Medicine
-
Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability. ⋯ Despite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes.
-
Comparative Study Observational Study
Single- versus 2-stage reconstruction for chronic post-radiation chest wall ulcer: A 10-year retrospective study of chronic radiation-induced ulcers.
Radiation therapy can have adverse effects on normal tissue and cause chronic ulcers. The purpose of this study was to compare breast cancer patients who underwent single-stage reconstruction with patients who underwent 2-stage reconstruction for chronic radiation-induced necrotic ulcers of the chest wall. This retrospective study comprised of 50 patients with chronic radiation-induced chest wall ulcers who underwent chest wall reconstruction in our hospital between January 2002 and January 2016. ⋯ Six patients in group A developed flap infection, among which 4 patients progressed to flap necrosis (group A: 6/25 vs group B: 0/25; P = .000). Compared to single-stage reconstruction, surgical reconstruction in 2 stages was safer and more effective in treating chronic radiation-induced ulcers of the chest wall, and is associated with fewer postoperative complications. The omentum majus flap was the most ideal tissue for the repair of these defects.
-
Comparative Study
Comparing the effectiveness of three scoring systems in predicting adult patient outcomes in the emergency department.
This study aimed to evaluate the performance of the rapid acute physiology score (RAPS), the rapid emergency medicine score (REMS), and the modified early warning score (MEWS) in predicting the outcomes of adult patients presenting to the emergency department (ED). A retrospective review was undertaken between February 2014 and February 2018 in an adult ED of a 3300-bed university hospital. The RAPS, REMS, and MEWS were calculated to assess their capability to predict hospital admission, length of hospital stay, and in-hospital mortality, using area under receiver operating characteristic analysis. ⋯ The predictabilities of REMS, RAPS, and MEWS for hospital admission were 0.76, 0.59, and 0.55, respectively; the predictability of REMS, RAPS, and MEWS for hospital mortality were 0.88, 0.72, and 0.73, respectively; and the predictability of REMS, RAPS, and MEWS for length of hospital stay were 0.76, 0.67, and 0.65, respectively. Multivariate analysis showed that the Glasgow coma scale (GCS) (odds ratio (OR), 1.61; P < .001), age (OR, 1.50; P < .001), and MAP (OR, 1.27; P < .001) were independent predictors for hospital admission; GCS (OR, 2.92; P < .001), respiratory rate (RR) (OR, 2.69; P < .001), peripheral oxygen saturation (OR, 2.67; P < .001), MAP (OR, 2.11; P < .001), age (OR, 1.75; P < .001), and pulse rate (PR) (OR, 1.73; P < .001) were independent predictors for in-hospital mortality; and RR (OR, 1.41; P < .001), temperature (OR, 1.05; P = .01), and PR (OR, 0.96; P = .04) were independent predictors for length of hospital stay. Our study evaluated and confirmed the REMS as a powerful predictor of ED adult patient outcomes, including hospital admission, length of hospital stay, and in-hospital mortality compared to RAPS and MEWS.
-
Observational Study
Risk factors associated with outcomes of peritoneal dialysis in Taiwan: An analysis using a competing risk model.
Peritoneal dialysis (PD) is one option for renal replacement therapy in patients with end-stage renal disease (ESRD). Maintenance of the PD catheter is an important issue for patient outcomes and quality of life. The aim of this retrospective cohort study is to clarify the risk factors of technique failure and outcomes at a single institute in Taiwan. ⋯ Diabetes mellitus is a risk factor contributing to PD-related peritonitis. Male patients and lower serum albumin levels were associated with higher rates of technique failure. Female gender, lower Kt/V, and WCCr are risk factors for overall mortality in PD patients.
-
We present a case of high spinal anesthesia after inadvertent injection of local anesthetics and corticosteroids into the subarachnoid space during attempted epidural injection. Cerebrospinal fluid (CSF) lavage is a suitable method for treatment. ⋯ We conclude that CSF lavage could be a helpful maneuver to clear lidocaine and betamethasone and avoid potential nerve damage caused by an unintentional intrathecal injection during an epidural injection for the treatment of chronic low back pain.