Pub Date : 2024-03-01Epub Date: 2024-02-07DOI: 10.3390/traumacare4010005
Yelissa Navarro, Elizabeth Huang, Chandler Johnson, Forrest Clark, Samuel Coppola, Suraj Modi, Gordon L Warren, Jarrod A Call
The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of trauma patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (n = 378) and after (n = 499) 1 April 2020 when Georgia's COVID-19 shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student's t-tests. A secondary analysis focused specifically on the after-COVID patients examined the extent to which mobilization (n = 328) or lack of mobilization (n = 171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student's t-tests. The after-COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before-COVID patients. After-COVID patients also had a greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or days to mobilization. Within the after-COVID cohort, those who were mobilized were older, had greater Glasgow Coma Scale scores, had longer total hospital days, and had a lesser mortality rate, and a higher proportion were female. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective.
本研究的目的是确定 COVID-19 对创伤患者物理治疗（PT）动员的影响，并确定动员是否会影响患者在重症监护室的治疗过程。这项回顾性研究包括入住二级创伤中心重症监护室的患者。患者被分为两组，即 2020 年 4 月 1 日佐治亚州 COVID-19 就地掩蔽令强制执行之前（n = 378）和之后（n = 499）入院的患者。使用卡方检验（Chi-square）和学生 t 检验（Student's t tests）对两组的名义变量和比率变量进行对比。一项专门针对 COVID 后患者的二次分析研究了动员（n = 328）或不动员（n = 171）对 ICU 结果（如死亡率、再入院率）的影响程度。采用卡方检验（Chi-square）和学生 t 检验（Student's t tests）对两组患者的名义变量和比率变量进行了对比。与COVID之前的患者相比，COVID之后的患者受伤严重程度更高，因为有更大比例的患者被归类为重伤（即受伤严重程度评分>15）。COVID后患者的累计合并症数量也更多，在重症监护室经历的并发症也更多。尽管如此，患者在接受康复治疗咨询或康复天数方面并无差异。在后COVID队列中，康复的患者年龄更大、格拉斯哥昏迷量表评分更高、住院总天数更长、死亡率更低、女性比例更高。尽管第 19 届世界艾滋病病毒/艾滋病联合会议后患者的损伤属性发生了变化，但动员护理仍然是一致和有效的。
{"title":"The Influence of COVID-19 on Patient Mobilization and Injury Attributes in the ICU: A Retrospective Analysis of a Level II Trauma Center.","authors":"Yelissa Navarro, Elizabeth Huang, Chandler Johnson, Forrest Clark, Samuel Coppola, Suraj Modi, Gordon L Warren, Jarrod A Call","doi":"10.3390/traumacare4010005","DOIUrl":"https://doi.org/10.3390/traumacare4010005","url":null,"abstract":"<p><p>The objectives of this study were to determine the effect of COVID-19 on physical therapy (PT) mobilization of trauma patients and to determine if mobilization affected patient course in the ICU. This retrospective study included patients who were admitted to the ICU of a level II trauma center. The patients were divided into two groups, i.e., those admitted before (<i>n</i> = 378) and after (<i>n</i> = 499) 1 April 2020 when Georgia's COVID-19 shelter-in-place order was mandated. The two groups were contrasted on nominal and ratio variables using Chi-square and Student's <i>t</i>-tests. A secondary analysis focused specifically on the after-COVID patients examined the extent to which mobilization (<i>n</i> = 328) or lack of mobilization (<i>n</i> = 171) influenced ICU outcomes (e.g., mortality, readmission). The two groups were contrasted on nominal and ratio variables using Chi-square and Student's <i>t</i>-tests. The after-COVID patients had higher injury severity as a greater proportion was classified as severely injured (i.e., >15 on Injury Severity Score) compared to the before-COVID patients. After-COVID patients also had a greater cumulative number of comorbidities and experienced greater complications in the ICU. Despite this, there was no difference between patients in receiving a PT consultation or days to mobilization. Within the after-COVID cohort, those who were mobilized were older, had greater Glasgow Coma Scale scores, had longer total hospital days, and had a lesser mortality rate, and a higher proportion were female. Despite shifting patient injury attributes post-COVID-19, a communicable disease, mobilization care remained consistent and effective.</p>","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"4 1","pages":"44-59"},"PeriodicalIF":0.0,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11007754/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140873120","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-11DOI: 10.3390/traumacare3040026
