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Mahon J, Nolan L, O'Sullivan D, Curtin M, Devitt A, Murphy CG. Bilateral tibial fractures associated with powered exoskeleton use in complete spinal cord injury - a case report & literature review. Spinal Cord Ser Cases 2024; 10:22. [PMID: 38627367 PMCID: PMC11021521 DOI: 10.1038/s41394-024-00635-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 03/31/2024] [Accepted: 04/05/2024] [Indexed: 04/19/2024] Open
Abstract
INTRODUCTION Powered robotic exoskeleton (PRE) physiotherapy programmes are a relatively novel frontier which allow patients with reduced mobility to engage in supported walking. Research is ongoing regarding their utility, risks, and benefits. This article describes the case of two fractures occurring in one patient using a PRE. CASE We report the case of a 54 year old man who sustained bilateral tibial fractures while using a PRE, on a background of T10 AIS A SCI. The initial session was discontinued due to acute severe bilateral knee swelling after approximately 15 min. The patient attended their local hospital the following day, where radiographs demonstrated bilateral proximal tibial fractures. The patient was treated with manipulation under anaesthetic and long-leg casting for five weeks, at which point he was stepped down to hinged knee braces which were weaned gradually while he remained non-weight bearing for 12 weeks. The patient was investigated with DEXA scan and was diagnosed with osteoporosis. He was liaised with rheumatology services and bone protection was initiated. Fracture healing was achieved and weight-bearing precautions were discontinued, however this period of immobilisation led to significant spasticity. The patient was discharged from orthopaedic services, with ongoing rehabilitation and physiotherapy follow-up. CONCLUSION PRE assisted physiotherapy programmes are a promising concept in terms of rehabilitation and independence, however they are not without risk and it is important that both providers and patients are aware of this. Furthermore, SCI patients are at increased risk for osteoporosis and should be monitored and considered for bone protection.
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Affiliation(s)
- John Mahon
- University Hospital Galway, Newcastle Road, Galway, Ireland.
| | - Lily Nolan
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | | | - Mark Curtin
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Aiden Devitt
- University Hospital Galway, Newcastle Road, Galway, Ireland
| | - Colin G Murphy
- University Hospital Galway, Newcastle Road, Galway, Ireland
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D’Itri L, Gattuso MS, Cobisi CD, Ferruzza M, Lucenti L, Camarda L. Bilateral Scaphoid Fractures: A Systematic Literature Review. J Pers Med 2024; 14:424. [PMID: 38673051 PMCID: PMC11051215 DOI: 10.3390/jpm14040424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 04/09/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Bilateral scaphoid fractures are rare lesions, warranting a review to synthesize current knowledge, identify gaps, and suggest research directions. Two authors, adhering to PRISMA guidelines, in January 2024 identified 16 case reports (1976-2023). Data extraction included demographics, injury mechanisms, associated injuries, fracture sites, treatments, and outcomes. Among 121 initial outcomes, 16 articles met the criteria, predominantly affecting young people (93.75% males, mean age 22 years). High-energy traumas (75%) often caused associated wrist injuries (68.75%). Most fractures required surgical intervention (68.75%), primarily headless compression screws. Bilateral scaphoid fractures, which are rare but associated with high-energy traumas, commonly involve wrist injuries. Surgical management is often necessary, yielding better outcomes with fewer complications. Further research is essential to understand the epidemiology, optimal management, and long-term results. Early diagnosis and appropriate treatment are crucial for preventing complications and ensuring favorable patient outcomes.
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Affiliation(s)
| | | | | | | | - Ludovico Lucenti
- Department of Orthopaedics and Traumatology, University of Palermo, 90133 Palermo, Italy; (L.D.); (M.S.G.); (C.D.C.); (M.F.); (L.C.)
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Zhang F, Huang C, Yan W, Ouyang H, Liu W. Attentional bias modification and attention control training in PTSD: a systematic review and meta-analysis. Ther Adv Psychopharmacol 2024; 14:20451253241243260. [PMID: 38633357 PMCID: PMC11022678 DOI: 10.1177/20451253241243260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 03/14/2024] [Indexed: 04/19/2024] Open
Abstract
Background Cognitive models of post-traumatic stress disorder (PTSD) highlighted the effect of maladaptive cognitive processing in the development and maintenance of PTSD. PTSD is related to attentional bias (AB) toward threatening stimuli and greater attentional bias variability (ABV). Attentional bias modification (ABM) and attention control training (ACT) have demonstrated the effect of improving PTSD, but the results of randomized controlled trials (RCTs) are controversial. Objectives The current study aimed to evaluate the extent of evidence supporting the efficacy of ABM in the treatment of PTSD. Design Systematic review and meta-analysis. Methods We searched PUBMED, PsycINFO, EMBASE, ClinicalTrials.gov, and the Cochrane Central Register of Controlled Trials for articles published between 1980 and 2022. RCTs of ABM for adult participants with PTSD symptoms were identified. The primary outcome was changes in PTSD severity, and the second outcome was changes in AB and ABV. Trial quality was assessed using the Cochrane Risk of Bias Tool. Publication bias was assessed using the Doi plot and Luis Furuya-Kanamori (LFK) index. Results Eight RCTs comparing the effect of ABM to ACT were included in the review, and six studies were meta-analyzed. Meta-analysis favored ACT in improving PTSD symptoms and ABV, and the effect size was large. ABM and ACT demonstrated similar effects in improving AB. Conclusion ACT should not only be seen as a control training condition but also has therapeutic values. However, since the current meta-analysis only included a limited number of studies, further research was still needed to examine the clinical value of ACT in PTSD treatment.
