scholarly journals Success of Immediate Manual Detorsion of Testicular Torsion

2021 ◽  
pp. 235-240
Author(s):  
Fahad Ahmed Alzahrani ◽  
Faris Abdulhamid Alsulami ◽  
Faisal Ali Alghamdi ◽  
Mohammad Hamzah Yassen ◽  
Abdullah Ghunaim Almtotah ◽  
...  
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Success Rate ◽  
Testicular Torsion ◽  
Small Population ◽  
Current Evidence ◽  
Sample Sizes ◽  
Initial Management ◽  
Surgical Exploration ◽  
Very High

Evidence shows that patients having testicular torsion usually present to the emergency department to apply immediate interventions. Immediate manual detorsion has been validated among different investigations as a productive technique for the initial management of testicular torsion. In the present literature review, we have elaborated on the success of manual detorsion for patients with torsion according to findings from previous relevant studies. Our findings indicate the favorable events that can be obtained after using manual detorsion. However, some studies reported that the success rate for the modality is not very high. In addition, it has been reported to reduce the time of ischemia as a temporary measure until surgery is prepared. Evidence also shows that the approach's efficacy is superior to that of surgical exploration and should be used since the time of diagnosis to prevent further deterioration of the affected case and enhance perfusion. However, the current evidence is based on a limited number of investigations that validated the efficacy of manual detorsion among a small population. Accordingly, we encourage further studies to be conducted in this context further to validate the current evidence with more adequate sample sizes.

scholarly journals The Ortho-Plastic Approach to Soft Tissue Management in Trauma

2014 ◽  
Vol 8 (1) ◽  
pp. 399-408 ◽  
Author(s):  
Daniel J Jordan ◽  
Marco Malahias ◽  
Wasim Khan ◽  
Sandip Hindocha
Keyword(s):  
Emergency Department ◽  
Soft Tissue ◽  
Soft Tissue Injuries ◽  
British Association ◽  
Current Evidence ◽  
Soft Tissue Management ◽  
Initial Management ◽  
Accident And Emergency ◽  
Accident And Emergency Department ◽  
British Orthopaedic Association

Fractures with associated soft tissue injuries, or those termed ‘open,’ are not uncommon. There has been much discussion regarding there management, with the guidance from the combined British Orthopaedic Association and British Association and Aesthetic Surgeons teams widely accepted as the gold level of therapy. We aim to discuss the current evidence about the initial management of this group of injuries, taking a journey from arrival in the accident and emergency department through to the point of definitive closure. Other modes of therapy are also reviewed.

scholarly journals Ailing and Failing Endosseous Dental Implants: A Literature Review

2003 ◽  
Vol 4 (2) ◽  
pp. 35-50 ◽  
Author(s):  
Lawrence G. Breault ◽  
Eric T. Ashley ◽  
Lemuel L. Covington ◽  
Barry G. Bishop
Keyword(s):  
Surgical Technique ◽  
Literature Review ◽  
Success Rate ◽  
Dental Implants ◽  
Oral Hygiene ◽  
Case Selection ◽  
Implant Dentistry ◽  
Very High

Abstract Although the overall success rate of implant dentistry is very high, dental implants occasionally fail. It is essential for the clinician to recognize unhealthy implants and to determine whether they are ailing, failing, or failed prior to beginning any salvage efforts. Ailing and failing implants are amenable to therapy. Implants diagnosed as failed should be removed. This review provides the reader with information on non-surgical and surgical therapies available for managing ailing and failing implants. Undoubtedly, the best steps to avoid encountering ailing or failing implants involve proper case selection, excellent surgical technique, placing an adequate restoration on the implant, educating the implant patient to maintain meticulous oral hygiene, and evaluating the implant both clinically and radiographically at frequent recall visits. Citation Ashley ET, Covington LL, Bishop BG, Breault LG. Ailing and & Failing Endosseous Dental Implants: A Literature Review. J Contemp Dent Pract 2003 May;(4)2:035-050.