Gaylene Armstrong, Taylor Gonzales, Michael R. Visenio, Ashley A. Farrens, Hannah Nelson, Charity H. Evans, Jennifer Burt, Zachary M. Bauman, Mark Foxall, Ashley A. Raposo-Hadley
Introduction: Personal, behavioral, and environmental risk factors are correlated to varying degrees with each other and with the overall likelihood of violent reinjury. When used with fidelity, risk assessment instruments, including the violence reinjury risk assessment instrument (VRRAI), identify domains in which individuals present elevated risk levels to aid in matching services with needs. Less is known about the collinearity among risk factors for violently injured individuals admitted to hospitals. Collinearity between risk factors has ramifications for predictive modeling of violent reinjury risk. The objective of this study was to identify significantly correlated risk factors when the VRRAI was used by hospital-based violence intervention programs (HVIP) for clients. Materials and Methods: Victims of violent injury by modality of firearm, stabbing, and physical assault who were admitted to a level 1 trauma center at a single institution were voluntarily enrolled in a hospital-based violence intervention program (HVIP) between September 2020 and June 2022. Violence intervention specialists (VIS) completed the VRRAI within the first month of participant enrollment. The VRRAI is comprised of 29 binary indicators that may signal elevated risk of violent reinjury. Data from completed assessments were used to apply risk-need-responsivity (RNR) principles along with phi coefficients of key indicators to examine overlap and prevalence in the population. Results: A total of 98 participants were enrolled in the HVIP. The median age was 27 years old and 79 (80.6%) were male, while 66 (67.3%) were non-Hispanic Black or African American, 9 (9.2%) were non-Hispanic White, and 17 (17.3%) identified as Hispanic or Latino. Several statistically significant relationships existed between key risk indicators in the VRRAI. Importantly, a robust relationship was found between the two dynamic risk factors of having heavy connection with gangs and a perception of imminent threat of violence (φc = 0.57, p < 0.01). Conclusion: Data suggest that some variables could be consolidated or removed from the VRRAI to create an even shorter instrument that can be performed more rapidly in the clinical setting. The application of the RNR model illustrates a limited number of dynamic risk factors that could be immediately addressed as part of case management should be prioritized among the questions selected from the VRRAI for inquiry at the intake assessment.
个人、行为和环境风险因素彼此之间存在不同程度的相关性，并与暴力再伤害的总体可能性相关。在忠实使用时，风险评估工具，包括暴力再伤害风险评估工具(VRRAI)，可确定个人风险水平升高的领域，以帮助将服务与需求相匹配。对于入院的暴力受伤个体的危险因素之间的共线性知之甚少。危险因素之间的共线性影响了暴力再伤害风险的预测建模。本研究的目的是确定VRRAI在医院暴力干预项目(HVIP)中使用时显著相关的危险因素。材料和方法:在2020年9月至2022年6月期间，在单一机构的一级创伤中心入院的枪支、刺伤和身体攻击方式的暴力伤害受害者自愿参加了以医院为基础的暴力干预计划(HVIP)。暴力干预专家(VIS)在参与者入组的第一个月内完成了VRRAI。VRRAI由29个二元指标组成，这些指标可能表明暴力再伤害的风险增加。完成评估的数据用于应用风险-需求-反应性(RNR)原则以及关键指标的phi系数来检查人群中的重叠和患病率。结果:共有98名参与者被纳入HVIP。中位年龄为27岁，男性79例(80.6%)，非西班牙裔黑人或非裔美国人66例(67.3%)，非西班牙裔白人9例(9.2%)，西班牙裔或拉丁裔17例(17.3%)。VRRAI中几个关键风险指标之间存在统计学上显著的关系。重要的是，与帮派有密切联系和认为暴力威胁迫在眉睫这两个动态风险因素之间存在显著关系(φc = 0.57, p <0.01)。结论:数据表明，一些变量可以被整合或从VRRAI中删除，以创建一个更短的仪器，可以在临床环境中更快地执行。RNR模型的应用表明，可以作为病例管理的一部分立即解决的有限数量的动态风险因素应该在VRRAI中选择的问题中优先考虑，以便在摄入评估时进行调查。
