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Zhang C, Wang Y, Xue Y, Cheng J, Chi P, Wang Z, Li B, Yan T, Wu B, Wang Z. Enhanced Hemostatic and Procoagulant Efficacy of PEG/ZnO Hydrogels: A Novel Approach in Traumatic Hemorrhage Management. Gels 2024; 10:88. [PMID: 38391418 PMCID: PMC10888357 DOI: 10.3390/gels10020088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/19/2024] [Indexed: 02/24/2024] Open
Abstract
Managing severe bleeding, particularly in soft tissues and visceral injuries, remains a significant challenge in trauma and surgical care. Traditional hemostatic methods often fall short in wet and dynamic environments. This study addresses the critical issue of severe bleeding in soft tissues, proposing an innovative solution using a polyethylene glycol (PEG)-based hydrogel combined with zinc oxide (ZnO). The developed hydrogel forms a dual-network structure through amide bonds and metal ion chelation, resulting in enhanced mechanical properties and adhesion strength. The hydrogel, exhibiting excellent biocompatibility, is designed to release zinc ions, promoting coagulation and accelerating hemostasis. Comprehensive characterization, including gelation time, rheological properties, microstructure analysis, and swelling behavior, demonstrates the superior performance of the PEG/ZnO hydrogel compared to traditional PEG hydrogels. Mechanical tests confirm increased compression strength and adhesive properties, which are crucial for withstanding tissue dynamics. In vitro assessments reveal excellent biocompatibility and enhanced procoagulant ability attributed to ZnO. Moreover, in vivo experiments using rat liver and tail bleeding models demonstrate the remarkable hemostatic performance of the PEG/ZnO hydrogel, showcasing its potential for acute bleeding treatment in both visceral and peripheral scenarios.
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Affiliation(s)
- Chuyue Zhang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Yifan Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Yuan Xue
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Junyao Cheng
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Pengfei Chi
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Zhaohan Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Bo Li
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Taoxu Yan
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
- Chinese PLA Medical School, Beijing 100853, China
| | - Bing Wu
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
| | - Zheng Wang
- Department of Orthopedics, Chinese PLA General Hospital, Beijing 100853, China
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Lee HD, Huh Y, Kim S, Baek JW, Lee H, Park SM, Kim JK. Educational effects of and satisfaction with mixed-reality-based major trauma care simulator: A preliminary evaluation. Medicine (Baltimore) 2024; 103:e36816. [PMID: 38181252 PMCID: PMC10766292 DOI: 10.1097/md.0000000000036816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 12/07/2023] [Indexed: 01/07/2024] Open
Abstract
Mixed reality (MR) is a hybrid system that projects virtual elements into reality. MR technology provides immersive learning using various real-world tools. However, studies on educational programs using MR are scarce. This study aimed to investigate the educational effects of and satisfaction with an MR-based trauma decision-making simulator. A total 40 of trainees self-selected to participate in this study. All of them participated in the MR trauma simulator for approximately 30 minutes and conducted voluntary learning without any external help. Declarative knowledge, measured using 20 multiple-choice questions, was assessed before and after MR trauma training. To confirm the educational effect, test scores before and after MR trauma training were compared using a paired t-test. Student satisfaction after training was measured using a ten-item questionnaire rated on a five-point Likert scale. A pretest-posttest comparison yielded a significant increase in declarative knowledge. The percentage of correct answers to multiple choice questions increased (from a mean of 42.3, SD 12.4-54.8, SD 13) after the MR-based trauma assessment and treatment training (P < .001). Of the participants, 79.45% were satisfied with the overall experience of using the MR simulator. This study demonstrated a meaningful educational effect of the MR-based trauma training system even after a short training time.
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Affiliation(s)
- Han-Dong Lee
- Department of Orthopedic Surgery, Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Yo Huh
- Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Sora Kim
- Gyeonggi South Regional Trauma Center, Ajou University Hospital, Suwon, Republic of Korea
| | - Ji-Woong Baek
- Department of Orthopedic Surgery, Ajou University, School of Medicine, Suwon, Republic of Korea
| | - Hojun Lee
- Armed Forces Trauma Center, Armed Forces Capital Hospital, Seongnam, Republic of Korea
| | - Sang-Min Park
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jin-Kak Kim
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
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Spering C, Bieler D, Ruchholtz S, Bouillon B, Hartensuer R, Lehmann W, Lefering R, Düsing H. Evaluation of the interhospital patient transfer after implementation of a regionalized trauma care system (TraumaNetzwerk DGU ®) in Germany. Front Med (Lausanne) 2023; 10:1298562. [PMID: 38034545 PMCID: PMC10684689 DOI: 10.3389/fmed.2023.1298562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/11/2023] [Indexed: 12/02/2023] Open
Abstract
Purpose The aim of the study was to evaluate how many patients are being transferred between trauma centers and and their characteristics in the 2006 initiated TraumaNetzwerk DGU® (TNW). We further investigated the time point of transfer and differences in outcome, compared to patients not being transferred. We wanted to know how trauma centers judged the performance of the TNW in transfer. Method (1) We analyzed the data of the TraumaRegister DGU® (TR-DGU) from 2014-2018. Included were patients that were treated in German trauma centers, maximum AIS (MAIS) >2 and MAIS 2 only in case of admission on ICU or death of the patient. Patients being transferred were compared to patients who were not. Characteristics were compared, and a logistic regression analysis performed to identify predictive factors. (2) We performed a survey in the TNW focussing on frequency, timing and communication between hospitals and improvement through TNW. Results Study I analyzed 143,195 patients from the TR-DGU. Their mean ISS was 17.8 points (SD 11.5). 56.4% were admitted primarily to a Level-I, 32.2% to a Level-II and 11.4% to a Level-III Trauma Center. 10,450 patients (7.9%) were transferred. 3,667 patients (22.7%) of the admitted patients of Level-III Center and 5,610 (12.6%) of Level-II Center were transferred, these patients showed a higher ISS (Level-III: 18.1 vs. 12.9; Level-II: 20.1 vs. 15.8) with more often a severe brain injury (AIS 3+) (Level-III: 43.6% vs. 13.1%; Level-II: 53.2% vs. 23.8%). Regression analysis showed ISS 25+ and severe brain injury AIS 3+ are predictive factors for patients needing a rapid transfer. Study II: 215 complete questionnaires (34%) of the 632 trauma centers. Transfers were executed within 2 h after the accident (Level-III: 55.3%; Level-II: 25.0%) and between 2-6 h (Level-III: 39.5%; Level-II: 51.3%). Most trauma centers judged that implementation of TNW improved trauma care significantly (Level III: 65.0%; Level-II: 61.4%, Level-I: 56.7%). Conclusion The implementation of TNW has improved the communication and quality of comprehensive trauma care of severely injured patients within Germany. Transfer is mostly organized efficient. Predictors such as higher level of head injury reveal that preclinical algorithm present a potential of further improvement.
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Affiliation(s)
- C. Spering
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany
| | - D. Bieler
- Department of Orthopaedics and Trauma Surgery, Heinrich Heine University Medical School, Düsseldorf, Germany
- Department of Orthopaedics and Trauma Surgery, Reconstructive Surgery, Hand Surgery, Plastic Surgery and Burn Medicine, German Armed Forces Central Hospital, Koblenz, Germany
| | - S. Ruchholtz
- Center for Orthopedics and Trauma Surgery, University Hospital Giessen and Marburg, Marburg, Germany
| | - B. Bouillon
- Department of Trauma Surgery, Orthopedics and Sports Traumatology, University of Witten/Herdecke, Cologne, Germany
| | - R. Hartensuer
- Center for Orthopaedics, Trauma Surgery, Hand Surgery and Sports Medicine, Surgical Clinic II, Klinikum Aschaffenburg-Alzenau, Aschaffenburg, Germany
| | - W. Lehmann
- Department of Trauma Surgery, Orthopedics and Plastic Surgery, Göttingen University Medical Center, Göttingen, Germany
| | - R. Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - H. Düsing
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
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Sa W, Shuihong C, Jingfen J, Mao Z, Zhiting G, Danping Y, Chang H, Yuwei W. The effect of trauma advanced practice nurse programme at a Level I regional trauma centre in mainland China. Nurs Open 2023; 10:6559-6565. [PMID: 37332249 PMCID: PMC10416056 DOI: 10.1002/nop2.1911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/25/2023] [Accepted: 06/05/2023] [Indexed: 06/20/2023] Open
Abstract
AIMS Trauma is the fifth-leading cause of death in China. Despite the establishment of the Chinese Regional Trauma Care System (CRTCS) in 2016, advanced trauma nurse practice has not been incorporated. This study aimed to identify the roles and responsibilities of trauma advanced practice nurse (APN), and to investigate the impact on patient outcomes in a Level I regional trauma centre in mainland China. DESIGN A single-centre pre- and post-control design was used. METHODS The trauma APN programme was established based on multidisciplinary experts' consultation. A retrospective study was conducted on all Level I trauma patients over a period of 5 years, spanning from January 2017 to December 2021, with a sample size of 2420. The data were divided into two comparison groups: a pre-APN programme (January 2017-December 2018; n = 1112) and post-APN programme (January 2020-December 2021; n = 1308). A comparison analysis was conducted to evaluate the effectiveness of trauma APN who were integrated into the trauma care team, with a focus on patient outcomes and time-efficiency indicators. RESULTS The certification of the regional Level I trauma centre resulted in a 17.63% increase in the number of trauma patients. The integration of advanced practice nurses (APN) into the trauma care system led to significant improvements in time-efficiency indicators, with the exception of advanced airway establishment time (p < 0.05). The average emergency department length of stay (LOS) decreased 21%, from 168 to 132 min (p < 0.001); additionally, the mean intensive care unit LOS decreased by nearly 1 day (p = 0.028). Trauma patients who were treated by trauma APN had a higher likelihood of survival, with an odds ratio of 1.816 (95%CI: 1.041, 3.167; p = 0.033), compared to patients who received care prior to the implementation of the trauma APN program. CONCLUSION A trauma APN programme has the potential to enhance the quality of trauma care in the CRTCS. IMPACT This study elucidates the roles and responsibilities of trauma advanced practice nurses (APN) in a Level I regional trauma centre in mainland China. Trauma care quality was significantly improved after the application of a trauma APN programme. In regions with inadequate medical resources, the utilization of advanced practice trauma nurses can enhance the quality of trauma care. In addition, trauma APN can provide a trauma nursing education programme within the regional centres as a strategy to augment the proficiency of regional trauma nursing. No patient or public contribution, the research data all from trauma data bank.
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Affiliation(s)
- Wang Sa
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Chen Shuihong
- Quality Management DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Jin Jingfen
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang ProvinceHangzhouChina
| | - Zhang Mao
- Key Laboratory of The Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang ProvinceHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Guo Zhiting
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Yan Danping
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Huang Chang
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
| | - Wang Yuwei
- Nursing DepartmentZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
- Emergency MedicineZhejiang University School of Medicine Second Affiliated HospitalHangzhouChina
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Imach S, Deschler A, Sammito S, Reis M, Michaelis S, Marche B, Paffrath T, Bouillon B, Tjardes T. Performing Advanced Trauma Life Support (ATLS) across Borders: Midterm Follow-Up of the Aeromedical Evacuation after Civilian Bus Accident at Madeira. J Clin Med 2023; 12:4556. [PMID: 37510671 PMCID: PMC10380882 DOI: 10.3390/jcm12144556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 07/30/2023] Open
Abstract
On 17 April 2019, a coach with tourists from Germany crashed in Madeira, requiring repatriation by the German Air Force. The Advanced Trauma Life Support (ATLS) concept was the central component of patient care. Data in Madeira were collected through a structured interview. The analysis of the Aeromedical Evacuation was based on intensive care transport records. In Germany, all available medical data sheets were reviewed for data collection. Quality of life (HRQoL) was evaluated by the 12-item Short Form Health Survey (SF-12). Twenty-eight prehospital patients were transported to the Level III Trauma Center in Funchal (Madeira). Five operative procedures were performed. Fifteen patients were eligible for Aeromedical Evacuation (AE). In the second hospital phase in Germany, in total 82 radiological images and 9 operations were performed. Hospital stay lasted 11 days (median, IQR 10-18). Median follow-up (14 of 15 patients) was 16 months (IQR 16-21). Eighty percent (8 out of 10) showed an increased risk for post-traumatic stress disorder (PTSD). Six key findings were identified in this study: divergent injury classification, impact of AE mission on health status, lack of communication, need of PTSD prophylaxis, patient identification, and media coverage. Those findings may improve AE missions in the future, e.g., when required after armed conflicts.
