scholarly journals Fragmentation of Care Is Associated with Poor Outcomes in Geriatric Trauma: A Nationwide Analysis of Outcomes and Predictors

2021 ◽  
Vol 233 (5) ◽  
pp. S104-S105
Author(s):  
Shekhar Gogna ◽  
Kamil Hanna ◽  
Peter Rhee ◽  
Ilya Shnaydman ◽  
Matthew Bronstein ◽  
...  
Keyword(s):  
Geriatric Trauma ◽  
Poor Outcomes ◽  
Fragmentation Of Care

scholarly journals Comprehensive Comparison Between Geriatric and Nongeriatric Patients With Trauma

2021 ◽  
Author(s):  
Pei-Chen Lin ◽  
Nan-Chun Wu ◽  
Hsiu-Chen Su ◽  
Chien-Chin Hsu ◽  
Kuo-Tai Chen
Keyword(s):  
Mortality Rate ◽  
Geriatric Patients ◽  
Long Term Care ◽  
Global Perspective ◽  
Geriatric Trauma ◽  
Trauma Patients ◽  
Term Care ◽  
Severity Scores ◽  
Poor Outcomes

Abstract Purpose:The incidence of geriatric trauma is increasing due to the growing elderly population. Healthcare providers require a global perspective to differentiate critical factors that might alter patients’ prognosis.Methods: We retrospectively reviewed all adult patients admitted to a trauma center during a 4-year period. We identified 655 adult trauma patients aged from 18 to 64 (nongeriatric group) and 273 trauma patients ≥65 years (geriatric group). Clinical data were collected and compared between the two groups. Results:The geriatric group had a higher incidence of trauma and higher Injury Severity Scores than did the nongeriatric group. Fewer geriatric patients underwent surgical treatment (all patients: geriatric vs. nongeriatric: 65.9% vs. 70.7%; patients with severe trauma: geriatric vs. nongeriatric: 27.6% vs. 44.5%). Regarding prognosis, the geriatric group exhibited higher mortality rate and less need for long-term care (geriatric vs. nongeriatric: mortality: 5.5% vs. 1.8%; long-term care: 2.2% vs. 5.0%). Conclusion:We observed that geriatric patients had higher trauma incidence and higher trauma mortality rate. Aging is a definite predictor of poor outcomes for trauma patients. Limited physiological reserves and preference for less aggressive treatment might be the main reasons for poor outcomes in elderly individuals.

Poor Outcomes Seen in Pregnancy-Tied Breast Ca

Ob Gyn News ◽  
2008 ◽  
Vol 43 (2) ◽  
pp. 15
Author(s):  
BRUCE JANCIN
Keyword(s):  
Poor Outcomes ◽  
In Pregnancy

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

2020 ◽  
Author(s):  
Hiroo Kimura ◽  
Akira Toga ◽  
Taku Suzuki ◽  
Takuji Iwamoto
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Delayed Diagnosis ◽  
Preoperative Assessment ◽  
Radiographic Examination ◽  
Clinical Images ◽  
Left Hand ◽  
Carpometacarpal Joints ◽  
Joint Deformity ◽  
Poor Outcomes

Abstract Background Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable. Case Description We report the case of a 17-year-old boy involved in a vehicular accident. Clinical images showed dorsal dislocation of all four ulnar CMC joints of the left hand associated with a fracture of the base of the fourth metacarpal. Although closed reduction was attempted immediately, the affected joints remained unstable and easily redislocated. Therefore, we performed open reduction and percutaneous fixation of all ulnar CMCs. He showed excellent recovery after 1 year postoperatively, reported no pain, and demonstrated complete grip strength and range of motion of the affected wrist and fingers. Literature Review Accurate clinical diagnosis of this lesion is difficult because of polytrauma, severe swelling masking the dislocated CMC joint deformity, and overlapping of adjacent metacarpals and carpal bones on radiographic examination. As for the treatment strategy, it has yet to obtain a consensus. Some reports value open reduction to guarantee anatomical reduction, and it is definitely needed in the patients with interposed tissues to be removed or with subacute and chronic injuries. Clinical Relevance Delayed diagnosis or treatment could lead to poor outcomes. Therefore, surgeons must be aware that precise preoperative assessment is critical, and anatomical open reduction of interposed bony fragments, like our case, may be required even in an acute phase.

