Video Documentation as a Measure of Written Documentation Accuracy in Emergency Medical Service Field Intubations.

Introduction: Quality improvement (QI) is a major focus of all departments and fields of health care, including emergency medical services. The chaotic and rapidly evolving atmosphere in which paramedics must practice can lead to inconsistency between what is documented and the actual events. This leads to difficulty when trying to evaluate the practitioners and when implementing a QI program. In this study, we evaluated the prevalence of discrepancy between the video and written record for Rapid Sequence Intubation (RSI) performed in the field as a demonstration of the utility of video documentation in QI. Methods: We used a systematic retrospective chart review to compare written with video documentation in 100 consecutive prehospital RSI encounters in a single EMS agency. Results: Of the patient care records (PCRs), only 6% matched the video record for all quality measures tracked. The largest reason for the discrepancy was in the time required to intubate (58%) whether LEMON was evaluated (42%), total number of intubation attempts (36%), first attempt success (24%), BVM used (18%), and whether an airway introducer device was used (12%). Conclusion: Written documentation is inaccurate compared to video documentation when used as a quality improvement process for EMS prehospital RSI encounters.

Bone Scan With SPECT/CT Demonstrated C1 to C2 Involvement in Rheumatic Arthritis.

ABSTRACT: An 80-year-old man was treated with rituximab for active rheumatoid arthritis until 2019, now controlled with Salazopyrin, prednisolone, methotrexate, and folic acid. However, laboratory data showed elevated C-reactive protein and erythrocyte sedimentation rate. Whole-body bone scan showed bony and joint destruction to the upper cervical vertebra (C spine), bilateral shoulders, wrists, finger joints, ankles, and left knee. SPECT/CT localized the upper C spine uptake to the C1/C2 joint and adjacent C1 and C2 with C1/C2 subluxation. C spine CT showed vertical atlantoaxial subluxation and bony erosions.

Significant association factors of bone mineral density in Taiwan adults.

OBJECTIVE: To examine the biofactors associated with bone mineral density (BMD) in southern Taiwanese adults. MATERIALS AND METHODS: The medical records of 3242 adults who underwent health examinations between June 2014 and February 2018 at a regional hospital in southern Taiwan were reviewed. The data collected included health history, anthropomorphic characteristics, clinical laboratory results, biochemical parameters, and BMD. The data were used to identify the biofactors associated with BMD/T-scores at the lumbar spine and femoral neck by multivariate linear regression analysis with the stepwise method. RESULTS: The mean age of the patients was 58.1 years, and 71.4% were male. Factors positively correlated with BMD and the T-score included body mass index (BMI), male gender, calcium, and creatinine. Age, alkaline phosphatase (ALP), triiodothyronine, serum thyroxine, low-density lipoprotein cholesterol, and a history of hyperlipidemia were negatively correlated with BMD and the T-score. CONCLUSION: The associated biofactors reported here were similar to and had similar relationships as the biofactors identified in previous literature reports. Not all of the sites examined for BMD were influenced by the same association factors, except for BMI, male gender, age, and ALP, implying that the bone remodeling processes that shape BMD involve a complex regulatory network and demonstrating that our extracted factors are the most useful for clinical practice.

Car Accident With Airbag Deployment Trauma Showed Special Pattern in Bone Scan.

A 72-year-old man had rectal adenocarcinoma with partial obstruction with liver and lung metastases. Bone scan showed special pattern with bony destructions to the lateral aspect of the left first to fourth and right first to 10th ribs (in a row in continuous vertical alignment), the costal end of the left second rib, the left sternoclavicular junction, and sternum. Patient recalled a car traffic accident with airbag deployment trauma to the anterior aspect of the chest about 2 months prior. Chest CT confirmed that the bone lesions were all fractures.

Leukocyte-endothelium interaction: measurement by laser tweezers force spectroscopy.

Leukocyte adhesion to vascular endothelium is an initial step of many inflammatory diseases. Although the atomic force microscopy (AFM) measurements of leukocyte-endothelial interaction have been recently introduced. with cell adhesion force unbinding curves (CAFUC). We obtained pico-Newton force in the initial interaction between a single living THP-1 cell and HUVEC monolayer using a custom-built laser tweezers (LT) system. The measured quantities included the non-linear force-distance relationship, and the effect of yielding in cell detachment. It is possible to introduce a time scale into the LT cell-detachment experiments for further exploration and more detailed information on the viscoelastic properties of living cells.