No description available.

Objectives of the study were to determine an accurate estimate of the rate of Early Trauma (childhood sexual, physical and emotional abuse and emotional and physical neglect) as measured by the CTQ instrument, amongst clients in contact with Mental Health Services in Aberdeen. To investigate the hypothesis that clients in contact with Mental Health Services in Aberdeen who report high levels of Early Trauma (as measured by the CTQ instrument), will have significantly higher levels of psychological distress, (as measured by the SCL-90-R instrument) than clients who report none or low levels of Early Trauma. To estimate the prevalence of personality disorder (as measured by the PDQ-4 instrument) amongst clients in contact with Mental Health Services in Aberdeen. To investigate the hypothesis that there is a significant association between Early Trauma (as measured by the CTQ instrument) and the presence of Personality Disorder (as measured by the PDQ-4 instrument) amongst clients in contact with Mental Health Services in Aberdeen. 136 inpatients at the Royal Cornhill Hospital were surveyed.  The survey used three questionnaires forming a structured interview: The Childhood Trauma Questionnaire (CTQ), Symptom Checklist 90 Revised (SCL-90-R) and The Personality Disorder Questionnaire (PDQ-4). A high percentage (66%) of this inpatient population reported moderate/severe early trauma (ET): males (65%), females (68%), prevalence rates for early trauma were: Emotional Abuse 47% (64 inpatients), Physical Abuse 34% (46 inpatients), Sexual Abuse 34% (46 inpatients), Emotional Neglect 40% (55 inpatients), and Physical Neglect 25% (34 inpatients). Inpatients with high levels of ET did not report higher levels of psychological distress when compared to inpatients with none/low ET for all ET categories. Male inpatients who reported high levels of emotional abuse had significantly higher levels in global severity index values.  Female inpatients regardless of high or none/low levels ET, in all the categories, reported similar symptom levels. 70% of participants have significant personality disturbance: males (78%), females (60%), but only 21% of the participants who have significant personality disturbance have a recorded diagnosis of Personality Disorder (PD). This study shows that ET has a specific effect on males; for males, significant associations were found between PD and emotional abuse and physical abuse.  Males who reported high levels of emotional abuse also had significantly higher levels of overall psychological distress.

Objetivo: Determinar los factores asociados a la mortalidad en pacientes con trauma abdominal abierto atendidos en el servicio de cirugía del Hospital Nacional Hipólito Unanue. Enero – diciembre 2015. Métodos: Se realizó un estudio no experimental, analítico, observacional, retrospectivo y de diseño transversal; en un población comprendida por 102 pacientes; llevado a cabo en el servicio de emergencia del departamento de Cirugía del Hospital Nacional Hipólito Unanue. Resultados: La edad promedio de la población evaluada fue de 27.19; en su mayoría de sexo masculino los cuales eran población económicamente activa. El distrito de mayor procedencia fue El Agustino. El hallazgo clínico de mayor frecuencia es el dolor abdominal; encontrándose además que la taquicardia, la hipotensión y la taquipnea fueron variables asociadas a la mortalidad p <0.05. La hemoglobina promedio hallada fue de 4mg/dl asociada a la mortalidad; mientras que el hematocrito con un valor de 14.3%; asimismo la lesión de un órgano fue el más predominante; siendo el intestino delgado el de mayor frecuencia 40.3% y el hígado el que estuvo asociado a mayor mortalidad. La causa más frecuente de trauma abdominal abierto fue la herida por arma blanca 69.4; mientras que la herida por arma de fuego la que mayor mortalidad presentó. Conclusiones: La agresión física por arma blanca ocasionó un mayor número de lesiones abdominales abierta, seguidas por las heridas por PAF. Por lo cual se propone mayor promoción y prevención dirigidas a disminuir la violencia social y mayor concientización de la población.

