The value of preliminary overhead traction in the closed management of DDH.
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ABSTRACT:
SUBMITTER: Sibinski M
PROVIDER: S-EPMC2532138 | biostudies-other | 2006 Aug
REPOSITORIES: biostudies-other
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Project description:IntroductionThe principle of the treatment for DDH is to establish a concentric, congruent, stable and safe reduction of the hip. Early treatment enables the subsequent hip development. Closed reduction and spica play an essential role during the process of DDH treatment, especially the young children, with high success rate and low complications.IndicationsThe indications for the procedure include DDH in children between the age of 6 months and 2 years, and failure of Pavlik harness treatment.TechniqueThe procedure is performed under general anaesthesia or deep sedation under guidance of image intensifier. We use a wooden board as spica table. The steps of the procedure are illustrated in the video and include: (1) gentle reduction, (2) confirmation of reduction and stability with arthrogram and (3) application of hip spica in human position.ConclusionThe article describes video technique for closed reduction, arthrogram and spika for management of DDH along with a list of useful tips and tricks.Supplementary informationThe online version contains supplementary material available at 10.1007/s43465-021-00542-y.
| S-EPMC8688678 | biostudies-literature
Project description:BackgroundManagement of a patient's body temperature is an important aspect of care that should be addressed by targeted temperature management (TTM). Often, non-invasive methods like forced-air blankets are used. Especially in the operating room this management may be a subsidiary and repetitive task requiring constant observation of the patient's body temperature and adaption using the limited set of available settings. Thus, automation of TTM is a feasible target to improve patient outcome and reduce caregiver workload.MethodsA Philips IntelliVue MP 50 patient monitor with an arterial PiCCO catheter system was used to measure patient blood temperature. Thermal management was performed with a 3M Bair Hugger 755 warming unit with forced air blankets. The warming unit was extended by a computer interface to allow for remote and automated control. A proposed closed-loop algorithm reads the measured temperature and performs automated control of the 3M Bair Hugger. Evaluation was performed in an experimental intensive care setting for animal studies. Two fully automated trials are compared with two manual and two uncontrolled trials in the same study setting using six female pigs for prolonged observation times of up to 90 hours in each trial.ResultsThe developed system and proposed algorithm allow more precise temperature management by keeping a set target temperature within a range of ±?0.5 °C in 88% of the observation time and within a range of ±?1.0 °C at all times. The proposed algorithm yielded better performance than did manual control or uncontrolled trials. It was able to adapt to individual patient needs as it is more dynamic than look-up table approaches with fixed settings for various temperatures.ConclusionsClosed-loop TTM using non-invasive forced-air warming blankets was successfully tested in a porcine study with the proposed hardware interface and control algorithm. This automation can be beneficial for patient outcome and can reduce caregiver workload and patient risk in clinical settings. As temperature readings are most often available, existing devices like the 3M Bair Hugger can easily be expanded. However, even if clinical application is feasible, open questions regarding approval and certification of such automated systems within the current legal situation still need to be answered.
| S-EPMC6029032 | biostudies-literature
Project description:INTRODUCTION:Developmental dysplasia of the hip (DDH) affects 4-6 per 1000 live births in developed countries. Effective treatment to realign the hip is necessary to avoid long-term morbidities and maximise functional outcome. Treatment options depend on patient age but typically involve hip bracing and/or reduction under general anaesthetic. Some centres also employ prereduction hip traction. Historical papers suggest traction reduces risk of avascular necrosis (AVN) femoral head and reduces requirement for open reduction. However, several studies including a large retrospective cohort study, dispute this. We propose to perform the first systematic review and meta-analysis to clarify the value of prereduction hip traction in the management of DDH in children under the age of 3?years by identifying whether it impacts on the rate of successful closed reduction (CR) and risk of AVN. METHODS AND ANALYSIS:We will search MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials to identify potentially relevant studies. Studies reporting on incidence of successful CR, AVN femoral head and complications associated with prereduction hip traction in children of less than 3?years with DDH will be eligible for inclusion. Only randomised controlled trials, prospective and retrospective case-control and comparative cohort studies will be included in quantitative review. There will be no study design restrictions for inclusion in qualitative review. Following study selection, full-text paper retrieval, data extraction and synthesis, studies will be assessed for risk of bias and heterogeneity. If the included studies are sufficiently homogeneous, then we will perform meta-analysis. A narrative synthesis of the systematic review's results will also be presented. ETHICS AND DISSEMINATION:Formal ethical approval is not required as primary patient data will not be collected. The systematic review's results will be disseminated through a peer-reviewed publication. TRIAL REGISTRATION NUMBER:CRD42017064254; Pre-results.
