Glasgow Coma Scale Scoring is Often Inaccurate.

INTRODUCTION: The Glasgow Coma Scale (GCS) is widely applied in the emergency setting; it is used to guide trauma triage and for the application of essential interventions such as endotracheal intubation. However, inter-rater reliability of GCS scoring has been shown to be low for inexperienced users, especially for the motor component. Concerns regarding the accuracy and validity of GCS scoring between various types of emergency care providers have been expressed. Hypothesis/Problem The objective of this study was to determine the degree of accuracy of GCS scoring between various emergency care providers within a modern Emergency Medical Services (EMS) system. METHODS: This was a prospective observational study of the accuracy of GCS scoring using a convenience sample of various types of emergency medical providers using standardized video vignettes. Ten video vignettes using adults were prepared and scored by two board-certified neurologists. Inter-rater reliability was excellent (Cohen's κ = 1). Subjects viewed the video and then scored each scenario. The scoring of subjects was compared to expert scoring of the two board-certified neurologists. RESULTS: A total of 217 emergency providers watched 10 video vignettes and provided 2,084 observations of GCS scoring. Overall total GCS scoring accuracy was 33.1% (95% CI, 30.2-36.0). The highest accuracy was observed on the verbal component of the GCS (69.2%; 95% CI, 67.8-70.4). The eye-opening component was the second most accurate (61.2%; 95% CI, 59.5-62.9). The least accurate component was the motor component (59.8%; 95% CI, 58.1-61.5). A small number of subjects (9.2%) assigned GCS scores that do not exist in the GCS scoring system. CONCLUSIONS: Glasgow Coma Scale scoring should not be considered accurate. A more simplified scoring system should be developed and validated.

Women doctors' purses as an unrecognized fomite.

OBJECTIVE: Health care associated infections are serious problems for today's medical community. It is generally assumed that health care workers come in contact with pathologic bacteria and unwittingly transfer them to patients either directly with their hands, or indirectly through some inanimate object. If a doctor washes his or her hands before seeing a patient and then touches a colonized object, the benefit of hand washing may have been undone. Previous studies have identified stethoscopes, neck ties, mobile phones, keyboards, lab coats, and other commonly worn accessories as potential sources of disease transmission contributing to health care associated infections. Women doctors' purses have not previously been studied as a potential source of disease transmission. This study evaluated whether doctors' purses served as a potential source of disease transmission. METHODS: We performed a case-control study to determine if women doctors' purses were colonized more frequently than controls. Purses were obtained from women doctors who visit a hospital as part of their clinical responsibilities in the experimental group. Thirteen doctors fit the criteria of visiting an acute care facility while bringing a purse with them. Fourteen controls were non-health care women who had not visited a hospital in the past six months. RESULTS: We observed that nine of 13 doctors' purses were colonized with bacteria compared with two of 14 controls. CONCLUSIONS: This statistically significant finding demonstrates that there is a potential for a doctor's purse to serve as a vector for disease transmission. It is prudent for women health care workers to be aware that their purses may be a source of bacterial contamination. We, therefore, recommend that women practitioners use appropriate infection control measures whenever their purses are in the health care environment.

Probing the structure of the silylene complex (Cy3P)2Pt=SiMes2.; UV-Vis and pre-resonance Raman investigations.

The UV-Vis, pre-resonance Raman and IR spectra of the complex (Cy3P)2Pt=SiMes2 (1) were obtained as well as Raman spectra of some model compounds. The experimental data and the results of normal coordinate calculations show that the stretching vibration of the Si?Pt bond in 1 is not localized, the nuSi=Pt internal coordinate makes significant contribution to two normal modes with frequencies at 465 and 612cm-1, whose Raman intensity is enhanced by pre-resonance.