O'Reilly, Gerard M; Cameron, Peter A; Joshipura, Manjul
The burden of injury is very high in developing countries. Trauma systems reduce mortality; the trauma registry is a key driver of improvements in trauma care. Developing countries have begun to develop trauma systems but the level of local trauma registry activity is unclear. The aim of this study was to determine a global estimate of trauma registry activity. A structured review of the literature was performed. All abstracts referring to a trauma registry over a two-year period were included. For the trauma registry described in each abstract, the source country was recorded. An additional search of web pages posted over a one year period was conducted. Those linked to an active trauma registry website were included and the country of the trauma registry was recorded. A selection of trauma registries from countries of different levels of development were identified and compared. 571 abstracts were included in the review. Most articles utilised "general" trauma registries (436(76%)) and were based at a single hospital (279(49%)). Other registries were limited to military or paediatric populations (36(6%) and 35(6%) articles respectively). Most articles sourced registries from the US (288(50%)), followed by Australia (45(8%)), Germany (32(6%)), Canada (27(5%)), UK (13(2%)), China (13(2%)) and Israel (12(2%)). The Americas produced most trauma registry articles and South East Asia the least. The majority of trauma registry articles originated from very highly developed countries 467(82%). Least developed countries had the fewest (5(1%)). The additional search yielded 37 web pages linked to 27 different trauma registry websites. Most of these were based in the US (16(59%)). The basic features of trauma registries, such as inclusion criteria, number and type of variables and injury severity scoring, varied widely depending on the country's level of development. This review, using a combination of the number of trauma registry articles and web pages to locate active
Pino Sánchez, F I; Ballesteros Sanz, M A; Cordero Lorenzana, L; Guerrero López, F
Traumatic disease is a major public health concern. Monitoring the quality of services provided is essential for the maintenance and improvement thereof. Assessing and monitoring the quality of care in trauma patient through quality indicators would allow identifying opportunities for improvement whose implementation would improve outcomes in hospital mortality, functional outcomes and quality of life of survivors. Many quality indicators have been used in this condition, although very few ones have a solid level of scientific evidence to recommend their routine use. The information contained in the trauma registries, spread around the world in recent decades, is essential to know the current health care reality, identify opportunities for improvement and contribute to the clinical and epidemiological research. Copyright © 2014 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.
Full Text Available Abstract Background Trauma is a major health problem in the United Arab Emirates (UAE as well as worldwide. Trauma registries provide large longitudinal databases for analysis and policy improvement. We aim in this paper to report on the development and evolution of a national trauma registry using a staged approach by developing a single-center registry, a two-center registry, and then a multi-center registry. The three registries were established by developing suitable data collection forms, databases, and interfaces to these databases. The first two registries collected data for a finite period of time and the third is underway. The steps taken to establish these registries depend on whether the registry is intended as a single-center or multi-center registry. Findings Several issues arose and were resolved during the development of these registries such as the relational design of the database, whether to use a standalone database management system or a web-based system, and the usability and security of the system. The inclusion of preventive medicine data elements is important in a trauma registry and the focus on road traffic collision data elements is essential in a country such as the UAE. The first two registries provided valuable data which has been analyzed and published. Conclusions The main factors leading to the successful establishment of a multi-center trauma registry are the development of a concise data entry form, development of a user-friendly secure web-based database system, the availability of a computer and Internet connection in each data collection center, funded data entry personnel well trained in extracting medical data from the medical record and entering it into the computer, and experienced personnel in trauma injuries and data analysis to continuously maintain and analyze the registry.
Outcome prediction models play an invaluable role in the evaluation and improvement of modern trauma care. Trauma registries underlying these outcome prediction models need to be accurate, complete and consistent. This thesis focused on the opportunities and limitations of trauma registries and
This combined retrospective and prospective study describes trauma patients in an urban African Hospital and assesses whether use of trauma registries leads to improved clinical assesment. The Kampala Trauma Score (KTS) is assessed as an injury severity filter. The level of clinical assessment was defined by Model ...
van Dongen, Thijs T C F|info:eu-repo/dai/nl/357301714; de Graaf, Johan|info:eu-repo/dai/nl/413649393; Huizinga, Eelco P; Champion, Howard R; Hoencamp, Rigo; Leenen, Luke P H|info:eu-repo/dai/nl/071390596
BACKGROUND: Structural collection of data from combat injuries is important to improve provided care and the outcome of (combat) casualties. Trauma registries are used in civilian and military health care systems for systematic administration of injury data. However, these registries often use
Full Text Available Background: In Peru, 11% of deaths are due to trauma. Iquitos is a large underserved Peruvian city isolated from central resources by its geography. Our objective was to implement a locally driven trauma registry to sustainably improve trauma healthcare in this region. Methods: All trauma patients presenting to the main regional referral hospital were included in the trauma registry. A pilot study retrospectively analyzed data from the first two months after implementation. Results: From March to April 2013, 572 trauma patients were entered into the database. Average age was 26.9 years. Ten percent of patients presented more than 24 hours after injury. Most common mechanisms of injury were falls (25.5%, motor vehicle collisions (23.3%, and blunt assault (10.5%. Interim analysis revealed that 99% of patients were entered into the database. However, documentation of vital signs was poor: 42% of patients had temperature, 26% had oxygen saturation documented. After reporting to registry staff, a significant increase in temperature (42 to 97%, P < 0.001 and oxygen saturation (26 to 92%, P < 0.001 documentation was observed. Conclusion: A trauma registry is possible to implement in a resource-poor setting. Future efforts will focus on analysis of data to enhance prevention and treatment of injuries in Iquitos.
Background: Trauma remains a significant cause of morbidity and mortality globally. Trauma registries are a key component of trauma systems in developed countries which have promoted improvement of patient care and outcomes. The experience with trauma registries in low income countries is limited. The current study ...
Chico-Fernández, M; Llompart-Pou, J A; Guerrero-López, F; Sánchez-Casado, M; García-Sáez, I; Mayor-García, M D; Egea-Guerrero, J; Fernández-Ortega, J F; Bueno-González, A; González-Robledo, J; Servià-Goixart, L; Roldán-Ramírez, J; Ballesteros-Sanz, M Á; Tejerina-Alvarez, E; García-Fuentes, C; Alberdi-Odriozola, F
To describe the characteristics and management of severe trauma disease in Spanish Intensive Care Units (ICUs). Registry of trauma in the ICU (RETRAUCI). Pilot phase. A prospective, multicenter registry. Thirteen Spanish ICUs. Patients with trauma disease admitted to the ICU. None. Epidemiology, out-of-hospital attention, registry of injuries, resources utilization, complications and outcome were evaluated. Patients, n=2242. Mean age 47.1±19.02 years. Males 79%. Blunt trauma 93.9%. Injury Severity Score 22.2±12.1, Revised Trauma Score 6.7±1.6. Non-intentional in 84.4% of the cases. The most common causes of trauma were traffic accidents followed by pedestrian and high-energy falls. Up to 12.4% were taking antiplatelet medication or anticoagulants. Almost 28% had a suspected or confirmed toxic influence in trauma. Up to 31.5% required an out-of-hospital artificial airway. The time from trauma to ICU admission was 4.7±5.3hours. At ICU admission, 68.5% were hemodynamically stable. Brain and chest injuries predominated. A large number of complications were documented. Mechanical ventilation was used in 69.5% of the patients (mean 8.2±9.9 days), of which 24.9% finally required a tracheostomy. The median duration of stay in the ICU and in hospital was 5 (range 3-13) and 9 (5-19) days, respectively. The ICU mortality rate was 12.3%, while the in-hospital mortality rate was 16.0%. The pilot phase of the RETRAUCI offers a first impression of the epidemiology and management of trauma disease in Spanish ICUs. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Full Text Available Abstract Background A trauma registry is an integral component of modern comprehensive trauma care systems. Trauma registries have not been established in most developing countries, and where they exist are often rudimentary and incomplete. This review describes the role of trauma registries in the care of the injured, and discusses how lessons from developed countries can be applied toward their design and implementation in developing countries. Methods A detailed review of English-language articles on trauma registry was performed using MEDLINE and CINAHL. In addition, relevant articles from non-indexed journals were identified with Google Scholar. Results The history and development of trauma registries and their role in modern trauma care are discussed. Drawing from past and current experience, guidelines for the design and implementation of trauma registries are given, with emphasis on technical and logistic factors peculiar to developing countries. Conclusion Improvement in trauma care depends on the establishment of functioning trauma care systems, of which a trauma registry is a crucial component. Hospitals and governments in developing countries should be encouraged to establish trauma registries using proven cost-effective strategies.
Zehtabchi, Shahriar; Nishijima, Daniel K; McKay, Mary Pat; Mann, N Clay
Trauma registries have been designed to serve a number of purposes, including quality improvement, injury prevention, clinical research, and policy development. Since their inception over 30 years ago, there are increasingly more institutions with trauma registries, many of which submit data to a national trauma registry. The goal of this review is to describe the history, logistics, and characteristics of trauma registries and their contribution to emergency medicine and trauma research. Discussed in this review are the limitations of trauma registries, such as variability in quality and type of the collected data, absence of data pertaining to long-term and functional outcomes, prehospital information, and complications as well as other methodologic obstacles limiting the utility of registry data in clinical and epidemiologic research. © 2011 by the Society for Academic Emergency Medicine.
Ringdal, K G; Lossius, H M
The organisation of trauma care in Scandinavia has several similarities, including trauma registries, but so far there are limited amount of research on efficiency and outcome. Data and results from trauma outcome studies like the US MTOS are not fully applicable to the Scandinavian trauma population. To reveal the feasibility of using data from existing trauma registries of major hospitals in Scandinavia, for a minimal common dataset, in a joint, prospective Scandinavian MTOS. We collected data points, data point definitions, and inclusion/exclusion criteria, from the major trauma registries of the Swedish trauma registry standard, three university hospitals in Denmark, one university hospital in Finland, and the Norwegian National Trauma Registry. The collected material was compared to reveal common data points, inclusion criteria, and the compatibility of data point definitions. The median number of data points was 147 (range 71-257; interquartile range = 90-205). Most registries lacked precise data definition catalogues. Only 16 data points could be considered as common, of which just a few were core trauma data. Four data points had the same data category options but were not considered having the same data point definitions. The inclusion criteria were not uniform. Trauma registries in Scandinavia have few common core data and data point definitions. There were data points for calculating the Trauma and Injury Severity Score (TRISS) but the inclusion criteria varied too much to ensure a valid comparison. A consensus process for a joint trauma core data set will be initiated by the Scandinavian Networking Group for Trauma and Emergency Management (SCANTEM) to increase research on trauma efficiency and outcome.
Laing, G L; Bruce, J L; Aldous, C; Clarke, D L
The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry. Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured. The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths. The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were
Gosselin, Richard A; Heitto, Merja; Zirkle, Lew
In this article the costs and effectiveness of introducing the SIGN nailing system for femoral shaft fractures in a provincial trauma hospital in Cambodia are compared to those of Perkin's traction treatment...
Kisitu, Dan K; Eyler, Lauren E; Kajja, I; Waiswa, G; Beyeza, T; Feldhaus, Isabelle; Juillard, Catherine; Dicker, Rochelle A
Musculoskeletal injuries are a major public health problem in low-income countries like Uganda. Patterns of musculoskeletal injuries presenting to district hospitals are unknown. Our pilot orthopedic trauma registry establishes a framework for broader district hospital injury surveillance. We interviewed and examined patients presenting to Mityana, Entebbe, and Nakaseke hospitals with musculoskeletal injuries from October 2013 to January 2014. We compared patient and Demographic and Health Survey population demographics and determined predictors of delayed presentation for care. Men, adults, and individuals with postsecondary education were more common among patients than in the Demographic and Health Survey population. Common causes included road traffic injuries (48.5%) and falls (25.1%). Closed, simple fractures comprised 70% of injuries. Compared to the self-employed, subsistence farmers (odds ratio [OR] = 2.99, 95% confidence interval [CI] = 1.15-7.91), motorcycle taxi drivers (OR = 10.50, 95% CI = 1.92-64.57), and preschool children (OR = 4.24, 95% CI = 1.05-17.39) were significantly more likely to be delayed to care after adjustment for covariates. Subsistence farmers were more likely than other occupations to seek care from traditional bonesetters (23% versus 7%, P = 0.001). All patients who visited bonesetters were delayed to hospital care. Policies for trauma systems strengthening must address the needs of underserved groups and involve all stakeholders, including bonesetters. Research should address reasons for delayed care among subsistence farmers, motorcycle taxi drivers, and preschool children. Injury surveillance at district hospitals facilitates evidence-based resource allocation and should continue in the form of an Ugandan national trauma registry. Copyright © 2015 Elsevier Inc. All rights reserved.
Taye, Mulat; Munie, Tadios
A simplified trauma registry was tested in Tikur anbessa hospital, with the aim of obtaining preliminary data on the patterns and magnitude of injuries and establishing the basis towards surveillance system. All injured patients presented to the surgical and pediatric emergency department between January 1, 1999 and June 31, 1999 were included. Interns completed the registry forms, which include demographic, injury event specific, severity and outcome data. The severity was assessed by new scoring system, Kampla Trauma Score (KTS). Among the 3822 injured patients 2869(75%) were males and 953(25%) were females and 80% were below the age of 40 years. 77% of the injuries were unintentional and motor vehicle injuries accounted for 41% of all causes among which 93% of them were pedestrians. Accidental fall and interpersonal assault accounted for 21% and 20% respectively. Admitted cases were 11.6%, while 20 (.5%) died at the outpatient department with the overall mortality of 1.47%. Though burn and gunshot accounted only for 6%, the case fatality rate was highest (4%) accounting for 20% of all deaths. The magnitude of fatal injuries is underestimated and the pattern of injuries may only reflect the situation in the big cities. Motor vehicle injuries, especially pedestrian injuries are serious problem in Addis as seen in patients in Tikur Anbessa hospital and require further situational studies and urgent intervention. Establishing hospital based simplified injury surveillance system is possible in Ethiopia and it is essential to asses the magnitude of the problem and identify priority area for injury prevention and control.
Stoica, Bogdan; Paun, Sorin; Tanase, Ioan; Negoi, Ionut; Chiotoroiu, Alexandru; Beuran, Mircea
A mixed score to predict the probability of survival has a key role in the modern trauma systems. The aim of the current studies is to summarize the current knowledge about estimation of survival in major trauma patients, in different trauma registries. Systematic review of the literature using electronic search in the PubMed/Medline, Web of Science Core Collection and EBSCO databases. We have used as a MeSH or truncated words a combination of trauma "probability of survival" and "mixed scores". The search strategy in PubMed was: "((((trauma(MeSH Major Topic)) OR injury(Title/Abstract)) AND score (Title/Abstract)) AND survival) AND registry (Title/Abstract))))". We used as a language selection only English language literature. There is no consensus between the major trauma registries, regarding probability of survival estimation in major trauma patients. The German (RISC II), United Kingdom (PS Model 14) trauma registries scores are based of the largest population, with demographics updated to the nowadays European injury pattern. The revised TRISS, resulting from the USA National Trauma Database, seems to be inaccurate for trauma systems managing predominantly blunt injuries. The probability of survival should be evaluated in all major trauma patients, with a score derived from a population which reproduce the current demographics.Only a careful audit of the unpredicted deaths may continuously improve our care for severely injured patients. Celsius.
He, Yutong; Liang, Di; Li, Daojuan; Zhai, Jingbo; Liu, Bo; Zhu, Junqing; Shan, Baoen
To analyze the cancer incidence and mortality in Hebei cancer registry available areas in 2011. Data were collected from 8 population-based cancer registries systems in Hebei province. Incidence and mortality rates stratified by areas (urban/rural), sex, age group and cancer site were analyzed. 10 common cancers in different groups, proportions and cumulative rates were calculated. The Chinese population census in the year 2000 and Segi's populations were used for age-standardized incidence/mortality rates. In all the 8 cancer registries that covering a total of 4 573 293 population (2 139 779 in urban and 2 433 514 in rural areas), data was used for the analysis. The total new cancer incidence cases and deaths were 11 269 and 7 477, respectively. All the morphologically verified cancer cases (MV%) accounted for 75.26% while 3.85% of the incident cases were identified only through death certification records (DCO%). The mortality to incidence ratio appeared as 0.66. The crude incidence appeared in the Hebei cancer registration areas was 246.41/10⁵ (264.55/10⁵ in males and 227.75/10⁵ in females). The age-standardized incidence rates by Chinese standard population (ASIRC) and by world standard population (ASIRW) appeared as 207.13/10⁵ and 206.61/10⁵ respectively, with the cumulative incidence rates as (0-74 age years old) 23.57%. The cancer incidence and ASIRC were 242.64/10⁵ and 200.19/10⁵ in urban areas, whereas 249.72/10⁵ and 214.11/10⁵, respectively in rural areas. The crude mortality in Hebei cancer registration areas was 163.49/10⁵ (196.54/10⁵ in male, 129.51/10⁵ in female), with age-standardized mortality rates by Chinese standard population (ASMRC) and by world standard population (ASMRW) as 144.48/10⁵ and 147.69/10⁵. The cumulative mortality rate (0-74 age years old) was 14.71%. The cancer mortality (167.91/10⁵) in rural areas seemed higher than the mortality (158.47/10⁵) in urban areas. The most common sites of cancers were
Hoopes, Megan J; Dankovchik, Jenine; Weiser, Thomas; Cheng, Tabitha; Bigback, Kristyn; Knaster, Elizabeth S; Sugerman, David E
The objectives of this study were to evaluate racial misclassification in a statewide trauma registry and to describe the epidemiology of trauma among the Washington American Indian and Alaska Native (AI/AN) population. We performed probabilistic record linkage between the Washington Trauma Registry (2005-2009) and Northwest Tribal Registry, a dataset of known AI/AN. AI/AN patients were compared with caucasians on demographic, injury and clinical outcome factors. A multivariable model estimated odds of mortality. Record linkage increased ascertainment of AI/AN cases in the trauma registry 71%, from 1777 to 3039 cases. Compared with caucasians, AI/AN trauma patients were younger (mean age=36 vs 47 years, pISSs were similar (ISS >15: 21.4% vs 20.5%, p=0.63), and no difference was observed in mortality after adjustment for covariates (p=0.58). Linkage to a state trauma registry improved data quality by correcting racial misclassification, allowing for a comprehensive description of injury patterns for the AI/AN population. AI/AN sustained more severe injuries with similar postinjury outcomes to caucasians. Future efforts should focus on primary prevention for this population, including increased use of seat belts and child safety seats and reduction of interpersonal violence and suicide. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Introduction. It has been shown repeatedly that hospital-based mortality data do not capture the actual mortality rate in South Africa, as many corpses are taken directly to the state mortuary. Objective. To present a comprehensive overview of the forensic mortality data for trauma in an urban metropolitan complex. Methods.
Accidental injury at home or on the roads was the most common cause of admission with majority of patients not receiving any pre-hospital care. Sixteen percent of patients died while admitted. Conclusion: The data obtained from this de novo registry largely aligns to previous institutional reports while revealing data points ...
Ordoñez, Carlos A; Morales, Mónica; Rojas-Mirquez, Johanna Carolina; Bonilla-Escobar, Francisco Javier; Badiel, Marisol; Miñán Arana, Fernando; González, Adolfo; Pino, Luis Fernando; Uribe-Gómez, Amadeus; Herrera, Mario Alain; Gutiérrez-Martínez, Maria Isabel; Puyana, Juan Carlos; Abutanos, Michael; Ivatury, Rao R
Trauma information systems are needed to improve decision making and to identify potential areas of intervention. To describe the first year of experience with a trauma registry in two referral centers in southwest Colombia. The study was performed in two referral centers in Cali. Patients with traumatic injuries seen between January 1 and December 31, 2012, were included. The collected information included demographics, mechanism of trauma, injury severity score (ISS), and mortality. A descriptive analysis was carried out. A total of 17,431 patients were registered, of which 67.8% were male with an average age of 30 (±20) years. Workplace injuries were the cause of emergency consultations in 28.2% of cases, and falls were the most common mechanism of trauma (37.3%). Patients with an ISS ≥15 were mostly found in the 18-35-year age range (6.4%). Most patients who suffered a gunshot wound presented an ISS ≥15. A total of 2.5% of all patients died, whereas the mortality rate was 54% among patients with an ISS ≥15 and a gunshot wound. Once the trauma registry was successfully implemented in two institutions in Cali, the primary causes of admission were identified as falls and workplace injuries. The most severely compromised patients were in the population range between 18 and 35 years of age. The highest mortality was caused by gunshot wounds.
Paulo Roberto Lima Carreiro
Full Text Available OBJECTIVE: Show the steps of a Trauma Registry (TR implementation in a Brazilian public hospital and evaluate the initial data from the database.METHODS: Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais and analysis of the initial results of the first 1,000 patients.RESULTS: The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7% and the importance of aggression as a cause of injuries in our environment (47.5%, surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%.CONCLUSION: Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Carreiro, Paulo Roberto Lima; Drumond, Domingos André Fernandes; Starling, Sizenando Vieira; Moritz, Mônica; Ladeira, Roberto Marini
Show the steps of a Trauma Registry (TR) implementation in a Brazilian public hospital and evaluate the initial data from the database. Descriptive study of the a TR implementation in João XXIII Hospital (Hospital Foundation of the state of Minas Gerais) and analysis of the initial results of the first 1,000 patients. The project was initiated in 2011 and from January 2013 we began collecting data for the TR. In January 2014 the registration of the first 1000 patients was completed. The greatest difficulties in the TR implementation were obtaining funds to finance the project and the lack of information within the medical records. The variables with the lowest completion percentage on the physiological conditions were: pulse, blood pressure, respiratory rate and Glasgow coma scale. Consequently, the Revised Trauma Score (RTS) could be calculated in only 31% of cases and the TRISS methodology applied to 30.3% of patients. The main epidemiological characteristics showed a predominance of young male victims (84.7%) and the importance of aggression as a cause of injuries in our environment (47.5%), surpassing traffic accidents. The average length of stay was 6 days, and mortality 13.7%. Trauma registries are invaluable tools in improving the care of trauma victims. It is necessary to improve the quality of data recorded in medical records. The involvement of public authorities is critical for the successful implementation and maintenance of trauma registries in Brazilian hospitals.
Gosselin, Richard A; Heitto, Merja; Zirkle, Lew
In this article the costs and effectiveness of introducing the SIGN nailing system for femoral shaft fractures in a provincial trauma hospital in Cambodia are compared to those of Perkin's traction treatment. At an average cost per patient of $1,107 in the traction group and $888 in the nail group (p < 0.01), and with better clinical outcomes in the nail group, internal fixation is more cost-effective than conservative treatment.
Kitchens, J W; Danis, R P
To evaluate an apparent increase in documented trauma from paintball related eye injuries reported to the Eye Injury Registry of Indiana. A retrospective review of cases reported to the database is reported, with representative case histories. No injuries from paintball were reported during the period June 1992 to June 1996. Over the next two years 11 injuries were reported, representing 4% of all ocular trauma reports over this period. Visual outcome is poor in many of these eyes and more than one half present with posterior segment ocular injury. Severe ocular trauma results from impacts from paintball pellets, and the occurrence of injuries appears to be increasing due to growth in popularity of this war game. Diligent use of eye protection by all participants is necessary to prevent a continuing rise in ocular trauma prevalence from this activity.
Chico-Fernández, M; Llompart-Pou, J A; Sánchez-Casado, M; Alberdi-Odriozola, F; Guerrero-López, F; Mayor-García, M D; Egea-Guerrero, J J; Fernández-Ortega, J F; Bueno-González, A; González-Robledo, J; Servià-Goixart, L; Roldán-Ramírez, J; Ballesteros-Sanz, M Á; Tejerina-Alvarez, E; Pino-Sánchez, F I; Homar-Ramírez, J
To validate Trauma and Injury Severity Score (TRISS) methodology as an auditing tool in the Spanish ICU Trauma Registry (RETRAUCI). A prospective, multicenter registry evaluation was carried out. Thirteen Spanish Intensive Care Units (ICUs). Individuals with traumatic disease and available data admitted to the participating ICUs. Predicted mortality using TRISS methodology was compared with that observed in the pilot phase of the RETRAUCI from November 2012 to January 2015. Discrimination was evaluated using receiver operating characteristic (ROC) curves and the corresponding areas under the curves (AUCs) (95% CI), with calibration using the Hosmer-Lemeshow (HL) goodness-of-fit test. A value of p<0.05 was considered significant. Predicted and observed mortality. A total of 1405 patients were analyzed. The observed mortality rate was 18% (253 patients), while the predicted mortality rate was 16.9%. The area under the ROC curve was 0.889 (95% CI: 0.867-0.911). Patients with blunt trauma (n=1305) had an area under the ROC curve of 0.887 (95% CI: 0.864-0.910), and those with penetrating trauma (n=100) presented an area under the curve of 0.919 (95% CI: 0.859-0.979). In the global sample, the HL test yielded a value of 25.38 (p=0.001): 27.35 (p<0.0001) in blunt trauma and 5.91 (p=0.658) in penetrating trauma. TRISS methodology underestimated mortality in patients with low predicted mortality and overestimated mortality in patients with high predicted mortality. TRISS methodology in the evaluation of severe trauma in Spanish ICUs showed good discrimination, with inadequate calibration - particularly in blunt trauma. Copyright © 2015 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Newgard, Craig D.; Sears, Gena K.; Rea, Thomas D.; Davis, Daniel P.; Pirrallo, Ronald G.; Callaway, Clifton W.; Atkins, Dianne L.; Stiell, Ian G.; Christenson, Jim; Minei, Joseph P.; Williams, Carolyn R.; Morrison, Laurie J.
Injury is a major public health problem generating substantial morbidity, mortality, and economic burden on society. The majority of seriously injured persons are initially evaluated and cared for by prehospital providers, however the effect of emergency medical services (EMS) systems, EMS clinical care, and EMS interventions on trauma patient outcomes is largely unknown. Outcome-based information to guide future EMS care has been hampered by the lack of comprehensive, standardized, multicenter prehospital data resources that include meaningful patient outcomes. In this paper, we describe the background, design, development, implementation, content, and potential uses of the first North American comprehensive epidemiologic prehospital data registry for injured persons. This data registry samples patients from 264 EMS agencies transporting to 287 acute care hospitals in both the United States and Canada. PMID:18482792
Bücking, Benjamin; Hartwig, Erich; Nienaber, Ulrike; Krause, Ulla; Friess, Thomas; Liener, Ulrich; Hevia, Maria; Bliemel, Christopher; Knobe, Matthias
Since 2014, hospitals with ortho-geriatric fracture centres could be certified as AltersTraumaZentrum DGU® in Germany. To measure the quality of treatment in these centres, a geriatric trauma registry (AltersTraumaRegister DGU®) was established. The aim of this work was to report the results of the pilot phase of the AltersTraumaRegister DGU® from the year 2015. Included were 118 patients >70 years with hip fracture or implant-related femoral fractures. Apart from other parameters, the point of surgery, initiation of anti-osteoporotic treatment and the EQ-5D one week post-surgery was measured. Surgery was performed in 87% of patients within 24 h. Specific osteoporotic therapy could be increased from 4 to 63 patients. The EQ-5D was strongly restricted to one week post-surgery. Based on the timing of surgery and anti-osteoporotic therapy, the treatment seems to be successful in the ortho-geriatric fracture centres. For a better evaluation of treatment quality in the AltersTraumaZentren DGU®, implementation of follow-up examinations in the AltersTraumaRegister DGU® is essential.
Pohlemann, Tim; Stengel, Dirk; Tosounidis, Georgios; Reilmann, Heinrich; Stuby, Fabian; Stöckle, Uli; Seekamp, Andreas; Schmal, Hagen; Thannheimer, Andreas; Holmenschlager, Francis; Gänsslen, Axel; Rommens, Pol Maria; Fuchs, Thomas; Baumgärtel, Friedel; Marintschev, Ivan; Krischak, Gert; Wunder, Stephan; Tscherne, Harald; Culemann, Ulf
To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. We studied 5048 patients with pelvic ring fractures enrolled in the German Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic regression analysis was employed to evaluate the impact of demographic, injury- and treatment-associated variables on all-cause in-hospital mortality. All-cause in-hospital mortality declined from 8% (39/466) in 1991 to 5% (33/638) in 2006. Controlling for age, Injury Severity Score, pelvic vessel injury, the need for emergency laparotomy, and application of a pelvic clamp, the odds ratio (OR) per annum was 0.94 (95% confidence interval [CI] 0.91-0.96). However, the risk of death did not decrease significantly in patients with complex injuries (OR 0.98, 95% CI 0.93-1.03). Raw mortality associated with this type of injury was 18% (95% CI 9-32%) in 2006. In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care professionals, and early management protocols need to be implemented to improve the survival prognosis. Copyright © 2011 Elsevier Ltd. All rights reserved.
Aharonson-Daniel, L; Boyko, V; Ziv, A; Avitzour, M; Peleg, K
To present a new systematic approach for summarizing multiple injury diagnosis data into patient injury profiles. International Classification of Diseases, ninth revision, clinical modification injury diagnosis codes were classified using a modification of the Barell body region by nature of injury diagnosis matrix, then grouped by body region, injury nature, or a combination of both. Profiles were built which describe patients' injury combinations based on matrix units, enabling the analysis of patients, and not only the study of injuries. The Israeli national trauma registry was used to retrieve patient demographic data, injury details, and information on treatment and outcome. Patients or subjects: All hospitalized patients injured in road traffic accidents and included in the trauma registry from January 1997 to December 2000 were included. Patient profiles consisting of body regions, injury natures, their combination, and their clinical outcomes. The study population comprised 17459 patients. Head and neck injuries were the most frequent in all subpopulations except for motorcyclists who sustained most injuries in the extremities. Fractures were the most common injury nature (60%). Pedestrians and drivers had the highest proportion of multiple injuries in both profiles. Forty eight percent of the patients had a single cell profile. The most frequent conditions as a sole condition were extremity fractures (14%), internal injuries to the head (11%), and injuries of other nature to the torso (6%). Mortality, length of stay, and intensive care unit treatment varied dramatically between profiles and increased for multiple injury profiles. Inpatient death was an outcome for 3.3% overall; however, in patients with an internal injury to the head and torso, inpatient death rate was nine times higher, at 31%. Profiles maintain information on body region and nature of injury. The use of injury profiles in describing the injured improves the understanding of casemix and
Zwingmann, Jörn; Aghayev, Emin; Südkamp, Norbert P; Neumann, Mirjam; Bode, Gerrit; Stuby, Fabian; Schmal, Hagen
As pelvic fractures in children and adolescents are very rare, the surgical management is not well delineated nor are the postoperative complications. The aim of this study using the prospective data from German Pelvic Trauma Registry study was to evaluate the various treatment approaches compared to adults and delineated the differences in postoperative complications after pelvic injuries.Using the prospective pelvic trauma registry established by the German Society of Traumatology and the German Section of the Arbeitsgemeinschaft für Osteosynthesefragen (AO), International in 1991, patients with pelvic fractures over a 12-year time frame submitted by any 1 of the 23 member level I trauma centers were reviewed.We identified a total of 13,525 patients including pelvic fractures in 13,317 adults and 208 children aged ≤14 years and compared these 2 groups. The 2 groups' Injury Severitiy Score (ISS) did not differ statistically. Lethality in the pediatric group was 6.3%, not statistically different from the adults' 4.6%. In all, 18.3% of the pediatric pelvic fractures were treated surgically as compared to 22.7% in the adult group. No child suffered any thrombosis/embolism, acute respiratory distress syndrome (ARDS), multiorgan failure (MOF), or neurologic deficit, nor was any septic MOF detected. The differences between adults and children were statistically significant in that the children suffered less frequently from thrombosis/embolism (P = 0.041) and ARDS and MOF (P = 0.006).This prospective multicenter study addressing patients with pelvic fractures reveals that the risk for a thrombosis/embolism, ARDS, and MOF is significant lower in pediatric patients than in adults. No statistical differences could be found in the ratios of operative therapy of the pelvic fractures in children compared to adults.
Burstein, Brett; Fauteux-Lamarre, Emmanuelle; As, Arjan Bastiaan van
Road traffic injuries (RTIs) are a significant cause of paediatric morbidity and mortality worldwide, with a disproportionate number of these injuries occurring in low- and middle-income countries (LMICs). Adult data from LMICs suggest that weekends are particularly high-risk for RTIs, but whether children are at increased risk of RTI on weekends has not previously been investigated in any setting. This study sought to assess patterns in paediatric RTI presentations using hospital-based trauma surveillance data in Cape Town, South Africa. Data was analysed from Childsafe South Africa's prospectively collected trauma registry for injured children below 13 years of age presenting to a tertiary paediatric referral Trauma Department between 2004 and 2013. During the 10-year study period, a total of 71,180 patients presented with traumatic injuries, of which 8,815 (12.4%) resulted from RTIs. RTI patients had a mean age of 5.2±3.6 years, and were predominantly males and pedestrians. RTIs were more common on weekends than weekdays (2.98 vs. 2.19 patients/day, ptrauma (15.5% vs. 11.2%, ptrauma patients (injury score 1.66 vs. 1.46 and 1.43, both ptrauma ward (1.14 vs. 0.79 patients/day, ptrauma ward (ptrauma surveillance data to inform targeted community prevention strategies for improving child road safety. Copyright © 2016. Published by Elsevier Ltd.
Krawczyk, Marek; Grąt, Michał; Adam, Rene; Polak, Wojciech G; Klempnauer, Jurgen; Pinna, Antonio; Di Benedetto, Fabrizio; Filipponi, Franco; Senninger, Norbert; Foss, Aksel; Rufián-Peña, Sebastian; Bennet, William; Pratschke, Johann; Paul, Andreas; Settmacher, Utz; Rossi, Giorgio; Salizzoni, Mauro; Fernandez-Selles, Carlos; Martínez de Rituerto, Santiago T; Gómez-Bravo, Miguel A; Pirenne, Jacques; Detry, Olivier; Majno, Pietro E; Nemec, Petr; Bechstein, Wolf O; Bartels, Michael; Nadalin, Silvio; Pruvot, Francois R; Mirza, Darius F; Lupo, Luigi; Colledan, Michele; Tisone, Giuseppe; Ringers, Jan; Daniel, Jorge; Charco Torra, Ramón; Moreno González, Enrique; Bañares Cañizares, Rafael; Cuervas-Mons Martinez, Valentin; San Juan Rodríguez, Fernando; Yilmaz, Sezai; Remiszewski, Piotr
Liver transplantation is the most extreme form of surgical management of patients with hepatic trauma, with very limited literature data supporting its use. The aim of this study was to assess the results of liver transplantation for hepatic trauma. This retrospective analysis based on European Liver Transplant Registry comprised data of 73 recipients of liver transplantation for hepatic trauma performed in 37 centers in the period between 1987 and 2013. Mortality and graft loss rates at 90 days were set as primary and secondary outcome measures, respectively. Mortality and graft loss rates at 90 days were 42.5% and 46.6%, respectively. Regarding general variables, cross-clamping without extracorporeal veno-venous bypass was the only independent risk factor for both mortality (P = 0.031) and graft loss (P = 0.034). Regarding more detailed factors, grade of liver trauma exceeding IV increased the risk of mortality (P = 0.005) and graft loss (P = 0.018). Moreover, a tendency above the level of significance was observed for the negative impact of injury severity score (ISS) on mortality (P = 0.071). The optimal cut-off for ISS was 33, with sensitivity of 60.0%, specificity of 80.0%, positive predictive value of 75.0%, and negative predictive value of 66.7%. Liver transplantation seems to be justified in selected patients with otherwise fatal severe liver injuries, particularly in whom cross-clamping without extracorporeal bypass can be omitted. The ISS cutoff less than 33 may be useful in the selection process.
Bunn, Terry L; Slavova, Svetla; Bernard, Andrew C
Work-related injuries exert a great financial and economic burden on the US population. The study objectives were to identify the industries and occupations associated with worker injuries and to determine the predictors for injured worker drug screening in trauma centers. Work-related injury cases were selected using three criteria (expected payer source of workers' compensation, industry-related e-codes, and work-related indicator) from the Kentucky Trauma Registry data set for years 2008 to 2012. Descriptive analyses and multiple logistic regression were performed on the work-related injury cases. The "other services" and construction industry sectors accounted for the highest number of work-related cases. Drugs were detected in 55% of all drug-screened work-related trauma cases. Higher percentages of injured workers tested positive for drugs in the natural resources and mining, transportation and public utilities, and construction industries. In comparison, higher percentages of injured workers in the other services as well as transportation and public utilities industries were drug screened. Treatment at Level I trauma centers and Glasgow Coma Scale (GCS) scores indicating a coma or severe brain injury were both significant independent predictors for being screened for drugs; industry was not a significant predictor for being drug screened. The injured worker was more likely to be drug screened if the worker had a greater than mild injury, regardless of whether the worker was an interfacility transfer. These findings indicate that there may be elevated drug use or abuse in natural resources and mining, transportation and public utilities, as well as construction industry workers; improved identification of the specific drug types in positive drug screen results of injured workers is needed to better target prevention efforts. Epidemiologic study, level III.
Alghnam, Suliman; Alkelya, Muhamad; Al-Bedah, Khalid; Al-Enazi, Saleem
In Saudi Arabia (SA), injuries are the second leading cause of death; however, little is known about their frequencies and outcomes. Trauma registries play a major role in measuring the burden on population health. This study aims to describe the population of the only hospital-based trauma registry in the country and highlight challenges and potential opportunities to improve trauma data collection and research in SA. Using data between 2001 and 2010, this retrospective study included patients from a large trauma center in Riyadh, SA. A staff nurse utilized a structured checklist to gather information on patients' demographic, physiologic, anatomic, and outcome variables. Basic descriptive statistics by age group ( 14 years) were calculated, and differences were assessed using student t and chi-square tests. In addition, the mechanism of injury and the frequency of missing data were evaluated. 10 847 patients from the trauma registry were included. Over 9% of all patients died either before or after being treated at the hospital. Patients who were older than 14 years of age (more likely to be male) sustained traffic-related injuries and died in the hospital as compared to patients who were younger than or equal to years of age. Deceased patients were severely injured as measured by injury severity score and Glasgow Coma Scale (P < .001). Overall, the most frequent type of injury was related to traffic (52.0%), followed by falls (23.4%). Missing values were mostly prevalent in traffic-related variables, such as seatbelt use (70.2%). This registry is a key step toward addressing the burden of injuries in SA. Improved injury classification using the International Classification of Disease-external cause codes may improve the quality of the registry and allow comparison with other populations. Most importantly, injury prevention in SA requires further investment in data collection and research to improve outcomes.
Hsieh, Ching-Hua; Lai, Wei-Hung; Wu, Shao-Chun; Chen, Yi-Chun; Kuo, Pao-Jen; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun
The aim of this study was to investigate and compare the injury characteristics, severity, and outcome between underweight and normal-weight patients hospitalized for the treatment of all kinds of trauma injury.This study was based on a level I trauma center Taiwan.The detailed data of 640 underweight adult trauma patients with a body mass index (BMI) of BMI ≥ 18.5 kg/m) were retrieved from the Trauma Registry System between January 1, 2009, and December 31, 2014. Pearson's chi-square test, Fisher's exact test, and independent Student's t-test were performed to compare the differences. Propensity score matching with logistic regression was used to evaluate the effect of underweight on mortality.Underweight patients presented a different bodily injury pattern and a significantly higher rate of admittance to the intensive care unit (ICU) than did normal-weight patients; however, no significant differences in the Glasgow Coma Scale (GCS) score, injury severity score (ISS), in-hospital mortality, and hospital length of stay were found between the two groups. However, further analysis of the patients stratified by two major injury mechanisms (motorcycle accident and fall injury) revealed that underweight patients had significantly lower GCS scores (13.8 ± 3.0 vs 14.5 ± 2.0, P = 0.020), but higher ISS (10.1 ± 6.9 vs 8.4 ± 5.9, P = 0.005), in-hospital mortality (odds ratio, 4.4; 95% confidence interval, 1.69-11.35; P = 0.006), and ICU admittance rate (24.1% vs 14.3%, P = 0.007) than normal-weight patients in the fall accident group, but not in the motorcycle accident group. However, after propensity score matching, logistic regression analysis of well-matched pairs of patients with either all trauma, motorcycle accident, or fall injury did not show a significant influence of underweight on mortality.Exploratory data analysis revealed that underweight patients presented a different bodily injury pattern from that of normal
JOSÉ GUSTAVO PARREIRA
Full Text Available ABSTRACTObjective:to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS, and its ability to identify points for improvement in the quality of care provided.Methods:the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1 or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process.Results:data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI.Conclusion: the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.
Evans, Christopher C D; Petersen, Ashley; Meier, Eric N; Buick, Jason E; Schreiber, Martin; Kannas, Delores; Austin, Michael A
Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. We included 2,300 patients who were predominately young (Epistry mean [SD], 39  years; PROPHET mean [SD], 40  years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6.3%) survived to hospital discharge. More patients with blunt (Epistry, 8.3%; PROPHET, 6.5%) vs. penetrating injuries (Epistry, 4.6%; PROPHET, 2.7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0.048) in the Epistry but not PROPHET (p = 0.14) registries.Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0.27; 95% confidence interval, 0.08-0.93; and 0.37; 95% confidence interval, 0.17-0.78, respectively) compared to those receiving bag-mask ventilation. No other procedures were associated with survival. Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased
Background Bicycle use has increased in some of France's major cities, mainly as a means of transport. Bicycle crashes need to be studied, preferably by type of cycling. Here we conduct a descriptive analysis. Method A road trauma registry has been in use in France since 1996, in a large county around Lyon (the Rhône, population 1.6 million). It covers outpatients, inpatients and fatalities. All injuries are coded using the Abbreviated Injury Scale (AIS). Proxies were used to identify three types of cycling: learning = children (0-10 years old); sports cycling = teenagers and adults injured outside towns; cycling as means of transport = teenagers and adults injured in towns. The study is based on 13,684 cyclist casualties (1996-2008). Results The percentage of cyclists injured in a collision with a motor vehicle was 8% among children, 17% among teenagers and adults injured outside towns, and 31% among those injured in towns. The percentage of serious casualties (MAIS 3+) was 4.5% among children, 10.9% among adults injured outside towns and 7.2% among those injured in towns. Collisions with motor-vehicles lead to more internal injuries than bicycle-only crashes. Conclusion The description indicates that cyclist type is associated with different crash and injury patterns. In particular, cyclists injured in towns (where cycling is increasing) are generally less severely injured than those injured outside towns for both types of crash (bicycle-only crashes and collisions with a motor vehicle). This is probably due to lower speeds in towns, for both cyclists and motor vehicles. PMID:21849071
Brockamp, Thomas; Maegele, Marc; Gaarder, Christine; Goslings, J Carel; Cohen, Mitchell J; Lefering, Rolf; Joosse, Pieter; Naess, Paal A; Skaga, Nils O; Groat, Tahnee; Eaglestone, Simon; Borgman, Matthew A; Spinella, Philip C; Schreiber, Martin A; Brohi, Karim
The BIG score (Admission base deficit (B), International normalized ratio (I), and Glasgow Coma Scale (G)) has been shown to predict mortality on admission in pediatric trauma patients. The objective of this study was to assess its performance in predicting mortality in an adult trauma population, and to compare it with the existing Trauma and Injury Severity Score (TRISS) and probability of survival (PS09) score. A retrospective analysis using data collected between 2005 and 2010 from seven trauma centers and registries in Europe and the United States of America was performed. We compared the BIG score with TRISS and PS09 scores in a population of blunt and penetrating trauma patients. We then assessed the discrimination ability of all scores via receiver operating characteristic (ROC) curves and compared the expected mortality rate (precision) of all scores with the observed mortality rate. In total, 12,206 datasets were retrieved to validate the BIG score. The mean ISS was 15 ± 11, and the mean 30-day mortality rate was 4.8%. With an AUROC of 0.892 (95% confidence interval (CI): 0.879 to 0.906), the BIG score performed well in an adult population. TRISS had an area under ROC (AUROC) of 0.922 (0.913 to 0.932) and the PS09 score of 0.825 (0.915 to 0.934). On a penetrating-trauma population, the BIG score had an AUROC result of 0.920 (0.898 to 0.942) compared with the PS09 score (AUROC of 0.921; 0.902 to 0.939) and TRISS (0.929; 0.912 to 0.947). The BIG score is a good predictor of mortality in the adult trauma population. It performed well compared with TRISS and the PS09 score, although it has significantly less discriminative ability. In a penetrating-trauma population, the BIG score performed better than in a population with blunt trauma. The BIG score has the advantage of being available shortly after admission and may be used to predict clinical prognosis or as a research tool to risk stratify trauma patients into clinical trials.
Ramachandran, Anu; Ranjit, Anju; Zogg, Cheryl K; Herrera-Escobar, Juan P; Appelson, Jessica R; Pino, Luis F; Aboutanous, Michel B; Haider, Adil H; Ordonez, Carlos A
The aim of this study was to compare the epidemiology of traumatic injuries and mortality outcomes between two tertiary-care trauma centers in Colombia using data from Pan-American Trauma Registry (PATR). January 1-December 31, 2012, data from the Hospital Universitario del Valle (HUV, public) and Fundacion Valle del Lili (FVL, private) in Cali, Colombia, were considered. Differences in demographic and clinical information were compared using descriptive statistics. Propensity score matching was used to match patients on age, gender, and ISS. Within matched cohorts, multivariable logistic regression models were used to assess for differences in in-hospital mortality, further adjusting for insurance type, employment, heart rate, presence of hypotension (SBP < 90), and GCS score. HUV (8539; 78% male) and FVL (10,456; 60% male) had a combined total of 18,995 trauma cases in 2012 with comparable mean ages of 29.7 years. There were significant differences in insurance status, injury severity, and mechanism of injury between patients at HUV and FLV. On risk-adjusted logistic regression analyses with propensity score matched cohorts, the odds of death in HUV was higher compared to patients presenting at FVL hospital (OR [95% CI]:4.93 [3.37-7.21], p < 0.001). The study established the utility of the PATR and revealed important trends in patient demographics, injury epidemiology, and mortality outcomes, which can be used to target trauma initiatives throughout the region. It underscores the profound importance that differences in case mix play in the risk of trauma-related mortality, further emphasizing the need to monitor and evaluate unique aspects of trauma in LMIC. III.
Ordóñez, Carlos A; Pino, Luis Fernando; Tejada, Jorge W; Badiel, Marisol; Loaiza, Jhon Harry; Mata, Lina V; Aboutanos, Michael B
To describes the experience in the implementation of a TRS in two hospitals in Cali, Colombia. The TRS includes prehospitalary, during hospitalization and discharging status information of each patient. Each hospital has an electronic data capture strategy. A three month Pilot-period descriptive analysis is presented. 3293 patients has been registered, 1626 (49.4%) from the Public hospital and 1613 (50.6%) from the Private one. 67.2% were men; the mean age ±SD was 30.5±20 years; 30.5% were less than 18 years. The overall mortality rate was 3.5%. The most frequent consulting cause were falls (33.7%); 11.6% of injuries are secondary to fire gunshot, and this group where mortality rate was 62%. It was determined the needing for the TRS implementation and the mechanisms to provide continuity. The registry becomes an information source for the investigation developing. It was identified the causes of consult, morbidity and death due to trauma that will allow a better planning of the emergency services and of the regional trauma system in order to optimize and reduce the attention costs. Based on optimal information system it will be able to present the necessary adjusts to redesign the Trauma and Emergencies Attention System in the Colombian South-West.
de Vries, Rob; Reininga, Inge H F; Pieske, Oliver; Lefering, Rolf; El Moumni, Mostafa; Wendt, Klaus
Polytrauma patients nowadays tend to be older due to the growth of the elderly population and its improved mobility. The aim of this study was to compare demographics, injury patterns, injury mechanisms and outcomes between younger and older polytrauma patients. Data from polytrauma (ISS≥16) patients between 2009 and 2014 were extracted from the Dutch trauma registry (DTR). Younger (Group A: ages 18-59) and older (Group B: ages ≥60) polytrauma patients were compared. Differences in injury severity, trauma mechanism (only data for the year 2014), vital signs, injury patterns, ICU characteristics and hospital mortality were analyzed. Data of 25,304 polytrauma patients were analyzed. The older patients represented 47.8% of the polytrauma population. Trauma mechanism in the older patients was more likely to be a bicycle accident (A: 17%; B: 21%) or a low-energy fall (A: 13%; B: 43%). Younger polytrauma patients were more likely to have the worst scores on the Glasgow coma scale (EMV = 3, A: 20%, B: 13%). However, serious head injuries were seen more often in the older patients (A: 53%; B: 69%). The hospital mortality was doubled for the older polytrauma patients (19.8% vs. 9.6%). Elderly are involved more often in polytrauma. Although injury severity did not differ between groups, the older polytrauma patients were at a higher risk of dying than their younger counterparts despite sustaining less high-energy accidents.
