ABSTRACT
We conducted a prospective study comparing two different pre-hospital triage tools for trauma: the American College of Surgeons Committee on Trauma (ACS-COT) field triage decision scheme and the TRENAU score. The main objective was to evaluate which triage tool was more appropriate in the setting of Lombardy's trauma system. Data were collected from the population of trauma patients admitted to Niguarda hospital in Milan from January to June 2021. RStudio and Excel were used for data analysis. For each triage tool performance measures, Receiver Operating Characteristics (ROC) curves, and overtriage and undertriage rates were obtained. A total of 1439 injured patients admitted through 118 pre-hospital Emergency Medical Services (EMS) were included in the study. The ACS-COT triage tool showed a good accuracy but an excessive overtriage rate (59%). The TRENAU triage tool had a moderately good accuracy and a low overtriage rate (23%) while maintaining an acceptable undertriage rate (3.9%). The TRENAU triage tool proved to be efficient in optimizing the use of resources dedicated to trauma care while resulting safe for the injured patient. In a modern trauma system such as Lombardy's it would be more appropriate to adopt the TRENAU score over the ACS-COT field triage decision scheme.
Subject(s)
Emergency Medical Services , Triage , Emergency Service, Hospital , Hospitals , Humans , Prospective Studies , Trauma Centers , Triage/methodsABSTRACT
This paper presents a simple device for the investigation of the human somatosensory system with functional magnetic imaging (fMRI). PC-controlled pneumatic actuation is employed to produce innocuous or noxious mechanical stimulation of the skin. Stimulation patterns are synchronized with fMRI and other relevant physiological measurements like electroencephalographic activity and vital physiological parameters. The system allows adjustable regulation of stimulation parameters and provides consistent patterns of stimulation. A validation experiment demonstrates that the system safely and reliably identifies clusters of functional activity in brain regions involved in the processing of pain. This new device is inexpensive, portable, easy-to-assemble and customizable to suit different experimental requirements. It provides robust and consistent somatosensory stimulation, which is of crucial importance to investigating the mechanisms of pain and its strong connection with the sense of touch.
Subject(s)
Magnetic Resonance Imaging , Models, Neurological , Pain , Robotics , Touch , HumansABSTRACT
El Instituto Universitario de Ciencias de las Salud ha mostrado un particular compromiso con la formación de sus estudiantes en la estrategia de Atención Primaria de la Salud, con las prácticas asistenciales dedicadas al 1er nivel de atención ambulatoria y a las patologías prevalentes en ese ámbito. Del mismo modo se han desenvuelto las actividades de formación en investigación. Como exponente de esa orientación, la revista Ciencias de la Salud publicó en el Vol. 2, N°1, 2011:4-9, el artículo Prevalencia de la Enfermedad de Chagas de Érica G. Morais, que había obtenido el premio Futuros Líderes, otorgado por el Curso Anual Internacional de Investigación en Ciencias de la Salud (IUCS-AMA, Prof. Carlos Álvarez Bermúdez). Aquella investigación formaba parte de un proyecto más amplio realizado en el Hospital Teodoro Álvarez entre 2004 y 2012, en el que participaron un conjunto de investigadores, que compartieron la autoría de la actual publicación. El Dr. Jorge Mitelman, Prosecretario de Ciencia y Técnica del IUCS e integrante de ese equipo, preparó además una reseña sobre la jornada del INCOSUR, realizada en abril del presente año, describiendo asimismo el proceso de desarrollo de la Ciudad de Buenos Aires, como área no endémica, para encarar las consecuencias de la enfermedad de Chagas
Subject(s)
Chagas Disease , Chagas Disease/epidemiology , Chagas Disease/pathology , Chagas Disease/prevention & controlABSTRACT
Cuffed tunneled venous access catheters are commonly used for temporary and permanent access in hemodialysis (HD) patients. These catheters serve an essential role in providing permanent access in subjects in whom all other access options have been exhausted. The predominant complications are catheter thrombosis, catheter fibrin sheating and infection. The aim of this study was to evaluate long-term survival and complications of permanent venous catheters (PVC) placed for the purpose of HD during the period from January 1992 to December 1998, at the Dialysis Units of Lucania (a southern Italian region). A total of 98 PVC were placed in 88 patients during this period. The catheters used were of three types: (a) 72 VasCath Soft Cell catheters (Bard Instrument Company, Toronto, Ont., Canada); (b) 22 PermCath catheters (Quinton Instrument Company, Seattle, Wash., USA), and (c) 4 Tesio catheters (Bellco SpA, Mirandola, Italy). Survival curves of catheters were calculated using the Kaplan-Meier product-limit estimator. The patient survival was 60% at the 78th month. Actually, 52 patients (27 males, 25 females) are still alive: 15 (26.9%) of these patients have diabetes mellitus and 1 has been transplanted. The actuarial survival rate of PVC was 89% in the whole population studied and 82% in subjects alive after 84 months. Twenty-five patients (28.4%) had PVC as the first reliable vascular access. Long-term complications occurred 27 times (1 episode every 44.81 month/patient) as: breakage (3.1%); thrombosis (10.2%); displacement (2.0%); subcutaneous tunnel bleeding (3.1%); inadequate blood flow (7.1%), and infection (10.2%). In conclusion, our data confirm that PVC might represent an effective long-term blood access route for HD. Again, PVC are getting the access of choice for selected patients (i.e., older subjects with cardiovascular diseases and cancer patients) and are enjoying a dramatic increase in use for subjects who are terrified of repetitive venopuncture.
Subject(s)
Catheterization, Central Venous/standards , Renal Dialysis/standards , Actuarial Analysis , Aged , Aged, 80 and over , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/methods , Female , Follow-Up Studies , Humans , Italy/epidemiology , Male , Middle Aged , Outcome Assessment, Health Care , Patient Satisfaction , Renal Dialysis/adverse effects , Renal Dialysis/methods , Survival RateABSTRACT
Previous studies comparing urea kinetic model (UKM) and direct dialysate quantification technique (DDQ) found statistically different results as far as the urea distribution volume (V) and protein catabolic rate (PCR) are concerned. In these studies, however, the true values for both the dialyser urea clearance (K) and urea concentration (C) were not used. The aim of this study was to compare UKM and DDQ using for both methods a variable-volume single-pool (VVSP) model as well as plasma water C and effective K. The study was performed during paired filtration dialysis (PFD) sessions because this technique allows bloodless measuring of K. Twenty dialysis patients were studied during a single PFD session. Dialysate and ultrafiltrate C and urea mass transfer rate were measured every 15 min to compute averaged K and total urea removal. Blood samples were obtained as for a three-point UKM, and an iterative technique was used for both methods. The results (means +/- SD) obtained with UKM were as follows: K = 176 +/- 23 ml/min; V = 29986 +/- 7620 ml, PCR = 65 +/- 15 g/day, Kt/V = 1.04 +/- 0.17. These results were not statistically different from those obtained using DDQ. In conclusion, when methodological errors are avoided, DDQ and UKM provide very similar results. This study shows also that PFD is very useful for studying solute kinetics during dialysis.