{"title":"Assessing Risk Factors for Victims of Violence in a Hospital-Based Violence Intervention Program","authors":"Gaylene Armstrong, Taylor Gonzales, Michael R. Visenio, Ashley A. Farrens, Hannah Nelson, Charity H. Evans, Jennifer Burt, Zachary M. Bauman, Mark Foxall, Ashley A. Raposo-Hadley","doi":"10.3390/traumacare3040026","DOIUrl":"https://doi.org/10.3390/traumacare3040026","url":null,"abstract":"Introduction: Personal, behavioral, and environmental risk factors are correlated to varying degrees with each other and with the overall likelihood of violent reinjury. When used with fidelity, risk assessment instruments, including the violence reinjury risk assessment instrument (VRRAI), identify domains in which individuals present elevated risk levels to aid in matching services with needs. Less is known about the collinearity among risk factors for violently injured individuals admitted to hospitals. Collinearity between risk factors has ramifications for predictive modeling of violent reinjury risk. The objective of this study was to identify significantly correlated risk factors when the VRRAI was used by hospital-based violence intervention programs (HVIP) for clients. Materials and Methods: Victims of violent injury by modality of firearm, stabbing, and physical assault who were admitted to a level 1 trauma center at a single institution were voluntarily enrolled in a hospital-based violence intervention program (HVIP) between September 2020 and June 2022. Violence intervention specialists (VIS) completed the VRRAI within the first month of participant enrollment. The VRRAI is comprised of 29 binary indicators that may signal elevated risk of violent reinjury. Data from completed assessments were used to apply risk-need-responsivity (RNR) principles along with phi coefficients of key indicators to examine overlap and prevalence in the population. Results: A total of 98 participants were enrolled in the HVIP. The median age was 27 years old and 79 (80.6%) were male, while 66 (67.3%) were non-Hispanic Black or African American, 9 (9.2%) were non-Hispanic White, and 17 (17.3%) identified as Hispanic or Latino. Several statistically significant relationships existed between key risk indicators in the VRRAI. Importantly, a robust relationship was found between the two dynamic risk factors of having heavy connection with gangs and a perception of imminent threat of violence (φc = 0.57, p < 0.01). Conclusion: Data suggest that some variables could be consolidated or removed from the VRRAI to create an even shorter instrument that can be performed more rapidly in the clinical setting. The application of the RNR model illustrates a limited number of dynamic risk factors that could be immediately addressed as part of case management should be prioritized among the questions selected from the VRRAI for inquiry at the intake assessment.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"22 16","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135086515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-09DOI: 10.3390/traumacare3040025
Khasim Zakaria Haider, Zubair Ahmed
Since 1995, it has been known that carbohydrate drinks (CHDs) can be safely consumed two to three hours (2–3 h) preoperatively. Furthermore, preoperative CHDs significantly benefit many outcomes, such as thirst, hunger, and insulin resistance. Patients, however, still fast excessively. This study aimed to determine if a CHD, consumed 2–3 h preoperatively, impacts postoperative inflammation compared to a placebo drink or fasting. This was achieved through analysing the levels of interleukin-6, C-reactive peptide, and serum albumin 10–24 h postoperatively. We conducted a systematic review of randomised control trials. We comprehensively searched the Embase, MEDLINE and Web of Science databases, identified 473 studies, and, after screening, were left with 10 randomised control trials. Our meta-analyses found a significantly lower mean interleukin-6 level of −21.26 pg/mL ((95% CI −33.37, −9.15); p = 0.0006) postoperatively in patients given a preoperative CHD compared to fasting and a significantly higher mean serum albumin level of 2.56 g/L ((95% CI 1.41, 3.71); p < 0.0001) postoperatively in patients given a preoperative CHD compared to a placebo. Our results therefore show that a CHD, consumed 2–3 h preoperatively, lowers proinflammatory cytokine levels and increases serum albumin levels. Thus, our study reinforces guideline recommendations to give patients a CHD 2–3 h preoperatively for improved outcomes.
