A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Purpose: The purpose of this study is to analyze patterns of injury, management, and outcomes associated with blunt and penetrating vascular injuries in the extremities of pediatric trauma patients. Methods: A retrospective review of data on pediatric patients between 2008 and 2014 was conducted within an institutional electronic medical records system at Phoenix Children’s Hospital. Patients were identified by ICD-9 codes for having received a diagnosis of non-iatrogenic extremity arterial vascular trauma with an associated attempt at restoring flow. Results: Forty-four patients with arterial injuries and repairs were identified and evaluated. Twenty-seven were male and 19 had a blunt mechanism. The average age of the male patients was 8.8 years and that of the female patients was 6.8 years, with a combined range of 1.3-16 years. The ICU was utilized more than twice as much and hospital stays were three times longer with blunt wounds. The average length of stay in the hospital was 6.4 days (range 1-68 days), while average ICU stays lasted 6.9 days. The distribution of extremity injuries included 48% in the right upper, 34% in the left upper, 9% in the right lower, and 7% in the left lower. An associated fracture was present in 100% of blunt injuries, and 4% of penetrating injuries. The greatest vascular risk was to the digital artery (63.2%) after blunt trauma. Primary anastomosis was used in 68% of penetrating injuries, while grafting was required in 64% of blunt wounds. Fasciotomy risk was not a function of trauma mechanism. Amputation risk was 16% in blunt trauma and 0% in penetrating trauma. There were no mortalities during the study period. Conclusions: Pediatric vascular injuries of the extremities are a rare but potentially serious subset of trauma that can be subdivided based on mechanisms, particular patterns of injury, and treatment modalities. Penetrating trauma is more common and typically managed by primary repair, and blunt trauma is associated with fractures, longer ICU stays, and carries a higher risk of amputation. Outcomes are usually very positive with a high rate of extremity salvage and no mortalities.

Thesis (D Phil (Counselling Psychology))--University of Pretoria, 2007. / Includes bibliographical references. Available on the Internet via the World Wide Web.

INTRODUCTION: Traumatic brain injury (TBI) is a major public health problem, causing approximately 52,000 deaths from 1.7 million injuries in the United States annually, with a combined direct and indirect economic cost estimated at $60-75 billion per year. Traumatic subarachnoid hemorrhage (tSAH), a subtype of closed head injury, has a high prevalence within TBI—evident in up to two-thirds of moderately and severely brain injured patients. tSAH is also associated with poor clinical outcomes; some research suggests mortality and unfavorable outcome rates are two-to-three times higher in patients with tSAH, based on brain imaging, compared to those without. To date, no pharmacological treatment has been conclusively shown to improve outcomes in humans for either moderate or severe TBI or for specific tSAH injury. The aim of this study was to assess whether the effect of PROG was substantially different in study TBI patients with evidence of tSAH on initial brain imaging compared to those that did not have evidence of tSAH. METHODS: ProTECT III clinical trial data was used for an exploratory, post hoc subgroup analysis to determine the effect of the hormone progesterone (PROG) on outcome. Study subjects with any abnormality on baseline brain imaging were included in the analysis and two subgroups, tSAH positive (+tSAH) and tSAH negative (–tSAH), were selected. The primary outcome evaluated was a favorable/unfavorable dichotomy derived from the 6-months post-injury Extended Glasgow Outcome Scale (GOSE) assessment, which evaluates both mortality and functional outcomes. Risk ratios (RRs) were calculated for the total sample and each of the two subgroups and used as statistical evidence for interaction between PROG and tSAH. RESULTS: All subjects from the original ProTECT III trial cohort (N=882) with no abnormalities found on baseline computed tomography (CT) image (n=125) or missing image (n=1) were excluded from this analysis. Subjects with one or more abnormalities noted on CT (+CT, n=756) were then divided into subgroups based on presence (n=582) or absence (n=174) of tSAH. Subjects with +tSAH were more severely injured than –tSAH (mean Rotterdam CT score 3.3 vs. 2.2; 3.1 overall) and had a lesser proportion of favorable outcomes (47.4% vs. 74.3%; 53.6% overall). Compared to placebo, patients treated with progesterone had marginally better likelihood of favorable outcomes (risk ratio among +tSAH 1.06, 95% confidence interval [CI], 0.89 to 1.26; and RR among –tSAH 1.02, 95% CI 0.85 to 1.22). A multivariable model, adjusted for baseline differences in treatment group covariates did not yield substantially different results for the effect of progesterone on favorable outcomes (+tSAH 1.07; 95% confidence interval [CI], 0.84 to 1.36, –tSAH 1.08; 95% CI 0.75 to 1.56, +CT 1.06; 95% CI 0.87 to 1.29). CONCLUSION: Our study demonstrated that progesterone did not result in different effects in patients with or without tSAH than those without based on initial brain imaging. This investigation supports previous research findings; tSAH is correlated with more severe injury and worsened outcomes. Concomitant injuries found in +tSAH group are likely worsening the outcomes over –tSAH, but this was not evaluated here. More complex statistical modeling should be used on this data to determine if it provides evidence that tSAH is an independent prognosticator of unfavorable outcome or merely associated with more severely injured patients.

