Comparison of SIRS criteria and qSOFA score for identifying culture-positive sepsis in the emergency department: a prospective cross-sectional multicentre study
Objective: To compare the daily practice of two emergency departments (ED) in the Netherlands, where systemic inflammatory response syndrome (SIRS) criteria and quick Sequential Organ Failure Assessment (qSOFA) score are used differently as screening tools for culture-positive sepsis.; Design: A prospective cross-sectional multicentre study.; Setting: Two EDs at two European clinical teaching hospitals in the Netherlands.; Participants: 760 patients with suspected infection who met SIRS criteria or had a qualifying qSOFA score who were treated at two EDs in the Netherlands from 1 January to 1 March 2018 were included.; Methods: SIRS criteria and qSOFA score were calculated for each patient. The first hospital treated the patients who met SIRS criteria following the worldwide Surviving Sepsis Campaign protocol. At the second hospital, only patients who met the qualifying qSOFA score received this treatment. Therefore, patients could be divided into five groups: (1) SIRS+, qSOFA-, not treated according to protocol (reference group); (2) SIRS+, qSOFA-, treated according to protocol; (3) SIRS+, qSOFA+, treated according to protocol; (4) SIRS-, qSOFA+, not treated according to protocol; (5) SIRS-, qSOFA+, treated according to protocol.; Primary and Secondary Outcome Measures: To prove culture-positive sepsis was present, cultures were used as the primary outcome. Secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission.; Results: 98.9% met SIRS criteri...
Introduction: Patient visits to the emergency department (ED) or urgent care centre (UCC) for the sole purpose of requesting prescriptions are challenging for the patient, the physician, and the department. The primary objective of this study was to determine the characteristics of these patients, the nature of their requests, and the response to these requests. Our secondary objective was to determine the proportion of these medication requests that had street value. Methods: This was a retrospective, electronic chart review of all adult patients requesting a prescription from a two-site ED and/or an UCC in a medium-...
A lot of questions about the Pfizer/BioNTech booster shots are circulating after decisions from the FDA and the CDC and recommendations from two vaccine advisory committees.Medscape Medical News
"We see it as a key public health priority and our regulatory obligation to make sure that marketed sunscreen products offer protection from the sun's effects."Medscape Medical News
Modern Approaches to Facial and Athletic Injuries
J. Regan Thomas
J. REGAN THOMAS, MD
FACIAL PLASTIC SURGERY CLINICS OF NORTH AMERICA
The major needs for cosmetic facial bone surgery come from anatomic differences in facial shape and in personal preference. Especially when consulting patients with different national or ethnic backgrounds, careful attention should be paid during consultation for the ideal or desirable facial shape that they have in mind. Patients generally seek a slim and smooth-contoured face. Surgery of the cosmetic facial bone has developed from surgical experiences in facial bone trauma and congenital anomalies. A limited approach is recommended for satisfactory aesthetic outcome. Surgeons should understand the basic procedures of L-s...
Unlike other surgery aimed at removing tumor or inflammation, facial plastic surgery is unique in that the anatomic characteristics of the patients largely determine the very success of the surgical outcome. The ultimate goal of facial plastic surgery is changing the anatomic structure of the face in ways favored by the subjects or general population. General anatomic differences between ethnicities have tremendous importance in planning and executing various facial plastic surgery procedures.