自1995年以来，人们已经知道，术前2-3小时(2-3小时)可以安全饮用碳水化合物饮料(CHDs)。此外，术前冠心病显著有利于许多结果，如口渴、饥饿和胰岛素抵抗。然而，患者仍然过度禁食。本研究旨在确定与安慰剂饮料或禁食相比，术前2-3小时摄入冠心病是否会影响术后炎症。这是通过分析术后10-24小时的白细胞介素-6、c反应肽和血清白蛋白水平来实现的。我们对随机对照试验进行了系统回顾。我们全面检索了Embase、MEDLINE和Web of Science数据库，确定了473项研究，经过筛选，只剩下10项随机对照试验。我们的荟萃分析发现，平均白细胞介素-6水平显著降低至- 21.26 pg/mL (95% CI为- 33.37，- 9.15);p = 0.0006)，术前冠心病患者的平均血清白蛋白水平显著高于空腹患者，为2.56 g/L (95% CI 1.41, 3.71);p & lt;0.0001)。因此，我们的研究结果表明，术前2-3小时摄入冠心病，可降低促炎细胞因子水平，提高血清白蛋白水平。因此，我们的研究强化了指南的建议，即术前2-3小时对患者进行冠心病检查以改善预后。
{"title":"Does a Preoperative Carbohydrate Drink Reduce Postoperative Inflammation? A Systematic Review and Meta-Analysis","authors":"Khasim Zakaria Haider, Zubair Ahmed","doi":"10.3390/traumacare3040025","DOIUrl":"https://doi.org/10.3390/traumacare3040025","url":null,"abstract":"Since 1995, it has been known that carbohydrate drinks (CHDs) can be safely consumed two to three hours (2–3 h) preoperatively. Furthermore, preoperative CHDs significantly benefit many outcomes, such as thirst, hunger, and insulin resistance. Patients, however, still fast excessively. This study aimed to determine if a CHD, consumed 2–3 h preoperatively, impacts postoperative inflammation compared to a placebo drink or fasting. This was achieved through analysing the levels of interleukin-6, C-reactive peptide, and serum albumin 10–24 h postoperatively. We conducted a systematic review of randomised control trials. We comprehensively searched the Embase, MEDLINE and Web of Science databases, identified 473 studies, and, after screening, were left with 10 randomised control trials. Our meta-analyses found a significantly lower mean interleukin-6 level of −21.26 pg/mL ((95% CI −33.37, −9.15); p = 0.0006) postoperatively in patients given a preoperative CHD compared to fasting and a significantly higher mean serum albumin level of 2.56 g/L ((95% CI 1.41, 3.71); p < 0.0001) postoperatively in patients given a preoperative CHD compared to a placebo. Our results therefore show that a CHD, consumed 2–3 h preoperatively, lowers proinflammatory cytokine levels and increases serum albumin levels. Thus, our study reinforces guideline recommendations to give patients a CHD 2–3 h preoperatively for improved outcomes.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":" 6-7","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135290895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-08DOI: 10.3390/traumacare3040024
Alexander J. Lee, Lucas S. LaFreniere
The United States Department of Veterans Affairs (VA) uses a systematized approach for disseminating evidence-based, trauma-focused psychotherapies for post-traumatic stress disorder (PTSD). Within this approach, veterans with PTSD must often choose between Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), each delivered in their standard protocols. Many veterans have been greatly helped by this approach. Yet limiting trauma-focused therapy to these two options leaves the VA unable to fully address the needs of a variety of veterans. This limitation, among other factors, contributes to the suboptimal attrition rates within the VA. The present review proposes solutions to address treatment barriers that are both practical (such as time and travel constraints) and psychological (such as resistance to trauma exposure). By reducing barriers, attrition may lessen. Proposed countermeasures against practical barriers include intensive protocols, shortened sessions, telehealth, smartphone application delivery, or any combination of these methods. Countermeasures against psychological barriers include alternative evidence-based treatment programs (such as Acceptance and Commitment Therapy), intensive protocols for exposure-based treatments, and the integration of components from complementary treatments to facilitate PE and CPT (such as Motivational Interviewing or family therapy). By further tailoring treatment to veterans’ diverse needs, these additions may reduce attrition in VA services for PTSD.
