Avoiding immediate whole-body trauma CT: a prospective observational study in stable trauma patients

2022 ◽  
Author(s):  
Elisa Reitano ◽  
Stefano Granieri ◽  
Fabrizio Sammartano ◽  
Stefania Cimbanassi ◽  
Miriam Galati ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Whole Body ◽  
Trauma Patients ◽  
Trauma Ct

A prospective observational study of combinatorial abiraterone (AA) and radical radiotherapy (RT) in node-positive (N+) prostate cancer (PCa).

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e17555-e17555
Author(s):  
Mark Ting Le Tan ◽  
Wai Yee Woo ◽  
Adelene Sim Yen Ling ◽  
Jeffrey Tuan ◽  
Terence Wee Kiat Tan ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Treatment Protocol ◽  
Whole Body ◽  
Control Group ◽  
Genetic Profiling ◽  
Psma Pet ◽  
Psa Response ◽  
Secondary Endpoints

e17555 Background: The conventional treatment backbone of N+ PCa has been hormonal therapy (HT) alone. Nonetheless, evidence from the STAMPEDE trial suggests that there could be survival benefit with the addition of local RT or AA, and there may be synergy between RT and AA in these advanced patients. We therefore conducted a prospective observational study to evaluate the efficacy of combination AA+HT+RT in patients with N+ PCa. Here, we report the preliminary biochemical response and toxicity data. Methods: Patients with N+M0/N+M1a, biopsy-proven adenocarcinoma of the prostate were enrolled. Patients were staged by 68Ga-PSMA-PET or whole body MRI. Exclusion criteria were i) ECOG ≥2; ii) cardiac event of < 6 mo interval; iii) bone and visceral metastasis. Treatment protocol entailed 18 mo of combination AA (1000 mg plus 5 mg prednisolone once daily) and HT (LHRH agonist/antagonist); RT was delivered to the prostate (78 Gy) +/- pelvis (54 Gy with simultaneous boost of 60-66 Gy to grossly involved lymph nodes in M0 patients). This was matched against a control group that received long-term HT +/- RT (N = 38). Primary endpoint of this analysis was PSA ≤0.1 ng/ml at 6 mo; secondary endpoints were PSA ≤0.1 ng/ml, testosterone ≤0.7 nmol/l at 12 mo, and toxicity outcomes. Germline genetic profiling was performed in all patients. Results: From Feb 2017 to Aug 2019, 18 men were recruited to this study, with a median fu of 15 mo (range 6.0-35.0 mo). Median age was 66.0 y (IQR 62.0-71.0y); median baseline PSA was 18.2 ng/ml (range 3.0-272); 66.7% had GS 8-10 disease; and 22.2% had M1a disease. Combination AA+HT+RT achieved PSA of ≤0.1 ng/ml in 80.0% (N = 12) and 93.3% (N = 14) of patients at 6 mo and 12 mo, respectively, in contrast to 29.4% and 25.0% of patients who were treated with HT+RT and HT alone, respectively. We observed profound castration of 87.5% (N = 14) at 6 mo, and 91.7% (N = 11) at 12 mo. Four and 6 patients experienced acute G2 genitourinary and gastrointestinal toxicities during RT, respectively; 2 patients reported late G2 GU. One patient experienced G2 fatigue and G1 liver enzyme dysfunction, resulting in dose reduction of AA. Genetic testing revealed a patient with BRCA2 frameshift mutation; interestingly, this patient failed to achieve a PSA of ≤0.1 ng/ml at 12 mo. Conclusions: We demonstrate that combinatorial AA+HT and definitive RT is well tolerated, and yield a pronounced early PSA response in N+ PCa. Long-term data will inform if this early efficacy signal leads to improved survival in these patients.

