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injury audit

Tracey Ying, Samantha Chan, Stephen Lane, Christine Somerville
AIM: To identify risk factors for acute kidney injury following major orthopaedic surgery. METHODS: We included all patients undergoing major orthopaedic surgery at University Hospital Geelong between 2008 and 2014 in the study. Out of 2188 surgeries audited, we identified cases of acute kidney injury using the RIFLE criteria and matched those to controls 2:1 for age, sex, procedure and chronic kidney disease stage. We reviewed their records for risk factors of postoperative acute kidney injury, including medications such as gentamicin, diuretics, non-steroidal anti-inflammatory drugs and angiotensin-converting enzyme inhibitor or angiotensin receptor blocker use...
October 5, 2016: Nephrology
Luke Wolfenden, Jannah Jones, Christopher M Williams, Meghan Finch, Rebecca J Wyse, Melanie Kingsland, Flora Tzelepis, John Wiggers, Amanda J Williams, Kirsty Seward, Tameka Small, Vivian Welch, Debbie Booth, Sze Lin Yoong
BACKGROUND: Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES: The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention...
October 4, 2016: Cochrane Database of Systematic Reviews
Matthew Pritam Taylor, Paul Wrenn, Andrew David O'Donnell
BACKGROUND: Injury to the spinal cord can result in loss of sympathetic innervation causing a drop in BP and HR, this condition is known as neurogenic shock. There is debate among the literature on how and when neurogenic shock presents and what values of HR and BP should be used to define it. Previous studies do not take into account multiple prehospital and emergency department recordings. OBJECTIVE: To improve understanding of how neurogenic shock presents in humans, allowing better identification and treatment...
October 3, 2016: Emergency Medicine Journal: EMJ
Prashanth J Rao, Kevin Phan, Ralph J Mobbs, David Wilson, Jonathon Ball
BACKGROUND: Immobilization of the cervical spine is a cornerstone of spinal injury management. In the context of suspected cervical spine injury, patients are immobilized in a 'neutral position' based on the head and trunk resting on a flat surface. It is hypothesized that the increased thoracic kyphosis and loss of cervical lordosis seen in elderly patients may require alternative cervical immobilization, compared with the 'neutral position'. METHODS: To investigate this, an audit of pan-scan CT performed on consecutive major trauma patients aged over 65 years was carried out over a 6-month period...
March 2016: J Spine Surg
J W Simcock, J A Dunn, N T Buckley, K D Mohammed, G P Beadel, A G Rothwell
STUDY DESIGN: Retrospective audit. OBJECTIVES: The objective of this study was to identify the proportion of patients with cervical spinal cord injury who would potentially benefit from nerve transfer surgery to gain active hand opening, and to determine when a safe nerve transfer decision can be made. SETTING: Christchurch, New Zealand. METHODS: Case note review of the first 12 months following acute cervical spinal cord injury (2007-2012)...
September 27, 2016: Spinal Cord
Andre S Madsen, George Oosthuizen, Grant L Laing, John L Bruce, Damian Luiz Clarke
BACKGROUND: The purpose of this study was to audit our experience with computed tomography angiography (CTA) for the detection of aerodigestive tract injury (ADTI) following penetrating neck injury (PNI) and to assess the significance of deep surgical emphysema on CTA. METHODS: A prospectively maintained trauma registry at the Pietermaritzburg Metropolitan Trauma Service, Pietermaritzburg, South Africa was retrospectively interrogated. The data of all patients with PNI investigated with CTA over a 4-y period were reviewed...
October 2016: Journal of Surgical Research
B Shazi, J L Bruce, G L Laing, B Sartorius, D L Clarke
INTRODUCTION The purpose of this study was to audit our current management of colonic trauma, and to review our experience of colonic trauma in patients who underwent initial damage control (DC) surgery. METHODS All patients treated for colonic trauma between January 2012 and December 2014 by the Pietermaritzburg Metropolitan Trauma Service were included in the study. Data reviewed included mechanism of injury, method of management (primary repair [PR], primary diversion [PD] or DC) and outcome (complications and mortality rate)...
September 23, 2016: Annals of the Royal College of Surgeons of England
Milan L Ridderikhof, Frederick J Schyns, Niels W Schep, Philipp Lirk, Markus W Hollmann, J Carel Goslings
BACKGROUND: Pain management in the emergency department (ED) remains suboptimal. Nursing staff protocols could improve this, but studies show divergent results. OBJECTIVE: Our aim was to evaluate a nurse-initiated pain-management protocol in adult patients with traumatic injuries in the short and in the long term, utilizing fentanyl for severe pain. METHODS: In this pre-post implementation study, ED patients were included during three periods...
