BACKGROUND: Transport of patients is sometimes necessary and unavoidable. However, there are many risks related to it. For this reason, safety of intra-hospital transport has been thoroughly studied in critical care patients; however there is no literature on adverse events during transport of trauma patients. Due to the acute nature of injury, trauma patients are fundamentally different than other populations of patients and require special consideration during transport. Lack of data makes initiating new protocols for transport conditions difficult. METHODS/RESULTS: Data from all activated trauma response patients who required transport to and from the CT scanner from the period of January 01, 2010 to December 31st, 2013 (total of 1103 patients) were collected. From these patients, 17 adverse events were identified (2.0% excluding missing documentation). Vomiting was the most common adverse event followed by peripheral IV line dislodgment. There were no cardiac arrests or deaths resulting from transport related events. CONCLUSION: Defining adverse events is a key part of evaluating safety during transport. Fluctuations in vital signs and other objective measures may reflect patient disease rather than transport. Our study provides clear definitions of what an adverse event is using outcomes and objectively identifies measures necessary for safe transport as well as areas of improvement.

<p>The first hospital outbreak of vancomycin-resistant enterococci (VRE) and carriage rates of VRE and ampicillin-resistant enterococci (ARE) in Sweden were investigated. Clonal relationships and mutations in fluoroquinolone resistance determining regions among ARE collected nation-wide were studied. Risk factors for ARE infection, shedding of ARE and the presence of the virulence gene <i>esp</i> in ARE isolates and patients on a hematology unit and other units at Uppsala University Hospital were further investigated. </p><p>The first Swedish hospital VRE outbreak was due to clonal spread of <i>E. faecium, vanA</i>. The nation wide carriage rates of ARE and VRE were 21.5% / 1% and 6% / 0%, among hospitalized patients and non-hospitalized individuals respectively. All ARE and VRE were <i>E. faecium</i> and >90% resistant to ciprofloxacin. All VRE carried<i> vanB</i>. Carriage of ARE was independently associated with >5 days of antibiotic treatment. Phenotypic and genetic typing showed a significantly higher homogeneity among ARE compared to matched ASE <i>E. faecium</i> isolates. Mutations conferring high-level ciprofloxacin resistance were found only in ARE. Risk factors for ARE infection included long duration of hospital stay and exposure to antibiotics. Skin carriage was associated with ARE shedding. ARE bacteremia was independently associated with prior ARE colonization and hematopoietic stem cell transplantation. Death was more common in ARE septicemia cases compared to controls. <i>Esp</i> was significantly more common in ARE surveillance compared to ARE blood isolates from patients on the hematology ward.</p><p>In conclusion, VRE were rare but clonally related multi-resistant ARE <i>E. faecium</i> were highly prevalent in Swedish hospitals. Spread of ARE in hospitals during the 1990s is suggested to be the main explanation for the emergence of ARE in Sweden. Spread was facilitated by use of antibiotics and probably by the presence of virulence genes in<i> E. faecium</i> isolates.</p>

The first hospital outbreak of vancomycin-resistant enterococci (VRE) and carriage rates of VRE and ampicillin-resistant enterococci (ARE) in Sweden were investigated. Clonal relationships and mutations in fluoroquinolone resistance determining regions among ARE collected nation-wide were studied. Risk factors for ARE infection, shedding of ARE and the presence of the virulence gene esp in ARE isolates and patients on a hematology unit and other units at Uppsala University Hospital were further investigated. The first Swedish hospital VRE outbreak was due to clonal spread of E. faecium, vanA. The nation wide carriage rates of ARE and VRE were 21.5% / 1% and 6% / 0%, among hospitalized patients and non-hospitalized individuals respectively. All ARE and VRE were E. faecium and &gt;90% resistant to ciprofloxacin. All VRE carried vanB. Carriage of ARE was independently associated with &gt;5 days of antibiotic treatment. Phenotypic and genetic typing showed a significantly higher homogeneity among ARE compared to matched ASE E. faecium isolates. Mutations conferring high-level ciprofloxacin resistance were found only in ARE. Risk factors for ARE infection included long duration of hospital stay and exposure to antibiotics. Skin carriage was associated with ARE shedding. ARE bacteremia was independently associated with prior ARE colonization and hematopoietic stem cell transplantation. Death was more common in ARE septicemia cases compared to controls. Esp was significantly more common in ARE surveillance compared to ARE blood isolates from patients on the hematology ward. In conclusion, VRE were rare but clonally related multi-resistant ARE E. faecium were highly prevalent in Swedish hospitals. Spread of ARE in hospitals during the 1990s is suggested to be the main explanation for the emergence of ARE in Sweden. Spread was facilitated by use of antibiotics and probably by the presence of virulence genes in E. faecium isolates.