Chuang, Jung-Fang; Rau, Cheng-Shyuan; Kuo, Pao-Jen; Chen, Yi-Chun; Hsu, Shiun-Yuan; Hsieh, Hsiao-Yun; Hsieh, Ching-Hua
The adverse impact of obesity has been extensively studied in the general population; however, the added risk of obesity on trauma-related mortality remains controversial. This study investigated and compared mortality as well injury patterns and length of stay (LOS) in obese and normal-weight patients hospitalized for trauma in the hospital and intensive care unit (ICU) of a Level I trauma center in southern Taiwan. Detailed data of 880 obese adult patients with body mass index (BMI) ≥ 30 kg/m(2) and 5391 normal-weight adult patients (25 > BMI ≥ 18.5 kg/m(2)) who had sustained a trauma injury between January 1, 2009 and December 31, 2013 were retrieved from the Trauma Registry System. Pearson's chi-squared, Fisher's exact, and independent Student's t-tests were used to compare differences between groups. Propensity score matching with logistic regression was used to evaluate the effect of obesity on mortality. In this study, obese patients were more often men, motorcycle riders and pedestrians, and had a lower proportion of alcohol intoxication compared to normal-weight patients. Analysis of Abbreviated Injury Scale scores revealed that obese trauma patients presented with a higher rate of injury to the thorax, but a lower rate of facial injuries than normal-weight patients. No significant differences were found between obese and normal-weight patients regarding Injury Severity Score (ISS), Trauma-Injury Severity Score (TRISS), mortality, the proportion of patients admitted to the ICU, or LOS in ICU. After propensity score matching, logistic regression of 66 well-matched pairs did not show a significant influence of obesity on mortality (odds ratio: 1.51, 95% confidence interval: 0.54-4.23 p = 0.438). However, significantly longer hospital LOS (10.6 vs. 9.5 days, respectively, p = 0.044) was observed in obese patients than in normal-weight patients, particularly obese patients with pelvic, tibial, or fibular fractures. Compared to normal-weight patients, obese
Lin, Li-Wei; Lin, Hsiao-Yu; Hsu, Chien-Yeh; Rau, Hsiao-Hsien; Chen, Ping-Ling
Trauma admissions are associated with weather and temporal factors; however, previous study results regarding these factors are contradictory. We hypothesised that weather and temporal factors have different effects on specific trauma events in an emergency medical service (EMS) system. EMS data from January 1, 2009, to December 31, 2010, were obtained from the fire department of Taipei City and associated with the local weather data. EMS trauma events were categorised into total trauma, traffic accidents (TAs), motorbike accidents (MBAs), and falls. Hourly data on trauma patients were analysed using the zero-inflated Poisson model. The hourly incidence of total trauma increased with the magnitude of precipitation (incidence rate ratio [IRR]=1.06, 1.09, and 1.11 in light, moderate, and heavy rain, respectively), and this effect was more prominent in fall patients than in patients with other injuries (IRR=1.07, 1.21, and 1.32). However, the hourly incidence of TAs and MBAs was associated only with light rain (IRR=1.11 and 1.06, respectively). An hour of sunshine exposure was associated with an increase in the hourly incidence of all groups, and higher temperatures were associated with an increased hourly incidence of total trauma, TAs, and MBAs, but not falls. The hourly incidence of falls increased only in late fall and winter. Compared with the hourly incidence between 3 am and 7 am, the hourly incidence of all groups plateaued between 7 am and 11 pm and declined from 11 pm to 3 am. During the plateau period, 2 peaks in the incidence of TAs (IRR=5.03 and 5.07, respectively) and MBAs (IRR=5.81 and 5.51, respectively) were observed during 7-11 am and 3-7 pm. The hourly incidence of total trauma, TAs, and MBAs plateaued during workdays, peaked on Fridays, declined on Saturdays, and troughed on Sundays. The incidence of falls increased only on Mondays (IRR=1.09). Weather and temporal factors had different impacts on the incidence of traffic-related accidents and falls
Juillard, Catherine; Kouo Ngamby, Marquise; Ekeke Monono, Martin; Etoundi Mballa, Georges Alain; Dicker, Rochelle A; Stevens, Kent A; Hyder, Adnan A
Road traffic injury surveillance systems are a cornerstone of organized efforts at injury control. Although high-income countries rely on established trauma registries and police databases, in low- and middle-income countries, the data source that provides the best collection of road traffic injury events in specific low- and middle-income country contexts without mature surveillance systems is unclear. The objective of this study was to compare the information available on road traffic injuries in 3 data sources used for surveillance in the sub-Saharan African country of Cameroon, providing potential insight on data sources for road traffic injury surveillance in low- and middle-income countries. We assessed the number of events captured and the information available in Yaoundé, Cameroon, from 3 separate sources of data on road traffic injuries: trauma registry, police records, and newspapers. Data were collected from a single-hospital trauma registry, police records, and the 6 most widely circulated newspapers in Yaoundé during a 6-month period in 2009. The number of road traffic injury events, mortality, and other variables included commonly in injury surveillance systems were recorded. We compared these sources using descriptive analysis. Hospital, police, and newspaper sources recorded 1,686, 273, and 480 road traffic injuries, respectively. The trauma registry provided the most complete data for the majority of variables explored; however, the newspaper data source captured 2, mass casualty, train crash events unrecorded in the other sources. Police data provided the most complete information on first responders to the scene, missing in only 7%. Investing in the hospital-based trauma registry may yield the best surveillance for road traffic injuries in some low- and middle-income countries, such as Yaoundé, Cameroon; however, police and newspaper reports may serve as alternative data sources when specific information is needed. Copyright © 2017 Elsevier
Swaid, Forat; Peleg, Kobi; Alfici, Ricardo; Matter, Ibrahim; Olsha, Oded; Ashkenazi, Itamar; Givon, Adi; Kessel, Boris
Non-operative management has become the standard approach for treating stable patients sustaining blunt hepatic or splenic injuries in the absence of other indications for laparotomy. The liberal use of computed tomography (CT) has reduced the rate of unnecessary immediate laparotomies; however, due to its limited sensitivity in the diagnosis of hollow viscus injuries (HVI), this may be at the expense of a rise in the incidence of missed HVI. The aim of this study was to assess the incidence of concomitant HVI in blunt trauma patients diagnosed with hepatic and/or splenic injuries, and to evaluate whether a correlation exists between this incidence and the severity of hepatic or splenic injuries. A retrospective cohort study involving blunt trauma patients with splenic and/or liver injuries, between the years 1998 and 2012 registered in the Israel National Trauma Registry. The association between the presence and severity of splenic and/or liver injuries and the incidence of HVI was examined. Of the 57,130 trauma victims identified as suffering from blunt torso injuries, 2335 (4%) sustained hepatic injuries without splenic injuries (H group), 3127 (5.4%) had splenic injuries without hepatic injuries (S group), and 564 (1%) suffered from both hepatic and splenic injuries (H+S group). Overall, 957 patients sustained 1063 HVI. The incidence of HVI among blunt torso trauma victims who sustained neither splenic nor hepatic injuries was 1.5% which is significantly lower than in the S (3.1%), H (3.1%), and H+S (6.7%) groups. In the S group, there was a clear correlation between the severity of the splenic injury and the incidence of HVI. This correlation was not found in the H group. The presence of blunt splenic and/or hepatic injuries predicts a higher incidence of HVI, especially if combined. While in blunt splenic injury patients there is a clear correlation between the incidence of HVI and the severity of splenic injury, such a correlation does not exist in patients
Huber, Stephan; Biberthaler, Peter; Delhey, Patrick; Trentzsch, Heiko; Winter, Hauke; van Griensven, Martijn; Lefering, Rolf; Huber-Wagner, Stefan
Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002-2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a devastating prognosis following blunt
Background Blunt thoracic trauma is one of the critical injury mechanisms in multiply injured trauma victims. Although these patients present a plethora of potential structural damages to vital organs, it remains debated which injuries actually influence outcome and thereby should be addressed initially. Hence, the aim of this study was to identify the influence of critical structural damages on mortality. Methods All patients in the database of the TraumaRegister DGU® (TR-DGU) from 2002–2011 with AIS Chest ≥ 2, blunt trauma, age of 16 or older and an ISS ≥ 16 were analyzed. Outcome parameters were in-hospital mortality as well as ventilation time in patients surviving the initial 14 days after trauma. Results 22613 Patients were included (mean ISS 30.5 ± 12.6; 74.7% male; Mean Age 46.1 ± 197 years; mortality 17.5%; mean duration of ventilation 7.3 ± 11.5; mean ICU stay 11.7 ± 14.1 days). Only a limited number of specific injuries had a significant impact on survival. Major thoracic vessel injuries (AIS ≥5), bilateral lung contusion, bilateral flail chest, structural heart injury (AIS ≥3) significantly influence mortality in study patients. Several extrathoracic factors (age, blood transfusion, systolic blood pressure and extrathoracic severe injuries) were also predictive of increased mortality. Most injuries of the thoracic wall had no or only a moderate effect on the duration of ventilation. Injuries to the lung (laceration, contusion or pneumothoraces) had a moderate prolonging effect. Cardiac injuries and severe injuries to the thoracic vessels induced a substantially prolonged ventilation interval. Conclusions We demonstrate quantitatively the influence of specific structural damages of the chest on critical outcome parameters. While most injuries of the chest wall have no or only limited impact in the study collective, injuries to the lung overall show adverse outcome. Injuries to the heart or thoracic vessels have a
Faulconer, Edwin R; Branco, Bernardino C; Loja, Melissa N; Grayson, Kevin; Sampson, James; Fabian, Timothy C; Holcomb, John B; Scalea, Thomas; Skarupa, David; Inaba, Kenji; Poulin, Nathaniel; Rasmussen, Todd E; Dubose, Joseph J
Vascular trauma data have been submitted to the American Association for the Surgery of Trauma PROspective Observational Vascular Injury Trial (PROOVIT) database since 2013. We present data to describe current use of endovascular surgery in vascular trauma. Registry data from March 2013 to December 2016 were reviewed. All trauma patients who had an injury to a named artery, except the forearm and lower leg, were included. Arteries were grouped into anatomic regions and by compressible and non-compressible region for analysis. This review focused on patients with non-compressible transection, partial transection, or flow limiting defect injuries. Bivariate and multivariate analyses were used to assess the relationships between study variables. 1143 patients from 22 institutions were included. Median age was 32 years (interquartile range IQR 23-48) and 76% (n=871) were male. Mechanisms of injury were 49% (n=561) blunt, 41% (n=464) penetrating, and 1.8% (n=21) of mixed aetiology. Gunshot wounds accounted for 73% (n=341) of all penetrating injuries. Endovascular techniques were used least often in limb trauma and most commonly in patients with blunt injuries to more than one region. Penetrating wounds to any region were preferentially treated with open surgery (74%, n=341/459). The most common indication for endovascular treatment was blunt non-compressible torso injuries (NCTI). These patients had higher injury severity scores and longer associated hospital stays, but required less packed red blood cells (PRBC), and had lower in hospital mortality than those treated with open surgery. On multivariate analysis, admission low hemoglobin concentration and abdominal injury were independent predictors of mortality. Our review of PROOVIT registry data demonstrates a high utilization of endovascular therapy among severely injured blunt trauma patients primarily with non-compressible torso hemorrhage. This is associated with decreased need for blood transfusion and improved
Grivna, Michal; Barss, Peter; Stanculescu, Cristina; Eid, Hani O; Abu-Zidan, Fikri M
A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry's value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products. © 2011 APJPH.
purpose of this audit was to test this theory, using data from the Trauma Unit at Groote Schuur Hospital in Cape Town. The Trauma Unit at Groote Schuur Hospital ..... significant in predicting both crash incidence and severity.17. Study Limitations. This study gives insight into when busy times are expected and what types of ...
as an indicator of EMS performance. Postoperative complications were graded according to Clavien-Dindo classification of surgical complications. Results: A total of 118 patients were admitted to the trauma surgery ward following abdominal trauma. The mechanism was penetrating 101 (85.6%) [stab wounds in 67 (56.8%) ...
Brockamp, Thomas; Maegele, Marc; Gaarder, Christine; Goslings, J. Carel; Cohen, Mitchell J.; Lefering, Rolf; Joosse, Pieter; Naess, Paal A.; Skaga, Nils O.; Groat, Tahnee; Eaglestone, Simon; Borgman, Matthew A.; Spinella, Philip C.; Schreiber, Martin A.; Brohi, Karim
The BIG score (Admission base deficit (B), International normalized ratio (I), and Glasgow Coma Scale (G)) has been shown to predict mortality on admission in pediatric trauma patients. The objective of this study was to assess its performance in predicting mortality in an adult trauma population,
Zwingmann, Jörn; Südkamp, Norbert P; König, Benjamin; Culemann, Ulf; Pohlemann, Tim; Aghayev, Emin; Schmal, Hagen
Percutaneous iliosacral screw placement following pelvic trauma is a very demanding technique involving a high rate of screw malpositions possibly associated with the risk of neurological damage or inadequate stability. In the conventional technique, the screw's correct entry point and the small target corridor for the iliosacral screw may be difficult to visualise using an image intensifier. 2D and 3D navigation techniques may therefore be helpful tools. The aim of this multicentre study was to evaluate the intra- and postoperative complications after percutaneous screw implantation by classifying the fractures using data from a prospective pelvic trauma registry. The a priori hypothesis was that the navigation techniques have lower rates of intraoperative and postoperative complications. This study is based on data from the prospective pelvic trauma registry introduced by the German Society of Traumatology and the German Section of the AO/ASIF International in 1991. The registry provides data on all patients with pelvic fractures treated between July 2008 and June 2011 at any one of the 23 Level I trauma centres contributing to the registry. A total of 2615 patients were identified. Out of these a further analysis was performed in 597 patients suffering injuries of the SI joint (187×with surgical interventions) and 597 patients with sacral fractures (334×with surgical interventions). The rate of intraoperative complications was not significantly different, with 10/114 patients undergoing navigated techniques (8.8%) and 14/239 patients in the conventional group (5.9%) for percutaneous screw implantation (p=0.4242). Postoperative complications were analysed in 30/114 patients in the navigated group (26.3%) and in 70/239 patients (29.3%) in the conventional group (p=0.6542). Patients who underwent no surgery had with 66/197 cases (33.5%) a relatively high rate of complications during their hospital stay. The rate of surgically-treated fractures was higher in the
Honore, Russel L; Boslego, David V
The Provincial Reconstruction Team (PRT) training mission completed by First U.S. Army in April 2006 was a joint Service effort to meet a requirement from the combatant commander to support goals in Afghanistan...
Prehospital endotracheal intubation and chest tubing does not prolong the overall resuscitation time of severely injured patients: a retrospective, multicentre study of the Trauma Registry of the German Society of Trauma Surgery.
Kulla, Martin; Helm, Matthias; Lefering, Rolf; Walcher, Felix
The aim of this study was to determine whether prehospital endotracheal intubation (ETI) and chest tube placement is unnecessarily time consuming in severely injured patients. A retrospective, multicentre study including all adult patients (ISS ≥9; 2002-7) of the Trauma Registry of the German Society of Trauma Surgery who were not secondarily transferred to a trauma centre and received a definitive airway and a chest tube. Creating four groups: AA (n=963) receiving ETI and chest tube on scene, AB (n=1547) ETI performed in the prehospital setting but chest tubing later in the emergency department (ED) and BB (n=640) receiving both procedures in the ED. The BA collective (ETI performed in the ED, but chest tubing on scene) was excluded from the study because of the small sample size (n=41). The trauma resuscitation time (TRT), demographic data, injuries, treatment and outcome of the remaining three collectives were compared. The prehospital TRT of the AA collective was longer than the AB and BB subgroups (80±37 min vs 77±44 min 65±46 min; pchest tube placement do not prolong the total TRT of severely injured patients.
Tansley, Gavin; Schuurman, Nadine; Erdogan, Mete; Bowes, Matthew; Green, Robert; Asbridge, Mark; Yanchar, Natalie
Trauma systems have been widely implemented across Canada, but access to trauma care remains a challenge for much of the population. This study aims to develop and validate a model to quantify the accessibility of definitive care within one provincial trauma system and identify populations with poor access to trauma care. A geographic information system (GIS) was used to generate models of pre-scene and post-scene intervals, respectively. Models were validated using a population-based trauma registry containing data on prehospital time intervals and injury locations for Nova Scotia (NS). Validated models were then applied to describe the population-level accessibility of trauma care for the NS population as well as a cohort of patients injured in motor vehicle collisions (MVCs). Predicted post-scene intervals were found to be highly correlated with documented post-scene intervals (β 1.05, paccess to Level III and Level I trauma care within 60 minutes of prehospital time from their residence, respectively. Access for victims of MVCs was lower, with 84.3% and 29.7% of the cohort having access to Level III and Level I trauma care within 60 minutes of the location of injury, respectively. GIS models can be used to identify populations with poor access to care and inform service planning in Canada. Although only 43% of the provincial population has access to Level I care within 60 minutes, the majority of the population of NS has access to Level III trauma care.
[Lethality and outcome in multiple injured patients after severe abdominal and pelvic trauma. Influence of preclinical volume replacement - an analysis of 604 patients from the trauma registry of the DGU].
Hussmann, B; Taeger, G; Lefering, R; Waydhas, C; Nast-Kolb, D; Ruchholtz, S; Lendemans, S
Uncontrollable hemorrhaging after blunt trauma and the resulting hemorrhagic shock is still one of the main causes of death in trauma patients. Starting volume replacement before admission to hospital is one of the main pillars of immediate treatment. The statements concerning the quantity of the preclinically administered fluid are still controversial and have a low level of evidence in the literature. Massive abdominal trauma and unstable pelvic fractures belong to the most relevant causes of hemorrhagic shock. The aim of this study was to analyze the influence of the quantity of the preclinically administered fluid on the posttraumatic course of patients with massive abdominal and pelvic injuries. All patients of the trauma registry of the DGU (German Society for Trauma Surgery) who met the following criteria were included: injury severity score ≥16 points, primary admission to hospital, age ≥16 years, initial blood pressure 3000 ml). Of the 375 patients with abdominal trauma and 229 patients with pelvic trauma were consistent with the inclusion criteria. In both groups an increasing volume replacement was associated with an increased need for transfusion and a reduction of the coagulation ability (Quick 61% in the case of 3000 ml). The rescue time had a relevant influence on the quantity of preclinically infused volume (62 min for 3000 ml). On admission to hospital the blood pressure values were on average the same in all patients (~ 95 mmHg). With an increasing volume a slight elevation of lethality was found as well as a significant increase of the transfused erythrocyte concentrates, a significant deterioration of coagulation and an increase of patients with mass transfusions. In the case of a preclinical relevant bleeding after blunt pelvic or abdominal trauma moderate volume replacement (<1000 ml) results in an enhancement of the initial coagulation situation and in a reduction in the need for transfusion. The results of this study support the
Lyons Ronan A
Full Text Available Abstract Background Determining population-based rates for major injury poses methodological challenges. We used hospital discharge data over a 10-year period (1996–2005 from a national trauma registry, the Trauma Audit and Research Network (TARN Manchester, to construct valid numerators and denominators so that we can calculate population-based rates of major injury in the future. Methods We examined data from all hospitals reporting to TARN for continuity of numerator reporting; rates of completeness for patient postcodes, and clear denominator populations. We defined local market areas (>70% of patients originating from the same postcode district as the hospital. For relevant hospitals we assessed data quality: consistency of reporting, completeness of patient postcodes and for one selected hospital, North Staffordshire Royal Infirmary (NSRI, the capture rate of numerator data reporting. We used an established method based on patient flow to delineate market areas from hospitals discharges. We then assessed the potential competitors, and characterized these denominator areas. Finally we performed a denominator sensitivity analysis using a patient origin matrix based on Hospital Episodes Statistics (HES to validate our approach. Results Sixteen hospitals met the data quality and patient flow criteria for numerator and denominator data, representing 12 hospital catchment areas across England. Data quality issues included fluctuations numbers of reported cases and poor completion of postcodes for some years. We found an overall numerator capture rate of 83.5% for the NSRI. In total we used 40,543 admissions to delineate hospital catchment areas. An average of 3.5 potential hospital competitors and 15.2 postcode districts per area were obtained. The patient origin matrix for NSRI confirmed the accuracy of the denominator/hospital catchment area from the patient flow analysis. Conclusion Large national trauma registries, including TARN, hold
Nov 4, 2017 ... Introduction. Nonoperative management strategies have been suggested for the management of flail chest since the 1950s and most trauma surgeons still follow this approach today.1-4 However, follow-up studies on patients with rib fractures which have been managed nonoperatively have demostrated a ...
key trauma procedures following successful completion of ATLS.10 However, it was noted that only 15% of all JDs had completed the ATLS course at the time of study.10 There is currently no literature focusing specifically on reasons for such low completion rate in our developing world setting. The aims of this study were to ...
This article argues that provincial culture in the 19th century, even while presenting itself as patriotic and nationalist, may sometimes contain elements in which a certain aspiration to overcome provincialism and introduce a cosmopolitan quality to local culture is detectable. The themes...... of nationalist political propaganda, in effect – is analysed, and it is suggested that while it is certainly suffused with patriotic rhetoric (such as the occasion demanded), Rung nevertheless at the same time took the opportunity to incorporate a number of significant international musical influences, notably...
Buehner, Michelle; Aden, Jay; Borgman, Mathew; Love, Preston; Wright, Brandi; Edwards, Mary
The purpose of this study was to define the demographics of pediatric traumatic injuries and to understand the predictive value of injury type, prehospital, and emergency department (ED) data regarding the mortality of pediatric trauma patients (<14 years of age) in South Central Texas. We report a retrospective review of pediatric trauma patients presenting to Trauma Service Area P in South Central Texas during 2004-2013. The primary outcome was mortality; secondary outcomes were ventilator days, hospital days, and intensive care unit stay. Demographics, Abbreviated Injury Score (AIS) codes, ICD-9 codes, transport times, Emergency Medical Services (EMS) vital signs en route and on arrival to the emergency department (ED), and outcomes were evaluated. A total of 8004 traumatically injured children presented to EDs in South Central Texas during the study period; 4109 of these presented via EMS. Most patients were Hispanic and male. Distribution was even across age groups. Overall mortality was 2%, and the mortality of those arriving by EMS was 3.7%. Abnormal vital signs and Glasgow Coma Score upon presentation to both EMS and the ED were strongly associated with mortality. Increased Injury Severity Score, the need for transfusion in the ED, and increased maximal AIS were also strongly associated with mortality. African American race was associated with increased mortality, although transport time and age were not. Most injuries overall were caused by motor vehicle collisions; however, burns and falls were most common in infants. The most lethal injuries were caused by firearms (mostly seen in preteens) and assaults (mostly seen in infants). This analysis of injured children in Southwest Texas offers insight into areas of needed quality improvement in the trauma system and potential areas to focus prevention efforts.
Black, Holly; Whalen, Desmond; Alani, Sabrina; Rogers, Peter; MacLean, Cathy
Injury and death involving all-terrain vehicles (ATV) has been reported in a number of Canadian provinces. The objective of this study is to describe the frequency, nature, severity, population affected, immediate health costs, efficacy of related legislation, and helmet use in ATV related injuries and deaths in Newfoundland and Labrador (NL). A retrospective review of injured or deceased ATV riders of all ages entered in the Newfoundland and Labrador Trauma Registry from 2003 to 2013 was conducted. Variables studied included demographics, injury type and severity, use of helmets, admission/discharge dates, and referring/receiving institution. Data was also obtained from the Newfoundland and Labrador Center for Health Information (NLCHI) and included all in-hospital deaths and hospitalizations due to ATVs between 1995 and 2013. There were a total of 298 patients registered in the trauma registry, resulting in 2759 admission days, nine deaths, and a total estimated immediate healthcare system cost in excess of $1.6 million. More males (N=253, 84.9%) than females (N=45, 15.1%) were injured in ATV related incidents, t(20)=7.12, p<.0001. Head and thorax injuries were the most serious. 38.6% of patients were confirmed to be wearing helmets. Mean injury severity scores are as follows: head injury (M=11, SD=9.51), thorax (M=10, SD=8.3), abdominal/pelvis (M=9, SD=7.62), upper extremity (M=9, SD=8.53), other injuries (M=9, SD=10.56) lower extremity (M=8, SD=8.34), and spine (M=8, SD=6.52). This study describes ATV related injuries and deaths in NL. Information from this study may guide physician practice, public education, and future legislation.
At link level it was possible to synchronise the upgraded network with the financial asset registry in order to gauge the current state of the provincial roads within Gauteng, and to identify those that are in need of attention and/or rehabilitation to optimise efficiency and safety. This approach can be standardised throughout the ...
Huisman, Thierry A G M; Poretti, Andrea
Traumatic brain and spine injury (TBI/TSI) is a leading cause of death and lifelong disability in children. The biomechanical properties of the child's brain, skull, and spine, the size of the child, the age-specific activity pattern, and variance in trauma mechanisms result in a wide range of age-specific traumas and patterns of brain and spine injuries. A detailed knowledge about the various types of primary and secondary pediatric head and spine injuries is essential to better identify and understand pediatric TBI/TSI, which enhances sensitivity and specificity of diagnosis, will guide therapy, and may give important information about the prognosis. The purposes of this chapter are to: (1) discuss the unique epidemiology, mechanisms, and characteristics of TBI/TSI in children; (2) review the anatomic and functional imaging techniques that can be used to study common and rare pediatric TBI/TSI and their complications; (3) comprehensively review frequent primary and secondary brain injuries; and (4) to give a short overview of two special types of pediatric TBI/TSI: birth-related and nonaccidental injuries. © 2016 Elsevier B.V. All rights reserved.
Carlos A. Ordóñez; Luis Fernando Pino; Jorge W Tejada; Marisol Badiel; Jhon Harry Loaiza; Mata,Lina V.; Michael B. Aboutanos
OBJETIVO: Describir la experiencia en la implementación de un Sistema de Registro de Trauma (SRT) en dos hospitales en Cali, Colombia. MÉTODOS: El SRT incluye información prehospitalaria, hospitalaria y estatus de egreso del paciente. Cada hospital tiene una estrategia para la captura electrónica de datos. Se presenta un análisis descriptivo exploratorio durante un piloto de tres meses. RESULTADOS: Se han registrado 3293 pacientes, 1626(49.4%) del Hospital Público y 1613(50.6%) en el Privado....
Barnard, Ed B G; Hunt, P A F; Lewis, P E H; Smith, J E
The UK military was continuously engaged in armed conflict in Iraq and Afghanistan between 2003 and 2014, resulting in 629 UK fatalities. Traumatic cardiac arrest (TCA) is a precursor to traumatic death, but data on military outcomes are limited. In order to better inform military treatment protocols, the aim of this study was to define the epidemiology of TCA in the military population with a particular focus on survival rates and injury patterns. A retrospective database analysis of the UK Joint Theatre Trauma Registry was undertaken. Patients who were transported to a UK deployed hospital between 2003 and 2014 and suffered TCA were included. Those patients injured by asphyxiation, electrocution, burns without other significant trauma and drowning were excluded. Data included mechanism of injury, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) for each body region and survival to deployed (Role 3) field hospital discharge. 424 TCA patients were identified during the study period; median age was 23 years, with a median ISS of 45. The most common mechanism of injury was explosive (55.7%), followed by gunshot wound (38.9%), road traffic collision (3.5%), crush (1.7%) and fall (0.2%). 45 patients (10.6% (95% CI 8.0% to 13.9%)) survived to deployed (Role 3) hospital discharge. The most prevalent body region with a severe to maximum AIS injury was the head, followed by the lower limbs, thorax and abdomen. Haemorrhage secondary to abdominal and lower limb injury was associated with survival; traumatic brain injury was associated with death. This study has shown that short-term survival from TCA in a military population is 10.6%. With appropriate and aggressive early management, although unlikely, survival is still potentially possible in military patients who suffer traumatic cardiac arrest. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise
Full Text Available Abstract Objective Non-operative management of blunt splenic injury in adults has been applied increasingly at the end of the last century. Therefore, the lifelong risk of overwhelming post-splenectomy infection has been the major impetus for preservation of the spleen. However, the prevalence of posttraumatic infection after splenectomy in contrast to a conservative management is still unknown. Objective was to determine if splenectomy is an independent risk factor for the development of posttraumatic sepsis and multi-organ failure. Methods 13,433 patients from 113 hospitals were prospective collected from 1993 to 2005. Patients with an injury severity score > 16, no isolated head injury, primary admission to a trauma center and splenic injury were included. Data were allocated according to the operative management into 2 groups (splenectomy (I and conservative managed patients (II. Results From 1,630 patients with splenic injury 758 patients undergoing splenectomy compared with 872 non-splenectomized patients. 96 (18.3% of the patients with splenectomy and 102 (18.5% without splenectomy had apparent infection after operation. Additionally, there was no difference in mortality (24.8% versus 22.2% in both groups. After massive transfusion of red blood cells (> 10 non-splenectomy patients showed a significant increase of multi-organ failure (46% vs. 40% and sepsis (38% vs. 25%. Conclusions Non-operative management leads to lower systemic infection rates and mortality in adult patients with moderate blunt splenic injury (grade 1-3 and should therefore be advocated. Patients with grade 4 and 5 injury, patients with massive transfusion of red blood cells and unstable patients should be managed operatively.
Grivna, Michal; Barss, Peter; Stanculescu, Cristina; Eid, Hani O; Abu-Zidan, Fikri M
Traffic-related injuries are the main cause of death during childhood and youth in the United Arab Emirates (UAE), use of safety restraints by citizens is uncommon, rollovers are frequent, and current legislation does not protect rear-seat occupants. Because little was known about the circumstances of hospitalizations for traffic injuries to guide prevention, a trauma registry was used to assess causes and determinants for traffic-related injuries during childhood and youth (trauma hospital in the Al-Ain region during a 36-month period (2003-2006). Injuries were analyzed by age, nationality, road user and vehicle types, severity, anatomical region, and the presence of head injury using Injury Severity Scores (ISS) and the Abbreviated Injury Scale (AIS). Traffic injuries represented 40 percent (n = 193) of injuries to 0- to 19-year-olds, followed by falls (39 percent). Among 15- to 19-year-olds, who accounted for 46 percent of child and youth victims, the incidence was 150/100,000 person years, compared to an incidence of 15 to 51 for younger age groups. Overall, 53 percent were vehicle occupants, 23 percent were pedestrians, 14 percent were bicyclists, 6 percent were motorcyclists, with 4 percent other. The ratio of male-to-female victims was 6.7:1; for drivers it was 33:0; and for pedestrians, bicyclists, and motorcyclists it was between 10:1 and 12:1; injured females were mainly rear-seat passengers and the male: female ratio was 1.4:1. Seventy-one percent of pedestrians were ≤9 years old. Although the ratio of UAE children to foreign children was estimated at 0.7:1 in the community, 58 percent of the injured were UAE citizens. The ratio of injured UAE: non-UAE citizens was 1.4:1 overall but 5.6:1 for drivers and 4.5:1 for motorcyclists. Forty-one percent of citizens were injured in 4-wheel drive sport utility vehicles compared to 13 percent of non-citizens. Head injuries occurred in 68 percent of vehicle occupants and 51 percent of nonoccupants, with AIS ≥ 3
Full Text Available Background: The diagnosis of diabetic hyperglycemia (DH does not preclude a diabetes patient from having a stress-induced hyperglycemic response. This study aimed to define the optimal level of elevated glucose concentration for determining the occurrence of stress-induced hyperglycemia (SIH in patients with diabetes. Methods: This retrospective study reviewed the data of all hospitalized trauma patients, in a Level I trauma center, from 1 January 2009 to 31 December 2016. Only adult patients aged ≥20 years, with available data on serum glucose and glycated hemoglobin A1c (HbA1c levels upon admission, were included in the study. Long-term average glucose levels, as A1c-derived average glucose (ADAG, using the equation, ADAG = ((28.7 × HbA1c − 46.7, were calculated. Patients with high glucose levels were divided into three SIH groups with diabetes mellitus (DM, based on the following definitions: (1 same glycemic gap from ADAG; (2 same percentage of elevated glucose of ADAG, from which percentage could also be reflected by the stress hyperglycemia ratio (SHR, calculated as the admission glucose level divided by ADAG; or (3 same percentage of elevated glucose as patients with a defined SIH level, in trauma patients with and without diabetes. Patients with incomplete registered data were excluded. The primary hypothesis of this study was that SIH in patients with diabetes would present worse mortality outcomes than in those without. Detailed data of SIH in patients with diabetes were retrieved from the Trauma Registry System. Results: Among the 546 patients with DH, 332 (32.0%, 188 (18.1%, and 106 (10.2% were assigned as diabetes patients with SIH, based on defined glucose levels, set at 250 mg/dL, 300 mg/dL, and 350 mg/dL, respectively. In patients with defined cut-off glucose levels of 250 mg/dL and 300 mg/dL, SIH was associated with a 3.5-fold (95% confidence interval (CI 1.61–7.46; p = 0.001 and 3-fold (95% CI 1.11–8.03; p = 0
Rau, Cheng-Shyuan; Wu, Shao-Chun; Chen, Yi-Chun; Chien, Peng-Chen; Hsieh, Hsiao-Yun; Kuo, Pao-Jen; Hsieh, Ching-Hua
Background: The diagnosis of diabetic hyperglycemia (DH) does not preclude a diabetes patient from having a stress-induced hyperglycemic response. This study aimed to define the optimal level of elevated glucose concentration for determining the occurrence of stress-induced hyperglycemia (SIH) in patients with diabetes. Methods: This retrospective study reviewed the data of all hospitalized trauma patients, in a Level I trauma center, from 1 January 2009 to 31 December 2016. Only adult patients aged ≥20 years, with available data on serum glucose and glycated hemoglobin A1c (HbA1c) levels upon admission, were included in the study. Long-term average glucose levels, as A1c-derived average glucose (ADAG), using the equation, ADAG = ((28.7 × HbA1c) - 46.7), were calculated. Patients with high glucose levels were divided into three SIH groups with diabetes mellitus (DM), based on the following definitions: (1) same glycemic gap from ADAG; (2) same percentage of elevated glucose of ADAG, from which percentage could also be reflected by the stress hyperglycemia ratio (SHR), calculated as the admission glucose level divided by ADAG; or (3) same percentage of elevated glucose as patients with a defined SIH level, in trauma patients with and without diabetes. Patients with incomplete registered data were excluded. The primary hypothesis of this study was that SIH in patients with diabetes would present worse mortality outcomes than in those without. Detailed data of SIH in patients with diabetes were retrieved from the Trauma Registry System. Results: Among the 546 patients with DH, 332 (32.0%), 188 (18.1%), and 106 (10.2%) were assigned as diabetes patients with SIH, based on defined glucose levels, set at 250 mg/dL, 300 mg/dL, and 350 mg/dL, respectively. In patients with defined cut-off glucose levels of 250 mg/dL and 300 mg/dL, SIH was associated with a 3.5-fold (95% confidence interval (CI) 1.61-7.46; p = 0.001) and 3-fold (95% CI 1.11-8.03; p = 0.030) higher odds
Wong, Ting Hway; Lim, Gek Hsiang; Chow, Khuan Yew; Zaw, Nyi Nyi; Nguyen, Hai Van; Chin, Hoong Chor; Ong, Marcus Eng Hock
Seatbelt non-compliance is a problem in middle income countries, and little is known about seatbelt compliance in populations with a high proportion of non-residents. This study analyses the profile of seatbelt non-compliance in Singapore based on trauma registry data from five of the six public hospitals. This is a cross-sectional study of seatbelt compliance of patients aged over 18 years, attending the emergency departments of five public hospitals in Singapore after road collisions from 2011-2014. Seatbelt data was obtained from paramedic and patient history. There were 4,576 patients studied. Most were Singapore citizens (83.4 %) or permanent residents (2.4 %), with the largest non-resident groups from Malaysia, India, and China. Overall seatbelt compliance was 82.1 %. On univariate analysis, seatbelt compliance was higher in older patients (OR 1.02, 95 % CI 1.001-1.021, p risk factors for non-compliance. On multivariable analysis, older age (OR 1.01, 95 % CI 1.001-1.014, p = 0.03) was associated with compliance, while non-residents from China (OR 0.43, 95 % CI 0.18-0.99, p = 0.05), seat position (front passenger compared to driver, OR 0.64, 95 % CI 0.48-0.85, p = 0.002; rear passenger compared to driver, OR 0.067, 95 % CI 0.05-0.09, p non-compliance. When the sub-group of drivers was analysed, only vehicle type was a significant predictor of seatbelt compliance, with bus drivers least likely to be compliant to seatbelts (multivariable analysis, OR 0.057 compared to cars, 95 % CI 0.019-0.18, p < 0.0001). While overall seatbelt compliance in our study is high, efforts can be made to increase compliance for morning rush hour passengers, rear seat passengers, and occupants of buses, heavy transport vehicles, and vans or pickups.
Does the presence of an emergency physician influence pre-hospital time, pre-hospital interventions and the mortality of severely injured patients? A matched-pair analysis based on the trauma registry of the German Trauma Society (TraumaRegister DGU(®)).
Bieler, Dan; Franke, Axel; Lefering, Rolf; Hentsch, Sebastian; Willms, Arnulf; Kulla, Martin; Kollig, Erwin
The role of emergency physicians in the pre-hospital management of severely injured patients remains controversial. In Germany and Austria, an emergency physician is present at the scene of an emergency situation or is called to such a scene in order to provide pre-hospital care to severely injured patients in approximately 95% of all cases. By contrast, in the United States and the United Kingdom, paramedics, i.e. non-physician teams, usually provide care to an injured person both at the scene of an incident and en route to an appropriate hospital. We investigated whether physician or non-physician care offers more benefits and what type of on-site care improves outcome. In a matched-pair analysis using data from the trauma registry of the German Trauma Society, we retrospectively (2002-2011) analysed the pre-hospital management of severely injured patients (ISS ≥16) by physician and non-physician teams. Matching criteria were age, overall injury severity, the presence of relevant injuries to the head, chest, abdomen or extremities, the cause of trauma, the level of consciousness, and the presence of shock. Each of the two groups, i.e. patients who were attended by an emergency physician and those who received non-physician care, consisted of 1235 subjects. There was no significant difference between the two groups in pre-hospital time (61.1 [SD 28.9] minutes for the physician group and 61.9 [SD 30.9] minutes for non-physician group). Significant differences were found in the number of pre-hospital procedures such as fluid administration, analgosedation and intubation. There was a highly significant difference (ppre-hospital care. It shows, however, that there was no significant difference in mortality although patients who were attended by non-physician teams received fewer pre-hospital interventions with similar scene times. Copyright © 2016 Elsevier Ltd. All rights reserved.
Ting Hway Wong
Full Text Available Abstract Background Seatbelt non-compliance is a problem in middle income countries, and little is known about seatbelt compliance in populations with a high proportion of non-residents. This study analyses the profile of seatbelt non-compliance in Singapore based on trauma registry data from five of the six public hospitals. Methods This is a cross-sectional study of seatbelt compliance of patients aged over 18 years, attending the emergency departments of five public hospitals in Singapore after road collisions from 2011–2014. Seatbelt data was obtained from paramedic and patient history. Results There were 4,576 patients studied. Most were Singapore citizens (83.4 % or permanent residents (2.4 %, with the largest non-resident groups from Malaysia, India, and China. Overall seatbelt compliance was 82.1 %. On univariate analysis, seatbelt compliance was higher in older patients (OR 1.02, 95 % CI 1.001–1.021, p < 0.0001; drivers, followed by front passengers (OR 0.65, 95 % CI 0.51–0.83, p < 0.0001, were more compliant than rear passengers (OR 0.08, 0.06–0.09, p < 0.0001; occupants of larger vehicle types (buses, heavy transport vehicles, minibuses and vans were more non-compliant compared to occupants of private cars and taxis. Morning peak travel (0700 h-0900 h and being a non-resident were other risk factors for non-compliance. On multivariable analysis, older age (OR 1.01, 95 % CI 1.001–1.014, p = 0.03 was associated with compliance, while non-residents from China (OR 0.43, 95 % CI 0.18–0.99, p = 0.05, seat position (front passenger compared to driver, OR 0.64, 95 % CI 0.48–0.85, p = 0.002; rear passenger compared to driver, OR 0.067, 95 % CI 0.05–0.09, p < 0.0001, vehicle type (bus compared to car, OR 0.04, 95 % CI 0.017–0.11, p < 0.0001, van compared to car, OR 0.55, 95 % CI 0.36–0.83, p = 0.004, and travel at morning peak periods were independent predictors of seatbelt
Green, Robert S; Butler, Michael B; Kureshi, Nelofar; Erdogan, Mete
A small proportion of pediatric sport- and recreation-related injuries are serious enough to be considered "major trauma." However, the immediate and long-term consequences in cases of pediatric major trauma are significant and potentially life-threatening. The objective of this study was to describe the incidence and outcomes of pediatric major traumas related to sport and recreational activities in Nova Scotia. This study was a retrospective case series. Data on major pediatric traumas related to sport and recreational activities on a provincial scope were extracted from the Nova Scotia Trauma Program Registry between 2000 and 2013. We evaluated frequency, type, severity, and outcomes of major traumas. Outcomes assessed included length of hospital stay, admission to a special care unit (SCU), and mortality. Overall, 107 children aged three to 18 years sustained a major trauma (mean age 12.5 [SD 3.8]; 84% male). Most injuries were blunt traumas (97%). The greatest proportion were from cycling (59, 53%), followed by hockey (8, 7%), skateboarding (7, 7%) and skiing (7, 7%). The Nova Scotia Pediatric Trauma Team was activated in 27% of cases. Mean in-hospital length of stay was five days (SD 5.6), and nearly half (49%) of patients required SCU admission. Severe traumatic brain injury occurred in 52% of cases, and mortality in five cases. Over a 13-year period, the highest incidence of pediatric major trauma related to sport and recreational activities was from cycling, followed by hockey. Severe traumatic brain injury occurred in over half of pediatric major trauma patients.
Connelly, Luke B
The discipline of economics supplies principles that may contribute to the discourse about investments in trauma registries and the role of the public sector, as well as the optimal use of the datasets those investments create. Principles from production economics, information economics, and public economics are employed to explore the reasons that trauma registries may be prone to underfunding, relative to their value, and to describe a threat to value maximization. The typical production activities and cost structures of registries are analyzed, along with the way registries generate social benefits. Assuming that the purpose of a trauma registry is to maximize the value or social good it creates, a number of investment, governance, and pricing principles are then proposed. Trauma registries are multiproduct enterprises. They are generally characterized by large and indivisible fixed, joint costs, and relatively low marginal costs. This implies that registries are subject to strong economies of scale and scope. Additionally, because registry data are not depleted by use, the registry's output is, technically, nonrival in consumption. The value created by registries may be maximized when a marginal-cost pricing policy is adopted. This means that the optimal price schedule for access to trauma registry data are likely to be zero, or close to zero, for some users. The economic principles presented here complement the contributions from other disciplines in discussions about the establishment of new registries or about improving some aspects of existing registries.
, scant attention has been paid to the psychological processes that underpin mental toughness. Objectives: To explore the relationship between mindfulness and mental toughness among provincial adolescent female hockey players.
Sun, Xiaoqi; An, Haizhong; Liu, Xiaojia
Global economic system is a huge network formed by national subnetworks that contains the provincial networks. As the second largest world economy, China has "too big to fail" impact on the interconnected global economy. Detecting the critical sectors and vital linkages inside Chinese economic network is meaningful for understanding the origin of this Chinese impact. Different from tradition network research at national level, this paper focuses on the provincial networks and inter-provincial network. Using Chinese inter-regional input-output table to construct 30 provincial input-output networks and one inter-provincial input-output network, we identify central sectors and vital linkages, as well as analyze economic structure similarity. Results show that (1) Communication Devices sector in Guangdong and that in Jiangsu, Transportation and Storage sector in Shanghai play critical roles in Chinese economy. (2) Advanced manufactures and services industry occupy the central positions in eastern provincial economies, while Construction sector, Heavy industry, and Wholesale and Retail Trades sector are influential in middle and western provinces. (3) The critical monetary flow paths in Chinese economy are Communication Devices sector to Communication Devices sector in Guangdong, Metals Mining sector to Iron and Steel Smelting sector in Henan, Communication Devices sector to Communication Devices sector in Jiangsu, as well as Petroleum Mining sector in Heilongjiang to Petroleum Processing sector in Liaoning. (4) Collective influence results suggest that Finance sector, Transportation and Storage sector, Production of Electricity and Heat sector, and Rubber and Plastics sector in Hainan are strategic influencers, despite being weakly connected. These sectors and input-output relations are worthy of close attention for monitoring Chinese economy.
Full Text Available This paper investigates the effect of provincial corruption on the performance of local development bank, specifically to the profitability and credit quality. We use the data of 26 local development banks in 2012 and 2013. For the provincial corruption measurement we use “Public Institution Openness Index”. Results of this study are first, corruption significantly has a negative effect on the profitability of local development bank. Second, corruption doesn’t affect the credit quality of local development bank. These results are expected to enrich the within country corruption effect to the economic studies, particularly to the local development bank which is infrequently investigated.
Andrea Mubi Brighenti
Full Text Available To be provincial is to be territorialized. Not simply because the province is a territory, but because it makes a territory, it territorializes people and affects. Territory and belonging should not be taken as primordial features of the province, but rather as the effects of a territorializing act or a series of such acts.
In the period 1969 to 1971 a research project on the ecology of angling species in the Vaal River was undertaken by the Nature Conservation Division of the Transvaal Provincial Administra- tion. A paper on aspects on the ecology of the yellowfish species appears in this same number. (Mulder 1973) and the present paper ...
Conclusions: Our trauma pattern profile is similar to the one found in west-European countries, with a predominance of traffic-related injuries and falls. The severity and anatomical puzzle for trauma lesions were more complex secondary to motorcycle or bicycle-to-auto vehicles collisions. A trauma registry, with prospective enrollment of patients, is a very effective tool for constant improvements in trauma care.
In North America, injury surveillance has generated an accumulation of data regarding trauma events and outcomes through the implementation of trauma registries. Trauma registries have been predominantly instituted in response to the desire to be accredited by the American College of Surgeons (ACS). Committee on ...
... News About Neurology Image Library Search The Internet Stroke Center Trials Registry Clinical Trials Interventions Conditions Sponsors ... a clinical trial near you Welcome to the Stroke Trials Registry Our registry of clinical trials in ...
Department of Veterans Affairs — The Clinical Case Registries (CCR) replaced the former Immunology Case Registry and the Hepatitis C Case Registry with local and national databases. The CCR:HIV and...
Department of Veterans Affairs — The Converged Registries platform is a hardware and software architecture designed to host individual patient registries and eliminate duplicative development effort...
Manuel Lucena Salmoral
Full Text Available El acontecimiento más sobresaliente del patriarcado de don Fernando Arias de Ugarte, en el que hubo muchos notables, fue el Primer Concilio Provincial del Nuevo Reino de Granada, celebrado en el año 1623. Cumplió así una vieja aspiración de los arzobispos santafereños y la obligación impuesta en el Concilio de Trento, por lo que resulta incomprensible lo historiado por don José Antonio Plaza quien, al referirse a este hecho, dice lo siguiente...
In the early nineteenth century, geology was a new but rapidly growing science, in the provinces and among the gentlemen scientists of London, Oxford and Cambridge. Industry, particularly mining, often motivated local practical geologists, and the construction of canals and railways exposed the strata for all to see. The most notable of the early practical men of geology was the mineral surveyor William Smith; his geological map of England and Wales, published in 1815, was the first of its kind. He was not alone. The contributions of professional men, and the provincial societies with which they were connected, are sometimes underestimated in the history of geology.
Pinto, Carolyn; Cameron, Peter A; Gabbe, Belinda; McLellan, Susan; Walker, Tony
The aim of the present study was to describe the trauma case review process and its role in a regionalised trauma system. Victoria has a population of 5.9 million people, accounting for 26% of Australia's population. Victoria has been serviced by an inclusive, organised trauma system since 2000 comprising 138 health services with trauma designations and three major trauma services. Pre- and interhospital guidelines prescribe the timely transport of patients to the appropriate level of trauma service. A review of the role and contribution of 10 years of operation of the trauma case review group (CRG) was undertaken to describe the aims, processes and governance surrounding the implementation of an individual case review for specified major trauma patients. Specified patients were those identified by the Victorian State Trauma Registry as being managed outside of established Victorian State Trauma System prehospital and interhospital guidelines. A state-wide trauma case review process was implemented across the trauma system using data-informed detection flags and screening criteria. Using data from the Victorian State Trauma Registry, detection flags were correlated with patients at risk of a poorer outcome, thereby ensuring that all patients managed outside of the requirements of established trauma triage and transfer guidelines were subject to review. The CRG provides an individual review process as a technique for assessing and monitoring major trauma patient care and compliance with trauma system triage and transfer guidelines. The process has been effective as a quality and safety strategy by improving clinician knowledge of major trauma triage and transfer guidelines and facilitating improved compliance, particularly with interhospital transfers. Strong compliance has been achieved from health services with the requirement to internally review and respond to CRG concerns regarding 'high-risk' trauma cases. Anecdotal feedback from health services regarding
Grid services are the fundamental building blocks of today's Distributed Computing Infrastructures (DCI). The discovery of services in the DCI is a primary function that is a precursor to other tasks such as workload and data management. In this context, a service registry can be used to fulfil such a requirement. Existing service registries, such as the ARC Information Index or UNICORE Registry, are examples that have proven themselves in production environments. Such implementations provide a centralized service registry, however, todays DCIs, such as EGI, are based on a federation model. It is therefore necessary for the service registry to mirror such a model in order for it to seamlessly fit into the operational and management requirements - a DCI built using federated approach. This document presents an architecture for a federated service registry and a prototype based on this architecture, the EMI Registry. Special attention is given to how the federated service registry is robust to environment failu...
Stanworth, Simon J; Morris, Timothy P; Gaarder, Christine
transfusion requirements could allow early activation of blood bank protocols. METHODS : Datasets on trauma admissions over a 1 or 2-year period were obtained from the trauma registries of five large trauma research networks. A fractional polynomial was used to model the transfusion-associated probability...... transfusion as a concept in trauma has limited utility, and emphasis should be placed on identifying patients with massive hemorrhage and acute traumatic coagulopathy....
Mitchell, W. [British Columbia Ministry of Finance, Victoria, BC (Canada). Land Use Coordination Office
The efforts being made to include Aboriginal communities in land use planning in British Columbia are discussed. British Columbia is in the midst of historic changes with respect to land and resource allocation, use and management. Historic trends in land use allocation and management are contrasted with land use planning and resource management of today. The impact of provincial government moves to double park space within the province, and the Protected Areas Strategy initiative will have on the natural gas and petroleum industry is discussed. New efforts being made to include First Nations directly in land use planning discussions in ways that do not prejudice treaty negotiations, are reviewed. Creation of a new Oil and Gas Commission in the Fort St. John area, is cited as the most recent example of the interconnections between First Nations communities and other public and industry stakeholders in land use planning in the province.
Liao, Hua; Liu, Yanan; Gao, Yixuan; Hao, Yu; Ma, Xiao-Wei; Wang, Kan
In China, more than 80% electricity comes from coal which dominates the CO2 emissions. Residential electricity demand forecasting plays a significant role in electricity infrastructure planning and energy policy designing, but it is challenging to make an accurate forecast for developing countries. This paper forecasts the provincial residential electricity consumption of China in the 13th Five-Year-Plan (2016-2020) period using panel data. To overcome the limitations of widely used predication models with unreliably prior knowledge on function forms, a robust piecewise linear model in reduced form is utilized to capture the non-deterministic relationship between income and residential electricity consumption. The forecast results suggest that the growth rates of developed provinces will slow down, while the less developed will be still in fast growing. The national residential electricity demand will increase at 6.6% annually during 2016-2020, and populous provinces such as Guangdong will be the main contributors to the increments.
Full Text Available This essay discusses the writing and personalities surrounding the 1981 establishment of the Australian art magazine, Art & Text, and traces its progression under Paul Taylor’s editorship up to his relocation to New York. During this period, Art & Text published Taylor’s own essays and, more importantly, those of other writers and artists — Meaghan Morris, Paul Foss, Philip Brophy, Imants Tillers, Rex Butler, Edward Colless — all articulating a consistent and complex postmodern position. The magazine’s founder and editor, Paul Taylor, personified the shattering impact of postmodernism upon the Australian art world as well as postmodernism’s limitations. Taylor facilitated a new theoretical framework for the discussion of Australian art, one that continues to dominate the internationalist aspirations of Australian art writers. He produced temporarily convincing solutions to problems that earlier critics had wrestled with unsuccessfully, in particular the twin problems of provincialism, and the relationship of Australian to international art.
Natalia Alejandra Alaniz
Full Text Available En el marco del proyecto “Dispositivos pedagógicos en las dinámicas de lavida escolar en contexto de pobreza urbana” lo que se propuso investigar es la forma de implementación del Programa de Lectura de la provincia de Chubut. El mismo fue creado por Resolución Ministerial N° 1044/ 08, a partir de diversos trabajos que comenzaron en el año 2003 a través de la Ley de Educación 26. 026, y que posteriormente se incorporaron a nivel provincial mediante la Resolución N ° 174/12 para revalorizar las trayectorias escolares de cada niño/a. El programa consiste en poner el énfasis en el vínculo pedagógico mediante la adecuación de los espacios curriculares, de tal modo que se pueda lograr una articulación entre los diferentes niveles educativos, desde el nivel inicial al secundario. Articulando para ello recursos materiales y humanos que posibiliten el acompañamiento del proceso de enseñanza y aprendizaje de lectura.A partir de esto, el objetivo de este trabajo fue indagar cómo perciben los docentes de una escuela pública la implementación del Programa Provincial de Lectura, lo que implico utilizar metodologías y técnicas de investigación apropiadas para obtener las experiencias actuales en el territorio y en la cotidianidad de los propios actores escolares. Teniendo en consideración que el dispositivo pedagógico es una construcción histórica, que produce subjetividades, y por consiguiente formas de ver y entender el mundo.
Objectives. To analyse the financial basis for downsizing of a provincial health department and suggest implications for fiscal policy. Design. Analysis of relevant departmental, provincial and national financing and expenditure trends from 1995/96 to 2002/03. Setting. Western Cape (WC) Department of Health (DOH).
...: Notice of Administrative Meetings for the Northwest Forest Plan Provincial Advisory Committees. SUMMARY... up under the Northwest Forest Plan. The PIECs facilitate the successful implementation of the Record... administrative meetings will be to inform the current Provincial Advisory Committee membership of the following...
This study explores the experiences of youth in the provincial town of Pontianak, West Kalimantan, done in Pontianak, the provincial capital of West Kalimantan during the years 2008-2009. It tries to understand the various patterns of relations between growing up and being young, how social
Review of Paediatric Admissions In Mongomo Provincial Hospital, Wele Nzas, Equatorial Guinea. Nnamdi B Onyire. Abstract. Background: The author was part of the Technical Aid Corps team of the Nigerian Government to Mongomo Provincial Hospital, Wele Nzas province of Equatorial Guinea, between May 1997 and ...
