in the adult patient sustaining injury.MethodsUsing NHS Evidence a literature search of MEDLINE (1946) and EMBASE (1974) was conducted to week 3 May 2016. Only articles published in English were included.ResultsThe search produced 241 articles, following a review of title and abstract 26 written English papers were identified to review in full. 5 papers were removed as inaccessible as full-text. Following full text review 9 were removed as non relevant. The remaining 12 relevant papers were included in the review.ConclusionThere is a paucity of high quality evidence (RCTs) surrounding pre-hospital triage of traumatically injury adult patients, with a number of studies contradicting one-another. The majority of the literature is reliant on the retrospective analysis of trauma registries with their associated limitations such as incomplete data capture and selection bias. There is currently no consensus as to what constitutes TCN, with both the output measured differing between identified studies and also the statistics employed to assess performance.Although there is some evidence to support physiological, anatomical injury and mechanism of injury as a predictor of TCN, it is not of high quality & is contradictory. Targeted research is required to determine the optimum method of pre-hospital identification of the adult trauma patient.
EMERGENCY CRICOTHYROTOMY: REVISED ANATOMY AND ITS IMPLICATIONS FOR CLINICAL PRACTICE
Authors: Nutbeam T , Enki D , Clarke R , Luff T , Gay D 
Published: November 2016

Objectives & BackgroundEmergency cricothyrotomy is a common feature in all difficult airway algorithms. It is the final step following failed attempts to oxygenate a patient. It is rarely performed and has a significant failure rate. The size of the cricothyroid membrane (CTM) has been previously reported in the literature. There is variation in the reported size of this membrane, especially across population groups. Procedure failure may result from a discrepancy between the size of the equipment used and the size of the CTM.MethodsAn initial sample of 61 trauma CT scans were reviewed by two radiologists independently. Electronic calipers were used to measure the maximum height of the CTM. This sample was used to power further data collection by assuming a 5% level of significance with 95% confidence interval and precision of 0.2 mm–further scans were reviewed until a sample size of 478 patients was achieved.ResultsThe median height reported was 5.85 mm (female) and 7.65 mm (male). These dimensions are much smaller than previously reported in the literature for Western patients. The external diameters of commonly used tubes used to pass through the CTM were compared with these measurements.ConclusionThe CTM in this population is smaller than previously reported. Practitioners encountering patients who may require a surgical airway should be aware of this. Rescue airway equipment of a smaller external diameter should be immediately available if required.Figure 1Table 1Comparison of surgical airway devices, their external diameter and the percentage of population in which CTM height>external diameter of deviceTube TypeExternal Diameter% of population in which CTM height>external diameter of device6 mm836.25 mm6.760.54 mm5.677.63 mm4.293.2Shilley10.87.7Melker8.234.6TracheoQuick586.5
CAN THE INTRODUCTION OF A “VIRTUAL” CLINIC IN A PAEDIATRIC TERTIARY CENTRE HELP TO REDUCE THE BURDEN OF FOLLOWUP FOR MINOR PAEDIATRIC FRACTURES?
Authors: Roy SK , McDonald N , Back D 
Published: November 2016

Objectives & BackgroundFractures account for 25% of all injuries during childhood in the UK. Of those the radius/ulna are common (30%) −80% of those are torus fractures. Despite their innocuous nature, they are often managed incorrectly. There is evidence showing that optimal treatment entails the use of a Futuro splint for 3 weeks, with minimal followup and adequate safety netting. Many emergency departments (ED) are adopting this approach successfully.The aim of this quality improvement project was to introduce a new pathway for the management of torus fractures, including a “virtual” fracture clinic in collaboration with our orthopaedic colleagues. We reviewed our current management and compared its costs against the new protocol, including attendance, plasters and splints.MethodsA list of children aged 0–16 years with wrist xrays between June–November 2015 was obtained. Those with a torus fracture were reviewed for method of immobilization and outcome of fracture clinic followup.Results24 children fulfilled the inclusion criteria; 14 were treated with a Futuro splint; 10 with a plaster of Paris (POP). All were reviewed in fracture clinic. 7 children switched from a Futuro to a POP, 3 switched from a POP to a Futuro, leaving 9 in total with a splint. 1 child was discharged from fracture clinic on first attendance; 23 required ongoing followup with at least one additional visit to clinic. This equates to at least 57 hospital appointments in this group for inclusion to the virtual clinic over 5 months. In this clinic, the Orthopaedic Consultant reviews the case notes and images; contacts the family by phone and decides whether a followup hospital attendance is required. The costs of running this would be approximately 20% cheaper on our current overheads.ConclusionThe majority of children were managed correctly within the ED. Some discrepancies were identified with preferential use of a POP in Fracture Clinic. Therefore, we educated staff on gold standard treatment through a new clinical guideline. The number of unnecessary followup attendances in this patient cohort has prompted the introduction of a virtual fracture clinic. This should generate significant cost savings as well as providing families with continuity of care, reassurance and convenience. In the future, we will reaudit whether this happens in view of expanding it to include other minor fractures.Figure 1Figure 2Patient Cohort and inclusion criteriaFigure 3New Torus Fracture Management GuidelineFigure 4Patient and Parent Discharge Information
THE 'SQUEEZED SAMPLE': IS THERE A RELATIONSHIP BETWEEN FALSELY ELEVATED LACTATE AND POTASSIUM IN BLOOD GAS SAMPLES IN CHILDREN?
Authors: Sinton D , Hall J , Roland D 
Published: November 2016