{"title":"Addressing Attrition from Psychotherapy for PTSD in the U.S. Department of Veterans Affairs","authors":"Alexander J. Lee, Lucas S. LaFreniere","doi":"10.3390/traumacare3040024","DOIUrl":"https://doi.org/10.3390/traumacare3040024","url":null,"abstract":"The United States Department of Veterans Affairs (VA) uses a systematized approach for disseminating evidence-based, trauma-focused psychotherapies for post-traumatic stress disorder (PTSD). Within this approach, veterans with PTSD must often choose between Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT), each delivered in their standard protocols. Many veterans have been greatly helped by this approach. Yet limiting trauma-focused therapy to these two options leaves the VA unable to fully address the needs of a variety of veterans. This limitation, among other factors, contributes to the suboptimal attrition rates within the VA. The present review proposes solutions to address treatment barriers that are both practical (such as time and travel constraints) and psychological (such as resistance to trauma exposure). By reducing barriers, attrition may lessen. Proposed countermeasures against practical barriers include intensive protocols, shortened sessions, telehealth, smartphone application delivery, or any combination of these methods. Countermeasures against psychological barriers include alternative evidence-based treatment programs (such as Acceptance and Commitment Therapy), intensive protocols for exposure-based treatments, and the integration of components from complementary treatments to facilitate PE and CPT (such as Motivational Interviewing or family therapy). By further tailoring treatment to veterans’ diverse needs, these additions may reduce attrition in VA services for PTSD.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135341930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-06DOI: 10.3390/traumacare3040023
Vicki Bitsika, Christopher Francis Sharpley
There is some evidence that autistic children experience more traumatic events than non-autistic children, but little research attention has been given to sex differences on this issue. This study investigated the presence of sex-based differences in the occurrence and severity of trauma-related events and resultant stress in autistic youth, and tested the null hypothesis of no sex differences. A sample of 32 autistic males and 32 autistic females (6 yr to 18 yr), plus one of their parents, participated in a survey study of (a) the presence of a traumatic event and ongoing stress regarding that event, and (b) recurrent memories or dreams of that event. Although the autistic children rated their experience of trauma, plus their recurrent memories or dreams of that event, as more severe than their parents did, neither of these sources of information showed any significant sex differences in the total score or diagnostic frequency for trauma-related stress. There were no significant correlations between age, IQ, or autism severity and trauma-related stress scores for the autistic males or females. These results challenge the generalizability of the prevalence of sex differences in trauma-related stress that has been reported in the wider community, arguing that equal attention should be given to male and female autistic youth for this possible comorbidity.
{"title":"Are There Sex Differences in the Prevalence and Severity of Early-Stage Trauma-Related Stress in Mildly Impaired Autistic Children and Adolescents?","authors":"Vicki Bitsika, Christopher Francis Sharpley","doi":"10.3390/traumacare3040023","DOIUrl":"https://doi.org/10.3390/traumacare3040023","url":null,"abstract":"There is some evidence that autistic children experience more traumatic events than non-autistic children, but little research attention has been given to sex differences on this issue. This study investigated the presence of sex-based differences in the occurrence and severity of trauma-related events and resultant stress in autistic youth, and tested the null hypothesis of no sex differences. A sample of 32 autistic males and 32 autistic females (6 yr to 18 yr), plus one of their parents, participated in a survey study of (a) the presence of a traumatic event and ongoing stress regarding that event, and (b) recurrent memories or dreams of that event. Although the autistic children rated their experience of trauma, plus their recurrent memories or dreams of that event, as more severe than their parents did, neither of these sources of information showed any significant sex differences in the total score or diagnostic frequency for trauma-related stress. There were no significant correlations between age, IQ, or autism severity and trauma-related stress scores for the autistic males or females. These results challenge the generalizability of the prevalence of sex differences in trauma-related stress that has been reported in the wider community, arguing that equal attention should be given to male and female autistic youth for this possible comorbidity.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135634188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-23DOI: 10.3390/traumacare3040022
