Basic life support teaching in the second year predraduate medical curriculum: quality of acquisition after 6 months

Purpose of the study: Basic life support (BLS) and automated externaldefibrillation (AED) represent important skills to be acquired duringpregraduate medical training. Since 3 years, our medical school hasintroduced a BLS-AED course (with certification) for all second yearmedical students. Few reports about quality and persistence over timeof BLS-AED learning are available to date in the medical literature.Comprehensive evaluation of students' acquired skills was performedat the end of the 2008 academic year, 6 month after certification.Materials and methods: The students (N = 142) were evaluated duringa 9 minutes «objective structured clinical examination» (OSCE) station.Out of a standardized scenario, they had to recognize a cardiac arrestsituation and start a resuscitation process. Their performance wererecorded on a PC using an Ambuman(TM) mannequin and the AmbuCPR software kit(TM) during a minimum of 8 cycles (30 compressions:2 ventilations each). BLS parameters were systematically checked. Nostudent-rater interactions were allowed during the whole evaluation.Results: Response of the victim was checked by 99% of the students(N = 140), 96% (N = 136) called for an ambulance and/or an AED. Openthe airway and check breathing were done by 96% (N = 137), 92% (N =132) gave 2 rescue breaths. Pulse was checked by 95% (N=135), 100%(N = 142) begun chest compression, 96% (N = 136) within 1 minute.Chest compression rate was 101 ± 18 per minute (mean ± SD), depthcompression 43 ± 8 mm, 97% (N = 138) respected a compressionventilationratio of 30:2.Conclusions: Quality of BLS skills acquisition is maintained during a6-month period after a BLS-AED certification. Main targets of 2005 AHAguidelines were well respected. This analysis represents one of thelargest evaluations of specific BLS teaching efficiency reported. Furtherfollow-up is needed to control the persistence of these skills during alonger time period and noteworthy at the end of the pregraduatemedical curriculum.

Are we living longer but less healthy? Trends in mortality and morbidity in Catalonia (Spain), 1994-2011

Evidence on trends in prevalence of disease and disability can clarify whether countries are experiencing a compression or expansion of morbidity. An expansion of morbidity as indicated by disease have appeared in Europe and other developed regions. It is likely that better treatment, preventive measures and increases in education levels have contributed to the declines in mortality and increments in life expectancy. This paper examines whether there has been an expansion of morbidity in Catalonia (Spain). It uses trends in mortality and morbidity from major causes of death and links of these with survival to provide estimates of life expectancy with and without diseases and functioning loss. We use a repeated cross-sectional health survey carried out in 1994 and 2011 for measures of morbidity; mortality information comes from the Spanish National Statistics Institute. Our findings show that at age 65 the percentage of life with disease increased from 52% to 70% for men, and from 56% to 72% for women; the expectation of life unable to function increased from 24% to 30% for men and 40% to 47% for women between 1994 and 2011. These changes were attributable to increases in the prevalences of diseases and moderate functional limitation. Overall, we find an expansion of morbidity along the period. Increasing survival among people with diseases can lead to a higher prevalence of diseases in the older population. Higher prevalence of health problems can lead to greater pressure on the health care system and a growing burden of disease for individuals.

Favorable outcome of an acute complex regional pain syndrome with immunoglobulin infusions.

OBJECTIVE: To emphasize that complex regional pain syndrome (CRPS), a disabling disorder with the implication of aberrant inflammation, vasomotor dysfunction, and maladaptive neuroplasticity, might be treated with a high dose of intravenous immunoglobulin infusions (IVIG). METHODS: We describe a patient who presented with CRPS in the acute phase of the disease. RESULTS: The CRPS developed secondary to sciatic compression in a young patient and was treated within 10 days by high-dose IVIG (2 g/kg). It resolved completely within days after infusions. DISCUSSION: This observational study emphasizes that high-dose IVIG may be a treatment option in the acute phase of CRPS.

Lésions traumatiques rachidiennes et indications au traitement chirurgical [Surgical indications in spinal trauma]

Surgical indications in spinal trauma remain a controversial topic. In general, unstable cervical injuries such as displaced odontoid fractures, burst fractures or tear drop fractures require surgical intervention. Thoracolumbar compression injuries without posterior wall involvement or significant kyphosis can be treated conservatively. Surgery is indicated in fractures-dislocations and burst fractures with significant canal narrowing and/or major kyphosis. The role of emergency decompression as well as that of steroids remain uncertain since no study to date has convincingly proven their efficacy.

