Incidence Of Injury Research Articles

Clinical Practice Guideline: The Diagnosis and Treatment of Acute Spinal Cord Injury.

In Germany, the incidence of traumatic spinal cord injury is approximately 16 per million inhabitants per year. This article aims to present evidence-based diagnostic and therapeutic measures for the first 14 days after injury to minimize neural damage, prevent complications, and preserve functioning as much as possible. After the formulation of key questions, systematic literature searches were carried out on multiple topics. The findings were evaluated for methodological quality, and recommendations were agreed upon by consensus. Spinal cord injury may be due to traumatic (e.g., a fall) or non-traumatic causes (e.g., ischemia). The evidence presented here on the diagnosis and treatment of spinal cord injury is mainly based on observational studies. 15 evidence-based and 43 consensus-based recommendations were formulated. The patients' neurological course should be monitored by clinical neurological examination according to the International Standards for Neurological Classification of Spinal Cord Injury (strength of recommendation [SOR]: strong). If traumatic spinal cord injury is suspected, the patient should be transported as rapidly as possible to a tertiary-care trauma center (SOR: strong). Spine decompression surgery should be performed within 24 hours (SOR: weak). Corticosteroids should not be given in the acute phase of traumatic spinal cord injury (SOR: strong) but are indicated if the spinal cord is compressed by a tumor (SOR: strong). The mean arterial pressure should be between 70 and 90 mmHg for the first 2-3 (maximum 7) days (SOR: weak). Pharmacotherapy with heparin should be started early to prevent thromboembolism, with due attention to the risk of hemorrhagic complications (SOR: strong). This (S3 level) clinical practice guideline aims to standardize clinical care. Early interdisciplinary management is essential to protect at-risk neural tissue and to prevent complications, and constitutes a key prerequisite for long term neurological and functional recovery. No neuroprotective or neuroregenerative treatments are available to date.

How safe is kitesurfing? A review of orthopaedic kitesurfing injuries.

This narrative review aims to provide a comprehensive overview of injuries arising from kitesurfing. We conducted a systematic search of articles from the last 20 years relating to kitesurfing orthopaedic injuries. Two of the authors independently conducted a systematic search of Pubmed (Medline), Embase, NHS Library and Knowledge Hub, TRIP, and Google Scholar: ultimately, after exclusions, the report analysed 25 articles. Kitesurfing is associated with a high incidence of lower limb injuries in which protective gear is uncommon. Furthermore, a lack of educational initiatives and specified strength training may compound this risk. Notably, there is a lack of prospective evidence documenting traumatic injury. Addressing this gap is a potential next step, to enhance our understanding of injury patterns and preventative measures. Common kitesurfing injuries include those to the foot, ankle, and knee, typically resulting from falls or collisions with the board or water. While the majority of injuries are relatively mild, more significant injuries such as ACL rupture, PCL rupture, and polytrauma have also been reported. What are the new findings: This systematic review confirmed that the majority of injuries occur below the knee (average 50%). Injuries of the chest (average 8.5%) and head (average 10.8%) also make up a significant proportion of injuries sustained. Although the majority of injuries in kitesurfing are minor, due to the high forces typically involved, there is the potential for catastrophic injury including; neurological, internal bleeding, polytrauma and death.

Injury Incidences related to Acute-to-Chronic Workload Ratios in Taekwondo: A Prospective Study with a 3-Year Follow-Up.

Although the relationship between workload and injury incidence has recently gained attention, data on the acute-to-chronic workload ratio (ACWR) and injury incidence in Taekwondo remain unavailable. To report the injury incidence related to the categorized ACWR, calculated using the rolling average (RA) and exponentially weighted moving average (EWMA) methods, for musculoskeletal injuries in Taekwondo. Descriptive epidemiologic study. Data were prospectively collected through Taekwondo training facilities and competition venues. A total of 110 collegiate Taekwondo players (58 females; 54 males) were studied over three consecutive seasons in 2020, 2021, and 2022. The traumatic and gradual onset of musculoskeletal injury (rate, body location, type, mechanism, and severity) and workloads (duration of training and competitions) were recorded. ACWRs for each injury were calculated using the RA and EWMA and categorized as either high (> 1.5), relatively high (1.3 - 1.5), moderate (0.8 - 1.3), or low (<0.8). Of the 841 injuries (training: 16 per 1,000 hours; competition: 548 per 1,000 hours), the ankle (n=86/501, 17% in traumatic) and thigh (n=106/340, 31% in gradual onset) were the most predominantly injured body locations. Contusion (n=201/501, 40% in traumatic) and muscle cramps/spasm (n=201/501, 75% in gradual onset) were the most frequent injury types. Although the most predominant mechanism was overuse (n=331/841, 40%), 32% of the injuries (n=230/721) took > 28 days to recover from injury. The greatest number of traumatic (RA: n=224/501, 45%; EWMA: n=259/501; 52%) and gradual onset (RA: n=118/340, 35%; EWMA: n=165/340; 49%) injuries were recorded under the moderate ACWR. The moderate ACWR range (0.8 - 1.3), which was considered as the "sweet spot" in team sports, was calculated to be the "danger zone" in Taekwondo. The high injury risk related workload could be used for planning training schedules.

