Curēus
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The purpose of this study is to define an algorithm that will predict the success of indirect decompression without the need for direct decompression in patients undergoing lateral lumbar interbody fusions. ⋯ Our algorithm can be used as an aid to assess which patients may benefit from indirect decompression alone, compared to indirect decompression combined with posterior decompression procedures.
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A 77-year-old man presented to the hospital for non-ambulation of 48 hours prior to admission. He was found to have a metastatic spinal cord compression (MSCC), a PSA exceeding 27,000, and biopsy-confirmed prostate cancer. After palliative radiation (RT) to the spine and medical treatment, the patient recovered his functions fully and survived for more than 7.5 years, far beyond what would be expected based on current published literature. A systematic review of the literature of MSCC in patients with prostate cancer was carried out. ⋯ Positive predictive factors of local control included single level of metastasis, time of development of motor deficits of more than 14 days, no prior androgen-deprivation therapy (ADT), age under 65, and longer course of RT (10 fractions of 2 Gy). Absence of prior ADT, pre-treatment ambulation, a single site of metastasis, and haemoglobin of less than 12g/L were positive predictors for survival.
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In a trauma situation, it is essential that emergency room physicians are able to think clearly, make decisions quickly and manage patients in a way consistent with their injuries. In order for emergency medicine residents to adequately develop the skills to deal with trauma situations, it is imperative that they have the opportunity to experience such scenarios in a controlled environment with aptly timed feedback. ⋯ The following describes a simulation session in which trainees were tasked with managing an infantile patient who had experienced a major trauma as a result of a single vehicle accident. The described simulation session utilized human patient simulators and was tailored to junior (year 1 and 2) emergency medicine residents.
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Review
Multimodality Neuromonitoring in Pediatric Neurocritical Care: Review of the Current Resources.
Brain insults in children represent a daily challenge in neurocritical care. Having a constant grasp on various parameters in the pediatric injured brain may affect the patient's outcome. Currently, new advances provide clinicians with the ability to utilize several modalities to monitor brain function. This multi-modal approach allows real-time information, leading to faster responses in management and furthermore avoiding secondary insults in the injured brain.
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To provide an informed choice of equipment purchase, we sought to use simulation to allow medical providers an opportunity to evaluate two potential laryngoscopes. ⋯ Providers overwhelmingly chose one laryngoscope over the other. Data from this evaluation were used to determine which of the two laryngoscope brands was purchased. Based on our experience, we feel other hospitals should consider the use of simulation to allow providers to examine, compare, and rate medical equipment prior to making purchasing decisions.