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Objectives: There is controversy over who should serve as the Trauma Team Leader (TTL) at trauma-receiving centres. This study compared survival and emergency department (ED) length-of-stay between patients cared for by 3 different groups of TTLs: surgeons, emergency physicians (EPs) on call for trauma cases and EPs on shift in the ED.Methods: We performed a retrospective cohort study involving all adult major blunt trauma patients (aged 17 and older) who were admitted to 2 level I trauma centres and who were entered into a provincial Trauma Registry between March 2000 and April 2002. The study was designed to compare the effect of TTL-type on survival and ED length-of-stay, while controlling for sex, age, and trauma severity as defined by the Injury Severity Score (ISS) and the Revised Trauma Score (RTS). Analysis was performed using linear regression modeling (for the ED lenght-of-stay outcome variable), and logistic regression modeling (for the surivial outcome variable).Results: There were 1412 patients enrolled in the study. The study population comprised 74% men and 26% women, with a mean age of 44.7 years (43.1, 46.6 and 42.8 years for surgeons, on-call EPs and on-shift EPs, respectively). The overall mean ISS was 23.2 (23.7 for surgeons, 22.9 for on-call EPs and 23.3 for on-shift EPs) and the overall average RTS was 7.6 (7.6 for surgeons, 7.6 for on-call EPs and 7.5 for on-shift EPs). The overall median ED length-of-stay was 5.3 hours (4.5, 5.3 and 5.6 hours for surgeons, on-call EPs and on-shift EPs, respectively; p = 0.07) and the overall survival was 87% (86% surgeon, 88% on-call EP, 87% on-shift EP; p = 0.08). No statistically significant relationship was found between TTL-type and ED length-of-stay (p = 0.42) or survival (p = 0.43) using multivariate modeling.Conclusion: Our results suggest that surgeons, on-call EPs, or on-shift EPs can act as the TTL without a negative impact on patient survival or ED length-of-stay. [ABSTRACT FROM AUTHOR]

Median raphe cyst is an uncommon developmental anomaly that can develop anywhere along the midline of the external genitals. Only a few hundred cases have been published in the English literature and the lack of awareness of this entity can lead to confusion and misdiagnosis. We report here a case of median raphe cyst located in the midline of the anterior scrotum of a 35- year-old man. Clinically, the patient presented with a scrotal mass increasing substantially in size over two days associated with tenderness, skin erythema, and scrotal pain. Radiologic interpretation of a sonogram and computed tomography scan suggested a thrombosed vessel. The patient was diagnosed with septic thrombophlebitis associated with overlying cellulitis. Despite conservative therapy with antibiotics, the patient developed pyrexia, tachycardia, and leukocytosis prompting surgical excision of the lesion. Histopathologic examination revealed an infected median raphe cyst. The cyst wall was lined by a stratified epithelium that included numerous Alcian blue positive goblet cells. The epithelial cells showed reactive changes with infiltration by numerous neutrophils. Our objective is to bring attention to and thereby facilitate the diagnosis of this unusual entity., Competing Interests: Conflict of interest: the authors declare no potential conflict of interest., (©Copyright: the Author(s), 2019.)

Background: Electronic documentation handling may facilitate information flows in health care settings to support better coordination of care among Health Care Providers (HCPs), but evidence is limited. Methods that accurately depict changes to the workflows of HCPs are needed to assess whether the introduction of a Critical Care clinical Information System (CCIS) to two Intensive Care Units (ICUs) represents a positive step for patient care. To evaluate a previously described method of quantifying amounts of time spent and interruptions encountered by HCPs working in two ICUs., Methods: Observers used PDAs running the Work Observation Method By Activity Timing (WOMBAT) software to record the tasks performed by HCPs in advance of the introduction of a Critical Care clinical Information System (CCIS) to quantify amounts of time spent on tasks and interruptions encountered by HCPs in ICUs., Results: We report the percentages of time spent on each task category, and the rates of interruptions observed for physicians, nurses, respiratory therapists, and unit clerks. Compared with previously published data from Australian hospital wards, interdisciplinary information sharing and communication in ICUs explain higher proportions of time spent on professional communication and documentation by nurses and physicians, as well as more frequent interruptions which are often followed by professional communication tasks., Conclusions: Critical care workloads include requirements for timely information sharing and communication and explain the differences we observed between the two datasets. The data presented here further validate the WOMBAT method, and support plans to compare workflows before and after the introduction of electronic documentation methods in ICUs.