Incidence of Medial Meniscus Injury Detected by Arthroscopy in Toy Breed Dogs (≤5 kg) with Cranial Cruciate Ligament Rupture.

To investigate the frequency and factors of medial meniscal injury (MMI) associated with cranial cruciate ligament rupture (CrCLR) in toy breed dogs by arthroscopic evaluation.Toy breed dogs (≤5 kg) diagnosed with CrCLR using stifle arthroscopy were included. Age, sex, body weight, breed, medial patellar luxation grade, degree of lameness at diagnosis, and duration of lameness until diagnosis were obtained from medical records. The tibial plateau angle was evaluated using preoperative radiography. On arthroscopic evaluation, degree of CrCLR was classified as partial or complete; MMI was classified as no, mild, or severe injury. MMI grade was used as objective variable; ordered logistic regression was used, and the final model was created using forward-backward stepwise selection.Overall, 202 stifles of 178 dogs were evaluated. Arthroscopic evaluation revealed partial and complete CrCLR, and MMI in 58, 144, and 74 stifles, respectively. MMI with mild and severe damage was noted in 50 and 24 stifles, respectively. Final model included body weight, lameness score, and degree of cranial cruciate ligament damage. A grade 3 lameness score had a higher MMI factor than grade 1. Higher body weight was associated with MMI, and complete rupture had a higher MMI factor than partial tears.Arthroscopic evaluation of CrCLR cases showed MMI in toy breed dogs. Cases with complete CrCLR or severe lameness are at high risk of MMI and should be evaluated cautiously.

Training-Related Sports Injury Patterns Among Elite Middle and High School Field Hockey Players in Korea

This study aimed to analyze the incidence, affected areas, and types of injuries sustained during training among youth field hockey players to identify key characteristics. A survey was conducted with 374 youth field hockey players (236 males, 138 females) from middle and high school teams registered with the Korea Hockey Association in 2024. Data were collected on injury status, training hours, injury sites, and prevention methods. Chi-square tests, independent t-tests, and frequency analyses were performed to assess differences in injury incidence based on gender and school level. The analysis revealed no significant gender differences in training-related injury experiences, with 17.2% of male athletes and 10.2% of female athletes reporting injuries during training. Similarly, no significant difference was found between middle and high school athletes, although high school athletes had a significantly lower injury incidence than middle school athletes (1.54 vs. 2.28 per 1000 h, p &lt; 0.05). The most common injury sites were the ankle and knee, with muscle injuries being the most frequent among males and ligament injuries among females. Additionally, male and high school athletes more frequently reported engaging in warm-up and cool-down exercises. There was no significant difference in injury rates between genders during training, but high school athletes tended to experience fewer injuries than middle school athletes. Ankle injuries were the most common, with muscle and ligament damage being the primary types of injuries. While warm-up exercises were commonly practiced, further research is needed to determine their actual effectiveness in injury prevention.

Impact of Point-of-care allogeneic red blood cell washing on markers of transfusion-related respiratory complications: A phase II randomized clinical trial.