The value of intraoperative ultrasound in oblique corpectomy for cervical spondylotic myelopathy and ossified posterior longitudinal ligament.

Intraoperative ultrasound (IOUS) has been described to be useful during central corpectomy for compressive cervical myelopathy. This study aimed at documenting the utility of IOUS in oblique cervical corpectomy (OCC). Prospective data from 24 patients undergoing OCC for cervical spondylotic myelopathy and ossified posterior longitudinal ligament (OPLL) were collected. Patients had a preoperative cervical spine magnetic resonance (MR) image, IOUS and a postoperative cervical CT scan. Retrospective data from 16 historical controls that underwent OCC without IOUS were analysed to compare the incidence of residual compression between the two groups. IOUS identified the vertebral artery in all cases, detected residual cord compression in six (27%) and missed compression in two cases (9%). In another two cases with OPLL, IOUS was sub-optimal due to shadowing. IOUS measurement of the corpectomy width correlated well with these measurements on the postoperative CT. The extent of cord expansion noted on IOUS after decompression showed no correlation with immediate or 6-month postoperative neurological recovery. No significant difference in residual compression was noted in the retrospective and prospective groups of the study. Craniocaudal spinal cord motion was noted after the completion of the corpectomy. IOUS is an inexpensive and simple real-time imaging modality that may be used during OCC for cervical spondylotic myelopathy. It is helpful in identifying the vertebral artery and determining the trajectory of approach, however, it has limited utility in patients with OPLL due to artifacts from residual ossification.

La thrombose veineuse superficielle : commentaire [Superficial vein thrombosis : commentary]

La thrombose veineuse superficielle (TVS) se caractérise cliniquement par un cordon induré, rouge, chaud et douloureux résultant d'un processus inflammatoire et de la présence d'un thrombus entraînant l'occlusion d'une veine superficielle. La TVS des membres inférieurs est le plus souvent considérée comme relativement bénigne et habituellement traitée par antiinflammatoires et compression élastique. Cependant, la TVS peut être associée à d'autres tableaux pathologiques tels la thrombose veineuse profonde requerrant dans certains cas des investigations complémentaires. Mots-clés:

Qualité de vie après traitement de l'insuffisance veineuse superficielle primaire. [Quality of life in patients traited for primary superficial venous insufficiency].

Venous symptoms and quality of life (QOL) of 78 patients (54 women, mean age 49,5±13,3 years) with primary superficial venous insufficiency (PSVI) were compared at one year after treatment with crossectomy and stripping (C/S, 56 patients) or endovenous laser ablation (EVLA, 22 patients) using the VEINES-QOL questionnaire. Both treatments significantly (p<0,001) improved the scores for venous symptoms (difference 10,6±9,9 and 9,9±8,2 score points for C/S and EVLA, respectively) and QOL (difference 10,3±8,7 and 8,4±6,6 score points for C/S and EVLA, respectively). No difference was found between treatments regarding symptoms or QOL improvement (p=0,30). We conclude that C/S and EVLA are equally effective in improving symptoms and QOL in PSVI.

Le fixateur externe dans les lésions traumatiques graves du bassin: résultats à propos de 20 cas consécutifs [External fixator in severe traumatic injuries of the pelvis: results apropos of 20 consecutive cases]

From August 91 to December 94, 20 external fixators were used for severely injured patients (avg. ISS 25.2). The fractures were essentially open book with or without lateral compression and vertical lesions. The indication for fixation was treatment of shock and stabilization in 8 cases, stabilization alone in 9 cases, and in 3 cases as complementary fixation after internal fixation of posterior lesions. The fixation of the pelvis was effective on the amount of blood loss. One acetabulum fracture required surgery, two patients had internal fixation for loss of reduction and two others for late pubic and posterior pain. The clinical results are good; they are more related to the severity of the initial lesion than to the mode of fixation or the quality of the reduction. No superficial sepsis or osteitis was observed in relation to the pins.

