Orientador: Gustavo Pereira Fraga / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-21T03:01:48Z (GMT). No. of bitstreams: 1 Pereira_BrunoMonteiroTavares_M.pdf: 4626301 bytes, checksum: 9451595a344efa48b56d290e6bb08e5d (MD5) Previous issue date: 2012 / Resumo: Objetivos: este estudo revisa o estado atual e as implicações do trauma de bexiga nas últimas duas décadas e traz à tona o significado do uso de escores de trauma como uma ferramenta neste cenário, bem como expõe o impacto pouco explorado das lesões associadas ao trauma de bexiga, principalmente lesões do reto, sobre a morbidade e sobrevida. Métodos: gênero, idade, mecanismo / localização dalesão, lesões associadas, pressão arterial sistólica (PAS), Escore de Trauma Revisado (Revised Trauma Score - RTS), Escore de Gravidadade da Lesão (InjurySeverity Score - ISS), Escore de Severidade da Lesão no Trauma (Trauma InjurySeverity Score - TRISS), complicações e tempo de permanência hospitalar, foram analisados em estudo prospectivo de lesões vesicais coletados no período entre 1990 a 2009 em um centro de referência para trauma. Resultados: Entre 2.575 pacientes que foram submetidos à laparotomia após trauma, 111 (4,3%) apresentaram lesões de bexiga grau II ou maior, sendo 83,8% (n = 93) homens, idade média de 31,5 anos (± 11,2). Mecanismo contuso foi responsável por 50,5% (n = 56) - acidentes com veículos automotores (47,3%) e atropelamentos (29,1%). Ferimentos causados por projétil de arma de fogo representaram 87,3% dos casos de mecanismo penetrante. A lesão mais freqüente foi grau IV (51 pacientes, 46%) de acordo com a classificação da Associação Americana para Cirurgia do Trauma (AAST - OIS). A média do ISS foi de 23,8 (± 11,2), TRISS 0,90 (± 0,24), e RTS 7,26 (± 1,48). Gravidade da lesão da bexiga, mecanismo, localização da lesão da bexiga, e nem lesão do reto concomitantemente foram associadas a complicações, maior tempo de permanência hospitalar ou morte. A taxa de mortalidade foi de 10,8%. ISS > 25 (p = 0,0001), PAS <90 mmHg (p = 0,0001), RTS <7,84 (p = 0,0001) e fratura pélvica (p = 0,0011) foram altamente associados com o prognóstico sombrio e morte com razão de risco de 5,46, 2,70, 2,22, e 2,06, respectivamente. Conclusões: Escores de trauma e fratura pélvica demonstraram impacto na sobrevida no trauma de bexiga. A taxa de mortalidade manteve-se estável durante as últimas duas décadas / Abstract: Objectives: this study reviews the current status and implications of bladder trauma in the past two decades and brings out the significance of using trauma scores as a tool in this scenario as well as exposes the unexplored impact of injuries associated with trauma to the bladder, especially lesions of the rectum, on morbidity and survival Methods Gender, age, mechanism/location of damage, associated injuries, systolic blood pressure (SBP), Revised Trauma Score (RTS), Injury Severity Score (ISS), Trauma Injury Severity Score (TRISS), complications, and length of stay (LOS) were analyzed in a prospective collected bladder injuries AAST-OIS grade II database (American Association for the Surgery of Trauma Organ Injury Scaling) from 1990 to 2009 in a trauma reference center. Results Among 2,575 patients experiencing laparotomy for trauma, 111 (4.3 %) presented bladder ruptures grade II, being 83.8 % (n = 93) males, mean age 31.5 years old (±11.2). Blunt mechanism accounted for 50.5 % (n = 56)- motor vehicle crashes 47.3 % (n = 26), pedestrians hit by a car (29.1 %). Gunshot wounds represented 87.3 % of penetrating mechanism. The most frequent injury was grade IV (51 patients, 46 %). The mean ISS was 23.8 (±11.2), TRISS 0.90 (±0.24), and RTS 7.26 (±1.48). Severity (AAST-OIS), mechanism (blunt/penetrating), localization of the bladder injury (intra/extraperitoneal, associated), and neither concomitant rectum lesion were related to complications, LOS, or death. Mortality rate was 10.8 %. ISS > 25 (p = 0.0001), SBP < 90 mmHg (p = 0.0001), RTS < 7.84 (p = 0.0001), and pelvic fracture (p = 0.0011) were highly associated with grim prognosis and death with hazard ratios of 5.46, 2.70, 2.22, and 2.06, respectively. Conclusions Trauma scores and pelvic fractures impact survival in bladder trauma. The mortality rate has remained stable for the last two decades / Mestrado / Fisiopatologia Cirúrgica / Mestre em Ciências da Cirurgia

