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Trauma best practice

John Dabis, Aliyah Hussein, Mark Rickman
Hip fractures represent a significant burden to the NHS: the cost for all UK hip fractures is approximately £2 billion and in 2013, 64 838 people were admitted to hospital with a fractured neck of femur (FNOF). In April 2010 St George's NHS Hospital was designated one of four Major Trauma Centres (MTC) in London. Following MTC designation, in April 2014 St George's Hospital opened a helipad. This study aimed to assess the impact of the helipad designation on the Trust's ability to meet the Best Practice Tariff (BPT) criteria for FNOF patients...
October 18, 2016: Surgeon: Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
John M Janzen
This study, with a focus on Central and Southern Africa, offers an overview of best practices and theoretical debates in the anthropology of violence, including the ethnography of situations where violence is pervasive and active efforts are made to deal with it. Although the multiple sites of recent violence in this region are unique in their scale, intensity, and cause, the literature review suggests a typical course of events of patterns of violence and trauma, construction of memory, efforts at mediation and healing, or persisting conflict and confronting the aftermath of violence at home or in exile...
September 2016: Journal of Public Health Policy
Alfin Okullo, Mehan Siriwardhane, Tony C Y Pang, Jane-Louise Sinclair, Vincent W T Lam, Arthur James Richardson, Henry Pleass, Emma Johnston
INTRODUCTION: Achieving primary fascial closure after damage control laparostomy can be challenging. A number of devices are in use, with none having yet emerged as best practice. In July 2013, at Westmead Hospital, we started using the abdominal reapproximation anchor (ABRA; Canica Design, Almonte, Ontario, Canada) device. We report on our experience. METHODS: A retrospective review of medical records for patients who had open abdomens managed with the ABRA device between July to December 2013 was done...
September 26, 2016: Surgical Innovation
Scott M Tintle, Christopher LeBrun, James R Ficke, Benjamin K Potter
Traumatic and trauma-related amputations represent unfortunate sequelae of severe injury, but should not be viewed as a treatment failure and may represent the best reconstructive option for some patients. Lessons from recent military conflicts have guided the evolution of modern surgical techniques and rehabilitation management of this challenging patient population, and treatment at a specialty center may improve patient outcomes. Despite appropriate management, however, surgical complications remain common and revision surgery is often necessary...
October 2016: Journal of Orthopaedic Trauma
Leressè Pillay, Timothy Hardcastle
INTRODUCTION: Establishing a definitive airway in order to ensure adequate ventilation and oxygenation is an important aspect of resuscitation of the polytrauma patient . AIM: To review the relevant literature that compares the different drugs used for rapid sequence intubation (RSI) of trauma patients, specifically reviewing: premedication, induction agents and neuromuscular blocking agents across the prehospital, emergency department and operating room setting, and to present the best practices based on the reviewed evidence...
September 19, 2016: World Journal of Surgery
M Maegele
Based upon the results of CRASH-2, early administration of antifibrinolytic tranexamic acid (TXA) is recommended in bleeding trauma patients or trauma patients presumed to bleed. Many trauma centers and emergency medical services have adopted this practice into their routine algorithms. The pitfalls of CRASH-2 have been discussed in the literature, but the positive effects could sometimes not be reproduced in follow-up studies. The mechanism of action of TXA in trauma is still not clear and major knowledge gaps with TXA in the context of trauma have been identified...
September 14, 2016: Der Unfallchirurg
John M Janzen
This study, with a focus on Central and Southern Africa, offers an overview of best practices and theoretical debates in the anthropology of violence, including the ethnography of situations where violence is pervasive and active efforts are made to deal with it. Although the multiple sites of recent violence in this region are unique in their scale, intensity, and cause, the literature review suggests a typical course of events of patterns of violence and trauma, construction of memory, efforts at mediation and healing, or persisting conflict and confronting the aftermath of violence at home or in exile...
September 2016: Journal of Public Health Policy
Nicole Powell-Dunford, Jose F Quesada, Kirby R Gross, Stacy A Shackelford
BACKGROUND: Identify challenges and best practices in the development of an austere air ambulance transfusion program. METHODS: A search of PubMed using combinations of the key terms 'prehospital,' 'blood product,' 'red blood cells,' 'damage control resuscitation,' 'transfusion,' 'air ambulance,' 'medical evacuation,' and 'medevac' yielded 196 articles for further analysis, with 14 articles suitable for addressing the background of prehospital transfusion within a helicopter...
August 2016: Aerospace Medicine and Human Performance
Chris Rossiter, Virginia Schmied, Lynn Kemp, Cathrine Fowler, Sue Kruske, Caroline Se Homer
AIMS: To explore the extent to which Australian child and family health nurses work with families with complex needs and how their practice responds to the needs of these families. BACKGROUND: Many families with young children face challenges to their parenting capacity, potentially placing their children at risk of poorer developmental outcomes. Nurses increasingly work with families with mental health problems, trauma histories and/or substance dependence. Universal child health services must respond effectively to these challenges, to address health inequalities and to promote the best outcomes for all children and families...
September 14, 2016: Journal of Advanced Nursing
Sage R Myers, Charles C Branas, Benjamin French, Michael L Nance, Brendan G Carr
OBJECTIVES: More childhood deaths are attributed to trauma than all other causes combined. Our objectives were to provide the first national description of the proportion of injured children treated at pediatric trauma centers (TCs), and to provide clarity to the presumed benefit of pediatric TC verification by comparing injury mortality across hospital types. METHODS: We performed a population-based cohort study using the 2006 Healthcare Cost and Utilization Project Kids Inpatient Database combined with national TC inventories...