Tran, K; Rahal, R; Brundage, M; Fung, S; Louzado, C; Milosevic, M; Xu, J; Bryant, H
As part of Choosing Wisely Canada (a national campaign to encourage patient-provider conversations about unnecessary medical tests, treatments, and procedures), a list of ten oncology practices that could be low-value in some instances was developed. Of those practices, two were specific to radiation therapy (rt): conventional fractionation as part of breast-conserving therapy (bct) for women with early-stage breast cancer, and multifraction radiation for palliation of uncomplicated painful bone metastases. Here, we report baseline findings for the current utilization rates of those two rt practices in Canada. The use of conventional fractionation as part of bct varied substantially from province to province. Of women 50 years of age and older, between 8.8% (Alberta) and 36.5% (Saskatchewan) received radiation in 25 fractions (excluding boost irradiation) as part of bct. The use of hypofractionated rt (that is, 16 fractions excluding boost irradiation)-a preferred approach for many patients-was more common in all 6 reporting provinces, ranging from 43.2% in Saskatchewan to 94.7% in Prince Edward Island. The use of multifraction rt for palliation of bone metastases also varied from province to province, ranging from 40.3% in British Columbia to 69.0% in Saskatchewan. The most common number of fractions delivered to bone metastases was 1, at 50.2%; the second most common numbers were 2-5 fractions, at 41.7%. Understanding variation in the use of potentially low-value rt practices can help to inform future strategies to promote higher-value care, which balances high-quality care with the efficient use of limited system resources. Further work is needed to understand the factors contributing to the interprovincial variation observed and to develop benchmarks for the appropriate rate of use of these rt practices.
Goldsmith, Rachel E; Martin, Christina Gamache; Smith, Carly Parnitzke
Substantial theoretical, empirical, and clinical work examines trauma as it relates to individual victims and perpetrators. As trauma professionals, it is necessary to acknowledge facets of institutions, cultures, and communities that contribute to trauma and subsequent outcomes. Systemic trauma-contextual features of environments and institutions that give rise to trauma, maintain it, and impact posttraumatic responses-provides a framework for considering the full range of traumatic phenomena. The current issue of the Journal of Trauma & Dissociation is composed of articles that incorporate systemic approaches to trauma. This perspective extends conceptualizations of trauma to consider the influence of environments such as schools and universities, churches and other religious institutions, the military, workplace settings, hospitals, jails, and prisons; agencies and systems such as police, foster care, immigration, federal assistance, disaster management, and the media; conflicts involving war, torture, terrorism, and refugees; dynamics of racism, sexism, discrimination, bullying, and homophobia; and issues pertaining to conceptualizations, measurement, methodology, teaching, and intervention. Although it may be challenging to expand psychological and psychiatric paradigms of trauma, a systemic trauma perspective is necessary on both scientific and ethical grounds. Furthermore, a systemic trauma perspective reflects current approaches in the fields of global health, nursing, social work, and human rights. Empirical investigations and intervention science informed by this paradigm have the potential to advance scientific inquiry, lower the incidence of a broader range of traumatic experiences, and help to alleviate personal and societal suffering.
Prah Ruger, Jennifer
The summer 2014 Ebola virus outbreak in Western Africa illustrates global health's striking inequalities. Globalisation has also increased pandemics, and disparate health system conditions mean that where one falls ill or is injured in the world can mean the difference between quality care, substandard care or no care at all, between full recovery, permanent ill effects and death. Yet attention to the normative underpinnings of global health justice and distribution remains, despite some important exceptions, inadequate in medical ethics, bioethics and political philosophy. We need a theoretical foundation on which to build a more just world. Provincial globalism (PG), grounded in capability theory, offers a foundation; it provides the components of a global health justice framework that can guide implementation. Under PG, all persons possess certain health entitlements. Global health justice requires progressively securing this health capabilities threshold for every person. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
U.S. Environmental Protection Agency — The Facility Registry Service (FRS) provides an integrated source of comprehensive (air, water, and waste) environmental information about facilities across EPA,...
... and international bodies as well as the military. Provincial Reconstruction Teams (PRTs), as employed in Afghanistan, are used as a vehicle to examine the wide range of activities necessary for Nation Building...
Five years after the 2008 recession, provincial unemployment rates in Canada remain higher than pre-recession levels. In some provinces, initial declines in unemployment have plateaued. When structural changes occur, a higher unemployment rate can persist even after a full economic recovery. This study undertakes an empirical analysis of provincial panel data to uncover potential causes of persistent unemployment across Canada. The results indicate that, after the recession, the structural co...
Full Text Available The huge regional disparity in government health expenditures (GHE is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed.
Pan, Jay; Wang, Peng; Qin, Xuezheng; Zhang, Shufang
The huge regional disparity in government health expenditures (GHE) is a major policy concern in China. This paper addresses whether provincial GHE converges in China from 1997 to 2009 using the economic convergence framework based on neoclassical economic growth theory. Our empirical investigation provides compelling evidence of long-term convergence in provincial GHE within China, but not in short-term. Policy implications of these empirical results are discussed. PMID:23977049
Duan, Haiping; Ning, Feng; Zhang, Dongfeng
In 1998, the Qingdao Twin Registry was initiated as the main part of the Chinese National Twin Registry. By 2005, a total of 10,655 twin pairs had been recruited. Since then new twin cohorts have been sampled, with one longitudinal cohort of adolescent twins selected to explore determinants of me...
Gilling, M.; Budtz-Jorgensen, E.; Boonen, S. E.
The Danish Huntington's Disease Registry (DHR) is a nationwide family registry comprising 14 245 individuals from 445 Huntington's disease (HD) families of which the largest family includes 845 individuals in 8 generations. 1136 DNA and/or blood samples and 18 fibroblast cultures are stored...
Schuurman, Ineke; Windhouwer, M.; Shkaravska, O.
Since a few months the CLARIN Concept Registry (CCR;www.clarin.eu/conceptregistry) is operational, the open access, OpenSKOS-based registry replacing ISOcat. Although using ISOcat had been encouraged by CLARIN, it had its drawbacks: a rich data model combined with a very open update strategy turned
Memon, S.; Szigeti, G.; Field, L.
This documents describes the overall development plan of the EMI Registry product, the plan focuses on the realisation of the EMI Registry specification as defined in the document. It is understood that during the course of the development phase the specification will likely evolve and the changes will be fed into the specification document.
Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten; Maagaard, Niels
Danish Hip Arthroscopy Registry (DHAR) was initiated in 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the epidemiologic and perioperative data of the first 2000 procedures in a Danish hip arthroscopy population and to describe the development of DH...
Rozenholc, Alexandre; Dodge, Jason; Bréguet, Magali; Sauthier, Philippe
In rare entities such as gestational trophoblastic disease (GTD), only multi-institutional registries can gather significant number of patients to build up valuable clinical databases. No Canada-wide GTD registry currently exists. We conducted a survey among members of the Canadian Society of Gynecologic Oncology (GOC) to investigate their interest in a pan-Canadian GTD registry. We also took the opportunity to explore their management of GTD. An electronic survey was conducted. The target group was the entire GOC Canadian Membership. The survey consisted of 25 questions. The survey participation rate was 39% (67/171). Seventy-six percent of responders treat patients with molar pregnancy or gestational trophoblastic neoplasia (GTN), and the majority treat only 5 or less cases of molar pregnancy and 5 or less cases of GTN per year. In cases of low-risk GTN, 80% of responders use generally recommended single-agent chemotherapy regimens. In cases of high-risk GTN, 76% use generally recommended multiagent chemotherapy regimens. Most respondents do not submit either molar pregnancy or GTN patients to any formal registry, although the vast majority (92%) would do so if they had access to a registry, given that most believe that a registry can or probably can help patients with GTD. Responders indicated that the jurisdiction of such a registry should be national (59%), provincial (25%), and regional (11%). Despite some variation, responders were generally knowledgeable about contemporary management issues. Canadian Society of Gynecologic Oncology members acknowledge generally low exposure to GTD patients in Canada and support the creation of a national GTD registry to facilitate optimal patient care, education, and research.
Prehospital trauma care on the scene of an accident— whether that is roadside care after a traffic collision, .... care practices.21 Establishing a trauma registry where none has previously existed is a challenging task.22 .... Jayaraman S, Mabweijano JR, Lipnick MS, Caldwell N, Miyamoto. J, Wangoda R, et al. First things first: ...
Malawi has no formal system of prehospital trauma care, and there is limited access to hospital-based trauma care, orthopaedic surgery, and rehabilitation. While some hospitals and research teams have established local trauma registries and quantified the burden of injuries in parts of Malawi, there is no national injury ...
Federal Communications Commission — Updated as of 5Oct2017. The Registry lists PSAPs by an FCC assigned identification number, PSAP Name, State, County, City, and provides information on any type of...
U.S. Environmental Protection Agency — Data Element Registry Services (DERS) is a resource for information about value lists (aka code sets / pick lists), data dictionaries, data elements, and EPA data...
Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager; Schaarup, Susanne Zielke; Gyllenborg, Jesper
The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. All patients with acute stroke (from 2003) or TIA (from 2013) treated at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. The registry holds prospectively collected data on key processes of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients with acute stroke and TIA. Patient outcomes are currently monitored using 30-day mortality, unplanned readmission, and for patients receiving revascularization therapy, also functional level at 3 months poststroke. Sociodemographic, clinical, and lifestyle factors with potential prognostic impact are registered. The Danish Stroke Registry is a well-established clinical registry which plays a key role for monitoring and improving stroke and TIA care in Denmark. In addition, the registry is increasingly used for research.
Shang, Mei; Fu, Yujie; Zhang, Liping
In the 13th Five-Year plan, promoting Low-carbon cycle development is proposed. Low-carbon economy has become the key direction. As the pillar industry of national economy, the construction industry contributes obviously to the economic development. And the consumption of energy and the pollution of the environment can not be ignored. Accurately grasping the carbon emission level of the provincial construction industry is critical to making the future development strategy. In the paper, carbon emissions, energy consumption and economic growth of the provincial construction industry are analyzed firstly., then low carbon evaluation index is built to measure low-carbon level of provincial construction industry, at last relevant policy suggestions are put forward accordingly.
Victor Y. Kong
Full Text Available “Major Trauma. Dr. Kong, please come to the Trauma Unit immediately. Dr. Kong, please come to the Trauma Unit immediately.” Even though I have been working at Edendale Hospital as a trauma registrar for over a year, whenever I hear this announcement over the hospital intercom system, my heart beats just a little faster than normal. When I first arrived at Edendale my colleagues told me that the adrenaline rush I would experience after being called out to attend a new emergency would decrease over time, and indeed they were right. However, it is also true to say that on some occasions more than others, it is still felt more strongly than ever.
Trauma Unit, Red Cross War Memorial Children's Hospital, Cape Town ... and international research projects, educational initiatives and advocacy roles on child safety initiatives regarding child injuries as well as child abuse. ... Road traffic.
Full Text Available Background. The most common cause of abdominal trauma is blunt trauma, gunshot wounds and stab wounds are rare. Most commonly injured organs in abdominal cavity are the spleen and the liver.Conclusions. Early diagnosis is very important and include precise phisical examination and all available diagnostic methods. The final decission about the method of treatmet depends on patients clinical condition, surgeon’s experience and other local conditions.
Leonard, Elizabeth; Curtis, Kate
The Australasian Trauma Verification Program was developed in 2000 to improve the quality of care provided at services in Australia and New Zealand. The programme outlines resources required for differing levels of trauma services. This study compares the human resources in Australia and New Zealand trauma services with those recommended by the Australasian College of Surgeons Trauma Verification Program. In September 2011, all trauma nurse coordinators in Australia and New Zealand were invited to participate in an electronic survey endorsed by the Australasian Trauma Society. This study expands on previous bi-national research and aimed to identify demographic and trauma service human resource levels. Fifty-three surveys (78%) were completed and all 27 Level 1 trauma centres represented. Of the Level 1 trauma centres, a trauma director and fellow were available at 16 (51.8%) and 14 (40.7%) centres, respectively. The majority (93%) had a full-time trauma coordinator although a trauma case manager was only available at 14 (48.1%) of Level 1 trauma centres. Despite the large amount of data collection and extraction required, trauma services had limited access to a data manager (50.9%) or clerical staff (36.9%). Human resources in Australian and NZ trauma services are not reflective of those recommended by the Australasian Trauma Verification Program. This impacts on the ability to coordinate trauma monitoring and performance improvement. Review of the Australasian Trauma Verification Model Resource Criteria is required. Injury surveillance in Australia and NZ is hampered by insufficient trauma registry resources. © 2014 Royal Australasian College of Surgeons.
Aim To determine the etiology and outcome of pediatric burns (0-12 years). Design A retrospective study of burn victims hospitalized at the Rift Valley Provincial General Hospital, Nakuru, Kenya from April 2004 to March 2007. Method Charts of all children hospitalized for burn injury were reviewed for patient demographics, ...
surgical/female burn ward were eligible. On average the ward admits 680 patients a year out of which 170 pa- tients (25.7 %) are due to pediatric burns. The Hospital attracts patients mostly from low socioeconomic status. Pediatric Burns at The Rift Valley. Provincial General Hospital, Nakuru,. Kenya. Author: Oduor P.R. ...
Psychological skills of provincial netball players in different playing positions. ... South African Journal for Research in Sport, Physical Education and Recreation ... Differences regarding the psychological skill levels of soccer, basketball, rugby union and American football players in different playing positions have been ...
The context of the study is the concern over declining provincial road conditions due to insufficient government funding for road maintenance. The roads are used by a ... There is a 20% reduction in the road condition during wet periods, which would indicate poor drainage and/or use of poor quality road building materials.
A major deflection from the exponential growth patterns seen hitherto can be anticipated only once all or most of the highly populated provinces have traversed their respective points of inflection. The exponential model significantly explains the HIV epidemics in the provinces. The combination of these provincial epidemics ...
Background: Injuries related to motorcycles contribute significantly to the number of road traffic injuries This study was aimed at determining the pattern of injuries caused by motorcycle crash among patients seen at Kakamega provincial hospital in Kenya... Methods: This was a cross sectional study which was conducted in ...
Results compare favourably with those from a principal component and cluster analysis, which has previously been used to demarcate the South African space economy into a hierarchy of development regions. Keywords: Journey-to-work flows, provincial boundaries, intramax method, principal component analysis, ...
..., intends to re-establish the Provincial Advisory Committees (PACs) for the provinces in California, Oregon, and Washington. This re-establishment is in response to the continued need for the PACs to provide... Northern Spotted Owl. The PACs also provide advice and recommendations to promote integration and...
van Klinken, G.; Berenschot, W.
The post-1998 surge in local politics has moved the provincial town back to centre stage. This book examines the Indonesian middle class (now 43%!) up close in the place where its members are most at home: the town. Middle Indonesia generates national political forces, yet it is neither particularly
Johnsen, Søren Paaske; Ingeman, Annette; Hundborg, Heidi Holmager
AIM OF DATABASE: The aim of the Danish Stroke Registry is to monitor and improve the quality of care among all patients with acute stroke and transient ischemic attack (TIA) treated at Danish hospitals. STUDY POPULATION: All patients with acute stroke (from 2003) or TIA (from 2013) treated...... at Danish hospitals. Reporting is mandatory by law for all hospital departments treating these patients. The registry included >130,000 events by the end of 2014, including 10,822 strokes and 4,227 TIAs registered in 2014. MAIN VARIABLES: The registry holds prospectively collected data on key processes...... of care, mainly covering the early phase after stroke, including data on time of delivery of the processes and the eligibility of the individual patients for each process. The data are used for assessing 18 process indicators reflecting recommendations in the national clinical guidelines for patients...
Afzal Ali Jat
Results and Conclusions: A total of 279 patients were registered in the trauma registry during the study period, including 18 trauma deaths. Peer review judged that six were preventable, seven were potentially preventable, and four were non-preventable. One patient was excluded because the record was not available for review. The proportion of preventable and potentially preventable deaths was significantly higher in our study than from developed countries. Of the multiple contributing factors identified, the most important were inadequate prehospital care, inappropriate interhospital transfer, limited hospital resources, and an absence of integrated and organized trauma care. This study summarizes the challenges faced in trauma care in a developing country.
Özcan, Cengiz; Juel, Knud; Lassen, Jens Flensted
AIM: The Danish Heart Registry (DHR) seeks to monitor nationwide activity and quality of invasive diagnostic and treatment strategies in patients with ischemic heart disease as well as valvular heart disease and to provide data for research. STUDY POPULATION: All adult (≥15 years) patients...... undergoing coronary angiography (CAG), percutaneous coronary intervention (PCI), coronary artery bypass grafting, and heart valve surgery performed across all Danish hospitals were included. MAIN VARIABLES: The DHR contains a subset of the data stored in the Eastern and Western Denmark Heart Registries (EDHR...
Full Text Available Lone Baandrup,1 Charlotte Cerqueira,2 Lea Haller,3 Lene Korshøj,3 Inge Voldsgaard,4 Merete Nordentoft5 1Centre for Neuropsychiatric Schizophrenia Research (CNSR and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS, Mental Health Centre Glostrup, Copenhagen University Hospital, Glostrup, 2Registry Support Centre (East – Epidemiology and Biostatistics, Research Centre for Prevention and Health, Capital Region of Denmark, Copenhagen, 3The Danish Clinical Registries, Registry Support Centre for Health Quality and Informatics (KCKS-West, Aarhus, 4Psychosis Ward, Section P, Aarhus University Hospital, Risskov, 5Mental Health Centre Copenhagen, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, DenmarkAim of database: To systematically monitor and improve the quality of treatment and care of patients with schizophrenia in Denmark. In addition, the database is accessible as a resource for research.Study population: Patients diagnosed with schizophrenia and receiving mental health care in psychiatric hospitals or outpatient clinics. During the first year after the diagnosis, patients are classified as incident patients, and after this period as prevalent patients.Main variables: The registry currently contains 21 clinical quality measures in relation to the following domains: diagnostic evaluation, antipsychotic treatment including adverse reactions, cardiovascular risk factors including laboratory values, family intervention, psychoeducation, postdischarge mental health care, assessment of suicide risk in relation to discharge, and assessment of global functioning.Descriptive data: The recorded data are available electronically for the reporting clinicians and responsible administrative personnel, and they are updated monthly. The registry publishes the national and regional results of all included quality measures in the annual audit reports. External researchers may
Furuya, T; Nobori, M; Tanaka, N
Vascular trauma is essentially acute arterial obstruction, often combined with hemorrhage, fracture, and infection. It can be both life-threatening and limb-threatening and needs an emergency operation. In vascular trauma patient, multiple fracture and organ injury, such as brain, lung, liver, spleen, kidney, or gastrointestinal tract should be evaluated to decide treatment priority. When the pulse distal from the injured site is absent or diminished, vascular trauma is most likely and reconstruction should be accomplished within "the golden time (6-8 hours)". Intimal damage followed by platelet aggregation and thrombus formation will necessitate resection and repair of the site instead of simple thrombectomy. Although autogenous vein is the first choice, artificial graft can be implanted for short segment in non-infected field.
... an ENT Doctor Near You Children and Facial Trauma Children and Facial Trauma Patient Health Information News ... staff at firstname.lastname@example.org . What is facial trauma? The term facial trauma means any injury to ...
... NIGMS NIGMS Home > Science Education > Physical Trauma Physical Trauma Tagline (Optional) Middle/Main Content Area PDF Version (572 KB) Other Fact Sheets What is physical trauma? Physical trauma is a serious injury to the ...
Pereira Júnior, Gerson Alves; Paganelli, Fernando; Scarpelini, Sandro; Stracieri, Luís Donizetti Silva; Féres, Ornar; Andrade, José Ivan de
Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste ...
Parvathi Devi Munishwar
Full Text Available Gunshot injuries are rather serious but uncommon type of trauma in India. Radiologists can contribute substantially in the evaluation and treatment of patients with gunshot wounds. Foreign bodies that enter a patient as a result of trauma are contaminated and produce a range of symptoms. Oral and maxillofacial gunshot injuries are usually fatal due to close proximity with vital structures. Here, we report a case in which radiographic evidence of foreign bodies in the right orofacial region exposed a history of a gunshot injury. The patient did not have any major complaints except for reduced mouth opening. These foreign bodies were clinically silent for approximately 12 years.
Dr. Loria Pollack, a Senior Medical Epidemiologist, talks about the importance of cancer registry data to understanding how cancer affects the United Statesânow and in the future. Created: 5/24/2017 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 5/24/2017.
Lilleker, James B; Vencovsky, Jiri; Wang, Guochun
AIMS: The EuroMyositis Registry facilitates collaboration across the idiopathic inflammatory myopathy (IIM) research community. This inaugural report examines pooled Registry data. METHODS: Cross-sectional analysis of IIM cases from 11 countries was performed. Associations between clinical subtyp...
Pedersen, Bodil Maria
There are two main trends in psychological approaches to human suffering related to what we term trauma. Although they have their respective limitations both approaches may help us explore and alleviate human suffering. One trend, primarily using concepts like traumatic events and traumatisation...
Feb 2, 2011 ... Industrial workers should be protected by safety glasses but injuries occur nonetheless. Eye trauma is frequent in homes, farms and backyards where safety glasses are not available. Angle-grinders, metal beating, hammering, fence mending, herding animals, forestry, fire fighting and cutting sugar cane ...
deaths due to other trauma types (gunshot wounds, road traffic fatalities and assault) were documented. Ethical approval was obtained from the University of Pretoria, Faculty of Health. Science Research Ethics Committee, prior to commencement of this study. Descriptive statistical analysis was conducted with the aid of a ...
of shock and who require “damage control” surgery are more likely to suffer a worse outcome, particularly when multiple physiological derangements .... Gun shot. 13. 15. Shot gun. 0. 1. Level of injury. Infrarenal. 11. 7. 0.248. Juxtarenal. 2. 7. Suprarenal. 2. 1. Retrohepatic. 2. 2. Trauma scores. RTS (mean). 7.28. 6.44. 0.095.
and track this epidemic. A number of socio-political changes have continued, and these will impact on the trauma patterns seen in the country. Gun control legislation has been enforced since the turn of the millennium, and there have been ongoing attempts to demilitarise society by removing assault weapons. The ongoing ...
Du, Wen-Bo; Liang, Bo-Yuan; Hong, Chen; Lordan, Oriol
The air transportation system is of a great impact on the economy and globalization of a country. In this paper, we analyze the Chinese air transportation network (ATN) from a provincial perspective via the complex network framework, where all airports located in one province are abstracted as a single node and flights between two provinces are denoted by a link. The results show that the network exhibits small-world property, homogeneous structure and disassortative mixing. The variation of the flight flow within 24 h is investigated and an obvious tide phenomenon is found in the dynamics of Chinese provincial ATN for high output level of tertiary industry. Our work will offer a novel approach for understanding the characteristic of the Chinese air transportation network.
Zhang, Yongjie; Zhang, Yuzhao; Shen, Dehua; Zhang, Wei
In this paper, we advocate the provincial TV audience rating as the novel proxy for the provincial investor sentiment (PIS) and investigate its relation with stock returns. The empirical results firstly show that the PIS is positively related to stock returns. Secondly, we provide direct evidence on the existence of home bias in China by observing that the provincial correlation coefficient is significantly larger than the cross-provincial correlation coefficient. Finally, the PIS can explain a large proportion of provincial comovement. To sum up, all these findings support the role of the non-traditional information sources in understanding the "anomalies" in stock market.
Cette étude prospective a été menée pour évaluer l'utilisation des services de soins prénatals à l'Hôpital Spécialisé Provincial à Mongomo en Guinée Equatoriale, en mettant l'accent sur les facteurs déconcertant qui affectent les prestations des soins prénatals (SP) efficaces. Nous avons recueilli des renseignements à ...
Battaloglu, Emir; McDonnell, Declan; Chu, Justin; Lecky, Fiona; Porter, Keith
To understand the epidemiology of pregnancy and obstetric complications encountered in the management of pregnant trauma patients. Retrospective analysis of national trauma registry for recording of pregnancy status or obstetric complication in cases of trauma. Sub-division of patient cohort by severity of trauma and stage of pregnancy. Comparison of data sets between pregnant trauma patients and age-matched non-pregnant female trauma patients to determine patterns of injury and impact upon clinical outcomes. National registry data for the United Kingdom. For the five year period between 2009 and 2014, a total of 15,140 female patients, aged between 15 years old and 50 years old were identified within the trauma registry. A record of pregnancy was identified in 173 patients (1.14%) from within this cohort. Mechanisms of injury within the cohort of pregnant trauma patients saw increased rate of vehicular collision and interpersonal violence, especially penetrating trauma. Higher abbreviated injury scores were recorded for the abdominal region in pregnancy than in the non-pregnant cohort. Maternal mortality rates were seen to be higher, when compared with the non-pregnant trauma patient. Foetal survival rate from this series was 56% following trauma. Foetal death in pregnant trauma patients most frequently occurred in the 2nd trimester. No cases of isolated foetal survival were recorded following maternal trauma. Trauma to pregnant patients is rare in the United Kingdom, encountered in 1% of female trauma patients of child bearing age. Observations in altered mechanisms of injury and clinical outcomes were recorded. This provides useful information regarding the clinical management of pregnant trauma patients and offers potential areas to investigate to optimise their care, as well as to focus injury prevention measures. IV--Case series. Copyright © 2015 Elsevier Ltd. All rights reserved.
SKYTTHE, AXEL; KYVIK, KIRSTEN OHM; HOLM, NIELS VILSTRUP; CHRISTENSEN, KAARE
Introduction The Danish Twin Registry is a unique source for studies of genetic, familial and environmental factors on life events, health conditions and diseases. Content More than 85,000 twin pairs born 1870–2008 in Denmark. Validity and coverage Four main ascertainment methods have been employed. Completeness of ascertainment varies according to birth cohorts. For birth cohorts 1870–1930 both twins should survive to age 6 years. From 1931–1968 72% of all twin pairs has been ascertained, with complete ascertainment of all live born twins since 1968. Conclusion Because twins have been identified independent of traits and on a population basis, the Danish Twin Registry is well suited for studies to understand the influence of genetic and environmental factors for a wide variety of diseases and traits. PMID:21775358
Skytthe, Axel; Ohm Kyvik, Kirsten; Vilstrup Holm, Niels
Introduction: The Danish Twin Registry is a unique source for studies of genetic, familial and environmental factors on life events, health conditions and diseases. Content: More than 85,000 twin pairs born 1870-2008 in Denmark. Validity and coverage: Four main ascertainment methods have been...... employed. Completeness of ascertainment varies according to birth cohorts. For birth cohorts 1870-1930 both twins should survive to age 6 years. From 1931-1968 72% of all twin pairs has been ascertained, with complete ascertainment of all live born twins since 1968. CONCLUSION: Because twins have been...... identified independent of traits and on a population basis, the Danish Twin Registry is well suited for studies to understand the influence of genetic and environmental factors for a wide variety of diseases and traits....
Haider, Adil H; Hashmi, Zain G; Gupta, Sonia; Zafar, Syed Nabeel; David, Jean-Stephane; Efron, David T; Stevens, Kent A; Zafar, Hasnain; Schneider, Eric B; Voiglio, Eric; Coimbra, Raul; Haut, Elliott R
National trauma registries have helped improve patient outcomes across the world. Recently, the idea of an International Trauma Data Bank (ITDB) has been suggested to establish global comparative assessments of trauma outcomes. The objective of this study was to determine whether global trauma data could be combined to perform international outcomes benchmarking. We used observed/expected (O/E) mortality ratios to compare two trauma centers [European high-income country (HIC) and Asian lower-middle income country (LMIC)] with centers in the North American National Trauma Data Bank (NTDB). Patients (≥16 years) with blunt/penetrating injuries were included. Multivariable logistic regression, adjusting for known predictors of trauma mortality, was performed. Estimates were used to predict the expected deaths at each center and to calculate O/E mortality ratios for benchmarking. A total of 375,433 patients from 301 centers were included from the NTDB (2002-2010). The LMIC trauma center had 806 patients (2002-2010), whereas the HIC reported 1,003 patients (2002-2004). The most important known predictors of trauma mortality were adequately recorded in all datasets. Mortality benchmarking revealed that the HIC center performed similarly to the NTDB centers [O/E = 1.11 (95% confidence interval (CI) 0.92-1.35)], whereas the LMIC center showed significantly worse survival [O/E = 1.52 (1.23-1.88)]. Subset analyses of patients with blunt or penetrating injury showed similar results. Using only a few key covariates, aggregated global trauma data can be used to adequately perform international trauma center benchmarking. The creation of the ITDB is feasible and recommended as it may be a pivotal step towards improving global trauma outcomes.
Pan, Jay; Liu, Gordon G
There is great divergence in provincial government health expenditures in China. Real per capita provincial government health expenditures (GHE) over the period 2002-2006 are examined using panel regression analysis. Key determinants of real per capita provincial GHE are real provincial per capita general budget revenue, real provincial per capita transfers from the central government, the proportion of provincial population under age 15, urban employee basic health insurance coverage, and proportion of urban population. Roughly equal and relatively low elasticities of budget revenue and transfers imply that the GHE is a necessity rather than a luxury good, and transfers have yet to become efficient instruments for the fair allocation of health resources by policy makers. Moreover, severe acute respiratory syndrome outbreak has increased the GHE, but we find no statistical evidence that provincial GHE have fluctuated according to the public health status. Copyright © 2011 John Wiley & Sons, Ltd.
(17%) and other trauma (14%), while during S2 the injuries were primarily muscle strains (16%), other trauma (20%), tendinopathy (16%) and acute sprains (15%). ... the fast bowler most likely to sustain an acute injury to the soft tissues of the lower limb while participating in matches and practices during the early part of the ...
Horst, Michael A; Jammula, Shreya; Gross, Brian W; Bradburn, Eric H; Cook, Alan D; Altenburg, Juliet; Morgan, Madison; Von Nieda, Danielle; Rogers, Frederick B
The care of patients at individual trauma centers (TCs) has been carefully optimized, but not the placement of TCs within the trauma systems. We sought to objectively determine the optimal placement of trauma centers in Pennsylvania using geospatial mapping. We used the Pennsylvania Trauma Systems Foundation (PTSF) and Pennsylvania Health Care Cost Containment Council (PHC4) registries for adult (age ≥15) trauma between 2003-2015 (n=377,540 and n=255,263). TCs and zip codes outside of PA were included to account for edge effects with trauma cases aggregated to the Zip Code Tabulation Area centroid of residence. Model assumptions included no prior TCs (clean slate), travel time intervals of 45, 60, 90 and 120 minutes, TC capacity based on trauma cases per bed size and candidate hospitals ≥200 beds. We used Network Analyst Location-Allocation function in ArcGIS Desktop to generate models optimally placing 1 to 27 TCs (27 current PA TCs) and assessed model outcomes. At a travel time of 60 minutes and 27 sites, optimally placed models for PTSF and PHC4 covered 95.6% and 96.8% of trauma cases in comparison with the existing network reaching 92.3% or 90.6% of trauma cases based on PTSF or PHC4 inclusion. When controlled for existing coverage, the optimal numbers of TCs for PTSF and PHC4 were determined to be 22 and 16, respectively. The clean slate model clearly demonstrates that the optimal trauma system for the state of Pennsylvania differs significantly from the existing system. Geospatial mapping should be considered as a tool for informed decision-making when organizing a statewide trauma system. Level III epidemiological study.
Ashley, Dennis W; Nicholas, Jeffrey M; Dente, Christopher J; Johns, Tracy J; Garlow, Laura E; Solomon, Gina; Abston, Dena; Ferdinand, Colville H
As quality and outcomes have moved to the fore front of medicine in this era of healthcare reform, a state trauma system Performance Based Payments (PBP) program has been incorporated into trauma center readiness funding. The purpose of this study was to evaluate the impact of a PBP on trauma center revenue. From 2010 to 2016, a percentage of readiness costs funding to trauma centers was placed in a PBP and withheld until the PBP criteria were completed. To introduce the concept, only three performance criteria and 10 per cent of readiness costs funding were tied to PBP in 2010. The PBP has evolved over the last several years to now include specific criteria by level of designation with an increase to 50 per cent of readiness costs funding being tied to PBP criteria. Final PBP distribution to trauma centers was based on the number of performance criteria completed. During 2016, the PBP criteria for Level I and II trauma centers included participation in official state meetings/conference calls, required attendance to American College of Surgeons state chapter meetings, Trauma Quality Improvement Program, registry reports, and surgeon participation in Peer Review Committee and trauma alert response times. Over the seven-year study period, $36,261,469 was available for readiness funds with $11,534,512 eligible for the PBP. Only $636,383 (6%) was withheld from trauma centers. A performance-based program was successfully incorporated into trauma center readiness funding, supporting state performance measures without adversely affecting the trauma center revenue. Future PBP criteria may be aligned to designation standards and clinical quality performance metrics.
Baandrup, Lone; Cerqueira, Charlotte; Haller, Lea
Aim of database: To systematically monitor and improve the quality of treatment and care of patients with schizophrenia in Denmark. In addition, the database is accessible as a resource for research. Study population: Patients diagnosed with schizophrenia and receiving mental health care...... to the data for use in specific research projects by applying to the steering committee. Conclusion: The Danish Schizophrenia Registry represents a valuable source of informative data to monitor and improve the quality of care of patients with schizophrenia in Denmark. However, continuous resources and time...
Baandrup, Lone; Cerqueira, Charlotte; Haller, Lea
Aim of database: To systematically monitor and improve the quality of treatment and care of patients with schizophrenia in Denmark. In addition, the database is accessible as a resource for research. Study population: Patients diagnosed with schizophrenia and receiving mental health care...... to the data for use in specific research projects by applying to the steering committee. Conclusion: The Danish Schizophrenia Registry represents a valuable source of informative data to monitor and improve the quality of care of patients with schizophrenia in Denmark. However, continuous resources and time...
Lillebo, Borge; Seim, Andreas; Vinjevoll, Ole-Petter; Uleberg, Oddvar
Trauma teams improve the initial management of trauma patients. Optimal timing of trauma alerts could improve team preparedness and performance while also limiting adverse ripple effects throughout the hospital. The purpose of this study was to evaluate how timing of trauma team activation and notification affects initial in-hospital management of trauma patients. Data from a single hospital trauma care quality registry were matched with data from a trauma team alert log. The time from patient arrival to chest X-ray, and the emergency department length of stay were compared with the timing of trauma team activations and whether or not trauma team members received a preactivation notification. In 2009, the trauma team was activated 352 times; 269 times met the inclusion criteria. There were statistically significant differences in time to chest X-ray for differently timed trauma team activations (P = 0.003). Median time to chest X-ray for teams activated 15-20 minutes prearrival was 5 minutes, and 8 minutes for teams activated <5 minutes before patient arrival. Timing had no effect on length of stay in the emergency department (P = 0.694). We found no effect of preactivation notification on time to chest X-ray (P = 0.474) or length of stay (P = 0.684). Proactive trauma team activation improved the initial management of trauma patients. Trauma teams should be activated prior to patient arrival.
Heim, C; Bosisio, F; Roth, A; Bloch, J; Borens, O; Daniel, R T; Denys, A; Oddo, M; Pasquier, M; Schmidt, S; Schoettker, P; Zingg, T; Wasserfallen, J B
Switzerland, the country with the highest health expenditure per capita, is lacking data on trauma care and system planning. Recently, 12 trauma centres were designated to be reassessed through a future national trauma registry by 2015. Lausanne University Hospital launched the first Swiss trauma registry in 2008, which contains the largest database on trauma activity nationwide. Prospective analysis of data from consecutively admitted shock room patients from 1 January 2008 to 31 December 2012. Shock room admission is based on physiology and mechanism of injury, assessed by prehospital physicians. Management follows a surgeon-led multidisciplinary approach. Injuries are coded by Association for the Advancement of Automotive Medicine (AAAM) certified coders. Over the 5 years, 1,599 trauma patients were admitted, predominantly males with a median age of 41.4 years and median injury severity score (ISS) of 13. Rate of ISS >15 was 42%. Principal mechanisms of injury were road traffic (40.4%) and falls (34.4%), with 91.5% blunt trauma. Principal patterns were brain (64.4%), chest (59.8%) and extremity/pelvic girdle (52.9%) injuries. Severe (abbreviated injury scale [AIS] score ≥ 3) orthopaedic injuries, defined as extremity and spine injuries together, accounted for 67.1%. Overall, 29.1% underwent immediate intervention, mainly by orthopaedics (27.3%), neurosurgeons (26.3 %) and visceral surgeons (13.9%); 43.8% underwent a surgical intervention within the first 24 hours and 59.1% during their hospitalisation. In-hospital mortality for patients with ISS >15 was 26.2%. This is the first 5-year report on trauma in Switzerland. Trauma workload was similar to other European countries. Despite high levels of healthcare, mortality exceeds published rates by >50%. Regardless of the importance of a multidisciplinary approach, trauma remains a surgical disease and needs dedicated surgical resources.
Vogel, Lara D; Vongsachang, Hurnan; Pirrotta, Elizabeth; Holmes, James F; Holmes, James M; Sherck, John; Newton, Christopher; D'Souza, Peter; Spain, David A; Wang, N Ewen
Due to the scarcity of specialized resources for pediatric trauma, "regionalization," or a system designed to get "the right child, to the right place, at the right time," is vital to quality pediatric trauma care. In Northern California, four pediatric trauma centers serve 3.9 million children within a geographically diverse area of 113,630 square miles. A significant proportion of children with trauma is initially triaged to nontrauma hospitals and may require subsequent transfer to a specialty center. Trauma transfer patterns to a pediatric trauma center may provide insight into regional primary triage practices. Transfers from hospitals in close proximity to pediatric trauma centers might suggest that some children could have avoided transfer with minimal additional transport time. While pediatric trauma centers are scarce and serve as regional resources, transfers from beyond the regular catchment area of a trauma center could be an indication of clinical need. The objective of this study was to gain an understanding of patterns of pediatric trauma transfer to all pediatric trauma centers within the region as a first step in assessing the efficacy and efficiency of trauma triage. The authors examined three groups of transfer patients: transfers from within the same county as the pediatric trauma center (near transfers), transfers from counties adjacent to the pediatric trauma center (catchment transfers), and transfers from more distant counties (far transfers). The hypothesis was that catchment transfers would form the bulk of transfers, near transfers would compose transfers, and far transfers would be younger and more severely injured than catchment transfers. This was a retrospective analysis of institutional trauma registry data of children pediatric trauma centers in Northern California from 2001 through 2009. Transfers were characterized by the location of the transfer hospital relative to the location of the pediatric trauma center. Characteristics
Mojca Globočnik Petrovič
Full Text Available Background. Ocular trauma is important cause of blindness. Birmingham Eye Trauma Terminology allows us to use a standardized eye injury terminology which permits an unambigous interpretation. The Eye Injury Registry enables the analysis of medical, epidemyologic and social data.The most frequent ocular injury ocular contusion has a relatively good prognosis. An adequate primary ocular repair and correct timing of pars plana vitrectomy are very important in open globe injury management. There still exist some controversial issues concerning the role of posterior segment surgery in open globe injuries. These include timing of surgery, prophylactic scleral buckle placement and a proper use of systemic and intravitreal antibiotics.Conclusions. With adequate primary ocular repair, the use of systemic, intravitreal antibiotics, scleral buckling and proper timing for pars plana vitrectomy the prognosis for ocular trauma cases can be better.
Gerson Alves Pereira Júnior
Full Text Available Apresentamos uma revisão sobre trauma renal, com ênfase na avaliação radiológica, particularmente com o uso da tomografia computadorizada, que tem se tornado o exame de eleição, ao invés da urografia excretora e arteriografia. O sucesso no tratamento conservador dos pacientes com trauma renal depende de um acurado estadiamento da extensão da lesão, classificado de acordo com a Organ Injury Scaling do Colégio Americano de Cirurgiões. O tratamento conservador não-operatório é seguro e consiste de observação contínua, repouso no leito, hidratação endovenosa adequada e antibioti- coterapia profilática, evitando-se uma exploração cirúrgica desnecessária e possível perda renal. As indicações para exploração cirúrgica imediata são abdome agudo, rápida queda do hematócrito ou lesões associadas determinadas na avaliação radiológica. Quando indicada, a exploração renal após controle vascular prévio é segura, permitindo cuidadosa inspeção do rim e sua reconstrução com sucesso, reduzindo a probabilidade de nefrectomia.
Frøen, J Frederik; Myhre, Sonja L; Frost, Michael J; Chou, Doris; Mehl, Garrett; Say, Lale; Cheng, Socheat; Fjeldheim, Ingvild; Friberg, Ingrid K; French, Steve; Jani, Jagrati V; Kaye, Jane; Lewis, John; Lunde, Ane; Mørkrid, Kjersti; Nankabirwa, Victoria; Nyanchoka, Linda; Stone, Hollie; Venkateswaran, Mahima; Wojcieszek, Aleena M; Temmerman, Marleen; Flenady, Vicki J
The Global Roadmap for Health Measurement and Accountability sees integrated systems for health information as key to obtaining seamless, sustainable, and secure information exchanges at all levels of health systems. The Global Strategy for Women's, Children's and Adolescent's Health aims to achieve a continuum of quality of care with effective coverage of interventions. The WHO and World Bank recommend that countries focus on intervention coverage to monitor programs and progress for universal health coverage. Electronic health registries - eRegistries - represent integrated systems that secure a triple return on investments: First, effective single data collection for health workers to seamlessly follow individuals along the continuum of care and across disconnected cadres of care providers. Second, real-time public health surveillance and monitoring of intervention coverage, and third, feedback of information to individuals, care providers and the public for transparent accountability. This series on eRegistries presents frameworks and tools to facilitate the development and secure operation of eRegistries for maternal and child health. In this first paper of the eRegistries Series we have used WHO frameworks and taxonomy to map how eRegistries can support commonly used electronic and mobile applications to alleviate health systems constraints in maternal and child health. A web-based survey of public health officials in 64 low- and middle-income countries, and a systematic search of literature from 2005-2015, aimed to assess country capacities by the current status, quality and use of data in reproductive health registries. eRegistries can offer support for the 12 most commonly used electronic and mobile applications for health. Countries are implementing health registries in various forms, the majority in transition from paper-based data collection to electronic systems, but very few have eRegistries that can act as an integrating backbone for health
Ciesla, David J; Pracht, Etienne E; Leitz, Pablo T; Spain, David A; Staudenmayer, Kristan L; Tepas, Joseph J
Florida serves as a model for the study of trauma system performance. Between 2010 and 2104, 5 new trauma centers were opened alongside 20 existing centers. The purpose of this study was to explore the impact of trauma system expansion on system triage performance and trauma center patients' profiles. A statewide data set was queried for all injury-related discharges from adult acute care hospitals using International Classification of Diseases, Ninth Revision (ICD-9) codes for 2010 and 2014. The data set, inclusion criteria, and definitions of high-risk injury were chosen to match those used by the Florida Department of Health in its trauma registry. Hospitals were classified as existing Level I (E1) or Level II (E2) trauma centers and new E2 (N2) centers. Five N2 centers were established 11.6 to 85.3 miles from existing centers. Field and overall trauma system triage of high-risk patients was less accurate with increased overtriage and no change in undertriage. Annual volume at N2 centers increased but did not change at E1 and E2 centers. In 2014, Patients at E1 and E2 centers were slightly older and less severely injured, while those at N2 centers were substantially younger and more severely injured than in 2010. The injured patient-payer mix changed with a decrease in self-pay and commercial patients and an increase in government-sponsored patients at E1 and E2 centers and an increase in self-pay and commercial patients with a decrease in government-sponsored patients at N2 centers. Designation of new trauma centers in a mature system was associated with a change in established trauma center demographics and economics without an improvement in trauma system triage performance. These findings suggest that the health of an entire trauma system network must be considered in the design and implementation of a regional trauma system. Therapeutic/care management study, level IV; epidemiological, level IV.
Arboe, Bente; Josefsson, Pär; Jørgensen, Judit
AIM OF DATABASE: The Danish National Lymphoma Registry (LYFO) was established in order to monitor and improve the diagnostic evaluation and the quality of treatment of all lymphoma patients in Denmark. STUDY POPULATION: The LYFO database was established in 1982 as a seminational database including...... all lymphoma patients referred to the departments of hematology. The database became nationwide on January 1, 2000. MAIN VARIABLES: The main variables include both clinical and paraclinical variables as well as details of treatment and treatment evaluation. Up to four forms are completed for each......-100 years) and a male/female ratio of 1.23:1. Patients can be registered with any of 42 different subtypes according to the World Health Organization classifications. CONCLUSION: LYFO is a nationwide database for all lymphoma patients in Denmark and includes detailed information. This information is used...
Berg, Regan J; Okoye, Obi; Teixeira, Pedro G; Inaba, Kenji; Demetriades, Demetrios
To examine the specific injuries, need for operative intervention, and clinical outcomes of patients with blunt thoracoabdominal trauma. Trauma registry and medical record review. Level I trauma center in Los Angeles, California. All patients with thoracoabdominal injuries from January 1996 to December 2010. Injuries, incidence and type of operative intervention, clinical outcomes, and risk factors for mortality. Blunt thoracoabdominal injury occurred in 1661 patients. Overall, 474 (28.5%) required laparotomy, 31 (1.9%) required thoracotomy (excluding resuscitative thoracotomy), and 1146 (69.0%) required no thoracic or abdominal operation. Overall incidence of intraabdominal solid organ injury was 59.7% and hollow viscus injury, 6.0%. Blunt cardiac trauma occurred in 6.3%; major thoracic vessel injury, in 4.6%; and diaphragmatic trauma, in 6.0%. The majority of solid organ injuries were managed nonoperatively (liver, 83.9%; spleen, 68.3%; and kidney, 91.2%). Excluding patients with severe head trauma, mortality ranged from 4.5% with nonoperative management to 18.1% and 66.7% in those requiring laparotomy and dual cavitary exploration, respectively. Age 55 years or older, Injury Severity Score of 25 or more, Glasgow Coma Scale score of 8 or less, initial hypotension, massive transfusion, and liver, cardiac, or abdominal vascular trauma were all independent risk factors for mortality. Most patients with blunt thoracoabdominal trauma are managed nonoperatively. The need for non-resuscitative thoracotomy or combined thoracoabdominal operation is rare. The abdomen contains the overwhelming majority of injuries requiring operative intervention and should be the initial cavity of exploration in the patient requiring emergent surgery without directive radiologic data.
Rosenblum, Amanda M.; Li, Alvin Ho-ting; Roels, Leo; Stewart, Bryan; Prakash, Versha; Beitel, Janice; Young, Kimberly; Shemie, Sam; Nickerson, Peter; Garg, Amit X.
The variability in deceased organ donation registries worldwide has received little attention. We considered all operating registries, where individual wishes about organ donation were recorded in a computerized database. We included registries which recorded an individual's decision to be a donor (donor registry), and registries which only recorded an individual's objection (non-donor registry). We collected information on 15 characteristics including history, design, use and number of regis...
Cheng, Liang; Zhu, Yong; Long, Haitao; Yang, Junxiao; Sun, Buhua; Li, Kanghua
To establish a database for pelvic trauma in Hunan Province, and to start the work of multicenter pelvic trauma registry. Methods: To establish the database, literatures relevant to pelvic trauma were screened, the experiences from the established trauma database in China and abroad were learned, and the actual situations for pelvic trauma rescue in Hunan Province were considered. The database for pelvic trauma was established based on the PostgreSQL and the advanced programming language Java 1.6. Results: The complex procedure for pelvic trauma rescue was described structurally. The contents for the database included general patient information, injurious condition, prehospital rescue, conditions in admission, treatment in hospital, status on discharge, diagnosis, classification, complication, trauma scoring and therapeutic effect. The database can be accessed through the internet by browser/servicer. The functions for the database include patient information management, data export, history query, progress report, video-image management and personal information management. Conclusion: The database with whole life cycle pelvic trauma is successfully established for the first time in China. It is scientific, functional, practical, and user-friendly.
Secco, Gioel Gabrio; Rittger, Harald; Hoffmann, Stefan; Richardt, Gert; Abdel-Wahab, Mohamed; Reinecke, Holger; Lotan, Chaim; Werner, Gerald; Sievert, Horst; Foin, Nicolas; Di Mario, Carlo
Provisional stenting of the side-branch (SB) is the universally accepted gold standard while there is still controversy on the usefulness of routine dilatation of the SB ostium. Recrossing the struts of a previously deployed stent with a wire and a balloon can prove challenging and is occasionally unsuccessful, mainly because the balloon tip hits a stent strut. This prospective multicenter international registry tested the crossing ability procedural results of a new-dedicated ultrashort balloon specifically designed for side branch dilatation (Glider, TriReme Medical, Pleasanton, CA, USA). One hundred and twenty five patients (for a total of 131 bifurcation lesions) were enrolled in the registry between January 2009 and May 2012. The Glider was used as first choice in alternative to conventional balloon (group I, 72%) or as bail-out after unsuccessful previous attempt at crossing with small conventional low-profile balloons (group II, 28%). Postprocedural coronary artery dissections and in-hospital MACE (death, myocardial infarction and repeat revascularization) were assessed. Technical success was defined as the ability of the Glider to recross the struts of a previously deployed stent while procedural success was defined as less of residual 50% diameter stenosis at the origin of the SB with a final TIMI 3 and/or freedom from in-hospital MACE. Technical success was achieved, respectively, in 92% (group I), and 83% (group II). Clinical and angiographic procedural success was achieved in 98% of the lesions. In Group II, no other balloon of the same size could cross in cases where Glider could not. A total of 13 complications were observed, including nine ostial SB dissection four of which needed a second stent on the SB, one stent loss, two severe coronary spasms, and two by thrombus formation. The unique possibility offered by this short dedicated balloon to orientate its beveled tip provides an effective strategy for recrossing stent struts when conventional low
van Gool, Matthijs H; Giannakopoulos, Georgios F; Geeraedts, Leo M G; de Lange-de Klerk, Elly S M; Zuidema, Wietse P
Laparotomy is a potential life-saving procedure after traumatic abdominal injury. There is limited literature about morbidity and mortality rates after trauma laparotomy. The primary aim of this study is to describe the complications which may occur due to laparotomy for trauma. Retrospective evaluated single-centre study with data registry up to 1 year after initial laparotomy for trauma was performed in a level 1 trauma centre in The Netherlands. Between January 2000 and January 2011, a total of 2390 severely injured trauma patients (ISS ≥ 16) were transported to the VUMC. Patient demographics; mechanism of injury; injury patterns defined by Abbreviated Injury Scale (AIS), Injury Severity Score (ISS) and Revised Trauma Score (RTS); surgical interventions and findings; and morbidity and mortality were documented. A total of 92 trauma patients who underwent a trauma laparotomy met the inclusion criteria. Of these patients, 71 % were male. Median age was 37 years. Median ISS was 27. Mechanisms of injury comprised of car accidents (20 %), fall from height (17 %), motorcycle accidents (12 %), pedestrian/cyclist hit by a vehicle (9 %) and other in three patients (5 %). Penetrating injuries accounted for 37 % of the injuries, consisting of stab wounds (21 %) and gunshot wounds (16 %). Complications classified by the Clavien-Dindo Classification of Surgical Complications showed grade I complications in 21 patients (23 %), grade II in 36 patients (39 %), grade III in 21 patients (23 %), grade IV in 2 patients (2 %) and grade V in 16 patients (17 %). Laparotomy for trauma has a high complication rate resulting in significant morbidity and mortality. Most events occur in the early postoperative period. Further prospective research needs to be conducted in order to identify possibilities to improve care in the future.