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Affiliation(s)
- Sebastian Imach
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 51109 Cologne, Germany
| | - Andreas Deschler
- Special Air Mission Wing, Federal Ministry of Defence, 51147 Cologne, Germany
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Bundeswehr Central Hospital, 56072 Koblenz, Germany
| | - Stefan Sammito
- Experimental Aerospace Medicine Research, German Air Force Centre of Aerospace Medicine, 51147 Cologne, Germany
- Department of Occupational Medicine, Medical Faculty, Otto von Guericke University, 39106 Magdeburg, Germany
| | - Miguel Reis
- Department of Surgery, Serviço Regional de Saúde da Madeira, 6180 Funchal, Portugal
| | - Sylta Michaelis
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 51109 Cologne, Germany
| | - Beneditk Marche
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 51109 Cologne, Germany
| | - Thomas Paffrath
- Department of Trauma Surgery, Hospital of the Augustinerinnen, 50678 Cologne, Germany
| | - Bertil Bouillon
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 51109 Cologne, Germany
| | - Thorsten Tjardes
- Department of Trauma and Orthopedic Surgery, Cologne-Merheim Medical Center (CMMC), University Witten/Herdecke, 51109 Cologne, Germany
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Bakhshaie J, Fishbein NS, Woodworth E, Liyanage N, Penn T, Elwy AR, Vranceanu AM. Health disparities in orthopedic trauma: a qualitative study examining providers' perspectives on barriers to care and recovery outcomes. Soc Work Health Care 2023; 62:207-227. [PMID: 37139813 PMCID: PMC10330459 DOI: 10.1080/00981389.2023.2205909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 04/05/2023] [Indexed: 05/05/2023]
Abstract
Social workers involved in interdisciplinary orthopedic trauma care can benefit from the knowledge of providers' perspectives on healthcare disparities in this field. Using qualitative data from focus groups conducted on 79 orthopedic care providers at three Level 1 trauma centers, we assessed their perspectives on orthopedic trauma healthcare disparities and discussed potential solutions. Focus groups originally aimed to detect barriers and facilitators of the implementation of a trial of a live video mind-body intervention to aid in recovery in orthopedic trauma care settings (Toolkit for Optimal Recovery-TOR). We used the Socio-Ecological Model to analyze an emerging code of "health disparities" during data analysis to determine at which levels of care these disparities occurred. We identified factors related to health disparities in orthopedic trauma care and outcomes at the Individual (Education- comprehension, health-literacy; Language Barriers; Psychological Health- emotional distress, alcohol/drug use, learned helplessness; Physical Health- obesity, smoking; and Access to Technology), Relationship (Social Support Network), Community (Transportation and Employment Security), and Societal level (Access- safe/clean housing, insurance, mental health resources; Culture). We discuss the implications of the findings and provide recommendations to address these issues, with a specific focus on their relevance to the field of social work in health care.
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Affiliation(s)
- Jafar Bakhshaie
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Nathan S. Fishbein
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States
| | - Emily Woodworth
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States
| | - Nimesha Liyanage
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States
| | - Terence Penn
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, 222 Richmond St, Providence, RI, 02903, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Road, Bedford, MA, 01730, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
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Orlando S. Editorial: Insights in disaster and emergency medicine: 2022. Front Public Health 2023; 11:1212448. [PMID: 37383260 PMCID: PMC10294705 DOI: 10.3389/fpubh.2023.1212448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 06/01/2023] [Indexed: 06/30/2023] Open
Affiliation(s)
- Stefano Orlando
- Department of Biomedicine and Prevention, University of Tor Vergata, Rome, Italy
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Caldwell RM, Dickey W, Sawyer A, Mann-Salinas EA, Crozier L, Montgomery HR, Moody G. Determining Clinical Priorities Using a Clinical Practice Guideline Deconstruction Tool: COVID-19 in Austere Operational Environments. J Spec Oper Med 2023:ZSN0-GOK7. [PMID: 37094289 DOI: 10.55460/zsn0-gok7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
The Joint Trauma System (JTS) publishes Clinical Practice Guidelines (CPGs) used by military and civilian healthcare providers worldwide. With the expansion of CPG development in recent years, there was a need to collate, sort, and deconflict existing and new guidance using systematic methodology both within and across CPGs. This need became readily apparent at the start of the COVID-19 pandemic when guidelines were rapidly developed and fielded in deployed environments. To meet the needs of deploying units requesting immediate and concise guidance for managing COVID-19, JTS developed the CPG entitled Management of Covid-19 in Austere Operational Environments. By applying a deconstruction process to organize clinical recommendations across multiple categories, JTS was able to present clear clinical recommendations across "role of care" and "scope of practice." The use of a deconstruction process supported the rapid socialization of the CPG and may have improved clinical understanding among deployed medical teams.
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Sukumar GM, Ghosh S, Gururaj G. Trauma care systems in healthcare facilities of an Indian District: Assessment and future directions. J Family Med Prim Care 2023; 12:567-575. [PMID: 37122654 PMCID: PMC10131948 DOI: 10.4103/jfmpc.jfmpc_1861_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/22/2022] [Accepted: 01/12/2023] [Indexed: 05/02/2023] Open
Abstract
Introduction With a long-term vision to strengthen the evidence-based trauma care programme in the Kolar district, an objective assessment and grading of the trauma care system (TCS) in public and private hospitals was undertaken. Methods This cross-sectional assessment used a specifically developed TCS assessment tool to collect data from all Level 2, 3, and 4 hospitals in the Kolar district using a review of records, observation of facilities, and interviews with stakeholders. Data were collected regarding macro areas, human resources, infrastructure, equipment, and drugs in ER, in an objective manner. TCS was scored and compared against criteria set in WHO essential guidelines for Trauma Care. The functioning of TCS was expressed as 'percentage of expected standards' and graded accordingly. Ethical clearance and informed consent were obtained. Results All available and eligible Level 2, 3, and 4 hospitals in the district (39 hospitals) covering the public and private sector were assessed. TCS in Level 2 and 3 hospitals was functioning at 56% and 59% of expected standards, respectively. TCS was better in Level 4 hospitals, at 83% of expected standards. Scores were lower for macro areas and human resources. Conclusion TCS in the district is functioning sub-par to expected standards. There is a need for comprehensive strengthening of TCS in both public and private healthcare facilities, especially in macro areas and human resources. Systematic monitoring and periodical TCS assessments are recommended at district levels throughout the country for improved outcomes in India.
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Affiliation(s)
- Gautham Melur Sukumar
- Department of Epidemiology, WHO CC for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences (NIMHANS) Bengaluru, Karnataka, India
- WHO CC for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Soumalya Ghosh
- Department of Epidemiology, WHO CC for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences (NIMHANS) Bengaluru, Karnataka, India
- Address for correspondence: Dr. Soumalya Ghosh, Former MPH Scholar—National Institute of Mental Health and Neuro Sciences (NIMHANS) Bengaluru, Karnataka, India. E-mail:
| | - Gopalkrishna Gururaj
- WHO CC for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Mavragani A, Rosen HE, Mitra S, Neki K, Mbugua LW, Hyder AA, Paichadze N. Estimating the Burden of Disability From Road Traffic Injuries in 5 Low- and Middle-Income Countries: Protocol for a Prospective Observational Study. JMIR Res Protoc 2023; 12:e40985. [PMID: 36723997 PMCID: PMC9932872 DOI: 10.2196/40985] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Road traffic injuries (RTIs) are a leading cause of death and unintentional injuries globally. They claim 1.35 million lives and produce up to 50 million injuries each year, causing a major drain on health systems. Despite this high burden, there is a lack of robust data on the long-term consequences of RTIs, specifically the level of disability experienced by many survivors and its impact on their everyday lives. OBJECTIVE This study aims to characterize RTIs, disability level, and related consequences affecting adult road traffic crash survivors in 5 low- and middle-income countries (LMICs). In addition, this study estimates the role of demographic and crash- and treatment-related factors in predicting adverse outcomes and disability as well as examining the disability level among patients with RTIs, likelihood of return to normal life, and the environmental factors that may influence these outcomes after discharge from the hospital. METHODS This prospective observational study was conducted at selected hospitals in Bangladesh, Cambodia, Ethiopia, Mexico, and Zambia. The study sample included all adult patients with RTIs admitted to the hospital for at least 24 hours. Consecutive sampling was performed until the minimum required sample size of 400 was reached for each participating country. Data were collected from patients or their caregivers using a hospital-based surveillance tool administered at the participating sites as well as a telephone-based follow-up instrument administered 1, 3, and 6 months after discharge. Descriptive analysis and multivariate models will be used to estimate the contribution of a range of factors in predicting adverse outcomes, disability, and return to normal life. RESULTS Enrollment began in June 2021 and was completed in April 2022. Follow-up data collection ended in September 2022. Data analysis is currently underway, with results expected for publication in mid-2023. Expected results include estimates of disability among patients with RTIs as well as identifying the predictors of adverse outcomes, disability, and the likelihood of return to normal life. CONCLUSIONS Research findings will help better understand the long-term burden of disability from RTIs in the 5 LMICs and the challenges facing survivors of road traffic crashes. They will be used to inform interventions aimed at improving the health care, social, physical, and policy conditions in LMICs that can facilitate recovery and rehabilitation for patients with RTIs, reduce the burden of disability, and enhance their participation in society. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40985.
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Affiliation(s)
| | - Heather E Rosen
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Sudeshna Mitra
- Global Road Safety Facility, World Bank, Washington, DC, United States
| | - Kazuyuki Neki
- Global Road Safety Facility, World Bank, Washington, DC, United States
| | | | - Adnan A Hyder
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
| | - Nino Paichadze
- Department of Global Health, Milken Institute School of Public Health, The George Washington University, Washington, DC, United States
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Hardway J, Lucente FC, T Crawford A, Jarrouj A, Samanta D. Impact of the 24/7 nurse practitioner model on emergency department stay at a level 1 trauma center: A retrospective study. J Clin Nurs 2023; 32:517-522. [PMID: 35307879 DOI: 10.1111/jocn.16300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/22/2022] [Accepted: 03/09/2022] [Indexed: 01/17/2023]
Abstract
AIMS The aim of the study was to assess the impact of 24/7 trauma nurse practitioner service model on the emergency department patient flow. BACKGROUND Seamless transition of trauma patients through the emergency department to inpatient hospital care is crucial for coordination of care, clinical safety and positive health outcomes. A level 1 trauma centre located in Southern West Virginia, USA expanded their trauma nurse practitioner service covering the emergency department 24/7. DESIGN Retrospective cohort study conducted in accordance with the Strengthening the Reporting of Observational studies in Epidemiology guidelines. METHODS Patients admitted to the trauma centre between March 2019 and February 2020 were divided into two groups: trauma patients managed by trauma nurse practitioners versus the hospitalist service. The hospital service group was chosen as the comparator group because any admission prior to night coverage by the trauma nurse practitioners were managed by the hospitalist service. RESULTS The emergency department length of stay was significantly lower in trauma nurse practitioners' patients by an average of 300 min (772.25 ± 831.91 vs. 471.44 ± 336.65, p = <.001). Similarly, time to place emergency department discharge order was shorter by 49 min (277.76 ± 159.69 vs. 228.27 ± 116.04, p = .001) for this group. Moreover, trauma nurse practitioners on an average placed one less consultation (1.06 ± 0.23 vs. 1.46 ± 0.74, p < .001). CONCLUSION The patient care provided by trauma nurse practitioners aided in the reduction of strain felt by their emergency department. They were able to help facilitate patient flow thus lessening the pressure of boarding in an overcrowded emergency department. The study institution hopes to sustain the current service model and continue to review outcomes and processes managed by trauma nurse practitioners to ensure consistency and quality. RELEVANCE TO CLINICAL PRACTICE Similar trauma centres should evaluate the structure of their trauma service that includes the role of trauma nurse practitioner service and work towards allowing them to manage patient care from the emergency department 24/7.
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Affiliation(s)
- Jessica Hardway
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Frank C Lucente
- Charleston Area Medical Center, West Virginia University Physicians of Charleston, Charleston, West Virginia, USA
| | - Adam T Crawford
- Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Aous Jarrouj
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
| | - Damayanti Samanta
- Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, West Virginia, USA
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Devassy SM, Scaria L, Varghese J, Benny AM, Hill N, Joubert L. Vulnerabilities and life stressors of people presented to emergency departments with deliberate self-harm; consolidating the experiences to develop a continuum of care using a mixed-method framework. Front Public Health 2023; 10:1019131. [PMID: 36711365 PMCID: PMC9874916 DOI: 10.3389/fpubh.2022.1019131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Suicide is a crucial public health concern. However, the interactions between bio psychosocial vulnerabilities and stressors leading to deliberate self-harm behavior remain unexplored, especially in the Indian context. This study examined the experiences leading to self-harm behavior among people who presented to emergency departments with suicidal attempts. Methods In this mixed-methods study, we enrolled 44 patients who presented with self-harm behavior at three tertiary health care facilities between October and December 2019. To collect quantitative data, we employed standardized tools: General Health Questionnaire (GHQ-28), General Help-Seeking Questionnaire, Mini International Neuropsychiatric Interview, and the Brief Resilience Scale. Further, we conducted semi-structured interviews to qualitatively explore participants' life experiences and other risk factors. Qualitative analyses were performed using thematic analysis and quantitative descriptive and inferential statistics were performed using STATA software. Results The mean age of subjects were 29.8 years. The mean suicidality score for the patients was 26 (±8.7). In univariate analysis, depression and anxiety were positively associated with suicidality. While help-seeking behavior and resilience were negatively associated with suicidality. Qualitative results were centered on three major themes; life stressors, family related stressors, and social support-related vulnerabilities. The subjects' lived experiences were introduced in the backdrop of the interplay of vulnerabilities and stressors. Conclusion The biopsychosocial vulnerabilities remain dormant until it is activated by life stressors resulting in severe self-harm behaviors. Mental health team-driven assertive engagement, positive coping, and social support interventions would help prevent reattempts in people with self-harm behaviors.