Soil compaction due to forest harvest operations

The objective of this work was to determine, through the use of the bearing capacity model, the traffic effects of the forest harvest operations on the preconsolidation pressure (sigmap), during one cycle of the eucalyptus plantation. The work was conducted using undisturbed soil samples, collected at the surface of the A horizon and in the top of the B horizon of an Udult (PA), Aquox (FX) and Udox (LA) soils. The undisturbed soil samples were used in the uniaxial compression tests. The soil sampling was done before and after the harvest operations. The operations performed with the Forwarder caused greater soil compaction than the ones done with the Feller Büncher and Harvester. The percentage of soil samples, in the region with additional soil compaction, indicated that the Udult was the soil class more susceptible to soil compaction, followed by the Aquox and Udox. Despite Udult is the more susceptible to soil compaction, the regeneration of the soil structure in this soil class was more efficient than in Aquox. The percentage of soil samples with sigmap values in the region with additional soil compaction in 1996, 1998 and 2004, after harvest operations, indicated a sustainable forest exploration in this period.

Investigation of Steel-Stringer Bridges: Superstructures and Substructures, Volume I, TR-522, 2007

There are hundreds of structurally deficient or functionally obsolete bridges in the state of Iowa. With the majority of these bridges located on rural county roads where there is limited funding available to replace the bridges, diagnostic load testing can be utilized to determine the actual load carrying capacity of the bridge. One particular family or fleet of bridges that has been determined to be desirable for load testing consists of single-span bridges with non-composite, cast-in-place concrete decks, steel stringers, and timber substructures. Six bridges with poor performing superstructure and substructure from the aforementioned family of bridges were selected to be load tested. The six bridges were located on rural roads in five different counties in Iowa: Boone, Carroll, Humboldt, Mahaska, and Marshall. Volume I of this report focuses on evaluating the superstructure for this family of bridges. This volume discusses the behavior characteristics that influence the load carrying capacity of this fleet of bridges. In particular, the live load distribution, partial composite action, and bearing restraint were investigated as potential factors that could influence the bridge ratings. Implementing fleet management practices, the bridges were analyzed to determine if the load test results could be predicted to better analyze previously untested bridges. For this family of bridges it was found that the ratings increased as a result of the load testing demonstrating a greater capacity than determined analytically. Volume II of this report focuses on evaluating the timber substructure for this family of bridges. In this volume, procedures for detecting pile internal decay using nondestructive ultrasonic stress wave techniques, correlating nondestructive ultrasonic stress wave techniques to axial compression tests to estimate deteriorated pile residual strength, and evaluating load distribution through poor performing timber substructure elements by instrumenting and load testing the abutments of the six selected bridges are discussed. Also, in this volume pile repair methods for restoring axial and bending capacities of pile are developed and evaluated.

Highway Applications for Rammed Aggregate Piers in Iowa Soils, TR-443, 2003

This report describes a study to evaluate Geopier® soil reinforcement technology in transportation construction. Three projects requiring settlement control were chosen for evaluation—an embankment foundation, a box culvert, and a bridge approach fill. For each project, construction observations, in situ soil testing, laboratory material characterization, and performance monitoring were carried out. For the embankment foundation project, Geopier elements were installed within and around an abutment footprint for the new I-35 overpass at the US Highway 5/Interstate 35 interchange in Des Moines, Iowa. Although the main focus of this investigation was to evaluate embankment foundation reinforcement using Geopier elements, a stone column reinforced soil provided an opportunity to compare systems. In situ testing included cone penetration tests (CPTs), pressuremeter tests (PMTs), Ko stepped blade tests, and borehole shear tests (BSTs), as well as laboratory material testing. Comparative stiffness and densities of Geopier elements and stone columns were evaluated based on full-scale modulus load tests and standard penetration tests. Vibrating wire settlement cells and total stress cells were installed to monitor settlement and stress concentration on the reinforcing elements and matrix soil. Settlement plates were also monitored by conventional optical survey methods. Results show that the Geopier system and the stone columns performed their intended functions. The second project involved settlement monitoring of a 4.2 m wide x 3.6 m high x 50 m long box culvert constructed beneath a bridge on Iowa Highway 191 south of Neola, Iowa. Geopier elements were installed to reduce total and differential settlement while ensuring the stability of the existing bridge pier foundations. Benefits of the box culvert and embankment fill included (1) ease of future roadway expansion and (2) continual service of the roadway throughout construction. Site investigations consisted of in situ testing including CPTs, PMTs, BSTs, and dilatometer tests. Consolidated drained triaxial compression tests, unconsolidated undrained triaxial compression test, oedometer tests, and Atterberg limit tests were conducted to define strength and consolidation parameters and soil index properties for classification. Vibrating wire settlement cells, total stress cells, and piezometers were installed for continuous monitoring during and after box culvert construction and fill placement. This project was successful at controlling settlement of the box culvert and preventing downdrag of the bridge foundations, but could have been enhanced by reducing the length of Geopier elements at the ends of the box culvert. This would have increased localized settlement while reducing overall differential settlement. The third project involved settlement monitoring of bridge approach fill sections reinforced with Geopier elements. Thirty Geopier elements, spaced 1.8 m apart in six rows of varying length, were installed on both sides of a new bridge on US Highway 18/218 near Charles City, Iowa. Based on the results of this project, it was determined that future applications of Geopier soil reinforcement should consider extending the elements deeper into the embankment foundation fill, not just the fill itself.

