Acute Medicine & Surgery最新文献

{"title":"Risk factors, complications and biomarkers associated with acute kidney injury after craniotomy: a comprehensive mini-review","authors":"Davood Dalil,&nbsp;Joben Kianparsa,&nbsp;Mahdi Isakhani,&nbsp;Mahdieh Ostadzadeh,&nbsp;Fatemeh Ravand","doi":"10.1002/ams2.70020","DOIUrl":"10.1002/ams2.70020","url":null,"abstract":"<p>Acute kidney injury (AKI) is a devastating medical condition that occurs mostly in hospitalized patients after a serious illness or major surgery and imposes a great health and financial burden on patients. Craniotomy is one of the major surgeries in which people who undergo this operation experience critical clinical conditions. Systemic inflammation, hemodynamic variation, and pharmacological agents administered during and after craniotomy can lead to the development of AKI and a poor prognosis. Moreover, AKI itself could cause other significant complications and increase the mortality rate in patients who undergo craniotomy. Determining the pre-, peri-, and postoperative risk factors associated with AKI after craniotomy is important for its prevention. Efficient care of patients after craniotomy and effective treatment approaches should be implemented to maintain normal metabolism, enhance nerve function recovery, and control inflammation. Novel biomarkers have been recognized as reliable indicators for the diagnosis and prognosis of AKI after brain surgery. This study aimed to summarize the most relevant literature regarding the risk factors, postoperative complications, and mortality associated with AKI after craniotomy. Moreover, we reviewed the approaches to postoperative care, followed by an overview of the significant diagnostic or prognostic biomarkers of AKI following craniotomy to provide a basis for preventing and decreasing AKI.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551589/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Training in trauma surgical techniques using cryopreserved porcine organs","authors":"Tsubasa Fujikawa,&nbsp;Hiroshi Homma,&nbsp;Yuri Ishii,&nbsp;Yusuke Tanino,&nbsp;Yuta Ishigami,&nbsp;Shoji Suzuki,&nbsp;Hidefumi Sano,&nbsp;Junya Tsurukiri","doi":"10.1002/ams2.70018","DOIUrl":"10.1002/ams2.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To develop a trauma surgery training program using porcine organs and evaluate its usefulness. This program allows participants to experience the tactile sensation of organs and bleeding, which are impossible in trauma surgery training using a cadaver.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Resected organs (heart, lung, liver, spleen, kidney, small intestine, bladder, and external carotid artery) from slaughtered pigs for medical research were perfused with saline solution, flash-frozen in a deep freezer, and thawed naturally on the morning of training. The training program consisted of half-day practical training in suture repair of artificially created damage to the parenchymal organs and suture or anastomotic repair of damage to the luminal organs. We injected the parenchymal organs' arteries with porcine blood and the renal ureters with saline solution to create models of organ hemorrhage and urinary leakage. The training's usefulness was evaluated using a participant questionnaire that included an 11-point self-assessment of confidence level (SACL) form.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Nine training seminars were conducted from September 2018 to February 2023, attended by 67 participants who were in their 1st to 20th post-graduate year. The mean SACL significantly increased immediately after the seminar but decreased half-year thereafter. However, it was maintained for those with surgical residency. It was also maintained for those with no surgical residency through seminar repetition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Training in trauma surgical techniques using porcine organs is beneficial regardless of whether the participant has prior surgical residency.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Obturator dislocation of hip with femoral neck fracture","authors":"Atsuhiro Ijiri,&nbsp;Hiroshi Kato,&nbsp;Hiroki Kobayashi,&nbsp;Yasumasa Sekine,&nbsp;Tetsuro Kiyozumi","doi":"10.1002/ams2.70013","DOIUrl":"10.1002/ams2.70013","url":null,"abstract":"<p>A 68-year-old woman was brought to the emergency department after being struck by a car from behind while walking. She complained of left hip pain and underwent pelvic radiography, computed tomography (CT), and three-dimensional CT, which revealed a fracture of the left femoral neck and insertion of the left femoral head into the left obturator foramen (Figure 1). Indirect traction was performed in the emergency room, and the femoral head, firmly seated in the obturator foramen, was removed later by an anterolateral approach to the hip, followed by total hip arthroplasty (THA). Obturator dislocation of the hip joint is rarely associated with a femoral neck fracture, and there are only nine reports of such cases in English literature.<span>¹</span> Anterior dislocation occurs when the hip is forced into abduction and external rotation, causing impingement of the femoral neck or greater trochanter and acetabulum, and the femoral head is pulled forward from the acetabulum.