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Affiliation(s)
- Saju Madavanakadu Devassy
- Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India,International Centre for Consortium Research in Social Care (ICRS), Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India,Department of Social Work, Melbourne School of Health Sciences at the University of Melbourne, Parkville, VIC, Australia,*Correspondence: Saju Madavanakadu Devassy ✉
| | - Lorane Scaria
- Department of Social Work, Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India,International Centre for Consortium Research in Social Care (ICRS), Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India
| | - Jaicob Varghese
- Department of Critical Care Medicine, Rajagiri Hospital, Kochi, Kerala, India
| | - Anuja Maria Benny
- International Centre for Consortium Research in Social Care (ICRS), Rajagiri College of Social Sciences (Autonomous), Kochi, Kerala, India
| | - Nicole Hill
- Department of Social Work, Melbourne School of Health Sciences at the University of Melbourne, Parkville, VIC, Australia
| | - Lynette Joubert
- Department of Social Work, Melbourne School of Health Sciences at the University of Melbourne, Parkville, VIC, Australia
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Kim S, Kim GU, Park J. Evaluation of Internet-Based Training in Trauma Care for Nurses in Mental Health Welfare Centers: A Cluster Randomized Controlled Trial. J Prim Care Community Health 2023; 14:21501319231181982. [PMID: 37335037 DOI: 10.1177/21501319231181982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVE This study evaluates the efficacy of Internet-Based Training in Trauma Care for Nurses (IBTTCN) to improve nurses' trauma intervention self-efficacy, professional quality of life, and attitudes and knowledge about post-traumatic stress disorder. METHODS Forty-one nurses participated from May to July 2021. The assessment points were at baseline (T1), immediately after program completion (4 weeks; T2), and 1 month after T2 (T3). Data were analyzed using repeated-measures analysis and generalized estimating equations. RESULTS In the intervention group, trauma intervention self-efficacy increased significantly after the IBTTCN, and the effect of such self-efficacy over time was significant. CONCLUSIONS The IBTTCN improved nurses' trauma intervention self-efficacy.
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Affiliation(s)
- Sunah Kim
- Yonsei University, Seoul, Republic of Korea
| | - Go-Un Kim
- Inje University, Busan, Republic of Korea
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Tanyanyiwa TA, Chimhutu V. Strengthening Cultural Competence in Health Professionals Through Partnerships: A Case Study of a Health Collaborative Exchange Between Malawi and Norway in Trauma Care and Emergency Medicine. Inquiry 2022; 59:469580221115263. [PMID: 36282080 PMCID: PMC9608186 DOI: 10.1177/00469580221115263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
North-South partnerships have been identified as one way of solving some of the challenges in health sectors globally. Norway and Malawi have one such partnership in trauma and emergence care. Lack of trauma care and emergency medicine is a major public health concern worldwide. This results in substantial loss to individual, families, and society. The study follows this partnership between Norway and Malawi, investigating on its socio-cultural benefits, and on how this contributes to the health professionals' cultural competence. A qualitative case study was chosen for this study, 20 semi-structured interviews were conducted with health professionals and coordinators of the program. Interviews were conducted digitally using platforms such as Zoom and WhatsApp. Interviews were collected between the period of December 2020and February 2021. We found out that exchange participants from both countries largely reported positive experiences. Their experiences centered around their interactions and encounters with patients, patients' relatives, and colleagues at host institutions. Participants reported a better understanding on health seeking behaviors in different contexts, the importance of communication with both patients and colleagues, and teamwork. In addition, the study revealed the importance on perceptions around identities such as race and gender and how these impact on health professionals' interactions with patients. We also found out that although working in a different socio-cultural environment was reported as challenging, it was experienced as enriching and rewarding in terms of building and developing cultural competence. The study concludes that North-South health professionals exchange partnerships can be a viable vehicle for developing and naturing cultural competence in health professionals, however, such programs need to invest in preparing the exchange participants to be ready for the challenges that lies ahead in host institutions and countries.
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Affiliation(s)
- Takunda Archlove Tanyanyiwa
- University of Bergen, Bergen, Norway,Takunda Archlove Tanyanyiwa, Department of Health Promotion and Development, University of Bergen, Postbox 7807, Bergen 5020, Norway.
| | - Victor Chimhutu
- University of Bergen, Bergen, Norway,Inland Norway University of Applied Sciences Elverum, Norway
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Abstract
This study examined the opioid prescribing patterns at discharge in the trauma center of a major Canadian hospital and compared them to the guidelines provided by the Illinois surgical quality improvement collaborative (ISQIC), a framework that has been recognized as being associated with reduced risk. This was a retrospective chart review of patient data from the trauma registry between January 1, 2018, and October 31, 2019. A total of 268 discharge charts of naïve opioid patients were included in the analysis. A Morphine Milligram Equivalents per day (MME/day) was computed for each patient who was prescribed opioids and compared with standard practice guidelines. About 75% of patients were prescribed opioids. More males (75%) than females (25%) were prescribed opioids to patients below 65 years old (91%). Best practice guidelines were followed in most cases. Only 16.6% of patients were prescribed over 50 mg MME/day, the majority (80.9%) were prescribed opioids for =<3 days and only 1% for >7 days. Only 7.5% were prescribed extended-release opioids and none were strong like fentanyl. Patients received a multimodal approach with alternatives to opioids in 88.9% of cases and 82.9% had a plan for opioid discontinuation. However, only 23.6% received an acute pain service referral. The majority of the prescriptions provided adhered to the best practice guidelines outlined by the ISQIC framework. These results are encouraging with respect to the feasibility of implementing opioid prescription guidelines effectively. However, routine monitoring is necessary to ensure that adherence is maintained.
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Affiliation(s)
- Priyanka Premachandran
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
| | - Pria Nippak
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
- *Correspondence: Pria Nippak, School of Health Services Management, Ted Rogers School of Management, Ryerson University, 8th floor, 2068, Toronto, Ontario, Canada (e-mail: )
| | - Housne Begum
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
| | - Julien Meyer
- School of Health Services Management, Ted Rogers School of Management, Ryerson University, Toronto, Ontario, Canada
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Holinga GJ, Foor JS, Van Horn SL, McGuire JE. Performance Evaluation of the Solo-T and the Combat Application Tourniquet in a Perfused Cadaver Model. J Spec Oper Med 2022; 22:49-55. [PMID: 35862840 DOI: 10.55460/24e1-mj5s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE We evaluated a 10.2-cm-wide, minimally elastic, adhesive wrap-based tourniquet (Solo-T or ST) alongside a 3.8-cm-wide windlass-based tourniquet (Combat Application Tourniquet Generation 7, or CAT) to determine if the tension wrap-tightened ST could deliver hemorrhage control equivalent to the windlass-tightened CAT. METHODS A cadaver model was used to simulate lower-thigh femoral arterial hemorrhage at "normal" (146 ± 5mmHg) and "elevated" (471 ± 3mmHg) perfusion pressures (mean ± standard error). Three study participants used the ST and CAT to control hemorrhage during 48 timed trials. Arterial occlusion was established by Doppler ultrasound and tourniquet performance was quantified by under-tourniquet pressure cuffs. RESULTS Participants achieved 100% (24/24) occlusion success rates and reported similar ease of use for both tourniquets. Occlusion and application times (mean ± standard error) were similar (p > .05) for the ST and CAT under "normal" (occlusion, ST: 25 ± 2 seconds, CAT: 22 ± 2 seconds; application, ST: 27 ± 2 seconds, CAT: 26 ± 2 seconds) and "elevated" (occlusion, ST: 24 ± 7 seconds, CAT: 24 ± 7 seconds; application, ST: 25 ± 7 seconds, CAT: 25 ± 7 seconds) perfusion alike. The ST mean completion pressures (mean ± standard error) were > 40% lower than the CAT under both "normal" perfusion (ST: 110 ± 20mmHg; CAT: 210 ± 30mmHg; p = 0.009) and "elevated" perfusion (ST: 190 ± 50mmHg; CAT: 340 ± 30mmHg; p = 0.03). CONCLUSION The adhesive wrap-based ST tourniquet delivered equivalent hemorrhage control performance at significantly lower completion pressures than the CAT.
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McCarthy J, Lauria MJ, Fisher AD. A Lost Opportunity: The Use of Unorthodox Training Methods for Prehospital Trauma Care. J Spec Oper Med 2022; 22:29-35. [PMID: 35862849 DOI: 10.55460/aqu3-f0up] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 06/15/2023]
Abstract
Prehospital trauma care guidelines and instruction have advanced significantly over the past 20 years. Although there have been efforts to create a standardized approach to instruction, the use of unorthodox techniques that lack supporting evidence persists. Many instructors use unrealistic scenarios, "no-win" scenarios, and unavoidable failing situations to train students. Doing so, however, creates student confusion and frustration and can result in poor skill acquisition. These training techniques should be reconsidered, with focus placed instead on the development of technical skills and far skill transfer. Knowing when to apply the appropriate type and level of stress within a training scenario can maximize student learning and knowledge retention. Furthermore, modalities such as deliberate practice, cognitive load theory (CLT), and stress exposure training (SET) should be incorporated into training. To improve delivery of prehospital trauma education, instructors should adopt evidence-based educational strategies, grounded in educational and cognitive science, that are targeted at developing long-term information retention as well as consistent, accurate, and timely life-saving interventions.
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Berg J, Alvesson HM, Roy N, Ekelund U, Bains L, Chatterjee S, Bhattacharjee PK, David S, Gupta S, Kamble J, Khajanchi M, Lal P, Malhotra V, Meher R, Mishra A, Mohan LN, Petzold M, Saxena R, Shrivastava P, Singh R, Soni KD, Sural S, Gerdin Wärnberg M. Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries. BMJ Open 2022; 12:e059948. [PMID: 35680271 PMCID: PMC9185581 DOI: 10.1136/bmjopen-2021-059948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To compare experts' perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness. DESIGN A mixed-methods approach using a multicentre online Delphi technique. SETTING Two large tertiary hospitals in urban India. METHODS Filters were rated on a scale from 1 to 10 in terms of perceived usefulness, with the option to add new filters and comments. The filters were categorised into three groups depending on their origin: low and middle-income countries (LMIC), WHO and New (locally developed), and their scores compared. Significance was determined using Kruskal-Wallis test followed by Wilcoxon rank-sum test. We performed a content analysis of the comments. RESULTS 26 predefined and 15 new filter suggestions were evaluated. The filters had high usefulness scores (mean overall score 9.01 of 10), with the LMIC filters having significantly higher scores compared with those from WHO and those newly added. Three themes were identified in the content analysis relating to medical relevance, feasibility and specificity. CONCLUSIONS Audit filters from other LMICs were deemed highly useful in the urban India context. This may indicate that the transferability of defined trauma audit filters between similar contexts is high and that these can provide a starting point when implemented as part of trauma quality improvement programmes in low-resource settings.