The work group editing trauma disorders for the upcoming edition of the International Classification of Diseases (ICD-11) made several changes. Specifically, they significantly simplified the guidelines for post-traumatic stress disorder (PTSD) and added a new trauma disorder called complex PTSD (CPTSD). The new domains for PTSD and the addition of CPTSD require new instruments to assess these novel constructs. We developed a measure of PTSD and CPTSD (Complex Trauma Inventory; CTI) according to the proposed ICD-11 domains, creating several items to assess each domain. We examined the factor structure of the CTI (using both exploratory and confirmatory factor analyses) in two separate samples of diverse college students (n1 = 501; n2 = 500), reducing the original 53 trauma items in the item pool to 21 items. Confirmatory factor analyses supported two highly-correlated second-order factors (PTSD and complex factors), with PTSD (i.e., re-experiencing, avoidance, hyper-arousal) and complex factors (i.e., affect dysregulation, alterations in self-perception and alterations in relationships with others) each loading on three of the six ICD-11-consistent first-order factors (RMSEA = .08, CFI = .92, GFI = .87, SRMR = .06). Internal consistency for PTSD (α = .92) and complex factors (α = .93) are excellent.

The thesis focuses on posttraumatic growth in adolescents and young adults. The subject of the research is finding and tracking reactions and changes that emerge after a specific stimulus - an existentially experienced trauma, where at the core is realizing the threat of life and afterwards thinking about one's own death. The theoretical part deals with psychological and philosophical sources of current concepts of post-traumatic growth. These sources support our assumption that for the specific course of post-traumatic reactions and changes the subject category or objective severity of events is not relevant. It is the respondents own perception of a life threat. We also deal with a particular PTG model by Tedeschi and Calhoun, whose concept of changes after a major life event was chosen as the starting point for our research and whose PTGI questionnaire is used in the quantitative part. In the empirical part we chose mixed research design. First, a quantitative part of the research was carried out, involving 407 respondents aged 17-25. The aim of this part was to determine the rate of post-traumatic growth and to demonstrate that perceived life threats occur among respondents across all event categories. The personal perception of a life threat will result into a higher score achieved in both...

The aim of the study is to examine if family therapists who work with traumatized clients in family treatment and investigation are affected by secondary trauma and whether there are opportunities to recover from work. To answer the study’s aim and questions, a qualitative method has been used where ten semi-structured interviews have been conducted. The collected empirical data has subsequently been interpreted and analyzed of the basis of previous research and Isdal's and Figley's psychological explanations of concepts. The results show that the family therapists experience secondary traumatic stress at work, but that a few have developed severe or long-term symptoms of secondary trauma as a result from the work. The results also indicate that family therapists who have experienced previous trauma feel strengthened in their professional role, while others feel that the event has weakened their ability to treat and provide support towards the client. Furthermore, the results show that several family therapists possess individual resources and strategies that enable their chances of recovery. However, the organization lacks methods in terms of offering organizational support that leads to deteriorating conditions for the family therapist’s recovery. / Syftet med föreliggande studie är att undersöka om familjebehandlare som arbetar med traumatiserade klienter i familjebehandling och utredning påverkas av sekundär traumatisering och om det finns möjligheter att återhämta sig från arbetet. För att besvara studiens syfte och frågeställningar har en kvalitativ metod använts där tio semistrukturerade intervjuer genomförts. Den insamlade empirin har därefter tolkats och analyserat utifrån tidigare forskning samt Isdals och Figleys psykologiska begreppsförklaringar. Resultatet visar att familjebehandlarna upplever sekundär traumatisk stress i arbetet men att ett fåtal har utvecklat allvarliga eller långvariga symtom för sekundär traumatisering till följd av arbetet. Resultatet indikerar även att familjebehandlare som erfarit tidigare trauman upplever sig stärkta i yrkesrollen medan andra upplever att händelsen försvagat deras förmåga att bemöta och tillhandahålla stödjande verktyg för klienten. Vidare synliggör resultatet att flera familjebehandlare besitter individuella resurser och strategier som möjliggör deras chans till återhämtning. Verksamheten brister dock i avseende att erbjuda organisatoriskt stöd som leder till försämrade förutsättningar till familjebehandlarnas återhämtning.