<span>²</span> Anterior hip joint dislocation can be classified into obturator dislocation and suprapubic dislocation. However, obturator dislocation is reported to occur when the hip joint is externally rotated in the flexed position, and further forced external rotation can result in a femoral neck fracture.<span>³</span> In some cases, osteosynthesis has been chosen for surgery in younger patients, but THA is recommended for elderly patients to avoid complications such as avascular necrosis and nonunion.<span>¹</span></p><p>The authors declare no conflicts of interest.</p><p>Approval of the research protocol: None.</p><p>Informed consent: Informed consent was obtained from the patient.</p><p>Registry and the registration no. of the study/trial: None.</p><p>Animal studies: None.</p>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11552647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of an eligibility checklist on arrival of emergency room as a registry system for corneal donation—A 9-year retrospective cohort study","authors":"Haruaki Wakatake,&nbsp;Koichi Hayashi,&nbsp;Miyuki Kurisu,&nbsp;Minoru Yoshida,&nbsp;Ken Tsutsumi,&nbsp;Hiroki Saito,&nbsp;Yu Nomura,&nbsp;Toru Yoshida,&nbsp;Yuka Kitano,&nbsp;Yoshihiro Masui,&nbsp;Shigeki Fujitani","doi":"10.1002/ams2.70014","DOIUrl":"10.1002/ams2.70014","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study aimed to evaluate whether the use of an eligibility checklist uncovered potential corneal donors among deceased outpatients and increased the donation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In this retrospective cohort study, we applied the eligibility checklist to nearly all outpatients (age ≥ 18 y/o) who were transferred to our emergency department and identified as deceased between 2012 and 2020. Whether the use of the checklist contributed to the increase in corneal donation was examined, and the reasons for refusal of the donation were also evaluated. Furthermore, yearly changes in the number of the donation were assessed, with the data obtained before initiation of the checklist in 2010–2011 as references. The primary outcome was the number of corneal donors, with yearly changes in donation numbers assessed using data from 2010 to 2011 as a reference before the checklist was introduced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 1776 outpatients to whom the eligibility checklist was applied, 1169 patients were regarded as potential donors. Of them, 126 families gave consent and 80 patients finally donated cornea; medical diseases as a cause of death were less likely to retract donation offer (OR = 0.31 [95% CI: 0.09–0.99]). The number of corneal donors in 2010–2011 corresponded to 1.6% of the deceased outpatients but increased since the checklist was introduced the total number of donors reached 87 (4.3%) during 2012–2020.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A routine use of the eligibility checklist at the initial interview will reinforce the awareness of corneal donation among the families of patients and contribute to the increased number of corneal donors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11551474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142611977","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of urinary culture on diagnosis and treatment strategy after empiric therapy in febrile neutropenic patients","authors":"Natsumi Hata,&nbsp;Takateru Ihara","doi":"10.1002/ams2.70012","DOIUrl":"10.1002/ams2.70012","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Febrile neutropenia (FN) is treated by a broad-spectrum antimicrobial. Subsequent antimicrobial therapy depends on identifying the source of the infection. Although urinary tract infections (UTIs) are common and urine culture (UC) is a valuable diagnostic tool, uncertainties remain about the specific indications for conducting UC in FN. This study examined whether performing routine UC would affect the subsequent antimicrobial therapy in FN.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>All emergency department patients who received chemotherapy for malignancy and met the definition of FN (neutrophil count &lt;0.5 × 10⁹/L and fever &gt;37.5°C) were included. The patient's demographic data, clinical symptoms, urinalysis results, urine and blood culture results, antibiotic therapy and duration, and patient outcomes were extracted from electronic medical records. UC was defined as positive if &gt;10⁵ colony-forming units/L were detected.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 115 of the initial 124 cases were included in the analysis. Thirty-one cases met the Infectious Diseases Society of America guideline definition for recommending UC (recommended group) and 84 cases did not (non-recommended group). In the recommended group, 16 of 31 cases had a positive UC, and antibiotics were changed for nine, based on UC results. In the non-recommended group, 15 of 84 cases had a positive UC, and antibiotics were changed for two. The same organism were identified in blood cultures. Seven of 115 cases were detected for the same pathogen in blood and urine cultures.