Curēus
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Background Cardiopulmonary resuscitation (CPR) metrics including compression rate and depth are associated with improved outcomes and the need for high-quality CPR is emphasized in both the American Heart Association (AHA) and Heart and Stroke Foundation of Canada (HSFC) guidelines. While these metrics can be utilized to assess the quality of CPR, they are infrequently measured in an objective fashion in the emergency department. Objectives As part of an Emergency Department (ED) Quality Improvement (QI) project, we sought to determine the impact of real-time audio-visual (AV) feedback during CPR amongst ED healthcare providers. Methods Participants performed two minutes of uninterrupted CPR without AV feedback, followed by two minutes of CPR with AV feedback after a two-minute rest period in a simulated CPR setting. ⋯ Importantly, 'compressions in target', where participants met both rate and depth simultaneously, improved with AV feedback (19 vs 61%, p < 0.0001). Conclusions We found a significant improvement in compliance with CPR depth and rate targets as well as 'compressions in target' with the use of real-time AV feedback during simulation training. Future research is needed to ascertain whether these results would be replicated in other settings. Our findings do provide a robust argument for the implementation of real-time AV CPR feedback in Hamilton Emergency Departments.
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Introduction There is a lack of information about the results of surgical treatment and complications in midshaft clavicle fracture non-unions. Our hypothesis was that there is no difference in functional outcomes between the surgical treatment of an acute displaced middle-third clavicle fracture and the surgical treatment of a chronic symptomatic non-union of a displaced middle-third clavicle fracture. Methods This was a case-control study. ⋯ Two out of 14 cases required a second surgery with a plate and bone graft to achieve bone union. Conclusion Symptoms from displaced midshaft clavicular fracture non-unions are due to related pain and dysfunctional deficits that result from displacement and shortening. According to our study, patients with a displaced midshaft clavicle fracture non-union who needed surgery achieved similar functional results as compared to patients treated in an acute setting for a displaced midshaft clavicle fracture. The median time to discharge and return to work was more than doubled in the non-union surgery group.
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The use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) has been steadily increasing over the past few years due to their efficacy in glycaemic control as well as added benefits of weight loss and reduction in cardiovascular mortality. SGLT2i are a class of oral hypoglycaemics that work by increasing urinary glucose excretion via the inhibition of the sodium-glucose cotransporter-2 in the proximal tubule of the kidney. Euglycaemic diabetic ketoacidosis (euDKA) is a potentially life-threatening adverse effect of SGLT2i. ⋯ We present two cases of patients with euDKA following SGLT2i use in the perioperative period. The cases discussed reiterate the importance of awareness of SGLT2i-induced euDKA during the perioperative period. Both cases raise the question of whether patients are being adequately educated about the drug, its adverse effects and under what conditions to cease the medication.
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Deep brain stimulation has emerged as an effective treatment for movement disorders such as Parkinson's disease, dystonia, and essential tremor with estimates of >100,000 deep brain stimulators (DBSs) implanted worldwide since 1980s. Infections rates vary widely in the literature with rates as high as 25%. Traditional management of infection after deep brain stimulation is systemic antibiotic therapy with wound incision and debridement (I&D) and removal of implanted DBS hardware. The aim of this study is to evaluate the infections occurring after DBS placement and implantable generator (IPG) placement in order to better prevent and manage these infections. ⋯ Infections after DBS implantation and IPG replacement occurred in 3% and 0.8% of patients respectively in our study which is lower than reported historically. Early infections were more common. No intracranial infections were found. Intra-operative use of vancomycin was not shown to decrease risk of infection after electrode implantation surgery or IPG replacement. However, in our study it was shown to increase risk of infection after electrode implantation surgery. Treatment includes antibiotic therapy and debridement with or without removal of hardware. DBS hardware can be safely left in place in select patients who may have significant adverse effects if it is removed.
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Introduction Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT) is used for non-invasive staging and restaging of solid malignant tumors. PET-CT based criteria have been developed to evaluate the response to targeted therapy. These include the European Organization for Research and Treatment of Cancer (EORTC) and the PET Response Criteria in Solid Tumors (PERCIST). ⋯ EORTC and PERCIST agreed on 43 (79.6%) of the patients with κ-coefficient of 0.62 indicating good agreement (p-value of <0.001). Conclusion EORTC and PERCIST criteria have a good agreement in evaluating treatment response in solid malignant tumors. Therefore, adoption of EORTC or PERCIST in PET-CT reporting can standardize the evaluation of oncological treatment results.