Activity

There is a growing trend toward verification of trauma centres, but its impact remains unclear. This systematic review aimed to synthesize available evidence on the effectiveness of trauma centre verification.

We conducted a systematic search of the CINAHL, Embase, HealthStar, MEDLINE and ProQuest databases, as well as the websites of key injury organizations for grey literature, from inception to June 2019, without language restrictions. Our population consisted of injured patients treated at trauma centres. The intervention was trauma centre verification. Comparison groups comprised nonverified trauma centres, or the same centre before it was first verified or re-verified. The primary outcome was in-hospital mortality; secondary outcomes included adverse events, resource use and processes of care. We computed pooled summary estimates using random-effects meta-analysis.

Of 5125 citations identified, 29, all conducted in the United States, satisfied our inclusion criteria. Mortality was the most frequently investigated outcome (n = 20), followed by processes of care (n = 12), resource use (n = 12) and adverse events (n = 7). The risk of bias was serious to critical in 22 studies. We observed an imprecise association between verification and decreased mortality (relative risk 0.74, 95% confidence interval 0.52 to 1.06) in severely injured patients.

Our review showed mixed and inconsistent associations between verification and processes of care or patient outcomes. The validity of the published literature is limited by the lack of robust controls, as well as any evidence from outside the US, which precludes extrapolation to other health care jurisdictions. Quasiexperimental studies are needed to assess the impact of trauma centre verification.

PROSPERO no. CRD42018107083.

PROSPERO no. CRD42018107083.Dr. Roger Keith, a former co-editor of the Canadian Journal of Surgery who died recently in Saskatoon, was a Canadian ambassador for surgery and one of its leaders in North America. His career spans a period when surgery made the greatest progress in its history.Diffusion-weighted imaging (DWI) provides a valuable diagnostic tool for tumor evaluation. Yet, it is difficult to acquire daily MRI data sets in the traditional radiotherapy clinical setting due to patient burden and limited resources. However, integrated MRI radiotherapy treatment systems facilitate daily functional MRI acquisitions like DWI during treatment exams. Before ADC values from MR-RT systems can be used clinically their reproducibility and accuracy must be quantified. this website This study used a NIST traceable DWI phantom to verify ADC values acquired on a 0.35 T MR-LINAC system at multiple gantry angles. A diffusion-weighted echo planar imaging sequence was used for all image acquisitions, with b-values of 0, 500, 900, 2000 s/mm2 for the 1.5 T and 3.0 T systems and 0, 200, 500, 800 s/mm2 for the 0.35 T system. Images were acquired at multiple gantry angles on the MR-LINAC system from 0° to 330° in 30° increments to assess the impact of gantry angle on geometric distortion and ADC values. CT images, and three fiducial markers were used as ground truth for geometric distortion measurements. The distance between fiducial markers increased by as much as 7.2 mm on the MR-LINAC at gantry angle 60°. ADC values of deionized water vials from the 1.5 T and 3.0 T systems were 8.30 × 10-6 mm2 /s and -0.85 × 10-6 mm2 /s off, respectively, from the expected value of 1127 × 10-6 mm2 /s. The MR-LINAC system provided an ADC value of the pure water vials that was -116.63 × 10-6 mm2 /s off from the expected value of 1127 × 10-6 mm2 /s. The MR-LINAC also showed a variation in ADC across all gantry angles of 33.72 × 10-6 mm2 /s and 20.41 × 10-6 mm2 /s for the vials with expected values of 1127 × 10-6 mm2 /s and 248 × 10-6 mm2 /s, respectively. This study showed that variation of the ADC values and geometric information on the 0.35 T MR-LINAC system was dependent on the gantry angle at acquisition.A nocturnal home blood pressure (BP) monitoring device that measures nighttime BP levels accurately with less sleep disturbance is needed for the 24-h management of hypertension. Here we conducted the first comparison study of simultaneous self-monitoring by both a supine position algorithm-equipped wrist nocturnal home BP monitoring device, the HEM-9601T (NightView; Omron Healthcare) with a similar upper arm device, the HEM-9700T (Omron Healthcare) in 50 hypertensive patients (mean age 68.9 ± 11.3 years). Both devices were worn on the same non-dominant arm during sleep over two nights. The patients self-measured their nighttime BP by starting nocturnal measurement mode just before going to bed. In total, 694 paired measurements were obtained during two nights (7.2 ± 1.5 measurements per night), and the mean differences (±SD) in systolic BP between the devices was 0.2 ± 10.2 mmHg (p = .563), with good agreement. In the comparison of nighttime BP indices, the difference in average SBP at 200, 300, and 400 AM and the average SBP of 1-h interval measurements was -0.5 ± 5.5 mmHg (p = .337), with good agreement. The HEM-9601T substantially reduced sleep disturbance compared to the upper arm-type device. The newly developed HEM-9601T (NightView) can thus accurately measure BP during sleep without reducing the wearer’s sleep quality.While there is huge promise in monitoring physiological parameters in free-living organisms, we also find high amounts of variability over time and space. This variation requires us to capitalize on long-term physiological monitoring to adequately address questions of population health, conservation status, or evolutionary trends as long-term sampling can examine ecoimmunological and endocrine interactions in wild populations while accounting for the variation that often makes ecophysiological field studies difficult to compare. In this study, we tested how immune efficacy and endocrinology interact while accounting for ecological context and environmental conditions in two snake species. Specifically, we measured bacterial killing ability, steroid hormones, and morphological characteristics in multiple populations of the Western Terrestrial Gartersnake (Thamnophis elegans) and Common Gartersnake (T. sirtalis) for multiple seasons over 6 years. Leveraging this long-term dataset, we tested how a broad immune measure and endocrine endpoints interact while accounting for individual traits, sampling date, and environmental conditions.