Objective: to evaluate the influence of initial oligohydramnios on the prognosis of women with preterm premature rupture of the membranes (PPROM) at 30 to 36 weeks' gestation., Methods: the Royal Alexandra Hospital ultrasound database was used to identify singleton pregnancies at 30 to 36 weeks' gestation with an ultrasound performed for confirmed PPROM from January 1992 to December 2006. Records were linked to the electronic provincial delivery record to perform a retrospective cohort study comparing the outcomes of pregnancies with an initial amniotic fluid index (AFI) < 5 cm with the outcomes of pregnancies with an AFI of 5 to 10 cm. Logistic and linear regression were used to analyze the association between binary outcome and explanatory variables., Results: the maternal and perinatal outcomes of 438 pregnancies were analyzed. Univariate analysis suggested statistically significant associations between initial oligohydramnios and decreased latency (P < 0.001), increased histologically proven chorioamnionitis (P = 0.01), neonatal length of stay in hospital (P = 0.002), and NICU (P = 0.003); however, after controlling for confounding variables (gestational age at delivery, parity, presentation, and antenatal antibiotic and corticosteroid administration), only latency remained significant (P = 0.004). No association was found between initial oligohydramnios and any other outcomes assessed, including mode of delivery, postpartum endometritis, maternal length of stay, non-reassuring fetal status, and neonatal morbidity and mortality., Conclusion: initial oligohydramnios is associated with decreased latency in singleton pregnancies complicated by PPROM at 30 to 36 weeks' gestation; however, it does not appear to influence maternal or neonatal infectious morbidity, and it may not be useful to determine candidacy for expectant management or intentional delivery.

Objective: To determine the incidence of maternal cell contamination (MCC) in the open-needle amniocentesis sampling technique compared with the trocar-in-place technique., Methods: A retrospective analysis was conducted on 2,498 mid-trimester amniocenteses performed in two tertiary care centres in Canada. The University of Alberta centre used the open-needle (without the trocar) technique and the University of British Columbia centre used the standard (with the trocar in place) technique. Data were gathered regarding the nature of the amniotic fluid, number of needle passes, amniocentesis results, and the occurrence of maternal cell contamination. The statistical analysis used logistic regression, and controlled for the potential confounders of bloody fluid taps and requirement for more than one needle insertion., Results: The incidence of maternal cell contamination was 1.16% with the open-needle technique and 0.78% with the standard trocar-in-place technique (p < 0.315), with a power of 42%., Conclusion: The data suggested there is no significant increase in maternal cell contamination with the open-needle versus trocar-in-place techniques of amniocentesis. However, the small sample size, combined with the low prevalence of the outcome of interest (MCC), provides insufficient power to draw firm conclusions about the difference in MCC between the two techniques.

Aim: To determine the correlation between gastric intramucosal pH and superior mesenteric artery (SMA) flow in newborn piglets., Methods: Fourteen newborn piglets were randomly assigned to either a control or to an epinephrine group which received 0,1,2,4,0 microg/kg/min of epinephrine for 60 minutes, each dose. Gastric tonometry was performed, SMA flow was measured, and intramucosal pH and the ratio of tonometer pCO(2) over arterial pCO(2) (rCO(2)) were calculated., Results: Intramucosal pH decreased over time in both groups, but tended to be lower in the epinephrine group. With increasing dose of epinephrine, SMA flow decreased; this in turn increased rCO(2) (p = 0.04) with a tendency to decrease intramucosal pH (p = 0.06)., Conclusions: Gastric tonometry may be useful in human neonates to evaluate gut ischaemia.