Thesis (Dr. P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2007. / Source: Dissertation Abstracts International, Volume: 68-10, Section: B, page: 6620. Adviser: Charles E. Begley. Includes bibliographical references.

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.

No description available.

Thesis (MPH)--University of Limpopo (Medunsa Campus), 2011.

Thesis (Ph. D)--Virginia Polytechnic Institute and State University, 1990. / Vita. Abstract. Includes bibliographical references (leaves 92-103). Also available via the Internet.

Thesis. / Includes vita. Includes bibliographical references (leaves 110-125)

Thesis (M.Arch.(Prof.))--University of Pretoria, 2005. / Includes bibliographical references. Available on the Internet via the World Wide Web.

Aim The aims of this project were to (i) evaluate whether the trauma care system established in Hong Kong has improved the survival rate among trauma patients; (ii) evaluate the effectiveness of trauma teams and their coordinators, primary trauma diversion, and performance improvement programmes, and assess the influence of gender and age on patient outcomes; and (iii) compare clinical outcomes before and after the establishment of a trauma system in Hong Kong and measure them against those achieved in an established regional trauma system in Australia. / Background Injury is a major public health problem that creates an enormous social burden. Although Hong Kong has tried to build up a trauma care system according to the criteria employed by the American College of Surgeons Committee on Trauma, there are a number of differences between the two. The effectiveness of the key components of trauma care processes and their clinical outcomes are unclear, and the final outcome in terms of survival rate is unknown. / Conclusion Proficient trauma teams, primary trauma diversion, and clinical guidelines are key components of the trauma system that contribute to improved outcomes. / Methods Retrospective analysis of data collected prospectively from the trauma registries in Hong Kong and Australia. The Trauma and Injury Severity Score (TRISS), the W score, the Z score, the M score, and Ws statistics are employed to evaluate the mortality rate. / Results The W score for Hong Kong improved significantly from - 4.79 in 1997 to 0.51 in 2009 after the trauma system was established (P<0.05). The improving trend observed in the Ws score (- 4.86 +/- SE 1.24 Vs 1.06 +/- SE 0.74) over the same period indicates that the survival rate increased from 1997 to 2009 (P < 0.01). The time taken to deliver the patient from the scene to definitive care was reduced by 97 minutes (P < 0.001) using a primary trauma diversion strategy. Proficient trauma teams are associated with reduced mortality in patients with a moderately poor probability of survival (p = 0.007) and trauma nurse coordinators play an essential role in conducting trauma audits and maintaining trauma registries. The introduction of guidelines and staff education could result in significant improvements to the trauma care process. Advancing age is associated with an increased mortality rate, whereas gender is not. Injury prevention programmes in Hong Kong are inadequate. / Yeung, Hiu Hung. / Advisers: Timothy H. Rainer; Wai Sang Poon. / Source: Dissertation Abstracts International, Volume: 73-02, Section: B, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2010. / Includes bibliographical references (leaves 282-328). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstract also in Chinese.

Thesis (M. Arch.)--University of Hong Kong, 1999. / Includes special study report entitled: The perception of space and motion. Includes bibliographical references.