| S-EPMC5829851 | biostudies-other
Project description:Study Design Case report. Objective We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1-C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing "spontaneous" ankylosis needs to be considered.
| S-EPMC4472283 | biostudies-other
Project description:Capsular management, from the initial capsulotomy to capsule closure is essential to success in hip arthroscopy to achieve optimal outcomes. Although an interportal capsulotomy is typically sufficient for resection of proximal cam lesions and for performing central compartment procedures, T-capsulotomy is usually performed when large cam deformity needs to be addressed because it provides a broader field of view. The purpose of this Technical Note is to summarize each step of capsule management and to define a traction-assisted T-capsulotomy technique that allows for accurate placement of the T-capsulotomy while also avoiding damage to the articular cartilage.
| S-EPMC8556758 | biostudies-literature
Project description:Background Drug closed-loop management reflects the level of hospital management and pharmacist service. It is a challenge for hospital pharmacists to realize the whole-process closed-loop management of drugs in hospital pharmacies. Therefore, this study aimed to evaluate the operational effect of using mobile technology to build a closed-loop drug management system. Methods Using mobile technology, replacing the traditional paper dispensing model and constructing a multinode information collection system according to the Healthcare Information and Management Systems Society Standard, we reformed the hospital information system and inpatient pharmacy workflow and then evaluated the new approach using statistical methods. Results After the transformation, the entire process of drug data can be traced. Closed-loop management, as well as real-time data verification and control, thereby improves the work efficiency and reduces the drug dispensing time. By reducing the work error rate, the number of dispensing errors decreased from 5 to 1 case/month. The comprehensive dispensing process can achieve the whole workflow of paperless operation and reduce the use of paper A4 by 180,000 pieces per year. Conclusions Mobile technology can improve the service level of pharmacies, enhance the level of drug management and hospital quality management, ensure the safety of medication for inpatients, and significantly reduce the amount of paper used. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-02067-2.
| S-EPMC9703708 | biostudies-literature
Project description:IntroductionSlips, trips, and falls are a major cause of injury in the workplace. Footwear is an important factor in preventing slips. Furthermore, traction performance (friction and under-shoe fluid drainage) are believed to change throughout the life of footwear. However, a paucity of data is available for how traction performance changes for naturally worn, slip-resistant footwear.MethodThe presented research is a preliminary analysis from an ongoing, larger study. Participants wore slip-resistant footwear while their distance walked was monitored. Friction and under-shoe fluid pressures were measured using a robotic slip tester under a diluted glycerol contaminant condition after each month of wear for the left and right shoes. The size of the worn region was also measured.ResultsFriction initially increased and then steadily decreased as the distance walked and the size of the worn region increased. Fluid pressures increased as the shoes were worn and were associated with increased walking distance and size of the worn region.DiscussionConsistent with previous research, increases in the size of the worn region are associated with increased under-shoe fluid pressures and decreased traction. These trends are presumably due to reduced fluid drainage between the shoe-floor interface when the shoe becomes worn.ConclusionsTraction performance changes with natural wear. The distance walked in the shoe and the size of the worn region may be valuable indicators for assessing loss of traction performance. Practical Applications: Current shoe replacement recommendations for slip-resistant shoes are based upon age and tread depth. This study suggests that tools measuring the size of the worn region and/or distance traveled in the shoes are appropriate alternatives for tracking traction performance loss due to shoe wear.