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Affiliation(s)
- Johanna Berg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Department of Emergency and Internal Medicine, Skane University Hospital, Malmo, Sweden
| | | | - Nobhojit Roy
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- The George Institute for Global Health India, New Delhi, Delhi, India
| | - Ulf Ekelund
- Emergency Medicine, Department of Clinical Sciences, Lund University Faculty of Medicine, Lund, Sweden
| | - Lovenish Bains
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
- WHO Collaboration Centre for Research in Surgical Care Delivery In Low and Middle-Income Countries, Mumbai, Maharashtra, India
| | - Shamita Chatterjee
- Department of Surgery, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | | | - Siddarth David
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Doctors For You, Mumbai, Maharashtra, India
| | - Swati Gupta
- Department of Radiodiagnosis and Imaging, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Jyoti Kamble
- Doctors For You, Mumbai, Maharashtra, India
- School of Public health, Tata Institute of Social Sciences, Mumbai, Maharashtra, India
| | - Monty Khajanchi
- WHO Collaboration Centre for Research in Surgical Care Delivery In Low and Middle-Income Countries, Mumbai, Maharashtra, India
- Department of Surgery, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Pawanindra Lal
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Vikas Malhotra
- Department of ENT and Head & Neck Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Ravi Meher
- Department of ENT and Head & Neck Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | | | - Max Petzold
- School Public Health and Community Medicine, Institute of Medicine, University of Gothenburg Sahlgrenska Academy, Goteborg, Sweden
| | - Ritu Saxena
- Department of Accident and Emergency, Lok Nayak Hospital, New Delhi, India
| | - Prabhat Shrivastava
- Department of Burns and Plastic Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Rajdeep Singh
- Department of Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Kapil Dev Soni
- Department of Critical and Intensive Care, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Sumit Sural
- Department of Orthopaedic Surgery, Maulana Azad Medical College, New Delhi, Delhi, India
| | - Martin Gerdin Wärnberg
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
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Gyedu A, Quainoo E, Nakua E, Donkor P, Mock C. Achievement of Key Performance Indicators in Initial Assessment and Care of Injured Patients in Ghanaian Non-tertiary Hospitals: An Observational Study. World J Surg 2022; 46:1288-1299. [PMID: 35286419 PMCID: PMC9058212 DOI: 10.1007/s00268-022-06507-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION We aimed to determine the level of achievement of key performance indicators (KPIs) during initial assessment and management of injured persons, as assessed by independent observers, at district and regional hospitals in Ghana. METHODS Trained observers were stationed at emergency units of six district (first level) and two regional (referral) hospitals, from October 2020 to February 2021, to observe management of injured patients by health service providers. Achievement of KPIs was assessed for all injured patients and for seriously injured patients (admitted for ≥ 24 h, referred, or died). RESULTS Management of 1006 injured patients was observed. Road traffic crash was the most common mechanism (63%). Completion of initial triage ranged from 65% for oxygen saturation to 92% for mobility assessment. For primary survey, airway was assessed in 77% of patients, chest examination performed in 66%, and internal abdominal bleeding assessed in 43%. Reassessment rates were low, ranging from 16% for respiratory rate to 23% for level of consciousness. Thirty-one percent of patients were seriously injured. Completion of KPIs was higher for these patients, but reassessment remained low, ranging from 25% for respiratory rate to 33% for level of consciousness. CONCLUSION KPIs were performed at a high level, but several specific elements should be performed more frequently, such as oxygen saturation and assessment for internal abdominal bleeding. Reassessment needs to be performed more frequently, especially for seriously injured patients. Overall, care for the injured at non-tertiary hospitals in Ghana could be improved with a more systematic approach.
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Affiliation(s)
- Adam Gyedu
- Department of Surgery, School of Medicine and Dentistry, KNUST, Private Mail Bag, University Post Office, Kumasi, Ghana.
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - Emmanuel Quainoo
- University Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Emmanuel Nakua
- Department of Epidemiology and Biostatistics, School of Public Health, Kwame Nkrumah, Kumasi, Ghana
| | - Peter Donkor
- Department of Surgery, School of Medicine and Dentistry, KNUST, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - Charles Mock
- Department of Surgery, University of Washington, Seattle, WA, USA
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Grenn E, Kutcher M, Hillegass WB, Iwuchukwu C, Kyle A, Bruehl S, Goodin B, Myers H, Rao U, Nag S, Kinney K, Dickens H, Morris MC. Social determinants of trauma care: Associations of race, insurance status, and place on opioid prescriptions, postdischarge referrals, and mortality. J Trauma Acute Care Surg 2022; 92:897-905. [PMID: 34936591 PMCID: PMC9038661 DOI: 10.1097/ta.0000000000003506] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Racial disparities in trauma care have been reported for a range of outcomes, but the extent to which these remain after accounting for socioeconomic and environmental factors remains unclear. The objective of this study was to evaluate the unique contributions of race, health insurance, community distress, and rurality/urbanicity on trauma outcomes after carefully controlling for specific injury-related risk factors. METHODS All adult (age, ≥18 years) trauma patients admitted to a single Level I trauma center with a statewide, largely rural, catchment area from January 2010 to December 2020 were retrospectively reviewed. Primary outcomes were mortality, rehabilitation referral, and receipt of opioids in the emergency department. Demographic, socioeconomic, and injury characteristics as well as indicators of community distress and rurality based on home address were abstracted from a trauma registry database. RESULTS Analyses revealed that Black patients (n = 13,073) were younger, more likely to be male, more likely to suffer penetrating injuries, and more likely to suffer assault-based injuries compared with White patients (n = 10,946; all p < 0.001). In adjusted analysis, insured patients had a 28% lower risk of mortality (odds ratio, 0.72; p = 0.005) and were 92% more likely to be referred for postdischarge rehabilitation than uninsured patients (odds ratio, 1.92; p = 0.005). Neither race- nor place-based factors were associated with mortality. However, post hoc analyses revealed a significant race by age interaction, with Black patients exhibiting more pronounced increases in mortality risk with increasing age. CONCLUSION The present findings help disentangle the social determinants of trauma disparities by adjusting for place and person characteristics. Uninsured patients were more likely to die and those who survived were less likely to receive referrals for rehabilitation services. The expected racial disparity in mortality risk favoring White patients emerged in middle age and was more pronounced for older patients. LEVEL OF EVIDENCE Prognostic and epidemiological, Level III.
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Affiliation(s)
- Emily Grenn
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Matthew Kutcher
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
| | - William B. Hillegass
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS
| | - Chinenye Iwuchukwu
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Amber Kyle
- Department of Surgery, University of Mississippi Medical Center, Jackson, MS
| | - Stephen Bruehl
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Burel Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Hector Myers
- Department of Psychology, Vanderbilt University, Nashville, TN
| | - Uma Rao
- Department of Psychiatry & Human Behavior and Center for Center for the Neurobiology of Learning and Memory, University of California – Irvine, California, USA
- Children’s Hospital of Orange County, Orange, CA, USA
| | - Subodh Nag
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, Meharry Medical College, Nashville, TN
| | - Kerry Kinney
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Harrison Dickens
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
| | - Matthew C. Morris
- Department of Psychiatry and Human Behavior, University of Mississippi Medical Center, Jackson, MS
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Denu ZA, Yassin MO, Azale T, Biks GA, Gelaye KA. Insufficient Supply, Diagnostic Services, and Lack of Trained Personnel in Primary Hospitals in North-West Ethiopia Worsened Trauma Care: A Mixed-Method Study. Disaster Med Public Health Prep 2022; 17:e135. [PMID: 35331362 DOI: 10.1017/dmp.2022.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Although there has been a massive expansion of hospitals in Ethiopia in the last 2 decades, most are primary-level hospitals. Assessing the capability of the hospitals in managing trauma victims is essential to strengthening the hospitals. METHODS We employed a mixed-method approach using quantitative descriptive design triangulated with qualitative research. We audited 10 hospitals using WHO essential trauma care checklist. We interviewed 37 health care professionals, 9 hospital managers, and 12 decision-makers using a semi-structured interview guide. We used the COREQ checklist to report the qualitative finding. RESULTS The physical structures of the hospitals were good in all cases. Airway, breathing and circulation management were partially available, with a score ranging from 0 - 3. The extent of injury, lack of radiology service, and scarcity of drugs and supplies were common causes for the referral of trauma victims to Gondar University hospital. CONCLUSION AND RECOMMENDATION Unavailability of drugs and supplies, lack of diagnostic services, inability to recruit specialist professionals, lack of training, and inconvenient working and living environment were stated as the main barriers to providing trauma care. In the study area, the gaps in trauma care in the primary hospitals can be improved by further commitment of the hospitals, the district, zonal administrators, and the regional health bureau.
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Sierra-Arévalo M, Nix J, O’Guinn B. A national analysis of trauma care proximity and firearm assault survival among U.S. police. Police Pract Res 2022; 23:388-396. [PMID: 38239930 PMCID: PMC10795852 DOI: 10.1080/15614263.2022.2036611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/05/2022] [Indexed: 01/22/2024]
Abstract
Past research on factors influencing firearm assault (FA) mortality have not focused on police officers who, compared to other U.S. workers and the general public, experience especially high rates of firearm victimization. This study focuses on this unique population of FA victims and examines the relationship between travel time to the nearest trauma care facility and the probability of survival among officers shot on duty. Combining data on trauma care center location and 7 years of data on U.S. police officers fatally or non-fatally assaulted with a firearm, we use logistic regression to model the probability of FA fatality among police by proximity of the FA to the nearest trauma care facility. We find that travel time to trauma care was not associated with reduced FA mortality among police from 2014 to 2020. FA mortality was significantly lower in 2020 than the six years prior.
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Affiliation(s)
| | - Justin Nix
- School of Criminology and Criminal Justice, Univesity of Nebraska—Omaha, Omaha, NE, USA
| | - Bradley O’Guinn
- School of Criminal Justice, University of Cincinnati, Cincinnati, OH, USA
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Catchpole K, Privette A, Roberts L, Alfred M, Carter B, Woltz E, Wilson D, Crookes B. A Smartphone Application for Teamwork and Communication in Trauma: Pilot Evaluation "in the Wild". Hum Factors 2022; 64:143-158. [PMID: 34126795 DOI: 10.1177/00187208211021717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To evaluate the potential for a smartphone application to improve trauma care through shared and timely access to patient and contextual information. BACKGROUND Disruptions along the trauma pathway that arise from communication, coordination, and handoffs problems can delay progress through initial care, imaging diagnosis, and surgery to intensive care unit (ICU) disposition. Implementing carefully designed and evaluated information distribution and communication technologies may afford opportunities to improve clinical performance. METHODS This was a pilot evaluation "in the wild" using a before/after design, 3 month, and pre- post-intervention data collection. Use statistics, usability assessment, and direct observation of trauma care were used to evaluate the app. Ease of use and utility were assessed using the technology acceptance model (TAM) and system usability scale (SUS). Direct observation deployed measures of flow disruptions (defined as "deviations from the natural progression of an procedure"), teamwork scores (T-NOTECHS), and treatment times (total time in emergency department [ED]). RESULTS The app was used in 367 (87%) traumas during the trial period. Usability was generally acceptable, with higher scores found by operating room (OR), ICU, and neuro and orthopedic users. Despite positive trends, no significant effects on flow disruptions, teamwork scores, or treatment times were observed. CONCLUSIONS Pilot trials of a clinician-centered smartphone app to improve teamwork and communication demonstrate potential value for the safety and efficiency of trauma care delivery as well as benefits and challenges of "in-the-wild" evaluation.
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Affiliation(s)
- Ken Catchpole
- 2345 Medical University of South Carolina, Charleston, USA
| | | | - Laura Roberts
- 2345 Medical University of South Carolina, Charleston, USA
| | - Myrtede Alfred
- 2345 Medical University of South Carolina, Charleston, USA
| | - Brittan Carter
- 2345 Medical University of South Carolina, Charleston, USA
| | - Erick Woltz
- 2345 Medical University of South Carolina, Charleston, USA
| | - Dulaney Wilson
- 2345 Medical University of South Carolina, Charleston, USA
| | - Bruce Crookes
- 2345 Medical University of South Carolina, Charleston, USA
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Driessen MLS, Sturms LM, Bloemers FW, Duis HJT, Edwards MJR, den Hartog D, Kuipers EJ, Leenhouts PA, Poeze M, Schipper IB, Spanjersberg RW, Wendt KW, de Wit RJ, van Zutphen SWAM, de Jongh MAC, Leenen LPH. The Detrimental Impact of the COVID-19 Pandemic on Major Trauma Outcomes in the Netherlands: A Comprehensive Nationwide Study. Ann Surg 2022; 275:252-258. [PMID: 35007227 PMCID: PMC8745885 DOI: 10.1097/sla.0000000000005300] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the impact of the COVID-19 pandemic on the outcome of major trauma patients in the Netherlands. SUMMARY BACKGROUND DATA Major trauma patients highly rely on immediate access to specialized services, including ICUs, shortages caused by the impact of the COVID-19 pandemic may influence their outcome. METHODS A multi-center observational cohort study, based on the Dutch National Trauma Registry was performed. Characteristics, resource usage, and outcome of major trauma patients (injury severity score ≥16) treated at all trauma-receiving hospitals during the first COVID-19 peak (March 23 through May 10) were compared with those treated from the same period in 2018 and 2019 (reference period). RESULTS During the peak period, 520 major trauma patients were admitted, versus 570 on average in the pre-COVID-19 years. Significantly fewer patients were admitted to ICU facilities during the peak than during the reference period (49.6% vs 55.8%; P=0.016). Patients with less severe traumatic brain injuries in particular were less often admitted to the ICU during the peak (40.5% vs 52.5%; P=0.005). Moreover, this subgroup showed an increased mortality compared to the reference period (13.5% vs 7.7%; P=0.044). These results were confirmed using multivariable logistic regression analyses. In addition, a significant increase in observed versus predicted mortality was recorded for patients who had a priori predicted mortality of 50% to 75% (P=0.012). CONCLUSIONS The COVID-19 peak had an adverse effect on trauma care as major trauma patients were less often admitted to ICU and specifically those with minor through moderate brain injury had higher mortality rates.