September 9, 2016: Pediatric Emergency Care
A Meder, M Lammerding-Köppel, S Zundel, U Stöckle, C Bahrs, C Gonser
Background: There is a serious lack of young doctors in trauma surgery, which has intensified in recent years. The reasons are complex. Studies have shown that the interest in starting a career in surgery significantly decreases during medical school. To counteract the lack of young talent in the clinic, interest in the subject should be aroused in medical school. The aim of the present study was to evaluate current teaching at our university, where trauma surgery is a curricular subject with mandatory attendance for all medical students...
September 9, 2016: Zeitschrift Für Orthopädie und Unfallchirurgie
James Halpern
As shared trauma reality becomes more common in Israel and other countries, this commentary argues that we need more research to inform how to best assist mental health professionals who are both victims and helpers in the aftermath of traumatic events. Typical remedies for the occupational hazards of working with trauma survivors may not apply for those who are exposed to a prolonged terror threat. Research-informed self-care strategies need to be identified and practiced.
2016: Israel Journal of Health Policy Research
Namita Jayaprakash, Rashid Ali, Rahul Kashyap, Courtney Bennett, Alexander Kogan, Ognjen Gajic
BACKGROUND: Diagnostic error and delay are critical impediments to the safety of critically ill patients. Checklist for early recognition and treatment of acute illness and injury (CERTAIN) has been developed as a tool that facilitates timely and error-free evaluation of critically ill patients. While the focused history is an essential part of the CERTAIN framework, it is not clear how best to choreograph this step in the process of evaluation and treatment of the acutely decompensating patient...
2016: BMC Emergency Medicine
Maryse C Cnossen, Suzanne Polinder, Hester F Lingsma, Andrew I R Maas, David Menon, Ewout W Steyerberg
INTRODUCTION: The strength of evidence underpinning care and treatment recommendations in traumatic brain injury (TBI) is low. Comparative effectiveness research (CER) has been proposed as a framework to provide evidence for optimal care for TBI patients. The first step in CER is to map the existing variation. The aim of current study is to quantify variation in general structural and process characteristics among centers participating in the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) study...
2016: PloS One
S J Mercer, C P Jones, M Bridge, E Clitheroe, B Morton, P Groom
INTRODUCTION: Non-iatrogenic trauma to the airway is rare and presents a significant challenge to the anaesthetist. Although guidelines for the management of the unanticipated difficult airway have been published, these do not make provision for the 'anticipated' difficult airway. This systematic review aims to inform best practice and suggest management options for different injury patterns. METHODS: A literature search was conducted using Embase, Medline, and Google Scholar for papers after the year 2000 reporting on the acute airway management of adult patients who suffered airway trauma...
September 2016: British Journal of Anaesthesia
Kelley A Saia, Davida Schiff, Elisha M Wachman, Pooja Mehta, Annmarie Vilkins, Michelle Sia, Jordana Price, Tirah Samura, Justin DeAngelis, Clark V Jackson, Sawyer F Emmer, Daniel Shaw, Sarah Bagley
PURPOSE OF THE REVIEW: Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population...
2016: Current Obstetrics and Gynecology Reports
Benjamin Lindquist, Matthew C Strehlow, G V Ramana Rao, Jennifer A Newberry
BACKGROUND: Many low- and middle-income countries depend on emergency medical technicians (EMTs), nurses, midwives, and layperson community health workers with limited training to provide a majority of emergency medical, trauma, and obstetric care in the prehospital setting. To improve timely patient care and expand provider scope of practice, nations leverage cellular phones and call centers for real-time online medical direction. However, there exist several barriers to adequate communication that impact the provision of emergency care...
2016: Curēus
Lígia N M Ribeiro, Michelle Franz-Montan, Márcia C Breitkreitz, Ana C S Alcântara, Simone R Castro, Viviane A Guilherme, Raquel M Barbosa, Eneida de Paula
In dental practice, local anesthesia causes pain, fear, and stress, and is frequently the reason that patients abandon treatment. Topical anesthetics are applied in order to minimize the discomfort caused by needle insertion and injection, and to reduce the symptoms of superficial trauma at the oral mucosa, but there are still no efficient commercially available formulations. Factorial design is a multivariate data analysis procedure that can be used to optimize the manufacturing processes of lipid nanocarriers, providing valuable information and minimizing development time...
October 10, 2016: European Journal of Pharmaceutical Sciences
Colleen G Le Prell, Douglas S Brungart
OBJECTIVE: In humans, the accepted clinical standards for detecting hearing loss are the behavioral audiogram, based on the absolute detection threshold of pure-tones, and the threshold auditory brainstem response (ABR). The audiogram and the threshold ABR are reliable and sensitive measures of hearing thresholds in human listeners. However, recent results from noise-exposed animals demonstrate that noise exposure can cause substantial neurodegeneration in the peripheral auditory system without degrading pure-tone audiometric thresholds...
September 2016: Otology & Neurotology
Lisseth Rojas-Flores, Mari L Clements, J Hwang Koo, Judy London
The mental health impact of parental detention and deportation on citizen children is a topic of increasing concern. Forced parent-child separation and parental loss are potentially traumatic events (PTEs) with adverse effects on children's mental health. Objective: This study examines posttraumatic stress disorder (PTSD) symptoms and psychological distress among 91 Latino U.S.-born children (ages 6 to 12), living in mixed-status families with a least 1 undocumented parent at risk for detention or deportation...
August 8, 2016: Psychological Trauma: Theory, Research, Practice and Policy
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