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Use of ketamine sedation for the management of displaced paediatric forearm fractures

World Journal of Orthopedics 2018年第3期9卷 50-57页

作者： Anatole Vilhelm Wiik Poonam Patel Joanna Bovis Adele Cowper Philip Socrates Pastides Alison Hulme Stuart Evans Charles Stewart Department of Surgery and Cancer Charing Cross Hospital Department of Paediatric Emergency Chelsea and Westminster Hospital Department of Trauma and Orthopaedics Chelsea Westminster Hospital

AIM To determine if ketamine sedation is a safe and cost effective way of treating displaced paediatric radial and ulna fractures in the emergency department. METHODS Following an agreed interdepartmental protocol, fractures of the radius and ulna(moderately to severely displaced) in children between the age of 2 and 16 years old, presenting within a specified 4 mo period, were manipulated in our paediatric emergency department. Verbal and written consent was obtained prior to procedural sedation to ensure parents were informed and satisfied to have ketamine. A single attempt at manipulation was performed. Pre and postmanipulation radiographs were requested and assessed to ensure adequacy of reduction. Parental satisfaction surveys were collected after the procedure to assess the perceived quality of treatment. After closed reduction and cast immobilisation, patients were then followed-up in the paediatric outpatient fracture clinic and functional outcomes measured prospectively. A cost analysis compared to more formal manipulation under a general anaesthetic was also *** During the 4 mo period of study, 10 closed, moderate to severely displaced fractures were identified and treated in the paediatric emergency department using our ketamine sedation protocol. These included fractures of the growth plate(3), fractures of both radius and ulna(6) and a single isolated proximal radius fracture. The mean time from administration of ketamine until completion of the moulded plaster was 20 min. The mean time interval from sedation to full recovery was 74 min. We had no cases of unacceptable fracture reduction and no patients required any further manipulation, either in fracture clinic or under a more formal general anaesthetic. There were no serious adverse events in relation to the use of ketamine. Parents, patients and clinicians reported extremely favourable outcomes using this technique. Furthermore, compared to using a manipulation under general anaesthes

关键词： Paediatrics Forearm fractures displaced fractures Ketamine Salter Harris Procedural sedation

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Bandwidth Maximization Approach for displaced Left-Turn Crossovers Coordination under Heterogeneous Traffic Conditions

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Journal of Traffic and Transportation Engineering 2018年第4期6卷 183-196页

作者： Sherif Shokry Shinji Tanaka Fumihiko Nakamura Ryo Ariyoshi Shino Miura Graduate School of Urban Innovation Yokohama National UniversityYokohama 240-8501Japan

As one of the UAIDs(unconventional alternative intersection designs),DLTs(displaced left-turn crossovers)have been presented to mitigate traffic ***,qualitatively and quantitatively isolated UAIDs outperform their conventional counterparts,there is no simplified procedure to consider the DLTs ***,this research investigates the coordination of consecutive DLTs under heterogeneous traffic *** achieve the optimal coordination and provide an efficient coordination control,a bandwidth maximization progression approach was *** the optimal offset for each pair of consecutive intersections to guarantee the green bandwidth waves along the coordinated corridor,a mixed-integer linear program was *** optimization problem was formulated and solved based on the standard branch-and-bound *** a real-world study case,data of three typical intersections located in an arterial corridor in Cairo,Egypt was ***-VISSIM as a microsimulation platform was employed to simulate and evaluate the different signal timing ***,to represent the heterogeneous traffic characteristics as close as possible to the reality,different simulation parameters were tuned and validated *** results emphasized the undoubted improvement of coordinated DLTs by different operational performance *** total travel time,average delay,the number of stops per vehicle were obviously improved.

