Category Archives: General

Crowdfunding: The Future Of Research Funding?

Many readers are familiar with the concept of “crowdsourcing”, or tapping into a pool of people connected via the internet to obtain something of value. This something might be information, services (think Uber), or content (99designs). And with the advent of websites like KickStarter, it is now possible to crowdsource money.

As anyone who has an academic focus can attest, there is tremendous pressure to pursue (hopefully) meaningful research. In many cases, this is an integral part of keeping one’s job. But research is expensive. Even the simplest retrospective study requires some kind of statistical analysis, and statisticians don’t work for free. And in more sophisticated research labs, there are huge personnel, equipment, as well as other infrastructure costs. 

Traditionally, researchers have pursued grant dollars from single sources like the federal government, local agencies, corporations, and charitable organizations. But this is very competitive, and it’s usually an all or none proposition. Only one of many applications gets all the cash, and the rest get none.

But now, crowdsourcing has moved beyond the technology and design type projects seen on KickStarter to what is now called crowdfunding. There are a number of sites that solicit small donations from individuals, pooling them together into large amounts. The largest campaign on KickStarter was able to amass over $20 million to create a new version of the Pebble watch. A small campaign to get $10 to develop a potato salad recipe ended up collecting over $55 thousand.

Bottom line: The concept of crowdfunding has now made the jump to funding research. There are a number of sites that are structured similarly to KickStarter that allow researchers to solicit donations from the public. Some are relatively rudimentary, and some are naive in their approach to soliciting funds. In order to engage the public to contribute sums of money, large or small, research teams will need to explain their ideas simply and describe some practical or potential application. And it won’t hurt to offer some type of schwag for donors at various financial levels.

A few interesting crowdfunding sites:

Print Friendly, PDF & Email

March Trauma MedEd Newsletter Released

The Marchnewsletter is now available! Click the image below or the link at the bottom to download. This month’s topic is “The Elderly”.

In this issue you’ll find articles on:

  • How we take care of our elders
  • Thoughts on geriatric trauma
  • Elderly trauma and the frailty index
  • The medical orthopedic service
  • Consequences of elderly falls
  • Effects of an in-hospital falls prevention program

Subscribers received the newsletter last week. If you want to subscribe to get early delivery in the future (and download back issues), click here.

Click here to download and/or subscribe.

Print Friendly, PDF & Email

Penetrating Injuries to the Extremities

Simple penetrating injuries to the arms and legs are often over-treated with invasive testing and admission for observation. Frequently, these injuries can be rapidly evaluated and disposed of using physical examination skills alone.

Stabs and low velocity gunshots (no rifles or shotguns, please) should be thoroughly examined. This includes an examination of the entire, unclothed body. If this is not carried out, there is a risk that additional penetrating injuries may be missed.

For gunshots, look at the wounds and the estimated trajectory to try to demonstrate that the object stayed clear of neurovascular structures. This exam is imprecise, and must be accompanied by a full neurovascular exam and evaluation of the bones and joints. If there is any doubt regarding bony involvement, plain radiographs with entry markers should be performed. Any abnormal findings will require more in-depth evaluation and inpatient admission.

If the exam is negative but the trajectory is “in proximity” to a major vessel, an arterial pressure index (API) should be measured. This test involves the calculation of the ratio of the systolic pressure in the injured extremity to the contralateral uninjured extremity. It should not be confused with the ankle brachial index (ABI) which compares the systolic pressure in the ipsilateral uninjured arm  or leg.

The magic ratio is 0.9. If the API is less than this, there is some likelihood that a vascular injury is present. If the API is higher, there is virtually no chance of injury.

The final test that must be performed before discharge is a function test. If the injured extremity is too painful to use or walk on, the patient may need to be admitted for pain management and therapy. Patients managed in this way can avoid arteriography, CT angiography or admission and save thousands of dollars in hospital charges.

Reference: Journal Am Coll Surgeons 2009;209:740-5.

Print Friendly, PDF & Email

A Better Concussion Test?

Concussions from sports activities are all over the news these days. This injury is particularly important when dealing with the developing brains of student athletes. Most organized sporting activities take advantage of existing concussion testing on the sidelines, such as the Standardized Assessment of Concussion test (SAC, a cognitive test), and the tandem gait test (balance). 

However, sports concussions frequently involve the visual pathways as well. In an effort to improve concussion recognition, a New York group studied the addition of a visual test (King-Devick test, K-D) to their concussion battery. A large group of youth and collegiate hockey and lacrosse players were evaluated at their baseline with K-D, SAC, and tandem gait. During games, athletes with potential concussions were tested on the sidelines. They were compared to non-concussed athletes who were also tested on the sidelines.

Here are the factoids:

  • 243 student athletes were studied, average age 11
  • 12 athletes sustained concussions, and their performance on the K-D test worsened significantly
  • The K-D test identified concussions better than the cognitive and balance tests

Bottom line: The addition of the King-Devick test appears to improve concussion identification in young athletes. In fact, it may be possible to use just this test alone. But practically speaking, it is probably better to use as part of a battery of tests to identify possible concussion after a significant impact. This enables coaches to minimize the number of players that might sustain additional injury and develop the risk for later sequelae of concussion. 

Related posts:

Reference: Adding vision to concussion testing: a prospective study of sideline testing in youth and collegiate athletes. J Neuro-opthalmology 2015 Feb 18, epub ahead of print.

Print Friendly, PDF & Email

Pigtail Catheters Instead Of Chest Tubes?

Traditionally, hemothorax and pneumothorax in trauma has been treated with chest tubes. I’ve previously written about some of the debate regarding using smaller tubes or catheters. A paper that will be presented at the EAST meeting in January looked at pain and failure rates using 14Fr pigtail catheters vs 28Fr chest tubes.

This was a relatively small, prospective study, and only 40 of 74 eligible patients were actually enrolled over 20 months at a Level I trauma center in the US. Pain was measured using a standard Visual Analog Scale, as was complication and failure rate, tube duration and hospital stay.

The following interesting findings were noted:

  • Chest wall pain was similar. This is expected because the underlying cause of the pneumothorax, most likely rib fractures, is unchanged.
  • Tube site pain was significantly less with the pigtail
  • The failure rate was the same (5-10%)
  • Complication rate was also the same (10%)
  • Time that the tube was in, and hospital stay was the same

Bottom line: There may be some benefit in terms of tube site pain when using a smaller catheter instead of a chest tube. But remember, this is a very small study, so be prepared for different results if you try it for your own trauma program. If you do choose to use a smaller tube or catheter, remember to do so only in patients with a pure pneumothorax. Clotted blood from a hemothorax will not be completely evacuated.

Related posts:

Reference: A prospective randomized study of 14-French pigtail catheters vs 28F chest tubes in patients with traumatic pneumothorax: impact on tube-site pain and failure rate. EAST Annual Surgical Assembly, Oral paper 12, 2013.

Print Friendly, PDF & Email