Search Results (12)

Prompt reversal of anticoagulation in the elderly population with subdural hematoma (SDH) is critical to reduce morbidity and facilitate timely surgical intervention. In patients receiving dabigatran, idarucizumab provides rapid anticoagulation reversal. We evaluated clinical and radiological outcomes of dabigatran-treated SDH patients receiving idarucizumab, including those undergoing surgical management. We conducted a single-center retrospective observational study of dabigatran-treated patients who received idarucizumab reversal for traumatic or spontaneous SDH between 2016 and 2024. Hematoma evolution was monitored using follow-up computed tomography. Clinical and neurological outcomes were recorded. Of eleven included patients (mean age 80.8 ± 6.7 years; 36% female), falls were the primary cause (64%). SDH was chronic in 64% and acute in 36%, with associated traumatic lesions in 33%. Surgical evacuation was performed in 82% of cases. Anticoagulation was resumed in 27% of patients within 3–4 weeks post-discharge. The median Glasgow Outcome Scale Extended (GOSE) score was 5, indicating moderate disability. In-hospital mortality was 9.1%. Idarucizumab enabled rapid and safe dabigatran reversal in this high-risk elderly cohort, supporting both surgical and conservative SDH management. Functional outcomes were moderate and mortality was low, underscoring its clinical utility. Targeted reversal strategies remain essential, and further research should refine long-term anticoagulation management. Full article

Background and Importance: Chronic subdural hematoma (cSDH) is a common and complex neurosurgical problem, particularly in elderly patients. Revision surgery for chronic subdural hematoma can be challenging, particularly in cases with inhomogeneous, firm consistency and extensive adhesions. Clinical Presentation: In this article, we present our endless-loop craniotomy technique, which offers a novel approach to address these challenges by performing the wide, curved exposure of the subdural space utilizing the already-present burr hole. This technique allows for a wide, unobstructed view of the subdural space, enabling the access and evacuation of this chronic and often adhesive subdural hematoma. Conclusion: We believe that endless-loop craniotomy is a valuable addition to the neurosurgeon’s armamentarium for managing complex cases of revision surgery in chronic subdural hematomas. Full article

The cognitive ability of the elderly significantly influences evacuation performance in urgent situations. Despite its importance, many fire evacuation studies overlook the impact of cognitive ability on elderly evacuation performance. To address this gap, this study employs multicriteria decision-making to identify nudging factors that enhance the cognitive abilities of the elderly during fire evacuations in long-term care facilities. Based on a literature review, key nudging factors include guidance lights, guide lines, handrails, and guidance equipment, with sub-criteria such as location, color, size, and intervals. Experts from academic and practical fields analyzed the nudging factors, followed by a hybrid analytic hierarchy process (AHP–TOPSIS) analysis. The findings emphasize the necessity of providing auditory information through guidance equipment (e.g., voice evacuation system) in high-level scenarios (practice experts AHP: 0.31) and visual information through the continuous installation of guide lines in strategic locations (academic experts AHP: 0.35) to facilitate efficient evacuation. As a result, this study confirms both the differing and concordant opinions among expert groups while recognizing the absolute necessity of elderly evacuation research and considering the unique challenges that prevent actual evacuation experiments with elderly individuals. By synthesizing these perspectives, the study derives the weights and ranks of nudging factors based on urgent-level circumstances, thereby conducting a quantitative assessment of factors that enhance cognitive ability during elderly evacuation. The findings of this study can serve as a basis for future evacuation policy formulation for elderly-related facilities and, as a derivative effect, contribute to ensuring the life safety of elderly individuals within the local community. Full article

Background: Chronic subdural hematoma (CSDH) is a common neurosurgical condition that usually occurs in the elderly. Surgical evacuation of the hematoma with burr holes is considered the standard of care for the treatment of patients with CSDH. However, a high risk of recurrence, up to 34%, after hematoma evacuation has been reported, while the risk factors linked with recurrence have not been studied in depth. In the present study, we set out to identify risk factors of recurrence in patients surgically treated for CSDH. Methods: We retrospectively studied patients with symptomatic CSDH who were treated surgically in our institute during a five-year period. All the patients were treated by single or double burr hole drainage. The data for this study were extracted by the pre-operative and post-operative CT scan of each patient. These data include the sex, the midline shift, the width, and the presence of acute clots and subdural air collection post-operatively. A univariate analysis was performed. A receiver operating characteristic (ROC) analysis was utilized to detect the hematoma’s width more efficiently, differentiating patients that developed recurrence. Results: A total of 222 patients were included in this study. Recurrence occurred in 20 (9.0%) patients. The univariate analysis showed that the presence of acute clots post-operatively are significant factors related with recurrence (OR = 4.01, CI 95% 1.55–10.33, and p = 0.002). There was no significant relationship between the recurrence rate and the hematoma’s width, sex, the midline shifts pre-operatively or post-operatively, the subdural space, and air collection post-operatively. Conclusions: The presence of acute clots in the post-operative CT scan is a potential, previously unexplored, risk factor associated with the recurrence of CSDH. Full article