Linitis Plastica of The Stomach: A Review

2020 ◽  
Vol 22 (2) ◽  
pp. 125-138
Author(s):  
Md Mizanur Rahman
Keyword(s):  
Gastric Cancer ◽  
Treatment Outcome ◽  
Surgical Resection ◽  
Linitis Plastica ◽  
Diffuse Gastric Cancer ◽  
Biological Behaviour ◽  
Desmoplastic Reaction ◽  
The Poor ◽  
Diagnostic Approaches ◽  
Poor Outcomes

Linitis plastica (LP) is a particular subtype of diffuse gastric cancer and is thought to have a separate entity in respect with its biological behaviour, pathology, presentation and treatment outcome. The poor prognosis of LP gastric cancer is due primarily to its advanced stage at diagnosis. The characteristic histopathological feature of this entity is cellular spread to the submucosa and stroma with minimal mucosal alterations accompanied by an excessive desmoplastic reaction. Despite recent research on alternative therapies, surgical resection appears the only potentially curative approach. Patient selection and multidisciplinary management are paramount when considering surgical resection in patients with gastric LP. The operative approach in patients with LP has historically been questioned because of the poor outcomes. The aim of this review is to highlight different dimension of linitis plastica stomach in respect to its definition, classification, clinico-pathological characters, diagnostic approaches and treatment outcome. Journal of Surgical Sciences (2018) Vol. 22 (2) : 125-138

Sociodemographic inequalities in lifetime treatment seeking and receipt for common mental health problems

2020 ◽  
Author(s):  
Christopher Rayner ◽  
Jonathan Richard Iain Coleman ◽  
Kirstin Lee Purves ◽  
Ewan Carr ◽  
Rosa Cheesman ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Mental Health Problems ◽  
Sociodemographic Factors ◽  
Treatment Seeking ◽  
Binary Outcomes ◽  
Treatment Access ◽  
Sociodemographic Correlates ◽  
Common Mental Health Problems ◽  
Poor Outcomes ◽  
Lifetime Treatment

Background: Anxiety and depressive disorders can be chronic and disabling, and are associated with poor outcomes. Whilst there are effective treatments, access to these is variable and only a fraction of those in need receive treatment. Aims: The primary aim was to investigate sociodemographic correlates of lifetime treatment access and unpick the relationships between socioeconomic features and treatment inequalities. As such, we aimed to identify groups at greatest risk of never accessing treatment and targets for intervention. Methods: We tested for sociodemographic factors associated with treatment access in UK Biobank participants with lifetime generalised anxiety or major depressive disorder, performing multivariable logistic regressions on two binary outcomes: treatment-seeking (n=33,704) and treatment receipt (n=28,940). Results: Treatment access was less likely in those who were male, from a UK ethnic minority background and who self-medicated with alcohol or drugs. Treatment access was more likely in those who reported use of self-help strategies, with lower income (<£30,000) and greater neighbourhood deprivation, as well as those with a university degree. Conclusion: This work on lifetime treatment seeking and receipt replicates known correlates of treatment receipt during time of treatment need. Our focus on treatment-seeking and receipt highlights two targets for improving treatment access. More work is required to understand the psychosocial barriers to treatment, which mediate the associations observed here.

Management and outcomes of isolated interhemispheric subdural hematomas associated with falx syndrome

2019 ◽  
Vol 131 (6) ◽  
pp. 1920-1925
Author(s):  
Daniel A. Tonetti ◽  
William J. Ares ◽  
David O. Okonkwo ◽  
Paul A. Gardner
Keyword(s):  
Neurological Deterioration ◽  
Neurological Deficits ◽  
Motor Deficits ◽  
Study Cohort ◽  
Venous Infarction ◽  
Nonsurgical Management ◽  
Subdural Hematomas ◽  
Poor Outcomes ◽  
Contemporary Management