Transfusion-related acute lung injury (TRALI) and transfusion-associated circulatory overload (TACO) are leading causes of transfusion-related morbidity and mortality. Soluble factors in red blood cell (RBC) supernatant may increase risk for these complications. We hypothesized that point-of-care allogeneic RBC washing may be an effective intervention to mitigate elevations in soluble factors as well as physiologic responses associated with transfusion-associated respiratory complications in the setting of cardiac surgery. This is a two-center, non-blinded, randomized clinical trial evaluating point-of-care washed versus standard-issue allogeneic RBC transfusions administered during or on the day of cardiac surgery. The primary analysis was performed via modified intention-to-treat. The primary outcomes assessed were changes in intermediate markers of lung injury as well as cardiopulmonary physiologic responses to RBC transfusion. Secondary outcomes included the duration of intensive care unit and hospital stay, durations of mechanical ventilation and oxygen supplementation, presence of TRALI or TACO, and mortality. Among 154 analyzed patients (81 washed, 73 standard issue), median age was 66 years and 77 (50.0%) were women. The median (IQR) number of allogeneic RBC units transfused on the day of surgery was 3.0 (2.0 - 5.0) in the washed RBC group and 3.0 (2.0 - 4.0) in the standard issue group (p = 0.13). No between-group differences were identified in any of the assessed recipient lung injury biomarkers (all p-values > adjusted alpha). Durations of intensive care unit stay (median [interquartile range]; 3.0 [2.0-5.0] versus 3.0 [2.0-4.0] days; p = 0.117) and hospital length of stay (12.0 [9.0-17.0] versus 12.0 [9.0-17.0] days; p = 0.801) were similar, as were the number of ventilator-free days at day 28 (27.0 [27.0-27.0] versus 27.0 [26.0-27.0]; p = 0.699) and oxygen free days at day 28 (24.0 [19.0-26.0] versus 24.0 [22.0-26.0]; p = 0.400) . No significant differences were noted in mortality rate nor in incidence rates for TRALI, TACO, and acute kidney injury. Among patients undergoing cardiovascular surgery with high risk of RBC transfusion, point-of-care washing of allogeneic RBC transfusions did not mitigate changes in intermediate markers of lung injury or cardiopulmonary physiologic responses to RBC transfusion and was not associated with improved clinical outcomes.

Comparison of the incidence and severity of postoperative sore throat and subglottic airway injury with cylindrical versus tapered cuff endotracheal tubes in women undergoing surgery for breast cancer: a randomized controlled trial

BackgroundPostoperative sore throat (POST) is a minor complication of general anesthesia with tracheal intubation but may negatively affect patient satisfaction and postoperative recovery. The shape of the endotracheal tube (ETT) cuff may influence the incidence and severity of POST.MethodsThis prospective, randomized, double-blinded study was conducted on 174 female patients with breast cancer. They were randomized into the cylindrical (CYL) (group C) and tapered (TAP) (group T) cuff ETT groups. Data on patient demographics, surgical characteristics, and factors related to tracheal intubation were collected. Furthermore, the incidence and severity of POST at the selected time points were duly recorded for analysis. Other adverse events and anesthesia satisfaction were also documented.ResultsDuring the 48-h evaluation period, group T exhibited reduced overall incidence of POST compared with group C. The incidence and severity of POST at 1, 6, 12, 24, and 48 h postoperatively were also significantly lower in group T than in group C. No significant difference in subglottic airway injury was observed between the two groups. Postoperative anesthesia satisfaction was higher in group T.ConclusionsThe present study demonstrates that the utilization of a TAP cuff ETT rather than a CYL cuff ETT in patients undergoing breast cancer surgery reduced the incidence and severity of POST. The selection of an appropriate ETT for surgical patients could play a pivotal role in alleviating airway complications, enhancing postoperative recovery, and improving anesthesia satisfaction.Trial registrationThe study was registered at ClinicalTrials.gov (NCT06505850) on 2024-07-17.

Non-Recurrent Laryngeal Nerve: Surgical Risk of Injury in Comparison With the Normal Recurrent Laryngeal Nerve-A Systematic Review and Meta-Analysis.

The non-recurrent laryngeal nerve (NRLN) is a known anatomical variation of the normal recurrent laryngeal nerve (RLN). Its prevalence is estimated to be < 1% and has a higher risk of iatrogenic injury. The risk during thyroid surgery has been reported variably in current literature, from 0% to 12%. This study aimed to systematically review the incidence of NRLN injury and present the results through meta-analysis. The incidence of injury to NRLN and RLN was compared statistically to determine its significance. The PRISMA protocol was followed for an online search of prominent literatures. Studies were selected according to specific criteria. Quality assessment was performed before data extraction. Meta-analysis was conducted for the incidence of injury of the NRLN and its comparison to the RLN. Results were presented in the form of a systematic review. Final analysis included 17 studies. The pooled risk of NRLN injury was 7% and the risk ratio of injury in comparison to the RLN was 3.8, showing a statistically significant difference. This is the first study to report the overall risk of NRLN injury and establish a statistically significant difference compared to the injury of the normal RLN. The NRLN is highly associated with the vascular anomaly of aberrant subclavian artery, which is radiologically predictable. The use of intra-operative nerve monitoring can significantly reduce the risk of injury to this nerve when it is identified pre-operatively, and the thyroid surgery should be performed by experienced thyroid surgeons with extra care to minimise the risk.

