Inhibition of annexin V binding to cardiolipin and thrombin generation in an unselected population with venous thrombosis

Interventional stent-graft placement is an effective treatment option for the emergency repair of descending aortic perforations.

Background. Many individuals who work in the military experience sleep deficiency which presents a significant problem given the nature of their work. The cause of their sleep problems is likely multifactorial, stemming from the interplay between their personal health, habits and lifestyle juxtaposed with the stress of their military work such as emotional and physical trauma experienced in service. Objective. To present an overview of sleep deficiency in military members (MMs) and review of nonpharmacological treatment options. Discussion. Although there are a number of promising nonpharmacological treatment options available for people working in the military who experience problems sleeping, testing interventions within the context of the military are still in the early stages. Further research utilizing rigorous design and standardized, context appropriate outcome measures is needed to help treat this burgeoning problem.

Objective Surveillance of patients identified with small abdominal aortic aneurysm (AAA) from an AAA screening program poses a challenge for health systems due to numerous patient follow-ups. This study evaluates the surveillance outcomes of patients identified with small AAA from a large screening program. Methods A retrospective chart review of all patients screened for small AAA (3.0 – 5.4 cm) from 2007–2011 was conducted. Patients with small AAA and no previous history of repair were tracked for follow-up using the 2013 RESCAN follow-up guidelines according to aortic diameter: (3.0 – 3.9 cm, 3 years; 4.0 –4.4 cm, 2 years; 4.5 – 5.4 cm, 1 year). Socioeconomic factors including marital status, distance to hospital from residence, estimated household income, and employment disability status that may influence the follow-up rate and all-cause mortality after screening were also evaluated. Results A total of 568 patients (mean±stdev: 73.4±7.2 years old) with small AAA (3.6±0.6 cm) were analyzed. Patient follow-up rate was 65.1% (n=370/568). Reasons for follow-up failure were: lack of physician ordering scan (n=139, 70.2%), delayed ordering of scans (n=36, 18.2%), patient no-show (n=18, 9.1%), or patient death prior to follow-up (n=5, 2.5%). Of all patient-specific factors, patients with smaller diameters were unlikely to achieve follow-up scans (p<.001). A significantly higher risk of all-cause mortality was found for patients with no ultrasound follow-up scan (hazard ratio, p-value: 0.369, p<0.001), assisted living (0.381, p<0.001), older age (1.04, p=0.001), and lower household incomes (0.989, p=0.01). Conclusions The follow-up rate of small AAA patients was poor at 65.1%. The data indicate that socioeconomic factors do not significantly affect follow-up success. Therefore, physician ordering of scans may exert the greatest influence on follow-up rates in patients with small AAA. Automatic ordering of follow-up scans for small AAA patients is proposed to improve follow-up rates.

Objective: We sought to determine who is involved in the care of a trauma patient. Methods: We recorded hospital personnel involved in 24 adult Priority 1 trauma patient admissions for 12 h or until patient demise. Hospital personnel were delineated by professional background and role. Results: We cataloged 19 males and 5 females with a median age of 50-y-old (interquartile range [IQR], 35.5-67.5). The average number of hospital personnel involved was 79.71 (standard deviation, 17.62; standard error 3.6). A median of 51.2% (IQR, 43.4%-59.8%) of personnel were first involved within hour 1. More personnel were involved in direct versus indirect care (median 54.5 [IQR, 47.5-67.0] vs 25.0 [IQR, 22.0-30.5]; P < 0.0001). Median number of health-care professionals and auxiliary staff were 74.5 (IQR, 63.5-90.5) and 6.0 (IQR, 5.0-7.0), respectively. More personnel were first involved in hospital locations external to the emergency department (median, 53.0 [IQR, 41.5-63.0] vs 27.5 [IQR, 24.0-30.0]; P < 0.0001). No differences existed in total personnel by Injury Severity Score (P = 0.1266), day (P = 0.7270), or time of admission (P = 0.2098). Conclusions: A large number of hospital personnel with varying job responsibilities respond to severe trauma. These data may guide hospital staffing and disaster preparedness policies.