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Affiliation(s)
| | | | - Frank W Bloemers
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | | | - Michael J R Edwards
- Department of Trauma Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dennis den Hartog
- Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - E J Kuipers
- Dutch Network for Emergency Care (LNAZ), Utrecht, The Netherlands
| | - Peter A Leenhouts
- Department of Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Inger B Schipper
- Department of Trauma Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Klaus W Wendt
- Department of Trauma Surgery, University Medical Center, Groningen, The Netherlands
| | - Ralph J de Wit
- Department of Trauma Surgery, Medical Spectrum Twente, Enschede, The Netherlands
| | | | | | - Luke P H Leenen
- Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Stone Luggya T, Alenyo Ngabirano A, Sarah R, Osire J, Achieng L, Nabulime J, Mabweijano J. Trauma unit management and outcomes at an urban tertiary hospital in sub-Saharan Africa: a descriptive study. Afr Health Sci 2021; 21:1794-1800. [PMID: 35283958 PMCID: PMC8889818 DOI: 10.4314/ahs.v21i4.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Injuries are a neglected burden despite accounting for 9% of deaths worldwide which is 1.7 times that of hiv, tb and malaria combined. Trauma remains overlooked as research and resources are focused on infectious diseases. Uganda with limited trauma epidemiological data has one of the highest traumatic injury rates. This study describes demographics, management and outcomes of patients admitted to mulago hospital trauma unit. Materials and methods This study was a retrospective record review from july 2012 to december 2015. A data collected included age, time and vitals of admission plus interventions, management and outcomes after which it was analyzed. Results 834 patient records were reviewed. The predominant age group was 18–35 and 86% of the patients were male. 54% of the patients presented during day and majority of the admission had gcs of less than 8. Antibiotics were given to 467 patients with mechanical ventilation (301) and intubation (289) as the frequent interventions done. 52% of admitted patients were discharged and 40% died. Conclusion Most admissions' were of youthful age and had severe head injuries (gcs<8). 56% received antibiotics with frequent interventions beig mechanical ventilation and intubation. 52% of admitted patients were discharged and 40% died
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Abstract
Background
Trauma-related injury causes higher mortality than a combination of prevalent infectious diseases. Mortality secondary to trauma is higher in low- and middle-income countries (LMICs) than high-income countries. This review outlines common issues, and potential solutions for those issues, identified in trauma care in LMICs that contribute to poorer outcomes.
Methods
A literature search was performed on PubMed and Google Scholar using the search terms “trauma,” “injuries,” and “developing countries.” Articles conducted in a trauma setting in low-income countries (according to the World Bank classification) that discussed problems with management of trauma or consolidated treatment and educational solutions regarding trauma care were included.
Results
Forty-five studies were included. The problem areas broadly identified with trauma care in LMICs were infrastructure, education, and operational measures. We provided some solutions to these areas including algorithm-driven patient management and use of technology that can be adopted in LMICs.
Conclusion
Sustainable methods for the provision of trauma care are essential in LMICs. Improvements in infrastructure and education and training would produce a more robust health care system and likely a reduction in mortality in trauma-related injuries.
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Affiliation(s)
| | - Anna Payne
- Department of Surgery, Royal London Hospital, London, United Kingdom
| | - Trish Leitch
- Department of Surgery, St George's Hospital, London, United Kingdom
| | - Maryam Alfa-Wali
- Department of Surgery, Royal London Hospital, London, United Kingdom
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MacKinnon RJ, Slater D, Pukk-Härenstam K, von Thiele Schwarz U, Stenfors T. Adaptations to practice and resilience in a paediatric major trauma centre during a mass casualty incident. Br J Anaesth 2021; 128:e120-e126. [PMID: 34563337 DOI: 10.1016/j.bja.2021.07.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/05/2021] [Accepted: 07/08/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Innovation and human adaptation in the face of unfolding catastrophe is the cornerstone of an effective systemwide response. Capturing, analysing, and disseminating this is fundamental in developing resilience for future events. The aim of this study was to understand the characteristics of adaptations to practice early in a paediatric major trauma centre during a mass casualty incident. METHODS A qualitative interview study of 40 healthcare staff at a paediatric major trauma centre in the immediate aftermath of a terrorist bombing was conducted. An inductive thematic analysis approach was used, followed by a deductive analysis of the identified adaptations informed by constructs of resilience engineering. RESULTS Five themes of adaptations to practice that enhanced the resilient performance of the hospital were identified: teamworking; psychologically supporting patients, families, and staff; reconfiguring infrastructure; working around the hospital electronic systems; and maintaining hospital safety. Examples of resilience potential in terms of respond, monitor, anticipate, and learn are presented. CONCLUSIONS Our study shows how adaptations to practice sustained the resilient performance of a paediatric major trauma centre during a mass casualty incident. Rapid, early capture of these data during a mass casualty incident provides key insights into enhancing future emergency preparedness, response, and resilience planning.
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Affiliation(s)
- Ralph J MacKinnon
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Department of Paediatric Anaesthesia, Royal Manchester Children's Hospital, Manchester, UK.
| | - David Slater
- School of Engineering, Cardiff University, Cardiff, UK
| | - Karin Pukk-Härenstam
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; Paediatric Emergency Department, Karolinska University Hospital, Stockholm, Sweden
| | - Ulrica von Thiele Schwarz
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
| | - Terese Stenfors
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
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Mousazadeh Y, Janati A, Pouraghaei M, Sadeghi Bazargani H. Identifying indicators and evaluation steps with suggestions for improving trauma care in Iran: experts' perspective. J Inj Violence Res 2021; 13. [PMID: 33893732 PMCID: PMC8435083 DOI: 10.5249/jivr.vo113i2.1589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Trauma is one of the major causes of mortality across the world. Trauma patients have critical status and need timely, adequate, and organized care. The different consequences of trauma care among service centers around the world and even within a country revealed the need for careful evaluation. This study was designed and executed to collect experts' opinions on the evaluation steps, related indicators, and improvement strategies in trauma care. METHODS This qualitative study was based on a conventional content analysis approach. 2 focus group discussions (FGD) with 6 participants per FGD and 16 face-to-face in-depth interviews were conducted to collect the required information (from September 2018 to early 2019). Participants were selected through the purposive sampling method. The experts' viewpoints were classified by the main and sub themes. RESULTS Four basic themes extracted from the interviews and focus group discussions including, trauma care importance (sub-themes: the involved individuals' being young and productive and the effectiveness of trauma care); trauma care indicators (sub-themes: pre-hospital indicators, in-hospital indicators, and post-hospital indicators); stages of trauma care evaluation (sub-themes: evaluation prerequisites, finalization of indicators before the evaluation, determining evaluation time scope, determining evaluation dimensions, external and internal evaluation and use of evaluation results); trauma care improvement (sub-themes: balancing workload in trauma centers, enhancement of information system, considering extra-organizational dimensions in trauma care and empowerment of trauma care providers). CONCLUSIONS According to experts' viewpoints, trauma is a very important issue, because it involves young people. They believed that having indicators covering all aspects of care assist health managers and policymakers to understand under-standard performance. These indicators should be used in the form of a specific evaluation program and related to Iran context. Besides, reforming macro policies, planning, development of infrastructures, and education was some recommendations of experts to improve trauma care.
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Affiliation(s)
- Yalda Mousazadeh
- a Department of Health Policy and Management, Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Ali Janati
- b Iranian Center of Excellence in Health Management, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Mahboub Pouraghaei
- c Emergency Medicine Research Team, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Homayoun Sadeghi Bazargani
- d Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
,
Corresponding Author at:
Homayoun Sadeghi-Bazargani: Head of Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Tel.: 041-33800568; (Sadeghi-Bazargani, H.). https://orcid.org/0000-0002-0396-8709
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Archambault P, Turcotte S, Smith PY, Said Abasse K, Paquet C, Côté A, Gomez D, Khechine H, Gagnon MP, Tremblay M, Elazhary N, Légaré F. Intention to Use Wiki-Based Knowledge Tools: Survey of Quebec Emergency Health Professionals. JMIR Med Inform 2021; 9:e24649. [PMID: 34142977 PMCID: PMC8277401 DOI: 10.2196/24649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Clinical decision support systems are information technologies that assist clinicians in making better decisions. Their adoption has been limited because their content is difficult to adapt to local contexts and slow to adapt to emerging evidence. Collaborative writing applications such as wikis have the potential to increase access to existing and emerging evidence-based knowledge at the point of care, standardize emergency clinical decision making, and quickly adapt this knowledge to local contexts. However, little is known about the factors influencing health professionals' use of wiki-based knowledge tools. OBJECTIVE This study aims to measure emergency physicians' (EPs) and other acute care health professionals' (ACHPs) intentions to use wiki-based knowledge tools in trauma care and identify determinants of this intention that can be used in future theory-based interventions for promoting the use of wiki-based knowledge tools in trauma care. METHODS In total, 266 EPs and 907 ACHPs (nurses, respiratory therapists, and pharmacists) from 12 Quebec trauma centers were asked to answer a survey based on the theory of planned behavior (TPB). The TPB constructs were measured using a 7-point Likert scale. Descriptive statistics and Pearson correlations between the TPB constructs and intention were calculated. Multiple linear regression analysis was conducted to identify the salient beliefs. RESULTS Among the eligible participants, 57.1% (152/266) of EPs and 31.9% (290/907) of ACHPs completed the questionnaire. For EPs, we found that attitude, perceived behavioral control (PBC), and subjective norm (SN) were significant determinants of the intention to use wiki-based knowledge tools and explained 62% of its variance. None of the sociodemographic variables were related to EPs' intentions to use wiki-based knowledge tools. The regression model identified two normative beliefs ("approval by physicians" and "approval by patients") and two behavioral beliefs ("refreshes my memory" and "reduces errors"). For ACHPs, attitude, PBC, SN, and two sociodemographic variables (profession and the previous personal use of a wiki) were significantly related to the intention to use wiki-based knowledge tools and explained 60% of the variance in behavioral intention. The final regression model for ACHPs included two normative beliefs ("approval by the hospital trauma team" and "people less comfortable with information technology"), one control belief ("time constraints"), and one behavioral belief ("access to evidence"). CONCLUSIONS The intentions of EPs and ACHPs to use wiki-based knowledge tools to promote best practices in trauma care can be predicted in part by attitude, SN, and PBC. We also identified salient beliefs that future theory-based interventions should promote for the use of wiki-based knowledge tools in trauma care. These interventions will address the barriers to using wiki-based knowledge tools, find ways to ensure the quality of their content, foster contributions, and support the exploration of wiki-based knowledge tools as potential effective knowledge translation tools in trauma care.
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Affiliation(s)
- Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
| | - Stéphane Turcotte
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Pascal Y Smith
- Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, QC, Canada
| | - Kassim Said Abasse
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Catherine Paquet
- Département de marketing, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - André Côté
- Département de management, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Dario Gomez
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Hager Khechine
- Département de systèmes d'information organisationnels, Faculté des sciences de l'administration, Université Laval, Québec, QC, Canada
| | - Marie-Pierre Gagnon
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Melissa Tremblay
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Elazhary
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - France Légaré
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada
- VITAM - Centre de recherche en santé durable, Université Laval, Québec, QC, Canada
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Chang HY, Tang JS, Feng JY. [Implementation of Trauma-Informed Healthcare]. Hu Li Za Zhi 2021; 68:81-89. [PMID: 34013509 DOI: 10.6224/jn.202106_68(3).11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Trauma that is rooted in extremely stressful events is an important factor affecting human health. Patients who have experienced trauma may present in a variety of different ways in healthcare settings. One of these ways is the exhibiting of strong emotional or behavioral reactions triggered by traumatic memories. Caring for patients affected by known or unknown trauma is a significant challenge for healthcare providers. The core of trauma-informed care includes understanding trauma; respecting, empathizing and responding to the needs and reactions of patients with trauma; and providing care in a manner that prevents re-traumatization. In this article, the impact of trauma on overall health is introduced followed by a presentation of trauma triggers in the healthcare context, underscoring the importance of prioritizing care for patients with a history of trauma. Lastly, the concept and principles of trauma-informed care are incorporated into healthcare practice, providing specific, practical application strategies for healthcare providers to use in clinical settings. Trauma-informed healthcare practice relies on healthcare providers and organizations working together. The principles include the self-awareness and self-care of healthcare providers, awareness of the patient's trauma reaction, ensuring patient safety, building trust and transparency in care, working collaboratively with the patient and the healthcare team, and providing choices and empowerment during the care process. This article provides a reference to healthcare providers for providing friendly and high-quality care to patients with trauma.