关键词： displaced left-turn crossovers signal coordination bandwidth maximization

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Pregnancy Outcomes of the Internally displaced Women in Juba, South Sudan

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Open Journal of Obstetrics and Gynecology 2019年第3期9卷 279-291页

作者： Sarah Mustafa Projestine S. Muganyizi Anthony Lupai Belinda S. Balandya Juba Teaching Hospital Juba Republic of South Sudan Muhimbili University of Health and Alied Sciences (MUHAS) Dar es Salaam Tanzania

Background: Conflict and displacement substantially affect maternal reproductive health by increasing the risks formorbidity and mortality. However, most literature on pregnancy outcomes is from cross-border refugees and migrants. To date, scanty literature is available on pregnancy outcomes of internally displaced women. South Sudan, with 16 women dying daily is badly affected by internal conflicts of which by the end of December 2013 about 2.2 million people were internally displaced. The aim of this study was to determine pregnancy outcomes of women living in the United Nations House Internally displaced People (UN IDP) camp and factors associated with poor outcomes. The study was ethically cleared by MUHAS and the Ministry of Health in South Sudan. Methods: A cross sectional study was conducted in UN House IDP Camp in Juba among internally displaced women who attended antenatal services in the camp, from September to November 2016. Among them, women who became pregnant in last 3 years, excluding the index, were interviewed about their immediate past pregnancy experiences. Additionally, the women were interviewed on reproductive health and gender violence matters. Interviews were guided by a structured questionnaire. Data were analyzed using SPSS software version 20. Descriptive and multivariate logistic regression analyses were computed for associations with poor pregnancy outcome. Results: A total of 300 internally displaced women participated in the study. Data for 289 participants were analyzed for poor pregnancy outcome. More than half of the women, 157 (54.3%), had poor pregnancy outcome. Poor Maternal outcome was established in 47% of the women and poor fetal outcome in 27.7%. Delivery in IDP camp compared with outside the camp, was independently associated with a 3-fold increase in risk for poor pregnancy outcome, OR = 2.9 (95% CI: 1.47 - 5.56). Conclusion: The prevalence of poor pregnancy outcome is unacceptably high among internally displaced women seek

关键词： Pregnancy Outcome Maternal Outcome Internally displaced Internal Conflict Camp South Sudan

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Clinical Outcome of Conservative Treatment of displaced Mandibular Fracture in Adults

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Surgical Science 2013年第11期4卷 500-505页

作者： Lipa Bodner Sigal Amitay Ben Zion Joshua Department of Oral and Maxillofacial Surgery Soroka Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva Israel Department of Otolaryngology Head and Neck Surgery Soroka Medical Center Faculty of Health Sciences Ben-Gurion University of the Negev Beer-Sheva Israel

The article evaluates 12 cases of conservative treatment of displaced mandibular fractures in adults. Twelve cases of displaced mandibular fractures treated surgically, either by closed reduction (IMF) or open reduction internal fixation (ORIF) served as controls. Occlusion, maximal mouth opening, lateral jaw movements, neurological dysfunction (=sensory deficit), and bone remodeling were evaluated and scored in both groups, and results were compared. No significant differences were found between the two groups in all the evaluated parameters. It is concluded that in certain cases, with displacement of 2 - 4 mm, where a surgical approach is not feasible, reasonable spontaneous reduction and bone remodeling can occur. Meticulous follow-up is mandatory.

关键词： Mandible Jaw Bone Trauma displaced Fracture Conservative Management

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Prevalence of <i>Helicobacter pylori</i>Infection among Internally displaced Persons from Bakassi Peninsular and Etim Ekpo in South Southern, Nigeria

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Journal of Biosciences and Medicines 2019年第9期7卷 28-37页

作者： Etanguno Effiong Owowo Mary Anthony Christopher Iquo Effiong Okon Ukponobong Effiong Antia Veronica Umoh Department of Microbiology Akwa Ibom State University Mkpat-Enin Nigeria Health Initiative for Stability & Safety in Africa (HIFASS) Uyo Nigeria

Helicobacter pylori (H. pylori), is an important global infection with a worldwide prevalence of about 40 percent. This infection is contagious and mostly acquired during childhood through the fecal-oral and oral-oral route. A total of 1560 blood specimens were aseptically collected from Internally displaced Persons comprising female and male from the warring communities of Bakassi Peninsular and Etim Ekpo Local Government Area in South Southern, Nigeria. The specimens were screened for H. pylori using Elisa kits following standard serological techniques. The overall prevalence rate was 464 (29.7%). There was significant difference (p H. pylori infection;its distribution varied between age group, educational status, habits or behaviors of the subjects with children within 5 to 14 years having the highest rate of 274 (17.6%), followed by 78 (4.99%) from adults (51 years and above) and 17 (1.08%) from active age range of 36 - 45 years old. Subjects with primary and quranic level of education showed a total of 274 (17.56%) positive cases to H. pylori. Analysis of sex-specific distribution revealed that females had the highest prevalence of 312 (20%). The helicobacter infection shows a significant difference at (p H. pylori infection. Crowding in camps and increasing household contact have been considered as risk factors of H. pylori infection. Adequate infrastructural provision and availability of portable water with good hygienic environment will drastically reduce the high rate spread of H. pylori bacterium in the IDPs communities in Nigeria.