Injuries and illnesses during the 54th FIS Nordic World Ski Championships 2023 in Planica: a prospective cohort study

ObjectiveTo describe the incidence and characteristics of injuries and illnesses that occurred during the 54th Nordic World Ski Championships in Planica (Slovenia) 2023, including the disciplines of cross-country skiing, Nordic...

"Natural history of low velocity ballistic nerve injuries to the humerus".

To assess ballistic humerus fractures with nerve injuries, their associated characteristics, and functional recovery. Retrospective review SETTING: Level 1 trauma center over 10-year period. 143 patients presenting with low-velocity ballistic humerus fractures. Operative intervention and clinical examination of nerve function. Nerve injury incidence and recovery. The overall incidence of nerve injury was 21% (30 injuries/143 fractures) with 66.7% of fractures treated operatively. Nerve injury varied based on anatomic region: 28.6% (12/42) distal humerus; 20% (15/75) shaft and, 11.5% (3/26) proximal humerus. Arterial injury (p = 0.011) and bone loss (p = 0.0001) were significantly associated with nerve injury. The nerve was visualized during index surgery in 15 patients, with 4 transections. Multiple nerve injuries (n = 6) were most common around the distal humerus: 41.7% (5/12). The radial nerve comprised 52.9% (n = 9) of injuries in the distal humerus and 62.5% (n = 10) in the shaft with spontaneous recovery occurring in 75% (6/8) with distal fractures and 66.7% (6/9) with shaft fractures. The ulnar nerve accounted for 35.3% (n = 6) of injuries in the distal humerus and 25% (n = 4) in the shaft. Spontaneous recovery occurred in 60% (3/5) of ulnar nerve injuries around distal fractures but in only 25% (1/4) in the shaft. Half of ulnar nerve injuries were associated with additional nerve or vascular injury. The median nerve was the least likely to be injured: 40% (n = 2) distal humerus, 40% (n = 2) shaft, and 20% (n = 1) proximal humerus and 40% (2/5) spontaneously recovered. In the setting of ballistic humerus fractures, arterial injury and bone loss were significantly associated with nerve injury. Multiple nerve injury occurred most commonly at the distal humerus. There was a 60-75% recovery rate of most nerve injuries however, ulnar nerve injuries around the shaft and median nerve injuries had lower rates of recovery. Level III.

Impact of perioperative organ injury on morbidity and mortality in 28 million surgical patients

Perioperative organ injury contributes to morbidity and mortality of surgical patients. This cohort study included all elective and emergent surgeries in Germany over 4 years to address the impact of perioperative organ injuries on outcomes. We analyzed 28,350,953 cases. In-hospital mortality was 1.4% (n = 393,157), and 4.4% of cases (n = 1,245,898) experienced perioperative organ injury. Perioperative organ injury was associated with 9-fold higher odds of death and prolonged hospital stay by 11.2 days. Acute kidney injury had the highest incidence (2.0%) and was associated with 25.0% mortality. While delirium had the second highest incidence (1.5%), it was associated with the lowest mortality (10.8%). This was followed by acute myocardial infarction (incidence 0.6%, mortality 15.6%), stroke (incidence 0.6%, mortality 13.1%), pulmonary embolism (incidence 0.3%, mortality 20.0%), liver injury (incidence 0.1%, mortality 68.7%), and acute respiratory distress syndrome (incidence 0.1%, mortality 44.7%). These findings help prioritize interventions for preventing or treating individual types of perioperative organ injury.

