The Economic and Clinical Impact of an Early Mobility Program in the Trauma Intensive Care Unit: A Quality Improvement Project.

Traumatic injury survivors often face a difficult recovery. Surgical and invasive procedures, prolonged monitoring in the intensive care unit (ICU), and constant preventive vigilance by medical staff guide standards of care to promote positive outcomes. Recently, patients with traumatic injuries have benefited from early mobilization, a multidisciplinary approach to increasing participation in upright activity and walking. The purpose of this project was to determine the impact of an early mobility program in the trauma ICU on length of stay (LOS), ventilator days, cost, functional milestones, and rehabilitation utilization. A quality improvement project compared outcomes and cost before and after the implementation of an early mobility program. The trauma team assigned daily mobility levels to trauma ICU patients. Nursing and rehabilitation staff collaborated to set daily goals and provide mobility-based interventions. Forty-four patients were included in the preintervention group and 43 patients in the early mobility group. Physical therapy and occupational therapy were initiated earlier in the early mobilization group (p = .044 and p = .026, respectively). Improvements in LOS, duration of mechanical ventilation, time to out-of-bed activity and walking, and discharge disposition were not significant. There were no adverse events related to the early mobility initiative. Activity intolerance resulted in termination of 7.1% of mobility sessions. The development and initiation of a trauma-specific early mobility program proved to be safe and reduce patient care costs. In addition, the program facilitated earlier initiation of physician and occupational therapies. Although not statistically significant, retrospective data abstraction provides evidence of fewer ICU and total hospital days, earlier extubations, and greater proactive participation in functional activities.

Civilian nuclear incidents: An overview of historical, medical, and scientific aspects.

Given the increasing number of operational nuclear reactors worldwide, combined with the continued use of radioactive materials in both healthcare and industry, the unlikely occurrence of a civilian nuclear incident poses a small but real danger. This article provides an overview of the most important historical, medical, and scientific aspects associated with the most notable nuclear incidents to date. We have discussed fundamental principles of radiation monitoring, triage considerations, and the short- and long-term management of radiation exposure victims. The provision and maintenance of adequate radiation safety among first responders and emergency personnel are emphasized. Finally, an outline is included of decontamination, therapeutic, and prophylactic considerations pertaining to exposure to various radioactive materials.

A review on bevacizumab and surgical wound healing: an important warning to all surgeons.

Bevacizumab (Avastin, Genentech, Inc, San Francisco, CA), a humanized monoclonal antibody against vascular endothelial growth factor, was recently approved for the treatment of metastatic breast cancer.A PubMed and OVID search was performed using keywords: bevacizumab, Avastin, wound healing, VEGF, angiogenesis, and colorectal cancer. Our objective was to review the current literature in regard to bevacizumab and its adverse effects on surgical wound healing.Bevacizumab has been associated with multiple complications in regard to wound healing, such as dehiscence, ecchymosis, surgical site bleeding, and wound infection. Current literature suggests patients should wait at least 6 to 8 weeks (>40 days) after cessation to have surgery (half-life = 20 days). In addition, postoperative reinitiation of bevacizumab must wait > or =28 days to prevent an increased risk of wound healing complications, and the surgical incision should be fully healed.The adverse effects of bevacizumab in regard to wound healing must be considered in all surgical patients.

Effects of hyperbaric oxygen therapy on an accelerated rate of mandibular distraction osteogenesis.

BACKGROUND: Distraction osteogenesis has become a standard therapy for lengthening of the human craniofacial skeleton. Because the technique is used predominately in a paediatric population, limiting the treatment protocol is beneficial. METHODS: Twenty-four animals were divided into four groups with distraction rates of 1mm and 2mm/day with and without hyperbaric oxygen (HBO) therapy. Following a 5-day latency period, mandibular lengthening of 15mm was performed with a uniaxial distractor along the body of the mandible. Consolidation period was 4 weeks in all groups. HBO therapy was administered to one of the 1 and 2mm/day groups 1 day preoperatively, throughout the latency and distraction phases and 2 weeks into the consolidation period. Animals were euthanised after consolidation and the mandibles harvested for bone mineral densitometry evaluation. RESULTS: The mean bone mineral density (BMD) (g/cm(2)) was 0.208+/-0.04 in Group 1 (1mm/day distraction, no HBO therapy), 0.228+/-0.09 in Group 2 (1mm/day distraction, + HBO therapy), 0.180+/-0.1 in Group 3 (2mm/day distraction, no HBO therapy), and 0.269+/-0.05 in Group 4 (2mm/day distraction, + HBO therapy). Using the Student's t-test for equality of means and the one-way analysis of variance (ANOVA), we found that the mean BMD was significantly higher in the groups that were administered HBO (Groups 2 and 4) than not (P=< 0.05). For the groups that had distraction of 1mm/day and 2mm/day, those that underwent HBO therapy had significantly higher BMD than those without HBO therapy (P=< 0.05). CONCLUSION: We have found that HBO therapy may serve to augment the healing process in distraction osteogenesis, allowing for more rapid distraction in order to decrease the overall treatment time.

Animal models for the study of osteomyelitis.

Osteomyelitis is an acute or chronic inflammatory process of the bone and its related structures secondary to an infection with pyogenic organisms. Because of the variety in disease presentations and pathophysiology of osteomyelitis, it is very difficult to evaluate in clinical studies. Therefore, animal models have been created for in vivo experimentation. A PubMed and OVID search was performed on March 31, 2008, using keywords osteomyelitis, animal model (rabbit, rat, mouse, avian, dog, sheep, and goat), and experimental osteomyelitis. The objective of this review was to provide a literature review of the animal models created to study osteomyelitis. The models were chosen based on historical relevance and clinical applicability. Numerous animal models exist to study both acute and chronic osteomyelitis. Many models have been created that allow investigators to study various aspects in the treatment and diagnosis of osteomyelitis. Based on the needs of investigators, an animal model must be carefully selected for ideal research, as no single model encompasses all aspects of osteomyelitis.