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Affiliation(s)
- Hsin-Yi Chang
- MSN, RN, Project Instructor, Department of Nursing, and Doctoral Student, International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Taiwan, ROC
| | - Jing-Shia Tang
- MSN, RN, Associate Professor, Department of Nursing, Chung Hwa University of Medical Technology, and Doctoral Student, International Doctoral Program in Nursing, College of Medicine, National Cheng Kung University, Taiwan, ROC
| | - Jui-Ying Feng
- DNS, RN, Professor, Department of Nursing, College of Medicine, National Cheng Kung University, and Adjunct Supervisor, Department of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Taiwan, ROC.
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Padilla-Rojas LG, López-Cervantes RE, López-Almejo L, Gutiérrez-Mendoza I, Amadei-Enghelmayer RE, Pesciallo CA, Osma-Rueda JL, Triana-Quijano MA, Santos-Silva JD. Orthopaedic trauma care during the COVID-19 Pandemic: the Latin American perspective. OTA Int 2021; 4:e114. [PMID: 38630063 PMCID: PMC7959869 DOI: 10.1097/oi9.0000000000000114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/08/2020] [Accepted: 12/11/2020] [Indexed: 11/25/2022]
Abstract
At first glance, the COVID-19 pandemic and the field of orthopaedics and traumatology do not appear to be related. Although orthopaedists are not considered front-line personnel in the fight against the pandemic, the role of the surgeon as part of the overall health care team is crucial. The specialty of orthopaedics and orthopaedic trauma, due to its extraordinary scope, affects individuals of all ages and timely care affects patients' long-term function and quality of life. Therefore, positioning the type and timing of care for musculoskeletal injuries and conditions, while maintaining the safety of the patient and healthcare providers, is essential. This article reviews the initial approaches to orthopaedic trauma care during the COVID-19 pandemic as established by 4 representative countries in Latin America: Mexico, Argentina, Colombia, and Brazil.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jorge Dos Santos-Silva
- Institute of Othopaedics and Traumatology Hospital das Clinicas Faculty of Medicine, University of San Paulo, San Paulo, Brazil
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Leenstra NF, Jung OC, Cnossen F, Jaarsma ADC, Tulleken JE. Development and Evaluation of the Taxonomy of Trauma Leadership Skills-Shortened for Observation and Reflection in Training: A Practical Tool for Observing and Reflecting on Trauma Leadership Performance. Simul Healthc 2021; 16:37-45. [PMID: 32732816 PMCID: PMC7850591 DOI: 10.1097/sih.0000000000000474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Trauma leadership skills are increasingly being addressed in trauma courses, but few resources are available to systematically observe and debrief trainees' performances. The authors therefore translated their previously developed, extensive Taxonomy of Trauma Leadership Skills (TTLS) into a practical observation tool that is tailored to the vocabulary of clinician instructors and their workflow and workload during simulation-based training. METHODS In 2016 to 2018, the TTLS was subjected to practical evaluation in an iterative process of 2 stages. In the first stage, testing panels of trauma specialists observed excerpts from videotaped simulations and indicated from the list of elements which behaviors they felt were being shown. Any ambiguities or redundancy were addressed by rephrasing or combining elements. In the second stage, iterations were used in actual scenario training to observe and debrief trainees' performances. The instructors' recommendations resulted in further improvements of clarity, ease of use, and usefulness, until no new suggestions were raised. RESULTS The resultant "TTLS-Shortened for Observation and Reflection in Training" was given a simpler structure and more concrete and self-explanatory benchmarks. It contains 6 skill categories for evaluation, each with 4 to 6 benchmark behaviors. CONCLUSIONS The TTLS-Shortened for Observation and Reflection in Training is an important addition to other trauma assessment tools because of its specific focus on leadership skills. It helps set concrete performance expectations, simplify note taking, and target observations and debriefings. One central challenge was striking a balance between its conciseness and specificity. The authors reflected on how the decisions for the resultant structure ease and leverage the conduct of observations and performance debriefing.
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Harwood L, Jarvis S, Salottolo K, Redmond D, Berg GM, Erickson W, Spruell D, Deas S, Sharpe P, Atnip A, Cornutt D, Mains C, Bar-Or D. Processes for Trauma Care at Six Level I Trauma Centers During the COVID-19 Pandemic. J Healthc Qual 2021; 43:3-12. [PMID: 33394838 PMCID: PMC7785512 DOI: 10.1097/jhq.0000000000000285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
INTRODUCTION As the COVID-19 pandemic spread, patient care guidelines were published and elective surgeries postponed. However, trauma admissions are not scheduled and cannot be postponed. There is a paucity of information available on continuing trauma care during the pandemic. The study purpose was to describe multicenter trauma care process changes made during the COVID-19 pandemic. METHODS This descriptive survey summarized the response to the COVID-19 pandemic at six Level I trauma centers. The survey was completed in 05/2020. Questions were asked about personal protective equipment, ventilators, intensive care unit (ICU) beds, and negative pressure rooms. Data were summarized as proportions. RESULTS The survey took an average of 5 days. Sixty-seven percent reused N-95 respirators; 50% sanitized them with 25% using ultraviolet light. One hospital (17%) had regional resources impacted. Thirty-three percent created ventilator allocation protocols. Most hospitals (83%) designated more beds to the ICU; 50% of hospitals designated an ICU for COVID-19 patients. COVID-19 patients were isolated in negative pressure rooms at all hospitals. CONCLUSIONS In response to the COVID-19 pandemic, Level I trauma centers created processes to provide optimal trauma patient care and still protect providers. Other centers can use the processes described to continue care of trauma patients during the COVID-19 pandemic.
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Sheikh S, Mulwafu W, Gondwe WTM, Nyirenda M, Mbomuwa F, Chokhotho L. Assessing knowledge and skills of laypersons bringing victims of road traffic collisions to Queen Elizabeth Central Hospital in Blantyre, Malawi. Trop Doct 2020; 51:24-28. [PMID: 33251980 DOI: 10.1177/0049475520974365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Malawi, pre-hospital care assistance is mainly provided by laypersons who witnessed the event. The aim of our study was to determine the knowledge and skills of such persons who bring victims of road traffic crashes to hospital. The study was conducted at Adult Emergency and Trauma Centre at Queen Elizabeth Central Hospital in Blantyre, Malawi. A total of 392 participants were interviewed. Most were merchants (22%) and unskilled labourers (14.5%). Three quarters (75.8%) provided assistance on the scene. The most common assistance provided was transporting victim to the hospital (68.7%), assisting with safe lifting (57.9%) and calling for help (39.7%). Airway protection was provided by only 1% of participants. Therefore, it is recommended to establish some formal pre-hospital assistance to reduce morbidity and mortality from road traffic crashes. Laypersons, especially merchants, students and drivers are potential strong first responders, and training them may help improve pre-hospital care outcome.
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Affiliation(s)
- Shabnam Sheikh
- Medical Officer, 299619Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Wakisa Mulwafu
- Senior Lecturer, Department of Surgery, College of Medicine, Blantyre, Malawi
| | | | - Mulinda Nyirenda
- Head of Adult Emergency and Trauma Center and Clinics (Ambulatory Unit), 299619Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - Foster Mbomuwa
- Project Coordinator, Beit Cure Hospital, Blantyre, Malawi
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Croke K, Chokotho L, Milusheva S, Bertfelt J, Karpe S, Mohammed M, Mulwafu W. Implementation of a multi-center digital trauma registry: Experience in district and central hospitals in Malawi. Int J Health Plann Manage 2020; 35:1157-1172. [PMID: 32715521 DOI: 10.1002/hpm.3023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/21/2020] [Accepted: 06/15/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Trauma is a rapidly growing component of the burden of disease in developing countries; yet systematic data collection about trauma in such contexts is relatively rare. METHODS This paper describes the implementation of a trauma registry in 10 government-run hospitals in Malawi, with a focus on implementation logistics, stakeholder engagement strategies, and data quality procedures. RESULTS 51 337 trauma cases were recorded over the first 14 months of registry operations. The number of cases per month, data accuracy, and the geographic coverage of the registry improved over time as data quality measures were implemented. CONCLUSIONS Multi-center digital trauma registries are feasible in low-resource settings. Stakeholder engagement, periodic in-person and frequent digital follow up with data teams, and regular channeling of findings back to data collection teams help to improve data quality and completeness over a 14 month period. Financial and staffing constraints remain challenges for sustainability over time, but this experience demonstrates the feasibility of large-scale registry operations.
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Affiliation(s)
- Kevin Croke
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Linda Chokotho
- Department of Surgery, College of Medicine, University of Malawi, Zomba, Malawi
| | - Sveta Milusheva
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Jonna Bertfelt
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Saahil Karpe
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Meyhar Mohammed
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
| | - Wakisa Mulwafu
- Development Impact Evaluation Unit, World Bank Group, DC, Washington, USA
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Scott M, Abouelela W, Blitzer DN, Murphy T, Peck G, Lissauer M. Trauma Service Utilization Increases Cost But Does Not Add Value for Minimally Injured Patients. Value Health 2020; 23:705-709. [PMID: 32540227 DOI: 10.1016/j.jval.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 02/06/2020] [Accepted: 02/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Trauma care provides value to the critically injured. Our aim was to assess whether trauma team involvement adds value to the care of minimally injured patients and to define its costs. METHODS Minimally injured patients admitted to a trauma center were propensity matched and compared by involvement versus no involvement of the trauma service (TS). Demographics, injury severity, complications, length of emergency department stay, mortality, and hospital costs and charges were studied. RESULTS A total of 1253 patients were enrolled, with 308 propensity matched to the following groups: TS (n = 102) and no TS (n = 206). TS demonstrated a 30% increase in total charges and costs with no difference in complications. TS did demonstrate decreased time in the emergency department but had an increased delay to operation. Findings were similar when stratified for only lower extremity injuries. CONCLUSIONS TS involvement for minimally injured patients does not increase value. Reducing TS involvement while avoiding trauma undertriage may reduce costs to the healthcare system without affecting outcomes.
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Affiliation(s)
- Michael Scott
- Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | | | | | - Timothy Murphy
- Robert Wood Johnson University Hospital, Trauma Services, New Brunswick, NJ, USA
| | - Gregory Peck
- Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; Rutgers-School of Public Health, New Brunswick, NJ, USA
| | - Matthew Lissauer
- Department of Surgery, Division of Acute Care Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Vinish V, Chakrabarty J, Vijayan S, Kulkarni M, Shashidhara YN, Nayak BS, George A. First responder's care package on management of road traffic accident victims of Udupi: Study protocol. J Adv Nurs 2020; 76:1812-1822. [PMID: 32202337 DOI: 10.1111/jan.14368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 03/11/2020] [Accepted: 03/16/2020] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effectiveness of 'first responder's care package' on knowledge and skill on the management of road traffic accident (RTA) victims. The outcomes relate to the quality of first responder's care by autorickshaw drivers. METHODS Autorickshaw drivers (N = 1,040) will be assessed to identify the impediments and knowledge to provide the first responder's care to RTA victims following which, 150 autorickshaw drivers will be selected based on a cut-off knowledge score to train half of them using workshops. Drivers below 55 years and willing to participate will be recruited and drivers with serious health issues, homophobia and who cannot read English or Kannada will be excluded. Randomized controlled trial with repeated measures design will be adopted. Funding for the research is by the Indian Council of Medical Research and it is registered in the Clinical Trial Registry of India. DISCUSSION Road traffic accidents are responsible for 85% of the total global mortality and 90% of the 'Disability Adjusted Life Years' in the developing countries amounting to an annual loss of $65 billion to $100 billion. India's rate of RTA deaths is high and postcrash care is not addressed efficiently by any agencies in India. Autorickshaw drivers could be ideal candidates for teaching the first responder's care package in India as they are a constant presence on the roads and reach all the main roads and small lanes of the country. IMPACT The research will add to knowledge on quality of first responder's care provided to accident victims. If the intervention is found to be fruitful for the accident victims of the locality, it can be recommended to be implemented all over the state.
