Key Points
Question
Is cerebrospinal fluid (CSF) diversion associated with improved outcomes or intracranial pressure in children with severe traumatic brain injury (TBI)?
Findings
In this comparative effectiveness study of 1000 children with severe TBI, there was no association between CSF diversion and Glasgow Outcome Score–Extended for Pediatrics at 6 months after injury in propensity-matched participants. However, CSF diversion was associated with decreased intracranial pressure in the propensity-matched participants.
Meaning
These findings suggest that the current evidenced-based guidelines that support CSF diversion as a first-line therapy for TBI in children should be reconsidered.
Although there is significant mortality among children with HIV infection admitted to PICU, many of them survive their admission, and over 80% of the survivors have good outcomes with the currently available highly active anti-retroviral therapy. This provides evidence that intensive care treatment is appropriate for this group of patients in the United Kingdom.
Collision with any vehicle can result in death or serious injury to a cyclist. Injury patterns vary with the type of vehicle involved. HGVs were associated with severe injuries and death as a result of uncontrollable haemorrhage. Awareness of this injury profile may aid prehospital management and expedite transfer to MTC care. Rapid haemorrhage control may salvage some, but not all, of these casualties. The need for continued collision prevention strategies and long-term outcome data collection in trauma patients is highlighted.
Debriefing is well established in healthcare teams after acute events, with a focus on clinical learning, improving practice and performance; however, the term is perceived by psychologists as something quite different. This article describes the Time Out model as a standardised method of providing support to staff after events that may cause distress. In addition to exploring clinical issues, the model aims to promote peer support networks, educate staff regarding common reactions to traumatic events and signpost to other sources of support.
We present a rare case of perineal recurrence of prostate cancer post low dose rate brachytherapy. Increased levels of prostate-specific antigen were recorded 12 years post brachytherapy. Pelvic CT and MRI visualized a nodular lesion in the perineum, and positron emission tomography demonstrated choline-avidity. Ultrasound-guided biopsy of the nodule was performed, yielding histology consistent with prostatic adenocarcinoma. Metastatic prostatic seeding to the perineum is a rare complication of brachytherapy. We discuss the putative mechanism, approach to diagnosis, and management.
Prostate cancer P rostate cancer accounts for a quarter of the male cancers managed in a GP's everyday practice. As GPs are the patient's primary point of contact, this article will outline when and how to investigate prostate cancer and discuss the ramifications of investigations such as the prostate-specific antigen test. Treatment options, their relative benefits and risks are discussed along with the role of the GP in palliative care, coordinating symptom control and planning for end of life.
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