September 17, 2016: Journal of Emergency Medicine
Matthew Keane
Multiple organ failure is a significant complication in traumatic injury, and can be exacerbated by a failure to adequately monitor and control trauma patients' core body temperature in emergency departments (EDs). Nearly half of trauma patients are hypothermic on arrival at emergency departments, often due to factors beyond the control of emergency service responders and during on-scene resuscitation attempts. This article examines the physiology of the 'triad of death' -hypothermia, metabolic acidosis and coagulopathy - to highlight the importance of monitoring and maintaining normothermia, or normal body temperature, which is between 36°C and 37...
September 2016: Emergency Nurse: the Journal of the RCN Accident and Emergency Nursing Association
Celeste Nota, John D Santamaria, David Reid, Antony E Tobin
BACKGROUND: Low tidal volume ventilation reduces mortality in patients with acute lung injury (ALI) and may reduce the risk of ALI in ventilated patients. A previous audit of our ventilation practices showed poor adherence to low tidal volume ventilation, and we subsequently introduced written ventilation guidelines and an education program to change practice. OBJECTIVES: To determine if adherence to low tidal volume ventilation (defined as mandatory tidal volumes of =?6...
September 2016: Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine
Anjni Patel, Mateus Mazorra Coelho Vieira, John Abraham, Nick Reid, Tu Tran, Kevin Tomecsek, João Ricardo N Vissoci, Stephanie Eucker, Charles J Gerardo, Catherine A Staton
Traumatic brain injury (TBI) is a leading cause of death worldwide and is increasing exponentially particularly in low and middle income countries (LMIC). To inform the development of a standard Clinical Practice Guideline (CPG) for the acute management of TBI that can be implemented specifically for limited resource settings, we conducted a systematic review to identify and assess the quality of all currently available CPGs on acute TBI using the AGREE II instrument. In accordance with PRISMA guidelines, from April 2013 to December 2015 we searched MEDLINE, EMBASE, Google Scholar and the Duke University Medical Center Library Guidelines for peer-reviewed published Clinical Practice Guidelines on the acute management of TBI (less than 24 hours), for any level of traumatic brain injury in both high and low income settings...
2016: PloS One
J F Maempel, O D Stone, A W Murray
Introduction Surgical procedures to manage trauma to the wrist, forearm and elbow in children are very common. Image intensifiers are used routinely, yet studies/guidelines that quantify expected radiation exposure in such procedures are lacking. Methods Information on demographics, injury type, surgeon grade and dose area product (DAP) of radiation exposure per procedure was collected prospectively for 248 patients undergoing manipulation/fixation of injuries to the elbow, forearm or wrist at a paediatric hospital over 1 year...
September 2016: Annals of the Royal College of Surgeons of England
P Ym Woo, H T Wong, J Ks Pu, W K Wong, L Yw Wong, M Wy Lee, K Y Yam, W M Lui, W S Poon
OBJECTIVES: To determine the frequency of primary ventriculoperitoneal shunt infection among patients treated at neurosurgical centres of the Hospital Authority and to identify underlying risk factors. METHODS: This multicentre historical cohort study included consecutive patients who underwent primary ventriculoperitoneal shunting at a Hospital Authority neurosurgery centre from 1 January 2009 to 31 December 2011. The primary endpoint was shunt infection, defined as: (1) the presence of cerebrospinal fluid or shunt hardware culture that yielded the pathogenic micro-organism with associated compatible symptoms and signs of central nervous system infection or shunt malfunction; or (2) surgical incision site infection requiring shunt reinsertion (even in the absence of positive culture); or (3) intraperitoneal pseudocyst formation (even in the absence of positive culture)...
October 2016: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Chih-Chung Shiao, Pei-Chen Wu, Vin-Cent Wu, Jui-Hsiang Lin, Heng-Chih Pan, Ya-Fei Yang, Tai-Shuan Lai, Tao-Min Huang, Che-Hsiung Wu, Wei-Shun Yang, Chih-Jen Wu, Chih-Chin Kao, Chiao-Yin Sun, Chun-Te Huang, Kuo-Hua Lee, Chan-Yu Lin, Te-Chuan Chen, Fu-Chang Hu, Hung-Hsiang Liou, Kuo-Cheng Lu, Kuo-Liong Chien, Jian-Jhong Wang, Wei-Chih Kan, Feng-Chi Kuo, Hugo You-Hsien Lin, Cheng-Min Chen, Zi-Hong You, Jen-Pi Tsai, Chih-Jen Weng, Hung-Yuan Chen, Chao-Fu Chang, Wen-Ding Hsu, Mai-Szu Wu, Chiu-Ching Huang, Kwan-Dun Wu
AIM: Acute kidney injury (AKI) carries an increasing incidence rate worldwide and increases the risk of developing end-stage renal disease (ESRD) as well as the medical expenses during the post-AKI course. The Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs) has thus launched a nationwide epidemiology and prognosis of dialysis-requiring acute kidney injury (NEP-AKI-D) study, which prospectively enrols critically ill patients with AKI. Through thoroughly evaluating the risk and prognostic factors of AKI, we hope to lower the incidence of AKI and ESRD from the perspective of AKI-ESRD interaction...