LIMA, M. M. P. Avaliação da Política Nacional de Transplantes no Ceará: atuação da Central Estadual e das Comissões Intra-Hospitalares. 2011. 120f. Dissertação (Mestrado em Avaliação de Políticas Públicas) – Universidade Federal do Ceará, Pro - Reitoria de Pesquisa e Pós-Graduação, Programa de Pós-Graduação em Avaliação de Políticas Públicas, Fortaleza, 2011. / Submitted by Ana Paula Paula (mappufce@gmail.com) on 2012-03-21T19:19:48Z No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-03-22T13:26:27Z (GMT) No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5) / Made available in DSpace on 2012-03-22T13:26:27Z (GMT). No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5) Previous issue date: 2011 / In recent decades, the transplants have had a profound impact on the care of end-stage patients with several kinds of diseases. In Brazil, public policies regarding people who need transplants require thorough assessments. This research aimed to evaluate the performance of the Organ Notification, Harvesting and Distribution Center of the State of Ceará (CNCDO) and Intra-hospital Commission on Organ and Tissue Donation for Transplant (CIHDOTTs) from Fortaleza, instances considered decisive in the operationalization of the National Transplant Policy in the State of Ceará. The research was conducted by using secondary and primary data, both quantitative and qualitative, developed from July 2010 to February 2011. The president of CNCDO was interviewed. It was applied a form to be filled out by 12 coordinators of CIHDOTTs and structured observations were accomplished in three CIHDOTTs. The following results had been highlighted: CIHDOTTs with reduced teams and nurse predominance; CNCDO overloaded and performing activities which belong to the CIHDOTTs; CIHDOTTs working essentially in an active search for potential donors; the family members refusal is largely responsible for the non-confirmation of a significant number of donations; it was identified fragility in campaign, qualification and joint planning actions between CNCDO and CIHDOTTs; CNCDO and CIHDOTTs resent greater support from health professionals and hospital managers and also the lack of equipment and appropriate physical space; the great expenditure of energy of CNCDO and CIHDOTTs result in an insignificant number of effective donations; there are difficulties in the process of identifying likely potential donor, delay in the diagnosis of brain death and in the beginning of the hemodynamic maintenance of the possible donor. The indication that greater results are obtained from the campaigns which favor the regional language confirms the initial assumption that educational initiatives, due to their immediate impact on the population, has the potential to leverage the transplant process. We conclude that human, structural and technological factors pose serious obstacles to the implementation of the National Transplant Policy in the State of Ceará, with little significant impact on the sole waiting list in the country. We suggest actions on several fronts: to redirect the dissemination campaigns towards approaches which are more culturally related to the region and closer to people; to offer more frequent courses to raise awareness and to improve the skills of health professionals; to develop strategies to raise awareness of professionals and managers regarding the noble task of CNCDO and CIHDOTTs; to employ more professionals and train them to perform the detection and diagnosis of brain death faster and to ensure the accomplishment of the hemodynamic maintenance efficiently / Nas décadas recentes, os transplantes tiveram um profundo impacto no cuidado dos pacientes em estágio final de diversos tipos de doenças. No Brasil, as políticas públicas relacionadas com as pessoas que necessitam de transplante carecem de avaliações aprofundadas para desenvolvimento e aplicação de políticas públicas. A presente pesquisa teve como objetivo avaliar a atuação da Central de Notificação de Transplantes do Estado do Ceará (CNCDO) e das Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplantes (CIHDOTTs) de Fortaleza, instâncias consideradas decisivas na