The elderly are a rapidly growing population in the United States and have the highest rate of TBI-related hospitalization. Across all levels of severity, elderly persons have uniformly poorer outcomes including quality of life, community integration, disability, and mortality, but there is a significant lack of published research regarding communication outcome in the elderly population. The likelihood that speech-language pathologists (SLPs) will clinically treat elderly clients with TBI is great; understanding the effects that age of injury has on communication may inform clinicians’ abilities to accurately and efficiently assess, diagnose, and treat the elderly. The present study examined the relationship between age of onset of injury and severity of communication deficits following traumatic brain injury (TBI); the study included a review of published research and a survey of SLP estimates of severity of impairment. Limitations of the study and directions for further research are discussed. / text

No description available.

No description available.

No description available.

No description available.

A dissertation submitted to the Faculty of Humanities in partial fulfilment of the requirements of the degree of Master of Arts Organisational Psychology University of the Witwatersrand March 2016 / Emergency first responders such as firefighters are exposed to higher levels of traumatic events through the course of their work. Accordingly, chances of such exposure resulting in negative psychological consequences are elevated. Previous research implicates the experience of trauma incident(s) and other organisational factors, among other factors, as causes of the development of consequences such as posttraumatic stress disorder and the variance thereof. However, research exploring these implications is limited. As a result, firefighters in the Emergency Medical Services were surveyed in the attempt to identify experiences of posttraumatic stress symptoms resulting from history of exposure to work-related traumatic events, perceived life threat during those incidents, general work-related stress and their perceived organisational support. The purpose of this study was to explore the predictive relationship PTSD symptoms and four predictors namely; perceived life threat, perceived organisational support, history of trauma and job-related stress, among Johannesburg firefighters. The sample was drawn from the City of Johannesburg Emergency Medical Services. A sample (N=100) of trauma-exposed firefighters was recruited for the study. Participants were recruited using a non-probability, convenience sampling strategy in which participation in the study was voluntary. The sample was made of 89 male participants and 11 female participants. All variables included in the study were measured using self-report instruments. Participants completed a demographic questionnaire to gather information pertaining to gender, age, organisational tenure and race. The following questionnaires were used to ascertain scores for the predictor variables: Survey of perceived Organisational Support, General Work Stress scale, Life Threat scale and a self-developed history of trauma scale. The Revised Impact of Event scale was used to measure the firefighters’ experience of PTSD related symptoms. Participants reported an average score of 29 on the IES-R scale indicating a stress reaction with the possibility of posttraumatic stress disorder. However, using a multiple regression analysis, this present study found that the four predictor variables explored did not have a substantial impact on the development of PTSD among firefighters. Secondary analyses were conducted to explore the individual association between each independent variable and PTSD. The results are reported. Overall, the results yielded suggest that there are other factors that exert a greater impact on the development of PTSD among firefighters. Future research among firefighters could focus on exploring other risk and protective factors associated with the development of PTSD. Alternatively, if this study is to be replicated, the researcher could employ a longitudinal, qualitative approach to explore the predictive relationship between history of trauma, perceived life threat, perceived organisational support, work-related stress and PTSD related symptoms. KEYWORDS: Post-traumatic stress disorder, perceived life threat, perceived organisational support, job-related stress, history of trauma

Introduction: Headache is one of the most common disorders of the nervous system and several of its subtypes lead to substantial levels of disability. Cervicogenic headache is a condition characterised by chronic hemi-cranial pain that is referred to the head from either bony structures or soft tissues of the neck. One of the common factors associated with all forms of headaches is the presence of trigger points. The aim of this study was to compare the sensitivity of trigger points, descriptive characteristics and level of disability in patients with cervicogenic and in patients with non-cervicogenic headaches. Methodology: The study was conducted as a quantitative, cross sectional, descriptive study. Forty participants (20 with cervicogenic and 20 non-cervicogenic headache) were included into this study sample. The classification of patients as having cervicogenic or non-cervicogenic headache was done according to the guidelines of Zito et al (2006). The sensitivity of trigger points in the upper trapezius, sternocleidomastoid, posterior cervical and temporalis muscles were established using a hand-held digital algometer with 1cm2 round head. Their level of disability was compared using the Henry Ford Headache Disability Inventory (HDI). The demographic and clinical presentation of both the groups was also compared including age, sex, duration of headache and pain rate scale. The above mentioned variables were compared using student t-test and chi-square test. Results: Descriptive characteristics, pain intensity and level of disability did not attain a statistical significant difference between the two groups. The results found evidence of a statistically significant difference with respect to trigger points sensitivity in right upper trapezius (p=0.02) and left upper trapezius (p=0.01). The sensitivity of trigger points of upper trapezius were higher in cervicogenic groups but none of the other muscles tested showed difference in sensitivity between both groups. Discussion Similarities in the descriptive characteristics, pain intensity and level of disability of both groups suggest that both types of headaches cannot be differentiated in terms of a specific age, sex, body mass index, pain intensity or level of disability. Increased sensitivity of trigger points especially in upper trapezius may be used as an additional diagnosing factor of cervicogenic headache group. Conclusion: The results of this study found that patients with cervicogenic headache had an increased sensitivity of the upper trapezius muscles compared to patients with non-cervicogenic headache. Since physiotherapists play an important role in the treatment of trigger points the value of physiotherapy treatment in the management of cervicogenic headache releasing the trigger points in the upper trapezius may result in a decrease in symptoms and an associated improvement in quality of life.