关键词： Helicobacter pylori Internally displaced Persons Camp

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Prevalence of Various Cancer-Related Risk Factors among the Forcibly displaced Myanmar National Community, the Rohingya, in Bangladesh: A Preliminary Assessment

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Journal of Cancer Therapy 2020年第5期11卷 251-264页

作者： Rumana Dowla Annekathryn Goodman Sadia Akter Bangladesh Palliative and Supportive Care Foundation Bangabandhu Sheikh Mujib Medical University and Hospital (BSMMU) Dhaka Bangladesh Division Gynecologic Oncology Harvard Medical School Massachusetts General Hospital Boston MA USA Bangladesh Palliative and Supportive Foundation (BPSCF) Dhaka Bangladesh

Background: Large numbers of Forcibly displaced Myanmar Nationals (FDMN), also called the Rohingya community, in Bangladesh face chronic life-threatening illnesses. Symptoms concerning for a cancer diagnosis are not easily evaluated and treated by healthcare systems available to this population. We conducted a rapid needs assessment of cancer screening and pain and palliative care with the goal of identifying the prevalence of cancer risk factors among the Rohingya who attended local health facilities. Methods: A cross-sectional study was conducted in the Kutupalong camp of Ukhiya, Cox’s Bazar among the Rohingya community. Data were?collected through purposive sampling. Face-to-face interviews were done using a structured questionnaire. Statistics were analyzed by using IBM SPSS 23.?Results: Out of 85 participants, 75 were female and 10 were male. 70 (82.4%) were uneducated (defined as lacking any formal institutional education), 10 (11.8%) people completed the primary level education and only 5 (5.9%) people received secondary level education. There were many participants with pulmonary disease with 35 (41.2%) people endorsing a history of asthma, bronchitis, and/or tuberculosis. There was a lack of female menstrual sanitation and hygiene with only 25 (29.4%) patients using sanitary napkins, that were donated by Non Government Organizations. Only 5.9% of the women had received any form of cervical cancer screening.?Conclusion: This study identifies risk factors associated with cancers and life-limiting diseases among the FDMN Rohingya refugees in Bangladesh. It is necessary to develop targeted education, cancer screening and cancer awareness programs for this population.

关键词： Cancer Risk Factors for Cancer Life-Limiting Illness Palliative Care FDMN (Forcibly displaced Myanmar National) Rohingya Menstrual Hygiene Pulmonary Disease Cox’s Bazar Bangladesh

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Accessibility and availability of health care services to internally displaced persons, in Kitgum and Pader districts, northern Uganda

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Health 2013年第9期5卷 1433-1442页

作者： Christopher Garimoi Orach Juliet Faith Aporomon Nelson Musoba Lukwiya Micheal Department of Community Health and Behavioural Sciences Makerere University School of Public Health Kampala Uganda Ministry of Health (MoH) Kampala Uganda Uganda Bureau of Statistics (UBOS) Kampala Uganda World Health Organisation (WHO) Kampala Uganda

Introduction: During 1986-2009, an estimated 1.6 million persons were internally displaced from northern and eastern regions of Uganda due to civil war. We investigated accessibility to and availability of health care services for the internally displaced persons in Kitgum and Pader districts, northern Uganda. Methods: This was a cross-sectional study conducted in Kitgum and Pader districts, northern Uganda. We interviewed a total of 1383 respondents comprising 968 (70%) adults and 415 (30%) adolescents;60% were females and 40% males, randomly selected from 35 of 67 (52.2%) internally displaced persons (IDP) camps. We held 27 key informant interviews and 52 focus group discussions. Data were entered in EPI data version 3.02 and analysed using SPSS version 12.00 statistical packages. Findings: Two thirds of the respondents 67.5% lived within 5 km distance of a health facility. The majority 62.9% of respondents mentioned that health related information was readily provided. 43.5% of health providers were always available in a health facility. A quarter 25.1% of health facilities always had drugs available, while 56.9% of the drugs prescribed were always available. Two thirds of the respondents 65.9% were satisfied with the health care services provided. The main reasons for the choice of a health facility were proximity 29.6%, provision of free treatment 24.7% and availability of drugs 17.2%. Main barriers to health care access were due to the lack of financial resources, trained personnel, and inadequate drugs and supplies in the health facilities. Conclusions and Recommendations: The majority of IDPs lived in close proximity to health facilities and obtained health care services from public health facilities. Access to health care was determined mainly by proximity and availability of free services and drugs. Although geographic accessibility to health services was high, lack of finances, information and decision power hindered access to health care services.