Full Text Available Islamic symbols have flourished in the public spaces of Indonesian provincial towns after Suharto. This phenomenon has occurred in parallel with the significant shifts in the social, economic and political fields, which is tied to the mounting impact of Islamization, social mobility, economic growth, and democratization occurring among town people. It is as if we see a parallel move between Islamization, modernization, globalization and democratization. Key concepts associated with these trends are appropriated with those rooted in tradition and local culture to inform the whole dynamics of Indonesian provincial towns today. The key player in this process is the new middle class, who look to Islam for inspiration both to claim distinction and social status and to legitimize their consumptive lifestyle. They are newly pious who act as active negotiators between the global and the local as well as the cosmopolitan centre and the hinterland. They also play a pivotal role as an agency that liberalizes religion from its traditionally subservient, passive and docile posture by turning it into a source of moral legitimacy and distinction to represent a modern form of life. Given its intimate relationship with locality, tradition, modernity as well as globalization, Islam has increasingly assumed a greater importance for local politics. Political elites have used Islamic symbols for the instrumental purpose of extending their political legitimacy and mobilizing constituency support, in a political environment of open competition and increased public participation in decision making. In this process religious symbols have irrefutably been distanced from their religious moorings and narrow, Islamist understandings, in favor of pragmatic political purposes. Keywords: Islamic symbols, middle class, globalization, lifestyle, local politics
Full Text Available This paper presents the CSIR’s contribution to technical advances in the approach to provincial spatial planning in South Africa. It demonstrates the CSIR’s involvement in conducting the national Provincial Growth and Development Strategy Assessment...
The aim of the study is to determine the attitudes of employees of Provincial Directorates of National Education and school administrators towards strategic planning. The research was designed as a survey model study. The population of the research consisted of employees of Provincial Directorate of National Education of Kutahya and school…
Aslani, Hamidreza; Nourbakhsh, Seyed Taghi; Lahiji, Farivar A; Heydarian, Keykavoos; Jabalameli, Mahmood; Ghazavi, Mohammad Taghi; Tahmasebi, Mohammad Naghi; Fayyaz, Mahmoud Reza; Sazegari, Mohammad Ali; Mohaddes, Maziar; Rajabpour, Mojtaba; Emami, Mohammad; Jazayeri, Seyyed Mohammad; Madadi, Firooz; Farahini, Hossein; Mirzatoloee, Fardin; Gharahdaghi, Mohammad; Ebrahimzadeh, Mohammad Hossein; Ebrahimian, Mohammadreza; Mirvakili, Hossein; Bashti, Kaveh; Almasizadeh, Mohtasham; Abolghasemian, Mansour; Taheriazam, Afshin; Motififard, Mehdi; Yazdi, Hamidreza; Mobarakeh, Mahmood Karimi; Shayestehazar, Masoud; Moghtadae, Mehdi; Siavashi, Babak; Sajjadi, Mohammadreza M; Rasi, Alireza Manafi; Chabok, Seyyed Kazem; Zafarani, Zohreh; Salehi, Shahin; Ahmadi, Monireh; Mohammadi, Amin; Shahsavand, Mohammad Ebrahim
Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR) with a joint collaboration of the Social Security Organization (SSO) and academic research departments considering the requirements of the Iran's Ministry of Health and Education.
Approaches 18 19 Primary ADL Registry Contributors Contributor Records Entry Date Navy eLearning (US Navy) 2,086 08/05/2008 Joint Knowledge Development...custom catalog items (content packages) to multiple environments and platforms 2008 21 U.S. Navy Organizational Challenges Lack of consistent...ADL Registry http://adlregistry.adlnet.gov/ Navy eLearning Content Team https://www.netc.navy.mil/ile Joint Knowledge Online http
Lara Gallego, Beatriz; Abaitua Borda, Ignacio; Galán Gil, Genaro; Castillo Villegas, Diego; Casanova Espinosa, Álvaro; Cano Jiménez, Esteban; Ojanguren Arranz, Iñigo; Posada de la Paz, Manuel
This report describes the general characteristics, objectives and organizational aspects of the registries of rare respiratory diseases included in the National Registry of Rare Diseases of the Research Institute for Rare Diseases (ISCIII), in order to publicize their existence and encourage the participation of professionals. Information is collected on the following conditions: alpha-1 antitrypsin deficiency, idiopathic tracheal stenosis, adult pulmonary Langerhans' cell histiocytosis, lymphangioleiomyomatosis, alveolar proteinosis, and sarcoidosis. Copyright © 2013 SEPAR. Published by Elsevier Espana. All rights reserved.
The Danish Nephrology Registry's (DNR) primary function is to support the Danish public health authorities' quality control program for patients with end-stage renal disease in order to improve patient care. DNR also supplies epidemiological data to several international organizations and supports epidemiological and clinical research. The study population included patients treated with dialysis or transplantation in Denmark from January 1, 1990 to January 1, 2016, with retrospective data since 1964. DNR registers patient data (eg, age, sex, renal diagnosis, and comorbidity), predialysis specialist treatment, details of eight dialysis modalities (three hemodialysis and five peritoneal dialysis), all transplantation courses, dialysis access at first dialysis, treatment complications, and biochemical variables. The database is complete (nutritional and uremia status. Date and cause of death are also included. Six quality indicators are published annually, and have been associated with improvements in patient results, eg, a reduction in dialysis patient mortality, improved graft survival, and earlier referral to specialist care. Approximately, ten articles, mainly epidemiological, are published each year. DNR contains a complete description of end-stage renal disease patients in Denmark, their treatment, and prognosis. The stated aims are fulfilled.
Jeanette M. Sebaeng
Full Text Available Background: Sexual assault poses a serious health problem to both the survivor and the health system. Experiencing sexual assault requires women to seek medical and psychological assistance as part of their journey towards recovery. This study examined the experiences of women who received post-sexual assault services from a specialised care centre within a provincial hospital.Methods: A qualitative, exploratory and contextual design was used to explore and describe experiences of women. Data were obtained through individual in-depth interviews from a total of 18 women aged between 18 and 55 years. Interviews were supplemented by the researcher’s field notes and audiotape recordings.Results: Findings yielded two main themes: Women expressed their lived experiences of sexual assault characterised by different forms of trauma. The second theme was an expression of a need for safety and support.Conclusion: Women who experience sexual assault are left with devastating effects such as physical and psychological harm and social victimisation. There is also a need for safety and support towards the recovery of these women. This study recommends that professional practitioners involved in the management of sexual assault be sensitised regarding the ordeal experienced by women and stop perceiving survivors as crime scene ‘clients’ from whom only medico-legal evidence has to be collected. Professional practitioners and family members must be supportive, non-judgemental and considerate of the dignity of survivors. The establishment of sexual assault response teams (SART is also recommended. There should also be inter-professional education for better coordination of services rendered to sexually assaulted women.
Jan H Havenga; Leila L Goedhals-Gerber; Anneke de Bod; Zane Simpson
Background: Logistics costs are most commonly measured on a national level. An understanding of the provincial logistics landscape can add significant value both to provincial and national policy interventions...
Ruch, L O; Leon, J J
An exploratory model of variables affecting level of sexual assault trauma at given times and change in trauma levels over time is developed and tested using a sample of female rape victims admitted to a treatment center over a two-year period. Based on a one-way analysis of variance and multiple classification analysis, the findings indicate that a previous rape best explains trauma change, while victim's demographics, social supports, and other prior life stress variables are important at specific time periods during the rape trauma syndrome. Implications of these results are discussed in terms of treatment-related issues.
Siebenga, J; van der Schoot, J T; Keeman, J N
Mortality due to trauma in pregnancy is not very common in the Netherlands. More often a pregnant woman presents herself for examination after trauma. Blunt trauma is more common in the third trimester. Minor trauma also needs good care, with special attention for solutio placentae. Maternal mortality after penetrating trauma is low because of the protection of vital organs by the uterus. With good treatment the mortality in pregnant trauma patients will not be higher than in nonpregnant patients. A rapid and effective resuscitation of the mother will give the foetus the best chance of survival.
Full Text Available James Heaf Department of Medicine, Roskilde Hospital, University of Copenhagen, Roskilde, Denmark Aim of database: The Danish Nephrology Registry's (DNR primary function is to support the Danish public health authorities' quality control program for patients with end-stage renal disease in order to improve patient care. DNR also supplies epidemiological data to several international organizations and supports epidemiological and clinical research. Study population: The study population included patients treated with dialysis or transplantation in Denmark from January 1, 1990 to January 1, 2016, with retrospective data since 1964. Main variables: DNR registers patient data (eg, age, sex, renal diagnosis, and comorbidity, predialysis specialist treatment, details of eight dialysis modalities (three hemodialysis and five peritoneal dialysis, all transplantation courses, dialysis access at first dialysis, treatment complications, and biochemical variables. The database is complete (<1% missing data. Patients are followed until death or emigration. Descriptive data: DNR now contains 18,120 patients, and an average of 678 is added annually. Data for each transplantation course include donor details, tissue type, time to onset of graft function, and cause of graft loss. Registered complications include peritonitis in peritoneal dialysis patients, causes of peritoneal dialysis technique failure, and transplant rejections. Fifteen biochemical variables are registered, mainly describing anemia control, mineral and bone disease, nutritional and uremia status. Date and cause of death are also included. Six quality indicators are published annually, and have been associated with improvements in patient results, eg, a reduction in dialysis patient mortality, improved graft survival, and earlier referral to specialist care. Approximately, ten articles, mainly epidemiological, are published each year. Conclusion: DNR contains a complete description of end
Civil, Ian; Isles, Siobhan
New Zealand is on the cusp of establishing a world-class trauma system. Many of the building blocks are in place with national and regional guidelines in both the pre-hospital and hospital phases of care established. A dedicated clinical workforce is available in all DHBs and national data available through the Major Trauma Registry. The greatest threat to achieving high-quality trauma care in New Zealand at this point is governance stability rather than clinical variability. Now is the time to lock the trauma system into a framework not subject to political or bureaucratic whims.
DiMarco, Gabriella; Hill, Dane; Feldman, Steven R
Patient registries are datasets containing information on patients with a particular disease or patients who are undergoing a specific treatment. Our objective was to search for and catalog the types of registries being used in dermatology and investigate their characteristics and uses. We searched Google, the Registry of Patient Registries, Orphanet, and ClinicalTrials.gov to compile a list of dermatology disease registries. We also conducted a literature review on the uses of dermatology registries using PubMed. We identified 48 dermatology patient registries, with 23 distinct diseases represented. We also identified 11 registries used for postmarketing surveillance of skin disease. Our search was limited to registries in English. Registries are commonly used for the study of rare dermatologic diseases and for postsurveillance monitoring of systemic therapies in more common dermatologic diseases, such as psoriasis. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.
Vijay Kumar Kundal
Conclusion: The high incidence of pediatric trauma on roads and falls indicate the need for more supervision during playing and identification of specific risk factors for these injuries in our setting. This study shows that these epidemiological parameters could be a useful tool to identify burden and research priorities for specific type of injuries. A comprehensive trauma registry in our set up seems to be important for formulating policies to reduce pediatric trauma burden.
Cordovilla-Guardia, Sergio; Fernández-Mondéjar, Enrique; Vilar-López, Raquel; Navas, Juan F; Portillo-Santamaría, Mónica; Rico-Martín, Sergio; Lardelli-Claret, Pablo
Estimate the effectiveness of brief interventions in reducing trauma recidivism in hospitalized trauma patients who screened positive for alcohol and/or illicit drug use. Dynamic cohort study based on registry data from 1818 patients included in a screening and brief intervention program for alcohol and illicit drug use for hospitalized trauma patients. Three subcohorts emerged from the data analysis: patients who screened negative, those who screened positive and were offered brief intervention, and those who screened positive and were not offered brief intervention. Follow-up lasted from 10 to 52 months. Trauma-free survival, adjusted hazard rate ratios (aHRR) and adjusted incidence rate ratios (aIRR) were calculated, and complier average causal effect (CACE) analysis was used. We found a higher cumulative risk of trauma recidivism in the subcohort who screened positive. In this subcohort, an aHRR of 0.63 (95% CI: 0.41-0.95) was obtained for the group offered brief intervention compared to the group not offered intervention. CACE analysis yielded an estimated 52% reduction in trauma recidivism associated with the brief intervention. The brief intervention offered during hospitalization in trauma patients positive for alcohol and/or illicit drug use can halve the incidence of trauma recidivism.
Full Text Available Estimate the effectiveness of brief interventions in reducing trauma recidivism in hospitalized trauma patients who screened positive for alcohol and/or illicit drug use.Dynamic cohort study based on registry data from 1818 patients included in a screening and brief intervention program for alcohol and illicit drug use for hospitalized trauma patients. Three subcohorts emerged from the data analysis: patients who screened negative, those who screened positive and were offered brief intervention, and those who screened positive and were not offered brief intervention. Follow-up lasted from 10 to 52 months. Trauma-free survival, adjusted hazard rate ratios (aHRR and adjusted incidence rate ratios (aIRR were calculated, and complier average causal effect (CACE analysis was used.We found a higher cumulative risk of trauma recidivism in the subcohort who screened positive. In this subcohort, an aHRR of 0.63 (95% CI: 0.41-0.95 was obtained for the group offered brief intervention compared to the group not offered intervention. CACE analysis yielded an estimated 52% reduction in trauma recidivism associated with the brief intervention.The brief intervention offered during hospitalization in trauma patients positive for alcohol and/or illicit drug use can halve the incidence of trauma recidivism.
... ZIP code here Enter ZIP code here Military Sexual Trauma Overview Programs & Services Articles & Fact Sheets Other Resources ... local Veterans Benefits Administration Regional Office . Overview Military sexual trauma (MST) is the term that the Department of ...
Estimating the number of coronary artery bypass graft and percutaneous coronary intervention procedures in Canada: a comparison of cardiac registry and Canadian Institute for Health Information data sources.
Gurevich, Yana; McFarlane, Anne; Morris, Kathleen; Jokovic, Aleksandra; Peterson, Gail M; Webster, Gregory K
Provincial cardiac registries and the Canadian Institute for Health Information (CIHI) pan-Canadian administrative databases are invaluable tools for understanding Canadian cardiovascular health and health care. Both sources are used to enumerate cardiovascular procedures performed in Canada. To examine the level of agreement between provincial cardiac registry data and CIHI data regarding procedural counts for coronary artery bypass grafts (CABGs) and percutaneous coronary interventions (PCIs). CIHI staff obtained CABG and PCI counts from seven provinces that, in 2004, performed these procedures and had a cardiac registry (ie, British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Nova Scotia, and Newfoundland and Labrador). Structured mail questionnaires, and e-mail and telephone follow-ups elicited information from a designated registry respondent. The CIHI derived its counts of CABG and PCI procedures by applying the geographical boundaries, procedural definitions and analytical case criteria used by the cardiac registries to CIHI inpatient and day procedure databases. Steps were taken to reduce double-counting procedures when combining results from the two CIHI databases. Two measures were calculated: the absolute difference between registry and CIHI estimates, and the per cent agreement between estimates from the two sources. All seven cardiac registries identified as eligible for the study participated. Agreement was high between the two sources for CABG (98.8%). For PCI, the level of agreement was high (97.9%) when CIHI sources were supplemented with day procedure data from Alberta. The high level of agreement between cardiac registry and CIHI administrative data should increase confidence in estimates of CABG and PCI counts derived from these sources.
Full Text Available Bente Arboe,1 Pär Josefsson,2 Judit Jørgensen,3 Jacob Haaber,4 Paw Jensen,5 Christian Poulsen,6 Dorthe Rønnov-Jessen,7 Robert S Pedersen,8 Per Pedersen,9 Mikael Frederiksen,10 Michael Pedersen,1 Peter de Nully Brown1 1Department of Hematology, Copenhagen University Hospital, Rigshospitalet, 2Department of Hematology, Copenhagen University Hospital, Herlev Hospital, Copenhagen, 3Department of Hematology, Aarhus University Hospital, Aarhus, 4Department of Hematology, Odense University Hospital, Odense, 5Department of Hematology, Aalborg University Hospital, Aalborg, 6Department of Hematology, Roskilde Hospital, Roskilde, 7Department of Hematology, Vejle Hospital, Vejle, 8Department of Hematology, Holstebro Hospital, Holstebro, 9Department of Hematology, Esbjerg Hospital, Esbjerg, 10Department of Hematology, Haderslev Hospital, Haderslev, Denmark Aim of database: The Danish National Lymphoma Registry (LYFO was established in order to monitor and improve the diagnostic evaluation and the quality of treatment of all lymphoma patients in Denmark. Study population: The LYFO database was established in 1982 as a seminational database including all lymphoma patients referred to the departments of hematology. The database became nationwide on January 1, 2000. Main variables: The main variables include both clinical and paraclinical variables as well as details of treatment and treatment evaluation. Up to four forms are completed for each patient: a primary registration form, a treatment form, a relapse form, and a follow-up form. Variables are used to calculate six result quality indicators (mortality 30 and 180 days after diagnosis, response to first-line treatment, and survival estimates 1, 3, and 5 years after the time of diagnosis, and three process quality indicators (time from diagnosis until the start of treatment, the presence of relevant diagnostic markers, and inclusion rate in clinical protocols. Descriptive data: Approximately 23
Drimousis, Panagiotis G; Theodorou, Dimitrios; Toutouzas, Konstantinos; Stergiopoulos, Spiros; Delicha, Eumorfia M; Giannopoulos, Panagiotis; Larentzakis, Antreas; Katsaragakis, Stylianos
The purpose of this study was to evaluate the impact of ATLS(®) on trauma mortality in a non-trauma system setting. ATLS represents a fundamental element of trauma training in every trauma curriculum. Nevertheless, there are limited studies in the literature as for the impact of ATLS training in trauma mortality, especially outside the US. This is a prospective observational study. The primary end point was to investigate factors that affect mortality of trauma patients in our health care system. We performed a multivariate analysis for this purpose and we identified ATLS certification as a predictor of overall mortality. Following this finding we stratified patients according to the severity of injury as expressed by the ISS score and we compared outcome between those treated by an ATLS certified physician and those treated by non-certified ones. Trauma volume and demographics of trauma patients, factors that affect mortality of traumatized patients and mortality between patients treated by ATLS(®) certified and non-certified physicians. In total, 8862 trauma patients were included in the analysis. The majority of trauma patients (5988, 67.6%) were treated by a general surgeon, followed by those treated by an orthopedic surgeon (2194, 24.8%). There were 446 deaths in the registry but, 260 arrived dead in the Emergency Department and were excluded from the analysis. Multivariate analysis of the 186 deaths that occurred in the hospital revealed age, high ISS score, low GCS score, urban location of injury, neck injury and ATLS(®) certification as factors predisposing to mortality. Cross tabulation of ATLS(®) certification and ISS of the trauma patients shows that those treated by certified physicians died more often in all subcategories of ISS score (pATLS(®) certified physicians achieve worse outcomes than their non-certified colleagues when managing trauma patients. We believe that these findings must be interpreted in the context of the National health care
Pohlemann, Tim; Stengel, Dirk; Tosounidis, Georgios
STUDY OBJECTIVE: To determine longitudinal trends in mortality, and the contribution of specific injury characteristics and treatment modalities to the risk of a fatal outcome after severe and complex pelvic trauma. METHODS: We studied 5048 patients with pelvic ring fractures enrolled in the German...... Pelvic Trauma Registry Initiative between 1991 and 1993, 1998 and 2000, and 2004 and 2006. Complete datasets were available for 5014 cases, including 508 complex injuries, defined as unstable fractures with severe peri-pelvic soft tissue and organ laceration. Multivariable mixed-effects logistic...... with this type of injury was 18% (95% CI 9-32%) in 2006. CONCLUSION: In contrast to an overall decline in trauma mortality, complex pelvic ring injuries remain associated with a significant risk of death. Awareness of this potentially life-threatening condition should be increased amongst trauma care...
Marco Cobus Pretorius
Full Text Available Problems experienced with website usability can prevent users from accessing and adopting technology, such as e-Government. At present, a number of guidelines exist for e-Government website user experience (UX design; however, the effectiveness of the implementation of these guidelines depends on the expertise of the website development team and on an organisation’s understanding of UX. Despite the highlighted importance of UX, guidelines are rarely applied in South African e-Government website designs. UX guidelines cannot be implemented if there is a lack of executive support, trained staff, budget and user-centred design processes. The goal of this research is to propose and evaluate a methodology (called the “Institutionalise UX in Government (IUXG methodology” to institutionalise UX in South African Provincial Governments (SAPGs. The Western Cape Government in South Africa was used as a case study to evaluate the proposed IUXG methodology. The results show that the IUXG methodology can assist SAPGs to establish UX as standard practice and improve the UX maturity levels.
Siddareddigari Velayudha Reddy
Full Text Available Trauma in pregnancy presents a unique challenge, because of the anatomical and physiological changes of pregnancy, and the assessment and treatment of pregnant patients differ accordingly. In this review article, the focus is on familiarizing the anesthesiologists with physiological changes of pregnancy, their effect on response to trauma, resuscitation, and anesthetic management of trauma patient during pregnancy.
particularly in trauma surgery. The benefits of ERAS/ERPs are well established. They have shown faster physiological patient recovery, and reduced length of hospital stay without. Enhanced recovery after surgery (ERAS) in penetrating abdominal trauma: A prospective single-center pilot study. TRAUMA. M R Moydien, R ...
Olden, G.D.J. van; Vugt, A.B. van; Biert, J.; Goris, R.J.A.
Documenting the timing and organisation of trauma resuscitation can be utilised to assess performance standards, and to ensure a high quality of trauma resuscitation procedures. Since there is no European literature available on trauma resuscitation time (TRT) in the emergency room, the aim of this
Horst, Michael A; Gross, Brian W; Cook, Alan D; Osler, Turner M; Bradburn, Eric H; Rogers, Frederick B
Trauma system expansion is a complex process often governed by financial and health care system imperatives. We sought to propose a new, informed approach to trauma system expansion through the use of geospatial mapping. We hypothesized that geospatial mapping set to specific parameters could effectively identify optimal placement of new trauma centers (TC) within an existing trauma system. We used Pennsylvania Trauma Systems Foundation registry data of adult (age, ≥ 15 years) trauma for calendar years 2003 to 2015 (n = 408,432), hospital demographics, road networks, and US Census data files. We included TCs and zip codes outside of Pennsylvania to account for edge effects with trauma cases aggregated to the zip code centroid of residence. Our model assumptions included existing Pennsylvania Trauma Systems Foundation Level I and II TCs, a maximum travel time of 60 minutes to the TC, capacity based on mean statewide ratios of trauma cases per hospital bed size, Injury Severity Score, candidate hospitals with 200 or more licensed beds and 30 minutes or longer or 15 minutes or longer from an existing TC in nonurban/urban areas, respectively. We used the Network Analyst Location-Allocation function in ArcGIS Desktop to generate spatial models. Of the 130 candidate sites, only 14 met the bed size and travel time criteria from an existing TC. Approximately 70% of zip codes and 91% of cases were within 60 minutes of an existing TC. Adding one to six new optimally paced TCs increased to a maximum of 82% of zip codes and 96% of cases within 60 minutes of an existing TC. Changes to model assumptions had an impact on which candidate sites were selected. Intelligent trauma system design should include an objective process like geospatial to determine the optimum locations for new TCs within existing trauma networks. Epidemiological study, level III.
Sturm, J A; Hoffmann, R
At the beginning of this century the German Trauma Society (DGU) became extensively active with an initiative on quality promotion, development of quality assurance and transparency regarding treatment of the severely injured. A white book on "Medical care of the severely injured" was published, focusing on the requirements on structural quality and especially procedural quality. The impact of the white book was immense and a trauma network with approved trauma centers, structured and graded for their individual trauma care performance, was developed. In order to monitor and document the required quality of care, a registry was needed. Furthermore, for cooperation within the trauma networks innovative methods for digital transfer of radiological images and patient documents became necessary. Finally, the auditing criteria for trauma centers had and still have to be completed with advanced medical education and training programs. In order to realize the implementation of such a broad spectrum of economically relevant and increasingly complex activities the Academy of Trauma Surgery (AUC) was established as a subsidiary of the DGU in 2004. The AUC currently has four divisions: 1) networks and health care structures, 2) registries and research management, 3) telemedicine, 4) medical education and training, all of which serve the goal of the initiative. The AUC is a full service provider and management organization in compliance with the statutes of the DGU. According to these statutes the business operations of the AUC also cover projects for numerous groups of patients, projects for the joint society the German Society for Orthopedics and Trauma (DGOU) as well as other medical institutions. This article describes the success stories of the trauma network (TraumaNetzwerk DGU®), the TraumaRegister DGU®, the telecooperation platform TKmed®, the new and fast-growing orthogeriatric center initiative (AltersTraumaZentrum DGU®) and the division of medical education and
Full Text Available Borge Lillebo,1 Andreas Seim,2 Ole-Petter Vinjevoll,3 Oddvar Uleberg31Norwegian EHR Research Centre, Department of Neuroscience, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway; 2Department of Computer and Information Science, Faculty of Information Technology, Mathematics and Electrical Engineering, NTNU, Trondheim, Norway; 3Department of Anaesthesia and Emergency Medicine, St Olav's University Hospital, Trondheim, NorwayBackground: Trauma teams improve the initial management of trauma patients. Optimal timing of trauma alerts could improve team preparedness and performance while also limiting adverse ripple effects throughout the hospital. The purpose of this study was to evaluate how timing of trauma team activation and notification affects initial in-hospital management of trauma patients.Methods: Data from a single hospital trauma care quality registry were matched with data from a trauma team alert log. The time from patient arrival to chest X-ray, and the emergency department length of stay were compared with the timing of trauma team activations and whether or not trauma team members received a preactivation notification.Results: In 2009, the trauma team was activated 352 times; 269 times met the inclusion criteria. There were statistically significant differences in time to chest X-ray for differently timed trauma team activations (P = 0.003. Median time to chest X-ray for teams activated 15–20 minutes prearrival was 5 minutes, and 8 minutes for teams activated <5 minutes before patient arrival. Timing had no effect on length of stay in the emergency department (P = 0.694. We found no effect of preactivation notification on time to chest X-ray (P = 0.474 or length of stay (P = 0.684.Conclusion: Proactive trauma team activation improved the initial management of trauma patients. Trauma teams should be activated prior to patient arrival.Keywords: emergency medical service communication systems
Rosenblum, Amanda M; Li, Alvin Ho-Ting; Roels, Leo; Stewart, Bryan; Prakash, Versha; Beitel, Janice; Young, Kimberly; Shemie, Sam; Nickerson, Peter; Garg, Amit X
The variability in deceased organ donation registries worldwide has received little attention. We considered all operating registries, where individual wishes about organ donation were recorded in a computerized database. We included registries which recorded an individual's decision to be a donor (donor registry), and registries which only recorded an individual's objection (non-donor registry). We collected information on 15 characteristics including history, design, use and number of registrants for 27 registries (68%). Most registries are nationally operated and government-owned. Registrations in five nations expire and require renewal. Some registries provide the option to make specific organ selections in the donation decision. Just over half of donor registries provide legally binding authorization to donation. In all national donor registries, except one, the proportion of adults (15+) registered is modest (donation decision mandatory to obtain a driver's license. Registered objections in non-donor registries are rare (organ donor registries worldwide necessitates public discourse and quality improvement initiatives, to identify and support leading practices in registry use. © 2012 The Authors. Transplant International © 2012 European Society for Organ Transplantation.
Lund, Bent; Mygind-Klavsen, Bjarne; Grønbech Nielsen, Torsten
The Danish Hip Arthroscopy Registry (DHAR) was initiated in January 2012 as a web-based prospective registry. The purpose of this study was to evaluate and report the first registry based outcome data of a national population with radiological and clinical femoroacetabular impingement (FAI......) data from DHAR between January 2012 and November 2015 were extracted. Radiological pincer-type FAI was defined as LCE > 35° and cam FAI as alpha-angle > 55°. These data were combined with FAI surgical data such as osteochondroplasty and labral repair or resection. PROMs consisting of HAGOS, EQ-5 D......, HSAS and NRS pain scores were submitted online by the patients pre-operatively and at 1 and 2-years follow-up. 2054 FAI procedures in 1835 patients were included in this study (219 patients had bilateral procedures performed). HAGOS demonstrated significant improvement in all subscales at follow up. EQ...
Cameron, Cate M; Purdie, David M; Kliewer, Erich V; McClure, Roderick J; Wajda, Andre
The Australian National Collaborative Research Infrastructure Strategy supports development of a national research capability in population health and clinical data linkage. This paper illustrates the importance of incorporating a population registry within such a system using an example provided by the Manitoba Injury Outcome Study (MIOS) that quantified the long-term burden of mortality attributable to injury in working-age adults. MIOS is a population-based matched cohort study that used administrative health data from Manitoba, Canada. An inception cohort of injured cases (ICD-9-CM 800-995) aged 18-64 years was identified from all Manitoba hospital admissions between 1988 and 1991. A matched non-injured comparison group was randomly selected from the total provincial population using the Manitoba Population Registry. Mortality outcomes were obtained by linking the two cohorts with the deaths data over 10 years. Mortality rate ratios (MRRs) were calculated to compare the injured and non-injured cohorts. A total of 21,032 matched pairs were identified. Using the population registry, the 10-year adjusted all-cause MRR comparing injured and non-injured cohort was 1.80 (95% CI 1.65-1.98). Without the registry, the unadjusted standardised morality ratio was 2.76 (95% CI 2.52-3.02). The effect of injury on mortality outcomes was over-estimated using only the injured cases, without use of the population registry. Use of the population registry enabled the selection of a matched non-injured group for comparison purposes, ensured comprehensive follow-up of almost all participants, and provided more accurate estimates of exposure time, incidence of mortality and relative risk.
Gunning, Amy C; Lansink, Koen W W; van Wessem, Karlijn J P; Balogh, Zsolt J; Rivara, Frederick P; Maier, Ronald V; Leenen, Luke P H
Trauma systems were developed to improve the care for the injured. The designation and elements comprising these systems vary across countries. In this study, we have compared the demographic patterns and patient outcomes of Level I trauma centers in three international trauma systems. International multicenter prospective trauma registry-based study, performed in the University Medical Center Utrecht (UMCU), Utrecht, the Netherlands, John Hunter Hospital (JHH), Newcastle, Australia, and Harborview Medical Center (HMC), Seattle, the United States. patients ≥18 years, admitted in 2012, registered in the institutional trauma registry. In UMCU, JHH, and HMC, respectively, 955, 1146, and 4049 patients met the inclusion criteria of which 300, 412, and 1375 patients with Injury Severity Score (ISS) > 15. Mean ISS was higher in JHH (13.5; p 15: JHH = 0.507 (95 % CI 0.300-0.857) and HMC = 0.451 (95 % CI 0.297-0.683) compared to UMCU. HMC = 0.931 (95 % CI 0.608-1.425) compared to JHH. TRISS analysis: UMCU: Ws = 0.787, Z = 1.31, M = 0.87; JHH, Ws = 3.583, Z = 6.7, M = 0.89; HMC, Ws = 3.902, Z = 14.6, M = 0.84. This study demonstrated substantial differences across centers in patient characteristics and mortality, mainly of neurological cause. Future research must investigate whether the outcome differences remain with nonfatal and long-term outcomes. Furthermore, we must focus on the development of a more valid method to compare systems.
Mattox, Kenneth L; Goetzl, Laura
The objective of this article was to review the existing standards of practice regarding trauma which occurs during pregnancy. The design of this study was to review the available data from the surgical and obstetrical literature regarding trauma during pregnancy. The design was also to incorporate the contemporary recommendations from the trauma resuscitation courses relating to trauma during pregnancy. Trauma occurs in 5% of pregnancies. A fetus is not considered to be viable until week 25. Motor vehicle accidents account for more than 50% of all trauma during pregnancy, with 82% of fetal deaths occurring during these automobile accidents. With life threatening trauma a 50% fetal loss rate exists. As anatomy, physiology, and even laboratory findings change during pregnancy, the clinician must consider both patients, the mother and fetus. Following blunt trauma abruption of the placenta is the more common cause of fetus loss. Anterior abdominal penetrating trauma almost never fails to injury the uterus and fetus in the last half of pregnancy. Preventive strategies exist in the areas of social violence, automobile restraints and use of alcohol and drugs by the mother. Perimortem caesarian section is rarely successful. Trauma during pregnancy is uncommon, but with increasing trauma severity leads to increased fetal loss. Preventive strategies exist and when admitted monitoring standards should be followed.
National Aeronautics and Space Administration — This data set contains the national and provincial boundaries of Ecuador as well as the boundaries of two national parks: the Cuyabeno Wildlife Reserve and the...
Provincial mortality in South Africa, 2000- priority-setting for now and a benchmark for the future. Debbie Bradshaw, Nadine Nannan, Pam Groenewald, Jane Joubert, Ria Laubscher, Beatrice Nojilana, Rosana Norman, Desiree Pieterse, Michelle Schneider ...
Full Text Available Abstract Background There are several well established scores for the assessment of the prognosis of major trauma patients that all have in common that they can be calculated at the earliest during intensive care unit stay. We intended to develop a sequential trauma score (STS that allows prognosis at several early stages based on the information that is available at a particular time. Study design In a retrospective, multicenter study using data derived from the Trauma Registry of the German Trauma Society (2002-2006, we identified the most relevant prognostic factors from the patients basic data (P, prehospital phase (A, early (B1, and late (B2 trauma room phase. Univariate and logistic regression models as well as score quality criteria and the explanatory power have been calculated. Results A total of 2,354 patients with complete data were identified. From the patients basic data (P, logistic regression showed that age was a significant predictor of survival (AUCmodel p, area under the curve = 0.63. Logistic regression of the prehospital data (A showed that blood pressure, pulse rate, Glasgow coma scale (GCS, and anisocoria were significant predictors (AUCmodel A = 0.76; AUCmodel P + A = 0.82. Logistic regression of the early trauma room phase (B1 showed that peripheral oxygen saturation, GCS, anisocoria, base excess, and thromboplastin time to be significant predictors of survival (AUCmodel B1 = 0.78; AUCmodel P +A + B1 = 0.85. Multivariate analysis of the late trauma room phase (B2 detected cardiac massage, abbreviated injury score (AIS of the head ≥ 3, the maximum AIS, the need for transfusion or massive blood transfusion, to be the most important predictors (AUCmodel B2 = 0.84; AUCfinal model P + A + B1 + B2 = 0.90. The explanatory power - a tool for the assessment of the relative impact of each segment to mortality - is 25% for P, 7% for A, 17% for B1 and 51% for B2. A spreadsheet for the easy calculation of the sequential trauma
Weile, Jesper; Nielsen, Klaus; Primdahl, Stine C
BACKGROUND: The Focused Assessment with Sonography in Trauma (FAST) protocol is considered beneficial in emergent evaluation of trauma patients with blunt or penetrating injury and has become integrated into the Advanced Trauma Life Support (ATLS) protocol. No guidelines exist as to the use...... of ultrasonography in trauma in Denmark. We aimed to determine the current use of ultrasonography for assessing trauma patients in Denmark. METHODS: We conducted a nation-wide cross-sectional investigation of ultrasonography usage in trauma care. The first phase consisted of an Internet-based investigation....... Twenty-one (95.5%) of the guidelines included and recommended FAST as part of trauma assessment. The recommended person to perform the examination was the radiologist in n = 11 (50.0%), the surgeon in n = 6 (27.3%), the anesthesiologist in n = 1 (4.5%), and unspecified in n = 3 (13.6%) facilities. FAST...
Andi Amin Akhiruddin
Full Text Available Abstract This study aims to describe the identification of regional Organization Structuring South Sulawesi Provincial Government under Government Regulation No. 38 of 2007 and Government Regulation No. 41 of 2007 knowing Planning Implications regional organization based on Government Regulation No. 38 of 2007 and Government Regulation No. 41 of 2007 on Performance government of South Sulawesi and analyze models of regional Organization Structuring South Sulawesi Provincial Government ideal based on Government Regulation No. 38 of 2007 and Government Regulation No. 41 of 2007. The method used is descriptive to assess the condition of the South Sulawesi provincial government organizations as a result of the implementation of Government Regulation No. 38 of 2007 and Government Regulation No. 41 Year 2007 on Organizational Structure Model of the Region of South Sulawesi Provincial Government and the resulting impact on South Sulawesi Provincial Government Performance. Data collection techniques used were interviews questionnaires and study documents analyzed by descriptive qualitative and quantitative in percentage. The results showed that the arrangement of the South Sulawesi Provincial Government Organizations related mass organizations using maximal patterns based on Government Regulation No. 41 of 2007 has not kept pace even found no addition of several fields and sub-sub-fields in the affairs handled by the regional work units of South Sulawesi Province. But seen from the Organization Structuring implications arising on the performance of the Government of South Sulawesi showed quite good results this is in line with some of the responses of respondents who said it was very appropriate views of some of the indicators used by the author in a variable rate Accountability Responsibility and Innovation as a parameter in describing South Sulawesi provincial government performance. Structuring the ideal model of the regional organization of South
Full Text Available The article presents the results of sociological study carried out to obtain a general model of ideas, expectations and preferences of provincial students in their attitude to higher education. The received results are presented in the form of diagrams. Provides a general interpretation of the data and on their basis are proposed recommendations for development marketing strategy and campaign to attract university entrants to the provincial university.
Farach, Sandra M; Danielson, Paul D; Amankwah, Ernest K; Chandler, Nicole M
Pediatric trauma patients presenting with stable, isolated injuries are often admitted to the trauma service for initial management. The purpose of this study was to evaluate admission patterns in trauma patients with isolated injuries and compare outcomes based on admitting service. The institutional trauma registry was retrospectively reviewed for patients presenting from January 2007-December 2012. A total of 3417 patients were admitted to a surgical service and further reviewed. Patients with isolated injuries were further stratified by admission to the general trauma service (GTS, n = 738) versus admission to the subspecialty surgical trauma service (STS, n = 2251). When compared to patients admitted to GTS, patients admitted to STS with isolated injuries were significantly younger, were more likely to present with injury severity scores ranging from 9-14, Glasgow coma scale ≥ 13, had shorter emergency room length of stay, were more likely to undergo surgery within 24 h, and had fewer computed tomography scans performed. There were no missed injuries in patients with isolated injuries admitted to STS (with 5% having a GTS consult) compared with one missed injury in those admitted to GTS. Patients with isolated injuries admitted to an STS were found to have significantly lower complication rates (0.6% versus 2.2%, P trauma patients presenting with stable, isolated injuries may be efficiently and safely managed by nontrauma services without an increase in missed injuries or complications. Copyright © 2015 Elsevier Inc. All rights reserved.
Al-Mahrouqi, Haitham H; Al-Harthi, Naila; Al-Wahaibi, Maryam; Hanumantharayappa, Kishore
To describe the epidemiology of ocular trauma in a tertiary hospital setting in Muscat, Oman. Medical records of all cases of ocular trauma which presented to the Emergency Department at Al-Nahdha Hospital and were seen by the ophthalmology service from January 1, 2013 to June 30, 2013 (6 months) were reviewed to collect data on ocular trauma according to the World Eye Injury Registry initial reporting form which uses the Birmingham Eye Trauma Terminology System. There were 27,951 patients seen at the Emergency Department and 611 of which were ocular trauma cases (cumulative incidence 2.2% [confidence interval 2.0-2.4]). The mean age of the patients was 23 years and males comprised the majority of the cases (72%). Thirty-two patients had bilateral injury giving a total of 643 eyes injured. More than half of all injuries were caused by either blunt or large sharp objects. The cornea was the most frequently injured tissue (49%), but most injuries were minor in nature. More than three quarters (77%) of all eyes had a visual acuity of 0.3 (LogMAR) or better on presentation. There were 35 eyes (6%) with open globe injuries (OGI) and three-quarters of them occurring in the manual laborers. Ocular trauma is a common presentation at Al-Nahdha Hospital. Although the majority of trauma cases were minor without any visual disability sequelae, OGI could have been prevented with better ocular protection in the workplace.
Department of Veterans Affairs — The Environmental Agent Service (EAS) Registries is the information system encompassing the Ionizing Radiation Registry (IRR), the Agent Orange Registry (AOR), and...
Full Text Available Changes are rapidly occur in this world, especially developments in the field of information and communication technology. Man must be able to adjust quickly to keep up. Developments in information and communication technology has made it easier for people in work. Utilization of information and communication technology are expected to make work performed by humans is more effective and efficient. National Library of Indonesia mandated by Law No. 43 of 2007 as an adviser to all types of libraries throughout Indonesia. In carrying out the task, the National Library should coordinate with local government including the provincial government, represented by the provincial library which can be said to represent the provincial government in the affairs of the library. National Library of Indonesia in coordination with the provincial library has been facilitated by information and communication technology such as telephone, fax and internet. In addition, coordination can also be done through conventional correspondency or direct face to face. This study tried to define which communication system that is commonly used by the National Library of Indonesia when coordinating with the provincial library and the reasons that lie behind them. The method used in this research is descriptive with a participatory approach, the researchers and respondents are equal and shared a mutual cooperation. This research indicates that face-to-face coordination is more preferred, because face-to-face coordination offers a social and economical benefit. Keywords: library, national library, provincial library, utilization technology
Full Text Available For the Benefit of the Common Good? A Historical View on the Flemish Provinces as an Intermediary at the Level of AdministrationThe nation state of Belgium saw its provinces chiefly as intermediary administrative entities from which political dispute had to be excluded. Nevertheless, they disposed of elected provincial councils and enjoyed fiscal autonomy. Although the provincial governments underwent a slow process of politicisation, the effects of the broad socio-political developments over the course of the last two centuries on this level remained far less tangible, due above all to the slow democratisation of the provincial suffrage. The provinces only had a modicum of public visibility and a very limited scope for policymaking. To argue their relevance, the provincial governments referred occasionally to the shared history of their respective inhabitants or to their cultural coherence(s. But this discourse was not powerful enough to shape a common provincial cultural identity. Moreover, it clashed on the artificial borders of the provinces and with the much stronger feelings of local and regional coherence. By clustering these expressions of (subregionalism, the provincial governments may have provided building stones for the creation of identity-structures on a higher level. However, this role too remained very modest and can hardly be used to substantiate the institutional tenacity of this level of government.
Rasmussen, Jeppe; Jakobsen, John; Brorson, Stig
(70% women) were reported to the registry between January 2006 and December 2008. Mean age at surgery was 69 years (SD 12). The most common indications were a displaced proximal humeral fracture (54%) or osteoarthritis (30%). 61% were stemmed hemiarthroplasties, 28% resurfacing hemiarthroplasties, 8...
Schjødt, Inge; Nakano, Anne; Egstrup, Kenneth
AIM OF DATABASE: The aim of the Danish Heart Failure Registry (DHFR) is to monitor and improve the care of patients with incident heart failure (HF) in Denmark. STUDY POPULATION: The DHFR includes inpatients and outpatients (≥18 years) with incident HF. Reporting to the DHFR is mandatory for the ...
Brønnum-Hansen, Henrik; Koch-Henriksen, Nils; Stenager, Egon
Introduction: The Danish Multiple Sclerosis (MS) Registry was established in 1956. Content: The register comprises data on all Danes who had MS in 1949 or who have been diagnosed since. Data on new cases and updated information on persons with an MS diagnosis already notified are continuously...
Goldman, Stanford M. E-mail: Stanford.M.Goldman@uth.tmc.edu; Sandler, Carl M
Objectives: This article will define the current controversies and concepts in the classification, clinical presentation, imaging approaches and management of upper urinary tract trauma. Materials and methods, results: This review will include the experience of the authors in the field of renal trauma over a 32-year period. Current thinking accepts the view that significant renal trauma is generally present when there is gross hematuria, signs of shock, or other clinical signs of severe injury. In most patients, suspected renal injury will be evaluated as a part of the overall assessment of the patient for suspected intraperitoneal injury. The authors will stress some exceptions to the rule. Conclusions: Most trauma experts now advocate conservative management, unless the patient is unstable or a renal vascular thrombosis or avulsion is suspected. Similarly, penetrating trauma to the kidney in and of itself no longer requires mandatory surgery. In the United States, computed tomography (CT), especially spiral CT, is considered the best diagnostic study, if available. Intravenous pyelography (IVP) is adequate if this is the only imaging modality available and if no concomitant injuries to the abdominal structure are suspected. Ultrasound, although strongly advocated in some countries, can lead to some significant false negatives. The diagnosis and management of unusual problems such as the traumatic AV fistula, the patient with an absent kidney or injury to the congenitally abnormal kidney, the serendipitous renal tumor in a patient with trauma, or serious bleeding after an apparent minor injury (i.e., spontaneous hemorrhage) are also reviewed in this article.
Factores de riesgo del bajo peso al nacer, Hospital Gineco-Obstétrico Provincial de Sancti Spíritus, Cuba Risk factors for low birthweight, Provincial Obstetric-Gynecologic Hospital of Sancti Spíritus, Cuba
Marcos Aurelio Grau Espinosa
Full Text Available El objetivo de este trabajo fue identificar algunos factores de riesgo que pudiera presentar la madre durante el embarazo, asociados con la incidencia de bajo peso al nacer (menos de 2500 g. Se diseñó un estudio con 378 casos y 649 controles del Hospital Gineco-Obstétrico Provincial de Sancti Spíritus, Cuba, durante el año 1994. Los datos se obtuvieron de la historia clínica, el registro de partos y una entrevista personal con la madre. Se realizó un análisis bivariado y se controlaron los posibles factores de confusión utilizando la regresión logística dicotómica, mediante los programas Epi Info 5 y SPSS. Por medio del modelo multivariado final se identificaron como factores de riesgo significativos de bajo peso al nacer la hipertensión arterial durante el embarazo, la consulta extemporánea de evaluación del embarazo, los abortos anteriores, último intervalo intergenésico menor de 2 años y el aumento de peso materno menor de 8 kg. Se debe dar prioridad a estas tres últimas variables para mantener buenos indicadores en el programa maternoinfantil de la Provincia de Sancti Spíritus, Cuba.The objective of this work was to identify some risk factors that women could present during pregnancy and that are associated with low birthweight (less than 2500 g. A study was performed during 1994 with 378 cases and 649 controls at the Provincial Obstetric-Gynecologic Hospital of Sancti Spíritus, Cuba. The data were obtained from clinical histories, the registry of births, and personal interviews with mothers. A bivariate analysis was carried out and possible confounding factors were controlled utilizing dichotomous logistic regression, using the Epi Info 5 and SPSS software programs. With the final multivariate model, the following risk factors for low birthweight were identified as significant: hypertension during pregnancy, infrequent checkups during pregnancy, previous abortions, a period of less than 2 years since the last birth, and
Rubenson Wahlin, Rebecka; Ponzer, Sari; Skrifvars, Markus B; Lossius, Hans Morten; Castrén, Maaret
Trauma systems and regionalized trauma care have been shown to improve outcome in severely injured trauma patients. The aim of this study was to evaluate the implementation of a prehospital trauma care protocol and transport directive, and to determine its effects on the number of primary admissions and secondary trauma transfers in a large Scandinavian city. We performed a retrospective observational study based on local trauma registries and hospital and ambulance records in Stockholm County; patients > 15 years of age with an Injury Severity Score (ISS) > 15 transported to any emergency care hospitals in the Stockholm area were included for the years 2006 and 2008. We also included secondary transferred patients to the regional trauma center during 2006, 2008, and 2013. A total of 693 primarily admitted trauma patients were included for the years 2006 and 2008. For the years 2006, 2008 and 2013, we included 114 secondarily transported trauma patients. The number of primary patient transports to the trauma center increased during the years by 20.2%, (p organizational change. Patients primarily admitted to the trauma center after the change had more severe injuries than patients transported to other emergency hospitals in the area even if 20 % of patients were not admitted primarily to a trauma center. This does not imply that the transport directives or the criteria were not followed but rather reveals the difficulties and uncertainties of field triage. With the introduction of a prehospital trauma transport directive in a large urban city, an increase in patients transported to the regional trauma center and a decrease in secondary transfers were detected, but a considerable number of severely injured patients were still transported to local hospitals.
The Breast Cancer Family Registry and the Colon Cancer Family Registry were established by the National Cancer Institute as a resource for investigators to use in conducting studies on the genetics and molecular epidemiology of breast and colon cancer.
Full Text Available Nikolaj Eldrup,1,2 Charlotte Cerqueira,3 Louise de la Motte,2,4 Lisbet Knudsen Rathenborg,2,4 Allan K Hansen2,5 1Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, 2Karbase, The Danish Vascular Registry, Aarhus, 3Registry Support Centre (East – Epidemiology and Biostatistics, Research Centre for Prevention and Health, Capital Region of Denmark, 4Department of Vascular Surgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, 5Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark Aim: The Danish Vascular Registry (DVR, Karbase, is monitoring arterial and advanced vein interventions conducted at all vascular departments in Denmark. The main aim of the DVR is to improve the quality of treatment for patients undergoing vascular surgery in Denmark by using the registry for quality assessment and research. Study population: All patients undergoing vascular interventions (surgical and endovascular at any vascular department in Denmark are registered in the DVR. The DVR was initiated in 1989, and each year, ~9,000 procedures are added. By January 2016, .180,000 procedures have been recorded. Since 2001, data completeness has been .90% (compared to the Danish National Patient Register. Main variables: Variables include information on descriptive patient data (ie, age, sex, height, and weight and comorbidity (ie, previous cardiovascular disease and diabetes. Process variable includes waiting time (time from event to medical contact and treatment and the type of procedures conducted. Outcome variables for in-hospital complications (ie, wound complications, myocardial infarction, stroke, amputation, respiratory complications, and renal insufficiency and 30-day patency are submitted. Variables for medical treatment (antithrombotic and statin treatment, amputation, and survival are extracted from nationwide, administrative registers. Conclusion: The DVR reports outcome on key indicators for
Tsang, Bonnie; McKee, Jessica; Engels, Paul T; Paton-Gay, Damian; Widder, Sandy L
Advanced Trauma Life Support (ATLS) protocols provide a common approach for trauma resuscitations. This was a quality review assessing compliance with ATLS protocols at a Level I trauma center; specifically whether the presence or absence of a trauma team leader (TTL) influenced adherence. This retrospective study was conducted on adult major trauma patients with acute injuries over a one-year period in a Level I Canadian trauma center. Data were collected from the Alberta Trauma Registry, and adherence to ATLS protocols was determined by chart review. The study identified 508 patients with a mean Injury Severity Score of 24.5 (SD 10.7), mean age 39.7 (SD 17.6), 73.8% were male and 91.9% were involved in blunt trauma. The overall compliance rate was 81.8% for primary survey and 75% for secondary survey. The TTL group compared to non-TTL group was more likely to complete the primary survey (90.9% vs. 81.8%, p = 0.003), and the secondary survey (100% vs. 75%, p = 0.004). The TTL group was more likely than the non-TTL group to complete the following tasks: insertion of two large bore IVs (68.2% vs. 57.7%, p = 0.014), digital rectal exam (64.6% vs. 54.7%, p = 0.023), and head to toe exam (77% vs. 67.1%, p = 0.013). Mean times from emergency department arrival to diagnostic imaging were also significantly shorter in the TTL group compared to the non-TTL group, including times to pelvis xray (mean 68min vs. 107min, p = 0.007), CT chest (mean 133min vs. 172min, p = 0.005), and CT abdomen and pelvis (mean 136min vs. 173min, p = 0.013). Readmission rates were not significantly different between the TTL and non-TTL groups (3.5% vs. 4.5%, p = 0.642). While many studies have demonstrated the effectiveness of trauma systems on outcomes, few have explored the direct influence of the TTL on ATLS compliance. This study demonstrated that TTL involvement during resuscitations was associated with improved adherence to ATLS protocols, and increased
Introduction Advanced Trauma Life Support (ATLS) protocols provide a common approach for trauma resuscitations. This was a quality review assessing compliance with ATLS protocols at a Level I trauma center; specifically whether the presence or absence of a trauma team leader (TTL) influenced adherence. Methods This retrospective study was conducted on adult major trauma patients with acute injuries over a one-year period in a Level I Canadian trauma center. Data were collected from the Alberta Trauma Registry, and adherence to ATLS protocols was determined by chart review. Results The study identified 508 patients with a mean Injury Severity Score of 24.5 (SD 10.7), mean age 39.7 (SD 17.6), 73.8% were male and 91.9% were involved in blunt trauma. The overall compliance rate was 81.8% for primary survey and 75% for secondary survey. The TTL group compared to non-TTL group was more likely to complete the primary survey (90.9% vs. 81.8%, p = 0.003), and the secondary survey (100% vs. 75%, p = 0.004). The TTL group was more likely than the non-TTL group to complete the following tasks: insertion of two large bore IVs (68.2% vs. 57.7%, p = 0.014), digital rectal exam (64.6% vs. 54.7%, p = 0.023), and head to toe exam (77% vs. 67.1%, p = 0.013). Mean times from emergency department arrival to diagnostic imaging were also significantly shorter in the TTL group compared to the non-TTL group, including times to pelvis xray (mean 68min vs. 107min, p = 0.007), CT chest (mean 133min vs. 172min, p = 0.005), and CT abdomen and pelvis (mean 136min vs. 173min, p = 0.013). Readmission rates were not significantly different between the TTL and non-TTL groups (3.5% vs. 4.5%, p = 0.642). Conclusions While many studies have demonstrated the effectiveness of trauma systems on outcomes, few have explored the direct influence of the TTL on ATLS compliance. This study demonstrated that TTL involvement during resuscitations was associated with improved
Andreasen, Jens Ove; Lauridsen, Eva; Gerds, Thomas Alexander
Diagnosis and treatment for traumatic dental injuries are very complex owing to the multiple trauma entities represented by six luxation types and nine fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and luxation injuries are often...... combined, the result is that more than 100 trauma scenarios exist, when the two dentitions are combined. Each of these trauma scenarios has a specific treatment demand and prospect for healing. With such a complexity in diagnosis and treatment, it is obvious that even experienced practitioners may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an Internet-based knowledge base consisting of 4000 dental trauma cases with long-term follow up is now available to the public and the professions on the Internet using the address http://www.DentalTrauma...