Predicting Injury in Collegiate Baseball and Softball Athletes Using Functional Testing: A Pilot Study

Non-contact injuries are common in collegiate throwing athletes. Identifying musculoskeletal issues that predispose athletes to injuries would be valuable for reducing the associated risk. The purpose of this pilot study was to use binomial logistic regression to identify injury-prone athletes with multiple pre-season functional measures and demographic information. Eighteen Division II baseball and softball athletes underwent pre-season functional testing including measures of manual muscle testing of the dominant shoulder muscles (MMT), the functional movement screen (FMS), and closed kinetic chain upper extremity stability (CKCUES). A certified athletic trainer at the university diagnosed and documented the injuries that these athletes sustained over the course of the season. Binomial logistic regression models were used to assess the effects of FMS composite score, CKCUES normative score, MMT scores, and demographic information on the likelihood that participants would sustain (a) any type of injury and (b) a shoulder injury during the competitive season. The model for injury was not significant (p = 0.822), correctly classifying 72.2% of cases. The model for shoulder injury was significant (p = 0.039) and correctly classified 100% of cases. These results suggest that shoulder injury incidence may potentially be predicted using sport-specific movement tests in baseball and softball athletes. A larger sample size is needed to verify these results in the future.

STRUCTURE OF OPHTHALMIC TRAUMA USING STATIONARY DATABASE FROM THE NATIONAL OPHTHALMOLOGY CENTRE NAMED AFTER ACADEMICIAN ZARIFA ALIYEVA (2019 - 2023)

Purpose – to analyze the structure of ophthalmic trauma among patients who received inpatient treatment at the National Ophthalmology Centre named after Academician Zarifa Aliyeva. Material and methods Within the framework of the study, statistical data on eye injuries among patients who received inpatient treatment at the National Ophthalmology Center named after Academician Zarifa Aliyeva were analyzed. A total of 2,152 medical records (2,225 injured eyes) were analyzed for the period from 2019 to 2023. The study retrospectively analyzed the frequency of various types of ocular injuries using the Birmingham Eye Trauma Terminology (BETT). The correlation between injury types and their locations was also analyzed. Results TThe study revealed the predominance of open-globe injuries throughout the observation period and a high incidence of ocular injuries associated with the presence of a foreign body. Among closed-globe injuries, lamellar ruptures were the most common, accounting for an average of 82.1±14.6% of all analyzed cases. Foreign body-related eye injuries constituted a significant portion of all ophthalmic traumas, with 45.1% involving corneal penetration and 33.6% involving penetration in vitreous. Of all the studied eye injuries, 48.1% occurred in open spaces (forest, garden, beach, etc.), while 23.6% were related to industrial activities. Conclusion The identified structural features of ophthalmic trauma among inpatients of the National Ophthalmology Centre named after Academician Zarifa Aliyeva and the assessment of injury locations, highlight the necessity of developing comprehensive preventive measures aimed at reducing trauma incidence and increasing awareness of associated risks. It is essential to continue monitoring and improving preventive programs, especially for vulnerable population groups. Key words: ophthalmic trauma, ocular injuries, closed-globe injuries, open-globe injuries, foreign bodies, prevention

The risk still remains: left circumflex artery subocclusion after radiofrequency application inside the coronary sinus during mitral isthmus block.

In ablation procedures for patients with perimitral atrial tachycardia, it is often necessary to apply radiofrequency energy inside the coronary sinus. Although this location is anatomically close to the left circumflex artery, its occlusion is a rare complication. A 40-year-old man underwent ablation for perimitral atrial tachycardia with radiofrequency applications inside the coronary sinus to create a lateral mitral block line. Minutes after the tachycardia was interrupted, the patient suddenly developed ST-segment elevation in the inferior leads and underwent successful angioplasty of the circumflex artery, with good clinical evolution over a 30-month follow-up period. Coronary artery injury secondary to radiofrequency ablation procedures is a rare complication. However, the incidence of circumflex artery injury during applications inside the coronary sinus may be underestimated, as suggested by some studies. Several strategies, including meticulous procedural planning, can help mitigate this risk. However, further research is essential to develop strategies that eliminate the risk altogether.