När en patient inkommer till akutmottagningen efter att blivit utsatt för yttre högenergivåld krävs ett snabbt omhändertagande i form av ett interprofessionellt traumateam. Att omhänderta traumapatienter kan upplevas som sårbart och tumultartat vilket medför att vårdpersonal behöver agera snabbt. Om kommunikation inom traumateamet utövades felaktigt kan detta riskera patientsäkerheten då detta kan medföra försämrade behandlingsresultat och utökad handläggningstid. Syftet med föreliggande studie var att beskriva faktorer som påverkade ett traumateam i deras interprofessionella arbete vid ett akut patientomhändertagande. Designen var en allmän litteraturstudie baserad på 18 vetenskapliga artiklar. Resultatet baseras på databasträffar genom CINAHL och PUBMED. En integrerad analys användes för att analysera insamlade data. Studiens resultat utgörs av tre huvudkategorier: Traumaledarens ansvar, Kommunikationsverktygens betydelse och Traumateamets gruppdynamik. Resultatet visade på traumaledaren har ett ansvar för helhetsperspektivet såväl över patienten som teamet. Beroende på vad situationen krävde hade traumaledaren olika ledarstilar. I traumateamet hade kommunikationsverktyg avgörande betydelse då bland annat closed-loop communication samt call-out, vilket kunde uppemot halvera patientens handläggningstid. Effektiv och tydlig kommunikationsväg inom traumateamet skapade en oproblematisk teamkommunikation. Traumateamets gruppdynamik utgjordes av tydlig struktur och positionering av medlemmarna i traumarummet. Genom en öppen atmosfär där allas kompetens involveras skapades en bra teamsammanhållning. Slutsatsen var att vid användning av kommunikationsverktyg inom traumateamet kunde patientomhändertagandet säkras och minimera eventuella missförstånd. Detta skapade ett välfungerande teamarbete med gynnsam gruppdynamik där samtliga ansvarsområden kompletterade varandra. / ABSTRACT When a patient enters the emergency room after being exposed to external high-energy violence, immediately care in the form of an interprofessional trauma team is required. Caring for trauma patients can be perceived as vulnerable and tumultuous, which means that care staff need to act quickly. If communication within the trauma team was exercised incorrectly, this may risk patient safety as this may lead to impaired treatment results and increased processing time. The purpose of the present study was to describe factors that influenced a trauma team in their interprofessional work in an acute patient care. The design was a general literature study based on 18 scientific articles. The results are based on database hits through CINAHL and PUBMED. An integrated analysis was used to analyze the collected data. The results of the study consist of three main categories: The Trauma Manager's responsibilities, The importance of Communication Tools and the Trauma Team's group dynamics. The results showed that the trauma leader has a responsibility for the overall perspective over both the patient and the team. Depending on what the situation required, the trauma leader had different leadership styles. In the trauma team, communication tools were crucial, including closed-loop communication and call-out, which could halve the patient's processing time. Effective and clear communication path within the trauma team created an unproblematic team communication. The trauma team's group dynamics consisted of a clear structure and positioning of the members in the trauma room. Through an open atmosphere where everyone's skills are involved, a good team cohesion was created. The conclusion was that when using communication tools within the trauma team, patient care could be secured and minimized any misunderstandings. This created a well-functioning teamwork with favorable group dynamics where all areas of responsibility complemented each other.