Full Text Available 【Abstract】Duodenal trauma is uncommon but nowadays seen more and more frequently due to the increased automobile accidents and violent events. The management of duodenal trauma can be complicated, especially when massive injury to the pancreatic-duodenal-biliary complex occurs simultaneously. Even the patients receive surgeries in time, multiple postoperative complications and high mortality are common. To know and manage duodenal trauma better, we searched the recent related literature in PubMed by the keywords of duodenal trauma, therapy, diagnosis and abdomen. It shows that because the diagnosis and management are complicated and the mortality is high, duodenal trauma should be treated in time and tactfully. And application of new technology can help improve the management. In this review, we discussed the incidence, diagnosis, management, and complications as well as mortality of duodenal trauma. Key words: Duodenum; Wounds and injuries; Diagnosis; Therapeutics
Chan, Ellen; Barnes, Morgan E; Sharif, Omar
Public Health Ontario (PHO) publishes various infectious disease surveillance reports, but none have yet been formally evaluated. PHO evaluated its monthly and annual infectious disease surveillance reports to assess public health stakeholders' current perception of the products and to develop recommendations for improving future products. An evaluation consisting of an online survey and a review of public Web sites of other jurisdictions with similar annual reports. For the online survey, stakeholder organizations targeted were the 36 local public health units and the Health health ministry in Ontario, Canada. Survey participants included epidemiologists, managers, directors, and other public health practitioners from participating organizations. Online survey respondents' awareness and access to the reports, their rated usefulness of reports and subsections, and suggestions for improving usefulness; timeliness of select annual reports from other jurisdictions based on the period from data described to report publication. Among 57 survey respondents, between 74% and 97% rated each report as useful; the most common use was for situational awareness. Respondents ranked timeliness as the most important attribute of surveillance reports, followed by data completeness. Among 6 annual reports reviewed, the median time to publication was 11.5 months compared with 23.2 months for PHO. Recommendations based on this evaluation have already been applied to the monthly report (eg, focusing on the most useful sections) and have become key considerations when developing future annual reports and other surveillance reporting tools (eg, need to provide more timely reports). Other public health organizations may also use this evaluation to inform aspects of their surveillance report development and evaluation. The evaluation results have provided PHO with direction on how to improve its provincial infectious disease surveillance reporting moving forward, and formed a basis for
Hickey, Graeme L; Grant, Stuart W; Cosgriff, Rebecca; Dimarakis, Ioannis; Pagano, Domenico; Kappetein, Arie P; Bridgewater, Ben
Clinical registries will have an increasingly important role to play in health-care, with a number already established in cardiac surgery. This review covers the fundamentals of establishing and managing clinical registries, including legal and ethical frameworks along with intellectual property attribution. Also discussed are important issues relating to the processing of data, data extraction and conducting analyses using registry data.
... 46 Shipping 2 2010-10-01 2010-10-01 false Registry endorsement. 67.17 Section 67.17 Shipping COAST... DOCUMENTATION OF VESSELS Forms of Documentation; Endorsements; Eligibility of Vessel § 67.17 Registry endorsement. (a) A registry endorsement entitles a vessel to employment in the foreign trade; trade with Guam...
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Feliciano, David V
Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.
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Manriquez, Maria; Srinivas, Gujjarappa; Bollepalli, Srigayatri; Britt, Lynley; Drachman, David
The objective of this study was to determine whether computed tomography (CT) is a reliable method of imaging to assess placental injury after acute trauma during pregnancy. This study was a retrospective review of digital CT images and electronically scanned charts of pregnant trauma patients identified from the hospital trauma registry list. Using delivery within 36 hours of trauma as the clinical marker for the occurrence of placental abruption, positive radiologic readings showed 86% sensitivity and 98% specificity. The overall accuracy was 96%. Given that defined patterns on CT can be identified and those can be correlated to actual abruption, CT may be a reliable method for evaluation of placental abruption after maternal trauma, especially in the face of abdominal trauma. Our results show that CT has both good sensitivity and specificity identifying abruption and should be considered for use in the management in the pregnant patient after trauma. Copyright 2010 Mosby, Inc. All rights reserved.
Phoenix Vuong; Jason Sample; Mary Ellen Zimmermann; Pierre Saldinger
Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA) criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontr...
Lagisetty, Jyothi [Memorial Hermann Medical Center, Emergency Medicine Department, Houston, TX (United States); Slovis, Thomas [Wayne State University School of Medicine, Department of Radiology, Pediatric Imaging, Children' s Hospital of Michigan, Detroit, MI (United States); Thomas, Ronald [Children' s Hospital of Michigan, Wayne State University of Medicine, Department of Pediatrics, Detroit, MI (United States); Knazik, Stephen; Stankovic, Curt [Wayne State University of Medicine, Division of Emergency Medicine, Children' s Hospital of Michigan, Detroit, MI (United States)
Screening pelvic radiographs to rule out pelvic fractures are routinely used for the initial evaluation of pediatric blunt trauma. Recently, the utility of routine pelvic radiographs in certain subsets of patients with blunt trauma has been questioned. There is a growing amount of evidence that shows the clinical exam is reliable enough to obviate the need for routine screening pelvic radiographs in children. To identify variables that help predict the presence or absence of pelvic fractures in pediatric blunt trauma. We conducted a retrospective study from January 2005 to January 2010 using the trauma registry at a level 1 pediatric trauma center. We analyzed all level 1 and level 2 trauma victims, evaluating history, exam and mechanism of injury for association with the presence or absence of a pelvic fracture. Of 553 level 1 and 2 trauma patients who presented during the study period, 504 were included in the study. Most of these children, 486/504 (96.4%), showed no evidence of a pelvic fracture while 18/504 (3.6%) had a pelvic fracture. No factors were found to be predictive of a pelvic fracture. However, we developed a pelvic fracture screening tool that accurately rules out the presence of a pelvic fracture P = 0.008, NPV 99, sensitivity 96, 8.98 (1.52-52.8). This screening tool combines eight high-risk clinical findings (pelvic tenderness, laceration, ecchymosis, abrasion, GCS <14, positive urinalysis, abdominal pain/tenderness, femur fracture) and five high-risk mechanisms of injury (unrestrained motor vehicle collision [MVC], MVC with ejection, MVC rollover, auto vs. pedestrian, auto vs. bicycle). Pelvic fractures in pediatric major blunt trauma can reliably be ruled out by using our pelvic trauma screening tool. Although no findings accurately identified the presence of a pelvic fracture, the screening tool accurately identified the absence of a fracture, suggesting that pelvic radiographs are not warranted in this subset of patients. (orig.)
Jakobsen, Erik; Rasmussen, Torben Riis
AIM OF DATABASE: The Danish Lung Cancer Registry (DLCR) was established by the Danish Lung Cancer Group. The primary and first goal of the DLCR was to improve survival and the overall clinical management of Danish lung cancer patients. STUDY POPULATION: All Danish primary lung cancer patients since...... 2000 are included into the registry and the database today contains information on more than 50,000 cases of lung cancer. MAIN VARIABLES: The database contains information on patient characteristics such as age, sex, diagnostic procedures, histology, tumor stage, lung function, performance...... the results are commented for local, regional, and national audits. Indicator results are supported by descriptive reports with details on diagnostics and treatment. CONCLUSION: DLCR has since its creation been used to improve the quality of treatment of lung cancer in Denmark and it is increasingly used...
Eldrup, Nikolaj; Cerqueira, Charlotte; de la Motte, Louise
AIM: The Danish Vascular Registry (DVR), Karbase, is monitoring arterial and advanced vein interventions conducted at all vascular departments in Denmark. The main aim of the DVR is to improve the quality of treatment for patients undergoing vascular surgery in Denmark by using the registry...... for quality assessment and research. STUDY POPULATION: All patients undergoing vascular interventions (surgical and endovascular) at any vascular department in Denmark are registered in the DVR. The DVR was initiated in 1989, and each year, ∼9,000 procedures are added. By January 2016, >180,000 procedures...... have been recorded. Since 2001, data completeness has been >90% (compared to the Danish National Patient Register). MAIN VARIABLES: Variables include information on descriptive patient data (ie, age, sex, height, and weight) and comorbidity (ie, previous cardiovascular disease and diabetes). Process...
Zuchelli, Daniel; Divaris, Nicholas; McCormack, Jane E; Huang, Emily C; Chaudhary, Neeta D; Vosswinkel, James A; Jawa, Randeep S
Extremity compartment syndrome is a recognized complication of trauma. We evaluated its prevalence and outcomes at a suburban level 1 trauma center. The trauma registry was reviewed for all blunt trauma patients aged ≥18 years, admitted between 2010 and 2014. Chart review of patients with extremity compartment syndrome was performed. Of 6180 adult blunt trauma admissions, 83 patients developed 86 extremity compartment syndromes; two patients had compartment syndromes on multiple locations. Their (n = 83) median age was 44 years (interquartile range: 31.5-55.5). The most common mechanism of injury was motor vehicle/motor cycle accident (45.8%) followed by a fall (21.7%). The median injury severity score was 9 (interquartile range: 5-17); 65.1% had extremity abbreviate injury score ≥3. Notably, 15 compartment syndromes did not have an underlying fracture. Among patients with fractures, the most commonly injured bone was the tibia, with tibial plateau followed by tibial diaphyseal fractures being the most frequent locations. Fasciotomies were performed, in order of frequency, in the leg (n = 53), forearm (n = 15), thigh (n = 9), foot (n = 5), followed by multiple or other locations. Extremity compartment syndrome was a relatively uncommon finding. It occurred in all extremity locations, with or without an associated underlying fracture, and from a variety of mechanisms. Vigilance is warranted in evaluating the compartments of patients with extremity injuries following blunt trauma. Copyright © 2017 Elsevier Inc. All rights reserved.
Lacaze, Paul; Millis, Nicole; Fookes, Megan; Zurynski, Yvonne; Jaffe, Adam; Bellgard, Matthew; Winship, Ingrid; McNeil, John; Bittles, Alan H
When registries collect accurate clinical data over time, they can act as fundamental support structures for patients and their families and powerful cost-effective instruments to support clinical trials and translational research to improve quality of care, quality of life and survival. Registries are critical for rare diseases (RD) with low prevalence and propensity for variation in treatment and outcomes. Rare Voices Australia is leading a call for action to the research and clinical community to prioritise RD data collection and develop an integrated RD Registry strategy for Australia. Financial, operational and governance challenges exist for establishing and maintaining RD registries. As a multidisciplinary team whose interests converge on RD, we highlight the need for the establishment of an Australian RD Registry Alliance. This 'umbrella' organisation will: (i) bring together existing RD registries across Australia; (ii) establish National RD Registry Standards to support interoperability and cohesion across registries; (iii) develop strategies to attract sustainable funding from government and other sources to maximise the utility of existing RD registries and support the development of new RD registries. The most important role for the Alliance would be to use the RD registries for translational research to address current knowledge gaps about RD and to improve the care for the over 1.4 million Australians estimated to live with RD. © 2017 Royal Australasian College of Physicians.
Clinical data registries are platforms to extract, store, analyze, and disseminate large amounts of clinical data. The type of data contained in clinical data registries varies by the registry, and may include patient demographics, clinical examination findings, imaging and laboratory results, procedures performed, and patient-reported outcomes. When large numbers of participants submit data to a clinical data registry the data can then be analyzed in aggregate to answer new clinical questions. Analyses on the data may be performed to show outcomes over time, compare procedures, evaluate care patterns, among others. With the launch of an otolaryngology-specific clinical data registry, Regent, facial plastic and reconstructive surgeons have the opportunity to participate in a clinical data registry for the first time. Through broad participation in the registry, the specialty has a chance to optimize patient outcomes in a manner never before possible. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
Bouvy, Jacoline C; Blake, Kevin; Slattery, Jim
in the post-marketing setting. Methodological challenges met in conducting this study highlighted the need for a clarification of definitions and epidemiological concepts around patient registries. The results will inform the EMA Patient Registry initiative to support use of existing patient registries......PURPOSE: Regulatory agencies and other stakeholders increasingly rely on data collected through registries to support their decision-making. Data from registries are a cornerstone of post-marketing surveillance for monitoring the use of medicines in clinical practice. This study was aimed...... for a registry was made as a condition of the marketing authorisation. All centrally authorised products that received a positive opinion of the EMA Committee for Medicinal Products for Human Use between 1 January 2005 and 31 December 2013 were included. Data regarding registry design and experiences were...
Full Text Available The aim of this paper is twofold: firstly to examine how the concepts of accounting andaccountability are understood by indigenous Fijians; and secondly to examine the role ofaccounting in the accountability of provincial councils.Provincial councils are part of the Fijian Administration, which runs alongside the centralgovernment but applies only to indigenous Fijians. The Fijian Administration was introducedby the British colonial administration in the late 1800s as a mechanism for controllingindigenous Fijians. It has undergone several reviews resulting from criticisms that it has failedto fulfill the aspirations of indigenous Fijians.There is evidence of implied and actual accountability by indigenous Fijians in Namosi. Thisis supported by monitoring mechanisms established by provincial offices. On the other hand,neither the Fijian Affairs Board nor the Namosi Provincial Council appears to take seriousresponsibility for accounting to indigenous Fijians in the province. Sadly, there is littleevidence to demonstrate an explicit accountability to indigenous Fijians. Significant scopeexists for improving the standard of accounting and accountability by provincial councils.This study contributes to understanding the role of accounting among indigenous peoples, inthe context of inherited colonial structures. It also represents accounting research conductedby indigenous academics, primarily in the Fijian language. This enables an examination ofhow language frames understanding of accounting concepts.
Dräger, J; Petzold, S; Ristau, H; Trepte, S
Quality saving measures are required at the execution of extracorporeal LDL apheresis therapy (LDL apheresis) by the NUB guidelines of the national committee of physicians and health insurance. The saving measures apply to specialist, organizational and apparatical conditions for execution and accounting of treatment methods. Furthermore, as a result of the lawful requirements of SGB V, complementary BUB guidelines were introduced in 1999. These ought to engage the therapeutic benefit of a LDL apheresis treatment. Beyond measures for quality assurance at execution a documentation of treatment is explicitly demanded. For two years now the non-profit Quasa gGmbH has been developed the quality assurance registry for LDL apheresis with the background of those requirements. Since March 2003 the apheresis physicians can voluntarily take part in the registry initiative by internet. Beside the clinical patient's medical history, treatment relevant data are recorded. Because of the analysis of the nationally ascertained clinical data, for the first time it will be possible for the medical profession to fulfill the guidelines of quality assurance for LDL apheresis. Moreover the treating apheresis physicians can establish an EDV-based individual patient documentation. All necessary measures of data protection and data security are in process on the technical and logistic realization of this registry initiative. An epidemiological data evaluation is regularly accomplished and the results are provided to the public.
Cuenca, Alex G; Islam, Saleem
Pancreatic trauma is rare in children and optimal care has not been defined. We undertook this study to review the cumulative experience from three centers. After obtaining Institutional Review Board approval at each site, the trauma registries of three institutions were searched for pancreatic injuries. The charts were reviewed and data pertaining to demographics, hospital course, and outcome were obtained and analyzed. During the study period, a total of 79 pancreatic injuries were noted. The most common mechanism of injury was motor vehicle crash (44%) followed by child abuse (11%) and bicycle crashes (11%). Computed tomographic (CT) scans were obtained in 95 per cent with peripancreatic fluid the most common finding. Median Injury Severity Score (ISS) was 9, whereas median organ injury score was 2, and a higher grade correlated with need for operation (P = 0.001). Pancreatic operations were performed in 32 patients, whereas nonoperative management was noted in 47 cases. We noted no differences in length of stay, age, ISS, or initial blood pressure in operative versus nonoperatively managed cases. Pancreatic injuries were rare in children with trauma. CT scans were the most common method of diagnosis. Nonoperative management appeared to be safe and was more common, especially for the lower grade injuries.
Thomsen, Lars; Lindholt, Jes; Roeder, Ole
University Hospital (OUH). METHODS: This study was based on a historical cohort comprising all arterial traumas treated at OUH between 1990 and 2012. The Personal Identification Numbers were drawn and cross-referenced between The Danish Vascular Registry and the Accident Analysis Group. Mortality......INTRODUCTION: Extant studies on arterial trauma originate from outside Denmark and their findings may therefore not apply to a Danish setting. The aim of the present study was to investigate the long-term mortality and clinical characteristics of patients with arterial trauma treated in Odense...... adjustment for the effect of the first year. Whether the observed mortality is due to surgery itself, patients' risk behaviour or other factors remains unclear. Further national investigation is needed. FUNDING: not relevant. TRIAL REGISTRATION: not relevant. The study was approved by the Danish Data...
Stanworth, Simon J; Morris, Timothy P; Gaarder, Christine
transfusion requirements could allow early activation of blood bank protocols. METHODS : Datasets on trauma admissions over a 1 or 2-year period were obtained from the trauma registries of five large trauma research networks. A fractional polynomial was used to model the transfusion-associated probability...... of death. A logistic regression model for the prediction of massive transfusion, defined as 10 or more units of red cell transfusions, was developed. RESULTS : In total, 5,693 patient records were available for analysis. Mortality increased as transfusion requirements increased, but the model indicated...... no threshold effect. Mortality was 9% in patients who received none to five PRBC units, 22% in patients receiving six to nine PRBC units, and 42% in patients receiving 10 or more units. A logistic model for prediction of massive transfusion was developed and validated at multiple sites but achieved only...
Deppe, Sharon; Truax, Christopher B; Opalek, Judy M; Santanello, Steven A
Hospital accounting methods use diagnosis-related group (DRG) data to identify patients and derive financial analyses and reports. The National Trauma Data Bank and trauma programs identify patients with trauma by International Classification of Diseases, Ninth Edition (ICD-9)-based definitions for inclusion criteria. These differing methods of identifying patients result in economic reports that vary significantly and fail to accurately identify the financial impact of trauma services. Routine financial data were collected for patients admitted to our Trauma Service from July 1, 2005 to June 30, 2006 using two methods of identifying the cases; by trauma DRGs and by trauma registry database inclusion criteria. The resulting data were compared and stratified to define the financial impact on hospital charges, reimbursement, costs, contribution to margin, downstream revenue, and estimated profit or loss. The results also defined the impact on supporting services, market share and total revenue from trauma admissions, return visits, discharged trauma alerts, and consultations. A total of 3,070 patients were identified by the trauma registry as meeting ICD-9 inclusion criteria. Trauma-associated DRGs accounted for 871 of the 3,070 admissions. The DRG-driven data set demonstrated an estimated profit of $800,000 dollars; the ICD-9 data set revealed an estimated 4.8 million dollar profit, increased our market share, and showed substantial revenue generated for other hospital service lines. Trauma DRGs fail to account for most trauma admissions. Financial data derived from DRG definitions significantly underestimate the trauma service line's financial contribution to hospital economics. Accurately identifying patients with trauma based on trauma database inclusion criteria better defines the business of trauma.
Jones, Valerie M.; Bults, Richard G.A.
The clinical motivation for Virtual Trauma Team is to improve quality of care in trauma care in the vital first "golden hour" where correct intervention can greatly improve likely health outcome. The motivation for Virtual Homecare Team is to improve quality of life and independence for patients by
Introduction. After patients survived major trauma, their prospects, in terms of the consequences for functioning, are uncertain, which may impact severely on patient, family and society. The studies in this thesis describes the long-term outcomes of severe injured patients after major trauma. In
Elaine Hyshka; Jalene Anderson-Baron; Kamagaju Karekezi; Lynne Belle-Isle; Richard Elliott; Bernie Pauly; Carol Strike; Mark Asbridge; Colleen Dell; Keely McBride; Andrew Hathaway; T Cameron Wild
.... We examined the quality of current provincial and territorial harm reduction policies in Canada, relative to how well official documents reflect internationally recognized principles and attributes...
Hansen, Michael; Hachenberg, Thomas
Penetrating thoracic injuries are rare in Germany and common in urban regions. 10 percent of the patients in Emergency Departments suffer from blunt thoracic trauma. Mechanism of trauma can predict the severity of the injuries. Very fast life-threatening injuries with hemodynamic problems like tension pneumothorax or cardiac tamponade have to be diagnosed. Prehospital emergency physicians need skills in ultrasound for diagnosis and in invasive therapy like chest tube or pericardium drainage tube. The application of an algorithm in exploration of a thoracic trauma seems to be useful. The selection of trauma center depends on the severity of the trauma, if necessary with the availability of extracorporeal circulation. Georg Thieme Verlag KG Stuttgart · New York.
Stensballe, Jakob; Ostrowski, Sisse Rye; Johansson, Par I.
PURPOSE OF REVIEW: To discuss the recent developments in and evolvement of next generation haemostatic resuscitation in bleeding trauma. RECENT FINDINGS: Mortality from major trauma is a worldwide problem, and massive haemorrhage remains a major cause of potentially preventable deaths. Development...... of coagulopathy further increases trauma mortality emphasizing that coagulopathy is a key target in the phase of bleeding. The pathophysiology of coagulopathy in trauma reflects at least three distinct mechanisms that may be present isolated or coexist: acute traumatic coagulopathy, coagulopathy associated...... with the lethal triad, and consumptive coagulopathy. The concepts of 'damage control surgery' and 'damage control resuscitation' have been developed to ensure early control of bleeding and coagulopathy to improve outcome in bleeding trauma. Haemostatic resuscitation aims at controlling coagulopathy and consists...
Andreasen, Jens Ove; Lauridsen, Eva Fejerskov; Christensen, Søren Steno Ahrensburg
Diagnose and treatment of traumatic dental injuries is very complex due to the multiple trauma entities represented by 6 lunation types and 9 fracture types affecting both the primary and the permanent dentition. When it is further considered that fracture and lunation injuries are often combined......, the result is, that more than 100 trauma scenario exist when the two dentitions are combined. Each of these trauma scenarios have a specific treatment demand and prospect for healing. With such a complexity in diagnose and treatment it is obvious that even experienced practitioners may have problems may have...... problems in selecting proper treatment for some of these trauma types. To remedy this situation, an internet based knowledge base consisting of 4000 dental trauma cases with long term follow up is now available to the public and professionals, on the internet using the address www...
Katrancha, Elizabeth D; Gonzalez, Luis S
Coagulopathy is the inability of blood to coagulate normally; in trauma patients, it is a multifactorial and complex process. Seriously injured trauma patients experience coagulopathies during the acute injury phase. Risk factors for trauma-induced coagulopathy include hypothermia, metabolic acidosis, hypoperfusion, hemodilution, and fluid replacement. In addition to the coagulopathy induced by trauma, many patients may also be taking medications that interfere with hemostasis. Therefore, medication-induced coagulopathy also is a concern. Traditional laboratory-based methods of assessing coagulation are being supported or even replaced by point-of-care tests. The evidence-based management of trauma-induced coagulopathy should address hypothermia, fluid resuscitation, blood components administration, and, if needed, medications to reverse identified coagulation disorders. ©2014 American Association of Critical-Care Nurses.
Liu, Lige; Brown, Melissa J.; Feldman, Marcus W.
Since the 1990s, inter-provincial female migration for marriage has become important in central and eastern rural China. Using survey data from X County in rural Anhui Province, we explore the arrangement of inter-provincial marriages, as well as the characteristics of husbands and wives, marital satisfaction, and marital stability for these marriages. We find that inter-provincial marriage is an important option for local men to respond to the marriage squeeze and the increasing expense of marriage. It helps to relieve the shortage of marriageable women in the local marriage market. Because this kind of marriage is based on economic exchange, but not affection, it is often subject to a higher risk of marriage instability, and can lead to such illegal behaviors as marriage fraud and mercenary marriage. PMID:26594102
O'Leary, Katrina; Kool, Bridget; Christey, Grant
To describe the epidemiology of injuries sustained by older adult trauma patients admitted to hospitals in the Midland region (population 886,000) of New Zealand. A review of older adult (≥65 years) trauma cases from the Midland Trauma Registry for the three-year period January 2012 to December 2014 was conducted. Demographics, mechanism of injury, severity of injuries, processes of care and outcomes were analysed. Older adults accounted for 14% (2,278/15,700) of all injury cases captured by the registry during the study period (average annualised incidence 585/100,000 population). The majority of injuries (90%) were minor in nature (ISS 0-12) and 65% resulted from unintentional falls. Falls was the most common mechanism in the major trauma group (38%), followed closely by road traffic crash (30%). Home was the leading place of injury (56%), followed by road/street/highway (15%). Injury rates were significantly higher among non-Māori than Māori. These findings illustrate the growing volumes and changing epidemiology of both major and minor trauma affecting older persons hospitalised following trauma in one of the four health regions of New Zealand. There is a need to prepare for an increase in demand for trauma services to meet the needs of an ageing population in New Zealand.
Fakhry, Samir M; Couillard, Debbie; Liddy, Casey T; Adams, David; Norcross, E Douglass
Trauma centers frequently report unfavorable financial results for the care of injured patients. Many variables contribute to these results. The objective of this study was to determine the relationship of adult trauma patient hospital length of stay (LOS) to trauma center profitability. The trauma registry of a Level I trauma center was queried for patients older than 18 years for the period July 1, 2003 to June 30, 2008. Hospital financial records were matched to patient trauma registry data. There were 7,990 patients who met selection criteria: 71% were men, mean age was 40 years, mean Injury Severity Score was 12 +/-10, 84.2% of injuries were blunt, and mean LOS was 6.23 days. In the 5 years of the study, total charges were $329,315,191, total costs were $137,680,039, and overall profit was $7,644,894. Total costs rose each year and percent collections fell. The bulk of the profit was realized from patients with LOS profitability as LOS increased. A notable "inflection point" at 11 days defined the cohort of profitable patients. Trauma patient LOS correlates closely with profitability. In this center, the vast majority of profit was realized from patients with LOS profitability and reflects the current reimbursement environment, which rewards shorter LOS over severity and quality. Copyright 2010 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Lorenz, Christian; Khalid, Muhammad
Since May 2009 the first National Health Accounts (NHA) for Pakistan have been finalised and published by Federal Bureau of Statistics (FBS) in cooperation with German Technical Cooperation (GTZ). This paper goes one step ahead of the report and analyses in more detail the regional differences in health expenditure structures in Pakistan. The further analyses can be divided into four parts: health expenditures in provinces (Provincial Health Accounts, PHA), Punjab provincial and district governments health expenditures and its comparison with ADB figures, all districts of Pakistan and comparison between total district government and provincial government expenditure for each province; the latter calculation is applied as indication for the degree of fiscal autonomy of the districts in each province. Consequently, first the provincial health expenditures by Financial Agents is analysed and compared between the provinces which leads to very heterogeneous results (section 2); the per capita health expenditures differ from 16 to 23 USD. Secondly, NHA results on Punjab district government are compared with available ADB results and differences in methods as possible reasons for different results are presented (section 3). Third, district data of all district governments in all four Pakistani provinces are analysed on the level of detailed function codes in section 4; the aim is to discover regional differences between districts of the same as well as of different provinces. Fourth, in section 5 the degree of fiscal autonomy on health of the districts in each province is analysed; therefore the ordinance description is reviewed and total district government with total provincial government expenditures are compared per province. Finally recommendations for future rounds of NHA in Pakistan are given regarding formats and necessities of detailed health expenditure data collection to ensure evidence based decision making not only on federal, but also on provincial and
Full Text Available This study aims to analyze the relationship remained the state with the provincial towns of Buenos Aires during the first years of Peronism, which was introduced as a particular feature of progressive intervention of the provincial government on communal administrations. This trend helped the formation of a centralized state that was characterized, among other things, limit the autonomy of municipal governments. Also this method was accompanied by a devaluation of the growing political role of the mayors, to benefit other areas of the state apparatus and the party itself, and its conversion into a single functionary.
Kim, Jungeun; Song, Kyoung Jun; Shin, Sang Do; Ro, Young Sun; Hong, Ki Jeong; Holmes, James F
Prehospital time potentially impacts clinical outcomes in severely injured trauma patients. The importance of individual components, including scene and response time, however, is controversial. Our objective was to determine the impact of prehospital times on survival in severely injured patients. We reviewed injured trauma patients enrolled in a Korean EMS trauma registry during 2012. Severe trauma patients were defined as having either a "V" or lower in the AVPU system, a systolic blood pressure ≤90mmHg, or respiratory rate 29. Patients with Injury Severity Scores(ISS) prehospital time as follows: prehospital time increased, OR = 1.0(16 to prehospital times did not increase mortality in severely injured trauma patients in Korea. Furthermore, longer scene times were associated with lower mortality.
context the author suggests changing the trajectory of development, building a positive image of the Volgograd region, enhancing the investment attractiveness of the region, improving the quality of life, building on the advantageous geographic and historical situation (the region’s past, natural and climatic conditions, natural resources, economic and geographic situation, agrarian conditions, prestigious universities, building trust in the authorities due to the efforts on the part of regional and municipal administration and improving the reputation of public servants, which would promote the strategy of adjusting inter-regional inequality and a renaissance of a provincial region.
Voskens, Frank J; van Rein, Eveline A J; van der Sluijs, Rogier; Houwert, Roderick M; Lichtveld, Robert Anton; Verleisdonk, Egbert J; Segers, Michiel; van Olden, Ger; Dijkgraaf, Marcel; Leenen, Luke P H; van Heijl, Mark
A major component of trauma care is adequate prehospital triage. To optimize the prehospital triage system, it is essential to gain insight in the quality of prehospital triage of the entire trauma system. To prospectively evaluate the quality of the field triage system to identify severely injured adult trauma patients. Prehospital and hospital data of all adult trauma patients during 2012 to 2014 transported with the highest priority by emergency medical services professionals to 10 hospitals in Central Netherlands were prospectively collected. Prehospital data collected by the emergency medical services professionals were matched to hospital data collected in the trauma registry. An Injury Severity Score of 16 or more was used to determine severe injury. The quality and diagnostic accuracy of the field triage protocol and compliance of emergency medical services professionals to the protocol. A total of 4950 trauma patients were evaluated of which 436 (8.8%) patients were severely injured. The undertriage rate based on actual destination facility was 21.6% (95% CI, 18.0-25.7) with an overtriage rate of 30.6% (95% CI, 29.3-32.0). Analysis of the protocol itself, regardless of destination facility, resulted in an undertriage of 63.8% (95% CI, 59.2-68.1) and overtriage of 7.4% (95% CI, 6.7-8.2). The compliance to the field triage trauma protocol was 73% for patients with a level 1 indication. More than 20% of the patients with severe injuries were not transported to a level I trauma center. These patients are at risk for preventable morbidity and mortality. This finding indicates the need for improvement of the prehospital triage protocol.
Schjødt, Inge; Nakano, Anne; Egstrup, Kenneth
AIM OF DATABASE: The aim of the Danish Heart Failure Registry (DHFR) is to monitor and improve the care of patients with incident heart failure (HF) in Denmark. STUDY POPULATION: The DHFR includes inpatients and outpatients (≥18 years) with incident HF. Reporting to the DHFR is mandatory......: The main variables recorded in the DHFR are related to the indicators for quality of care in patients with incident HF: performance of echocardiography, functional capacity (New York Heart Association functional classification), pharmacological therapy (angiotensin converting enzyme/angiotensin II...
Einy, Shmuel; Abdel Rahman, Nura; Siman-Tov, Maya; Aizenbud, Dror; Peleg, Kobi
Motor vehicle accidents (MVA) and falls are major causes of maxillofacial injuries posing real challenges for the medical staff. To describe the demographic and injury characteristics, as well as the treatment procedures of casualties diagnosed with maxillofacial injuries. The investigators implemented a multicenter retrospective study composed of hospitalized maxillofacial trauma patients recorded in the Israel Trauma Registry for 2000 to 2011. The predictor variable was mechanism of injury and the outcome variable was type of injury, severity, and hospital resources utilization. Descriptive and bivariate statistics with P values was set at 0.05. The study included 11,592 reported hospitalized maxillofacial trauma patients (39.4% of them were MVA, 33.5% were falls), with a male predominance of a 3:1 ratio. The high-risk age groups were the first 3 decades of life in both etiologies, while age groups above 75 years were also frequent in falls. Severity of maxillofacial injuries, multiple injuries, admission to intensive care units, hospitalization for more than 15 days, inpatient mortality, and rehabilitation after discharge was significantly higher in MVA compared with falls. Conversely, maxillofacial surgeries were performed slightly more among patients injured in falls (34.1% and 31.1% respectively), as tongue and mouth are more prone targets in falls, compared with zygoma, maxilla, mandible, and teeth in MVA. The results of this study suggest that the etiologies present an entire separate pattern of trauma. A better understanding and proper identification of their high-risk groups should lead to appropriate prevention programs and treatment protocols.
Genét, Gustav Folmer; Johansson, Per; Meyer, Martin Abild Stengaard
It remains debated whether traumatic brain injury (TBI) induces a different coagulopathy compared to non-TBI. This study investigated traditional coagulation tests, biomarkers of coagulopathy and endothelial damage in trauma patients with and without TBI. Blood from 80 adult trauma patients were...... sampled (median of 68 min (IQR 48-88) post-injury) upon admission to our trauma centre. Plasma/serum were retrospectively analysed for biomarkers reflecting sympathoadrenal activation (adrenaline, noradrenaline), coagulation activation/inhibition and fibrinolysis (protein C, activated protein C, tissue...
Bent, C. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)], E-mail: email@example.com; Iyngkaran, T.; Power, N.; Matson, M. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom); Hajdinjak, T.; Buchholz, N. [Department of Urology, Barts and The London NHS Trust, London (United Kingdom); Fotheringham, T. [Department of Diagnostic Imaging, Barts and The London NHS Trust, London (United Kingdom)
Blunt renal trauma is the third most common injury in abdominal trauma following splenic and hepatic injuries, respectively. In the majority, such injuries are associated with other abdominal organ injuries. As urological injuries are not usually life-threatening, and clinical signs and symptoms are non-specific, diagnosis is often delayed. We present a practical approach to the diagnosis and management of these injuries based on our experience in a busy inner city trauma hospital with a review of the current evidence-based practice. Diagnostic imaging signs are illustrated.
Hanke, A A; Rahe-Meyer, N
The main cause of death in the patient group less than 45 years is trauma. Beside severe traumatic brain injury, bleeding remains a leading cause of death in this group. For a causal therapy, it is necessary to understand the pathophysiology of trauma-induced coagulopathy (TIC). Beside the well-known lethal triad of trauma (hypothermia, acidosis, and coagulopathy), dilution and hypoperfusion with activation of the protein C pathway play a crucial role. TIC is a complex independent syndrome which may be present without initial hypercoagulopathy. A rapid and differentiated diagnosis and goal-directed therapy is crucial for causal therapy.
Holena, Daniel N; Wiebe, Douglas J; Carr, Brendan G; Hsu, Jesse Y; Sperry, Jason L; Peitzman, Andrew B; Reilly, Patrick M
Admission physiology predicts mortality after injury, but may be improved by resuscitation before transfer. This phenomenon, which has been termed lead-time bias, may lead to underprediction of mortality in transferred patients and inaccurate benchmarking in centers receiving large numbers of transfer patients. We sought to determine the impact of using vital signs on arrival at the referring center vs on arrival at the trauma center in mortality prediction models for transferred trauma patients. We performed a retrospective cohort study using a state-wide trauma registry including all patients age 16 years or older, with Abbreviated Injury Scale scores ≥ 3, admitted to level I and II trauma centers in Pennsylvania, from 2011 to 2014. The primary outcomes measure was the risk-adjusted association between mortality and interhospital transfer (IHT) when adjusting for physiology (as measured by Revised Trauma Score [RTS]) using the referring hospital arrival vital signs (model 1) compared with trauma center arrival vital signs (model 2). After adjusting for patient and injury factors, IHT was associated with reduced mortality (odds ratio [OR] 0.85; 95% CI 0.77 to 0.93) using the RTS from trauma center admission, but with increased mortality (OR 1.15; 95% CI 1.05 to 1.27) using RTS from the referring hospital. The greater the number of transfer patients seen by a center, the greater the difference in center-level mortality predicted by the 2 models (β -0.044; 95% CI -0.044 to -0.0043; p ≤ 0.001). Trauma center vital signs underestimate mortality in transfer patients and may lead to incorrect estimates of expected mortality. Where possible, benchmarking efforts should use referring hospital vital signs to risk-adjust IHT patients. Copyright Â© 2016 American College of Surgeons. Published by Elsevier Inc. All rights reserved.
Terrier, Jean-Etienne; Paparel, Philippe; Gadegbeku, Blandine; Ruffion, Alain; Jenkins, Lawrence C; N'Diaye, Amina
Traffic accidents are the most frequent cause of genitourinary injuries (GUI). Kidney injuries after trauma have been well described. However, there exists a paucity of data on other traumatic GUI after traffic accidents. The objective of this study was to analyze the frequency and type of all GUI, by user category, after traffic accidents. Patient cases were extracted from the trauma registry of the French department of Rhone from 1996 to 2013. We assessed the urogenital injuries presented by each of road user's categories. Severity injuries were coded with the Abbreviated Injury Scale and the Injury Severity Score. Kidney trauma was mapped with the classification of the American Association for the Surgery of Trauma. Multivariate prediction models were used for analysis of data. Of 162,690 victims, 963 presented with GUI (0.59%). 47% were motorcyclists, 22% were in a car, 18% on bicycles, and 9% were pedestrians. The most common organ injury was kidney (41%) followed by testicular (23%). Among the 208 motorists with a GUI, kidney (70%), bladder (10%), and adrenal gland (9%) were the most frequent lesions. Among the 453 motorcyclist victims with GUI, kidney (35%) and testicular (38%) traumas were the most frequent and 62% of injuries involved external genitalia. There were 175 cyclists with GUI, 70% of injuries involved external genitalia; penile traumas (23%) were the most frequent. In total, there were 395 kidney injuries, most being low grade. According to the American Association for the Surgery of Trauma kidney injuries were grade I, 59%; grade II, 11%; grade III, 16%; grade IV, 9%; grade V, 3%; and indeterminate, 2%. GUI is an infrequent trauma after traffic accidents, with kidneys being the most commonly injured. Physicians must maintain a high awareness for external genitalia injuries in motorcyclists and cyclists. Prognostic and epidemiologic study, level III.
Full Text Available During the last decade in Argentina, the growth of open pit mining has faced strong social resistance and provincial laws prohibiting such activity. This work aims to analyse the ways in which the different subnational political regimes and economic systems impact upon the possibility of incidence of social resistance on provincial mining legislation, looking at the cases of Cordoba and Catamarca.
Benedict, Leo Andrew; Paulus, Jessica K; Rideout, Leslie; Chwals, Walter J
To assess whether pediatric trauma patients initially evaluated at referring institutions met Massachusetts statewide trauma field triage criteria for stabilization and immediate transfer to a Pediatric Trauma Center (PTC) without pre-transfer CT imaging. A 3-year retrospective cohort study was completed at our level 1 PTC. Patients with CT imaging at referring institutions were classified according to a triage scheme based on Massachusetts statewide trauma field triage criteria. Demographic data and injury profile characteristics were abstracted from patient medical records and our pediatric trauma registry. A total of 262 patients with 413 CT scans were reviewed from 2008 to 2011. 172 patients scanned (66%, 95% CI: 60%, 71%) met criteria for immediate transfer to a pediatric trauma center. Notably, 110 scans (27% of the total performed at referring institutions) were duplicated within four hours upon arrival to our PTC. GCS score transfer, and CT scan of the head was the most frequent scan obtained (53%). The majority of pediatric trauma patients were subjected to CT scans at referring institutions despite meeting Massachusetts trauma triage guidelines that call for stabilization and immediate transfer to a pediatric trauma center without any CT imaging. © 2014.
Eldrup, Nikolaj; Cerqueira, Charlotte; de la Motte, Louise; Rathenborg, Lisbet Knudsen; Hansen, Allan K
Aim The Danish Vascular Registry (DVR), Karbase, is monitoring arterial and advanced vein interventions conducted at all vascular departments in Denmark. The main aim of the DVR is to improve the quality of treatment for patients undergoing vascular surgery in Denmark by using the registry for quality assessment and research. Study population All patients undergoing vascular interventions (surgical and endovascular) at any vascular department in Denmark are registered in the DVR. The DVR was initiated in 1989, and each year, ∼9,000 procedures are added. By January 2016, >180,000 procedures have been recorded. Since 2001, data completeness has been >90% (compared to the Danish National Patient Register). Main variables Variables include information on descriptive patient data (ie, age, sex, height, and weight) and comorbidity (ie, previous cardiovascular disease and diabetes). Process variable includes waiting time (time from event to medical contact and treatment) and the type of procedures conducted. Outcome variables for in-hospital complications (ie, wound complications, myocardial infarction, stroke, amputation, respiratory complications, and renal insufficiency) and 30-day patency are submitted. Variables for medical treatment (antithrombotic and statin treatment), amputation, and survival are extracted from nationwide, administrative registers. Conclusion The DVR reports outcome on key indicators for monitoring the quality at all vascular departments in Denmark for the purpose of quality improvement. Furthermore, data are available for research and are being used in international collaborations on changes in clinical practices. PMID:27822118
... Frequently Asked Questions Español Condiciones Chinese Conditions Pediatric Ocular Trauma What causes eye injuries ? Injuries to the ... only the eyelid but the structures that drain tears from the eye. Lacerations of the eyelid or ...
... Emphasis Programs Directives Severe Violators TOPICS By Sector Construction Health Care Agriculture Maritime Oil and Gas Federal ... such fatalities often are referred to as "harnessinduced pathology" or "suspension trauma." Signs & symptoms that may be ...
Full Text Available Bleeding and coagulation disorders related to trauma are pathological processes which are frequently seen and increase mortality. For the purpose, trauma patients should be protected from hypoperfusion, hypothermia, acidosis and hemodilution which may aggravate the increase in physiological responses to trauma as anticoagulation and fibrinolysis. Performing damage control surgery and resuscitation and transfusion of adequate blood and blood products in terms of amount and content as stated in protocols may increase the rate of survival. Medical treatments augmenting fibrin formation (fibrinogen, desmopressin, factor VIIa or preventing fibrin degradation (tranexamic acid have been proposed in selected cases but the efficacy of these agents in trauma patients are not proven. (Journal of the Turkish Society Intensive Care 2011; 9:71-6
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Windeløv, Nis A; Sørensen, Anne M; Perner, Anders
We aimed to elucidate platelet function in trauma patients, as it is pivotal for hemostasis yet remains scarcely investigated in this population. We conducted a prospective observational study of platelet aggregation capacity in 213 adult trauma patients on admission to an emergency department (ED......). Inclusion criteria were trauma team activation and arterial cannula insertion on arrival. Blood samples were analyzed by multiple electrode aggregometry initiated by thrombin receptor agonist peptide 6 (TRAP) or collagen using a Multiplate device. Blood was sampled median 65 min after injury; median injury...... severity score (ISS) was 17; 14 (7%) patients received 10 or more units of red blood cells in the ED (massive transfusion); 24 (11%) patients died within 28 days of trauma: 17 due to cerebral injuries, four due to exsanguination, and three from other causes. No significant association was found between...
Johansson, P I; Ostrowski, S R
Acute coagulopathy of trauma predicts a poor clinical outcome. Tissue trauma activates the sympathoadrenal system resulting in high circulating levels of catecholamines that influence hemostasis dose-dependently through immediate effects on the two major compartments of hemostasis, i.......e., the circulating blood and the vascular endothelium. There appears to be a dose-dependency with regards to injury severity and the hemostatic response to trauma evaluated in whole blood by viscoelastic assays like thrombelastography (TEG), changing from normal to hypercoagulable, to hypocoagulable and finally......, is an evolutionary developed response that counterbalances the injury and catecholamine induced endothelial activation and damage. Given this, the rise in circulating catecholamines in trauma patients may favor a switch from hyper- to hypocoagulability in the blood to keep the progressively more procoagulant...
... Guide Purpose and Scope Find Assessment Measures Instrument Authority List Research and Biology Research on PTSD Biology ... Mental Health Mental Health Home Suicide Prevention Substance Abuse Military Sexual Trauma PTSD Research (MIRECC) Military Exposures ...
Grossman, Nancy Beth
Trauma is the most common cause of nonobstetric death among pregnant women in the United States. Motor vehicle crashes, domestic violence, and falls are the most common causes of blunt trauma during pregnancy. All pregnant patients with traumatic injury should be assessed formally in a medical setting because placental abruption can have dire fetal consequences and can present with few or no symptoms. Evaluation and treatment are the same as for nonpregnant patients, except that the uterus should be shifted off the great vessels. After initial stabilization, management includes electronic fetal monitoring, ultrasonography, and laboratory studies. Electronic fetal monitoring currently is the most accurate measure of fetal status after trauma, although the optimal duration of monitoring has not been established. Prevention of trauma through proper seat belt use during pregnancy and recognition of domestic violence during prenatal care is important.
Witt, Cordelie E; Arbabi, Saman; Nathens, Avery B; Vavilala, Monica S; Rivara, Frederick P
The implications of childhood obesity on pediatric trauma outcomes are not clearly established. Anthropomorphic data were recently added to the National Trauma Data Bank (NTDB) Research Datasets, enabling a large, multicenter evaluation of the effect of obesity on pediatric trauma patients. Children ages 2 to 19years who required hospitalization for traumatic injury were identified in the 2013-2014 NTDB Research Datasets. Age and gender-specific body mass indices (BMI) were calculated. Outcomes included injury patterns, operative procedures, complications, and hospital utilization parameters. Data from 149,817 pediatric patients were analyzed; higher BMI percentiles were associated with significantly more extremity injuries, and fewer injuries to the head, abdomen, thorax and spine (p values trauma, increased BMI percentile is associated with increased risk of death and potentially preventable complications. These findings suggest that obese children may require different management than nonobese counterparts to prevent complications. Level III; prognosis study. Copyright © 2017 Elsevier Inc. All rights reserved.
Martini, Wenjun Z
Traumatic injury is one of the leading causes of death, with uncontrolled hemorrhage from coagulation dysfunction as one of the main potentially preventable causes of the mortality. Hypothermia, acidosis, and resuscitative hemodilution have been considered as the significant contributors to coagulation manifestations following trauma, known as the lethal triad. Over the past decade, clinical observations showed that coagulopathy may be present as early as hospital admission in some severely injured trauma patients. The hemostatic dysfunction is associated with higher blood transfusion requirements, longer hospital stay, and higher mortality. The recognition of this early coagulopathy has initiated tremendous interest and effort in the trauma community to expand our understanding of the underlying pathophysiology and improve clinical treatments. This review discusses the current knowledge of coagulation complications following trauma.
Bax, C.A. & Jagtman, H.M.
This study investigates what information provinces use in decision-making about the construction of infrastructural road safety measures on provincial 80km/h roads. The following questions are answered in this study: ? Do provinces use general information about costs and effects, and specific
The aim of the study was to identify the most preferred post-match recovery methods utilized by U19 and U21 provincial rugby union players (n=97; Mean age: ± 20.2 years) in Gauteng Province of South Africa. Questionnaire-based data were collected from a purposive sample size of 97 rugby players. The findings ...
Burnett, Kristin; Skinner, Kelly; Hay, Travis; LeBlanc, Joseph; Chambers, Lori
This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC) and by reporting on the grocery shopping experiences of people living in northern Canada. We employed two methodological approaches to assess northern retail food environments. First, we mapped food retailers in the North to examine the breadth of retail competition in the provincial Norths, focussing specifically on those communities without year-round road access. Second, we surveyed people living in communities in northern Canada about their retail and shopping experiences. Fifty-four percent of communities in the provincial Norths and Far North without year-round road access did not have a grocery store that competed with the NWC. The provinces with the highest percentage of northern communities without retail competition were Ontario (87%), Saskatchewan (83%) and Manitoba (72%). Respondents to the survey (n = 92) expressed concern about their shopping experiences in three main areas: the cost of food, food quality and freshness, and availability of specific foods. There is limited retail competition in the provincial Norths. In Manitoba, Saskatchewan and Ontario, the NWC has no store competition in at least 70% of northern communities. Consumers living in northern Canada find it difficult to afford nutritious foods and would like access to a wider selection of perishable foods in good condition.
Bukin, V. P.
A survey conducted in two provincial areas of Russia provides the basis for an examination of the relation between the self-identification and the social status affiliation of young people. Self-assessments serve as the basis for a model of the social structure and a typology of the younger generation in these regions, in accordance with their…
Vanderloo, Leigh M; Tucker, Patricia; Ismail, Ali; van Zandvroort, Melissa M
Preschoolers spend a substantial portion of their day in childcare; therefore, these centers are an ideal venue to encourage healthy active behaviors. It is important that provinces'/territories' childcare legislation encourage physical activity (PA) opportunities. The purpose of this study was to review Canadian provincial/territorial childcare legislation regarding PA participation. Specifically, this review sought to 1) appraise each provincial/territorial childcare regulation for PA requirements, 2) compare such regulations with the NASPE PA guidelines, and 3) appraise these regulations regarding PA infrastructure. A review of all provincial/territorial childcare legislation was performed. Each document was reviewed separately by 2 researchers, and the PA regulations were coded and summarized. The specific provincial/territorial PA requirements (eg, type/frequency of activity) were compared with the NASPE guidelines. PA legislation for Canadian childcare facilities varies greatly. Eight of the thirteen provinces/territories provide PA recommendations; however, none provided specific time requirements for daily PA. All provinces/territories did require access to an outdoor play space. All Canadian provinces/territories lack specific PA guidelines for childcare facilities. The development, implementation, and enforcement of national PA legislation for childcare facilities may aid in tackling the childhood obesity epidemic and assist childcare staff in supporting and encouraging PA participation.
This article focuses on the physical composition of the Eastern Indonesian provincial town of Kupang, a town thought to be characterized by interethnic tensions. I examine the assumption that social segmentation is explainable in terms of ethnicity. In order to show that ethnicity not the sole
Linden, van der J.; Poelmans, W.
Since 1987 the distribution of many plant species in the central and eastern parts of the province Noord-Brabant has been mapped for country use planning by the Provincial Authorities. Distribution maps (with a 5 x 5 km² grid) of the Potamogeton (broad-leaved pondweed) species, which are important
Leydesdorff, L.; Perevodchikov, E.; Uvarov, A.
