Injury
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The National Health Service in England has successfully used learning from its National Hip Fracture Database to drive improvements in care of the most frail orthopaedic trauma patients. While this could simply be viewed as achieving its primary function, the learning with regard to meaningful change that resulted has been applied across the other aspects of trauma to achieve improvements including multiply injured patients within trauma systems (Trauma Audit and Research Network (TARN)) and community level trauma. ⋯ It explains the UK system and the navigation of this to gain political and administrative traction in the creation of a national network and how this momentum was used to achieve a complete overhaul of the trauma system. There are lessons that are applicable across all healthcare systems.
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The new EU Medical Device Regulation (MDR) was introduced in 2017 to increase the safety and quality of medical devices in the European Union. Theoretically, several hundred thousand medical devices must be approved under the new MDR guidelines, although the majority of these products have been and will be in daily use in countless operations on the European market for decades. The expected expenditure of time and money until the MDR is fully implemented is associated with high costs, patient disadvantages but also manufacturer problems. The following briefly summarizes the current situation in many European countries and presents the consequences for patients and hospitals and in this context also emphasizes the interdependence between hospitals, patients and manufacturers.
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Traumatic brain injury (TBI) is an urgent global health issue. Neuroinflammation, due partially to microglia, can worsen or even cause neuropsychiatric disorders after a TBI. An increasing number of studies have found that adipose-derived stem cell (ADSC) derived exosomes can alleviate many diseases by delivering non-coding RNAs including circRNA and miRNAs, but the mechanism of action remains unclear. ⋯ Taken together, we found that exosomes from ADSCs ameliorate nerve damage in the hippocampus post TBI through the delivery of circ-Scmh1 and the promotion of microglial M2 polarization.