Doriane Deloye, Alexandra Nadeau, Amanda Barnes-Métras, Christian Malo, Marcel Émond, Lynne Moore, Pier-Alexandre Tardif, Axel Benhamed, Xavier Dubucs, Pierre-Gilles Blanchard, Eric Mercier
Sex disparities in access and quality of care are well known for some time-sensitive conditions. However, the impact of sex on early trauma care remains unknown. In this study, we compared delays of completion of life-saving interventions (LSIs) between females and males among severely injured patients. This is a retrospective cohort study of all patients who consulted or were transported by ambulance in the emergency department (ED) of a level-one trauma centre following injury between September 2017 and December 2019 and for whom at least one LSI was performed. The list of LSIs was established by an expert consensus and included trauma team leader (TTL) activation, endotracheal intubation, chest decompression, blood transfusion, massive transfusion protocol, neurosurgery, spinal surgery, intestinal surgery, and spleen, liver and/or kidney angiography. A total of 905 patients were included. No significant statistical differences in the LSI delays were found when comparing females and males brought directly to the ED and transferred from another health care setting. Results of this study suggest that delays before completion of LSIs are similar for severely injured patients at our major trauma centre regardless of their sex.
{"title":"Impact of Sex on Completion of Life-Saving Interventions for Severely Injured Patients: A Retrospective Cohort Study","authors":"Doriane Deloye, Alexandra Nadeau, Amanda Barnes-Métras, Christian Malo, Marcel Émond, Lynne Moore, Pier-Alexandre Tardif, Axel Benhamed, Xavier Dubucs, Pierre-Gilles Blanchard, Eric Mercier","doi":"10.3390/traumacare3040022","DOIUrl":"https://doi.org/10.3390/traumacare3040022","url":null,"abstract":"Sex disparities in access and quality of care are well known for some time-sensitive conditions. However, the impact of sex on early trauma care remains unknown. In this study, we compared delays of completion of life-saving interventions (LSIs) between females and males among severely injured patients. This is a retrospective cohort study of all patients who consulted or were transported by ambulance in the emergency department (ED) of a level-one trauma centre following injury between September 2017 and December 2019 and for whom at least one LSI was performed. The list of LSIs was established by an expert consensus and included trauma team leader (TTL) activation, endotracheal intubation, chest decompression, blood transfusion, massive transfusion protocol, neurosurgery, spinal surgery, intestinal surgery, and spleen, liver and/or kidney angiography. A total of 905 patients were included. No significant statistical differences in the LSI delays were found when comparing females and males brought directly to the ED and transferred from another health care setting. Results of this study suggest that delays before completion of LSIs are similar for severely injured patients at our major trauma centre regardless of their sex.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"49 5","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135366453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-05DOI: 10.3390/traumacare3040021
Bridget N. Jules, Victoria L. O’Connor, Jennifer Langhinrichsen-Rohling
Infidelity, a betrayal within a romantic partnership, often violates a person’s core beliefs about themselves and their significant other and can influence the degree to which a person can feel safe in romantic relationships. Infidelity can also increase exposure to sexually transmitted diseases that can compromise physical and mental health. Therefore, infidelity can be judged as central to one’s identity and potentially traumatic, possibly triggering outcomes similar to other DSM-5 Criterion A traumas. The current research examines the contribution of centrality perceptions to the development of PTG and PTS post-infidelity. Bivariate regressions examined the relationships between the judged centrality of infidelity and PTG and PTS, respectively. Exploratory analyses considered the moderating role of relationship form (i.e., casually dating, exclusively dating, and engaged/married) on those relationships. In a sample of 177 adults, greater judgments of the centrality of infidelity were associated with both PTG and PTS. Results demonstrated a significant moderating effect of relationship form on the relationship between the centrality of infidelity and PTG but not between the centrality of infidelity and PTS. Moderation results demonstrated that if infidelity is considered central in a casually dating relationship, it is more strongly related to PTG than in other relationship forms. Considering infidelity as central may generate both beneficial and problematic post-traumatic outcomes. However, an early infidelity experience may provide increased opportunities for engagement in different behaviors in the future (e.g., selecting a different partner, setting different relational boundaries), which, in turn, may be more conducive to growth.
