Articles: function.
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Boxer's fractures are common hand injuries, but their management varies greatly. Two years ago, a boxer's fracture care pathway was developed for use in the Royal London Hospital emergency department to standardise management. ⋯ The evaluation examined the functional outcomes of patients with boxer's fractures with 50° or less palmar angulation who were discharged with no follow up. Findings show that most returned to work immediately and had good functional outcomes, which suggests that the pathway is safe for uncomplicated fractures with 50° or less palmar angulation.
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Overactivity (activity engagement that significantly exacerbates pain) is a common term in the chronic pain literature. Overactivity is accepted clinically as a behaviour that adversely affects an individual's daily functioning and is the target of one of the most widely endorsed pain management strategies among health professionals (ie, activity pacing). Little research, however, has investigated links between overactivity behaviour and indicators of patient functioning, and activity pacing has not been evaluated as a stand-alone treatment specifically for individuals with chronic pain who are habitually overactive. ⋯ Some participants who were followed up 3 to 6 months after a pain management program were able to learn pacing strategies and enact behaviour change with health professional support; however, the majority reported difficulties changing their behaviour after treatment. It is suggested that provision of pacing education, alone, to chronic pain patients who engage in overactivity behaviour may not be effective in eliciting behavioural change. Key factors that participants believed to contribute to the development and maintenance of their overactive behaviour in this study should be considered in future clinical approaches and empirical investigations.
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Multicenter Study
Natural history of multiple system atrophy in the USA: a prospective cohort study.
Multiple system atrophy is a rare, fatal neurodegenerative disorder with symptoms of autonomic failure plus parkinsonism, cerebellar ataxia, or both. We report results of the first prospective natural history study of multiple system atrophy in the USA, and the effects of phenotype and autonomic failure on prognosis. ⋯ US National Institutes of Health, Mayo Clinic, and Kathy Shih Memorial Foundation.
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Observational Study
Rationale for Prospective Assays of Intrathecal Mixtures Including Morphine, Ropivacaine and Ziconotide: Prevention of Adverse Events and Feasibility in Clinical Practice.
Use of intrathecal admixtures is widespread, but compounding these is sometimes challenging and may result in errors and complications causing super-potency or sub potency adverse events in patients or malfunctions in the pump itself. ⋯ Prospective assays provide benefits in ensuring accuracy of intrathecal mixture compounding and in preventing overdosing or sub dosing, most notably concerning Ziconotide.
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Intensive care medicine · Jul 2015
Acute kidney injury after out-of-hospital cardiac arrest: risk factors and prognosis in a large cohort.
Characteristics of acute kidney injury (AKI) occurring after out-of-hospital cardiac arrest (OHCA) are incompletely described. We aimed to evaluate the prevalence of AKI, identifying risk factors and assessing the impact of AKI on outcome after OHCA. ⋯ AKI stage 3 was frequent after OHCA and was associated with poorer outcome. Improvement strategies in post-resuscitation care should consider AKI as a potential target of treatment.