Unexpected bleeding following eyelid tumor resection leading to the rare diagnosis of acquired haemophilia.

BACKGROUND: Our goal is to report for the first time in the literature a case of uncontrolled bleeding after an oculoplastic surgical procedure leading to the diagnosis of acquired haemophilia. HISTORY AND SIGNS: An 82-year-old patient underwent tumor excision and reconstruction of his right lower eyelid. On the same day, uncontrolled bleeding occurred that resisted optimal blood pressure control, external compression, surgical haemostasis and wound revision. Usual coagulation screening tests were normal, except for a slightly prolonged activated partial thromboplastin time. THERAPY AND OUTCOME: Extensive coagulation check was performed, which showed a severely reduced factor VIII due to the presence of an inhibitor. The bleeding was immediately stopped after administration of recombinant factor VIIa. After healing of the wound, factor VIIa treatment was replaced by immunosuppressive therapy. The factor VIII inhibitor became unmeasurable and remained so for three months after stopping the immunosuppressive therapy. CONCLUSIONS: Ophthalmologists confronted with unexpected uncontrolled bleeding should think about the possibility of blood dyscrasia, in particular acquired haemophilia.

Changes in running mechanics and spring-mass behaviour during a 5-km time trial.

Research into the biomechanical manifestation of fatigue during exhaustive runs is increasingly popular but additional understanding of the adaptation of the spring-mass behaviour during the course of strenuous, self-paced exercises continues to be a challenge in order to develop optimized training and injury prevention programs. This study investigated continuous changes in running mechanics and spring-mass behaviour during a 5-km run. 12 competitive triathletes performed a 5-km running time trial (mean performance: ̴17 min 30 s) on a 200 m indoor track. Vertical and anterior-posterior ground reaction forces were measured every 200 m by a 5-m long force platform system, and used to determine spring-mass model characteristics. After a fast start, running velocity progressively decreased (- 11.6%; P<0.001) in the middle part of the race before an end spurt in the final 400-600 m. Stride length (- 7.4%; P<0.001) and frequency (- 4.1%; P=0.001) decreased over the 25 laps, while contact time (+ 8.9%; P<0.001) and total stride duration (+ 4.1%; P<0.001) progressively lengthened. Peak vertical forces (- 2.0%; P<0.01) and leg compression (- 4.3%; P<0.05), but not centre of mass vertical displacement (+ 3.2%; P>0.05), decreased with time. As a result, vertical stiffness decreased (- 6.0%; P<0.001) during the run, whereas leg stiffness changes were not significant (+ 1.3%; P>0.05). Spring-mass behaviour progressively changes during a 5-km time trial towards deteriorated vertical stiffness, which alters impact and force production characteristics.

Gériatrie [Review in geriatric medicine 2012].

2012 brought additional evidence regarding the benefits of exercise in older persons in showing morbidity compression in those most active. Several studies invite to revise therapeutic targets in older diabetics, especially those with cognitive impairment or dementia where a value of 8 to 9% for HbAlc might be a good compromise. On the dementia side, a study suggests that biological and structural abnormalities associated with Alzheimer's disease might occur as early as 25 years before its first clinical manifestations. On the therapeutic side, ginkgo and the double therapy with memantine and donepezil did not make it in RCTs, and two studies about treatments for behavioral symptoms of dementia showed that interruption could be deleterious.

Transposition of great arteries and single coronary artery: a new surgical technique for the arterial switch operation.

A single coronary artery can complicate the surgical technique of arterial switch operations, impairing early and late outcomes. We propose a new surgical approach, successfully applied in a 2.1 kg neonate, aimed at reducing the risk of early and late compression and/or distortion of the newly constructed coronary artery system.