{"title":"Judgments of Event Centrality as Predictors of Post-Traumatic Growth and Post-Traumatic Stress after Infidelity: The Moderating Effect of Relationship Form","authors":"Bridget N. Jules, Victoria L. O’Connor, Jennifer Langhinrichsen-Rohling","doi":"10.3390/traumacare3040021","DOIUrl":"https://doi.org/10.3390/traumacare3040021","url":null,"abstract":"Infidelity, a betrayal within a romantic partnership, often violates a person’s core beliefs about themselves and their significant other and can influence the degree to which a person can feel safe in romantic relationships. Infidelity can also increase exposure to sexually transmitted diseases that can compromise physical and mental health. Therefore, infidelity can be judged as central to one’s identity and potentially traumatic, possibly triggering outcomes similar to other DSM-5 Criterion A traumas. The current research examines the contribution of centrality perceptions to the development of PTG and PTS post-infidelity. Bivariate regressions examined the relationships between the judged centrality of infidelity and PTG and PTS, respectively. Exploratory analyses considered the moderating role of relationship form (i.e., casually dating, exclusively dating, and engaged/married) on those relationships. In a sample of 177 adults, greater judgments of the centrality of infidelity were associated with both PTG and PTS. Results demonstrated a significant moderating effect of relationship form on the relationship between the centrality of infidelity and PTG but not between the centrality of infidelity and PTS. Moderation results demonstrated that if infidelity is considered central in a casually dating relationship, it is more strongly related to PTG than in other relationship forms. Considering infidelity as central may generate both beneficial and problematic post-traumatic outcomes. However, an early infidelity experience may provide increased opportunities for engagement in different behaviors in the future (e.g., selecting a different partner, setting different relational boundaries), which, in turn, may be more conducive to growth.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134975342","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-25DOI: 10.3390/traumacare3040020
Amy Thandeka Crankshaw, Veronica Melody Dwarika
An acknowledgement that the legacy of apartheid lives on in the minds of South Africa’s born free generation necessitates an exploration of psychologists’ interventions for transgenerational trauma. This research aimed to contribute to research on this subject by interviewing South African psychologists with the ultimate objective of assisting professionals who formulate interventions. Firstly, the ways in which psychologists identify transgenerational trauma were explored. This provided a foundation for exploring the psychologists’ interventions for transgenerational trauma and contributed to a discussion of how interventions could be enhanced. Thematic analysis of the semistructured interviews revealed that stuckness paired with guilt, grief resulting from silence and certain manifestations of identity and relationship issues are identifiers of transgenerational trauma. The findings also pointed to the utility of certain approaches to individual, group, family and community interventions. Recommendations for enhancing psychologists’ interventions for transgenerational trauma in Gauteng’s born free generation revealed the imperative for psychologists to actively engage in professional and personal growth, predicated on the complexity of the challenges within.
{"title":"Exploring Psychologists’ Interventions for Transgenerational Trauma in South Africa’s Born Free Generation","authors":"Amy Thandeka Crankshaw, Veronica Melody Dwarika","doi":"10.3390/traumacare3040020","DOIUrl":"https://doi.org/10.3390/traumacare3040020","url":null,"abstract":"An acknowledgement that the legacy of apartheid lives on in the minds of South Africa’s born free generation necessitates an exploration of psychologists’ interventions for transgenerational trauma. This research aimed to contribute to research on this subject by interviewing South African psychologists with the ultimate objective of assisting professionals who formulate interventions. Firstly, the ways in which psychologists identify transgenerational trauma were explored. This provided a foundation for exploring the psychologists’ interventions for transgenerational trauma and contributed to a discussion of how interventions could be enhanced. Thematic analysis of the semistructured interviews revealed that stuckness paired with guilt, grief resulting from silence and certain manifestations of identity and relationship issues are identifiers of transgenerational trauma. The findings also pointed to the utility of certain approaches to individual, group, family and community interventions. Recommendations for enhancing psychologists’ interventions for transgenerational trauma in Gauteng’s born free generation revealed the imperative for psychologists to actively engage in professional and personal growth, predicated on the complexity of the challenges within.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135863601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-19DOI: 10.3390/traumacare3030019
Lisa Tamburini, Francine Zeng, Dillon Neumann, Casey Jackson, Michael Mancini, Andrew Block, Seema Patel, Ian Wellington, David Stroh
Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures.