关键词： Accessibility Availability Health Care Services Quality Satisfaction Internally displaced Persons Uganda

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Into the Fold Refugees, internally displaced persons, returnees and the challenge of integration in Africa

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ChinAfrica 2019年第3期11卷 16-17页

作者： Charles Onunaiju Center for China Studies in Abuja Nigeria

Refugees,internally displaced persons,returnees and the challenge,of integration in Africa.

关键词： Refugees internally displaced persons Africa

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Estimating the Lost Economic Production Caused by Internal Displacement Because of Disasters

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International Journal of Disaster Risk Science 2018年第4期9卷 496-506页

作者： Mario A.Salgado-Gálvez Centre Internacional de Metodes Numerics en Enginyeria(CIMNE) 08034 BarcelonaSpain

Disasters are a large cause of internal displacement at the global level, in 2017 alone affecting more than19 million people. This dimension of disaster risk is usually overlooked in many disaster risk management strategies and assessments. It is only very recently that efforts to quantify displacement risk and integrate that dimension into existing physical risk models have been made. A key component of internal displacement assessment is the quantification of its economic impacts, both direct and indirect, not only to make a figure available but to raise awareness and increase accountability among governments, stakeholders, policymakers, and decision *** article presents a novel and peril-agnostic methodology with which to estimate, using a scenario-based approach, the economic production lost because of internal population displacement. The methodology is applied by using as a triggering event the April 2015 Gorkha, Nepal M7.8 earthquake. The method quantifies the indirect cost caused by internal population displacement because of that event in terms of lost economic production and estimates the loss to be between USD 400 and 850 million.

关键词： Disability adjusted life years Disaster risk Internally displaced people Lost economic production Disaster risk assessment

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Effect of early surgery in high surgical risk geriatric patients with femoral neck fracture and taking antiplatelet agents

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World Journal of Orthopedics 2015年第11期6卷 970-976页

作者： Paphon Sa-ngasoongsong Noratep Kulachote Norachart Sirisreetreerux Pongsthorn Chanplakorn Sukij Laohajaroensombat Nithiwut Pinsiranon Patarawan Woratanarat Viroj Kawinwonggowit Chanyut Suphachatwong Wiwat Wajanavisit Department of Orthopedics Faculty of Medicine Ramathibodi HospitalMahidol University

AIM: To investigate the effect of early surgical intervention on the high surgical risk elderly patients who sustained femoral neck fracture(FNF) and taking concomitant antiplatelet agents. METHODS: Between 2010 and 2012, a prospective study was conducted on 49 geriatric patients, who took antiplatelet agents, sustained FNF and underwent surgery within 72 h [early surgery(ES) group], and these were compared with a retrospective consecutive case series of patients with similar characteristics(45 cases) who had delayed surgery(DS group) after 72 h during an earlier 3-year period. Postoperative outcomeswere followed for one year and compared. RESULTS: There were non-significant differences in perioperative blood loss, blood transfusion, intensive care unit requirement and postoperative mortality(P > 0.05 all). There were 2 patients(4%) in the DS group who died after surgery(P = 0.23). However, the ES group showed a significantly better postoperative outcome in terms of postoperative complications, length of hospital stay, and functional outcome(P < 0.05 all).CONCLUSION: Early hip surgery in geriatric hip fracture patients with ongoing antiplatelet treatment was not associated with a significant increase of perioperative blood loss and postoperative mortality. Moreover, ES resulted in a better postoperative surgical outcome. In early hip surgery protocol, the antiplatelet agents are discontinued and the patient is operated on within 72 h after admission, which is safe and effective for the medically fit patients.

关键词： Early hip surgery Blood loss Elderly hip fracture Antiplatelet agents displaced femoral neck fracture Hip arthroplasty

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