OBJECTIVELarge interhemispheric subdural hematomas (iSDHs) causing falx syndrome are rare; therefore, a paucity of data exists regarding the outcomes of contemporary management of iSDH. There is a general consensus among neurosurgeons that large iSDHs with neurological deficits represent a particular treatment challenge with generally poor outcomes. Thus, radiological and clinical outcomes of surgical and nonsurgical management for iSDH bear further study, which is the aim of this report.METHODSA prospectively collected, single-institution trauma database was searched for patients with isolated traumatic iSDH causing falx syndrome in the period from January 2008 to January 2018. Information on demographic and radiological characteristics, serial neurological examinations, clinical and radiological outcomes, and posttreatment complications was collected and tallied. The authors subsequently dichotomized patients by management strategy to evaluate clinical outcome and 30-day survival.RESULTSTwenty-five patients (0.4% of those with intracranial injuries, 0.05% of those with trauma) with iSDH and falx syndrome represented the study cohort. The average age was 73.4 years, and most patients (23 [92%] of 25) were taking anticoagulants or antiplatelet medications. Six patients were managed nonoperatively, and 19 patients underwent craniotomy for iSDH evacuation; of the latter patients, 17 (89.5%) had improvement in or resolution of motor deficits postoperatively. There were no instances of venous infarction, reaccumulation, or infection after evacuation. In total, 9 (36%) of the 25 patients died within 30 days, including 6 (32%) of the 19 who had undergone craniotomy and 3 (50%) of the 6 who had been managed nonoperatively. Patients who died within 30 days were significantly more likely to experience in-hospital neurological deterioration prior to surgery (83% vs 15%, p = 0.0095) and to be comatose prior to surgery (100% vs 23%, p = 0.0031). The median modified Rankin Scale score of surgical patients who survived hospitalization (13 patients) was 1 at a mean follow-up of 22.1 months.CONCLUSIONSiSDHs associated with falx syndrome can be evacuated safely and effectively, and prompt surgical evacuation prior to neurological deterioration can improve outcomes. In this study, craniotomy for iSDH evacuation proved to be a low-risk strategy that was associated with generally good outcomes, though appropriately selected patients may fare well without evacuation.

Glucose Levels and Outcome After Primary Intraventricular Hemorrhage

2019 ◽  
Vol 16 (1) ◽  
pp. 40-46
Author(s):  
Rui Guo ◽  
Ruiqi Chen ◽  
Chao You ◽  
Lu Ma ◽  
Hao Li ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Glucose ◽  
Blood Glucose Level ◽  
Incidence Rate ◽  
Glucose Level ◽  
Intraventricular Hemorrhage ◽  
Laboratory Data ◽  
History Of ◽  
Poor Outcomes ◽  
The Impact

Background and Purpose: Hyperglycemia is reported to be associated with poor outcome in patients with spontaneous Intracerebral Hemorrhage (ICH), but the association between blood glucose level and outcomes in Primary Intraventricular Hemorrhage (PIVH) remains unclear. We sought to identify the parameters associated with admission hyperglycemia and analyze the impact of hyperglycemia on clinical outcome in patients with PIVH. Methods: Patients admitted to Department of Neurosurgery, West China Hospital with PIVH between 2010 and 2016 were retrospectively included in our study. Clinical, radiographic, and laboratory data were collected. Univariate and multivariate logistic regression analyses were used to identify independent predictors of poor outcomes. Results: One hundred and seventy patients were included in the analysis. Mean admission blood glucose level was 7.78±2.73 mmol/L and 10 patients (5.9%) had a history of diabetes mellitus. History of diabetes mellitus (P = 0.01; Odds Ratio [OR], 9.10; 95% Confidence Interval [CI], 1.64 to 50.54) was independent predictor of admission critical hyperglycemia defined at 8.17 mmol/L. Patients with admission critical hyperglycemia poorer outcome at discharge (P < 0.001) and 90 days (P < 0.001). After adjustment, admission blood glucose was significantly associated with discharge (P = 0.01; OR, 1.30; 95% CI, 1.06 to 1.59) and 90-day poor outcomes (P = 0.03; OR, 1.27; 95% CI, 1.03 to 1.58), as well as mortality at 90 days (P = 0.005; OR, 1.41; 95% CI, 1.11 to 1.78). In addition, admission critical hyperglycemia showed significantly increased the incidence rate of pneumonia in PIVH (P = 0.02; OR, 6.04; 95% CI 1.27 to 28.80) even after adjusting for the confounders. Conclusion: Admission blood glucose after PIVH is associated with discharge and 90-day poor outcomes, as well as mortality at 90 days. Admission hyperglycemia significantly increases the incidence rate of pneumonia in PIVH.

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