{"title":"A Review of Tibial Shaft Fracture Fixation Methods","authors":"Lisa Tamburini, Francine Zeng, Dillon Neumann, Casey Jackson, Michael Mancini, Andrew Block, Seema Patel, Ian Wellington, David Stroh","doi":"10.3390/traumacare3030019","DOIUrl":"https://doi.org/10.3390/traumacare3030019","url":null,"abstract":"Tibial shaft fractures are a commonly seen injury in orthopedic trauma patients. Fractures commonly occur following high energy mechanisms, such as motor vehicle collisions. There are multiple ways to stabilize tibial shaft fractures. Knowledge of the indications, contraindications, techniques, and complications associated with each technique allows the orthopedic surgeon to make the appropriate decision for each patient by providing both fracture and patient characteristics. This review discusses the indications, techniques, outcomes, and complications associated with intramedullary nailing, minimally invasive percutaneous plate osteosynthesis, and external fixation of tibial shaft fractures.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135015417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-09-11DOI: 10.3390/traumacare3030018
Joseph Mendlovic, Idan Haklay, Roxanne Elliott, Mooli Lahad
This study examines the psychological repercussions of the COVID-19 pandemic on a medical team in an Israeli general hospital. The research explores the professional quality of life, burnout symptoms, secondary traumatic stress, and mindfulness among team members across three distinct phases of the pandemic. Analysis was conducted for different subgroups based on job roles and seniority, allowing for an evaluation of the phase-specific effects on ProQOL (Professional Quality of Life) and mindfulness. Results align with established crisis trajectories: honeymoon/heroic phases, inventory, disillusionment, and recovery. As a result of the prolonged pandemic and the need to change shifts and recruit staff to deal with the affected patients, it is an accumulative study not following the same person but the same ward and the same hospital. The findings suggest a negative correlation between compassion satisfaction and burnout, as well as between mindfulness and burnout/secondary traumatic stress. Unlike most studies, healthcare workers (HCWs) were less affected than doctors in all measures. This study highlights doctors’ vulnerability and underscores hospital management’s key role in promoting effective support for professional quality of life. This is especially important for male doctors facing distinct well-being challenges.
{"title":"COVID-19’s Impact on Medical Staff Wellbeing: Investigating Trauma and Resilience in a Longitudinal Study—Are Doctors Truly Less Vulnerable Than Nurses?","authors":"Joseph Mendlovic, Idan Haklay, Roxanne Elliott, Mooli Lahad","doi":"10.3390/traumacare3030018","DOIUrl":"https://doi.org/10.3390/traumacare3030018","url":null,"abstract":"This study examines the psychological repercussions of the COVID-19 pandemic on a medical team in an Israeli general hospital. The research explores the professional quality of life, burnout symptoms, secondary traumatic stress, and mindfulness among team members across three distinct phases of the pandemic. Analysis was conducted for different subgroups based on job roles and seniority, allowing for an evaluation of the phase-specific effects on ProQOL (Professional Quality of Life) and mindfulness. Results align with established crisis trajectories: honeymoon/heroic phases, inventory, disillusionment, and recovery. As a result of the prolonged pandemic and the need to change shifts and recruit staff to deal with the affected patients, it is an accumulative study not following the same person but the same ward and the same hospital. The findings suggest a negative correlation between compassion satisfaction and burnout, as well as between mindfulness and burnout/secondary traumatic stress. Unlike most studies, healthcare workers (HCWs) were less affected than doctors in all measures. This study highlights doctors’ vulnerability and underscores hospital management’s key role in promoting effective support for professional quality of life. This is especially important for male doctors facing distinct well-being challenges.","PeriodicalId":75251,"journal":{"name":"Trauma care (Basel, Switzerland)","volume":"76 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135982343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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