Aims: To describe the presence of trauma team activation and outcomes of health care interventions in two trauma team levels. Background: Trauma is the most common cause of death among Swedish men aged <44 years. Every year ca 4500 people in Sweden dies due to trauma. During the 90’s, hospitals in USA developed a two level trauma activation algorithm to speed up the initial assessment for the injured patients who needed it, and to conserve resources when patients didn’t need to see the full trauma team. Design: This study is a retrospective records audit over trauma team activations during 2 years. Methods: This study audited trauma team activations through medical records during the period 1/1 2013 - 31/12 2014 on Norrlands university hospital in Umeå, Sweden. Results: Of all the trauma team activations 35% activated the large trauma team and 65% the small trauma team. Average age was 44 years and 61% of the patients were men while 39% were women. 36,3% of the large trauma team activations were in need of anaesthesiological interventions and 1% of the small trauma team activations. 47,8% was in need of Intensive care of the large trauma team activation and 3,5% of the small trauma team activation. 41,6% of the large trauma team activation was planned for surgery within the first 24-hours and 4,5 of the small. Mean wardtime was 8,49 days for the large trauma team activation and 2,86 days for small trauma team activation. Mortality for large trauma team activation was 8,8% compared to 1,5 of the small. Conclusion: This study shows that two levels of trauma team activation can provide a safe and appropriate care. More longitudinal and multicenter studies is necessary for increased evidence. / Syfte: Att beskriva förekomst av aktiverade traumalarm samt utfall av vårdinsatser i två traumalarmsnivåer. Bakgrund: Trauma är den vanligaste dödsorsaken bland män under 44år i Sverige, totalt avlider ca 4500 personer per år till följd av trauma. I USA infördes under 90-talet två traumalarmsnivåer för att öka patientsäkerheten och spara vårdresurser. Design: Denna studie är en retrospektiv journalgranskning över traumalarm som inträffat under en 2 års period. Metod: Studien granskade aktiverade traumalarm via journaldata från perioden 1/1-2013 t.o.m 31/12-2014 på Norrlands Universitetssjukhus i Umeå. Resultat: Av de aktiverade traumalarmen var 35% stora och 65% små. Medelåldern var 44år och 61% av patienterna var män medan 39% var kvinnor. 36,3% av de stora traumalarmen var i behov av narkoskompetens och 1% av de små. 47,8% av de stora traumalarmen var i behov av IVA-vård samt 3,5% av de små. 41,6% av stora traumalarm planerades för operation inom 24timmar och 4,5% av de små. Medelvårdtiden var 8,49 dygn för stora traumalarm och 2,86 dygn för små traumalarm. Mortaliteten för stort traumalarm var 8,8% jämfört med 1,5% av de små traumalarmen. Slutsats: Denna studie visar på att triagering enligt två traumalarmsnivåer för vuxna kan i hög grad ge en patientsäker och ändamålsenlig vård. Fler longitudinella och multicenterstudier i området är nödvändigt för ökad evidens

OBJECTIVE: We aimed to evaluate whether early administration of high plasma to red blood cells ratios influences outcomes in injured patients who received massive transfusion protocol (MTP). METHODS: A retrospective analysis was conducted at the only level 1 national trauma center in Qatar for all adult patients(≥18 years old) who received MTP (≥10 units) of packed red blood cell (PRBC) during the initial 24 h post traumatic injury. Data were analyzed with respect to FFB:PRBC ratio [(high ≥ 1:1.5) (HMTP) vs. (low < 1:1.5) (LMTP)] given at the first 4 h post-injury and also between (>4 and 24 h). Mortality, multiorgan failure (MOF) and infectious complications were studied as well. RESULTS: During the study period, a total of 4864 trauma patients were admitted to the hospital, 1.6 % (n = 77) of them met the inclusion criteria. Both groups were comparable with respect to initial pH, international normalized ratio, injury severity score, revised trauma score and development of infectious complications. However, HMTP was associated with lower crude mortality (41.9 vs. 78.3 %, p = 0.001) and lower rate of MOF (48.4 vs. 87.0 %, p = 0.001). The number of deaths was 3 times higher in LMTP in comparison to HMTP within the first 30 days (36 vs. 13 cases). The majority of deaths occurred within the first 24 h (80.5 % in LMTP and 69 % in HMTP) and particularly within the first 6 h (55 vs. 46 %). CONCLUSIONS: Aggressive attainment of high FFP/PRBC ratios as early as 4 h post-injury can substantially improve outcomes in trauma patients.