Stress urinary incontinence: injection method of treatment (literature review)

GYNECOLOGY ◽  
2018 ◽  
Vol 20 (6) ◽  
pp. 31-34
Author(s):  
E I Ermakova
Keyword(s):  
Urinary Incontinence ◽  
Stress Urinary Incontinence ◽  
Literature Review ◽  
Scientific Data ◽  
Diagnosis And Treatment ◽  
Current Evidence ◽  
Injection Method ◽  
Periurethral Injection

The purpose of the review - presentation of clinical scientific data based on current evidence of information on the management of patients with stress urinary incontinence, the effectiveness and safety of periurethral injections of various bulking substances. Material and methods. А review of Russian and foreign sources on the prevalence, etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, in particular the injection method. Results. The review presents data of the etiopathogenesis, diagnosis and treatment of stress urinary incontinence in women, depending on the severity of the pathology. Analyzed the data of periurethral injection of various bulking materials, their effectiveness and safety.

Improvement of medical and technological support of emergency department in multi-field hospital (analytical literature review)

2017 ◽  
Vol 0 (2.81) ◽  
pp. 21-27
Author(s):  
G.G. Roshchin ◽  
V.Yu. Kuzmіn ◽  
E.D. Moroz ◽  
M.D. Blyznjuk ◽  
V.O. Kryliuk ◽  
...  
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Field Hospital ◽  
Technological Support

scholarly journals Conditional power of antidepressant network meta-analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Lisa Holper
Keyword(s):  
Meta Analysis ◽  
Indirect Evidence ◽  
Dropout Rate ◽  
Conclusive Evidence ◽  
Effect Sizes ◽  
Current Evidence ◽  
Hamilton Depression Scale ◽  
Conditional Power ◽  
Sample Sizes ◽  
Antidepressant Treatments

Abstract Background Conditional power of network meta-analysis (NMA) can support the planning of randomized controlled trials (RCTs) assessing medical interventions. Conditional power is the probability that updating existing inconclusive evidence in NMA with additional trial(s) will result in conclusive evidence, given assumptions regarding trial design, anticipated effect sizes, or event probabilities. Methods The present work aimed to estimate conditional power for potential future trials on antidepressant treatments. Existing evidence was based on a published network of 502 RCTs conducted between 1979-2018 assessing acute antidepressant treatment in major depressive disorder (MDD). Primary outcomes were efficacy in terms of the symptom change on the Hamilton Depression Scale (HAMD) and tolerability in terms of the dropout rate due to adverse events. The network compares 21 antidepressants consisting of 231 relative treatment comparisons, 164 (efficacy) and 127 (tolerability) of which are currently assumed to have inconclusive evidence. Results Required sample sizes to achieve new conclusive evidence with at least 80% conditional power were estimated to range between N = 894 - 4190 (efficacy) and N = 521 - 1246 (tolerability). Otherwise, sample sizes ranging between N = 49 - 485 (efficacy) and N = 40 - 320 (tolerability) may require stopping for futility based on a boundary at 20% conditional power. Optimizing trial designs by considering multiple trials that contribute both direct and indirect evidence, anticipating alternative effect sizes or alternative event probabilities, may increase conditional power but required sample sizes remain high. Antidepressants having the greatest conditional power associated with smallest required sample sizes were identified as those on which current evidence is low, i.e., clomipramine, levomilnacipran, milnacipran, nefazodone, and vilazodone, with respect to both outcomes. Conclusions The present results suggest that conditional power to achieve new conclusive evidence in ongoing or future trials on antidepressant treatments is low. Limiting the use of the presented conditional power analysis are primarily due to the estimated large sample sizes which would be required in future trials as well as due to the well-known small effect sizes in antidepressant treatments. These findings may inform researchers and decision-makers regarding the clinical relevance and justification of research in ongoing or future antidepressant RCTs in MDD.