Trauma är vanligt förekommande internationellt och drabbar främst unga under livets fyra första årtionden. Dödligheten relaterat till trauma förväntas att fortsätta öka till 2030 i Sverige. Trauma orsakar såväl ett fysiskt som ett psykiskt lidande för patienter, samt skapar stora samhällskostnader. Kunskap om patienters upplevelser och erfarenheter angående traumaomhändertagandet initialt är begränsat. Det är av vikt att sjuksköterskan har kunskap om patienters upplevelser och erfarenheter så att sjuksköterskan kan göra patienten delaktig i vården och tillgodose patientens behov och samtidigt tillhandahålla och bedriva en patientsäker vård i mötet med traumapatienten.  Syftet var att beskriva patienters upplevelser och erfarenheter av traumaomhändertagande. Metoden till studien var en allmän litteraturstudie. PubMed och CINAHL var databaserna som användes. Manuell sökning och kedjesökning utfördes också. Kvalitetsgranskningen resulterade i 15 artiklar som inkluderades för att därefter bearbetas med hjälp av en integrerad analys.  Resultatet mynnade ut i två huvudkategorier; patienternas positiva upplevelser och erfarenheter och patientens negativa upplevelser och erfarenheter. Till vardera huvudkategorier identifierades fem respektive sex underkategorier. Under huvudkategorin patienternas positiva upplevelser och erfarenheter identifierades underkategorierna; en välfungerande vårdkedja, tillfredsställande undersökning och behandling, professionellt bemötande, gynnsam informationsöverföring och kommunikation, och gynnsamma emotionella aspekter. Under den andra huvudkategorin patienternas negativa upplevelser och erfarenheter identifierades; brister i vårdkedjan, otillfredsställande undersökning och behandling, fysiologiska konsekvenser, brister i personalens kompetens, hinder för informationsöverföring och kommunikation, och psykologiska påfrestningar.  Slutsatsen av litteraturstudien är att upplevelserna och erfarenheterna av traumaomhändertagande är mångfacetterat och individuellt, vilket ställer höga krav på personalens kommunikationsförmåga samt krav på att individanpassa hälso- och sjukvården, då vården av traumapatienter är komplex. / Trauma is common internationally and mainly affects young people during the first four decades of life. Mortality related to trauma is expected to continue to increase until 2030 in Sweden. Trauma causes both physical and psychological suffering for patients and creates large societal costs. Knowledge of the patient's experiences regarding initial trauma care is limited. It is important that the nurse has knowledge of the patient's experiences so that the nurse can involve the patient in the care and ensure that the patient's needs are met, and at the same time provide care that is safe in the meeting with the trauma patient.  The aim was to describe patients' experiences of trauma care.  The method of the study was a general literature study. PubMed and CINAHL were the databases used. Manual search and snowballing were also performed. The result after quality review of articles contributed to 15 included articles that were analyzed according to an integrated analysis.  The analysis resulted in two main categories: the patients' positive experiences and the patients' negative experiences. Five respectively six subcategories were identified for each main category. Under the main category of patients' positive experiences, the subcategories were: a well-functioning care, satisfaction with examination and treatment, professional treatment, adequate knowledge and skills of the staff, good information transfer and communication, and that emotional aspects were considered as favorable. Under the second main category, the patients' negative experiences were identified; the lack of care, dissatisfaction with examination and treatment, the physiological consequences, lack of competence, obstacles to information transfer and communication, and psychological stress.  The conclusion of the literature study was that the experiences of trauma care are multifaceted and individual, which put high demands on health care staff in communication skills and the ability to adapt care individually, since the care of trauma patients is complex.

Child and Adolescent caregivers are rarely the focus of research and/or trauma-focused or informed models when working with traumatized children (Baynard, Englund, & Rozelle, 2001; Chapman, Dube, & Anda, 2007). It has been shown that use of caregivers in the treatment of children who have suffered trauma can have a significant impact on not only the child, but also reduce the trauma symptoms of the caregivers themselves (Cohen, Mannarino, & Staron, 2006). The purpose of this study is to critically review the empirical research of trauma-focused and trauma-informed trainings and treatment models for children who have suffered some form of trauma and whose caregiver is included in the treatment. The outcomes of trauma-focused models will be examined in terms of its purpose, intervention, facilitation, adaptability and modification. Implications for further research and application are drawn.