operacionalização da Política Nacional de Transplantes no território do Ceará. A pesquisa foi realizada utilizando dados secundários e primários, tanto quantitativos quanto qualitativos, sendo desenvolvida no período de julho de 2010 a fevereiro de 2011. Foi realizada entrevista com a presidente da CNCDO, aplicado um formulário com 12 coordenadoras das CIHDOTTs e realizadas observações estruturadas em três CIHDOTTs. Destacam-se entre os resultados: CNCDO sobrecarregada e realizando atividades da alçada das CIHDOTTs; CIHDOTTs com equipes reduzidas e predomínio de enfermeiras, atuando essencialmente na busca ativa de potenciais doadores; a recusa dos familiares sendo a grande responsável pela não confirmação de significativo número de doações; identificadas fragilidades nas ações de campanha, qualificação e planejamento conjunto da CNCDO com as CIHDOTTs; ambas ressentem-se de maior apoio dos profissionais de saúde e dos gestores dos hospitais e também da falta de equipamentos e espaço físico apropriado; o grande dispêndio de energia da CNCDO e das CIHDOTTs resulta em números ínfimos de efetivas doações; há dificuldades no processo de identificação de provável potencial doador, demora no diagnóstico de morte encefálica e em iniciar a manutenção hemodinâmica do possível doador. A indicação de que são maiores os resultados obtidos com as campanhas que privilegiam a linguagem regional confirma o pressuposto inicial de que ações educativas, por impactarem imediatamente na população, têm potencial para alavancar o processo de transplante. Concluímos que fatores humanos, estruturais e tecnológicos representam sérios entraves à execução da Política Nacional de Transplante no Estado do Ceará, com impacto pouco significativo na fila de espera, que é única para o País. Indicamos ações em diversas frentes: redirecionar as campanhas de divulgação para abordagens mais identificadas com a cultura regional e mais próxima às pessoas; cursos mais frequentes para maior sensibilização e qualificação dos profissionais de saúde; desenvolvimento de estratégias para maior sensibilização dos profissionais e gestores quanto às nobres tarefas da CNCDO e das CIHDOTTs; maior número de profissionais e capacitação mais frequente deles para que realizem a detecção e diagnóstico de morte encefálica de forma precoce e mais agilmente e que assegurem a realização da manutenção hemodinâmica de quantos potenciais doadores sejam identificados.

nÃo hà / Nas dÃcadas recentes, os transplantes tiveram um profundo impacto no cuidado dos pacientes em estÃgio final de diversos tipos de doenÃas. No Brasil, as polÃticas pÃblicas relacionadas com as pessoas que necessitam de transplante carecem de avaliaÃÃes aprofundadas para desenvolvimento e aplicaÃÃo de polÃticas pÃblicas. A presente pesquisa teve como objetivo avaliar a atuaÃÃo da Central de NotificaÃÃo de Transplantes do Estado do Cearà (CNCDO) e das ComissÃes Intra-Hospitalares de DoaÃÃo de ÃrgÃos e Tecidos para Transplantes (CIHDOTTs) de Fortaleza, instÃncias consideradas decisivas na operacionalizaÃÃo da PolÃtica Nacional de Transplantes no territÃrio do CearÃ. A pesquisa foi realizada utilizando dados secundÃrios e primÃrios, tanto quantitativos quanto qualitativos, sendo desenvolvida no perÃodo de julho de 2010 a fevereiro de 2011. Foi realizada entrevista com a presidente da CNCDO, aplicado um formulÃrio com 12 coordenadoras das CIHDOTTs e realizadas observaÃÃes estruturadas em trÃs CIHDOTTs. Destacam-se entre os resultados: CNCDO sobrecarregada e realizando atividades da alÃada das CIHDOTTs; CIHDOTTs com equipes reduzidas e predomÃnio de enfermeiras, atuando essencialmente na busca ativa de potenciais doadores; a recusa dos familiares sendo a grande responsÃvel pela nÃo confirmaÃÃo de significativo nÃmero de doaÃÃes; identificadas fragilidades nas aÃÃes de campanha, qualificaÃÃo e planejamento conjunto da CNCDO com as CIHDOTTs; ambas ressentem-se de maior apoio dos profissionais de saÃde e dos gestores dos hospitais e tambÃm da falta de equipamentos e espaÃo fÃsico apropriado; o grande dispÃndio de energia da CNCDO e das CIHDOTTs resulta em nÃmeros Ãnfimos de efetivas doaÃÃes; hà dificuldades no processo