A whole system approach to promoting health and human performance in military settings as vital prerequisites for force readiness and operational capability

The military role and associated occupation-specific training contribute to a high musculoskeletal injury (MSKI) incidence and poor health burden. A fit Force is better prepared for achieving mission success, as well as being more resilient to operational physical and cognitive demands. Conversely, MSKI and ill-health reduce Force readiness. Internationally, militaries have common workforce capacity and capability challenges, where more is being asked of fewer personnel. Unhealthy body composition, low aerobic fitness, poor movement control and poor health behaviours interact to adversely impact human performance. The military workplace—including leadership prioritisation and resource allocation—has generally not strategically managed and supported health and performance interventions to maximise people outcomes. Efforts have focused on the individual and their capabilities to address their ill-health or poor performance. Only through system-based thinking—adopting a Whole System Approach (WSA)—can effective evidence-based interventions to promote health and human performance be: holistically developed; successfully implemented at scale across geographically dispersed organisations to realise meaningful and enduring outcomes; and impacts measured and evaluated. This paper provides a synthesis of scientific and practice-based evidence to operationalise system-thinking in developing integrated WSA workplace interventions for military health and human performance, and measure effect and return on investment. Whilst militaries are recognising the need for a paradigm shift to realise the benefits of effective health and performance interventions, persuasive financial arguments could assist with overcoming large-organisation inertia. Moreover, system-based thinking—addressing individual and organisational factors—could maximise military health and performance, foster resilience and deliver operational effectiveness.

Distinct patterns of ligament and meniscal injuries in multiligamentous knee injuries with and without dislocation: a 15-year retrospective study

PurposeThis study aimed to compare the incidence rates of concomitant injuries, including meniscal and cartilage injuries, between multiligamentous knee injuries (MLKI) with and without dislocation based on our 15-year experience of knee dislocation and MLKI at a level 1 trauma center.MethodsWe retrospectively identified 100 patients (115 knees) with MLKIs and/or dislocations at our trauma center between 2007 and 2021. Magnetic resonance imaging was routinely performed to evaluate the injured structures and extent of injury. The anatomic structures of the knee were categorized into anterior and posterior cruciate ligaments (ACL, PCL) and medial and posterolateral structures, and further classified according to the modified Schenck classification. The study participants were divided into two groups: 40 and 75 knees classified as MLKI with and without dislocation, respectively.ResultsMLKIs with dislocations showed 13% (5/40 knees) and 18% (7/40 knees) incidence, whereas MLKIs without dislocation showed 15% (11/75 knees) and 13% (10/75 knees) incidence of medial and lateral meniscal tears respectively. The two groups also had a significant discrepancy in the patterns of meniscal tears. For medial meniscal tears, radial tears were more prevalent in MLKIs with dislocation, and longitudinal tears in MLKIs without dislocation (p = 0.197). For lateral meniscal tears, anterior horn or totally detached tears were more prevalent in MLKIs with dislocation, and radial tears in MLKIs without dislocation (p = 0.026). Additionally, complete rupture of all four major ligaments was found in 38% (15/40 knees) of the cases with dislocation, with the majority showing complete ruptures of both the ACL and PCL. Concomitant serious injuries, such as popliteal artery injury and fractures, were observed only in cases involving high-energy trauma and dislocation.ConclusionsMLKIs with dislocation show distinct ligament and meniscal injury patterns compared to those without, highlighting the importance of severity and anatomical classification in diagnosing associated knee injuries.Clinical relevanceThe initial distinction in the severity of MLKIs, along with the anatomical classification, have practical implications in identifying associated meniscal tears and injuries to structures surrounding the knee joint.Level of evidenceIV Retrospective comparative study.

Evaluating the Impact of the Failure Mode and Effects Analysis Nursing Approach on Complications of Chronic Obstructive Pulmonary Disease Patients With Respiratory Failure

Aims/Background Noninvasive intermittent positive pressure ventilation is a widely used approach for managing Chronic obstructive pulmonary disease (COPD) complicated with respiratory failure. Treatment procedures often result in severe complications, requiring the implementation of proactive and effective nursing measures. Therefore, this study investigated the impact of failure mode and effects analysis (FMEA) on preventing complications in COPD patients with respiratory failure and assessed its influence on negative emotions, hope level, and quality of life. Methods This retrospective study included 356 patients with COPD combined with respiratory failure who underwent treatment in the First Affiliated Hospital of Wenzhou Medical University, China, between January 2023 and December 2023. Patients receiving usual care were included in the care-as-usual (CAU) group (n = 204), and those who underwent FMEA were assigned to the FMEA group (n = 152). Baseline characteristics and clinical data were compared between the two groups. Furthermore, the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), Herth Hope Index (HHI) and 36-item Short-Form were collected and comparatively analyzed between the two groups. Results The FMEA group exhibited a significantly lower incidence of facial compression injury, dry mouth, phlegm obstruction, flatulence, bronchiectasis, and aspiration pneumonia than the CAU group (p &lt; 0.05). After the intervention, the SAS and SDS scores were significantly reduced in the FMEA group than in the CAU group (p &lt; 0.001). The temporality and future, positive readiness and expectancy, inter-connectedness, and HHI scale total scores were significantly higher in the FMEA group compared to the CAU group (p &lt; 0.05). The physiological function, role-physical, body pain, general health perceptions, vitality, social functioning, role-emotional, and mental health of patients were significantly higher in the FMEA group than in the CAU group (p &lt; 0.05). Conclusion The application of the FMEA nursing approach helps reduce the risk of complications in patients with COPD combined with respiratory failure, while effectively reducing anxiety and depression, improving their hope level and enhancing their overall quality of life. These observations offer a basis for preventing complications, and provide a reference for the formulation of nursing plans for these patients in clinical practice.