Quality of Care Variations in a Multi-Institutional Prospective Observational Study of Chest Tube Use in Adult Trauma Patients

2019 ◽  
Vol 229 (4) ◽  
pp. e63
Author(s):  
Michaela A. West ◽  
Joseph Farhat ◽  
Barb Curran ◽  
M. Kelley Bullard ◽  
Charles Fox ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Observational Study ◽  
Chest Tube ◽  
Prospective Observational Study ◽  
Trauma Patients

scholarly journals MP14: Quantification of head-neck motion in trauma patients in the emergency department under spinal motion restriction: a prospective observational study

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S47-S47
Author(s):  
M. Kulas ◽  
L. Brueton-Campbell ◽  
E. Weldon ◽  
N. McDonald ◽  
R. Pryce
Keyword(s):  
Emergency Department ◽  
Observational Study ◽  
Prospective Observational Study ◽  
Injury Severity ◽  
Low Risk ◽  
Trauma Patients ◽  
Patient Handling ◽  
Spinal Motion ◽  
Flexion Extension ◽  
Head Neck

Introduction: This was a prospective observational study involving a convenience sample of low-risk trauma patients presenting to a Level 1 Trauma Centre under spinal motion restriction (SMR). To our knowledge no prior studies have objectively measured head-neck (H-N) motion in trauma patients with suspected spine injuries during emergency department (ED) care. The goal was to establish the feasibility of deploying non-invasive motion sensors on trauma patients in the ED and to provide initial estimates for H-N kinematics under SMR during different phases of treatment. Methods: Low-risk adult patients treated by Winnipeg Fire Paramedic Service who sustained non-life threatening trauma with the potential for spine injury were eligible for inclusion. Participants received usual pre-hospital care; application of spine board and/or cervical collar, as determined by local practice protocol. Inertial measurement units (IMUs) were placed on participant's forehead, sternum and stretcher upon arrival to the ED. Data was collected during three phases of care: patient handling (log rolls, transfers, clothing removal); stretcher movement (to imaging, etc); stretcher stationary. IMUs were removed upon disposition decision by the attending physician. IMUs yielded data on H-N motion in terms of linear acceleration (resultant) and angular displacement (rotation + flexion-extension + side-flexion = total). Peak (M +/- SE) displacements and accelerations are reported, with comparisons across treatment phases using repeated measures ANOVA. Results: Eleven patients were enrolled in the study (age: 49 +/- 16 years; Injury Severity Score 13.4 +/- 9.9; female = 2). Substantial H-N motion was observed during ED care. Total H-N displacement (28.6 +/- 3.6 deg) and acceleration (7.8 +/- 1.0 m/s2) were higher during patient handling compared to stretcher moving (13.0 +/- 2.5 deg; 4.6 +/- 0.9 m/s2; p < .05) but not while the stretcher was stationary (18.9 +/- 3.4 deg; 5.4 +/- 1.2 m/s2; p > .06). Similar differences were detected for side-flexion and flexion-extension (p < .05), with peak displacements of 11.4+/-1.5 deg and 14.6 +/- 2.2 deg during patient handling, respectively. Conclusion: IMU use on trauma patients safely described H-N motion kinematics in a small sample of patients with different spectrums of illness during their care in the ED. Future studies utilizing IMUs could inform ED spine motion restriction protocols and compare movement of patients in specific subsets (intoxicated, spinal tenderness, injury severity etc.).

Preliminary outcomes of a prospective observational study of combinatorial abiraterone acetate/enzalutamide (AA/Enz) and radical radiotherapy (RT) in nonmetastatic node-positive (N+M0) prostate cancer (PCa).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 227-227
Author(s):  
Mark Ting Le Tan ◽  
Wai Yee Woo ◽  
Jeffrey Tuan ◽  
Terence Wee Kiat Tan ◽  
Michael Lian Chek Wang ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Treatment Protocol ◽  
Median Number ◽  
Abiraterone Acetate ◽  
Whole Body ◽  
High Dose ◽  
Once Daily ◽  
Genetic Profiling ◽  
Psma Pet