Digital technologies can support designers in balancing architectural heritage conservation and performances using multidisciplinary approaches. Fire safety represents a challenging issue, especially in public historical buildings hosting vulnerable occupants, since heavy modifications are often required to facilitate their evacuation. Digital tools based on evacuation simulation are able to verify the impact of other sustainable, compatible evacuation management and planning approaches, especially considering the use of generic software, which can be used by low-trained technicians according to rapid setups. Nevertheless, simulator reliability should be experimentally verified through case study applications. This work thus offers the experimental verification of a rapid setup-based generic evacuation simulator in the context of a significant case study (the “Omero Museum”, Ancona, Italy), placed in a historic building hosting vulnerable occupants (disabled, elderly, children), thanks to a full-scale evacuation drill. The rapid setup described different vulnerable occupants’ categories according to literature data. Comparisons between drill and simulation results, using consolidated verification indicators, showed the overall reliability of the proposed approach, and thus encourage additional tests in historical buildings. The proposed setup-based simulator could be combined with other digital tools (virtual reality, BIM-related) to provide full support to fire risk and evacuation assessments when vulnerable occupants are present. Full article

Chronic subdural hematoma (cSDH) is one of the most common neurosurgical entities, especially in the elderly population. Diagnosis is usually established via a head computed tomography, while an increasing number of studies are investigating biomarkers to predict the natural history of cSDH, including progression and recurrence. Surgical evacuation remains the mainstay of treatment in the overwhelming majority of cases. Nevertheless, many controversies are associated with the nuances of surgical treatment. We performed a systematic review of the literature between 2010 and 2022, aiming to identify and address the issues in cSDH surgical management where consensus is lacking. The results show ambiguous data in regard to indication, the timing and type of surgery, the duration of drainage, concomitant membranectomy and the need for embolization of the middle meningeal artery. Other aspects of surgical treatment—such as the use of drainage and its location and number of burr holes—seem to have been adequately clarified: the drainage of hematoma is strongly recommended and the outcome is considered as independent of drainage location or the number of burr holes. Full article

Objective: The aim of this study was the verification of the Subdural Hematoma in the Elderly (SHE) score proposed by Alford et al. as a mortality predictor in patients older than 65 years with nontraumatic/minor trauma acute subdural hematoma (aSDH). Additionally, we evaluated further predictors associated with poor outcome. Methods: Patients were scored according to age (1 point is given if patients were older than 80 years), GCS by admission (1 point for GCS 5–12, 2 points for GCS 3–4), and SDH volume (1 point for volume 50 mL). The sum of points determines the SHE score. Multivariate logistic regression analysis was performed to identify additional independent risk factors associated with 30-day mortality. Results: We evaluated 131 patients with aSDH who were treated at our institution between 2008 and 2020. We observed the same 30-day mortality rates published by Alford et al.: SHE 0: 4.3% vs. 3.2%, p = 1.0; SHE 1: 12.2% vs. 13.1%, p = 1.0; SHE 2: 36.6% vs. 32.7%, p = 0.8; SHE 3: 97.1% vs. 95.7%, p = 1.0 and SHE 4: 100% vs. 100%, p = 1.0. Additionally, 18 patients who developed status epilepticus (SE) had a mortality of 100 percent regardless of the SHE score. The distribution of SE among the groups was: 1 for SHE 1, 6 for SHE 2, 9 for SHE 3, and 2 for SHE 4. The logistic regression showed the surgical evacuation to be the only significant risk factor for developing the seizure. All patients who developed SE underwent surgery (p = 0.0065). Furthermore, SHE 3 and 4 showed no difference regarding the outcome between surgical and conservative treatment. Conclusions: SHE score is a reliable mortality predictor for minor trauma acute subdural hematoma in elderly patients. In addition, we identified status epilepticus as a strong life-expectancy-limiting factor in patients undergoing surgical evacuation. Full article