We measure synergy for the Russian national, provincial, and regional innovation systems as reduction of uncertainty using mutual information among the 3 distributions of firm sizes, technological knowledge bases of firms, and geographical locations. Half a million units of data at firm level in
José Luis Merlo Fuertes
Full Text Available This article will analyze the urban plans of those municipalities in the Province of Valencia that embraced the technical assistance given by the Provincial Council for the planning composition, at the time of Luis Albert Ballesteros, the provincial council architect. Those first urban plans of the Provincial Council make up a homogeneous set of documents since they respond to a unique style of urban planning that varies as much as the original core of the population does. The common element is the ground plan centrality that would be highlighted by an area or a protected green zone that will somehow link to the urban proposals connected to the city-garden model by Howard. Commencement of which began at a time characterized mainly by the co-existence of a great diversity of laws and percepts, making it so that the meaning of the term urban planning could be applied in a variety of ways. The urban plans of the Provincial Council represent the latest inheritance of the extension models and interior remodeling. In the transition to the Land Planning Act (Ley de Suelo of 1956, these plans have the interest in being, in addition to the last examples of the so-called urbanism in the municipal tradition, one of the ancestors of the current master plans of urban development (plan general de ordenación urbana.
After the fall of Soeharto in 1998, and an increased connection to the global world, politics at the local level in Indonesia have changed significantly. This has contributed to a change in how business is conducted in provincial towns. This thesis explores the changing relationship between the
Chemistry 300. Administration Manual for Supervising Teachers, Provincial Examination, Answer Key--Multiple-Choice and Written-Answer Questions, and Provincial Summary Report = Chimie 300. Guide d'administration a l'intention des surveillants d'examen, Examen provincial, Cle de correction--Questions choix multiple et Questions responses ouvertes, et Rapport sommaire provincial.
Manitoba Dept. of Education and Training, Winnipeg.
This collection of manuals contains the Manitoba Provincial Chemistry Examination for students seeking credit in Senior 4 Chemistry (Chemistry 300) and instructions for its use and grading. The examination is based on the Core Topics of the Senior 4 Chemistry course and accounts for 30% of the student's final grade in the course. The examination…
Full Text Available Introduction: This paper looks at the market food environments of First Nations communities located in the provincial Norths by examining the potential retail competition faced by the North West Company (NWC and by reporting on the grocery shopping experiences of people living in northern Canada. Methods: We employed two methodological approaches to assess northern retail food environments. First, we mapped food retailers in the North to examine the breadth of retail competition in the provincial Norths, focussing specifically on those communities without year-round road access. Second, we surveyed people living in communities in northern Canada about their retail and shopping experiences. Results: Fifty-four percent of communities in the provincial Norths and Far North without year-round road access did not have a grocery store that competed with the NWC. The provinces with the highest percentage of northern communities without retail competition were Ontario (87%, Saskatchewan (83% and Manitoba (72%. Respondents to the survey (n = 92 expressed concern about their shopping experiences in three main areas: the cost of food, food quality and freshness, and availability of specific foods. Conclusion: There is limited retail competition in the provincial Norths. In Manitoba, Saskatchewan and Ontario, the NWC has no store competition in at least 70% of northern communities. Consumers living in northern Canada find it difficult to afford nutritious foods and would like access to a wider selection of perishable foods in good condition.
M. Grandia Mantas
De Provincial Reconstruction Teams (PRT’s) zijn voor de NAVO het belangrijkste middel geweest om haar gebiedsuitbreiding naar geheel Afghanistan te realiseren. Daarnaast zijn PRT’S populair bij de media omdat ze veel met de lokale bevolking werken en projecten opzetten. De PRT’s zijn er in
Stewart, Daphne J
Blunt chest trauma is associated with a wide range of injuries, many of which are life threatening. This article is a case study demonstrating a variety of traumatic chest injuries, including pathophysiology, diagnosis, and treatment. Literature on the diagnosis and treatment was reviewed, including both theoretical and research literature, from a variety of disciplines. The role of the advance practice nurse in trauma is also discussed as it relates to assessment, diagnosis, and treatment of patients with traumatic chest injuries.
Avery, Pascale; Salm, Leopold; Bird, Flora; Hutchinson, Anja; Jarman, Heather; Nilsson, Maria Bergman; Konig, Tom; Tai, Nigel; Fevang, Espen; Hognestad, B?rge; Abrahamsen, H?kon B.; Cheetham, Olivia V.; Thomas, Matthew J. C.; Rooney, Kieron D.; Murray, Josephine
Table of contents I1: Trauma, Pre-hospital and Cardiac Arrest Care 2015 Pascale Avery, Leopold Salm, Flora Bird A1: Retrospective evaluation of HEMS ?Direct to CT? protocol Anja Hutchinson, Ashley Matthies, Anthony Hudson, Heather Jarman A2 Rush hour ? Crush hour: temporal relationship of cyclist vs. HGV trauma admissions. A single site observational study Maria Bergman Nilsson, Tom Konig, Nigel Tai A3 Semiprone position endotracheal intubation during continuous cardiopulmonary resuscitation ...
Moffatt, Samuel Edwin
Hypovolaemic shock that results through traumatically inflicted haemorrhage can have disastrous consequences for the victim. Initially the body can compensate for lost circulating volume, but as haemorrhage continues compensatory mechanisms fail and the patient's condition worsens significantly. Hypovolaemia results in the lethal triad, a combination of hypothermia, acidosis and coagulopathy, three factors that are interlinked and serve to worsen each other. The lethal triad is a form of vicious cycle, which unless broken will result in death. This report will focus on the role of hypothermia (a third of the lethal triad) in trauma, examining literature to assess how prehospital temperature control can impact on the trauma patient. Spontaneous hypothermia following trauma has severely deleterious consequences for the trauma victim; however, both active warming of patients and clinically induced hypothermia can produce particularly positive results and improve patient outcome. Possible coagulopathic side effects of clinically induced hypothermia may be corrected with topical haemostatic agents, with the benefits of an extended golden hour given by clinically induced hypothermia far outweighing these risks. Active warming of patients, to prevent spontaneous trauma induced hypothermia, is currently the only viable method currently available to improve patient outcome. This method is easy to implement requiring simple protocols and contributes significantly to interrupting the lethal triad. However, the future of trauma care appears to lie with clinically induced therapeutic hypothermia. This new treatment provides optimism that in the future the number of deaths resulting from catastrophic haemorrhaging may be significantly lessened.
Full Text Available Background: Operative intervention for thoracic trauma typically requires thoracotomy. We hypothesized that thoracoscopy may be safely and effectively utilized for the acute management of thoracic injuries. Materials and Methods: The Trauma Registry of a Level I trauma center was queried from 1999 through 2010 for all video-assisted thoracic procedures within 24 h of admission. Data collected included initial vital signs, operative indication, intraoperative course, and postoperative outcome. Results: Twenty-three patients met inclusion criteria: 3 (13% following blunt injury and 20 (87% after penetrating trauma. Indications for urgent thoracoscopy included diaphragmatic/esophageal injury, retained hemothorax, ongoing hemorrhage, and open/persistent pneumothorax. No conversions to thoracotomy were required and no patient required re-operation. Mean postoperative chest tube duration was 2.9 days and mean length of stay was 5.6 days. Conclusion: Video-assisted thoracoscopic surgery is safe and effective for managing thoracic trauma in hemodynamically stable patients within the first 24 h post-injury.
Cowan Anne E
Full Text Available Abstract Background Population-based registries have been promoted as an effective method to improve childhood immunization rates, yet rates of registry participation in the private sector are low. We sought to describe, through a national overview, the perspectives of childhood immunization providers in private practice regarding factors associated with participation or non-participation in immunization registries. Methods Two mailed surveys, one for 264 private practices identified as registry non-participants and the other for 971 identified as registry participants, from 15 of the 31 states with population-based statewide immunization registries. Frequency distributions were calculated separately for non-participants and participants regarding the physician-reported factors that influenced decisions related to registry participation. Pearson chi-square tests of independence were used to assess associations among categorical variables. Results Overall response rate was 62% (N = 756. Among non-participants, easy access to records of vaccines provided at other sites (N = 101, 68% and printable immunization records (N = 82, 55% were most often cited as "very important" potential benefits of a registry, while the most commonly cited barriers to participation were too much cost/staff time (N = 36, 38% and that the practice has its own system for recording and monitoring immunizations (N = 35, 37%. Among registry participants, most reported using the registry to input data on vaccines administered (N = 326, 87% and to review immunization records of individual patients (N = 302, 81%. A minority reported using it to assess their practice's immunization coverage (N = 110, 29% or generate reminder/recall notices (N = 54, 14%. Few participants reported experiencing "significant" problems with the registry; the most often cited was cost/staff time to use the registry (N = 71, 20%. Conclusion Most registry participants report active participation with few
Full Text Available Specialized trauma teams have been shown to improve outcomes in critically injured patients. At our institution, an the American College of Surgeons Committee on trauma level I Trauma center, the trauma team activation (TTA criteria includes both physiologic and anatomic criteria, but any attending physician can activate the trauma team at their discretion outside criteria. As a result, the trauma team has been activated for noninjured patients meeting physiologic criteria secondary to nontraumatic hemorrhage. We present two cases in which the trauma team was activated for noninjured patients in hemorrhagic shock. The utilization of the TTA protocol and subsequent management by the trauma team are reviewed as we believe these were critical factors in the successful recovery of both patients. Beyond the primary improved survival outcomes of severely injured patients, trauma center designation has a “halo effect” that encompasses patients with nontraumatic hemorrhage.
Tessler, Robert A; Lyons, Vivian H; Hagedorn, Judith C; Vavilala, Monica S; Goldin, Adam; Arbabi, Saman; Rivara, Frederick P
Regionalization of trauma care is a national priority and hospitalization for blunt abdominal trauma, that may include transfer, is common among children. The objective of this study was to determine whether there were differences in mortality, treatment, or length of stay between patients treated at or transferred to a higher level trauma center and those not transferred and admitted to a lower level trauma center. Cohort from Washington state trauma registry from 2000-2014 of patients 16 years or younger with isolated Grade I-III spleen, liver, or kidney injury. Among 54034 patients 16 years or younger, the trauma registry captured 1177 (2.2 %) patients with isolated low grade solid organ injuries; 226 (19.2%) presented to a higher level trauma center, 600 (51.0%) presented to a lower level trauma center and stayed there for care, and 351 (29.8%) were transferred to a higher level trauma center. Forty patients (3.4%) underwent an abdominal operation. Among the 950 patients evaluated initially at a lower level trauma center, the risk of surgery did not differ significantly between those who were not transferred compared to those who were (RR 2.19 95%CI 0.80-6.01). The risk of total splenectomy was no different for patients who stayed at a lower level trauma center compared to those who were transferred to a higher level trauma center (RR 0.84 95%CI 0.33-2.16). Non-transferred patients had a 0.63 (95% CI: 0.45-0.88) times lower risk of staying in the hospital for an additional day compared to patients who were transferred to a higher level trauma center. One patient died. Few pediatric patients with isolated low grade blunt solid organ injury require intervention and thus may not need to be transferred; trauma systems should revise their transfer policies. Prevention of unnecessary transfers is an opportunity for cost savings in pediatric trauma. III, Epidemiological.
Full Text Available Payam Dehghani,1 Varun Chopra,1 Ali Bell,2 Sheila Kelly,1 Lori Zulyniak,2 Jeff Booker,1 Rodney Zimmermann,1 William Semchuk,2 Asim N Cheema,3 Andrea J Lavoie1 1Prairie Vascular Research Network, University of Saskatchewan, Regina, SK, 2Regina Qu’Appelle Health Region, Regina, SK, 3St Michael’s Hospital, University of Toronto, Toronto, ON, Canada Background: As ticagrelor enters into clinical use for acute coronary syndrome, it is important to understand patient/physician behavior in terms of appropriate use, adherence, and event rates. Methods: The Saskatchewan Registry is a prospective, observational, multicenter cohort study that identifies consecutive patients started on ticagrelor. We aimed to evaluate both on- and off-label use, identify characteristics of patients who prematurely stop ticagrelor, and describe patient/physician behavior contributing to inappropriate stoppage of this medication. Results: From April 2012 to September 2013, 227 patients were initiated on ticagrelor, with a mean age of 62.2±12.1 years. The participants were 66% men and had a mean follow up of 157.4±111.7 days. Seventy-four patients (32.4% had off-label indications. Forty-seven patients (20.7% prematurely stopped ticagrelor and were more likely to be older, women, nonwhite, present with shock, and complain of dyspnea. Twenty-six of the 47 patients stopped ticagrelor inappropriately because of patient nonadherence (18 patients and physician advice (eight patients. A composite outcome event of death from vascular causes, myocardial infarction, or stroke occurred in 8.8% of the entire cohort and was more likely to occur in those older then 65 years, those presenting with cardiogenic shock, and those who prematurely stopped ticagrelor. Conclusion: In this real-world registry of patients started on ticagrelor, a third have off-label indications and a fifth prematurely stop the medication. Premature discontinuation was an independent predictor of major
Knox, Jeffrey; Schneider, John; Wimberly, Robert L; Riccio, Anthony I
Nonaccidental trauma (NAT) is considered an uncommon cause of spine trauma in the pediatric population. Little has been published on such injuries and no large series is available in the literature. The purpose of this study is to describe the incidence and characteristics of spine trauma secondary to NAT. An IRB-approved retrospective review of all patients presenting to a single level 1 pediatric trauma center with a spinal injury between 2003 and 2011 was performed. Patients were identified using our institution's trauma registry. Medical records were reviewed to identify all spine injuries that occurred as a result of NAT. These cases were reviewed for details regarding injury mechanism, type and location of injury, associated injuries, and the treatment. Our institution's NAT database was also queried to identify the total number of patients formally determined to have sustained any injury as a result of NAT during the same period. NAT was the cause of 11/342 (3.2%) spine injuries diagnosed during the study period. A total of 726 cases of NAT were identified, with spine injury present in 1.5%. All patients with spine trauma secondary to NAT were under the age of 2 years with an average age of 7 months. Among patients below 2 years with spinal trauma, NAT was tied as the most common mechanism, resulting in 38% of injuries. Eight of the 11 patients' spine injuries were cervical and 7 of these injuries were in the atlanto-occipital and atlantoaxial regions. Multilevel spine trauma was present in 64% of patients. Associated head and thoracic trauma was present in 73% and 36% of patients, respectively. Neurological injury was found in 54% of patients. The majority of injuries were treated nonoperatively and 1 patient required surgical management. NAT represents a very common yet often overlooked cause of spinal trauma in children under the age of 2 years. Because of its frequency in this age group, clinicians should consider including an assessment of the spine in
Dinh, Michael M; Roncal, Susan; Byrne, Christopher M; Petchell, Jeffrey
Elderly patients with major trauma are an increasingly important public health concern. The objective of the study was to describe the long term trend in patients aged 65 years and older with major trauma. A retrospective single centre trauma registry study conducted at an inner city Major Trauma Centre in Sydney. Data on patients aged 65 years or older with major trauma (Injury Severity Score greater than 15) presenting between 1991 and 2010 were extracted from the data registry. Demographic data, mechanism of injury, injury severity scores and outcomes were collected. Study outcomes were proportion of total major trauma volume due to patients aged 65 years and older, in hospital mortality and total beddays occupied per year. The proportion of major trauma volume due to older patients increased by 4.9% per year currently accounting for a third of major trauma volume. The proportion of major trauma in older patients due to falls has also increased. Standardised mortality rates have declined by 2.2% per year. There has been a disproportionate increase in the proportion of major trauma due to older patients at this institution over the past twenty years. If this trend continues, it is likely to have significant impacts on future hospital and rehabilitation resources. © 2012 The Authors. ANZ Journal of Surgery © 2012 Royal Australasian College of Surgeons.
Ferreira Pires, Luis; Wang, J.; van Oostrum, Arjen; Wijnhoven, Alphonsus B.J.M.
A service registry is a Service-Oriented Architecture (SOA) component that keeps a ‘catalogue’ of available services. It stores service specifications so that these specifications can be found by potential users. Discussions on the design of service registries currently focus on technical issues,
da Cunha-Bang, Caspar; Geisler, Christian Hartmann; Enggaard, Lisbeth
AIM: In 2008, the Danish National Chronic Lymphocytic Leukemia Registry was founded within the Danish National Hematology Database. The primary aim of the registry is to assure quality of diagnosis and care of patients with chronic lymphocytic leukemia (CLL) in Denmark. Secondarily, to evaluate...
... 50 Wildlife and Fisheries 8 2010-10-01 2010-10-01 false Registry process. 600.1410 Section 600.1410 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND ATMOSPHERIC... United States § 600.1410 Registry process. (a) A person may register through the NMFS web site at www...
... be shown where required on labels and markings of containers or cases filled at the wine premises... OF THE TREASURY LIQUORS WINE Establishment and Operations Application § 24.115 Registry number. Upon..., bonded wine cellar, or taxpaid wine bottling house. The registry number will be used in all...
Jørgensen, Marit Eika; Kristensen, Jette K.; Husted, Gitte Reventlov
Aim of the database: The aim of the Danish Adult Diabetes Registry (DADR) is to provide data from both the primary health care sector (general practice [GP]) and the secondary sector (specialized outpatient clinics) to assess the quality of treatment given to patients with diabetes. The indicators...... represent process and outcome indicators selected from the literature. Study population: The total diabetes population in Denmark is estimated to be ∼300,000 adult diabetes patients. Approximately 10% have type 1 diabetes, which is managed mainly in the secondary sector, and 90% have type 2 diabetes......, glucose-, blood pressure-, and lipid-lowering treatment (yes/no), insulin pump treatment (yes/ no), and date of last eye and foot examination. Descriptive data: In 2014, the annual report included data regarding over 38,000 patients from outpatient clinics, which is assumed to have included almost all...
Schjødt, Inge; Nakano, Anne; Egstrup, Kenneth
AIM OF DATABASE: The aim of the Danish Heart Failure Registry (DHFR) is to monitor and improve the care of patients with incident heart failure (HF) in Denmark. STUDY POPULATION: The DHFR includes inpatients and outpatients (≥18 years) with incident HF. Reporting to the DHFR is mandatory......: The main variables recorded in the DHFR are related to the indicators for quality of care in patients with incident HF: performance of echocardiography, functional capacity (New York Heart Association functional classification), pharmacological therapy (angiotensin converting enzyme/angiotensin II...... antagonist inhibitors, beta-blockers, and mineralocorticoid receptor antagonist), nonpharmacological therapy (physical training, patient education), 4-week readmission rate, and 1-year mortality. Furthermore, basic patient characteristics and prognostic factors (eg, smoking and alcohol) are recorded...
Harlan Carvey brings readers an advanced book on Windows Registry - the most difficult part of Windows to analyze in forensics! Windows Registry Forensics provides the background of the Registry to help develop an understanding of the binary structure of Registry hive files. Approaches to live response and analysis are included, and tools and techniques for postmortem analysis are discussed at length. Tools and techniques will be presented that take the analyst beyond the current use of viewers and into real analysis of data contained in the Registry. This book also has a DVD containing tools, instructions and videos.
Richard Matthew G
Full Text Available Abstract Introduction Access to governmental and international nongovernmental sources of health care within eastern Myanmar's conflict regions is virtually nonexistent. Historically, under these circumstances effective care for the victims of trauma, particularly landmine injuries, has been severely deficient. Recognizing this, community-based organizations (CBOs providing health care in these regions sought to scale up the capacity of indigenous health workers to provide trauma care. Case description The Trauma Management Program (TMP was developed by CBOs in cooperation with a United States-based health care NGO. The goal of the TMP is to improve the capacity of local health workers to deliver effective trauma care. From 2000 to the present, international and local health care educators have conducted regular workshops to train indigenous health workers in the management of landmine injuries, penetrating and blunt trauma, shock, wound and infection care, and orthopedics. Health workers have been regularly resupplied with the surgical instruments, supplies and medications needed to provide the care learnt through TMP training workshops. Discussion and Evaluation Since 2000, approximately 300 health workers have received training through the TMP, as part of a CBO-run health system providing care for approximately 250 000 internally displaced persons (IDPs and war-affected residents. Based on interviews with health workers, trauma registry inputs and photo/video documentation, protocols and procedures taught during training workshops have been implemented effectively in the field. Between June 2005 and June 2007, more than 200 patients were recorded in the trauma patient registry. The majority were victims of weapons-related trauma. Conclusion This report illustrates a method to increase the capacity of indigenous health workers to manage traumatic injuries. These health workers are able to provide trauma care for otherwise inaccessible
Schwemer, Sebastian Felix
The link of lawful domain names to unlawful content is a phenomenon that until recently has not been very topical. Traditionally, domain registries have been off the radar of content-related debates. Enforcement efforts, public discourse and academic research have focused on other intermediaries...... such as Internet access service providers, hosting platforms, and websites that link to content. This article shows that in recent years, however, that the (secondary) liability of domain registries and registrars, and more specifically country code top-level domain registries (ccTLDs) for website content, has...... been tested in several EU Member States. The article investigates tendencies in the national lower-court jurisprudence and explores to what extent the liability exemption regime of the E-Commerce Directive applies to domain registries. The analysis concludes that whereas domain registries fall under...
Benson, Kevin; Plante, Ray; Auden, Elizabeth; Graham, Matthew; Greene, Gretchen; Hill, Martin; Linde, Tony; Morris, Dave; O`Mullane, Wil; Rixon, Guy; Stébé, Aurélien; Andrews, Kona; Benson, Kevin; Plante, Ray
Registries provide a mechanism with which VO applications can discover and select resources--e.g. data and services--that are relevant for a particular scientific problem. This specification defines the interfaces that support interactions between applications and registries as well as between the registries themselves. It is based on a general, distributed model composed of so-called searchable and publishing registries. The specification has two main components: an interface for searching and an interface for harvesting. All interfaces are defined by a standard Web Service Description Language (WSDL) document; however, harvesting is also supported through the existing Open Archives Initiative Protocol for Metadata Harvesting, defined as an HTTP REST interface. Finally, this specification details the metadata used to describe registries themselves as resources using an extension of the VOResource metadata schema.
Full Text Available Background: Central registry in psychiatry is being practiced in few countries and has been found useful in research and clinical management. Role of central registry has also expanded over the years. Materials and Methods: All accessible internet database Medline, Scopus, Embase were accessed from 1990 till date. Available data were systematically reviewed in structured manner and analyzed. Results: Central registry was found useful in epidemiological analysis, association studies, outcome studies, comorbidity studies, forensic issue, effective of medication, qualitative analysis etc., Conclusion: Central registry proves to be effective tool in quantitative and qualitative understanding of psychiatry practice. Findings of studies from central registry can be useful in modifying best practice and evidence based treatment in psychiatry.
da Cunha-Bang, Caspar; Geisler, Christian Hartmann; Enggaard, Lisbeth; Poulsen, Christian Bjørn; de Nully Brown, Peter; Frederiksen, Henrik; Bergmann, Olav Jonas; Pulczynski, Elisa Jacobsen; Pedersen, Robert Schou; Nielsen, Linda Højberg; Christiansen, Ilse; Niemann, Carsten Utoft
In 2008, the Danish National Chronic Lymphocytic Leukemia Registry was founded within the Danish National Hematology Database. The primary aim of the registry is to assure quality of diagnosis and care of patients with chronic lymphocytic leukemia (CLL) in Denmark. Secondarily, to evaluate adherence to national guidelines and to provide source data for research purposes. All patients diagnosed with CLL in Denmark from 2008 onward are included in the registry. Patients are followed in one of nine hematology centers. All centers participate in the registry and are all obliged to collect data. Predefined data are collected at the time of diagnosis, and follow-up at the time of significant events: treatment, progression, transplantation, and death. Parameters included in the International Workshop on Chronic Lymphocytic Leukaemia criteria for diagnosis, and for decision on treatment initiation as well as characteristics included in the CLL International Prognostic Index are collected. To ensure full coverage of Danish CLL patients in the registry, both continuous queries in case of missing data, and cross-referencing with the Danish National Patient Registry are performed. Data from the registry are published in an annual report summarizing the collected data, the overall survival for yearly cohorts, and the degree of data coverage. Per year approximately 450 new patients with CLL are registered in the registry, cumulative as of July 1, 2015, 3,082 patients have been registered. The Danish National CLL Registry is based within the Danish National Hematology Database. The registry covers a cohort of all patients diagnosed with CLL in Denmark since 2008. It forms the basis for quality assessment of CLL treatment in Denmark and offers a unique opportunity for population-based research.
Alberdi, F; García, I; Atutxa, L; Zabarte, M
Major injury is the sixth leading cause of death worldwide. Among those under 35 years of age, it is the leading cause of death and disability. Traffic accidents alone are the main cause, fundamentally in low- and middle-income countries. Patients over 65 years of age are an increasingly affected group. For similar levels of injury, these patients have twice the mortality rate of young individuals, due to the existence of important comorbidities and associated treatments, and are more likely to die of medical complications late during hospital admission. No worldwide, standardized definitions exist for documenting, reporting and comparing data on severely injured trauma patients. The most common trauma scores are the Abbreviated Injury Scale (AIS), the Injury Severity Score (ISS) and the Trauma and Injury severity Score (TRISS). Documenting the burden of injury also requires evaluation of the impact of post-trauma impairments, disabilities and handicaps. Trauma epidemiology helps define health service and research priorities, contributes to identify disadvantaged groups, and also facilitates the elaboration of comparable measures for outcome predictions. Copyright © 2014 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.
Jordan, G.H.; Gilbert, D.A.
We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved. 38 references.
Full Text Available Trauma is the most common non-obstetrical cause of death in pregnant women. Pregnancy must always be suspected in any female trauma patient of childbearing age until proved otherwise. Unique changes in anatomy and physiology that takes place during pregnancy alter the pathophysiology and location of maternal injuries in pregnancy, which may be significantly different from the non-pregnant state. Trauma from road traffic accidents, falls and domestic violence are the most common causes of abdominal blunt trauma. As pregnancy progresses, the change of accidental injury increases. Head and neck injuries, respiratory failure, and hypovolemic shock constitute the most frequent causes of trauma related maternal death in pregnancy. Even the pregnant woman with minor injuries should be carefully observed. Initial management is directed at resuscitation and stabilization of the mother that takes precedence over that of the fetus, unless vital signs cannot be maintained and perimortem cesarean section decided upon. Fetal monitoring should be maintained after satisfactory resuscitation and stabilization of the mother. Preventive measures include proper seat belt use and identifying and counseling victims of suspected domestic violence.
Full Text Available The complex records of the District Land Registry in Cracow contain 916 j. a. records and books – 14 mb and 595 j. map. The most important part of the complex are documents from the Faculty of Agricultural Devices concerning aspects connected with conducting agricultural reform. Statistical materials that relate to large secular and church land ownership are next part of the complex records. They are gathered mainly to establish land supply which can be used to allotment. The separate group of records are matters concerning aspects of land turnover. These are land registries’ permissions for part and entirely sale the properties for one buyer. Materials concerning aspects of financing agri-cultural reform on the Małopolska Voivodeship ought to be searched at the Administra-tive Faculty. A very essential supplement for upper mentioned records is the set of 573 maps and the District Land Registry in Cracow’ plans. The news included in mentioned documents of the District Land Registry in Cracow have an invaluable value, not only for people engaged in polish village issues in the XIX and XX centuary, but they are very es-sential saurce of information for judical and economic purposes. It’s worth remembering of reaching for records of the Provincial Office in Cracow while using with land registry documents, too. There are a lot of materials concerning land registries organization and aspects connected with land allotment and join.
Mansouri, Mohammad Reza; Hosseini, Mona; Mohebi, Masoumeh; Alipour, Fateme; Mehrdad, Ramin
Occupational eye injuries are among the major causes of ocular trauma and can cause severe visual impairment, with even minor injuries incurring considerable financial costs due to work absenteeism. This study was designed to evaluate the epidemiology of eye trauma and the role of occupational injuries at Farabi Eye Hospital, which is the largest eye hospital in Iran. In this prospective, cross-sectional study, 822 eyes from 768 trauma patients presenting to Farabi Eye Hospital were enrolled in the study. The Birmingham Eye Trauma Terminology System and the United States Eye Injury Registry model were adopted as the basis for the study questionnaire. The questionnaires were completed through in-person interviews and comprehensive ocular examinations. The mean age of ocular trauma patients was 31.11 years, and 685 (89.2%) patients were male. Of all eye injuries, 73.7% were work-related. Only 2.2% of the patients were wearing safety goggles at the time of injury. History of previous eye trauma was positive in 44.3% of cases. An Ocular Trauma Score 3 or more was present in 4% of patients. Work-related eye trauma is the major cause of eye injury in Iran and most often occurs as a result of the lack of proper eye protection. Most work-related eye injury patients are young men.
Full Text Available Abstract Preventable trauma deaths are defined as deaths which could be avoided if optimal care has been delivered. Studies on preventable trauma deaths have been accomplished initially with panel reviews of pre-hospital and hospital charts. However, several investigators questioned the reliability and validity of this method because of low reproducibility of implicit judgments when they are made by different experts. Nevertheless, number of studies were published all around the world and ultimately gained some credibility, particularly in regions where comparisons were made before and after trauma system implementation with a resultant fall in mortality. During the last decade of century the method of comparing observed survival with probability of survival calculated from large trauma registries has obtained popularity. Preventable trauma deaths were identified as deaths occurred notwithstanding a high calculated probability of survival. In recent years, preventable trauma deaths studies have been replaced by population-based studies, which use databases representative of overall population, therefore with high epidemiologic value. These databases contain readily available information which carry out the advantage of objectivity and large numbers. Nowadays, population-based researches provide the strongest evidence regarding the effectiveness of trauma systems and trauma centers on patient outcomes.
Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura A.
Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will this in some way impair their responding to current or ongoing trauma? The paper addresses practical strategies for implementing one evidence-based ...
Huarcaya Godoy, Madison
El presente trabajo de investigación: "Aplicación del Mentoring para lograr una gestión eficiente en la Municipalidad Provincial del Callao", es producto de un estudio y análisis de la gestión pública de la Municipalidad Provincial del Callao, con el objeto de determinar la eficiencia en el desempeño de los colaboradores, de niveles jerárquicos, órganos intermedios y órganos operativos de la Municipalidad Provincial del Callao a fin de mejorar la gestión de la provincia. El resultado, de la p...
V Trichur Ramakrishnan
Full Text Available Resuscitation of a severely traumatised patient with the administration of crystalloids, or colloids along with blood products is a common transfusion practice in trauma patients. The determination of this review article is to update on current transfusion practices in trauma. A search of PubMed, Google Scholar, and bibliographies of published studies were conducted using a combination of key-words. Recent articles addressing the transfusion practises in trauma from 2000 to 2014 were identified and reviewed. Trauma induced consumption and dilution of clotting factors, acidosis and hypothermia in a severely injured patient commonly causes trauma-induced coagulopathy. Early infusion of blood products and early control of bleeding decreases trauma-induced coagulopathy. Hypothermia and dilutional coagulopathy are associated with infusion of large volumes of crystalloids. Hence, the predominant focus is on damage control resuscitation, which is a combination of permissive hypotension, haemorrhage control and haemostatic resuscitation. Massive transfusion protocols improve survival in severely injured patients. Early recognition that the patient will need massive blood transfusion will limit the use of crystalloids. Initially during resuscitation, fresh frozen plasma, packed red blood cells (PRBCs and platelets should be transfused in the ratio of 1:1:1 in severely injured patients. Fresh whole blood can be an alternative in patients who need a transfusion of 1:1:1 thawed plasma, PRBCs and platelets. Close monitoring of bleeding and point of care coagulation tests are employed, to allow goal-directed plasma, PRBCs and platelets transfusions, in order to decrease the risk of transfusion-related acute lung injury.
Cohen, Judith A.; Mannarino, Anthony P.; Murray, Laura K.
Many youth experience ongoing trauma exposure, such as domestic or community violence. Clinicians often ask whether evidence-based treatments containing exposure components to reduce learned fear responses to historical trauma are appropriate for these youth. Essentially the question is, if youth are desensitized to their trauma experiences, will…
Alvarado, Camilo; Vargas, Fernando; Guzmán, Fernando; Zárate, Alejandro; Correa, José L.; Ramírez, Alejandro; Quintero, Diana M.; Ramírez, Erika M.
El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestacio...
Meka Srinivasa Rao
Full Text Available The purpose of this article is to depict the spectrum of scrotal injuries in blunt trauma. Scrotal injuries are not very common and are mostly due to blunt trauma from direct injury, sports injuries or motor vehicle accidents. To minimize complications and ensure testicular salvage, rapid and accurate diagnosis is necessary. High-resolution USG is the investigation of choice, as it is readily available, accurate and has been seen to improve outcomes. An understanding of and familiarity with the sonographic appearance of scrotal injuries on the part of the radiologist/sonographer is therefore of key importance.
Operation Brain Trauma Therapy. J Trauma 71(1 Suppl):S15-24, 2011. 2. Diaz-Arrastia R, Kochanek PM, Bergold P, Kenney K, Marx C, Grimes JB, Loh Y...severe traumatic brain injury. J. Neurotrauma 29, 1096–1104. 66. Diaz-Arrastia, R., Kochanek, P.M., Bergold, P., Kenney K, Marx CE, Grimes CJ, Loh LT...Proc. Nat. Acad. Sci. U.S.A. 96, 15268–15273. 4. Mendoza-Torreblanca, J.G., Vanoye- Carlo , A., Phillips-Farfan, B.V., Carmona-Aparicio, L., and
Cohen, Mitchell J; Christie, S Ariane
Coagulopathy is common after injury and develops independently from iatrogenic, hypothermic, and dilutional causes. Despite considerable research on the topic over the past decade, trauma-induced coagulopathy (TIC) continues to portend poor outcomes, including decreased survival. We review the current evidence regarding the diagnosis and mechanisms underlying trauma induced coagulopathy and summarize the debates regarding optimal management strategy including product resuscitation, potential pharmacologic adjuncts, and targeted approaches to hemostasis. Throughout, we will identify areas of continued investigation and controversy in the understanding and management of TIC. Copyright Â© 2016 Elsevier Inc. All rights reserved.
Poffley, Alison; Thomas, Emma; Grace, Sherry L; Neubeck, Lis; Gallagher, Robyn; Niebauer, Josef; O'Neil, Adrienne
Introduction Despite cardiac rehabilitation being recommended in clinical practice guidelines internationally these services are underutilised, programmes are not standardised and quality improvement methods and outcomes are rarely published. National registries are an important strategy to characterise service delivery, quality and outcomes, yet the number, type and components of national cardiac rehabilitation registries have not been reported. Aims To identify and describe national and international cardiac rehabilitation registries, and summarise their key features. Methods We systematically reviewed the literature reporting on cardiac rehabilitation registries at a national and international level. A search of four databases was conducted in July 2016, with two reviewers independently screening titles/abstracts and full texts for inclusion. Data were extracted from included studies, independently checked by a second reviewer and synthesised qualitatively. Results Eleven articles were included in the review comprising seven national registries and one international registry (of 12 European countries) for a total sample of 265,608 patients. Data were most commonly provided to the registry by a web-based application, and included individual-level data (i.e. sociodemographic characteristics, medical history, and clinical measurements). When reported, service-level data most commonly included wait times, programme enrolment and completion. The overarching governance, funding modes (e.g. industry ( n = 2), government ( n = 1)), and incentives for registry participation (e.g. benchmarking, financial reimbursement, or mandatory requirement) varied widely. Conclusion The use of national and international registries for characterising cardiac rehabilitation and providing a benchmark for quality improvement is in its early stages but shows promise for national and global benchmarking.
Joaquín Martínez Pino
Full Text Available Recoge este artículo la labor desarrollada por la Comisión Provincial de Monumentos de Murcia desde su creación en 1844 hasta su reorganización en 1865. Procura este estudio también plasmar las actividades llevadas a cabo por la Comisión Científico Artística de Murcia, como organismo precedente de las Comisiones de Monumentos.This article puts forward the work developed by the Provincial Commission on Monuments of Murcia (Spain since it was created in 1844 until its reorganization in 1865. This research also tries to capture the activities carried out by the Scientific Artistic Commission of Murcia (Spain, as the predecessor of the Commission on Monuments.
Hu, Song Bo; Wang, Fang; Yu, Chuan Hua
To assess the data quality and estimate the provincial infant mortality rate (1q0) from China's sixth census. A log-quadratic model is applied to under-fifteen data. We analyze and compare the average relative errors (AREs) for 1q0 between the estimated and reported values using the leave-one-out cross-validation method. For the sixth census, the AREs are more than 100% for almost all provinces. The estimated average 1q0 level for 31 provinces is 12.3‰ for males and 10.7‰ for females. The data for the provincial 1q0 from China's sixth census have a serious data quality problem. The actual levels of 1q0 for each province are significantly higher than the reported values. Copyright © 2015 The Editorial Board of Biomedical and Environmental Sciences. Published by China CDC. All rights reserved.
Ye, Z.; Xiang, H.
The paper discusses the basic principles and the problem solutions during the design and implementation of the mobile GIS system, and base on the research result, we developed the General Provincial Situation Visualization System Based on iOS of Shandong Province. The system is developed in the Objective-C programming language, and use the ArcGIS Runtime SDK for IOS as the development tool to call the "World-map Shandong" services to implement the development of the General Provincial Situation Visualization System Based on iOS devices. The system is currently available for download in the Appstore and is chosen as the typical application case of ESRI China ArcGIS API for iOS.
Full Text Available Beginning in 1909, mainland Chinese governments routinely held elections, and lawmakers devoted considerable resources to writing and revising election laws. The earliest elections, held under the late Qing and the early Republic, utilized laws based on restricted electorates and indirect voting. By contrast, election laws designed during the provincial autonomy movement of the 1920s and the post-1927 Nationalist government featured direct voting in elections with (near-universal adult suffrage. Each of these two systems of electoral law incorporated different elements of foreign electoral practice with concerns and ideas that arose from the experiences and ideals of late imperial Chinese political thought. The transition between these two systems highlights the surprising influence of the short-lived provincial autonomy movement on the legal structures of the centralized one-party states that followed.
Haugaard, Michael V; Wettergren, André; Hillingsø, Jens Georg
BACKGROUND: Pancreatic trauma in children is a serious condition with high morbidity. Blunt traumatic pancreatic lesions in children can be treated non-operatively or operatively. For less severe, grade I and II, blunt pancreatic trauma a non-operative or conservative approach is usually employed....... Currently, the optimal treatment, of whether to perform operative or non-operative treatment of severe, grade III to V, blunt pancreatic injury in children is unclear. OBJECTIVES: To assess the benefits and harms of operative versus non-operative treatment of blunt pancreatic trauma in children. SEARCH...... proceeding abstracts and clinical trials registries. We conducted the search on the 21 June 2013. SELECTION CRITERIA: We planned to select all randomised clinical trials investigating non-operative versus operative treatment of blunt pancreatic trauma in children, irrespective of blinding, publication status...
Represión en Sevilla: el tribunal de responsabilidades políticas. Fondo del Archivo Histórico Provincial de Sevilla (Repression in Seville: the court of political responsibilities. Fund of the Historical Provincial Archive of Seville)
Rosa Félix, Antonio
... situación anterior a la reforma agraria.Abstract: The Historical Provincial Archive of Seville keeps a collection of files record of Political Responsibilities, proceeding from the Court of The First Instance and Sanlúcar's Instruction...
Li, Laura; Koranne, Rahul
There is little data on the long-term health outcomes of patients with neurological conditions treated at long-term acute care specialty hospitals. In order to learn more about these patients and the most effective way to care for them, Bethesda Hospital in St. Paul created a neuroscience research registry. The registry's target population is patients with complex neurological conditions such as aneurysm or intracranial bleed, stroke, seizures, delirium and confusion and traumatic brain injury. This article describes the development of the registry, which has enrolled 857 patients thus far, and what is being learned about those patients.
Hindar, A.; Henriksen, A.
Calculations of critical loads for inputs of strong acids to lakes and exceedances of critical load can be a useful tool for the management of polluted areas. In Sudbury, Canada, large emissions of sulfur dioxide have resulted in widespread lake acidification in parts of northeastern Canada. Due to its vicinity to Sudbury, extensive lake acidification and fish loss has occurred in the Killarney Provincial Park. We have linked measured water quality to critical loads and strong acid deposition...
Nielsen, Thomas Alexander Sick
This paper presents the results from a detailed study of the land use ? transport connection, with special emphasis on the location of residences, in the context of a larger Danish provincial city (the city of Aalborg with approx. 120.000 inhabitants, situated in North Jutland). The study...... was carried out as a part of the authors PhD-work and as part of the research programme: Transportation and urban structure at Aalborg University....
ZHOU Li¡¯an; Tao, Jing
Using a panel data at the provincial level during the period of 1989–2004, this paper examines the effects of social and economic factors such as government scale, privatization, openness, and education on regional corruption. Applying a fixed-effect model and IV estimation, we find that government size positively affects the incidence rate of corruption, and the effect becomes larger with the increase in the size of the core department of the government. 1% increase in the core department of...
van Gijn, Jan; Gijselhart, Joost P
Dirk Hoogendoorn (1914-1990) was a solo general practitioner in the village of Wijhe (eastern part of the Netherlands) from 1941, during the time of the German occupation, until 1971. From the very beginning, he combined his practice with the recording of disease patterns. He first concentrated on infectious diseases, especially whooping cough, which was the subject of his doctoral thesis. He later set up registries in two regional hospitals. When his initiative expanded to a national organisation, he became its advisor. He nonetheless continued to produce statistics on a variety of disorders as well as on surgical procedures, even more so after his retirement. The subjects ranged from traffic accidents and tonsillectomies to the discrepancy between increased body height and the unchanging height of the tennis net, but he had the most affinity with the practice of obstetrics. He stirred up much emotion by showing that a decrease in perinatal mortality was proceeding slower in the Netherlands than in other European countries, especially by suggesting a causal relationship between this lag and the high rate of Dutch home deliveries. This debate has continued to this day.
Mitchell, Rebecca J; Curtis, Kate; Chong, Shanley; Holland, Andrew J A; Soundappan, S V S; Wilson, Kellie L; Cass, Daniel T
Paediatric trauma centres seek to optimise the care of injured children. Trends in state-wide paediatric care and outcomes have not been examined in detail in Australia. This study examines temporal trends in paediatric trauma outcomes and factors influencing survival and length of stay. A retrospective review was conducted using data from the NSW Trauma Registry during 2003-2008 for children aged 15 years and younger who were severely injured (injury severity score >15). To examine trauma outcomes descriptive statistics and multivariable logistic and linear regression were conducted. There were 1138 children severely injured. Two-thirds were male. Road trauma and falls were the most common injury mechanisms and over one-third of incidents occurred in the home. Forty-eight percent of violence-related injuries were experienced by infants aged less than 1 year. For the majority of children definitive care was provided at a paediatric trauma centre, but less than one-third of children were taken directly to a paediatric trauma centre post-injury. Children who received definitive treatment at a paediatric trauma centre had between 3 and 6 times higher odds of having a survival advantage than if treated at an adult trauma centre. The number of severe injury presentations to the 14 major trauma centres in NSW remains constant. It is possible that injury prevention measures are having a limited effect on severe injury in NSW. This research provides stimulus for change in the provision and co-ordination in the delivery of trauma care for injured children. Copyright © 2011 Elsevier Ltd. All rights reserved.
Quick, J.C.; Brill, T.
We observe a 1.3 kg C/net GJ variation of carbon emissions due to inertinite abundance in some commercially available bituminous coal. An additional 0.9 kg C/net GJ variation of carbon emissions is expected due to the extent of coalification through the bituminous rank stages. Each percentage of sulfur in bituminous coal reduces carbon emissions by about 0.08 kg C/net GJ. Other factors, such as mineral content, liptinite abundance and individual macerals, also influence carbon emissions, but their quantitative effect is less certain. The large range of carbon emissions within the bituminous rank class suggests that rank- specific carbon emission factors are provincial rather than global. Although carbon emission factors that better account for this provincial variation might be calculated, we show that the data used for this calculation may vary according to the methods used to sample and analyze coal. Provincial variation of carbon emissions and the use of different coal sampling and analytical methods complicate the verification of national greenhouse gas inventories. Published by Elsevier Science B.V.
Schmidt, Simone; Duangdala, Phouvieng; Saysanasongkham, Bounnack; Sabir, Hemmen; Brenner, Sebastian; Schmid, Manuel; Kuehn, Thomas; Hoehn, Thomas
The aim of this study was to identify the causes and incidences of neonatal diseases and deaths in five provincial hospitals in People's Democratic Republic of Laos retrospectively for the years 2010-12. Data of neonatal patients were collected before a 3-year-training program for medical and nursing staff involved in the care of newborn infants in the provincial and associated district hospitals. In the years 2010-12, a total of 1673 neonatal patients were treated in the provincial hospitals. The reasons of treatment were as follows: 48% infections, 17% complications of prematurity, 14% intrapartum-related complications and 9% other, not categorized diseases. The average mortality rate in all hospitals was 6.5%. The main causes of death were complications because of prematurity, infectious diseases and asphyxia. These data could be the basis for any teaching program aimed at reducing neonatal mortality. Furthermore, they enable an evaluation of the ongoing teaching program. © The Author . Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Full Text Available The relationship between urbanization, economic growth, and water use change is one of the key issues for China’s sustainable development, as rapid urbanization and continuous economic growth are accompanied by a steady water stress. Thus, we applied a cointegration test and a VECM (vector error correction model Granger causality test to investigate the causal relationship between the urbanization level, the economic development level, and the total water use in China and its 31 provincial administrative regions during 1997–2013. Results show that the three indicators have a long-run equilibrium relationship in most provincial administrative regions in China. However, the short-run effects and Granger causal relationship are insignificant for China and most provincial administrative regions. Therefore, that an idea such as urbanization as the engine or major driving force of economic growth, and that China’s urbanization and economic growth will bring a water crisis and will be strongly constrained by water resources, might be properly weakened. Targeted and relatively separate policies should be emphasized more for the coordinated development of China’s urbanization, economy, and water resources.
Kort, Rodney; Stuart, Allison J; Bontovics, Erika
The SARS crisis revealed critical gaps in Ontario's health emergency response capacity, and identified, in the starkest terms possible, the need for improved emergency response planning. This article reviews the development of the Ontario Health Plan for an Influenza Pandemic (OHPIP), released in June 2005. Some key points arising from the provincial planning process include the necessity to: ensure a broad and inclusive development process; ensure the pandemic plan identifies: 1) clear roles and responsibilities of federal, provincial/territorial and municipal levels of government, 2) the approach to occupational health and safety issues and ethical decision-making, 3) a communications strategy linking all affected sectors and levels of government and health sector; 4) any commitments to antiviral stockpiling, vaccine and antiviral allocation and use, and an approach for drug delivery from provincial stockpiles to local public health units; 5) health human resource management and supplementation; and 6) key programs/services to be scaled back to maximize surge capacity; address best practices (e.g., involve all sectors of the health care system at the outset, acquire strategic expertise, coordinate/advocate with broader emergency response system, etc); and, outline future stages that include strengthening the delivery of clinical care to influenza cases; clarifying the role of primary care practitioners during a pandemic; leveraging Ontario's significant e-Health investments.
MacKenzie, Colin; Lippert, Freddy
Initial assessment and management of severely injured patients may occur in a specialized area of an emergency department or in a specialized area of a trauma center. The time from injury until definitive management is of essence for survival of life-threatening trauma. The initial care delivered...... injured patients after these patients reach a hospital emergency department or a trauma center....
Gláucio Ary Dillon Soares
Full Text Available As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se devem ao tipo de trauma. Testamos a hipótese de que as mulheres são mais suscetíveis à desordem de estresse pós-trauma (DEPT numa situação traumática comum, usando dados qualitativos e quantitativos. Comparamos os sintomas do trauma e as percepções sobre o significado da perda de seus entes queridos. A amostra, de 425 mulheres (62% e 265 homens (38%, foi retirada de uma lista de parentes de pessoas que sofreram morte violenta na cidade do Rio de Janeiro. Incluímos trinta relatos de parentes e amigos próximos das vítimas diretas. Os resultados revelaram que 54% das mulheres e 41% dos homens tiveram o cotidiano alterado depois da morte de um parente/amigo. Há diferenças estatisticamente significativas nos problemas de saúde e na diversão. Essa área foi a mais afetada, atingindo metade dos entrevistados. Uma variável intimamente correlacionada com os sintomas da DEPT é o contato com o corpo: controlando a extensão do contato (fez o reconhecimento do corpo; viu, mas não reconheceu e nem viu nem reconheceu. Em cada uma dessas categorias, as mulheres foram mais afetadas do que os homens. O artigo conclui que as mulheres sentem mais as perdas do que os homens, mas que parte das diferenças não são internas aos gêneros, mas externas a eles, dependendo das interações e dos contatos pessoais.The social and psychological consequences endured by friends and relatives of people victimized by violent death (homicide, suicide or
Walther, Ashley E; Pritts, Timothy A; Falcone, Richard A; Hanseman, Dennis J; Robinson, Bryce R H
The optimal treatment facility for adolescent trauma patients is controversial. We sought to investigate risk-adjusted outcomes of adolescents treated at adult-only trauma centers (ATCs) versus pediatric-only trauma centers (PTCs) in a state system with legislated American College of Surgeons-verified institutions to determine ideal prehospital referral patterns. The Ohio Trauma Registry was queried for patients 15 years to 19 years with a length of stay (LOS) greater than 1 day at ATC (Level 1) or PTC (Levels 1 and 2) from 2008 to 2012. Race, sex, emergency department vital signs, Injury Severity Score (ISS), computed tomography, and ultrasound imaging were reviewed. Outcomes by mechanism of injury included ventilator days, intensive care unit LOS, hospital LOS, and mortality. Statistical analysis was performed using χ test, t test, and Wilcoxon rank-sum test. Propensity score-based risk adjustment matching was used to compare groups (propensity score within 0.01, ISS within 5). Of 5,793 adolescents examined, (84% blunt, 16% penetrating) 66% were treated at an ATC. In unmatched comparisons, age, ISS, vital signs, and mortality differed significantly between centers (p < 0.01). For adolescents with blunt injury, more males (71.6% vs. 66.3%, p < 0.01) and nonwhites (19.2% vs. 15.8%, p < 0.01) were seen at PTCs. For penetrating trauma, more males (88.6% vs. 50.8%, p < 0.01) and nonwhites (66.4% vs. 34.3%, p < 0.01) were admitted to ATCs. In 873 propensity-matched pairs for blunt trauma and 95 propensity-matched pairs of penetrating injuries, no differences were seen in a priori outcomes. Imaging (blunt, head computed tomography and abdominal ultrasound, p < 0.01; penetrating, abdominal ultrasound, p = 0.02) was more common at ATCs. Major outcome differences for injured adolescents do not exist between ATCs and PTCs, regardless of injury pattern. Imaging remains more prevalent at ATCs. In a state system with mandatory American College of Surgeons-verified centers
Aug 5, 1989 ... Five case reports demonstrate the value of bone scintigraphy in trauma. The bone scans clearly demonstrated fractures of the hip and pelvis that were not radiologically evident or the presence of which was doubtful, and also identified a number of unsuspected fractures in a patient with multiple injuries.
Pedersen, Bodil Maria
Our understanding of 'reactions to trauma' is dominated by concepts like Post-Traumatic Stress Disorder. The use of such concepts has been criticised but simultaneously integrated in folk-psychology. Connecting emotional and cognitive processes as well as acts - such as in gendered practices - to...
Pedersen, Bodil Maria
Our understanding of 'reactions to trauma' is dominated by concepts like Post-Traumatic Stress Disorder. The use of such concepts has been criticised but simultaneously integrated in folk-psychology. Connecting emotional and cognitive processes as well as acts - such as in gendered practices...
life are lost annually from trauma than malignant disease, heart disease, and AIDS combined, and by the ... diffused and rapidly spreading condition affecting many people in anyone region at the same time and tending ... upon inadequate and overcrowded methods of transportation. TABLE I. INTERPERSONAL VIOLENCE ...
