Medicine
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Delays in discharging patients can impact hospital and emergency department (ED) throughput. The discharge process is complex and involves setting specific challenges that limit generalizability of solutions. The aim of this study was to assess the effectiveness of using Six Sigma methods to improve the patient discharge process. ⋯ ED mean LOS of patients admitted to the hospital was significantly lower in the postintervention period (6.9 ± 7.8 vs 5.9 ± 7.7 hours; P < 0.001). Six Sigma methodology can be an effective change management tool to improve discharge time. The focus of institutions aspiring to tackle delays in the discharge process should be on adopting the core principles of Six Sigma rather than specific interventions that may be institution-specific.
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The purpose of this study was to investigate the peripapillary retinal nerve fiber layer (RNFL) thickness in myopic, emmetropic, and hyperopic children using optical coherence tomography. Two-hundred one right eyes of subjects aged 4 to 18 years were divided into 3 groups based on their postcycloplegic spherical equivalent: myopes (<-1.0 D), emmetropes (≥-1.0 to ≤+1.0 D), and hyperopes (>+1.0 D). The RNFL was correlated with age, spherical equivalent, and axial length. ⋯ The apparently thicker RNFL in hyperopic and emmetropic children was attributed to their younger age as compared with their myopic counterparts. When adjusted for age, only myopia was associated with a thinner RNFL, with emmetropic and hyperopic children having equal RNFL thicknesses. Advancing age, a more myopic spherical equivalent, and a longer axial length were associated with a thinner RNFL in children.
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Review Meta Analysis Comparative Study
Interventions for treating displaced midshaft clavicular fractures: a Bayesian network meta-analysis of randomized controlled trials.
Displaced midshaft clavicle fractures are frequent injuries. There are 3 treatment methods including conservative treatment, plate fixation, and intramedullary pin fixation. However, which is the best treatment remains a topic of debate. ⋯ There was no significant difference between plate and intramedullary pin fixation in infection (OR, 3.64; 95% CI, 0.31-17.27). SUCRA probabilities were 46.5% and 8.5% for intramedullary pin and plate fixation, respectively. Our network meta-analysis suggested that intramedullary pin fixation is the optimum treatment method for displaced midshaft clavicle fracture because of the low probabilities of nonunion and infection.
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The purpose of this article is to assess the diagnostic accuracy of C-reactive protein (CRP) and white blood cell (WBC) count to discriminate between urgent and nonurgent conditions in patients with acute abdominal pain at the emergency department, thereby guiding the selection of patients for immediate diagnostic imaging. Data from 3 large published prospective cohort studies of patients with acute abdominal pain were combined in an individual patient data meta-analysis. CRP levels and WBC counts were compared between patients with urgent and nonurgent final diagnoses. ⋯ A high CRP level (>50 mg/L) combined with a high WBC count (>15 ×10/L) leads to the highest PPV. However, this applies only to a small subgroup of patients (8.7%). Overall, CRP levels and WBC count are insufficient markers to be used as a triage test in the selection for diagnostic imaging, even with a longer duration of complaints (>48 hours).
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Review Case Reports
Simulated activity but real trauma: a systematic review on Nintendo Wii injuries based on a case report of an acute anterior cruciate ligament rupture.
Video gaming injuries are classically regarded as eccentric accidents and novelty diagnoses. A case of an anterior cruciate ligament (ACL) tear sustained during Wii boxing spurned us to review the literature for other Wii-related injuries and Wii-based posttraumatic rehabilitation. The English literature listed in PubMed was systematically reviewed by searching for "Wii (trauma or injury or fracture)." Full-text articles were included after duplicate, blinded review. ⋯ Because of their wide acceptance and entertaining nature, they are also increasingly recognized as a tool in rehabilitation. However, although the activity is simulated, injuries are real. Our systematic review shows that Wii gaming can lead to severe injuries, sometimes with lasting limitations.