| S-EPMC7506145 | biostudies-literature
Project description:Vitreomacular traction (VMT) and VMT with macular hole (MH) are serious conditions, being associated with visual disturbance, for example, metamorphopsia, and diminished visual acuity (VA). Pars plana vitrectomy is the routine treatment for symptomatic VMT and VMT+MH. However, ocriplasmin has demonstrated favourable efficacy and safety in specific patient groups with VMT/MH and is now recommended as a treatment option for certain patients by the National Institute of Health and Care Excellence. This means that services for managing patients with VMT/MH may need to be revised, as patients can now potentially receive treatment earlier in the course of the disease. VMT triage clinics could provide a more efficient way of managing VMT/MH patients. Patient assessment should always include high-definition optical coherence tomography, as this is the most accurate means of assessing abnormalities in the vitreoretinal (VR) interface, and an accurate measurement of best-corrected VA. It has been proposed that patients with VMT+MH be managed as a routine 6-week referral, with the complete patient journey-from initial referral to treatment-taking no longer than 6 months. It is important that patients are entered onto VR surgical lists so that there is no delay if ocriplasmin treatment is unsuccessful. Patients will need appropriate counselling about the expected outcomes and possible side effects of ocriplasmin treatment. One-year follow-up data should be collected by treatment centres in order to evaluate the new VMT service.
| S-EPMC4097190 | biostudies-other
Project description:Introduction and hypothesisThis study aimed to describe a novel strategy to determine the traction forces needed to reproduce physiologic uterine displacement in women with and without prolapse.MethodsParticipants underwent dynamic stress magnetic resonance imaging (MRI) testing as part of a study examining apical uterine support. Physiologic uterine displacement was determined by analyzing uterine location in images taken at rest and at maximal Valsalva. Force-displacement curves were calculated based on intraoperative cervical traction testing. The intraoperative force required to achieve the uterine displacement measured during MRI was then estimated from these curves. Women were categorized into three groups based on pelvic organ support: group 1 (normal apical and vaginal support), group 2 (normal apical support but vaginal prolapse present), and group 3 (apical prolapse).ResultsData from 19 women were analyzed: five in group 1, five in group 2, and nine in group 3. Groups were similar in terms of age, body mass index (BMI), and parity. Median operating room (OR) force required for uterine displacement measured during MRI was 0.8 N [interquartile range (IQR) 0.62-3.22], and apical ligament stiffness determined using MRI uterine displacement was 0.04 N/mm (IQR 0.02-0.08); differences between groups were nonsignificant. Uterine locations determined at rest and during maximal traction were lower in the OR compared with MRI in all groups.ConclusionsUsing this investigative strategy, we determined that only 0.8 N of traction force in the OR was required to achieve maximal physiologic uterine displacement seen during dynamic (maximal Valsalva) MRI testing, regardless of the presence or absence of prolapse.
| S-EPMC4947418 | biostudies-literature
Project description:ObjectiveTo enable early prediction of strong traction force vacuum extraction.DesignObservational cohort.SettingKarolinska University Hospital delivery ward, tertiary unit.Population and sample sizeTerm mid and low metal cup vacuum extraction deliveries June 2012-February 2015, n = 277.MethodsTraction forces during vacuum extraction were collected prospectively using an intelligent handle. Levels of traction force were analysed pairwise by subjective category strong versus non-strong extraction, in order to define an objective predictive value for strong extraction.Statistical analysisA logistic regression model based on the shrinkage and selection method lasso was used to identify the predictive capacity of the different traction force variables.PredictorsTotal (time force integral, Newton minutes) and peak traction (Newton) force in the first to third pull; difference in traction force between the second and first pull, as well as the third and first pull respectively. Accumulated traction force at the second and third pull.OutcomeSubjectively categorized extraction as strong versus non-strong.ResultsThe prevalence of strong extraction was 26%. Prediction including the first and second pull: AUC 0,85 (CI 0,80-0,90); specificity 0,76; sensitivity 0,87; PPV 0,56; NPV 0,94. Prediction including the first to third pull: AUC 0,86 (CI 0,80-0,91); specificity 0,87; sensitivity 0,70; PPV 0,65; NPV 0,89.ConclusionTraction force measurement during vacuum extraction can help exclude strong category extraction from the second pull. From the third pull, two-thirds of strong extractions can be predicted.
| S-EPMC5336195 | biostudies-literature