de identificaÃÃo de provÃvel potencial doador, demora no diagnÃstico de morte encefÃlica e em iniciar a manutenÃÃo hemodinÃmica do possÃvel doador. A indicaÃÃo de que sÃo maiores os resultados obtidos com as campanhas que privilegiam a linguagem regional confirma o pressuposto inicial de que aÃÃes educativas, por impactarem imediatamente na populaÃÃo, tÃm potencial para alavancar o processo de transplante. ConcluÃmos que fatores humanos, estruturais e tecnolÃgicos representam sÃrios entraves à execuÃÃo da PolÃtica Nacional de Transplante no Estado do CearÃ, com impacto pouco significativo na fila de espera, que à Ãnica para o PaÃs. Indicamos aÃÃes em diversas frentes: redirecionar as campanhas de divulgaÃÃo para abordagens mais identificadas com a cultura regional e mais prÃxima Ãs pessoas; cursos mais frequentes para maior sensibilizaÃÃo e qualificaÃÃo dos profissionais de saÃde; desenvolvimento de estratÃgias para maior sensibilizaÃÃo dos profissionais e gestores quanto Ãs nobres tarefas da CNCDO e das CIHDOTTs; maior nÃmero de profissionais e capacitaÃÃo mais frequente deles para que realizem a detecÃÃo e diagnÃstico de morte encefÃlica de forma precoce e mais agilmente e que assegurem a realizaÃÃo da manutenÃÃo hemodinÃmica de quantos potenciais doadores sejam identificados. / In recent decades, the transplants have had a profound impact on the care of end-stage patients with several kinds of diseases. In Brazil, public policies regarding people who need transplants require thorough assessments. This research aimed to evaluate the performance of the Organ Notification, Harvesting and Distribution Center of the State of Cearà (CNCDO) and Intra-hospital Commission on Organ and Tissue Donation for Transplant (CIHDOTTs) from Fortaleza, instances considered decisive in the operationalization of the National Transplant Policy in the State of CearÃ. The research was conducted by using secondary and primary data, both quantitative and qualitative, developed from July 2010 to February 2011. The president of CNCDO was interviewed. It was applied a form to be filled out by 12 coordinators of CIHDOTTs and structured observations were accomplished in three CIHDOTTs. The following results had been highlighted: CIHDOTTs with reduced teams and nurse predominance; CNCDO overloaded and performing activities which belong to the CIHDOTTs; CIHDOTTs working essentially in an active search for potential donors; the family members refusal is largely responsible for the non-confirmation of a significant number of donations; it was identified fragility in campaign, qualification and joint planning actions between CNCDO and CIHDOTTs; CNCDO and CIHDOTTs resent greater support from health professionals and hospital managers and also the lack of equipment and appropriate physical space; the great expenditure of energy of CNCDO and CIHDOTTs result in an insignificant number of effective donations; there are difficulties in the process of identifying likely potential donor, delay in the diagnosis of brain death and in the beginning of the hemodynamic maintenance of the possible donor. The indication that greater results are obtained from the campaigns which favor the regional language confirms the initial assumption that educational initiatives, due to their immediate impact on the population, has the potential to leverage the transplant process. We conclude that human, structural and technological factors pose serious obstacles to the implementation of the National Transplant Policy in the State of CearÃ, with little significant impact on the sole waiting list in the country. We suggest actions on several fronts: to redirect the dissemination campaigns towards approaches which are more culturally related to the region and closer to people; to offer more frequent courses to raise awareness and to improve the skills of health professionals; to develop strategies to raise awareness of professionals and managers regarding the noble task of CNCDO and CIHDOTTs; to employ more professionals and train them to perform the detection and diagnosis of brain death faster and to ensure the accomplishment of the hemodynamic maintenance efficiently.