Causes of delayed exploration of the acute scrotum in a regional tertiary centre

2020 ◽  
pp. 205141582098119
Author(s):  
Benjamin Storey ◽  
Nathan Shugg ◽  
Alison Blatt
Keyword(s):  
Retrospective Review ◽  
Testicular Torsion ◽  
Tertiary Hospital ◽  
Adverse Outcomes ◽  
Acute Scrotum ◽  
Tertiary Institution ◽  
Level Of Evidence ◽  
Scrotal Pain ◽  
Surgical Exploration ◽  
Significant Difference

Background: Testicular torsion is an organ-threatening surgical emergency with a limited timeframe for intervention. Objective: To identify the delays to surgical exploration of patients with an acute scrotum in a tertiary hospital to prevent adverse outcomes associated with this time critical emergency. Methods: A retrospective review of medical records for all patients who underwent scrotal exploration for acute scrotal pain in a tertiary hospital in regional New South Wales between January 2008 to December 2018 was performed. Results: Retrospective review identified 242 patients, of whom 161 had testicular torsion and 56 resultant orchidectomies. No statistically significant difference in pre-hospital delays between paediatric or adult populations was found. The average time from presentation to theatre was 4 h 36 min. Patients who were delayed > 6 h from presentation to surgical exploration had significantly increased rates of orchidectomy. Delays that significantly affected rates of orchidectomy were transfer from peripheral sites, late presentation, misdiagnosis and representation after discharge. Conclusion: The most common reason for delay was diagnostic error with the patient later re-presenting to hospital. Patient transfer from the primary hospital to a tertiary institution and subsequent delayed surgical exploration also contributed to significantly higher rates of orchidectomy. Level of Evidence: 3

scholarly journals 303 What goes bump in the night? A literature review and noise exposure experiment in a UK paediatric emergency department

2020 ◽  
Vol 37 (12) ◽  
pp. 841.1-841
Author(s):  
Lucy Hall ◽  
Sophie Dando ◽  
Anthony Hanks
Keyword(s):  
Emergency Department ◽  
Literature Review ◽  
Literature Search ◽  
Noise Exposure ◽  
Cochrane Library ◽  
Noise Levels ◽  
Paediatric Emergency Department ◽  
Paediatric Emergency ◽  
Sound Levels ◽  
Exposure Experiment

Aims/Objectives/BackgroundIn the Emergency department (ED), noise is a frequent and often unavoidable consequence of work undertaken and levels can often be raised during the day and night. Raised ambient noise levels have potential implications for the workforce, patients and relatives.Investigation into the problem of noise levels in the ED follows feedback from a young patient who couldn’t sleep during a prolonged stay. His complaint focused on loud, irregular banging noises such as those from closing bins that kept him awake.The team felt work should be done to see if it was a wider spread problem or just isolated to his case. A simple sound recording experiment and literature search was conducted.Methods/DesignThe literature search was conducted using electronic/online databases (Medline; Cochrane library) with a fixed date range and specific inclusion criteria.The noise exposure experiment was conducted using a verified phone app to record the sound levels. They were measured at 3 times, during a night shift, in the paediatric emergency department of UHW. All measurements were at a fixed distance and were averaged and compared with WHO recommendations.Results/ConclusionsThere are many sources of noise pollution in the ED, some are unavoidable for safety and clinical reasons.The literature review produced a small number of papers all of which found that sound levels were raised above recommended levels. Similarly, all the sounds measured in the ED also exceeded the recommendations.The most consistent finding across the papers, matched by findings from recordings, was that human behavioural modification is an easy and effective way to reduce noise levels.There are simple steps that can be taken to reduce and eliminate soundsRaising awareness regarding this problem is of great importance and focussing future work on assessing the impact in younger patients within the Emergency Department is paramount.

scholarly journals Iodine allergy: Common misperceptions

2021 ◽  
Author(s):  
Nicole R Wulf ◽  
John Schmitz ◽  
Amy Choi
Keyword(s):  
Literature Review ◽  
Adverse Reactions ◽  
Povidone Iodine ◽  
Cross Reactivity ◽  
Current Evidence ◽  
Allergic Reactions ◽  
Iodinated Contrast Media ◽  
Inclusion Criteria ◽  
Iodinated Contrast ◽  
Final Article