Objectives & BackgroundGaining intervenous access in children, especially those who are unwell, can be difficult. Blood samples are often taken from the cannula hub to avoid repeated venepuncture but leads to concerns about whether it is “free-flowing' and what effect it has on the accuracy of results. We postulated that this process should equally impact on all electrolytes and metabolites. In particular we wondered if there was a relationship between potassium and lactate which are both felt to be affected by procedures in which blood was difficult to obtain.MethodsA retrospective convenience sample of 101 children and young people (<16) who had had a blood gas performed were collated and analysed via microsoft excel.Results4 patients were excluded due to insufficient or inadequate data leaving 97 data sets available for analysis. A scatter graph of potassium and lactate results was plotted (figure 1). The correlation coeffecient was very weak (r=0.11). Mean potassium samples when lactates were seperated into values above and below 2.0 was not significantly different (4.4 vs 4.1)ConclusionThere appears to be no obvious relationship between lactate and potassium values. A procedure which results in a perceived haemolysed sample may therefore not affect all electrolytes or metabolites. Further data is needed to confirm the abence or precence of any relationship.Figure 1Scatter graph of potassium versus lactate in a convenience sample of 97 patients
INCIDENCE AND SEVERITY OF ACUTE MOUNTAIN SICKNESS AND ASSOCIATED SYMPTOMS IN TAIWANESE CHILDREN ON XUE MOUNTAIN (3,886 M)
Authors: Cheng F 
Published: November 2016

Objectives & BackgroundAcute mountain sickness (AMS) is common among people who trek at high altitudes. Headache, the cardinal symptom of AMS, is often accompanied by dizziness, fatigue, nausea and vomiting, and sleep disturbances. The incidence of AMS in children varies, and large group population studies in children are rare. We examined the incidence of AMS and prevalence of AMS-associated symptoms in older children trekking Xue Mountain in Taiwan.MethodsThis prospective cohort study included 197 healthy, non-acclimatized 11 and 12-year-old children who participated in a round-trip trek from the trailhead to the summit of Xue Mountain (2,179 m to 3,886 m) over 3 days. We used the Lake Louise AMS scoring criteria to record daily AMS-associated symptoms (headache, dizziness, fatigue, anorexia, vomiting, and sleep disturbances) and to diagnose AMS. Medication was prescribed at the onset of AMS symptoms. Written informed consent was obtained from all of the subjects and their parents.ResultsThe overall incidence of AMS was 40.6%. The incidence was higher in males and in children with a higher body mass index (p<0.05). Previous high altitude experience, AMS history, and menstruation were not associated with the development of AMS. The mean overall AMS score of was 1.77±2.08. The mean AMS score of subjects developed AMS (3.02±2.46) was significantly higher than that of those in the non-AMS group (0.92±1.16,p<0.001). The most common symptom was sleep disturbance followed by dizziness, and headache. The prevalence of headache was 46.2% on Day 2 at 3,100 m, and 31.3% on Day 3 at the same altitude. Males experienced significantly more headache and fatigue during the trip (p<0.05). The AMS scores and prevalence of all the AMS symptoms were significantly higher in the AMS than in the non-AMS group (p<0.05).ConclusionAlthough AMS was common among the participants in our study, the symptoms were mild in most cases. Sleep disturbance was the most common symptom. The effects of medication or acclimatization may explain the lower incidence of headache on Day 3 compared to Day 2. The incidence of AMS in our study was higher than that previously reported in adults, and lower than that of a previous study on Jade Mountain (3,952 m) in Taiwan.Figure 1Overall and daily incidence of AMS in children trekking on Xue Mountain (3,886 m).Figure 2Daily AMS scores.Figure 3Prevalence of AMS-associated symptoms in males and females.
DESCRIPTIVE STUDY OF PAEDIATRIC OBSERVATION PRIORITY SCORE (POPS) TRIAGE TOOL IN BRONCHIOLITIS
Authors: Roland D , Arshad F 
Published: November 2016