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Performing UC regardless of symptoms could diagnose several asymptomatic UTIs in FN, but seldom impact an antimicrobial treatment strategy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11538900/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142589641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adherence to balanced transfusion among severely injured patients: A post hoc analysis of the RESTRIC trial","authors":"Makoto Aoki,&nbsp;Kazunori Fukushima,&nbsp;Mineji Hayakawa,&nbsp;Daisuke Kudo,&nbsp;Takashi Tagami,&nbsp;Kiyohiro Oshima,&nbsp;Shigeki Kushimoto","doi":"10.1002/ams2.70016","DOIUrl":"https://doi.org/10.1002/ams2.70016","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>A balanced transfusion strategy has been a standard resuscitation method for trauma patients, and adherence to a massive transfusion protocol incorporating balanced transfusion is reported to reduce mortality. This study aimed to assess adherence to balanced transfusion among severely injured patients in Japan.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study analyzes RESTRIC (restrictive transfusion strategy for critically injured patients) trial patients who were cluster-randomized based on restrictive or liberal transfusion strategy. We defined two transfusion groups: massive transfusion group 1, which includes RBC transfusions of at least eight units within 6 h; and massive transfusion group 2, which includes RBC transfusions of at least 20 units within 24 h. Adherence to balanced transfusion was assessed as the ratios of fresh frozen plasma (FFP) to red blood cells (RBC) and platelet concentrate (PC) to RBC ratio &gt;0.5.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 220 eligible patients, 98 (44.5%) were grouped as massive transfusion group 1 and 38 (17.3%) as massive transfusion group 2. The balanced transfusion in terms of the FFP to RBC ratio was nearly 100% for groups 1 and 2 over all periods. However, the balanced transfusion in terms of the PC to RBC ratio within 6 h were 51.0% for group 1 and 68.4% for group 2.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study revealed that while the ratio of FFP to RBC was balanced among patients from the early phase, the ratio of PC to RBC was not fully balanced, particularly in the early phase.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142579578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increased number of dispatches in emergency medical services correlates to response time extension","authors":"Natsuko Ishikawa,&nbsp;Keisuke Tomita,&nbsp;Takashi Shimazui,&nbsp;Yoko Tochigi,&nbsp;Taka-aki Nakada","doi":"10.1002/ams2.70017","DOIUrl":"https://doi.org/10.1002/ams2.70017","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>This study investigated the correlation between the number of emergency medical service (EMS) dispatches and response time extension. In addition, we conducted a simulation to assess the potential for reducing response times by relocating the ambulance based on the number of dispatches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study analyzed data on patients treated with EMS between May 1 and June 25, 2021, in an urban area (Chiba City, Japan). Spearman's rank correlation tests were used to analyze the correlations among the number of dispatches, response time extension, and ambulance distance. We created a heat map to visualize the number of dispatches and distribution of emergency case occurrences, and simulated the relocation of the EMS team with the lowest number of dispatches to the closest EMS team with the highest number of dispatches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In total, 7915 emergency cases were included. The median response time across all dispatches was 9 min, whereas that for the response time extension cases was 12 min. There was a significant positive correlation between the increased number of dispatches, response time extension (<i>r</i> = 0.94, <i>p</i> &lt; 0.0001), and ambulance distance (<i>r</i> = 0.95, <i>p</i> &lt; 0.0001). The relocation simulation significantly shortened the average response time from 13 min and 30 s to 12 min and 11 s (9.9% decrease, <i>p</i> &lt; 0.0001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>An increased number of dispatches significantly increased the response time extension cases and ambulance distance. Our simulation suggests that EMS relocation can potentially shorten the response time. While increased dispatches influence the response time extension, optimal EMS allocation may improve response times.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142579618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful transition from intravenous to inhalation anesthesia for respiratory management of coronavirus disease pneumonia: A case report","authors":"Reijiro Kato,&nbsp;Yuhei Irie,&nbsp;Yoshito Izutani,&nbsp;Hiroyasu Ishikura","doi":"10.1002/ams2.70010","DOIUrl":"https://doi.org/10.1002/ams2.70010","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with coronavirus disease pneumonia, strong spontaneous breathing increases pulmonary vascular permeability and induces self-inflicted lung injury, prolonging the intensive care unit stay and worsening prognosis. Therefore, spontaneous respiration must be strictly controlled.