National Child Traumatic Stress Network, 2010
Early childhood trauma generally refers to the traumatic experiences that occur to children aged 0-6. Because infants' and young children's reactions may be different from older children's, and because they may not be able to verbalize their reactions to threatening or dangerous events, many people assume that young age protects children from the…
finally revealed testicular torsion. Remarkably, the testis was viable and the finding of a hematoma of the epididymis suggested a history of trauma which was not forthcoming from the patient. The acute scrotum demands expeditious attention and the clinician must aim to reach a definitive diagnosis in the shortest time ...
OBTT.85 However, blunting of hyperglycemia that is seen in CNS insults could play some role in the observed benefit. 18 Beam Balance Days Post...62. Abrahamson EE, Ikonomovic MD, Dixon CE, DeKosky ST. Simvastatin therapy prevents brain trauma- induced increases in β-amyloid peptide levels
Gelen Welch Ruiz
Full Text Available Se realizó un estudio descriptivo de tipo retrospectivo longitudinal cuyo universo estuvo constituido por 72 ojos de 72 pacientes con traumatismos oculares mecánicos que fueron hospitalizados en el Hospital Militar Central “Dr. Carlos J. Finlay” desde enero de 1999 hasta enero de 2005. Para el análisis estadístico de la información se utilizó el programa automatizado SPSS versión 11.5 en el cual también se conformó la base de datos y se realizaron los cálculos de acuerdo con el tipo de variable analizada. Se utilizaron medidas de resumen, tendencia central y asociación estadística con un nivel de significación de p A retrospective longitudinal and descriptive study was carried out in 72 eyes from 72 patients with mechanical occular traumas, who had been hospitalized in “Dr. Carlos J. Finlay” Military Hospital from December 1999 to January 2005. For the statistical data analysis, an automated program (SPSS 11.5 version was used to create the database and estimations were made according to the variable types. Summary measures, central tendency measures and statistical association with significance level equal to p < 0.05 were employed. Males prevailed (95.8%, the average age was 30.26 years with a minimum rate of 17 years and maximum rate of 82 years. The most frequent mechanisms of trauma were aggressions (23. 6% and injures from secondary projectiles (13.9%. The anterior segment traumas were more frequent (61, 1% than posterior segment traumas (6.94%. Both segments of the eyeball were affected in 39, 1% of eyes which evinced the worst visual acuity. The most common associated injures were hyphema (54, 2% and vitreous hemorrhage (16.6%. Closed trauma (contusions were more common and most of the eyes had better final visual acuity (45, 2% with vision range of 0.6-1.0 and 26.2% with vision range of 0.59-0.1. On the other hand, eyes affected by open trauma (simple wound, contusion-wound, wound with intraocular foreign body and
Gallagher, Ryan; Dangers, Jonathan; Thornton, Stephen L
Phencyclidine (PCP) use is anecdotally associated with agitation and injury and is frequently tested for in the setting of trauma. We sought to determine characteristics of trauma patients with a PCP-positive urine immunoassay drug screen (UDS) and if they had increased levels of care or mortality. A 5-year retrospective review of a level 1 trauma center's trauma registry identified patients with a PCP-positive UDS. This group was then compared with 2 randomly selected control groups from the same trauma registry which were matched for age and sex but differed in that one had no sEtOH detected and a negative UDS (drug-free group) whereas the other had sEtOH or an other-than-PCP-positive UDS (other-drug group). Subgroup analysis was performed comparing PCP-positive patients with undetectable sEtOH with other-drug patients with undetectable sEtOH. The registry contained 7770 patients of which 156 met inclusion criteria. The mean age was 33.4years (range, 19-63), and 77% were male (n=121). When compared with the other-drug group, the PCP-positive group had significantly lower injury severity score, rates of intensive care unit admission, and sEtOH. No difference was seen in vital signs, mechanism of injury, ventilator days, intensive care unit days, total hospital days, disposition, or mortality between the 3 groups. This remained true even when subgroups with negative sEtOH were compared. This study suggests that a PCP-positive UDS in the setting of trauma is not associated with increased level of care, length of stay, or mortality. Copyright © 2016 Elsevier Inc. All rights reserved.
This GIS dataset contains data on power plants, based on the Energy Information Administration's EIA-860 dataset and supplemented with data from EPA's Facility Registry Service (FRS) compiled from various EPA programs.
U.S. Environmental Protection Agency — This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link...
U.S. Environmental Protection Agency — This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link...
Department of Veterans Affairs — The Veterans Affairs Central Cancer Registry (VACCR) receives and stores information on cancer diagnosis and treatment constraints compiled and sent in by the local...
U.S. Department of Health & Human Services — Linking Medicare, Medicaid, and Cancer Registry Data to Study the Burden of Cancers in West Virginia In the United States, the elderly carry an unequal burden of...
U.S. Environmental Protection Agency — This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of non-hazardous waste...
U.S. Environmental Protection Agency — This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link...
U.S. Environmental Protection Agency — This web feature service contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of hazardous waste...
U.S. Environmental Protection Agency — This dataset contains location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of facilities that link to the Oil...
Hardman, S.; Hughes, J. S.; Joyner, R.; Crichton, D.; Law, E.
The PDS Tool Registry enables search and discovery of tools, services, and APIs for working with data following the PDS standards. Tools and services have been submitted from the broad PDS community and multiple institutions.
U.S. Environmental Protection Agency — This web feature service consists of location and facility identification information from EPA's Facility Registry Service (FRS) for the subset of sites that link to...
U.S. Environmental Protection Agency — This web feature service contains location and facility identification information from EPA's Facility Registry System (FRS) for the subset of facilities that link...
Kristensen, Anders Elgaard; Larsen, Jacob Moesgaard; Nielsen, Jens Cosedis
AIMS: The validity of registry data on defibrillator lead performance is described only sparsely, despite its clinical importance. This study investigated the validity of defibrillator lead performance registry data in a nationwide and population-based registry. METHODS AND RESULTS: We identified.......9% (95% CI: 85.2-90.2%) with a κ value of 0.82 (95% CI:0.78-0.86) representing an almost perfect match. CONCLUSION: The validity of data on defibrillator lead performance recorded in the DPIR is excellent for the specific types of lead intervention and good for the specific reasons for defibrillator lead...... intervention. The validity of the less detailed overall reasons for lead interventions commonly used to report lead performance is also excellent. These findings indicate high registry data quality appropriate for scientific analysis and industry-independent post-marketing surveillance....
Full Text Available In response to the growing role of personal support workers (PSWs in the delivery of health care services to Ontarians, the Ontario government has moved forward with the creation of a PSW registry. This registry will be mandatory for all PSWs employed by publicly funded health care employers, and has the stated objectives of better highlighting the work that PSWs do in Ontario, providing a platform for PSWs and employers to more easily access the labour market, and to provide government with information for human resources planning. In this paper we consider the factors that brought the creation of a PSW registry onto the Ontario government’s policy agenda, discuss how the registry is being implemented, and provide an analysis of the strengths and weaknesses of this policy change.
U.S. Environmental Protection Agency — The Substance Registry Services (SRS) is the authoritative resource for basic information about substances of interest to the U.S. EPA and its state and tribal...
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Swanson, Jordan; Oppenheimer, Adam; Al-Mufarrej, Faisal; Pet, Mitchell; Arakawa, Chris; Cunningham, Michael; Gruss, Joseph; Hopper, Richard; Birgfeld, Craig
Premature cranial suture fusion may prevent neonatal skull malleability during birth, increasing the risk of unplanned cesarean delivery and neonatal birth trauma caused by cephalopelvic disproportion. We sought to determine the incidence of perinatal maternofetal complications in cases of craniosynostosis. Records of children presenting with nonsyndromic craniosynostosis to a tertiary pediatric hospital from 1996 to 2012 were reviewed retrospectively with focus on birth history and birth-related complications. Six hundred eighteen births were reviewed. Rates of cesarean delivery among mothers of children with craniosynostosis [n = 201 (32.5 percent)] exceeded the overall regional rate of 24.5 percent (OR, 1.50; p < 0.0001). Unplanned cesarean delivery occurred in 19.7 percent of births, and were most associated with nulliparous mothers, breech fetal presentations, and lambdoid or multisuture synostosis patterns. Eleven neonates (1.8 percent) exhibited cranial birth trauma, including cephalohematoma and subgaleal hematoma. Neonates with sagittal or multisuture synostosis patterns were more likely to suffer birth trauma and had a higher mean head circumference than those who did not (81st versus 66th percentile, p < 0.05). In the setting of craniosynostosis, birth trauma is increased-for mothers in the form of increased cesarean delivery risk, and for fetuses in the form of subgaleal and subperiosteal perinatal bleeding. Difficult maternal labor may be mediated especially by multisuture or lambdoid synostosis, whereas fetal birth trauma may be mediated to a greater extent by large head size. Prenatal diagnosis of craniosynostosis could influence decision-making in the management of labor. Risk, IV.
Gustavo P. Fraga
Full Text Available OBJECTIVE: The purpose of this series is to report our experience in managing ureteral trauma, focusing on the importance of early diagnosis, correct treatment, and the impact of associated injuries on the management and morbid-mortality. MATERIALS AND METHODS: From January 1994 to December 2002, 1487 laparotomies for abdominal trauma were performed and 20 patients with ureteral lesions were identified, all of them secondary to penetrating injury. Medical charts were analyzed as well as information about trauma mechanisms, diagnostic routine, treatment and outcome. RESULTS: All patients were men. Mean age was 27 years. The mechanisms of injury were gunshot wounds in 18 cases (90% and stab wounds in two (10%. All penetrating abdominal injuries had primary indication of laparotomy, and neither excretory urography nor computed tomography were used in any case before surgery. The diagnosis of ureteric injury was made intra-operatively in 17 cases (85%. Two ureteral injuries (10% were initially missed. All patients had associated injuries. The treatment was dictated by the location, extension and time necessary to identify the injury. The overall incidence of complications was 55%. The presence of shock on admission, delayed diagnosis, Abdominal Trauma Index > 25, Injury Severity Score > 25 and colon injuries were associated to a high complication rate, however, there was no statistically significant difference. There were no mortalities in this group. CONCLUSIONS: A high index of suspicion is required for diagnosis of ureteral injuries. A thorough exploration of all retroperitoneal hematoma after penetrating trauma should be an accurate method of diagnosis; even though it failed in 10% of our cases.
Goethem, J.W.M. van [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium); Algemeen Ziekenhuis Maria Middelares, Department of Radiology, Sint-Niklaas (Belgium); Maes, Menno; Oezsarlak, Oezkan; Hauwe, Luc van den; Parizel, Paul M. [Universitair Ziekenhuis Antwerpen, University of Antwerp, Belgium, Department of Radiology, Edegem (Belgium)
Because it may cause paralysis, injury to the spine is one of the most feared traumas, and spinal cord injury is a major cause of disability. In the USA approximately 10,000 traumatic cervical spine fractures and 4000 traumatic thoracolumbar fractures are diagnosed each year. Although the number of individuals sustaining paralysis is far less than those with moderate or severe brain injury, the socioeconomic costs are significant. Since most of the spinal trauma patients survive their injuries, almost one out of 1000 inhabitants in the USA are currently being cared for partial or complete paralysis. Little controversy exists regarding the need for accurate and emergent imaging assessment of the traumatized spine in order to evaluate spinal stability and integrity of neural elements. Because clinicians fear missing occult spine injuries, they obtain radiographs for nearly all patients who present with blunt trauma. We are influenced on one side by fear of litigation and the possible devastating medical, psychologic and financial consequences of cervical spine injury, and on the other side by pressure to reduce health care costs. A set of clinical and/or anamnestic criteria, however, can be very useful in identifying patients who have an extremely low probability of injury and who consequently have no need for imaging studies. Multidetector (or multislice) computed tomography (MDCT) is the preferred primary imaging modality in blunt spinal trauma patients who do need imaging. Not only is CT more accurate in diagnosing spinal injury, it also reduces imaging time and patient manipulation. Evidence-based research has established that MDCT improves patient outcome and saves money in comparison to plain film. This review discusses the use, advantages and disadvantages of the different imaging techniques used in spinal trauma patients and the criteria used in selecting patients who do not need imaging. Finally an overview of different types of spinal injuries is given
Full Text Available AIM To estimate the incidence of Liver Trauma injuries and grade their severity of injury. To assess the factors responsible for morbidity and mortality after Liver Trauma. To study the postoperative complications and the management of Liver Trauma. MATERIALS AND METHODS The present prospective study was conducted on 100 patients who were admitted to Department of General Surgery for treatment who were managed operatively or non-operatively for abdominal trauma and having liver injury forms the material of the study. This study was conducted over a span of 24 months from June 2013 to November 2015. RESULTS Maximum number of patients are in the age group of 21-30 years (46%. 85% patients (85/100 are males and 15% of patients (15/100 are females. Lapse time of injury and admission varied from 25 minutes to 66 hours and 30 minutes. 75 % of the patients (75/100 presented within 24 hours after injury. Death rate of patients who reached hospital after 24 hours of injury was higher than the patients who reached hospital within 24 hours of injury. 28% of patients (28/100 had associated bony injuries, out of which 5% of patients (5/100 expired due to primary haemorrhage of fractured femur. More than one segment was injured in many patients. Segment V is involved commonly making 55% (55/100 of patients. Next common segment involved is segment VII, making 39% (39/100. CONCLUSION Mechanism of injury is the important factor which is responsible for morbidity in liver injury. Nonoperative management proved to be safe and effective and often has been used to treat patients with liver trauma.
Simmons, Jeffrey W; Pittet, Jean-Francois; Pierce, Bert
Trauma is the leading cause of death among people under the age of 44. Hemorrhage is a major contributor to deaths related to trauma in the first 48 h. Accordingly, the management of these patients is a time-sensitive and critical affair that anesthesiologists responsible for surgical resuscitation will face. Coagulopathy associated with trauma exists in one-third of all severely injured patients upon presentation to the hospital. Trauma patients presenting with coagulopathy have significantly higher mortality. This trauma-induced coagulopathy (TIC) must be managed adroitly in the resuscitation of these patients. Recent advancements in our understanding of TIC have led to new protocols and therapy guidelines. Anesthesiologists must be aware of these to effectively manage this form of shock. TIC driven by a combination of endogenous biological processes, as well as iatrogenic causes, can ultimately lead to the lethal triad of hypothermia, acidemia, and coagulopathy. Providers should understand how to promptly diagnose TIC and be aware of the early indicators of massive transfusion. The use of common laboratory studies and patient vital signs serve as our current guide, but the importance of each is still under debate. Thromboelastography is a tool used often in the diagnosis of TIC and can be used to guide blood product transfusion. Certain pharmaceutical strategies and non-transfusion strategies also exist, which aid in the management of hemorrhagic shock. Damage control surgery, rewarming, tranexamic acid, and 1:1:1 transfusion protocols are promising methods used to treat the critically wounded. Though protocols have been developed, controversies still exist on the optimal resuscitation strategy.
Sebastian van As A
Full Text Available Background: Childhood trauma has become a major cause of mortality and morbidity, disability and socio-economic burden and it is expected by the World Health Organization (WHO that by 2020 it will be the number 1 disease globally. The WHO and UNICEF have published their third World Report on Child Injury Prevention in December 2008. Materials and Methods: A systematic review was performed on the history and magnitude of paediatric trauma worldwide. Additionally exciting developments and new trends were assessed and summarized. Results: Paediatric trauma is a growing field of clinical expertise. New developments include total body digital imaging of children presenting with polytrauma; targeted management of head injuries; conservative management of abdominal injuries in children and diagnostic laparoscopy, including the laparoscopic management of complications following the conservative management of solid organ injuries. Conclusion: Paediatric trauma has long been neglected by the medical profession. In order to deal with it appropriately, it makes sense to adopt the public health approach, requiring that we view child injuries similarly to any other disease or health problem. The greatest gain in our clinical practice with dealing with child injuries will result from a strong focus on primary (preventing the injury, secondary (dealing with the injury in the most efficient manner as well as tertiary prevention (making sure that children treated for trauma will be appropriately reintegrated within our society. By actively promoting child safety we will not only achieve a most welcome reduction in medical cost and disability, but also the ever-so-much desired decline of avoidable childhood misery and suffering.
Branas, C C; Sing, R F; Davidson, S J
To describe one urban trauma transport system to clarify the impact of transport by nonmedical personnel on patient outcome. Retrospective data were assembled over a six-year period through the use of the state trauma registry for an urban county served by seven state-accredited trauma centers. A subset of 4,767 consecutive assaulted patients was analyzed using the TRISS method to estimate survival probability. An unexpected death index (UDI), calculated as the difference between expected (TRISS method) and observed death rates, also was determined. Outcomes for patients transported by fire medics (FMs) vs nonmedical, police personnel (NPs) were compared. FMs transported 2,108 (44%) and NPs transported 1,356 (29%) of the injured assault victims. The FM-transported patients had a lower expected probability of survival than had the NP-transported patients (p UDIs were not different overall, although the NP-transported patients who had blunt trauma had a significantly lower UDI (p < 0.01). NP transport of assaulted patients is generally associated with equivalent outcomes in comparison with FM transport in this urban environment. However, these data also provide evidence of an on-scene implicit triage with more severely injured patients generally transported by FMs.
Michael M. Neeki
Full Text Available Introduction: Mobilization of trauma resources has the potential to cause ripple effects throughout hospital operations. One major factor affecting efficient utilization of trauma resources is a discrepancy between the prehospital estimated time of arrival (ETA as communicated by emergency medical services (EMS personnel and their actual time of arrival (TOA. The current study aimed to assess the accuracy of the perceived prehospital estimated arrival time by EMS personnel in comparison to their actual arrival time at a Level II trauma center in San Bernardino County, California. Methods: This retrospective study included traumas classified as alerts or activations that were transported to Arrowhead Regional Medical Center in 2013. We obtained estimated arrival time and actual arrival time for each transport from the Surgery Department Trauma Registry. The difference between the median of ETA and actual TOA by EMS crews to the trauma center was calculated for these transports. Additional variables assessed included time of day and month during which the transport took place. Results: A total of 2,454 patients classified as traumas were identified in the Surgery Department Trauma Registry. After exclusion of trauma consults, walk-ins, handoffs between agencies, downgraded traumas, traumas missing information, and traumas transported by agencies other than American Medical Response, Ontario Fire, Rialto Fire or San Bernardino County Fire, we included a final sample size of 555 alert and activation classified traumas in the final analysis. When combining all transports by the included EMS agencies, the median of the ETA was 10 minutes and the median of the actual TOA was 22 minutes (median of difference=9 minutes, p<0.0001. Furthermore, when comparing the difference between trauma alerts and activations, trauma activations demonstrated an equal or larger difference in the median of the estimated and actual time of arrival (p<0.0001. We also found
Tai B; Hu L; Ghitza UE; Sparenborg S; VanVeldhuisen P; Lindblad R
Betty Tai,1 Lian Hu,2 Udi E Ghitza,1 Steven Sparenborg,1 Paul VanVeldhuisen,2 Robert Lindblad2 1Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA; 2The EMMES Corporation, Rockville, MD, USA Abstract: This commentary discusses the need for developing patient registries of substance use disorders (SUD) in general medical settings. A patient registry is a tool that documents the natural history of target diseases. Clinicia...
Parkinson’s Institute Sunnyvale, CA 94085-2934 This registry initiates a program of epidemiological assessments of PS among...Center. Alaska Native; Parkinson’s disease; Registry; Etiology; Epidemiology ; Ascertainment 8 23 June 2012 - 22 June 2013AnnualJuly 2013 ctanner...Investigator 4 A. Introduction Parkinsonism (PS) is a syndrome characterized by tremor , rigidity, slowness of movement, and problems with walking and
Awdish, R; Cajigas, H
Pulmonary arterial hypertension (PAH) is a subcategory of pulmonary hypertension (PH) that comprises a group of disorders with similar pulmonary vascular pathology. Though PH is common, the estimated incidence of IPAH is 1-3 cases per million, making it a rare disease. The hemodynamic definition of PAH is a mean pulmonary artery pressure at rest >OR = 25 mm Hg in the presence of a pulmonary capillary wedge pressure
Full Text Available Betty Tai,1 Lian Hu,2 Udi E Ghitza,1 Steven Sparenborg,1 Paul VanVeldhuisen,2 Robert Lindblad2 1Center for the Clinical Trials Network, National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, USA; 2The EMMES Corporation, Rockville, MD, USA Abstract: This commentary discusses the need for developing patient registries of substance use disorders (SUD in general medical settings. A patient registry is a tool that documents the natural history of target diseases. Clinicians and researchers use registries to monitor patient comorbidities, care procedures and processes, and treatment effectiveness for the purpose of improving care quality. Enactments of the Affordable Care Act 2010 and the Mental Health Parity and Addiction Equity Act 2008 open opportunities for many substance users to receive treatment services in general medical settings. An increased number of patients with a wide spectrum of SUD will initially receive services with a chronic disease management approach in primary care. The establishment of computer-based SUD patient registries can be assisted by wide adoption of electronic health record systems. The linkage of SUD patient registries with electronic health record systems can facilitate the advancement of SUD treatment research efforts and improve patient care. Keywords: substance use disorders, primary care, registry, electronic health records, chronic care model
Sherman, Simon; Shats, Oleg; Ketcham, Marsha A.; Anderson, Michelle A.; Whitcomb, David C.; Lynch, Henry T.; Ghiorzo, Paola; Rubinstein, Wendy S.; Sasson, Aaron R.; Grizzle, William E.; Haynatzki, Gleb; Feng, Jianmin; Sherman, Alexander; Kinarsky, Leo; Brand, Randall E.
The Pancreatic Cancer Collaborative Registry (PCCR) is a multi-institutional web-based system aimed to collect a variety of data on pancreatic cancer patients and high-risk subjects in a standard and efficient way. The PCCR was initiated by a group of experts in medical oncology, gastroenterology, genetics, pathology, epidemiology, nutrition, and computer science with the goal of facilitating rapid and uniform collection of critical information and biological samples to be used in developing diagnostic, prevention and treatment strategies against pancreatic cancer. The PCCR is a multi-tier web application that utilizes Java/JSP technology and has Oracle 10 g database as a back-end. The PCCR uses a “confederation model” that encourages participation of any interested center, irrespective of its size or location. The PCCR utilizes a standardized approach to data collection and reporting, and uses extensive validation procedures to prevent entering erroneous data. The PCCR controlled vocabulary is harmonized with the NCI Thesaurus (NCIt) or Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT). The PCCR questionnaire has accommodated standards accepted in cancer research and healthcare. Currently, seven cancer centers in the USA, as well as one center in Italy are participating in the PCCR. At present, the PCCR database contains data on more than 2,700 subjects (PC patients and individuals at high risk of getting this disease). The PCCR has been certified by the NCI Center for Biomedical Informatics and Information Technology as a cancer Biomedical Informatics Grid (caBIG®) Bronze Compatible product. The PCCR provides a foundation for collaborative PC research. It has all the necessary prerequisites for subsequent evolution of the developed infrastructure from simply gathering PC-related data into a biomedical computing platform vital for successful PC studies, care and treatment. Studies utilizing data collected in the PCCR may engender new approaches
Roberto Alejandro Guerra García
Full Text Available Se consultó la bibliografía actualizada para ofrecer una orientación práctica sobre el manejo de las afecciones vítreorretinales más frecuentes provocadas por los traumas oculares contusos. Estos se encuentran presentes en 31 % de los casos y presentan como complicación seria más frecuente el desprendimiento de retina en 44 %. Se explicó la importancia de la creación de un registro nacional de trauma como herramienta inicial para la prevención de esta enfermedad. Finalmente se expuso algunas consideraciones y un flujograma orientador para el manejo de esta urgencia.Current papers were reviewed to provide practical managing guidelines in most frequent vitreous and retinal disorders infringed by blunt ocular trauma. They are present in 31 % of traumas, with retinal detachment in 44 % of cases as the most frequent serious complication. The importance of the creation of a national eye injury registry as an initial tool to prevent this disease was explained. Finally, some considerations and a guiding flowchart for the management of this visual problem were included.
Alexander Y. Sheng
Full Text Available Objective. We sought to describe the trend in abdominal CT use in adult trauma patients after a point-of-care emergency ultrasound program was introduced. We hypothesized that abdominal CT use would decrease as FAST use increased. Methods. We performed a retrospective study of 19940 consecutive trauma patients over the age of 18 admitted to our level one trauma center from 2002 through 2011. Data was collected retrospectively and recorded in a trauma registry. We plotted the rate of FAST and abdominal CT utilization over time. Head CT was used as a surrogate for overall CT utilization rates during the study period. Results. Use of FAST increased by an average of 2.3% (95% CI 2.1 to 2.5, P<0.01 while abdominal CT use decreased by the same rate annually. The percentage of patients who received FAST as the sole imaging modality for the abdomen rose from 2.0% to 21.9% while those who only received an abdominal CT dropped from 21.7% to 2.3%. Conclusions. Abdominal CT use in our cohort declined while FAST utilization grew in the last decade. The rising use of FAST may have played a role in the reduction of abdominal CT performed as decline in CT utilization appears contrary to overall trends.
Edlich, Richard F
academic career. His dreams for having a comprehensive trauma system in the Pacific Northwest are described in detail so that it an be replicated in our nation and our world.Dr. Long became the Trauma Medical Director for Emanuel Hospital in the Fall of 1983. He began building Emanuel's trauma program by establishing an infrastructure that would support technically advanced ways of restoring life and function. His trauma center consisted of the following components: trauma registry, trauma resuscitation nurse program, direct to operating room policy with unstable trauma patients, anesthesia as part of the trauma resuscitation team, massive transfusion protocol, mobile surgical transport team, outreach to rural communities, recruitment of specialists with interest in trauma care, development of a new trauma physical facility, and the Physician Assistant educational program.
Bolandparvaz, Shahram; Yadollahi, Mahnaz; Abbasi, Hamid Reza; Anvar, Mehrdad
Abstract Administrative data from trauma referral centers are useful sources while studying epidemiologic aspects of injuries. We aimed to provide a hospital-based view of injuries in Shiraz considering victims’ age and gender, using administrative data from trauma research center. A cross-sectional registry-based study of adult trauma patients (age ≥15 years) sustaining injury through traffic accidents, violence, and unintentional incidents was conducted. Information was retrieved from 3 hospital administrative databases. Data on demographics, injury mechanisms, injured body regions, and injury descriptions; outcomes of hospitalization; and development of nosocomial infections were recorded. Injury Severity Score (ISS) was calculated by crosswalking from ICD-10 (International Classification of Diseases) injury diagnosis codes to AIS-98 (Abbreviated Injury Scale) severity codes. Patients were compared based on age groups and gender differences. A total of 47,295 trauma patients with a median age of 30 (interquartile range: 24–44 years) were studied, of whom 73.1% were male and the remaining 26.9% were female (M/F = 2.7:1.0). The most common injury mechanisms in the male group were car and motorcycle accidents whereas females were mostly victims of falls and pedestrian accidents (P trauma center, male gender and age >65 years are associated with increased risk of injury incidence, prolonged hospitalizations, and in-hospital death following trauma. Development of a regional trauma surveillance system may provide further opportunities for studying injuries and evaluating preventive actions. PMID:29019874
Mitchell, Rebecca J; Curtis, Kate; Holland, Andrew Ja; Balogh, Zsolt J; Evans, Julie; Wilson, Kellie L
To describe the costs of acute trauma admissions for children aged ≤15 years in trauma centres; to identify predictors of higher treatment costs and quantify differences in actual and state-wide average cost in New South Wales (NSW), Australia. Admitted trauma patient data provided by 12 trauma centres was linked with financial data for 2008-2009. Demographic, injury details and injury severity scores (ISS) were obtained from trauma registries. Individual patient costs, Australian Refined Diagnostic Related Groups (AR-DRG) and state-wide average costs were obtained. Actual costs incurred by each hospital were compared with state-wide AR-DRG average costs. Multivariate multiple linear regression identified predictors of cost. There were 3493 patients with a total cost of AUD$20.2 million. Falls (AUD$6.7 million) and road trauma (AUD$4.4 million) had the highest total expenditure. The reduction in cost between ISS 12 was significant (P trauma centres were AUD$1.4 million above the NSW peer group average cost estimates. The high financial cost of paediatric patient treatment highlights the need to ensure prevention remains a priority in Australia. Hospitals tasked with providing trauma care should be appropriately funded and future funding models should consider trauma severity. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Rottenstreich, Misgav; Fay, Shmuel; Gendler, Sami; Klein, Yoram; Arkovitz, Marc; Rottenstreich, Amihai
Tension pneumothorax is one of the leading causes of preventable death in trauma patients. Needle thoracotomy (NT) is the currently accepted first-line intervention but has not been well validated. In this review, we have critically discussed the evidence for NT procedure, re-examined the recommendations by the Advanced Trauma Life Support organization and investigated the safest and most effective way of NT. The current evidence to support the use of NT is limited. However, when used, it should be applied in the 2nd intercostal space at midclavicular line using a catheter length of at least 4.5 cm. Alternative measures should be studied for better prehospital management of tension pneumothorax. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.
The changing complexity of maxillofacial fractures in recent years has created a situation where classical systems of classification of maxillofacial injuries fall short of defining trauma particularly that observed with high-velocity collisions where more than one region of the maxillofacial skeleton is affected. Trauma scoring systems designed specifically for the maxillofacial region are aimed to provide a more accurate assessment of the injury, its prognosis, the possible treatment outcomes, economics, length of hospital stay, and triage. The evolution and logic of such systems along with their merits and demerits are discussed. The author also proposes a new system to aid users in quickly and methodically choosing the system best suited to their needs without having to study a plethora of literature available in order to isolate their choice. Copyright © 2016 Elsevier Ltd. All rights reserved.
Átila Varela Velho
Full Text Available A videolaparoscopia (VL vem contribuindo de forma crescente, para diagnóstico e terapêutica de várias afecções cirúrgicas abdominais, introduzindo profundas mudanças na cirurgia contemporânea. Esse avanço incorporou-se também às urgências traumáticas, fazendo parte da avaliação diagnóstica e, às vezes, da terapêutica do trauma abdominal. Os autores apresentam uma revisão concisa da literatura sobre a VL no trauma, atualizando o tema e discutindo os aspectos mais relevantes das indicações, limitações e complicações do método.
The introduction of an inclusive trauma system in the Netherlands during last decade of the past century, has led to an improvement in Dutch trauma care. Eleven trauma regions were formed nationwide each surrounding a level I trauma center. All hospitals in a trauma region were assigned levels I, II or III, and are working together in a trauma network. Also part of the introduction of the inclusive trauma system was the regionalization of individual ambulance care and the introduction of mobi...
intracranial hemorrhage following hypertension and ischemia due to hypoperfusion during shock. Cerebrovas- cular injury is only one mechanism, and a...fracture, neurologic exam not explained by grain imaging, Horner’s syndrome , LeFort I or II fractures, skull-base fractures involving the foramen lacerum, or...into the study, and it again fails to represent the total trauma popu- lation. For example, skull fractures, intracranial injuries, and extremity
Vanaja Ratnakumari Billa
Full Text Available BACKGROUND In the recent times there has been increased incidence of abdominal trauma cases due to several causes. Quick and prompt intervention is needed to decrease the mortality of the patients. So we conducted a study to assess the cause and the management of abdominal trauma cases in our institution. The aim of this study was to know the incidence of blunt and penetrating injuries and their causes, age and sex incidence, importance of various investigations, mode of treatment offered and post-operative complications. To study the cause of death and evolve better management. MATERIALS AND METHODS The present study comprises of patients admitted to and operated in various surgical units in the Department of Surgery at Government General Hospital, attached to Guntur Medical College Guntur, from August 2014 to October 2016. RESULTS Increase incidence seen in age group 20-29 years (30%. Male predominance 77.5%. Mechanism of injury–road traffic accidents 65%. Isolated organ injury–colon and rectum 40%. Other associated injuries–chest injuries with rib fractures 7.5%. Complications–wound infection 17.5%. Duration of hospital stay 8–14 days. Bowel injury management–closure of perforation 84.6%. Resection anastomosis 15.38%. CONCLUSION Thorough clinical examination, diagnostic paracentesis, plain X-ray erect abdomen and ultrasound proved to be very helpful in the diagnosis of intra-abdominal injuries. Spleen is the commonest organ involved in blunt trauma and colon is the commonly injured organ in penetrating abdominal trauma, many patients have associated extremity and axial skeleton injuries. With advances in diagnosis and intensive care technologies, most patients of solid visceral injuries with hemodynamic stability can be managed conservatively. Surgical site infection is the most common complication following surgery. The mortality is high; reason might be patient reaching the hospital late, high incidence of postoperative septic
Becker, Minerva, E-mail: Minerva.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Leuchter, Igor, E-mail: Igor.Leuchter@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Platon, Alexandra, E-mail: Alexandra.Platon@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Becker, Christoph D., E-mail: Christoph.Becker@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Dulguerov, Pavel, E-mail: Pavel.Dulguerov@hcuge.ch [Department of Otorhinolaryngology and Cervico-facial Surgery, University Hospital of Geneva, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland); Varoquaux, Arthur, E-mail: Arthur.Varoquaux@hcuge.ch [Department of Radiology, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14 (Switzerland)
External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed.
Becker, Minerva; Leuchter, Igor; Platon, Alexandra; Becker, Christoph D; Dulguerov, Pavel; Varoquaux, Arthur
External laryngeal trauma is a rare but potentially life-threatening situation in the acutely injured patient. Trauma mechanism and magnitude, maximum focus of the applied force, and patient related factors, such as age and ossification of the laryngeal cartilages influence the spectrum of observed injuries. Their correct diagnosis and prompt management are paramount in order to avoid patient death or long-term impairment of breathing, swallowing and speaking. The current review provides a comprehensive approach to the radiologic interpretation of imaging studies performed in patients with suspected laryngeal injury. It describes the key anatomic structures that are relevant in laryngeal trauma and discusses the clinical role of multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI) in the acute emergency situation. The added value of two-dimensional multiplanar reconstructions (2D MPR), three-dimensional volume rendering (3D VR) and virtual endoscopy (VE) for the non-invasive evaluation of laryngeal injuries and for treatment planning is discussed. The clinical presentation, biomechanics of injury, diagnostic pitfalls and pearls, common and uncommon findings are reviewed with emphasis of fracture patterns, involvement of laryngeal joints, intra- and extralaryngeal soft tissue injuries, and complications seen in the acute emergency situation. The radiologic appearance of common and less common long-term sequelae, as well as treatment options are equally addressed. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
Uldall, P; Michelsen, Susan Ishøy; Topp, M
Cerebral palsy (CP) is the commonest disabling impairment in childhood, with a prevalence of 2-3 per 1000 live births. The Danish Cerebral Palsy Registry is a research registry that contains cases of CP from birth year 1925 and has estimated the birth prevalence since 1950. Data on children with ...
Sernadela, Pedro; González-Castro, Lorena; Carta, Claudio; van der Horst, Eelke; Lopes, Pedro; Kaliyaperumal, Rajaram; Thompson, Mark; Thompson, Rachel; Queralt-Rosinach, Núria; Lopez, Estrella; Wood, Libby; Robertson, Agata; Lamanna, Claudia; Gilling, Mette; Orth, Michael; Merino-Martinez, Roxana; Posada, Manuel; Taruscio, Domenica; Lochmüller, Hanns; Robinson, Peter; Roos, Marco; Oliveira, José Luís
Patient registries are an essential tool to increase current knowledge regarding rare diseases. Understanding these data is a vital step to improve patient treatments and to create the most adequate tools for personalized medicine. However, the growing number of disease-specific patient registries brings also new technical challenges. Usually, these systems are developed as closed data silos, with independent formats and models, lacking comprehensive mechanisms to enable data sharing. To tackle these challenges, we developed a Semantic Web based solution that allows connecting distributed and heterogeneous registries, enabling the federation of knowledge between multiple independent environments. This semantic layer creates a holistic view over a set of anonymised registries, supporting semantic data representation, integrated access, and querying. The implemented system gave us the opportunity to answer challenging questions across disperse rare disease patient registries. The interconnection between those registries using Semantic Web technologies benefits our final solution in a way that we can query single or multiple instances according to our needs. The outcome is a unique semantic layer, connecting miscellaneous registries and delivering a lightweight holistic perspective over the wealth of knowledge stemming from linked rare disease patient registries.
Archambault, Patrick M; Turgeon, Alexis F; Witteman, Holly O; Lauzier, François; Moore, Lynne; Lamontagne, François; Horsley, Tanya; Gagnon, Marie-Pierre; Droit, Arnaud; Weiss, Matthew; Tremblay, Sébastien; Lachaine, Jean; Le Sage, Natalie; Émond, Marcel; Berthelot, Simon; Plaisance, Ariane; Lapointe, Jean; Razek, Tarek; van de Belt, Tom H; Brand, Kevin; Bérubé, Mélanie; Clément, Julien; Grajales Iii, Francisco Jose; Eysenbach, Gunther; Kuziemsky, Craig; Friedman, Debbie; Lang, Eddy; Muscedere, John; Rizoli, Sandro; Roberts, Derek J; Scales, Damon C; Sinuff, Tasnim; Stelfox, Henry T; Gagnon, Isabelle; Chabot, Christian; Grenier, Richard; Légaré, France
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. 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. 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.
World, Michael J
The lack of need for immediate renal replacement treatment for military trauma victims suggests that the current policy of restricting operational deployment of those Service personnel with active inflammatory renal disease and significantly impaired renal function, combined with good prehospital care for all trauma casualties, is probably correct. No published estimates of renal function in civilian or military trauma victims in the earliest period following injury have been retrieved. The purpose of the present retrospective study was to assess the renal function of military trauma victims on arrival in the Emergency Department of the field hospital. The case records of 287 military trauma casualties with severe injury (New Injury Severity Score, NISS≥16) were retrospectively reviewed to assess renal function by calculating estimated glomerular filtration rate (eGFR) using the serum creatine concentration obtained immediately on arrival in the Emergency Department of the field hospitals in Iraq and Afghanistan, 2005-2009. Correlations were attempted between eGFR and other clinical and laboratory variables. Hospital case notes recording management following repatriation were retrieved in 221/287 (77%) cases. None had required immediate renal support in the field. Serum creatine concentration on arrival in the field hospital with demographic data permitting calculation of eGFR was recorded in 158 cases. Median eGFR=76 ml/min/1.73 m(2) (range=43-144). Statistically significant correlations were found among eGFR and pulse rate (r=-0.3, p=0.0002), body temperature (r=0.24, p=0.01) and mean arterial pressure (r=0.2, p=0.02). No statistically significant correlation was found among eGFR and NISS, white cell count, or respiration rate. A stepwise multivariate regression analysis of 106 cases suggested that the best combination of clinical observations to predict renal function were pulse rate and body temperature but the prediction was overoptimistic at lower e
Lu, L N; He, X G; Zhu, J F; Xu, X; Zhang, R; Hu, X; Zou, H D
Objective: To establish an assessment system, including indexes and scoring methods, that can be used for performance evaluation of the provincial blindness prevention technical guidance group properly and effectively . Methods: The indexes and scoring methods were set based on the core content of The " National Plan of Prevention and Treatment of Blindness (2012-2015)" , the specific requirement and target of the World Health Organization (WHO) "For the General Eye Health: Global plan of Action (2014-2019)" , and the current situation of the China's provinces and autonomous regions. These indexes should be of effectiveness, feasibility, comparability, guidance and advancing. Formed by a literature review of candidate indicators, the framework of the system is built by qualitative assessment. With the Delphi method, the system was further revised and improved. Empirical pilot study was then used to prove the feasibility, followed by the final qualitative analysis that establish the " Chinese provincial Blindness prevention technical guidance group performance evaluation system" . Results: Through the literature review and qualitative assessment, a six dimensional system framework was built, including 6 first-level indicators, 16 second-level indicators, and 29 third-level indicators through Delphi method evaluation. With the variation coefficient method, the coeffiences of the first-level index weight were calculated as: Organization and management 0.15, Development and implementation of blindness prevention plans 0.15, Implementation of blindness prevention projects 0.14, Training 0.17, Health education 0.18, and Cooperation and exchanges 0.21. The specific scoring method for this system is confirmed as: data and files check, field interview, and record interview, sampling investigation. Empirical pilot study was conducted in the Jilin, Guizhou and Gansu provinces, and the self-assessment results from local experts were consistent with the scores from the systems
To analyse the financial basis for downsizing of a provincial health department and suggest implications for fiscal policy. Analysis of relevant departmental, provincial and national financing and expenditure trends from 1995/96 to 2002/03. Western Cape (WC) Department of Health (DOH). Downsizing involving 9,282 health workers (27.9%) and closure of 3,601 hospital beds (24.4%) over 5 years. Total aggregate provincial transfers (all provinces) remained fairly constant in real terms. The WC's share decreased from 11.8% in 1996/97 to 9.8% in 2002/03. This was offset by the DOH's share of the WC budget increasing from 25.6% to 29.6%, mainly because of an increase in national health conditional grants. The net effect of financing changes was that the DOH's allocation in real terms was similar in 2002/03 and 1995/96, which suggests that financing changes are not the major cause of downsizing. Expenditure analysis revealed a 39.7% real rise in the average cost of health personnel. Substantial interprovincial inequities remain. The major cause of downsizing was wage growth, particularly following the 1996 wage agreement. Disjointed fiscal and wage policy has affected health services. Simultaneous application of policies of fiscal constraint, redistribution and substantial real wage growth has resulted in substantial downsizing with limited inroads into inequities. Inequities will continue to call for further redistribution, reduction in conditional grants and downsizing, much of which could have been avoided if fiscal and wage policy choices had been optimal.
Full Text Available City green economy plays an important role in the development of low-carbon economy and the achievement of sustainable development of economy, society and ecological environment. From the perspective of economy, society, environment and resources, the evaluation of the green economy in urban areas tends to offer us a new insight into the green economy of cities. This paper is about the creation of a novel urban green economy evaluation model and its application. First of all, we established a city green economy evaluation index system based on R cluster analysis and coefficient of variation. Secondly, based on the nonlinear weighted utilizing entropy weight method, a city green economy evaluation model is established based on inferior constraints. Thirdly, by comparing the differences between evaluation rankings under inferior constraints and non-inferior constraints, the advantageous factors and the disadvantageous ones in urban green economy development are obtained. The proposed model has been verified with the data on 15 sub-provincial cities in China. Empirical analysis results show that: (1 The proposed approach can accurately find out the advantageous and disadvantageous factors for each sub-provincial city; (2 In the evaluation of green economy development, the order of importance of the three criterion layers is X1 Economy development > X2 Social livelihood of the people > X3 Resources and environment; (3 Local governments should implement differential, reasonable policies in order to improve their green economy development. Moreover, our research is not only significant for developing green economy in China’s sub-provincial cities, but also serves as a reference for the development of green economy in other cities in the world.
Gustavo Pereira Fraga
Full Text Available OBJETIVO: O trauma da laringe é pouco freqüente. O objetivo do presente trabalho é avaliar os procedimentos e resultados no tratamento destas lesões. MÉTODO: Este trabalho baseou-se em estudo prospectivo de 35 de pacientes com trauma de laringe atendidos no período de janeiro de 1990 a abril de 2003. RESULTADOS: A média de idade foi de 31,4 anos, sendo 30 pacientes (85,7% do sexo masculino. O mecanismo predominante foi o trauma penetrante (30 casos - 85,7%, a maioria causada por ferimento por projétil de arma de fogo (17 casos - 48,6%. Dez pacientes (28,6% necessitaram de intubação traqueal na admissão hospitalar e o valor médio do RTS foi de 7,28. As observações mais freqüentes no exame clínico das vítimas de trauma penetrante foram exposição de cartilagens da laringe (30% e saída de ar pelo orifício do ferimento cervical (30%. Nos cinco pacientes (14,3% com trauma contuso o achado mais freqüente foi enfisema subcutâneo (80%.O tratamento foi cirúrgico em 34 pacientes (97,1%, através de cervicotomia em colar na maioria dos casos (91,2%. A cartilagem tireóide foi a mais lesada (20 casos - 57,1%. Em 33 pacientes operados a lesão foi tratada com sutura, associada a traqueostomia em 24 casos (72,7%. Lesões cervicais associadas ocorreram em 20 casos (57,1%, sendo mais comum as de veia jugular (10 casos. A média do ISS e do TRISS foram, respectivamente, 16,3 e 0,93. A morbidade relacionada diretamente à lesão laríngea foi de 34,3% (12 casos, sendo mais freqüente a disfonia (seis casos. Foi necessária a reexploração cervical em dois pacientes, um devido a abscesso cervical e outro, tardiamente, por estenose supra-glótica, este último tratado com molde. Dois pacientes apresentaram complicações tardias, um com disfagia e outro com disfonia. A mortalidade pós-operatória foi de 5,7% (dois casos, decorrente de complicações não relacionadas ao trauma laríngeo. CONCLUSÕES: A utilização de condutas padronizadas
Paredes Vílchez, Margarita Eulalia; Hospital Provincial Docente Belén de Lambayeque; País Lescano, Doris; Hospital Provincial Docente Belén de Lambayeque
El objetivo fue determinar el nivel de satisfacción laboral de las enfermeras/os con la finalidad de proponer estrategias de mejora mediante un estudio descriptivo transversal en 55 Enfermeras/os de los diferentes servicios del Hospital Provincial Docente Belén de Lambayeque, durante julio – agosto del 2012. Como técnica de recolección de datos se utilizó, la encuesta y como instrumento el Cuestionario "Satisfacción Laboral del Enfermero" elaborada por el Ministerio de Salud en el 2002, agru...
David F. Mitchell
Full Text Available This article introduces a new provincial-level dataset on non-governmental organizations (NGOs in Afghanistan. The data—which are freely available for download—provide information on the locations and sectors of activity of 891 international and local (Afghan NGOs that operated in the country between 2000 and 2014. A summary and visualization of the data is presented in the article following a brief historical overview of NGOs in Afghanistan. Links to download the full dataset are provided in the conclusion.
Chira Sosa, Jorge Luis; Universidad Nacional Pedro Ruiz Gallo; Sosa Flores, Jorge Luis; Universidad Nacional Pedro Ruiz Gallo
El nacimiento pretérmino es la mayor causa de morbilidad y mortalidad neonatal y responsable de 75 a 90% de las muertes neonatales no relacionadas con malformaciones congénitas. Determinar los factores de riesgo del parto pretérmino en el Hospital Provincial Docente Belén de Lambayeque durante el año enero-diciembre 2010. El presente estudio es analítico, de casos y controles pareados de tipo retrospectivo, descriptivo comparativo, trasversal en el que se analizaron las historias clínicas de ...
Serrano Morales, Riansares
En este artículo se analiza el papel que representan las Asociaciones culturales en la difusión de las actividades de los archivos. A través de una experiencia concreta, la Asociación de Amigos del Archivo Histórico Provincial de Guadalajara (España), se muestra la colaboración de la sociedad civil en la gestión cultural. This article describes the role played by cultural associations in order to disseminate the activities of the archives. Through a concrete experience as the Association ...
Lech, L; Jerkku, T; Kanz, K-G; Wierer, M; Mutschler, W; Koeppel, T A; Lefering, R; Banafsche, R
There is a lack of evidence as to the relevance of vascular trauma (VT) in patients with severe injuries. Therefore, we reviewed registry data in the present study in order to systematically objectify the effect of VT in these patients. This study aimed to provide an adequate picture of the relevance of vascular trauma and to identify adverse prognostic factors. In a retrospective analysis of records from the TraumaRegister DGU® (TR-DGU) in two subgroups with moderate and severe VT, we examined the records for differences in terms of morbidity, mortality, follow-up and prognostic parameters compared to patients without VT with the same ISS. From a total of 42,326 patients, 2,961 (7 %) had a VT, and in 2,437 cases a severe VT (AIS ≥ 3) was diagnosed (5.8 %). In addition to a higher incidence of shock and a 2 to 3-fold increase in fluid replacement and erythrocyte transfusion, patients with severe VT had a 60 % higher rate of multiple organ failure, and in-hospital mortality was twice as high (33.8 %). The massively increased early mortality (8.0 vs. 25.2 %) clearly illustrates how severely injured patients are placed at risk by the presence of a relevant VT with a comparable ISS. In our opinion, due to an unexpected poor prognosis in the TR-DGU data for vascular injuries, increased attention is required in the care of severely injured patients. Based on our comprehensive analysis of negative prognostic factors, a further adjustment to the standards of vascular medicine could be advisable. The influence of the level of care provided by the admitting hospital and the relevance of a further hospital transfer to prognosis and clinical outcome is currently being analysed. Georg Thieme Verlag KG Stuttgart · New York.
Sansone, Randy A; Chang, Joy; Jewell, Bryan; Rock, Rachel
Childhood trauma has been empirically associated with various types of self-regulatory difficulties in adulthood. However, according to the extant literature, no study has examined relationships between various types of childhood trauma and compulsive buying behavior in adulthood. Using a self-report survey methodology in a cross-sectional consecutive sample of 370 obstetrics/gynecology patients, we examined five types of childhood trauma before the age of 12 years (i.e. witnessing violence, physical neglect, emotional abuse, physical abuse, sexual abuse) in relationship to compulsive buying as assessed by the Compulsive Buying Scale (CBS). All forms of trauma demonstrated statistically significant correlations with the CBS. Using a linear regression analysis, both witnessing violence and emotional abuse significantly contributed to CBS scores. Further analyses indicated that race did not moderate the relationship between childhood trauma and compulsive buying. Findings indicate that various forms of childhood trauma are correlated with compulsive buying behavior, particularly witnessing violence and emotional abuse.
Metcalf, Meredith; Broghammer, Joshua A
The geriatric population is the fastest growing segment of the population, and geriatric trauma patients are increasingly common. Caring for this population has unique challenges. The goal of the review is to identify factors that may help in the care of geriatric patients suffering from genitourinary trauma. Multiple factors lead to inferior outcomes in patients with geriatric trauma including failure to rescue, treatment in lower volume trauma centers, and undertriage of geriatric patients. Improvement in geriatric trauma outcomes occurs with the use of dedicated geriatric consult teams. The surgical management of genitourinary injuries in the geriatric population remains unchanged. Interventions for geriatric patients differ from younger populations. Direct changes in overall management of the geriatric population lead to improved outcomes. The treatment of geriatric trauma patients with genitourinary injuries is similar to a younger cohort. The lack of recent studies in clinical outcomes in this population has been identified as a gap in knowledge that will require future research to answer.
The introduction of an inclusive trauma system in the Netherlands during last decade of the past century, has led to an improvement in Dutch trauma care. Eleven trauma regions were formed nationwide each surrounding a level I trauma center. All hospitals in a trauma region were assigned levels I, II
Mesquita, Joana; Varela, Ana; Medina, José Luís
The endocrine system may be the target of different types of trauma with varied consequences. The present article discusses trauma of the hypothalamic-pituitary axes, adrenal glands, gonads, and pancreas. In addition to changes in circulating hormone levels due to direct injury to these structures, there may be an endocrine response in the context of the stress caused by the trauma. Copyright © 2010 SEEN. Published by Elsevier Espana. All rights reserved.
Jessula, Samuel; Murphy, Nadia; Yanchar, Natalie L
In 2004-2005, legislation restricting all-terrain vehicle (ATV) use by children and an extensive social marketing campaign intended to reduce pediatric ATV-related morbidity. The frequency, nature, and severity of pediatric ATV-associated trauma were compared before and after such interventions. A retrospective cohort study was performed for all pediatric ATV-related injuries that presented to the provincial level 1 pediatric trauma center from 1998 to 2014. National databases were queried for ATV-related injury hospitalizations (n=258), trauma center emergency department visits (n=342), and admissions (n=136) in Nova Scotia from 2002 to 2014. Admissions between 1998 and 2003 (n=68) and 2006-2014 (n=60) were compared using chi square analysis for age and gender distribution, length of stay, critical care admission, helmet use, mechanism, and severity of injury. Admissions, trauma center emergency room visits and admissions initially decreased following legislative and social marketing interventions and subsequently gradually increased. Interventions resulted in no significant difference in age or gender distribution, length of hospital stay, critical care admission, helmet use, and mechanism of injury. There was a significantly higher proportion of severe injuries post interventions. Legislation and social marketing interventions had a short-term decrease on the frequency of ATV-related injuries and no sustained effect on the frequency, nature, and severity of ATV-related injuries. Level IV. Copyright © 2017 Elsevier Inc. All rights reserved.
