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Background\ud \ud In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI).\ud \ud \ud \ud Methods\ud \ud The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (

Background\ud \ud Prehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients.\ud \ud \ud Methods\ud \ud Patients with moderate and severe TBI (Glasgow Coma Scale

Full list of CENTER TBI Participants and Investigators can be found in publication (p.8-11): https://sjtrem.biomedcentral.com/articles/10.1186/s13049-021-00930-1#Abs1Background: Prehospital care for patients with traumatic brain injury (TBI) varies with some emergency medical systems recommending direct transport of patients with moderate to severe TBI to hospitals with specialist neurotrauma care (SNCs). The aim of this study is to assess variation in levels of early secondary referral within European SNCs and to compare the outcomes of directly admitted and secondarily transferred patients. Methods: Patients with moderate and severe TBI (Glasgow Coma Scale < 13) from the prospective European CENTER-TBI study were included in this study. All participating hospitals were specialist neuroscience centers. First, adjusted between-country differences were analysed using random effects logistic regression where early secondary referral was the dependent variable, and a random intercept for country was included. Second, the adjusted effect of early secondary referral on survival to hospital discharge and functional outcome [6 months Glasgow Outcome Scale Extended (GOSE)] was estimated using logistic and ordinal mixed effects models, respectively. Results: A total of 1347 moderate/severe TBI patients from 53 SNCs in 18 European countries were included. Of these 1347 patients, 195 (14.5%) were admitted after early secondary referral. Secondarily referred moderate/severe TBI patients presented more often with a CT abnormality: mass lesion (52% vs. 34%), midline shift (54% vs. 36%) and acute subdural hematoma (77% vs. 65%). After adjusting for case-mix, there was a large European variation in early secondary referral, with a median OR of 1.69 between countries. Early secondary referral was not associated with functional outcome (adjusted OR 1.07, 95% CI 0.78–1.69), nor with survival at discharge (1.05, 0.58–1.90). Conclusions: Across Europe, substantial practice variation exists in the proportion of secondarily referred TBI patients at SNCs that is not explained by case mix. Within SNCs early secondary referral does not seem to impact functional outcome and survival after stabilisation in a non-specialised hospital. Future research should identify which patients with TBI truly benefit from direct transportation.

IMPORTANCE:Intraocular lens (IOL) calculations in post-refractive cases remain a concern. Our study identifies improved options for surgeons. BACKGROUND:To evaluate and compare the prediction accuracy of IOL power calculation methods after previous laser refractive surgery using standard keratometry (SK), measured posterior corneal astigmatism (PCA) and total keratometry (TK). DESIGN:Retrospective consecutive cohort. PARTICIPANTS:A total of 50 consecutive patients (72 eyes) at a private institution who underwent cataract surgery with prior laser refractive procedures. METHODS:Methods using SK included ASCRS mean, Barrett True-K no history, Haigis-L and Shammas IOL formulae. Barrett True-K using posterior values (True K TK), Haigis and Holladay 1 Double-K methods using TK were also assessed. Post-surgery refraction was undertaken at minimum 3 weeks following surgery. MAIN OUTCOME MEASURES:Arithmetic and absolute IOL refractive prediction errors, variances in mean arithmetic IOL prediction error, and percentage of eyes within ±0.25D, ±0.50D, ±0.75D and ±1.00D of refractive prediction errors were compared. RESULTS:The Barrett True-K (TK) provided the lowest mean refractive prediction error (RPE) and variance for both prior myopes and hyperopes undergoing cataract surgery. The Barrett True-K (TK) exhibited the highest percentages of eyes within ±0.50D, ±0.75D and ±1.00D of the RPE compared to other formulae for prior myopic patients. CONCLUSIONS AND RELEVANCE:Accuracy of IOL power calculations in post-laser eyes can be improved by the addition of posterior corneal values as measured by the IOLMaster 700. The use of total keratometry may supplement outcomes when no prior refraction history is known.

Background Expert opinion derived disability weights are widely employed for estimating the global burden of diseases and injuries. For chronic diseases such as soil transmitted helminthiasis and schistosomiasis it has been suggested that a patient based quality of life (QoL) approach should be considered for a more accurate appraisal of disability weights. Methods and Results We carried out a cross sectional survey and assessed the prevalence and intensity of soil transmitted helminth infections as well as self rated QoL indicators among 252 students attending grades 5 8 in two schools (Bulangshan and Pu'er) in Yunnan province People's Republic of China. Each student provided a single stool sample which was subjected to duplicate Kato Katz thick smear readings and a single FLOTAC examination for parasitological diagnosis. Prevalence rates for hookworm Trichuris trichiura and Ascaris lumbricoides were high in Bulangshan (75.9 70.0 and 68.2) while the respective prevalence rates in Pu'er were 66.9 56.5 and 9.2. Students were interviewed with two standardised questionnaires the EuroQoL 5 Dimensions (EQ 5D) and ShortForm 12 (SF 12) Health Survey. Impairment in any of the five dimensions of the EQ 5D was reported by 87 of the students. However no clear differences could be observed between individuals with and those without helminth infections and there were discrepancies between the two schools. A multivariate logistic regression model revealed no differences between students with varying infection status in the domains of the SF 12 (odds ratio close to 1.0). Somewhat more pronounced yet not statistically significant differences were observed when end of school term marks were compared with students' helminth infection status: infected individuals had lower marks in Chinese English and mathematics but not in sports compared to their helminth free counterparts. Conclusions Our results point to unresolved issues and challenges regarding the cultural appropriateness of the widely used standard QoL questionnaires. Hence new research is needed to further develop these instruments and to validate them in connection with chronic parasitic diseases.

The presence of large Trichuris spp. eggs in human faecal samples is occasionally reported. Such eggs have been described as variant Trichuris trichiura or Trichuris vulpis eggs. Within the frame of a randomised controlled trial, faecal samples collected from 115 Bulang individuals from Yunnan, People's Republic of China were subjected to the Kato-Katz technique (fresh stool samples) and the FLOTAC and ether-concentration techniques (sodium acetate-acetic acid-formalin (SAF)-fixed stool samples). Large Trichuris spp. eggs were noted in faecal samples with a prevalence of 6.1% before and 21.7% after anthelminthic drug administration. The observed prevalence of standard-sized T. trichiura eggs was reduced from 93.0% to 87.0% after treatment. Considerably more cases of large Trichuris spp. eggs and slightly more cases with normal-sized T. trichiura eggs were identified by FLOTAC compared to the ether-concentration technique. No large Trichuris spp. eggs were observed on the Kato-Katz thick smears.