No abstract

No abstract

BackgroundOur objective was to perform a systematic review of studies reporting the accuracy of termination of resuscitation rules (TORRs) for out-of-hospital cardiac arrest (OHCA).MethodsWe performed a comprehensive search of the literature for studies evaluating the accuracy of TORRs, with two investigators abstracting relevant data from each study regarding study design, study quality and the accuracy of the TORRs. Bivariate meta-analysis was performed using the mada procedure in R.ResultsWe identified 14 studies reporting the performance of 9 separate TORRs. The sensitivity (proportion of eventual survivors for whom the TORR recommends resuscitation and transport) was generally high: 95% for the European Resuscitation Council (ERC) TORR, 97% for the basic life support (BLS) TORR and 99% for the advanced life support (ALS) TORR. The BLS and ERC TORR were more specific, which would lead to fewer futile transports, and all three of these TORRs had a miss rate of ≤0.13% (defined as a case where a patient is recommended for termination but survives). The pooled proportion of patients for whom each rule recommends TOR was much higher for the ERC and BLS TORRs (93.5% and 74.8%, respectively) than for the ALS TORR (29.0%).ConclusionsThe BLS and ERC TORRs identify a large proportion of patients who are candidates for termination of resuscitation following OHCA while having a very low rate of misclassifying eventual survivors (<0.1%). Further prospective validation of the ERC TORR and direct comparison with BLS TORR are needed.

Background. Proximal hamstring tendinopathy is a common cause of gluteal pain. Extracorporeal shockwave therapy may be an effective treatment in proximal hamstring tendinopathy. However, published outcomes are primarily limited to evaluating radial shockwave, and the use of combined treatment (focus and radial treatment) and outcomes for management in runners are not well described. The purpose of this report was to characterize functional outcomes using radial and combined shockwave in the management of proximal hamstring tendinopathy in runners. We hypothesized that runners who received R-SWT or C-SWT would experience improvement in functional outcomes using the VISA-H. Methods. This study is a quality improvement initiative evaluating clinical outcomes in a single outpatient clinic. Sixty-three runners (mean and standard deviation for age and duration of symptoms 42.8 ± 14.7 years and 16.9 ± 23.8 months, respectively), were identified as receiving treatment for management of unilateral or bilateral proximal hamstring tendinopathy. Patients were treated with either radial (n = 40) or combined shockwave therapy (n = 23) using similar post-procedure protocols, including recommendations to complete physical therapy exercises of core and lumbopelvic stabilization with gradual progression to eccentric strengthening of the hamstring complex. Victorian Institute of Sport Assessment -Proximal Hamstring Tendons (VISA-H) was used to assess treatment outcomes, evaluated as differences between treatment cohorts by mean values from baseline to follow-up after shockwave treatment. The number in both treatment groups who met minimal clinical important difference (MCID) was defined as a gain of 22 points or more on VISA-H. Results. Patients in both radial and combined shockwave groups received a similar average number of treatments (5.0 ± 2.2 vs 5.2 ± 1.9; p = 0.740). The radial and combined shockwave groups' mean VISA-H scores were similar at baseline (39.4 ± 17.4 vs 40.7 ± 17.0) and achieved similar final scores (62.6 ± 19.7 vs 63.4 ± 21.3; p = 0.812), and nearly all had measured increases of VISA-H with treatment (P < 0.0001). The MCID was met in a majority of patients who received either radial (62.5%) or combined treatment (56.5%). Conclusions. Overall findings suggest radial and combined shockwave treatment with physical therapy exercises can be effective in the management of proximal hamstring tendinopathy in runners.