Lubis, M Zuhri Nanda Rizki
117102007 Background: Thorax trauma is trauma to the of the thoracic cavity. Traumatic thoracic can be blunt and penetrating trauma. Blunt thoracic trauma could potentially pose a threat to respiratory and cardiac circulation. (Mefire, 2009). The risk factors most important to the death of thoracic trauma include a preliminary assessment score trauma, include the Injury Severity Score (ISS), tinggiSkala Glasgow Coma (SKG) is low, Revised Trauma Score (RTS) and the Trauma Injury Severity Sc...
Alexander Pérez Llanes
Full Text Available Los traumatismos de los anejos oculares son frecuentes, debido a la ubicación anatómica de estas estructuras y cumplir con una de sus principales funciones de protección del globo ocular. Se pueden clasificar en afecciones traumáticas de párpados, conjuntiva, órbita y traumas del aparato lagrimal. Según los datos aportados por el United States Eye Injury Registry, las lesiones de los anejos oculares constituyen el 5 % de todos los traumas oculares y las más frecuentes con 81 % son las laceraciones canaliculares. Se presentan dos casos de pacientes masculinos con diagnóstico de trauma palpebral severo (avulsión palpebral que fueron atendidos en el servicio de urgencia y recibieron tratamiento quirúrgico con evolución satisfactoria. El reporte de estos casos nos permite un mejor manejo en el diagnóstico y tratamiento de los traumas palpebrales severos.The ocular adnexal traumas are common due to the anatomical location of these structures, and the fulfilling of one of its main duties, that is, the protection of the eyeball. They are classified into traumatic conditions of the eyelids, the conjunctiva, the orbit, and lachrymal system traumas. According to data provided by the United States Eye Injury Registry, the ocular adnexal injuries account for 5 % of all ocular traumas, and the most common are canalicular lacerations with 81 %. Two cases of male patients diagnosed with severe eyelid trauma (eyelid avulsion were presented. They had been treated in the emergency department; they had undergone surgical treatment with satisfactory results. The report of these cases allows us to better manage the diagnosis and treatment of severe palpebral traumas.
Hurley, Donna S; Sukal-Moulton, Theresa; Gaebler-Spira, Deborah; Krosschell, Kristin J; Pavone, Larissa; Mutlu, Akmer; Dewald, Julius PA; Msall, Michael E
The aims of this study were to provide a comprehensive summary of the body of research disseminated by Cerebral Palsy (CP) registries and surveillance programs from January 2009 through May 2014 in order to describe the influence their results have on our overall understanding of CP. Secondly, registries/surveillance programs and the work they produced were evaluated and grouped using standardized definitions and classification systems. Method A systematic review search in PubMed, CINAH and Embase for original articles published from 1 January 2009 to 20 May 2014 originating from or supported by population based CP registries and surveillance programs or population based national registries including CP were included. Articles were grouped by 2009 World CP Registry Congress aim, registry/surveillance program classification, geographical region, and the International Classification of Function, Disability and Health (ICF) domain. Registry variables were assessed using the ICF-CY classification. Results Literature searches returned 177 articles meeting inclusion criteria. The majority (69%) of registry/surveillance program productivity was related to contributions as a Resource for CP Research. Prevention (23%) and Surveillance (22%) articles were other areas of achievement, but fewer articles were published in the areas of Planning (17%) and Raising the Profile of CP (2%). There was a range of registry/surveillance program classifications contributing to this productivity, and representation from multiple areas of the globe, although most of the articles originated in Europe, Australia, and Canada. The domains of the ICF that were primarily covered included body structures and function at the early stages of life. Encouragingly, a variety of CP registry/surveillance program initiatives included additional ICF domains of participation and environmental and personal factors. Interpretation CP registries and surveillance programs, including novel non-traditional ones
Nielsen, Lene Hüche; Nørgaard, Bjarne Linde; Tilsted, Hans-Henrik
BACKGROUND: As a subregistry to the Western Denmark Heart Registry (WDHR), the Western Denmark Cardiac Computed Tomography Registry (WDHR-CCTR) is a clinical database established in 2008 to monitor and improve the quality of cardiac computed tomography (CT) in Western Denmark. OBJECTIVE: We...... examined the content, data quality, and research potential of the WDHR-CCTR. METHODS: We retrieved 2008-2012 data to examine the 1) content; 2) completeness of procedure registration using the Danish National Patient Registry as reference; 3) completeness of variable registration comparing observed vs...... expected numbers; and 4) positive predictive values as well as negative predictive values of 19 main patient and procedure variables. RESULTS: By December 31, 2012, almost 22,000 cardiac CTs with up to 40 variables for each procedure have been registered. Of these, 87% were coronary CT angiography...
Østgård, Lene Sofie Granfeldt; Nørgaard, Jan Maxwell; Raaschou-Jensen, Klas Kræsten
AIM OF DATABASE: The main aim of the Danish National Acute Leukemia Registry (DNLR) was to obtain information about the epidemiology of the hematologic cancers acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS). STUDY POPULATION: The registry...... was established in January 2000 by the Danish Acute Leukemia Group and has been expanded over the years. It includes adult AML patients diagnosed in Denmark since 2000, ALL patients diagnosed since 2005, and MDS patients diagnosed since 2010. The coverage of leukemia patients exceeds 99%, and the coverage of MDS...... years. To ensure this high coverage, completeness, and quality of data, linkage to the Danish Civil Registration System and the Danish National Registry of Patients, and several programmed data entry checks are used. CONCLUSION: The completeness and positive predictive values of the leukemia data have...
De Leede, E. M.; Sibinga Mulder, B. G.; Bastiaannet, E.
Care, is a platform aiming to harmonize cancer data collection and improve cancer care by feedback. After the prior launch of the projects on colorectal, breast and upper GI cancer, EURECCA's newest project is collecting data on pancreatic cancer in several European countries. Methods National cancer...... registries, as well as specific pancreatic cancer audits/registries, were invited to participate in EURECCA Pancreas. Participating countries were requested to share an overview of their collected data items. Of the received datasets, a shared items list was made which creates insight in similarities between...... data. Conclusions A list of 25 shared items on pancreatic cancer coming from eleven participating registries was created, providing a basis for future prospective data collection in pancreatic cancer treatment internationally....
Bilello, John; McCray, Victor; Davis, James; Jackson, Lascienya; Danos, Leigh Ann
Many trauma patients are acutely intoxicated with alcohol. Animal studies have demonstrated that acute alcohol intoxication inhibits the normal release of epinephrine, norepinephrine, and vasopressin in response to acute hemorrhage. Ethanol also increases nitric oxide release and inhibits antidiuretic hormone secretion. This article studies the effects of alcohol intoxication (measured by blood alcohol level, BAL) on the presentation and resuscitation of trauma patients with blunt hepatic injuries. A retrospective registry and chart review was conducted of all patients who presented with blunt liver injuries at an ACS-verified, level I trauma center. Data collected included admission BAL, systolic blood pressure, hematocrit, International Normalized Ratio (INR), liver injury grade, Injury Severity Score (ISS), intravenous fluid and blood product requirements, base deficit, and mortality. From September 2002 to May 2008, 723 patients were admitted with blunt hepatic injuries. Admission BAL was obtained in 569 patients, with 149 having levels >0.08%. Intoxicated patients were more likely to be hypotensive on admission (p = 0.01) despite a lower liver injury grade and no significant difference in ISS. There was no significant difference in the percent of intoxicated patients requiring blood transfusion. However, when blood was given, intoxicated patients required significantly more units of packed red blood cells (PRBC) than their nonintoxicated counterparts (p = 0.01). Intoxicated patients also required more intravenous fluid during their resuscitation (p = 0.002). Alcohol intoxication may impair the ability of blunt trauma patients to compensate for acute blood loss, making them more likely to be hypotensive on admission and increasing their PRBC and intravenous fluid requirements. All trauma patients should have BAL drawn upon admission and their resuscitation should be performed with an understanding of the physiologic alterations associated with acute alcohol
Full Text Available Background: Occupation trauma is a social and economic problem which industrialization in developing countries has increased its prevalence. This study was designed to assess the distribution of occupation – related ocular trauma in Esfahan. Methods: In this descriptive cross-sectional study, all first time referrals to eye emergency department in Feiz Hospital who suffered from occupation-related trauma were evaluated using questionnaire designed according to United State Eye Injury Registry. Results: A total of 450 (27.9% out of 1610 patients, consisting 447 male (99.3% and 3 female (0.7% who referred to Feiz Hospital had occupational-related trauma and their mean age was 30.4 (15-62 years old. A total of 202 patients (44.9% were 21-30 years old. The level of education in 162 (36% subjects was junior high-school and 110 of them (24.4% were arc-welders. Metallic foreign body injured 70.2% of patients and in 62.2% of subjects, corneal foreign body was the most common injury. Only 19.6% of the patients used protective goggles and 15.1% (68 of them had been receiving educational instructions for eye healthcare and safety strategies. At the end of the treatment, visual acuity of 12 (2.8% subjects was significantly decreased. Conclusion: Occupation–related ocular trauma was a very prevalent eye injury in Esfahan. Metallic foreign body was the most common causative agent and corneal injury was also the most common form of ocular injury. Thus convincing workers to use protective goggles and giving education about correct way of using them is an effective step to prevent ocular injuries.
Kaddis, Mina; Stockton, Kellie; Kimble, Roy
The aim of this study was to describe trauma in children secondary to the use of wheeled recreational devices (WRDs). This study retrospectively described trauma secondary to use of WRDs sustained by children 16 years or younger over a period of 12 months at two tertiary paediatric hospitals in Brisbane, Queensland. Data were analysed from the Paediatric Trauma Registry at these two facilities. Data were also retrieved from The Commission for Children and Young People and Child Guardian to provide information regarding deaths in Queensland from the use of WRDs for the period January 2004 to September 2013. Outcome measures included age, gender, types of injuries, Injury Severity Scores, admission to Intensive Care, and length of hospital stay for all hospital admissions greater than 24 h. A total number of 45 children were admitted with trauma relating to WRDs during the 12 months, representing 5.3% of all trauma admissions of greater than 24 h during this time period. Of these, 34 were male with a median age of 11.0 years (IQR = 9-13). Limbs accounted for the majority (54.5%) of injuries, with other common injuries being spine/cranial fractures (14.5%), lacerations (12.7%), internal organ injuries (9.1%), and intracranial bleeds (9.1%). There were six admissions to the Paediatric Intensive Care Unit and one death. WRDs contribute significantly to injuries sustained by children. A large proportion of these injuries may be preventable, suggesting that mandating the use of protective equipment in Queensland may be of great benefit. © 2015 The Authors. Journal of Paediatrics and Child Health © 2015 Paediatrics and Child Health Division (Royal Australasian College of Physicians).
Singnurkar, Amit; Wang, Jonathan; Joshua, Anthony M; Langer, Deanna L; Metser, Ur
The Ontario PET Registry was established to provide evidence on the clinical impact of 18-FDG-PET/CT (PET) imaging to inform Ontario Health Insurance Plan funding decisions. The melanoma registry assessed the use of melanoma staging by PET in advanced or high-risk melanoma as a useful adjunct to clinical and standard radiologic investigation. Between January 2011 and July 2013, approximately 319 consecutive patients with potentially resectable localized high-risk melanoma or recurrent disease under consideration for metastasectomy underwent PET imaging for staging across 9 institutions in Ontario. Pre-PET stage information was provided by the referring clinician and compared with post-PET stage. The ability of PET to reclassify disease from M0 to M1 status was assessed. The registry data were then linked to provincial administrative databases using deidentified health insurance numbers to determine PET stage-based rates of systemic therapy, radiotherapy, and surgery. There was a significant increase in stage to M1 status after PET in 56 of 319 patients (17.6%) (P < 0.0001). There was no significant relationship between upstaging with PET and the proportion of patients receiving radiation therapy (P = 0.066) or systemic therapy (P = 0.072). There was a significant relationship between upstaging with PET and the proportion of patients undergoing surgical resection of metastases distant to the primary melanoma site (P = 0.034). This prospective, multicenter registry of high-risk or advanced melanoma found that PET significantly upstages patients and impacts surgical management.
Mann, Steven A; McCleskey, Brandi; Marques, Marisa B; Adamski, Jill
Apheresis was first performed as a therapeutic procedure in the 1950s. The first national therapeutic apheresis (TA) registry was established in Canada in 1981 and other national registries followed, including two attempts at establishing an international TA registry. There is no national registry in the United States. Our large, academic, tertiary hospital has a very active TA service. We created a TA database to track all procedures performed by the apheresis service by transferring data from paper appointment logs and the electronic medical records into a Microsoft Access database. Retrospective data from each TA procedure performed at UAB from January 1, 2003 through December 31, 2012 were entered, including the type of procedure, indication, date, and patient demographics. Microsoft Excel was used for data analysis. During the 10-year period, our TA service treated 1,060 patients and performed 11,718 procedures. Of these patients, 70% received therapeutic plasma exchange (TPE), 21% received extracorporeal photopheresis (ECP), 4.5% received red cell exchange (RCE), 4.2% received leukocytapheresis, and 0.6% underwent platelet depletion. Among the procedures, 54% were TPEs, 44% were ECPs, 1.3% were RCEs, 0.5% were leukocytaphereses, and 0.1% were platelet depletions. According to the current literature, national and international TA use is underreported. We believe that the UAB TA registry provides useful information about TA practices in our region and can serve as a model for other institutions. Furthermore, data from multiple institutional registries can be used for clinical research to increase the available evidence for the role of TA in various conditions. J. Clin. Apheresis 31:516-522, 2016. © 2015 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.
Nielsen, Lene Hüche; Nørgaard, Bjarne Linde; Tilsted, Hans-Henrik
BACKGROUND: As a subregistry to the Western Denmark Heart Registry (WDHR), the Western Denmark Cardiac Computed Tomography Registry (WDHR-CCTR) is a clinical database established in 2008 to monitor and improve the quality of cardiac computed tomography (CT) in Western Denmark. OBJECTIVE: We......-CCTR, showed that coronary CT angiographies accounted for only 23% of all nonregistered cardiac CTs, indicating >90% completeness of coronary CT angiographies in the WDHR-CCTR. The completeness of individual variables varied substantially (range: 0%-100%), but was >85% for more than 70% of all variables. Using......, making it a valuable tool for clinical epidemiological research....
Napier, Kathryn R; Tones, Megan; Simons, Chloe; Heussler, Helen; Hunter, Adam A; Cross, Meagan; Bellgard, Matthew I
Angelman syndrome (AS) is a rare neurodevelopmental disorder that is characterised by severe global developmental delays, ataxia, loss of speech, epilepsy, sleep disorders, and a happy disposition. There is currently no cure for AS, though several pharmaceutical companies are anticipating drug trials for new therapies to treat AS. The Foundation for Angelman Therapeutics (FAST) Australia therefore identified a need for a global AS patient registry to identify patients for recruitment for clinical trials.The Global AS Registry was deployed in September 2016 utilising the Rare Disease Registry Framework, an open-source tool that enables the efficient creation and management of patient registries. The Global AS Registry is web-based and allows parents and guardians worldwide to register, provide informed consent, and enter data on individuals with AS. 286 patients have registered in the first 8 months since deployment.We demonstrate the successful deployment of the first patient-driven global registry for AS. The data generated from the Global AS Registry will be crucial in identifying patients suitable for clinical trials and in informing research that will identify treatments for AS, and ultimately improve the lives of individuals and their families living with AS.
Xu, W.; Kruminaite, M.; Onrust, B.; Liu, H.; Xiong, Q.; Zlatanova, S.
3D models are more powerful than 2D maps for indoor navigation in a complicate space like Hubei Provincial Museum because they can provide accurate descriptions of locations of indoor objects (e.g., doors, windows, tables) and context information of these objects. In addition, the 3D model is the preferred navigation environment by the user according to the survey. Therefore a 3D model based indoor navigation system is developed for Hubei Provincial Museum to guide the visitors of museum. The system consists of three layers: application, web service and navigation, which is built to support localization, navigation and visualization functions of the system. There are three main strengths of this system: it stores all data needed in one database and processes most calculations on the webserver which make the mobile client very lightweight, the network used for navigation is extracted semi-automatically and renewable, the graphic user interface (GUI), which is based on a game engine, has high performance of visualizing 3D model on a mobile display.
Chen, Nengcheng; Xu, Lei
Air pollution in China has become increasingly severe with rapid economic growth in recent years. We analyzed the relationship between the gross regional product (GRP) per capita and the Integrated Air Pollution Index (IAPI) in all the provincial capital cities in China from 2003 to 2014 and clustered them into six urban development patterns. These patterns are as follows: inverse U-shaped, N-1-shaped, N-2-shaped, U-shaped, linear decline, and stable. The majority of the provincial capitals are N-1, N-2, and U types, suggesting that the air quality is deteriorating currently or will deteriorate in the future. Meteorological conditions and industrial structure are taken into consideration when testing the environmental Kuznets curve (EKC) hypothesis between the economy and air pollutant concentration. Results show that there exists no direct relationship between three main pollutants and GRP per capita, while an inverse U-shaped relationship with the secondary industry and a U-shaped relationship with the tertiary industry. These results will be a meaningful reference for policy makers to develop policies that coordinate the environmental protection and economic development.
Sim, S Meaghan; Kirk, Sara F L
Healthy Eating Nova Scotia represents the first provincial comprehensive healthy eating strategy in Canada and a strategy that is framed within a population-health model. Five years after strategy launch, our objective was to evaluate Healthy Eating Nova Scotia to determine perceptions of strategy implementation and strategy outputs. The focus of the current paper is on the findings of this evaluation. We conducted an evaluation of the strategy through three activities that included a document review, survey of key stakeholders and in-depth interviews with key strategy informants. The findings from each of the activities were integrated to determine what has worked well with strategy implementation, what could be improved and what outputs have resulted. The evaluation was conducted in the Canadian province of Nova Scotia. Participants for this evaluation included survey respondents (n 120) and key informants (n 16). A total of 156 documents were also reviewed. Significant investments have been made towards inter-sectoral partnerships and resourcing that has provided the necessary leadership and momentum for the strategy. Policy development has been leveraged through the strategy primarily in the health and education sectors and is perceived as a visible success. Clarity of human resource roles and funding within the context of a provincial strategy may be beneficial for continued strategy implementation, as is expansion of policy development. Known to be the first evaluation of its kind, these findings and related considerations will be of interest to policy makers developing and implementing similar strategies in their own jurisdictions.
Rehabilitation Physical therapy/ rehabilitation evaluation Fracture femur OR tibia OR pelvis AND not in ICU 25. Evaluation Abdominal CT scans during...Trauma, ICU , education, research, training, analysis, practice 15. SUBJECT TERMS 16. SECURITY CLASSIFICATION OF: 17. LIMITATION OF ABSTRACT...POC encompassed all aspects of trauma care, including initial evaluation, resuscitation, oper- ative care, critical care, rehabilitation , and injury
Cohen, Judith A.; Mannarino, Anthony P.; Kliethermes, Matthew; Murray, Laura A.
Objectives: Many youth develop complex trauma, which includes regulation problems in the domains of affect, attachment, behavior, biology, cognition, and perception. Therapists often request strategies for using evidence-based treatments (EBTs) for this population. This article describes practical strategies for applying Trauma-Focused Cognitive…
Urry, R J; Clarke, D L; Bruce, J L; Laing, G L
The purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries. The Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014. Of 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service. Traumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries. Copyright © 2016 Elsevier Ltd. All rights reserved.
Warden, Craig; Sahni, Ritu; Newgard, Craig
To determine clusters of trauma incidents with high injury severity and resource utilization and to test their association with census demographic information. Using "trauma band" unique identifiers and probabilistic linkage for unmatched cases, we matched injury location information collected from a centralized regional trauma communications center to the state trauma system registry for patients directly transported to two level I trauma centers for the years 2001-2003 in a three-county area. The injury locations were aggregated at the census tract level using a geographic information system (GIS). Moran's I analysis was used to determine clusters of census tracts that had a high incidence of either total trauma injuries, Injury Severity Scores (ISSs) >15, or high resource use (in-hospital mortality, admission to the intensive care unit, or major nonorthopedic surgery). These clusters were then tested for association with census tract demographics using logistic regression. Eight thousand seven hundred fifty-one injured persons were directly transported from the tricounty area to a trauma center during the study period. The mean (+/- standard deviation) age was 37 +/- 21 years, 67.4% were male, 18.9% had ISSs >15, and 29.8% had a high-resource-use indicator. Moran's I analysis demonstrated a single large cluster of incidents for total injuries, ISS >15, and occurrence of a high-resource-use indictor that overlapped except for one small census tract. Logistic regression revealed that the high-risk cluster was associated with a higher prevalence of nonwhite population and vacant housing and a lower prevalence of foreign-born residents and family housing. GIS cluster analysis demonstrated high-risk census tracts for trauma incidents and associated population demographics. Geospatial analyses may assist injury prevention interventions and emergency medical services deployment strategies for trauma.
Murphy, Margaret; Curtis, Kate; Lam, Mary K; Palmer, Cameron S; Hsu, Jeremy; McCloughen, Andrea
Simulation has been promoted as a platform for training trauma teams. However, it is not clear if this training has an impact on health service delivery and patient outcomes. This study evaluates the association between implementation of a simulation based multidisciplinary trauma team training program at a metropolitan trauma centre and subsequent patient outcomes. This was a retrospective review of trauma registry data collected at an 850-bed Level 1 Adult Trauma Centre in Sydney, Australia. Two concurrent four-year periods, before and after implementation of a simulation based multidisciplinary trauma team training program were compared for differences in time to critical operations, Emergency Department (ED) length of stay (LOS) and patient mortality. There were 2389 major trauma patients admitted to the hospital during the study, 1116 in the four years preceding trauma team training (the PREgroup) and 1273 in the subsequent 4 years (the POST group). There were no differences between the groups with respect to gender, body region injured, incidence of polytrauma, and pattern of arrival to ED. The POST group was older (median age 54 versus 43 years, p team training was associated with a reduction in time to critical operation while overall ED length of stay increased. Simulation is promoted as a platform for training teams; but the complexity of trauma care challenges efforts to demonstrate direct links between multidisciplinary team training and improved outcomes. There remain considerable gaps in knowledge as to how team training impacts health service delivery and patient outcomes. Retrospective comparative therapeutic/care management study, Level III evidence. Crown Copyright © 2018. Published by Elsevier Ltd. All rights reserved.
Frijling, Jessie L; van Zuiden, Mirjam; Koch, Saskia B J; Nawijn, Laura; Veltman, Dick J; Olff, Miranda
There is a need for effective, early post-trauma preventive interventions for post-traumatic stress disorder (PTSD). Attenuating amygdala hyperreactivity early post-trauma, a likely PTSD vulnerability factor, may decrease PTSD risk. Since oxytocin modulates amygdala reactivity to emotional stimuli, oxytocin administration early post-trauma may be a promising candidate for PTSD prevention. In a randomized double-blind placebo-controlled fMRI study, we investigated effects of a single intranasal oxytocin administration (40 IU) on amygdala reactivity to happy, neutral and fearful faces in 41 recently trauma-exposed men and women showing moderate to high distress after initial post-trauma screening. We explored treatment interactions with sex. Participants were scanned within 11 days post-trauma. Compared with placebo, oxytocin significantly increased right amygdala reactivity to fearful faces. There was a significant treatment by sex interaction on amygdala reactivity to neutral faces, with women showing increased left amygdala reactivity after oxytocin. These findings indicate that a single oxytocin administration may enhance fearful faces processing in recently trauma-exposed individuals and neutral faces processing in recently trauma-exposed women. These observations may be explained by oxytocin-induced increased salience processing. Clinical implications of these findings for PTSD prevention should be further investigated. Netherlands Trial Registry; Boosting Oxytocin after trauma: Neurobiology and the Development of Stress-related psychopathology (BONDS); NTR3190; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC = 3190. © The Author (2015). Published by Oxford University Press. For Permissions, please email: email@example.com.
Full Text Available Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting the adoption of mHealth by focusing on maternal health in Nakuru Provincial General Hospital. Objectives of the study were to determine the extent to knowledge and awareness affects the adoption of mHealth in maternal health care at Nakuru PGH to identify the government policies affecting the adoption of mHealth in maternal health care at Nakuru PGH to assess how access to technology affects the adoption of mHealth in maternal healthcare to establish the effects of ICT infrastructure on the adoption of mHealth in maternal health care and to identify the cost aspects affecting the adoption of mHealth in maternal health care at Nakuru Provincial General Hospital. It is envisaged that the study could provide useful information on the adoption of mHealth in managing maternal health care in Nakuru Provincial General Hospital. Descriptive survey research design will be used where all the medical staff and patients of Nakuru Provincial General Hospital was surveyed. The study population therefore was made up of 24 medical staff and 3460 mothers visiting the antenatal clinic selected using clustered random sampling technique. The main instrument for primary data collection was the questionnaire. Data analysis was then done using both descriptive and inferential statistics. Descriptive statistics to be used include frequency counts percentages and measures of central tendency. Inferential statistics on the other hand include t-test analysis and spearman correlation
Moore, Lynne; Lavoie, André; Bourgeois, Gilles; Lapointe, Jean
According to Donabedian's health care quality model, improvements in the structure of care should lead to improvements in clinical processes that should in turn improve patient outcome. This model has been widely adopted by the trauma community but has not yet been validated in a trauma system. The objective of this study was to assess the performance of an integrated trauma system in terms of structure, process, and outcome and evaluate the correlation between quality domains. Quality of care was evaluated for patients treated in a Canadian provincial trauma system (2005-2010; 57 centers, n = 63,971) using quality indicators (QIs) developed and validated previously. Structural performance was measured by transposing on-site accreditation visit reports onto an evaluation grid according to American College of Surgeons criteria. The composite process QI was calculated as the average sum of proportions of conformity to 15 process QIs derived from literature review and expert opinion. Outcome performance was measured using risk-adjusted rates of mortality, complications, and readmission as well as hospital length of stay (LOS). Correlation was assessed with Pearson's correlation coefficients. Statistically significant correlations were observed between structure and process QIs (r = 0.33), and process and outcome QIs (r = -0.33 for readmission, r = -0.27 for LOS). Significant positive correlations were also observed between outcome QIs (r = 0.37 for mortality-readmission; r = 0.39 for mortality-LOS and readmission-LOS; r = 0.45 for mortality-complications; r = 0.34 for readmission-complications; 0.63 for complications-LOS). Significant correlations between quality domains observed in this study suggest that Donabedian's structure-process-outcome model is a valid model for evaluating trauma care. Trauma centers that perform well in terms of structure also tend to perform well in terms of clinical processes, which in turn has a favorable influence on patient outcomes
Seventh cranial nerve palsy due to birth trauma; Facial palsy - birth trauma; Facial palsy - neonate; Facial palsy - infant ... this condition. Some factors that can cause birth trauma (injury) include: Large baby size (may be seen ...
... Enter ZIP code here Health Awareness Campaigns: Sexual Trauma Sexual Trauma Women Veterans Health Care has created materials to ... 10-320LG Dimensions: 11" x 17" Effects of Sexual Trauma One in five women in the United States ...
Estroff, Jordan M; Foglia, Robert P; Fuchs, Julie R
Child abuse, or nonaccidental trauma (NAT), is a major cause of pediatric morbidity and mortality, and is often unrecognized. Our hypothesis was that injuries due to accidental trauma (AT) and NAT are significantly different in incidence, injury, severity, and outcome, and are often unrecognized. Our aim was to carry out an examination of the differences between pediatric injuries due to AT and NAT regarding incidence, demographics, injury severity, and outcomes. A 4-year retrospective review of the Trauma Registry at Children's Medical Center Dallas, a large Level I pediatric trauma center, comparing incidence, age, race, trauma activation, intensive care unit (ICU) need, Injury Severity Score (ISS), and mortality between AT and NAT patients was carried out. There were 5948 admissions, 92.5% were AT and 7.5% were NAT victims. The NAT patients were younger (1.8 ± 3.3 years vs. 6.8 ± 4.2 years for AT patients; p trauma child. Copyright © 2015 Elsevier Inc. All rights reserved.
Wong, Camilla L; Al Atia, Raghda; McFarlan, Amanda; Lee, Holly Y; Valiaveettil, Christina; Haas, Barbara
Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012-December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence.
Wong, Camilla L.; Al Atia, Raghda; McFarlan, Amanda; Lee, Holly Y.; Valiaveettil, Christina; Haas, Barbara
Background Proactive geriatric trauma consultation service (GTCS) models have been associated with better delivery of geriatric care and functional outcomes. Whether such collaborative models can be improved and sustained remains uncertain. We describe the sustainability and process improvements of an inpatient GTCS. Methods We assessed workflow using interviews and surveys to identify opportunities to optimize the referral process for the GTCS. Sustainability of the service was assessed via a prospective case series (July 2012–December 2013). Study data were derived from a review of the medical record and trauma registry database. Metrics to determine sustainability included volume of cases, staffing levels, rate of adherence to recommendations, geriatric-specific clinical outcomes, trauma quality indicators, consultation requests and discharge destination. Results Through process changes, we were able to ensure every eligible patient was referred for a comprehensive geriatric assessment. Compared with the implementation phase, volume of assessments increased and recommendation adherence rates were maintained. Delirium and/or dementia were the most common geriatric issue addressed. The rate of adherence to recommendations made by the GTCS team was 88.2%. Only 1.4% of patients were discharged to a nursing home. Conclusion Workflow assessment is a useful means to optimize the referral process for comprehensive geriatric assessment. Sustainability of a GTCS was shown by volume, staffing and recommendation adherence. PMID:27669402
Badger, S A
BACKGROUND: Blunt and penetrating liver trauma is common and often presents major diagnostic and management problems. METHODS: A literature review was undertaken to determine the current consensus on investigation and management strategies. RESULTS: The liver is the most frequently injured organ following abdominal trauma. Immediate assessment with ultrasound has replaced diagnostic peritoneal lavage in the resuscitation room, but computerised tomography remains the gold standard investigation. Nonoperative management is preferred in stable patients but laparotomy is indicated in unstable patients. Damage control techniques such as perihepatic packing, hepatotomy plus direct suture, and resectional debridement are recommended. Major complex surgical procedures such as anatomical resection or atriocaval shunting are now thought to be redundant in the emergency setting. Packing is also recommended for the inexperienced surgeon to allow control and stabilisation prior to transfer to a tertiary centre. Interventional radiological techniques are becoming more widely used, particularly in patients who are being managed nonoperatively or have been stabilised by perihepatic packing. CONCLUSIONS: Management of liver injuries has evolved significantly throughout the last two decades. In the absence of other abdominal injuries, operative management can usually be avoided. Patients with more complex injuries or subsequent complications should be transferred to a specialist centre to optimise final outcome.
Angelini, Romeo; Rutolo, Ferdinando; Cozzolino, Giuseppe; D'Amario, Vanessa; Spigonardo, Francesca
The Authors report on a series of 61 vascular traumas treated over a 7 years, separated in two groups. The first one includes 35 cases, that are street accidents, on the work and gunshot wounds. The second group includes 26 iatrogenic causes due to arterial catheterism. All patients underwent ecocolor Doppler directly in the operating theatre and, when this diagnostic procedure was not enough, pre-operating angiography was used (10 cases of complex traumas of the lower limb). One death was reported far each groups (3.27%). In 55 cases (90.1%), limb savage was achieved. In the others 4 (6.93%) of the first group, limb demolition was necessary for different causes. In the first group, severe neurological sequelaes were observed in 2 cases and motor deficits caused by tendon lesions in 1 case. The good results obtained are the result of the short ischemic interval between the acute event and treatment, thanks to a multidisciplinary approach of a specific equipe, that is rapid as possible.
Bak, Marie; Ibfelt, Else Helene; Stauffer Larsen, Thomas
AIM: The Danish National Chronic Myeloid Neoplasia Registry (DCMR) is a population-based clinical quality database, introduced to evaluate diagnosis and treatment of patients with chronic myeloid malignancies. The aim is to monitor the clinical quality at the national, regional, and hospital...
A health economist at CDC talks about a new tool for estimating how much it costs to run cancer registries in developing countries. Created: 11/21/2016 by National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP). Date Released: 11/21/2016.
Østgård, Lene Sofie Granfeldt; Nørgaard, Jan Maxwell; Raaschou-Jensen, Klas Kræsten; Pedersen, Robert Schou; Rønnov-Jessen, Dorthe; Pedersen, Per Troellund; Dufva, Inge Høgh; Marcher, Claus Werenberg; Nielsen, Ove Juul; Severinsen, Marianne Tang; Friis, Lone Smidstrup
The main aim of the Danish National Acute Leukemia Registry (DNLR) was to obtain information about the epidemiology of the hematologic cancers acute myeloid leukemia (AML), acute lymphoblastic leukemia (ALL), and myelodysplastic syndrome (MDS). The registry was established in January 2000 by the Danish Acute Leukemia Group and has been expanded over the years. It includes adult AML patients diagnosed in Denmark since 2000, ALL patients diagnosed since 2005, and MDS patients diagnosed since 2010. The coverage of leukemia patients exceeds 99%, and the coverage of MDS patients is currently 90%. Approximately, 250 AML patients, 25 ALL patients, and 230 MDS patients are registered in the DNLR every year. In January 2015, the registry included detailed patient characteristics, disease characteristics, treatment characteristics, and outcome data on more than 3,500 AML, 300 ALL, and 1,100 MDS patients. Many of the included prognostic variables have been found to be of high quality including positive predictive values and completeness exceeding 90%. These variables have been used in prognostic observational studies in the last few years. To ensure this high coverage, completeness, and quality of data, linkage to the Danish Civil Registration System and the Danish National Registry of Patients, and several programmed data entry checks are used. The completeness and positive predictive values of the leukemia data have been found to be high. In recent years, the DNLR has shown to be an important high-quality resource for clinical prognostic research.
Pettifer, S.; Thorne, D.; McDermott, P.; Attwood, T.; Baran, J.; Bryne, J.C.; Hupponen, T.; Mowbray, D.; Vriend, G.
SUMMARY: The EMBRACE Registry is a web portal that collects and monitors web services according to test scripts provided by the their administrators. Users are able to search for, rank and annotate services, enabling them to select the most appropriate working service for inclusion in their
Werner, Claudius; Lablans, Martin; Ataian, Maximilian
Primary ciliary dyskinesia (PCD) is a rare autosomal recessive disorder leading to chronic upper and lower airway disease. Fundamental data on epidemiology, clinical presentation, course and treatment strategies are lacking in PCD. We have established an international PCD registry to realise an u...
Treffert, Darold A; Rebedew, David L
A registry has been established to document certain characteristics on a sizeable worldwide sample of individuals with savant syndrome, a rare but remarkable condition in which persons with developmental disabilities, brain injury, or brain disease have some spectacular "islands" of skill or ability that stand in jarring, marked contrast to overall handicap. Of the 319 savants included in the registry, 90% are congenital savants, while 10% are acquired savants. The registry includes individuals from 33 countries, with 70% from the United States or Canada. Sex distribution was 79% male vs. 21% female (4:1). This report summarizes the findings in the congenital savant syndrome category of the registry. Among the individuals with congenital savant syndrome, the most common underlying disability was Autistic Spectrum Disorder (75%); various other central nervous system (CNS) disorders were present in the other 25%. Fifty-five percent possessed a single special skill, while 45% had multiple skills. Music was the most frequent principal skill followed by art, memory, mathematics, calendar calculating, language, visual-spatial/mechanical, athletic, computer, extrasensory perception, and other skills.
Allende-López, Aldo; Fajardo-Gutiérrez, Arturo
A cancer registry is to record the data which let us to know the epidemiology of neoplasm, but led us take a decision in medical policy about this health problem that benefit patients. In this paper we did a brief historical review about models and attempts for having a cancer registry in Mexico. However, since 1940 "the fight against cancer" was declared, we have not had a confident cancer registry today validated and built with data from whole the country. In 1982, the Registro Nacional del Cancer was created. The design and validation of a registration card in four hospitals were the main results. In 1988, the Registro Nacional del Cancer was reinforced with a computerized system for facilitation the data capture. In 1994, it was signed the first interinstitutional agreement that led to Registro Histopatol6gico de Neoplasias Malignas. In 1996, the Instituto Mexicano del Seguro Social established a cancer registry in children in Mexico with the intention to have data from this population.
Cannada, Lisa K; Pan, Ping; Casey, Brian M; McIntire, Donald D; Shafi, Shahid; Leveno, Kenneth J
This study was performed to determine the effects of orthopedic trauma on pregnancy outcomes in pregnant trauma patients. This was an observational study completed after electronically linking databases for the obstetric service and the trauma service at our Level I trauma center. All pregnant women who presented during the years 1995 to 2007 were eligible for inclusion. Selected pregnancy outcomes in women who delivered at our trauma center during or after their trauma admission were evaluated according to the presence of orthopedic injuries. Statistical analyses were performed using χ, Student's t test, and Wilcoxon rank-sum test; and p injuries (6%) and 990 without orthopedic injuries. Women with orthopedic trauma had an average gestational age of 28 weeks versus 31 weeks for women without orthopedic trauma. Compared with the patients without orthopedic injuries, patients with orthopedic injuries had a significant increased risk of preterm birth before 37 weeks of gestation (31% vs. 3%; p injuries are high-risk obstetrical patients and may benefit from referral to a medical center capable of handling both the primary injury and the potential preterm birth associated with the injury.
Musculoskeletal trauma is among the ten most common causes for loss of healthy life years (disability adjusted life years) in Western Countries. Nine percent of all musculoskeletal trauma is related to the elbow; in athletes the prevalence is 11 percent. Approximately 80 percent of patients that had
Harcke, H.T. (Alfred I. du Pont Institute, Wilmington, DE (USA))
The sensitivity of radionuclide imaging in identifying skeletal trauma in children has been established. Growth plates present a set of problems unique to pediatric studies and diagnotic accuracy is very technique dependent. Imaging for sports injuries and suspected child abuse has been productive. An expanding role for bone scintigraphy in the management of orthopedic problems post-trauma is developing.
acido - sis (Cosgriff et al., 1997; Brohi et al., 2007). Extensive injury causes consumption of coagulation factors and platelets, so that in polytrauma...transfused trauma patient: hypothermia and acidoses revisited. Journal of Trauma, 42, 857 861. Counts, R.B., Haisch, C., Simon, T.L., Maxwell, N.G
Krejci, Mark J.; Thompson, Kevin M.; Simonich, Heather; Crosby, Ross D.; Donaldson, Mary Ann; Wonderlich, Stephen A.; Mitchell, James E.
This study assessed the association between spirituality and psychopathology in a group of sexual abuse victims and controls with a focus on whether spirituality moderated the association between sexual trauma and psychopathology. Seventy-one sexual trauma victims were compared to 25 control subjects on spiritual well-being, the Eating Disorder…
Christiaans, Sarah C; Duhachek-Stapelman, Amy L; Russell, Robert T; Lisco, Steven J; Kerby, Jeffrey D; Pittet, Jean-François
Trauma remains the leading cause of morbidity and mortality in the United States among children aged 1 to 21 years. The most common cause of lethality in pediatric trauma is traumatic brain injury. Early coagulopathy has been commonly observed after severe trauma and is usually associated with severe hemorrhage and/or traumatic brain injury. In contrast to adult patients, massive bleeding is less common after pediatric trauma. The classical drivers of trauma-induced coagulopathy include hypothermia, acidosis, hemodilution, and consumption of coagulation factors secondary to local activation of the coagulation system after severe traumatic injury. Furthermore, there is also recent evidence for a distinct mechanism of trauma-induced coagulopathy that involves the activation of the anticoagulant protein C pathway. Whether this new mechanism of posttraumatic coagulopathy plays a role in children is still unknown. The goal of this review is to summarize the current knowledge on the incidence and potential mechanisms of coagulopathy after pediatric trauma and the role of rapid diagnostic tests for early identification of coagulopathy. Finally, we discuss different options for treating coagulopathy after severe pediatric trauma.
Blazsó, Péter; Kákonyi, Kornél; Forster, Tamás; Sepp, Róbert
The Szeged cardiomyopathy and ion channel diseases registry aims to establish a representative disease-specific registry based on the recruitment of patients with different cardiomyopathies and ion channel diseases followed at the Cardiology Center, University of Szeged. The registry collects patient data on the main forms of primary cardiomyopathies (hypertrophic, dilated, restrictive, arrhythmogenic right ventricular, left ventricular non-compact, tako-tsubo cardiomyopathy) and ion channel diseases (long QT syndrome, short QT syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia). Patients with hypertrophic cardiomyopathy (388 patients) make up the largest group of patients in the registry. Patients with dilated cardiomyopathy (310 patients) and patients with the long QT syndrome (111 patients) form two other sizable groups. Analyzed data of the group of patients with hypertrophic cardiomyopathy indicate similar figures with regard to disease related mortality and morbidity and clinical parameters. Orv. Hetil., 2017, 158(3), 101-105.
Backus, Lisa I; Gavrilov, Sergey; Loomis, Timothy P; Halloran, James P; Phillips, Barbara R; Belperio, Pamela S; Mole, Larry A
The Department of Veterans Affairs (VA) has a system-wide, patient-centric electronic medical record system (EMR) within which the authors developed the Clinical Case Registries (CCR) to support population-centric delivery and evaluation of VA medical care. To date, the authors have applied the CCR to populations with human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Local components use diagnosis codes and laboratory test results to identify patients who may have HIV or HCV and support queries on local care delivery with customizable reports. For each patient in a local registry, key EMR data are transferred via HL7 messaging to a single national registry. From 128 local registry systems, over 60,000 and 320,000 veterans in VA care have been identified as having HIV and HCV, respectively, and entered in the national database. Local and national reports covering demographics, resource usage, quality of care metrics and medication safety issues have been generated.
von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C
The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome and t......%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents.......The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome...... and treatment of acetabular fractures in children (fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent...
von Heyden, Johanna; Hauschild, Oliver; Strohm, Peter C; Stuby, Fabian; Südkamp, Norbert P; Schmal, Hagen
The aim of this study was to present an analysis of acetabular fractures during childhood as compared to those in adults. Within a multicenter register study, data of 3 time periods (1991-93, 1998-2000, 2004-2008) were pooled and analyzed for incidence, epidemiology, classification, outcome and treatment of acetabular fractures in children (< 15 years). One hundred fifty three children (2.1%) among 7360 patients with pelvic fractures were included in the study. Only 15 children sustained an acetabular fracture (9.8%). Simple fracture types according to Letournels' classification were more frequent in paediatric patients (p < 0.01), receiving less often operative treatment. Multiple injuries were present in 36% of children, the average Injury Severity Score (ISS) of all children was 17 points. Clinical results were good with an average Merle d'Aubigné score of 16.4 points and a Karnofsky performance of 90%. Fractures of the acetabulum in childhood remain a rare injury with distinct fracture characteristics, usually caused by high impact accidents.
Full Text Available Periodic evaluation and monitoring the health and economic outcome of joint replacement surgery is a common and popular process under the territory of joint registries in many countries. In this article we introduce the methodology used for the foundation of the National Iranian Joint Registry (IJR with a joint collaboration of the Social Security Organization (SSO and academic research departments considering the requirements of the Iran’s Ministry of Health and Education.
Sim, Doo Sun; Jeong, Myung Ho
The Korea Acute Myocardial Infarction Registry (KAMIR) is the first nationwide registry that reflects current therapeutic approaches and acute myocardial infarction (AMI) management in Korea. The results of the KAMIR demonstrated different risk factors and responses to medical and interventional treatments. The results indicated that the incidence of ST-elevation myocardial infarction (STEMI) was relatively high, and that the prevalence of dyslipidemia was relatively low with higher triglycer...
Full Text Available In order to meet the dual requirements of economic development and energy consumption, the Chinese government has adopted a series of measures and policies to improve energy efficiency. However, the developing characteristics are not the same in different regions. Thus, it is necessary to analyze the actual energy efficiency levels in a more targeted manner. In this paper, 30 provinces in China will be adopted to study energy efficiency based on the statistical data from National Energy Administration and National Bureau of Statistics. With the trends of Chinese energy consumption and economy development, the Lorenz curve between Chinese energy consumption and GDP is fitted firstly. The Lorenz coefficient (0.1562 shows that the energy allocation in China is neither reasonable nor balanced. Then, by cluster analysis, the regions of different provinces are newly divided into five divisions from the dimensions of economy and energy, i.e., (high development level and high consumption level, HH, (moderate development level and moderate consumption level, MM, (moderate development level and low consumption level, ML, (low development level and low consumption level, LL, and (low development level and moderate consumption level, LM. Based on the division results, the provincial promotion potentialities are estimated quantitatively according to the absolute convergence feature of energy efficiency promotion. The provinces that have more promotion potentialities of energy efficiency are located, such as Hebei (56.29% in division (HH, Liaoning (38.15% in division (MM, Anhui (44.17% in division (ML, Ningxia (71.63% in division (LL, and Xinjiang (35.26% in division (LM, According to the different provincial potentialities, energy efficiency in China needs to improve more, but the improvement approaches should be specific and differential. Driven by technology, policy and mechanism, and industrial restructuring, the Chinese economy and energy resources
Saunders, K T; Langbaum, J B; Holt, C J; Chen, W; High, N; Langlois, C; Sabbagh, M; Tariot, P N
The Arizona Alzheimer's Consortium (AAC) created the Arizona Alzheimer's Registry, a screening and referral process for people interested in participating in Alzheimer's disease related research. The goals of the Registry were to increase awareness of Alzheimer's disease research and accelerate enrollment into AAC research studies. Participation was by open invitation to adults 18 and older. Those interested provided consent and completed a written questionnaire. A subset of Registrants underwent an initial telephone cognitive assessment. Referral to AAC sites was based on medical history, telephone cognitive assessment, and research interests. A total of 1257 people consented and 1182 underwent an initial cognitive screening. Earned media (38.7%) was the most effective recruitment strategy. Participants had a mean age of 68.1 (SD 10.6), 97% were Caucasian, had 15.2 (SD 2.7) mean years of education, and 60% were female. 30% reported a family history of dementia and 70% normal cognition. Inter-rater agreement between self-reported memory status and the initial telephone cognitive assessment had a kappa of 0.31-0.43. 301 were referred to AAC sites. IThe Registry created an infrastructure and process to screen and refer a high volume of eager Registrants. These methods were found to be effective at prescreening individuals for studies, which facilitated AAC research recruitment. The established infrastructure and experiences gained from the Registry have served as the prototype for the web-based Alzheimer's Prevention Registry, a national registry focusing on Alzheimer's disease prevention research.
Maret-Ouda, John; Tao, Wenjing; Wahlin, Karl; Lagergren, Jesper
All five Nordic countries (Denmark, Finland, Iceland, Norway and Sweden) have nationwide registries with similar data structure and validity, as well as personal identity numbers enabling linkage between registries. These resources provide opportunities for medical research that is based on large registry-based cohort studies with long and complete follow-up. This review describes practical aspects, opportunities and challenges encountered when setting up all-Nordic registry-based cohort studies. Relevant articles describing registries often used for medical research in the Nordic countries were retrieved. Further, our experiences of conducting this type of study, including planning, acquiring permissions, data retrieval and data cleaning and handling, and the possibilities and challenges we have encountered are described. Combining data from the Nordic countries makes it possible to create large and powerful cohorts. The main challenges include obtaining all permissions within each country, usually in the local language, and retrieving the data. These challenges emphasise the importance of having experienced collaborators within each country. Following the acquisition of data, data management requires the understanding of the differences between the variables to be used in the various countries. A concern is the long time required between initiation and completion. Nationwide Nordic registries can be combined into cohorts with high validity and statistical power, but the considerable expertise, workload and time required to complete such cohorts should not be underestimated.
Full Text Available El trauma cardiaco constituye una de las primeras causas de mortalidad en la población general. Requiere alto índice de sospecha en trauma cerrado severo, mecanismo de desaceleración y en presencia de signos indirectos como: equimosis, huella del volante o del cinturón en el tórax anterior. Las lesiones incluyen: conmoción cardiaca, ruptura cardiaca, lesión cardiaca indirecta como la trombosis coronaria aguda, lesión aórtica, lesión del pericardio y herniación cardiaca. Entre las manifestaciones clínicas están: la angina refractaria a nitratos, el dolor pleurítico, la hipotensión arterial, la taquicardia, la ingurgitación yugular que aumenta con la inspiración, el galope por tercer ruido, el frote pericárdico, los soplos de reciente aparición, los estertores crepitantes por edema pulmonar. El electrocardiograma es el primer eslabón en el algoritmo diagnóstico con hallazgos como: la taquicardia sinusal, los complejos ventriculares prematuros, la fibrilación auricular, el bloqueo de rama derecha y los bloqueos auriculoventriculares. La radiografía de tórax ayuda a descartar lesiones adicionales óseas y pulmonares. La troponina I tiene un valor predictivo negativo del 93% para el trauma cardiaco, otras enzimas como la creatina quinasa total y la creatina quinasa fracción MB son menos específicas. El ecocardiograma está indicado en caso de hipotensión persistente, electrocardiograma con alteraciones o falla cardiaca aguda. El tratamiento incluye la estabilización inicial y un manejo específico de las lesiones. Entre las complicaciones se incluyen: el taponamiento cardiaco, la contusión miocárdica, el síndrome coronario agudo, las arritmias cardíacas y la lesión aórtica. El pronóstico se determina en mayor medida por los signos vitales al ingreso y la presencia de paro cardiaco durante el abordaje inicial.
Noriega, David; Maestretti, Gianluca; Renaud, Christian; Francaviglia, Natale; Ould-Slimane, Mourad; Queinnec, Steffen; Ekkerlein, Helmut; Hassel, Frank; Gumpert, Rainer; Sabatier, Pascal; Huet, Herv?; Plasencia, Miguel; Theumann, Nicolas; Kunsky, Alexander; Kr?ger, Antonio
This prospective, consecutive, multicentre observational registry aimed to confirm the safety and clinical performance of the SpineJack system for the treatment of vertebral compression fractures (VCF) of traumatic origin. We enrolled 103 patients (median age: 61.6 years) with 108 VCF due to trauma, or traumatic VCF with associated osteoporosis. Primary outcome was back pain intensity (VAS). Secondary outcomes were Oswestry Disability Index (ODI), EuroQol-VAS, and analgesic consumption. 48 ho...
... 42 Public Health 5 2010-10-01 2010-10-01 false Registry of nurse aides. 483.156 Section 483.156... That Must Be Met by States and State Agencies: Nurse Aide Training and Competency Evaluation, and Paid Feeding Assistants § 483.156 Registry of nurse aides. (a) Establishment of registry. The State must...
... 15 Commerce and Foreign Trade 3 2010-01-01 2010-01-01 false Registry of data users. 995.21 Section 995.21 Commerce and Foreign Trade Regulations Relating to Commerce and Foreign Trade (Continued... § 995.21 Registry of data users. (a) CED or CEVAD shall maintain a registry of customers receiving NOAA...
... 37 Patents, Trademarks, and Copyrights 1 2010-07-01 2010-07-01 false Visual Arts Registry. 201.25... AND PROCEDURES GENERAL PROVISIONS § 201.25 Visual Arts Registry. (a) General. This section prescribes the procedures relating to the submission of Visual Arts Registry Statements by visual artists and...
Gláucio Ary Dillon Soares; Dayse Miranda
As conseqüências sociais e psicológicas da violência urbana sobre os parentes e amigos de pessoas vitimadas por mortes violentas (homicídio, suicídio ou acidentes) são analisadas à luz das diferenças de gênero. A literatura especializada nesta área propõe que mulheres e homens vivenciam experiências traumáticas de forma peculiar. Porém, os traumas típicos são diferentes em cada gênero, deixando em aberto a questão sobre quanto das diferenças entre as respostas se devem a gênero e quanto se de...