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. / The Rural Trauma Team Development Course (RTTDC) is a one day course given to trauma personnel at various rural medical centers across the United States with the goal of improving care to injured patients in such areas. The purpose of this study is to determine the retention of RTTDC knowledge by those trained, as well as the migration rates of trainees out of these sites. The teaching of the RTTDC includes both pre‐test and post‐test assessments to ensure proper skills were learned. There was a statistically significant increase in score from the average course pre‐test score of 76.9% to the average course post‐test score of 92.1%. At this interim analysis, plotting the study post‐test scores over time since the course was given does reveal a pattern of decreased scores over time. The average study post‐test score of 88.8% is only slightly below the average initial post‐test score of 92.1%, though this was not significant. When assessed by individual questions, the participants scored significantly worse with questions addressing initial approach to the trauma patient and management of burn patients. There was no significant difference in scores between trauma team role. In this data set, the percentage of trainees remaining at course sites was 100%, though this was not expected based on previous studies. Our goal of 200 participants to achieve power has not been met at this time, but this could be established if more sites become involved, thus providing significant feedback for possible course revision.

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. / In the United States the responsibility to develop criteria for trauma patient’s triage status rests upon individual hospitals rather than the American College of Surgeons. Traumatic injuries from large animals represent a potential need for expanded hospital resources. Urban emergency departments are less likely to regularly see patients with large‐animal related injuries and might be expected to underestimate the predicted injuries. There is scarce research on the topic of initial triage designation for large‐animal related injuries. The aim of this study is to investigate the adequacy of the initial triage designation given to patients presenting with injuries from animals larger than themselves at an urban, safety net, academic Emergency Department and Trauma Center (ACS Level 1 Adult, Level 2 Pediatric). A retrospective chart review was performed on patients presenting to the emergency department (ED) from Jan 2006 until September 2015 with injuries resulting from animals larger than the patient. A total of 213 patients met the inclusion criteria. Our study found that trauma patients injured by large animals who are triaged as low priority have dispositions that are not statistically different from those with higher initial prioritization.

Background: Palliative care focuses on improving quality of life for patients and their families by providing relief from the stress, pain, and other symptoms of a serious disease or injury. Trauma care has a heavy focus on improving resuscitation efforts, which has left little room in the literature for studies on utilization of palliative care in this population. Objective: The purpose of this DNP project was to better understand the use of palliative care for trauma patients at a Level 1 trauma center in southern Arizona to inform a future quality improvement (QI) project. Project Design: A survey was completed to determine 1) how palliative care is utilized for trauma patients at this institution; 2) what barriers exist for the use of palliative care in this population; 3) what is the culture of the trauma team regarding palliative care; and 4) whether there are differences in palliative care use between physicians and advanced practice providers (APPs) on the trauma service. Participants and Setting: Eleven trauma APPs and attending physicians at a Level 1 trauma center in southern Arizona. Measurements: APPs and physicians were surveyed using a survey tool created by the author to answer the project questions. This survey assessed barriers to the use of palliative care, situations and patient characteristics prompting palliative consults, previous education in palliative care, comfort with difficult topics and symptoms, and suggestions for improving palliative care use at this facility. Results: As a team, there was agreement between APPs and attending physicians that lack of timely availability of palliative care staff was a barrier to initiating consults, in addition resistance from families regarding palliative care. Both groups were also likely to consult palliative care for assistance with transitions of care and when there is family conflict in decision making. Both groups felt that increased availability of palliative staff to cover nights and weekends, as well as provider education on palliative concepts would improve utilization of palliative care. Conclusion: Future QI projects should focus on provider-identified interventions to improve palliative care use, such as continuing education on palliative care and increased availability of palliative care staff.

Diese Arbeit vergleicht zeitnah und zeitlich verzögert versorgte Sprengungen des Akromioklavikulargelenkes nach traumatischer Verletztung. Die Ergebnisse zeigen einen signifikanten Vorteil einer zeitnahen Operation hinsichtlich Constant Score, Anzahl der Komplikationen und Zufriedenheit des Patienten. / In this retrospective study the results of early ACJ reconstructions immediately after trauma were compared with the results of delayed reconstructions in patients who first got conservative treatment and failed after some time. A comparison of the overall results revealed a statistically significant better outcome in the early repair group, regarding the Constant Score, the degree of acromioclavicularjoint-reduction, numbers of complications and patients satisfaction.