Psykiskt trauma är vanligt hos patienter inom rättspsykiatrisk vård. Det finns idag effektiva metoder som traumamedveten omvårdnad för att vårda trauma. Det saknas forskning om hur sjuksköterskor inom denna vårdkontext upplever arbetet med trauma. Huvudsyftet med studien var att utforska sjuksköterskans arbete med trauma inom rättspsykiatrisk vård. Sju semistrukturerade intervjuer genomfördes med sjuksköterskor som arbetade inom rättspsykiatrisk vård. Intervjuerna transkriberades och analyserades med konventionell innehållsanalys med induktiv ansats. Resultatet var tre huvudteman: Sjuksköterskans arbete med trauma, Hinder i att arbeta med patientens trauma och Utvecklingsmöjligheter inom vården. Sjuksköterskor använder olika sätt att identifiera trauma och önskar mer kunskap i ämnet. Sjuksköterskor erfar hinder såsom patientens egna svårigheter och organisatoriska brister. Som slutsats konstateras att sjuksköterskor beskriver svårigheter med att arbeta omvårdnadsmässigt med trauma hos patienter inom rättspsykiatrisk vård, som bristande kunskap, bristande rutiner och bristande avdelningskulturer. Sjuksköterskorna har en vilja att upptäcka, förebygga och vårda trauma genom att förändra rutiner och lära sig mer om evidensbaserade behandlingsmetoder i vårdandet av trauma. Vidare beskrivs att den finns en medvetenhet om att delar av den rättspsykiatriska vården kan vara potentiellt traumatiserande eller retraumatiserande. Sjuksköterskorna beskriver att de har metoder för att förebygga denna risk genom att till exempel arbeta med tydlig information och lugn. / Mental trauma is common among patients in forensic psychiatric care. Today, there are such as Trauma-informed Care to There is a lack ofresearch on how nurses within forensic psychiatry experience their work with trauma. The main purpose of the study was to explore how nurses describe their work with trauma in forensic psychiatric care. Seven semi-structured interviews were conducted with nurses working in forensic psychiatric care. The interviews were transcribed and analyzed with a conventional content analysis with inductive approach. The result ended up in three main themes: How the nurse works with trauma, The difficulties in working with the patients’ trauma and Opportunities for Development in Care. Nurses use different ways to identify effective methods nurture trauma. trauma and want more knowledge of the subject. Nurses experience obstacles such as the patient's own difficulties and organizational shortcomings. In conclusion, it is stated that nurses describe difficulties in working with nursing the trauma of patients in forensic psychiatric care, such as lack of knowledge, lack of routines and lack of ward cultures. Nurses have a desire to detect, prevent and nurture trauma by changing routines and learning more about evidence-based treatment methods in the care of trauma. It is further described that there is an awareness that parts of forensic psychiatric care can be potentially traumatic or retraumatizing. The nurses describe that they have methods for preventing this risk by, for example, working with clear information and being calm.

The purpose of this quantitative study was to further the understanding on how access to trauma-informed professional learning changed research-based practices in classroom and school-wide settings in K-12 schools. The guiding question for this quantitative study was: How has trauma-informed professional learning influenced changes in research-based practices in school-wide and classroom settings in K-12 schools? This research assessed the perceptions of elementary, middle, and high school teachers in one school district to investigate access to trauma-informed professional learning and potential changes in research-based practices in school-wide and classroom settings. Participants were teachers, in Northeast Tennessee, employed in urban schools implementing trauma-informed practices. Six research questions guided the study and quantitative data were analyzed using one-sample t-tests. Additionally, this researcher analyzed themes gleaned from the four-open ended questions at the end of the survey. The findings indicated that the means of all measures were significantly higher than the midpoint in elementary, middle, and high schools. The findings also indicated that trauma-informed professional learning supports the development of school-wide and classroom research-based practices and application of trauma-informed strategies in K-12 schools.

This research determined if the patterns resulting from different chainsaw chain types impacting bone leave tool marks are dissimilar enough from one another to determine which type of chainsaw was used in dismemberment mimicking homicide cases. Multiple styles of commercially available chainsaw chains were used. The long bones of adult white tailed deer (Odocoileus virginianus) were cut to produce false start cuts and complete sectioning to mimic typical human dismemberment. The cut areas were examined macroscopically and microscopically to note features common to each chain. The chains were compared to one another to note differences. It was proposed that each chainsaw would leave different tool marks. It was found that the style of tooth significantly affects the size of the exit chipping, size of the breakaway notch, angling of the kerf floor, and the mass of bone wastage produced. The most significant differences were produced with a standard tooth. The skip of the chainsaw did not create significant differences. This research has applications in forensic anthropology through the additional information on tool marks and the ability to identify specific tool types. The information is also useful to law enforcement investigations involving dismemberments.