J Trauma
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Managing refractory osteomyelitis around the ankle joint has been challenging. Destruction of both the ankle and the subtalar joints was common in cases of open fracture. For those who already had multiple surgeries, it would be tough to salvage the limb. Our goal was to set up a staged surgical protocol aiming in treating the aforementioned clinical issue. ⋯ This study has shown our staged surgical protocol may be effective in solving complicated osteomyelitis around the ankle, although salvaging the limb with successful ankle arthrodesis and minimized limb length inequality, yet improving the patients' ambulation level.
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To identify predictors of mortality and long-term outcomes in survivors after pentobarbital coma (PBC) in patients failing current treatment standards for severe traumatic brain injuries (TBI). This is a retrospective cohort study of severe TBI patients receiving PBC at Level I Trauma Center and tertiary university hospital. ⋯ In patients with severe TBI and RICH, survival at discharge of 40% with good functional outcomes in 68% of survivors at 1 year or more can be achieved with PBC after failure of HOsmRx. Based on 50% mortality cut-points, analysis suggests the limits of HOsmRx to be Na of 160 mEq/L and Osm of 330 mOsm/Kg H2O. Maintenance of higher cerebral perfusion pressure after PBC is associated with survival. PBC treatment of RIH may be even more important when other treatments of RIH, such as decompressive craniectomy, are not available.
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To investigate the association between a number of hospital level composite index methodologies developed from trauma indicators with inhospital mortality. ⋯ Trauma composite indices demonstrate construct validity when used as measures of hospital level process and represent potentially useful methods of analyzing and reporting quality indicators.
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Comparative Study
The combination of an online organ and tissue registry with a public education campaign can increase the number of organs available for transplantation.
A persistent shortage of organs and inexhaustible waiting lists continue to result in many people dying while awaiting transplantation. On July 1, 2006, the California Department of Motor Vehicles joined forces with California's Online Organ and Tissue Registry and launched a campaign to increase donation rates. This campaign included intense public and media education. The efficacy of such a campaign on donor demographics has not been studied. ⋯ Public and media education significantly improved organ donor demographics. Although this study compares only 2 years before with 2 years after the donation campaign, the results are extremely favorable. Therefore, a public donation campaign and an organ donor registry are effective promotions that could help increase the number of organs available for transplantation.