MA, Faculty of Humanities, University of the Witwatersrand

Objectives: The majority of injured patients transported to hospital ED’s do not require emergency surgery, yet our protocols require a surgeon to be present on their arrival. There is a drive to develop clinical decision rules so as to apply “secondary triage” criteria to trauma patients in the hope that there can be more efficient use of the surgeons’ time. My objective was to identify the proportion of trauma patients that required emergency trauma surgeon intervention within 60 minutes of patient arrival. Design: A retrospective study of all Priority 1 trauma patients that presented to the ED of three Level 1 trauma centres in three private hospitals in Johannesburg. These units are staffed with ED doctors experienced in trauma management and backed up by either specialist trauma surgeons or surgeons experienced in trauma management. Methods: We analysed data from 4,500 patients in our trauma centre registry (TraumaBank). We identified emergency procedural intervention and emergency operative intervention (within one hour) by a general surgeon. Main Results: Emergency operative intervention occurred in 2.7% of cases and emergency procedural intervention occurred in 0.8% of cases. Existing triage and secondary triage systems performed poorly with unacceptable over and under-triage. Conclusions: Routine surgeon presence during the initial phase of the management of trauma patients is hard to justify. Triage policies need to strike a balance between resources and optimal care. To identify those patients that require emergency operative intervention by trauma surgeons based on pre-arrival triage criteria alone, we need to look primarily at truncal penetrating injury, persistent shock and patients transferred from other facilities.

Introduction and Background Trauma Casualty is an environment of constant unpredictability which has an impact on the both the casualty staff, the patient and family. Family members are usually not prepared for the sudden crisis of having a loved one injured. The Trauma Nurse therefore, has a very important role with regards to meeting the needs of the family of patients brought into the unit. The needs of family members in the Intensive Care or Critical Care setting has been extensively researched using the critical care family needs inventory (CCFNI), however very little has been researched in the setting of a trauma or emergency setting. The needs of family members in the emergency setting has been researched in Australia, but no work has been done in South Africa. There is, therefore, a need for research in this area. Purpose of the study The aim of the study was to determine the needs of family members accompanying patients into trauma casualty, in order of importance as perceived by them, and to determine if these needs are being met. Identification of needs will inform the role of the nurse with regard to holistic nursing care including care of the family of the patient. Research Method The study made use of a quantitative descriptive exploratory design. The population (n=97) included family members of patients brought into casualty. The sample size was determined in consultation with a statistician from the Medical Research Council. The inclusion Criteria incorporated family members, over the age of 18, who were willing to complete a self administered questionnaire. Family members of patients who had died in the unit were excluded. An Australian developed instrument, using a Likert Scale to categorise and quantify needs statements, was used. The tool was validated by review of a panel of experts and an inter rater agreement of 90% established. The tool was adapted for the South African context and validated on a subscale level using the Cronbach Alpha correlation test. Five major themes make up the critical care family needs inventory, these consist of “Meaning”, “Proximity”, “Communication”, “Comfort”, and “Support”. Two questionnaires were used, comprised of the same needs statements, however CCFNI-1 was used to determine the level of importance of needs statements, while CCFNI-2 sought to determine the level of satisfaction of needs met. The study setting made use of a Level 1 Trauma Casualty in a Public Tertiary Academic Hospital, in which the pilot study was conducted before data collection in the same setting. The data analysis process made use of descriptive statistics. After cleaning and coding, the data were exported to STATA statistical software for values to be calculated and interpreted. Data were analysed in three steps, namely analysis of demographic data, thematic organisation of analysed data and content analysis of open ended questions. Main Findings The main findings highlighted the importance of needs relating to the themes “Meaning” and “Communication”, while satisfaction was highest in the theme “Meaning”. A concerning finding was the low level of satisfaction with needs being met related to communication.