Comparing the effects of curvilinear position and micromovement on prevention of intraoperative acquired pressure injuries among patients undergoing surgery in the supine position: A randomized controlled trial.

Comparing the effects of curvilinear position and micromovement on prevention of intraoperative acquired pressure injuries among patients undergoing surgery in the supine position: A randomized controlled trial.

Incidence, Risk Factors and Epidemiological Errors of Vancomycin Associated Acute Kidney Injury: A Systematic Review

Changes in the incidence of Vancomycin Associated-Acute Kidney Injury (VA-AKI), risk factors and applicability of studies are questionable in recent times. This review aims to evaluate the incidence, risk factors and the epidemiological errors of findings on VA-AKI. All studies related to vancomycin associated acute kidney injury in the past 20 years were identified from PubMed, MEDLINE, Google scholar and UWIlinC. During the past decade, the incidence of VA-AKI varied between 7.3% to 15.8%. The lowest incidence was found among the patients who received pharmacist intervention prior to the initiation of therapy, and the highest incidence was among elderly patients over 65-year-old. Notable risk factors were old age, high trough ≥15 μg/mL, AUC/MIC ratio &gt; 650 mg × hour/L, concomitant use of aminoglycosides, broad-spectrum antibiotics, diuretics and vasopressor, using vancomycin without pharmacist intervention, hyperuricemia, respiratory failure, cardiac failure, chronic kidney disease, mechanical ventilation, obesity and black race. Common epidemiological errors in these studies were generalization and selection bias. The disparity of facilities among healthcare services is a concern. Knowing modifiable risks, using vancomycin as monotherapy and advance consultation with pharmacists seem valuable preventive tools for VA-AKI regardless of resource settings.

Development of a neural network model for early detection of creatinine change in critically Ill children

IntroductionRenal dysfunction is common in critically ill children and increases morbidity and mortality risk. Diagnosis and management of renal dysfunction relies on creatinine, a delayed marker of renal injury. We aimed to develop and validate a machine learning model using routinely collected clinical data to predict 24-hour creatinine change in critically ill children before change is observed clinically.MethodsRetrospective cohort study of 39,932 pediatric intensive care unit encounters in a national multicenter database from 2007 to 2022. A neural network was trained to predict &amp;lt;50% or ≥50% creatinine change in the next 24 h. Admission demographics, routinely measured vital signs, laboratory tests, and medication use variables were used as predictors for the model. Data set was randomly split at the encounter level into model development (80%) and test (20%) sets. Performance and clinical relevance was assessed in the test set by accuracy of prediction classification and confusion matrix metrics.ResultsThe cohort had a male predominance (53.8%), median age of 8.0 years (IQR 1.9−14.6), 21.0% incidence of acute kidney injury, and 2.3% mortality. The overall accuracy of the model for predicting change of &amp;lt;50% or ≥50% was 68.1% (95% CI 67.6%−68.7%). The accuracy of classification improved substantially with higher creatinine values from 29.9% (CI 28.9%−31.0%) in pairs with an admission creatinine &amp;lt;0.3 mg/dl to 90.0–96.3% in pairs with an admission creatinine of ≥0.6 mg/dl. The model had a negative predictive value of 97.2% and a positive predictive value of 7.1%. The number needed to evaluate to detect one true change ≥50% was 14.Discussion24-hour creatinine change consistent with acute kidney injury can be predicted using routine clinical data in a machine learning model, indicating risk of significant renal dysfunction before it is measured clinically. Positive predictive performance is limited by clinical reliance on creatinine.