Trauma Network for Severely Injured Patients.

Trauma network for severely injured patients.

Ann Fr Anesth Reanim. 2013 Jul 29;
Bouzat P, Broux C, Ageron FX, Thony F, Arvieux C, Tonetti J, Gay E, Rancurel E, Payen JF

Survival after severe trauma may depend on a structured chain of care from the management at the scene of trauma to hospital care and rehabilitation. In the USA, the trauma system is organized according to a pre-hospital triage by paramedics to facilitate the admission of patients to tertiary trauma centres. In France, trauma patients are transported to the most suitable facility, according to the on-scene triage by an emergency physician. Because French hospital’s resources become scarce and expensive, the access to all techniques of resuscitation after severe trauma is restricted to tertiary trauma centres, at the expense of prolonged duration of transfer to these centres with a possible impact on mortality. The Northern French Alps Emergency Network created a regional trauma network system in 2008. This organization was based upon the interplay between the resources of each hospital participating to the network and the categorization of trauma severity at the scene. A regional registry allows the assessment of trauma system, which has included 3,690 severe trauma patients within the past 3years. Bystanders, medical call dispatch centres, and interdisciplinary trauma team should form a structured and continuous chain of care to allocate each severe trauma patient to the best place of treatment. HubMed – rehab

Intensive complete decongestive physiotherapy for cancer-related upper-limb lymphedema: 11days achieved greater volume reduction than 4.

Gynecol Oncol. 2013 Jul 29;
Vignes S, Blanchard M, Arrault M, Porcher R

Upper-limb lymphedema (ULL) occurs in 15%-20% of women after breast-cancer treatment. Its intensive therapy relies on complete (complex) decongestive physiotherapy (CDP), whose duration is not well-established.Determine optimal intensive-phase CDP duration for lymphedema-volume reduction and factors predicting its success, with the hope of halving it from 11 to 4days.All patients with ULL (08/2011-06/2012) after breast-cancer treatment referred to our Department of Lymphology in a rehabilitation facility for 11days of CDP were eligible. Lymphedema volume was calculated using the truncated-cone formula. Volume reduction considered clinically relevant after 4days was defined as ?75% of the total reduction obtained after 11days.We included 129 women (mean age: 64 (range: 42-88) years). Mean (sd) lymphedema volume was 907 (558) ml at CDP onset, decreased to 712 (428) ml after 4days (vs. onset, P<.0001) and 606 (341) ml after 11days (vs. 4, P<.0001), corresponding to 33% total lymphedema-volume reduction. For all patients, 4days of CDP achieved 63% (sd 40%) of that total reduction, with ?75% for 50 (39%) patients. Surgery-to-lymphedema-onset interval >2years was the only factor significantly associated with 4days achieving ?75% of the total lymphedema-volume reduction.Intensive phase CDP for 11days obtained significantly more volume reduction of breast cancer-related ULL than 4. HubMed – rehab

[Chinese experts consensus on cardiac rehabilitation/secondary prevention for coronary artery disease].

Zhonghua Xin Xue Guan Bing Za Zhi. 2013 Apr; 41(4): 267-75
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HubMed – rehab