Journal of clinical medicine
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This article discusses the importance and effectiveness of viscoelastic hemostatic assays (VHAs) in assessing hemostatic competence and guiding blood component therapy (BCT) in patients with postpartum hemorrhage (PPH). In recent years, VHAs such as thromboelastography and rotational thromboelastometry have increasingly been used to guide BCT, hemostatic adjunctive therapy and prohemostatic agents in PPH. The three pillars of identifying hemostatic competence include clinical observation, common coagulation tests, and VHAs. ⋯ These VHAs can also be used in cases of uterine atony, preeclampsia, acute fatty liver of pregnancy, amniotic fluid embolism, placental abruption, genital tract trauma, surgical trauma, and inherited and prepartum acquired coagulopathies. There exists an immediate need for a point-of-care test that can equip obstetricians with rapid results on developing coagulopathic states. The use of VHAs in predicting and treating PPH, although in an incipient state, can fulfill this need.
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Acute respiratory distress syndrome (ARDS) is an intense inflammatory process of the lungs. Most ARDS patients require mechanical ventilation (MV). Few studies have investigated the prediction of MV duration over time. ⋯ The best early prediction model was obtained with data captured in the 2nd day. Conclusions: Supervised ML can make early and accurate predictions of MV duration in ARDS after onset over time across ICUs. Supervised ML models might have important implications for optimizing ICU resource utilization and high acute cost reduction of MV.
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In acute COVID-19, D-Dimer levels can be elevated and those patients are at risk for thromboembolic events. This study aims to investigate differences in preoperative D-Dimer levels in SARS-CoV-2 IgG positive and negative patients undergoing primary total knee and total hip replacement (TJA) or spine surgery. ⋯ There is no difference in D-Dimer levels between SARS-CoV-2 IgG positive and negative patients and there does not seem to be any difference for different orthopedic specialty patients. Routine testing of D-Dimer levels is not recommended for patients undergoing elective orthopedic surgery.
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Electric bicycles (E-bikes) are an increasingly popular means of transport, and have been designed for a higher speed comparable to that of small motorcycles. Accident statistics show that E-bikes are increasingly involved in traffic accidents. To test the hypothesis of whether accidents involving E-bikes bear more resemblance to motorcycle accidents than conventional bicyclists, this study evaluates the injury pattern and severity of E-bike injuries in direct comparison to injuries involving motorcycle and bicycle accidents. ⋯ The following distribution was found in the individual groups: 67 E-bike, 1141 bicycle and 588 motorcycle accidents. The injury pattern of E-bikers resembled that of bicyclists much more than that of motorcyclists. The patients with E-bike accidents were almost 14 years older and had a higher incidence of moderate traumatic brain injuries than patients with bicycle accidents, in spite of the fact that E-bike riders were nearly twice as likely to wear a helmet as compared to bicycle riders. The rate of pelvic injuries in E-bike accidents was twice as high compared with bicycle accidents, whereas the rate of upper extremity injuries was higher following bicycle accidents. Conclusion: The overall E-bike injury pattern is similar to that of cyclists. The differences in the injury pattern to motorcycle accidents could be due to the higher speeds at the time of the accident, the different protection and vehicle architecture. What is striking, however, is the higher age and the increased craniocerebral trauma of the E-bikers involved in accidents compared to the cyclists. We speculate that older and untrained people who have a slower reaction time and less control over the E-bike could benefit from head protection or practical courses similar to motorcyclists.
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Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. ⋯ The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field.