Objectives & BackgroundBronchiolitis is a common diagnosis in patients presenting over the winter months. Predicting early in the patient journey the need for continued observation may improve patient flow and reduce crowding. In this study we aimed to assess the correlation between guideline derived severity of illness and initial acuity with outcome.MethodsData on 100 patients who presented to our Children's Emergency Department with a diagnosis of bronchiolitis between September 2012 and June 2013 was analysed (data was also being used for an international study on outcomes of bronchiolitis). Severity of illness (via local guidance), initial POPS (Paediatric Observation Priority Score) and patient disposition was analysed.Results4 patients were excluded due to insufficient data, 14/96 had severity documented by the clinician and 96/96 had severity derived based on local guidelines. Figure 1 demonstrates POPS scores at the three levels of severity. Excluding patients who represented, Pearson's correlation between POPS and percentage discharged/admitted was significant (p=0.002) with r2value of 0.72.ConclusionIn this small sample initial acuity (via POPS) demonstrates an association with patient disposition and bronchiolitis severity grading. It is noted the confidence intervals are large, potentially due to an insufficient sample size or large heterogeneity presenting features of bronchiolitis. We also note generally good agreement between a clinician's subjective opinion of severity and guideline derived severity. There is the potential for POPS to reduce cognitive error when there is a discrepancy between these assessments.Figure 1
PAEDIATRIC OUT-OF-HOSPITAL TRAUMATIC CARDIAC ARREST: A REVIEW OF THE PS14 SURVIVAL PREDICTION MODEL
Authors: Mynors-Wallis D , Lecky F , Bouamra O , Burke D 
Published: November 2016

Objectives & BackgroundTrauma is a leading cause of death in children. Paediatric out-of-hospital traumatic cardiac arrest (POOHTCA) is a subsection of this. The Ps14 survival prediction model is used to predict survival in trauma patients on the Trauma Audit and Research Network (TARN) database. TARN collects and audits data from all trauma receiving hospitals in the UK and many others internationally. It has been hypothesised that there is a difference between the Ps14 survival prediction for POOHTCA and actual survival for POOHTCA patients on the TARN database.MethodsData from the TARN database between 1989–2015 was analysed. A comparison between the Ps14 and actual survival was made. Univariate and logistic regression analyses were conducted on the data using SPSS. A new model to predict survival after POOHTCA was constructed and a comparison between the Ps14 and the new model was made.ResultsThere was a significant difference between the Ps14 prediction model and actual survival. For Known outcomes, predicted survival was 44.9% (95% CI 40.2–49.5%) compared with actual survival of 5.0% (95% CI 3.0%–7.0%). On univariate analysis, age, drowning, year of presentation and time from scene to Emergency Department were found to be significantly different between survivors and non-survivors. Further logistic regression showed only year of presentation and those who received care in the most recent time cohort, remained significant with the remaining variables losing significance. Three models of varying care and patient factors were constructed. The new models were not significantly different to the Ps14 model, C-statistic: 0.709 (95% CI 0.614–0804), 0.709 (0.614–0804) 0.798 (0.672–0.920) and 0.715 (0.603–0.827) for models 1,2,3 and Ps14 respectively.ConclusionThe current Ps14 model is not a good predictor of survival for POOHTCA patients. This is most likely due to the small number of POOHTCA patients that survive to discharge. Although the model could be improved with a larger data set, it has been suggested that a traumatic arrest variable could be inserted into the Ps14 model which would reduce predicted survival to between 3% and 7% for this patient population. This would be much closer to actual survival rates and could improve the audit of paediatric trauma care.Figure 1Figure 2
Aging is associated with impaired angiogenesis, but normal microvascular network structure, in the rat mesentery
Authors: Sweat Richard S. , Sloas David C. , Stewart Scott A. , Czarny-Ratajczak Malwina , Baddoo Melody , Eastwood James R. , Suarez-Martinez Ariana D. , Azimi Mohammad S. , Burks Hope E. , Chedister Lee O. , Myers Leann , Murfee Walter L. 
Published: November 2016

A big problem associated with aging is thought to be impaired microvascular growth or angiogenesis. However, to link the evidence for impaired angiogenesis to microvascular dysfunction in aged tissues, we must compare adult vs. aged microvascular networks in unstimulated scenarios. The objective of this study was to test the hypothesis that aged microvascular networks are characterized by both fewer vessels and the impaired ability to undergo angiogenesis. Mesentery tissues from adult (9-mo) and aged (24-mo) male Fischer 344 rats were harvested and immunolabeled for platelet/endothelial cell adhesion molecule (an endothelial cell marker) according to two scenarios: unstimulated and stimulated. For unstimulated groups, tissues harvested from adult and aged rats were compared. For stimulated groups, tissues were harvested 3 or 10 days after compound 48/80-induced mast cell degranulation stimulation. Unstimulated aged microvascular networks displayed larger mean vascular area per tissue area compared with the unstimulated adult networks. The lack of a decrease in vessel density was supported at the gene expression level with RNA-Seq analysis and with comparison of vessel densities in soleus muscle. Following stimulation, capillary sprouting and vessel density were impaired in aged networks at 3 and 10 days, respectively. Our results suggest that aging associated with impaired angiogenesis mechanisms might not influence normal microvascular function, since unstimulated aged microvascular networks can display a “normal adult-like” vessel density and architecture. NEW & NOTEWORTHY Using a multidimensional approach, we present evidence supporting that aged microvascular networks display vessel density and patterning similar to adult networks despite also being characterized by a decreased capacity to undergo angiogenesis. Thus, vessel loss is not necessarily a characteristic of aging.