Abstract Disclaimer In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. Purpose The current evidence regarding iodine-containing compounds and iodine allergy cross-reactivity is reviewed. Summary Iodine is an essential human nutrient found in the thyroid gland. It is used in the synthesis of the thyroid hormones thyroxine and triiodothyroxine. Patients who report having adverse reactions to iodine-containing substances are often labelled as having an “iodine allergy,” which can result in delays in care or patients being denied essential ICM or other iodine-containing drugs. A literature review was conducted to evaluate the evidence regarding iodine allergy and iodine-containing drugs. Of 435 articles considered potentially appropriate for full review (plus 12 additional articles included on the basis of references from the eligible articles), 113 could not be obtained. After exclusion of 353 articles that did not meet all inclusion criteria, the remaining 81 articles were included in the review. The results of the literature review indicated that iodine has not been shown to be the allergen responsible for allergic reactions to iodinated contrast media, amiodarone, povidone-iodine, and other iodine-containing compounds. Conclusion There is a lack of evidence to support cross-reactivity between iodine-containing compounds in so called iodine-allergic individuals.

scholarly journals Transitional care models for chronic patients: preliminary results from an umbrella review

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M T Riccardi ◽  
M Cicconi ◽  
W Ricciardi ◽  
M M Gianino ◽  
G Damiani
Keyword(s):  
Emergency Department ◽  
Usual Care ◽  
Hospital Readmission ◽  
Readmission Rate ◽  
Care Setting ◽  
Transitional Care ◽  
Emergency Department Visits ◽  
Current Evidence ◽  
Chronic Patients ◽  
Care Models

Abstract Worldwide, chronic diseases are burdening and the health systems need to be rethought to better manage this epidemiologic shift. One of the critical points in the care pathway of chronic patients is the transition from one care setting to another. Aim of this study is to provide an overview of the current evidence on the impact of transitional care programs on health and economic outcomes for chronic patients Medline, Web of Science and EMBASE were queried for relevant reviews using the Population-Intervention-Context-Outcome (PICO) model. The quality of the included articles was determined using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2). Data were analyzed using descriptive statistic, and comparison among studies carried out in European Union (EU) versus non-EU was performed (Chi-square test was used and a p < 0.05 was deemed as statistically significant) 124 reviews were assessed for eligibility and 14 were eventually included (for a total of 167 primary articles). Quality appraisal was critically low in 60% of the reviews. Both hospital readmission rate and Emergency Department (ED) visit rate were lower than those in usual care group, but this difference was significant in 40% of articles. In EU studies readmission rate was lower in 65% of cases while in non-EU ones the percentage was 51.0%, but the difference was not significant (p = 0.23). Six reviews (43%) investigated the economic impact of the transitional care: most reported an initial increase in cost due to investment in staff training and creation of organizational networks, followed by a sharp decrease in costs due to a better utilization of health services, thus leading to a reduction in overall costs. Compared with usual care, transitional care shows an overall cost reduction, even if with limited effects on re-hospitalization or ED visit rates. These findings should encourage decision makers to invest in the development of this kind of programs in order to identify models that best perform. Key messages The patient transfer supervision from one care setting to another is necessary for continuity of care, but there is no robust evidence about the better performance of transitional care models. Systematically reviewed transitional care models has been shown be more cost saving, with a moderate impact on hospital readmission or emergency department visits rates.

A Clinical Study of Violence in Patients Referred on a Form I to a General Hospital Psychiatric Unit

1988 ◽  
Vol 33 (8) ◽  
pp. 711-715 ◽  
Author(s):  
A.J. Cooper
Keyword(s):  
Emergency Department ◽  
Mental Illness ◽  
Clinical Study ◽  
Hospital Stay ◽  
General Hospital ◽  
Alcohol Misuse ◽  
Psychiatric Ward ◽  
Violent Behaviour ◽  
Initial Management ◽  
Retrospective Examination

A retrospective examination of all patients referred by the emergency department of a medium sized general hospital for a mandated Form I psychiatric assessment during a 12 month period was conducted. The principal aim was an analysis of the clinical phenomena and especially the antecedents and course of violent behaviour (following admission and throughout the hospital stay) which in the majority of cases was the reason for the referral. Thirty percent had behaved violently prior to admission but within 24 hours all had settled and during the remainder of their hospital stay were indistinguishable from the generality of the ward population (for example, non-violent). Two-thirds of the patients were non-psychotic; that is, not suffering from a major mental illness; nevertheless, they required a disproportionate amount of time and effort in initial management. A high proportion had several prior admissions to the psychiatric ward, particularly for alcohol misuse and/or a personality disorder.

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