The continued increase in human lifespans is accelerating the aging of the population in most countries. The increase in elderly care facilities corresponds to a relative increase in the number of people who are vulnerable in the context of evacuation. For example, an elderly care hospital is a representative facility for vulnerable populations as regards evacuation, as residents in such a hospital cannot evacuate themselves in the event of a fire. It is therefore necessary for such buildings to formulate detailed evacuation plans that consider the walking situations of their residents in the event of a disaster. In this study, the fire dynamics simulator (FDS) was used to calculate the available safety escape time (ASET)—which is the point at which evacuation is impossible from the ignition time of the fire—for inpatients in nursing hospitals. The required safety escape time (RSET), which is the time required to move to a safe place, was calculated by reflecting a patient’s evacuation speed using Pathfinder. In addition, the evacuation route was simulated with three variables—stairs, elevators, and ramps—along with the movement pattern. The simulations of evacuation performance evaluation based on time analysis showed that there were differences in the number of fatalities depending on the choice of evacuation routes and movement patterns for each disabled group. Evacuation using ramps was confirmed to reduce fatalities from at least 48 to up to 60 people compared to evacuation using stairs or elevators. The usage of ramp evacuation in elderly care hospitals has proved to be superior to other evacuation routes in ensuring the safety of vulnerable persons during fire evacuation. Full article

(1) Background: Indoor air pollution can affect the well-being and health of humans. Sources of indoor pollution with particulate matter (PM) are outdoor particles and indoor causes, such as construction materials, the use of cleaning products, air fresheners, heating, cooking, and smoking activities. In 2017, according to the Global Burden of Disease study, 1.6 million people died prematurely because of indoor air pollution. The health effects of outdoor exposure to PM have been the subject of both research and regulatory action, and indoor exposure to fine particles is gaining more and more attention as a potential source of adverse health effects. Moreover, in critical situations such as the current pandemic crisis, to protect the health of the population, patients, and staff in all areas of society (particularly in indoor environments, where there are vulnerable groups, such as people who have pre-existing lung conditions, patients, elderly people, and healthcare professionals such as dental practitioners), there is an urgent need to improve long- and short-term health. Exposure to aerosols and splatter contaminated with bacteria, viruses, and blood produced during dental procedures performed on patients rarely leads to the transmission of infectious agents between patients and dental health care staff if infection prevention procedures are strictly followed. On the other hand, in the current circumstances of the pandemic crisis, dental practitioners could have an occupational risk of acquiring coronavirus disease as they may treat asymptomatic and minimally symptomatic patients. Consequently, an increased risk of SARS-CoV-2 infection could occur in dental offices, both for staff that provide dental healthcare and for other patients, considering that many dental procedures produce droplets and dental aerosols, which carry an infectious virus such as SARS-CoV-2. (2) Types of studies reviewed and applied methodology: The current work provides a critical review and evaluation, as well as perspectives concerning previous studies on health risks of indoor exposure to PM in dental offices. The authors reviewed representative dental medicine literature focused on sources of indoor PM10 and PM2.5 (particles for which the aerodynamic diameter size is respectively less than 10 and 2.5 μm) in indoor spaces (paying specific attention to dental offices) and their characteristics and toxicological effects in indoor microenvironments. The authors also reviewed representative studies on relations between the indoor air quality and harmful effects, as well as studies on possible indoor viral infections acquired through airborne and droplet transmission. The method employed for the research illustrated in the current paper involved a desk study of documents and records relating to occupational health problems among dental health care providers. In this way, it obtained background information on both the main potential hazards in dentistry and infection risks from aerosol transmission within dental offices. Reviewing this kind of information, especially that relating to bioaerosols, is critical for minimizing the risk to dental staff and patients, particularly when new recommendations for COVID-19 risk reduction for the dental health professional community and patients attending dental clinics are strongly needed. (3) Results: The investigated studies and reports obtained from the medical literature showed that, even if there are a wide number of studies on indoor human exposure to fine particles and health effects, more deep research and specific studies on indoor air pollution with fine particles and implications for workers’ health in dental offices are needed. As dental practices are at a higher risk for hazardous indoor air because of exposure to chemicals and microbes, the occupational exposures and diseases must be addressed, with special attention being paid to the dental staff. The literature also documents that exposure to fine particles in dental offices can be minimized by putting prevention into practice (personal protection barriers such as masks, gloves, and safety eyeglasses) and also keeping indoor air clean (e.g., high-volume evacuation, the use of an air-room-cleaning system with high-efficiency particulate filters, and regularly maintaining the air-conditioning and ventilation systems). These kinds of considerations are extremely important as the impact of indoor pollution on human health is no longer an individual issue, with its connections representing a future part of sustainability which is currently being redefined. These kinds of considerations are extremely important, and the authors believe that a better situation in dentistry needs to be developed, with researchers in materials and dental health trying to understand and explain the impact of indoor pollution on human health. Full article