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Affiliation(s)
- V Vinish
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Jyothi Chakrabarty
- Department of Medical-Surgical Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Sandeep Vijayan
- Departmentt of Orthopedics, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Mahesh Kulkarni
- Departmentt of Orthopedics, Kasturba Hospital, Manipal Academy of Higher Education, Manipal, India
| | - Y N Shashidhara
- Department of Community Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anice George
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
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Wang T, Wang Y, Xu T, Li L, Huo M, Li X, He Y, Lin Q, Mei B, Zhou X, Jiang B. Epidemiological and clinical characteristics of 3327 cases of traffic trauma deaths in Beijing from 2008 to 2017: a retrospective analysis. Medicine (Baltimore) 2020; 99:e18567. [PMID: 31895799 PMCID: PMC6946352 DOI: 10.1097/md.0000000000018567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We investigated the epidemiological and clinical characteristics deaths from road traffic injury (RTI) in Beijing, and provided evidence useful for the prevention of fatal traffic trauma and for the treatment of traffic-related injuries.We retrospectively reviewed death cases provided by the Beijing Red Cross Emergency Center on road traffic injury deaths from 2008 to 2017. We analyzed population characteristics, time distribution, distribution of transportation modes, intervals to death, locations and injured body parts.From 2008 to 2017, there were 3327 deaths from RTI recorded by the Beijing Red Cross Emergency Center, with mainly males among these deaths. The average age at death was 46.19 ± 17.43 years old (46.19, 0.43-100.24). In accidents with more detail recorded, pedestrians and people using nonmotorized transportation modes suffered the most fatalities (664/968, 68.60%). The most commonly injured body parts were the head (2569/3327, 77.22%), followed by the chest (180/3327, 5.41%), abdomen (130/3327, 3.91%), lower extremities (68/3327, 2.04%), pelvis (67/3327, 2.01%), spinal cord (31/3327, 0.93%), and upper extremities (26/3327, 0.78%). Burns accounted for 0.96% (32/3327), and unknown body parts were affected in 11.28% (365/3327). The average time interval from injury to death was 36.90 ± 89.57 h (36.90, 0-720); 46.7% (1554/3327) died within 10 minutes after injury; 9.02% (300/3327) died between 10 min and 1 hour; 30.33% (1009/3327) died between 1 hour and 3 days; 13.95% (464/3327) died between 3 and 30 days.In Beijing, RTI is a significant cause of preventable death, particularly among pedestrians and users of non-motorized vehicles. Head trauma was the most lethal cause of RTI deaths. Our findings suggested that interventions to prevent collisions and reduce injuries, and improved trauma treatment process and trauma rescue system could address a certain proportion of avoidable RTI deaths.
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Affiliation(s)
- Tianbing Wang
- Trauma Medicine Center
- Department of Trauma and Orthopedics, Peking University People's Hospital
| | - Yanhua Wang
- Trauma Medicine Center
- Department of Trauma and Orthopedics, Peking University People's Hospital
| | - Tingmin Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital
| | | | | | - Xian Li
- Beijing Red Cross Emergency Center
| | - Yingdong He
- Biostatitics Department, School of Public Health
| | - Qiushi Lin
- Beijing International Center for Mathematical Research, Peking University
| | - Bingsong Mei
- Beijing Traffic Management Bureau, Beijing, China
| | - Xiaohua Zhou
- Biostatitics Department, School of Public Health
- Beijing International Center for Mathematical Research, Peking University
| | - Baoguo Jiang
- Trauma Medicine Center
- Department of Trauma and Orthopedics, Peking University People's Hospital
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Plate JDJ, Peelen LM, Leenen LPH, Hietbrink F. Optimizing critical care of the trauma patient at the intermediate care unit: a cost-efficient approach. Trauma Surg Acute Care Open 2018; 3:e000228. [PMID: 30402563 PMCID: PMC6203138 DOI: 10.1136/tsaco-2018-000228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 02/03/2023] Open
Abstract
Background The aim of this study was to describe the case load, safety, and cost savings of critical care of the trauma patient provided at the surgical intermediate care unit (IMCU). Methods This cohort study included all trauma admissions between January 1, 2011 and January 7, 2015 at the general intensive care unit (ICU), stand-alone neuro(surgical) IMCU, and stand-alone (trauma) surgical IMCU. Trauma mechanism, Abbreviated Injury Scale score and Injury Severity Score (ISS), vital signs, laboratory parameters, admission duration, intubation duration, ICU transfer, and in-hospital mortality were prospectively collected. Hypothetical cost savings were calculated using the fixed cost price per IMCU (US$1500) and ICU (US$2500) admission day. Results A total of 1320 admissions were included, 675 (51.1%) at the IMCU and 645 (48.9%) at the ICU. Patients admitted at the IMCU had a median ISS of 17 (11, 22). Their median duration of admission was 32.8 hours (18.8, 62.5). At the IMCU, one patient died due to aneurogenic shock. A subsequent ICU transfer was required in 38 (5.6%) IMCU admissions. Of these transfers, four patients died due to neurological deterioration. At the ICU, the median ISS was 22 (14, 30). Nearly all (n=620, 96.3%) ICU trauma patients required mechanical ventilation. Expected total cost savings due to the presence of the IMCU were US$1 772 785. Discussion A substantial amount of trauma patients in need of critical care can safely be admitted at the IMCU, without the need for further mechanical ventilation. Thereby, the IMCU could fulfill an essential cost-saving role in the management of severely injured trauma patients. Level of evidence Level IV.
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Affiliation(s)
- Joost D J Plate
- Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Linda M Peelen
- Julius Centre for Health Sciences and Primary Care, Utrecht University, Utrecht, The Netherlands.,Departments of Anesthesiology and Intensive Care Medicine, Utrecht University, Utrecht, The Netherlands
| | - Luke P H Leenen
- Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Falco Hietbrink
- Division of Surgery, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Boles L, Alexander C, Pace L, Haggard W, Bumgardner J, Jennings J. Development and Evaluation of an Injectable Chitosan/β-Glycerophosphate Paste as a Local Antibiotic Delivery System for Trauma Care. J Funct Biomater 2018; 9:E56. [PMID: 30322006 DOI: 10.3390/jfb9040056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 09/23/2018] [Accepted: 10/09/2018] [Indexed: 01/03/2023] Open
Abstract
Complex open musculoskeletal wounds are a leading cause of morbidity worldwide, partially due to a high risk of bacterial contamination. Local delivery systems may be used as adjunctive therapies to prevent infection, but they may be nondegradable, possess inadequate wound coverage, or migrate from the wound site. To address this issue, a thermo-responsive, injectable chitosan paste was fabricated by incorporating beta-glycerophosphate. The efficacy of thermo-paste as an adjunctive infection prevention tool was evaluated in terms of cytocompatibility, degradation, antibacterial, injectability, and inflammation properties. In vitro studies demonstrated thermo-paste may be loaded with amikacin and vancomycin and release inhibitory levels for at least 3 days. Further, approximately 60% of thermo-paste was enzymatically degraded within 7 days in vitro. The viability of cells exposed to thermo-paste exceeded ISO 10993-5 standards with approximately 73% relative viability of a control chitosan sponge. The ejection force of thermo-paste, approximately 20 N, was lower than previously studied paste formulations and within relevant clinical ejection force ranges. An in vivo murine biocompatibility study demonstrated that thermo-paste induced minimal inflammation after implantation for 7 days, similar to previously developed chitosan pastes. Results from these preliminary preclinical studies indicate that thermo-paste shows promise for further development as an antibiotic delivery system for infection prevention.
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Sigal A, Martin A, Ong A. Availability and use of hemostatic agents in prehospital trauma patients in Pennsylvania translation from the military to the civilian setting. Open Access Emerg Med 2017; 9:47-52. [PMID: 28740438 PMCID: PMC5505603 DOI: 10.2147/oaem.s134657] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To understand the translation of one innovation in trauma care from the military to the civilian setting, the adoption of topical hemostatic agents in the Emergency Medical Services (EMS) community and in Trauma Centers in Pennsylvania. METHOD We utilized an anonymous electronic survey of EMS Agency Administrative Officers and Trauma Center Coordinators. RESULTS We received responses from 23% (93/402) Advanced Life Support and Air Medical agencies in the State. Of the EMS agencies that responded, 46.6% (61/131) stock hemostatic products, with 55.5% (44/79) carrying QuickClot® Combat Gauze®. Of the agencies that carried hemostatic products, 50% utilized them at least once in the prior 6 months and 59% over the past 12 months. Despite the infrequent number of applications, prehospital providers ranked themselves as somewhat skilled and comfortable both with the application of the products and the indications for their use. CONCLUSION Our survey found that 46.6% of the respondents indicated they carry hemostatic products, a much greater number than found on prior surveys of EMS agencies. There is a steady acceptance by EMS of new innovations in trauma care although more work is needed in translating the exact role of hemostatic agents in the civilian setting.
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Affiliation(s)
| | | | - Adrian Ong
- Department of Surgery, Trauma Section, The Reading Hospital, West Reading, PA, USA
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Stanford P, Booth N, Suckley J, Twelvetree T, Thomas D. Assessment of injury severity in patients with major trauma. Nurs Stand 2016; 30:54-63. [PMID: 27484568 DOI: 10.7748/ns.2016.e10342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Major trauma centres provide specialised care for patients who have experienced serious traumatic injury. This article provides information about major trauma centres and outlines the assessment tools used in this setting. Since patients in major trauma centres will be transferred to other settings, including inpatient wards and primary care, this article is relevant for both nurses working in major trauma centres and in these areas. Traumatic injuries require rapid assessment to ensure the patient receives prompt, adequate and appropriate treatment. A range of assessment tools are available to assist nurses in major trauma centres and emergency care to assess the severity of a patient's injury. The most commonly used tools are triage, Catastrophic Haemorrhage Airway to Exposure assessment, pain assessment and the Glasgow Coma Scale. This article summarises the use of these assessment tools in these settings, and discusses the use of the Injury Severity Score (ISS) to determine the severity of patient injuries.
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Affiliation(s)
- Penelope Stanford
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, England
| | | | - Janet Suckley
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, England
| | - Timothy Twelvetree
- Central Manchester University Hospitals NHS Foundation Trust, University of Manchester, Manchester, England
| | - Debbie Thomas
- Central Manchester University Hospitals NHS Foundation Trust, England
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Chippendale T, Gentile PA, James MK, Melnic G. Indoor and outdoor falls among older adult trauma patients: A comparison of patient characteristics, associated factors and outcomes. Geriatr Gerontol Int 2016; 17:905-912. [PMID: 27138451 DOI: 10.1111/ggi.12800] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 02/12/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022]
Abstract
AIM The aim of the present study was to examine significant differences in patient characteristics, associated factors and outcomes for indoor versus outdoor falls among trauma patients. METHODS A retrospective cross-sectional study using data from the trauma registry and electronic medical records at a level 1 trauma center in the USA was carried out. People aged 55 years or older, for whom fall location could be identified (n = 712), were included in the study. Demographic information, functional status before admission, comorbid conditions, activation level, Injury Severity Score, discharge disposition and injury type were included in the comparative analyses. Associated factors for falls and fractures in each location were also examined using logistic regression. RESULTS Significant differences were found in patient characteristics between indoor and outdoor fallers. Significant differences in outcomes were found related to discharge disposition and injury type. Open wounds were more common among outdoor fallers (26.5%) as compared with indoor fallers (16.3%, P = 0.002). Although disorders of joints with difficulty walking were associated with fractures among both indoor (OR 7.20, CI 2.19-23.66) and outdoor fallers (OR 5.65, CI 1.27-25.06), sex was only associated with fractures among those who fell indoors (OR 1.69 CI 1.12-2.56). CONCLUSIONS Significant differences exist in characteristics of indoor and outdoor fallers, and for discharge disposition and injury type for each fall location among patients admitted for trauma care. Factors associated with fractures differ between indoor and outdoor fallers. Results can help to inform targeted primary and secondary prevention initiatives. Geriatr Gerontol Int 2017; 17: 905-912.
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Affiliation(s)
- Tracy Chippendale
- New York University, Steinhardt School of Culture, Education, and Human Development, Department of Occupational Therapy, New York, NY, USA
| | - Patricia A Gentile
- Jamaica Hospital Medical Center, Department of Surgery, Jamaica, NY, USA
| | - Melissa K James
- Jamaica Hospital Medical Center, Department of Surgery, Jamaica, NY, USA
| | - Gloria Melnic
- New York Presbyterian Hospital, Department of Surgery, New York, NY, USA
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Singh S, Gupta S, Daga A, Siddharth V, Wundavalli L. Cost analysis of a disaster facility at an apex tertiary care trauma center of India. J Emerg Trauma Shock 2016; 9:133-138. [PMID: 27904258 PMCID: PMC5113079 DOI: 10.4103/0974-2700.193347] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: For the Commonwealth Games 2010, Jai Prakash Narayan Apex Trauma Centre (JPNATC) of India had been directed by the Director General Health Services and Ministry of Health and Family Welfare, Government of India, to set up a specialized unit for the definitive management of the injured/unwell athletes, officials, and related personnel coming for the Commonwealth Games in October 2010. The facility included a 20-bedded fully equipped ward, six ICU beds with ventilator capacity, one very very important person observation area, one perioperative management cubicle, and one fully modular and integrated operating room. Objective: The objective of this study was to calculate the cost of disaster facility at JPNATC, All India Institute of Medical Sciences, New Delhi. Methodology: Traditional (average or gross) costing methodology was used to arrive at the cost for the provisioning of these services by this facility. Results: The annual cost of providing services at disaster facility at JPNATC, New Delhi, was calculated to be INR 61,007,334.08 (US$ 983,989.258) while the per hour cost was calculated to be INR 7061.03 of the total cost toward the provisioning of services by disaster facility where 26% was the capital cost and 74% was the operating cost. Human resource caters to maximum chunk of the expenditures (47%). Conclusion: The results of this costing study will help in the future planning of resource allocation within the financial constraints (US$ 1 = INR 62 in the year 2013).