Background: A history of complex trauma alters basic self-structure, attachment system and core areas of interpersonal functioning and relationships. There is increasing recognition of the high proportions of complex trauma histories within substance misusers and limited research into the sequelae of complex trauma, particularly in relation to comorbid complex trauma and substance misuse. There is a distinct lack of adequate theory and guidelines for treatment. Research Aim: to explore psychologist’s experiences of and perspectives about their work with substance misusers with a history of complex trauma. Complex trauma is a term used to describe experience’s which arise from severe, prolonged and repeated trauma which is often interpersonal in nature. Courtois & Ford (2009) have defined complex trauma as “involving stressors that: are repetitive or prolonged, involve direct harm and/or neglect and abandonment by ostensibly responsible adults, occur at developmentally vulnerable times in the victim’s life, such as early childhood, have great potential to compromise severely a child’s development.” (p1). The prototype trauma that was first described under the term complex trauma was child abuse and neglect. Method: Semi-structured interviews were conducted with eleven clinical and counselling substance misuse psychologists working across four health boards in Central Scotland. The data was analysed using Interpretative Phenomenological Analysis (IPA). Results: Six main superordinate themes emerged from the data: 1. Challenges in negotiating therapeutic relationship; 2. Balancing relational forces; 3. Walking the tightrope of comorbidity; 4. Conceptual dearth (surrounding complex trauma); 5. Emotional impact of Work, and, 6. Core role of therapeutic relationship (in treatment and recovery). Discussion: Participants accounts suggest there are many risks to balance as well as paradoxes inherent in this type of work. The nature of a history of complex trauma means that often clients have difficulties with attachment and relational aspects in their lives, which in turn affect their engagement in the therapeutic relationship. The findings of this study suggest that it is precisely because relationships seem so threatening and challenging for these clients, that the therapeutic relationship appears to form such a vital role in the therapeutic treatment and recovery process for these client.

<p>Antalet kejsarsnitt, både planerade och akuta, har ökat markant i Sverige under de senaste åren. Syftet med denna examensuppsats var att undersöka hur kvinnor i Stockholm upplevde den psykologiska hjälp, bestående av deltagande i kejsarsnittsgrupper, som de blev erbjudna efter ett akut eller urakut kejsarsnitt samt hur de upplevde bemötandet inom vården. I uppsatsen sammanställdes enkäter som delats ut i kejsarsnittsgrupperna efter sista gruppträffen. Enkäterna handlade om upplevelsen av vården under graviditet, förlossning och sjukhusvistelsen efter förlossningen, samt vad kvinnorna tyckte om kejsarsnittsgrupperna. Enkäten bestod av öppna frågor. Materialet analyserades utifrån en tematisk analys. De faktorer som kvinnorna värderade som avgörande för en positiv förlossningsupplevelse var vänligt bemötande inom vården, upplevelse av kontroll, information under hela förloppet samt att få träffa barnet så snabbt som möjligt efter förlossningen. Endast små förändringar inom vården kring en komplicerad förlossning skulle förbättra upplevelsen för många familjer.</p>

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Dissociation may be broadly described as a subjective experience in which information from the individual's internal or external environment is not appropriately integrated into conscious awareness, memory or identity. A number of studies have found an association between dissociative experience and anxious arousal, and in particular, between dissociation and trauma. Recent reviews suggest the existence of an unspecified mediating variable that accounts for these associations. The present study compared dissociative experiences reported by a community sample (N = 74) and a sample of individuals with a range of anxiety disorders (N = 20). The potential influence of anxiety sensitivity was a particular focus. Participants completed a battery of measures assessing dissociative experience, anxious arousal, social anxiety, generalised anxiety, panic and agoraphobia, traumatic experience and posttraumatic stress in addition to measures of anxiety sensitivity and substance use. Participants in the anxiety group reported a greater variety and frequency of dissociative experiences, particularly of experiences considered to be pathological in nature. Elevated dissociation scores were associated with somatic symptoms of anxiety, social anxiety, generalised anxiety, agoraphobia and posttraumatic stress. No association between trauma exposure and dissociation was evident; however, trauma intensity was associated with dissociation in the anxiety group. Symptoms of depersonalisation / derealisation and absorption were most strongly associated with increased anxiety. Anxiety Sensitivity accounted for more of the variance in dissociation scores than did measures of expressed anxiety. These results suggest that anxiety sensitivity may account for the relationship between trauma anxiety and dissociation. Therapeutic intervention directed at anxiety sensitivity, particularly fear of cognitive discontrol, may prove helpful in treating dissociative detachment.

There is a paucity of research into traumatic incidents concerning police workers (Hart et al. 1995). There are also few studies relating the prolonged and repetitive exposure to traumatic stressors, or 'sequential trauma' (Gersons and earlier 1990; 1992). Whilst it was acknowledged that organisational stress contributes to adaptive or maladaptive well being, dependent on transactional variables between the person and their environment, it was also argued that further along the stress continuum, there exists gross stress reactions similar to Post Traumatic stress Disorders (PTSD; DSM-IIIR; American Psychiatric Association 1989) and newly revised PTSD criterion (DSM-IV; American Psychiatric Association 1994). However PTSD exclusively relates to a single event of overwhelming magnitude (Davidson and Foa 1991), whilst sequential trauma relates to mUltiple event exposure (Peters-Bean 1990b; 1996). It was argued that the magnitude of stimuli in trauma is not as important as the management of the trauma. Rather trauma is an artefact of person-environment transactions and the operation of 'traumatic signatures' which can be used adaptively or maladaptively in certain scenarios. Models of sequential trauma were proposed and tested. These notions are discussed in relation to three studies: an interview booklet survey (N=89); a Metropolitan Police Survey (N=134) and a Main U.K. Forces Survey (N=528) Results and implications for police workers and further research was discussed. It was found that trauma signatures may possibly assist in the processes involved with encountering trauma, primary and secondary appraisal mechanisms, coping post-event and physiological and psychological well-being with reference to individual and organisational outcomes.

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