Social vulnerability indicators seek to identify populations susceptible to hazards based on aggregated sociodemographic data. Vulnerability indices are rarely validated with disaster outcome data at broad spatial scales, making it difficult to develop effective national scale strategies to mitigate loss for vulnerable populations. This paper validates social vulnerability indicators using two flood outcomes: death and damage. Regression models identify sociodemographic factors associated with variation in outcomes from 11,629 non-coastal flood events in the USA (2008–2012), controlling for flood intensity using stream gauge data. We compare models with (i) socioeconomic variables, (ii) the composite social vulnerability index (SoVI), and (iii) flood intensity variables only. The SoVI explains a larger portion of the variance in death (AIC = 2829) and damage (R² = 0.125) than flood intensity alone (death—AIC = 2894; damage—R² = 0.089), and models with individual sociodemographic factors perform best (death—AIC = 2696; damage—R² = 0.229). Socioeconomic variables correlated with death (rural counties with a high proportion of elderly and young) differ from those related to property damage (rural counties with high percentage of Black, Hispanic and Native American populations below the poverty line). Results confirm that social vulnerability influences death and damage from floods in the USA. Model results indicate that social vulnerability models related to specific hazards and outcomes perform better than generic social vulnerability indices (e.g., SoVI) in predicting non-coastal flood death and damage. Hazard- and outcome-specific indices could be used to better direct efforts to ameliorate flood death and damage towards the people and places that need it most. Future validation studies should examine other flood outcomes, such as evacuation, migration and health, across scales. Full article

The mobility impaired, the deaf or hard of hearing, the blind or visually impaired, the cognitively impaired, and the elderly population are among several examples of groups categorized as particularly vulnerable to fire-related hazards. Given the severity of the threat that building fires pose for these vulnerable groups in terms of the different types of debilitation they experience, it is crucial to distinguish the respective attributes of each group and map out how such differences lead to differing performance levels during fire evacuations. To better gauge each group’s capacity to cope with building fires, this study collected survey data from social service providers and staff members who provide care for vulnerable healthcare facility residents. The questionnaires were designed to assess each group’s emergency response abilities and render them in quantifiable form in terms of perception, interpretation, decision-making, and mobility. The results of the survey serve as the input values for an evacuation simulation model which analyzes the evacuation performances (i.e., response and movement time) of vulnerable groups. The study concludes by proposing managerial strategies for the enhancement of fire safety in healthcare facilities on the basis of outcome analysis. Understanding the evacuation characteristics of disabled and vulnerable groups is expected to provide a foundation for the safety managers and staff members of relevant facilities to prepare for and deal with unexpected emergencies in an efficient and effective manner. Full article

Glaucoma is a common complex disease that leads to irreversible blindness worldwide. Even though preclinical studies showed that lowering intraocular pressure (IOP) could prevent retinal ganglion cells loss, clinical evidence suggests that lessening IOP does not prevent glaucoma progression in all patients. Glaucoma is also becoming more prevalent in the elderly population, showing that age is a recognized major risk factor. Indeed, recent findings suggest that age-related tissue alterations contribute to the development of glaucoma and have encouraged exploration for new treatment approaches. In this review, we provide information on the most frequently used experimental models of glaucoma and describe their advantages and limitations. Additionally, we describe diverse animal models of glaucoma that can be potentially used in translational medicine and aid an efficient shift to the clinic. Experimental animal models have helped to understand the mechanisms of formation and evacuation of aqueous humor, and the maintenance of homeostasis of intra-ocular pressure. However, the transfer of pre-clinical results obtained from animal studies into clinical trials may be difficult since the type of study does not only depend on the type of therapy to be performed, but also on a series of factors observed both in the experimental period and the period of transfer to clinical application. Conclusions: Knowing the exact characteristics of each glaucoma experimental model could help to diminish inconveniences related to the process of the translation of results into clinical application in humans. Full article