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Affiliation(s)
- Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Shakti Gupta
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Anoop Daga
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Vijaydeep Siddharth
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - LaxmiTej Wundavalli
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
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Abstract
Medical school does not prepare trainees for the reality of the practice of medicine, where book knowledge takes second place to the more pragmatic skills of time management, conflict resolution, and damage control. Junior residents, overwhelmed by the demands of daily floor work, can easily lose sight of the reasons that they went into medicine to begin with. Taken out of the context of the hospital, though, the opportunity to care for a patient one-on-one can be a vital reminder of the gift that is to know how to heal the sick. Reflecting on the opportunity to care for an accident victim at the scene, rather than in the hospital, reinforces to one young physician the remarkable thing that it is to be a physician.
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Affiliation(s)
- Jonathan Emerson Kohler
- Division of Pediatric Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Archambault PM, Turgeon AF, Witteman HO, Lauzier F, Moore L, Lamontagne F, Horsley T, Gagnon MP, Droit A, Weiss M, Tremblay S, Lachaine J, Le Sage N, Émond M, Berthelot S, Plaisance A, Lapointe J, Razek T, van de Belt TH, Brand K, Bérubé M, Clément J, Grajales Iii FJ, Eysenbach G, Kuziemsky C, Friedman D, Lang E, Muscedere J, Rizoli S, Roberts DJ, Scales DC, Sinuff T, Stelfox HT, Gagnon I, Chabot C, Grenier R, Légaré F. Implementation and Evaluation of a Wiki Involving Multiple Stakeholders Including Patients in the Promotion of Best Practices in Trauma Care: The WikiTrauma Interrupted Time Series Protocol. JMIR Res Protoc 2015; 4:e21. [PMID: 25699546 PMCID: PMC4376233 DOI: 10.2196/resprot.4024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 11/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background Trauma is the most common cause of mortality among people between the ages of 1 and 45 years, costing Canadians 19.8 billion dollars a year (2004 data), yet half of all patients with major traumatic injuries do not receive evidence-based care, and significant regional variation in the quality of care across Canada exists. Accordingly, our goal is to lead a research project in which stakeholders themselves will adapt evidence-based trauma care knowledge tools to their own varied institutional contexts and cultures. We will do this by developing and assessing the combined impact of WikiTrauma, a free collaborative database of clinical decision support tools, and Wiki101, a training course teaching participants how to use WikiTrauma. WikiTrauma has the potential to ensure that all stakeholders (eg, patients, clinicians, and decision makers) can all contribute to, and benefit from, evidence-based clinical knowledge about trauma care that is tailored to their own needs and clinical setting. Objective Our main objective will be to study the combined effect of WikiTrauma and Wiki101 on the quality of care in four trauma centers in Quebec. Methods First, we will pilot-test the wiki with potential users to create a version ready to test in practice. A rapid, iterative prototyping process with 15 health professionals from nonparticipating centers will allow us to identify and resolve usability issues prior to finalizing the definitive version for the interrupted time series. Second, we will conduct an interrupted time series to measure the impact of our combined intervention on the quality of care in four trauma centers that will be selected—one level I, one level II, and two level III centers. Participants will be health care professionals working in the selected trauma centers. Also, five patient representatives will be recruited to participate in the creation of knowledge tools destined for their use (eg, handouts). All participants will be invited to complete the Wiki101 training and then use, and contribute to, WikiTrauma for 12 months. The primary outcome will be the change over time of a validated, composite, performance indicator score based on 15 process performance indicators found in the Quebec Trauma Registry. Results This project was funded in November 2014 by the Canadian Medical Protective Association. We expect to start this trial in early 2015 and preliminary results should be available in June 2016. Two trauma centers have already agreed to participate and two more will be recruited in the next months. Conclusions We expect that this study will add important and unique evidence about the effectiveness, safety, and cost savings of using collaborative platforms to adapt knowledge implementation tools across jurisdictions.
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Affiliation(s)
- Patrick M Archambault
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec, QC, Canada.
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Abstract
INTRODUCTION The Glasgow Coma Scale (GCS) is widely applied in the emergency setting; it is used to guide trauma triage and for the application of essential interventions such as endotracheal intubation. However, inter-rater reliability of GCS scoring has been shown to be low for inexperienced users, especially for the motor component. Concerns regarding the accuracy and validity of GCS scoring between various types of emergency care providers have been expressed. Hypothesis/Problem The objective of this study was to determine the degree of accuracy of GCS scoring between various emergency care providers within a modern Emergency Medical Services (EMS) system. METHODS This was a prospective observational study of the accuracy of GCS scoring using a convenience sample of various types of emergency medical providers using standardized video vignettes. Ten video vignettes using adults were prepared and scored by two board-certified neurologists. Inter-rater reliability was excellent (Cohen's κ = 1). Subjects viewed the video and then scored each scenario. The scoring of subjects was compared to expert scoring of the two board-certified neurologists. RESULTS A total of 217 emergency providers watched 10 video vignettes and provided 2,084 observations of GCS scoring. Overall total GCS scoring accuracy was 33.1% (95% CI, 30.2-36.0). The highest accuracy was observed on the verbal component of the GCS (69.2%; 95% CI, 67.8-70.4). The eye-opening component was the second most accurate (61.2%; 95% CI, 59.5-62.9). The least accurate component was the motor component (59.8%; 95% CI, 58.1-61.5). A small number of subjects (9.2%) assigned GCS scores that do not exist in the GCS scoring system. CONCLUSIONS Glasgow Coma Scale scoring should not be considered accurate. A more simplified scoring system should be developed and validated.
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Archambault PM, Gagnon S, Gagnon MP, Turcotte S, Lapointe J, Fleet R, Côté M, Beaupré P, Le Sage N, Emond M, Légaré F. Development and validation of questionnaires exploring health care professionals' intention to use wiki-based reminders to promote best practices in trauma. JMIR Res Protoc 2014; 3:e50. [PMID: 25281856 PMCID: PMC4213801 DOI: 10.2196/resprot.3762] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 08/28/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Little is known about factors influencing professionals' use of wikis. OBJECTIVE We developed and validated two questionnaires to assess health care professionals' intention to use wiki-based reminders for the management of trauma patients. METHODS We developed questionnaires for emergency physicians (EPs) and allied health professions (AHPs) based on the Theory of Planned Behavior and adapted them to the salient beliefs of each, identified in an earlier study. Items measured demographics and direct and indirect theoretical constructs. We piloted the questionnaires with 2 focus groups (5 EPs and 5 AHPs) to identify problems of wording and length. Based on feedback, we adjusted the wording and combined certain items. A new convenience sample of 25 EPs and 26 AHPs then performed a test-retest of the questionnaires at a 2-week interval. We assessed internal consistency using Cronbach alpha coefficients and temporal stability of items with an agreement intraclass correlation coefficient (ICC). RESULTS Five EPs and 5 AHPs (3 nurses, 1 respiratory therapist, and 1 pharmacist) formed 2 focus groups; 25 EPs and 26 AHPs (12 nurses, 7 respiratory therapists, and 7 pharmacists) completed the test and retest. The EP questionnaire test-retest scores for consistency (Cronbach alpha) and stability (ICC) were intention (test: Cronbach alpha=.94; retest: Cronbach alpha=.98; ICC=.89), attitude (.74, .72, .70), subjective norm (.79, .78, .75), perceived behavioral control (.67, .65, .66), attitudinal beliefs (.94, .86, .60), normative beliefs (.83, .87, .79), and control beliefs barriers (.58, .67, .78) and facilitators (.97, .85, .30). The AHP questionnaire scores for consistency and stability were: intention (test Cronbach alpha=.69, retest Cronbach alpha=.81, ICC=.48), attitude (.85, .87, .83), subjective norm (.47, .82, .62), perceived behavioral control (.55, .62, .60), attitudinal beliefs (.92, .91, .82), normative beliefs (.85, .90, .74), and control beliefs barriers (.58, .55, .66) and facilitators (.72, .94, -.05). To improve the psychometric properties of both questionnaires, we reformulated poorly consistent or unstable items. CONCLUSIONS Our new theory-based questionnaires to measure health care professionals' intention to use wiki-based reminders have adequate validity and reliability for use in large surveys. In the long run, they can be used to develop a theory-based implementation intervention for a wiki promoting best practices in trauma care.
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Gururaj G, Uthkarsh PS, Rao GN, Jayaram AN, Panduranganath V. Burden, pattern and outcomes of road traffic injuries in a rural district of India. Int J Inj Contr Saf Promot 2014; 23:64-71. [PMID: 25109622 DOI: 10.1080/17457300.2014.945465] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Road traffic injuries (RTIs) are a leading public health problem and the understanding of RTIs in rural India is limited. The present report documents the burden, pattern, characteristics and outcomes of RTIs in a rural district of India using combined data sources: police and hospital. RTIs contributed for 38% of fatal and 39% of non-fatal injuries with an annual mortality rate of 18.1/100,000 population/year. Young males were affected most and two-wheeler users and pedestrians were involved in 45% and 20% of fatal crashes, respectively. Nearly half (51%) of fatal RTIs occurred on national highways of the district; 46% died immediately at the site. Among those hospitalised, 20% were under the influence of alcohol while use of helmets and seat belts was <5%. Trauma care was deficient in the district leading to greater number of referrals. Road safety should be given high importance in rural India with a focus on safe roads, safe vehicles and safe people along with trauma care.
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Affiliation(s)
- Gopalkrishna Gururaj
- a Department of Epidemiology, WHO Collaborating Centre for Injury Prevention and Safety Promotion, Centre for Public Health , National Institute of Mental Health and Neuro Sciences , Bangalore 560029 , India
| | - Pallavi Sarji Uthkarsh
- b Department of Community Medicine , Sree Siddhartha Medical College and Research Centre , B.H. Road, Agalkote, Tumkur 527107 , India
| | - Girish N Rao
- c Department of Epidemiology, Centre for Public Health , National Institute of Mental Health and Neuro Sciences , Bangalore 560029 , India
| | - Ashok N Jayaram
- b Department of Community Medicine , Sree Siddhartha Medical College and Research Centre , B.H. Road, Agalkote, Tumkur 527107 , India
| | - Venkatesh Panduranganath
- b Department of Community Medicine , Sree Siddhartha Medical College and Research Centre , B.H. Road, Agalkote, Tumkur 527107 , India
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Schwerdtfeger K, Wand S, Schmid O, Roessler M, Quintel M, Leissner KB, Russo SG. A prospective, blinded evaluation of a video-assisted '4-stage approach' during undergraduate student practical skills training. BMC Med Educ 2014; 14:104. [PMID: 24885140 PMCID: PMC4040470 DOI: 10.1186/1472-6920-14-104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 05/09/2014] [Indexed: 05/21/2023]
Abstract
BACKGROUND The 4-stage approach (4-SA) is used as a didactic method for teaching practical skills in international courses on resuscitation and the structured care of trauma patients. The aim of this study was to evaluate objective and subjective learning success of a video-assisted 4-SA in teaching undergraduate medical students. METHODS The participants were medical students learning the principles of the acute treatment of trauma patients in their multidiscipline course on emergency and intensive care medicine. The participants were quasi- randomly divided into two groups. The 4-SA was used in both groups. In the control group, all four steps were presented by an instructor. In the study group, the first two steps were presented as a video. At the end of the course a 5-minute objective, structured clinical examination (OSCE) of a simulated trauma patient was conducted. The test results were divided into objective results obtained through a checklist with 9 dichotomous items and the assessment of the global performance rated subjectively by the examiner on a Likert scale from 1 to 6. RESULTS 313 students were recruited; the results of 256 were suitable for analysis. The OSCE results were excellent in both groups and did not differ significantly (control group: median 9, interquantil range (IQR) 8-9, study group: median 9, IQR 8-9; p = 0.29). The global performance was rated significantly better for the study group (median 1, IQR 1-2 vs. median 2, IQR 1-3; p < 0.01). The relative knowledge increase, stated by the students in their evaluation after the course, was greater in the study group (85% vs. 80%). CONCLUSION It is possible to employ video assistance in the classical 4-SA with comparable objective test results in an OSCE. The global performance was significantly improved with use of video assistance.
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Affiliation(s)
- Katrin Schwerdtfeger
- Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany
| | - Saskia Wand
- Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany
| | - Oliver Schmid
- Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany
| | - Markus Roessler
- Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany
| | - Michael Quintel
- Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany
| | | | - Sebastian G Russo
- Department of Anaesthesiology, University Hospital Göttingen, Göttingen 37075, Germany
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