227 Background: Treatment paradigm for N+M0 PCa has evolved, with the advent of multiple options for upfront AA/Enz or RT in combination with conventional hormonal therapy (HT). However, the optimal treatment protocol remains undefined. We therefore conducted a prospective observational study of combination AA/Enz+RT in N+M0 PCa patients. Methods: Patients with biopsy-proven adenocarcinoma of the prostate and N+M0 by imaging (68Ga-PSMA-PET or whole body MRI) were included. Exclusion criteria were 1) ECOG ≥2; 2) severe comorbidities; 3) cardiac event of <6 mo interval. Treatment protocol involved 18 mo of AA (1000 mg with 5 mg prednisolone once daily)/Enz (160 mg once daily)+HT (LHRH agonist/antagonist) in combination with RT to pelvis (54 Gy with simultaneous boost of 60-66 Gy in 27 fr) and prostate (78 Gy/39 fr); RT commenced 1-3 mo upon initiation of AA/Enz. Primary endpoint of this analysis was PSA of ≤0.1 ng/ml at 12 mo. Results: From Jun 2017-Sep 2019, 13 men were recruited; median follow-up duration was 14.0 mo (range 3.0-28.0 mo). Median age of the cohort was 67.0 y (IQR 61.0 – 69.0 y); 84.0% of men had GS8-10 disease, and median number of cN+ nodes was 2 (range 1-5 nodes). 11 received AA, and 2 received Enz. 53.8% (N = 7) and 69.2% (N = 9) of patients achieved a PSA nadir of ≤0.1 ng/ml at 6.0 and 12.0 mo, respectively; this contrasts against a propensity-matched cohort (N = 27) treated by HT+RT alone (33.3% and 51.9%, respectively). No biochemical recurrence was recorded at the time of analysis. 3 and 2 acute ≥G2 GU and GI toxicities were reported during RT. Late ≥G2 GU toxicities were observed in 2 men (G2 frequency). 2 patients experienced G2 fatigue and one with G2 transaminitis secondary to AA, with dose reduction. Germline genetic profiling with whole exome sequencing revealed two patients (15.4%) with BRCA2 frameshift mutations; interestingly, GU/GI RT toxicities were not observed in these patients. Conclusions: Our preliminary results suggest that combinatorial AA/Enz and high dose RT is tolerated and can induce a pronounced PSA response in low volume N+M0 PCa.

Trauma Computed Tomography in the Modern Era: Not Always Quick and Safe

2021 ◽  
pp. 000313482110613
Author(s):  
Cameron Ghafil ◽  
Kazuhide Matsushima ◽  
Hiroto Chiba ◽  
Renqing Wu ◽  
Heeseop Shin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Adverse Events ◽  
Ct Scanning ◽  
Trauma Team ◽  
Whole Body ◽  
Trauma Patients ◽  
Diagnostic Modality ◽  
Scanning Process ◽  
Whole Body Ct ◽  
Trauma Ct

Background Computed tomography (CT) has emerged as the diagnostic modality of choice in trauma patients. Recent studies suggest its use in hemodynamically unstable patients is safe and potentially lifesaving; however, the incidence of adverse events (AE) during the trauma CT scanning process remains unknown. Study Design Over a 6-month period at a Level 1 trauma center, data on patients undergoing trauma CT (whole-body CT (WBCT) +/− additional CT studies) were prospectively collected. All patients requiring a trauma team activation (TTA) were included. Adverse events and specific time intervals were recorded from the time of TTA notification to the time of return to the resuscitation bay from the CT suite. Results Of the 94 consecutive patients included in the study, 47.9% experienced 1 or more AE. Median duration away from the resuscitation bay for all patients was 24 minutes. Patients with AE spent a significantly longer time away from the resuscitation bay and had longer scan times. Vasopressor support and ongoing transfusion requirement at the time of CT scanning were associated with AE. Conclusion Adverse events of varying clinical significance occur frequently in patients undergoing emergent trauma CT. A standard trauma CT protocol could improve the efficiency and safety of the scanning process.

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