KCI (Germany)

To characterize and evaluate indications for use of damage control (DC) surgery in civilian trauma patients. Although DC surgery may improve survival in select, severely injured patients, the procedure is associated with significant morbidity, suggesting that it should be used only when appropriately indicated. Two investigators used an abbreviated grounded theory method to synthesize indications for DC surgery reported in peer-reviewed articles between 1983 and 2014 into a reduced number of named, content-characteristic codes representing unique indications. An international panel of trauma surgery experts (n = 9) then rated the appropriateness (expected benefit-to-harm ratio) of the coded indications for use in surgical practice. The 1107 indications identified in the literature were synthesized into 123 unique pre- (n = 36) and intraoperative (n = 87) indications. The panel assessed 101 (82.1%) of these indications to be appropriate. The indications most commonly reported and assessed to be appropriate included pre- and intraoperative hypothermia (median temperature <34°C), acidosis (median pH <7.2), and/or coagulopathy. Others included 5 different injury patterns, inability to control bleeding by conventional methods, administration of a large volume of packed red blood cells (median >10 units), inability to close the abdominal wall without tension, development of abdominal compartment syndrome during attempted abdominal wall closure, and need to reassess extent of bowel viability. This study identified a comprehensive list of candidate indications for use of DC surgery. These indications provide a practical foundation to guide surgical practice while studies are conducted to evaluate their impact on patient care and outcomes.

Two hundred eighteen persons with myasthenia gravis (MG) responded to a mailed survey regarding experiences with their disease. The most commonly used regimen reported to control MG was taking medication on a regular schedule. One hundred ninety-four respondents reported using pyridostigmine bromide with 104 reporting experiencing diarrhea from their medication. Respondents reported situations that aggravated and alleviated adverse effects associated with their medication. Sixty-two respondents reported taking prednisone regularly for their MG. Forty-five of these respondents reported a weight gain. Seventy-seven respondents reported having had a thymectomy. The total remission rate was 11.6% for those who had undergone thymectomy and was 10.2% for those who had not undergone thymectomy. Thirty-one respondents reported having had plasmapheresis with only 3 respondents using plasmapheresis on a regular basis. Results generated by this study can provide useful information to assist nurses in the development of educational materials for persons with MG, their significant others and health care professionals.