September 2016: Nephrology
Ashim N Adhikari, Andrew A C Heggie, Jocelyn M Shand, Patrishia Bordbar, Anastasia Pellicano, Nicky Kilpatrick
BACKGROUND: Mandibular distraction osteogenesis (MDO) is an effective method of treating upper airway obstruction (UAO) in micrognathic infants. The short-term outcomes include relief of UAO, avoidance of tracheostomy, and prompt discharge from hospital. However, it is a significant surgical procedure with potential associated morbidities. This study describes a cohort of infants managed using MDO over a twelve-year period. METHODS: A retrospective chart review was undertaken for children who had MDO before the age of 5 years between 2000 and 2012...
July 2016: Plastic and Reconstructive Surgery. Global Open
K Halliday, K Drinkwater, D C Howlett
AIM: To compare paediatric radiology provision across the UK with national standards published by the Department of Health and the Royal College of Radiologists (RCR). MATERIALS AND METHODS: Audit standards and indicators for paediatric imaging were derived from "Delivering quality imaging services for children",(1) "Standards for imaging in cases of suspected non-accidental injury"(2) and "Improving paediatric interventional radiology services"(3) and agreed jointly by the Clinical Radiology Audit Committee and the British Society of Paediatric Radiology...
August 4, 2016: Clinical Radiology
G V Oosthuizen, J L Bruce, W Bekker, N Shangase, G L Laing, D L Clarke
BACKGROUND: Pan computed tomography (CT) is widely used in the evaluation of patients with blunt polytrauma, but there is growing concern about the radiation risks imposed. OBJECTIVE: To ascertain whether we were possibly overutilising pan CT in our trauma service, and whether we could safely cut down on scans without missing significant injuries. METHODS: We audited all pan scans performed in the Metropolitan Trauma Service, Pietermaritzburg, South Africa, during the 12-month period 1 January - 31 December 2012...
August 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Phuphit Fuangworawong, Lacey N LaGrone, Witaya Chadbunchachai, Vorasith Sornsrivichai, Charles N Mock, Monica S Vavilala
BACKGROUND: Given the current exceptional burden of injury in Thailand, the proven efficacy of quality improvement programs, and the current scarcity of national-level information on trauma quality improvement program (TQIP) implementation in Thailand, we aimed to examine the use of TQIPs and barriers to TQIP adoption in Thai public trauma centers. METHODS: We distributed a survey to 110 public hospitals which are designated to provide trauma care in Thailand. The survey assessed the presence or absence of the four core elements of the World Health Organization (WHO) recommended TQIPs (morbidity and mortality (M&M) conferences, preventable death panels, trauma registries, and audit filters), and provider perception of barriers and priorities in TQIP implementation...
September 2016: International Journal of Surgery
William Wynell-Mayow, Borna Guevel, Benjamin Quansah, Ronan O'Leary, Andrew D Carrothers
Addenbrooke's Hospital, the Major Trauma Centre for the East of England Trauma Network, received 1070 major trauma patients between 1st January and 31st December 2014. In order to improve care, an audit was performed of 59 patients meeting our own selection criteria for orthopaedic polytrauma between 1st January 2013 and 31st December 2013. The Cambridge Polytrauma Pathway was devised through NCEPOD guidelines, literature review, internal and external discussion. It facilitates provision of best practice Early Appropriate Care, encompassing - multidisciplinary consultant decisions around the patient in our Neurological and Trauma Critical Care Unit, early full body trauma CT scans, serial measurements of lactate and fibrinogen levels, and out-of-hours orthopaedic theatre reserved for life-and-limb threatening injuries...
October 2016: Injury
Joel Grossbard, Carol A Malte, Gwen Lapham, Kathleen Pagulayan, Aaron P Turner, Anna D Rubinsky, Katharine A Bradley, Andrew J Saxon, Eric J Hawkins
OBJECTIVE: Information on prevalence and management of alcohol misuse among Afghanistan and Iraq veterans with traumatic brain injury (TBI) is limited. This study compared rates of alcohol misuse and follow-up care-brief intervention (BI) and addiction treatment-among Afghanistan and Iraq veterans with and without TBI receiving care from the Department of Veterans Affairs (VA). METHODS: The sample included veterans ages 18 and older screened with the Alcohol Use Disorders Identification Test alcohol consumption questions (AUDIT-C) in 2012 who received VA health care in the prior year (N=358,417)...
August 1, 2016: Psychiatric Services: a Journal of the American Psychiatric Association
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