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Case Presentation</h3>\u0000 \u0000 <p>A 48-year-old man was admitted for respiratory management of severe coronavirus disease pneumonia. Despite immediate ventilatory management, ventilatory failure and air leak syndrome developed, necessitating venovenous extracorporeal membrane oxygenation, intravenous sedation, and muscle relaxation. Over time, the patient's inspiratory effort worsened and the requirement for transvenous anesthesia increased. Therefore, management was switched to inhalation anesthesia after discontinuation of all transvenous anesthetics, maintaining morphine-only analgesia. Subsequent management enabled effective control of spontaneous respiration, allowing eventual discontinuation of inhalation anesthesia, venovenous extracorporeal membrane oxygenation, and ventilation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Management of spontaneous respiration in coronavirus disease pneumonia can be complicated by resistance to transvenous anesthesia; however, the use of an inhaled anesthetic may present a valuable alternative.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70010","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142447771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early do-not-attempt resuscitation orders and neurological outcomes in older out-of-hospital cardiac arrest patient: A multicenter observational study","authors":"Megumi Kohri,&nbsp;Takashi Tagami,&nbsp;Kensuke Suzuki,&nbsp;Shinnosuke Kitano,&nbsp;Tomohito Amano,&nbsp;Suzuka Hagiwara,&nbsp;Nobuya Kitamura,&nbsp;Satoo Ogawa","doi":"10.1002/ams2.70008","DOIUrl":"https://doi.org/10.1002/ams2.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To explore the association between Do-Not-Attempt Resuscitation (DNAR) orders issued within 6 h of admission and neurological outcomes in older patients with out-of-hospital cardiac arrest (OHCA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Patients aged ≥65 years who experienced OHCA between September 2019 and March 2021 enrolled in the multicenter observational study in Japan (SOS-KANTO 2017) were included. Data regarding DNAR decisions were prospectively collected and the time required to obtain DNAR orders. Patients who received DNAR orders within 6 h of admission (DNAR group) were compared with those who did not (non-DNAR group) using propensity score analysis with inverse probability treatment weighting (IPTW) to adjust for potential confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 9909 registered individuals in the SOS-KANTO 2017 study across 42 facilities, 685 were selected for analysis, with 361 (52.7%) in the DNAR group. Even after adjusting for the confounding factors, the frequency of post-admission therapeutic interventions was lower, and the proportion of patients with favorable neurological outcomes was significantly lower (2.6% vs. 19.3%, <i>p</i> &lt; 0.001) in the DNAR group. Twenty-six (7.3%) patients in the DNAR group survived for 1 month, of whom six (1.7%) had favorable neurological outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Older patients with OHCA who had early DNAR had significantly fewer therapeutic interventions after admission and had worse neurological outcomes at 30 days than those without a DNAR order, even after adjusting for demographic and prehospital variables.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ams2.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142435619","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of black bear-related trauma: A retrospective observational study","authors":"Hideomi Tsuchida,&nbsp;Kasumi Satoh,&nbsp;Nobuhisa Hirasawa,&nbsp;Manabu Okuyama,&nbsp;Hajime Nakae","doi":"10.1002/ams2.70009","DOIUrl":"10.1002/ams2.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>Bear-related trauma is a significant concern in Japan. This study identified trauma patterns, outcomes, and therapeutic approaches for bear-related injuries treated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective observational study used medical records from Akita University Hospital, focusing on patients with bear-related trauma in 2023. Demographic data, injury details, treatment procedures, and outcomes were extracted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The study included 20 patients (median age: 74.5 years, 65% males). Most injuries occurred in human habitats, mainly in autumn, with the face being the most affected area (90%). Three patients required emergency transfusions and tracheal intubation. Emergency surgery was performed in 52.6% of patients, and 42.1% were admitted to the intensive care unit. All patients survived with a median hospital stay of 17 days. However, 15.8% of patients had significant sequelae, such as blindness. Despite prophylactic antibiotics, wound infections occurred in 21.1% of patients, particularly in deep wounds that were not adequately washed under general anesthesia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Bear-related trauma often results in severe upper-body injuries that require prompt medical intervention. These findings highlight the need for improved preventive measures and strategies for initial treatment and long-term care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":7196,"journal":{"name":"Acute Medicine & Surgery","volume":"11 1","pages":""},"PeriodicalIF":1.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11456809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142387140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}