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Affiliation(s)
- Fan Zhang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Chenwei Huang
- Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Wenjie Yan
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Hui Ouyang
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, #800 Xiangyin Road, Shanghai 200433, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, Shanghai, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
| | - Weizhi Liu
- Lab for Post-traumatic Stress Disorder, Faculty of Psychology, Naval Medical University, #800 Xiangyin Road, Shanghai 200433, China
- The Emotion and Cognition Lab, Faculty of Psychology, Naval Medical University, Shanghai, China
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Bonny P, Bogaert C, Abreu de Carvalho LF, Gryspeerdt F, Eker H, Hermie L, Berrevoet F. Evolution in liver trauma management: a single centre experience. Acta Chir Belg 2024:1-12. [PMID: 38607666 DOI: 10.1080/00015458.2024.2342132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/08/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVES Liver trauma is common and can be treated non-operatively, through radiological embolisation, or surgically. Non-operative management (NOM) is preferred when possible, but specific criteria remain unclear. This retrospective study at a level I trauma centre assessed the evolution and outcomes of liver injury management over more than 20 years. METHODS Data from January 1996 to June 2020 were analysed for liver trauma cases. Variables were evaluated, including the type of injury, diagnostic modalities, liver injury grade, transfer from other hospitals, treatment type, and length of hospital stay. Outcomes were assessed using soft (hospitalisation time and intensive care unit stay) and hard (mortality) endpoints. RESULTS In total 406 patients were analysed, of which 375 (92.4%) had a blunt and 31 (7.6%) a penetrating liver trauma. Approximately one-third (31.2%) were hemodynamically unstable, although 78.8% had low-grade liver lesions. The initial treatment was non-operative in 72.9% of the patients (68.5% conservative, 4.4% interventional radiology). Blunt trauma was treated by surgery in 23.2% of the patients, while 74.2% in case of penetrating trauma. Overall mortality was 11.1% including death caused by associated lesions. The 24-h mortality was 5.7%. Indication for surgical treatment was determined by hemodynamic instability, high grade liver lesion, penetrating trauma, and associated lesions. CONCLUSIONS Although the role of surgery in liver trauma management has strongly diminished over recent decades, hemodynamically unstable patients, high-grade lesions, penetrating trauma, and severe associated lesions are the main indications for surgery. In other situations, NOM by full conservative therapy or radiological embolisation seems effective.
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Affiliation(s)
- Paulien Bonny
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Constantijn Bogaert
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | | | - Filip Gryspeerdt
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Hasan Eker
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
| | - Laurens Hermie
- Division of Interventional Radiology, Department of Radiology, Ghent University Hospital, Ghent, Belgium
| | - Frederik Berrevoet
- Department of General and HPB Surgery and Liver Transplantation, Ghent University Hospital, Ghent, Belgium
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Dokkedahl SB, Lahav Y. Peri traumatic dissociation and posttraumatic stress symptoms: the moderating role of perceived threat. Eur J Psychotraumatol 2024; 15:2338670. [PMID: 38618677 PMCID: PMC11020594 DOI: 10.1080/20008066.2024.2338670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/27/2024] [Indexed: 04/16/2024] Open
Abstract
Background: Although peritraumatic dissociation (PD) is viewed as a risk factor for posttraumatic stress disorder (PTSD), prospective studies taking into account other well-known risk factors for PTSD have been scarce, and the exploration of potential moderators within the relations between PD and PTSD has been lacking.Objective: Filling this gap, this prospective study explored the moderating role of perceived threat within the relations between PD and PTSD, above and beyond age, gender, education, and early trauma-related symptoms.Method: A convenience sample of 200 Israeli civilians filled out self-report questionnaires during the peritraumatic phase (T1) and one to two months after the posttraumatic phase (T2) of being exposed to rocket attacks.Results: The results showed that perceived threat and PD were associated with early trauma-related symptoms and PTSD symptoms. Moreover, perceived threat moderated the relationship between PD and all PTSD symptom clusters apart from avoidance.Conclusions: The present results suggest that the implications of PD are shaped by levels of perceived threat, so that detriments of PD are evident when the trauma is appraised as being highly threatening. Therefore, early interventions that aim to decrease PD may be beneficial in preventing PTSD symptoms of intrusion, hyper arousal, and negative alterations in mood and cognition, for individuals who perceive traumatic events as highly threatening.
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Affiliation(s)
- Sarah Bøgelund Dokkedahl
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- National Center of Psychotraumatology, Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Yael Lahav
- Department of Occupational Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Seidel A, Chidda A, Perez V, Krause F, Zderic I, Gueorguiev B, Lalonde KA, Meulenkamp B. Biomechanical Effects of Hindfoot Alignment in Supination External Rotation Malleolar Fractures: A Human Cadaveric Model. Foot Ankle Int 2024:10711007241241075. [PMID: 38618682 DOI: 10.1177/10711007241241075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
BACKGROUND Pressure distribution in the ankle joint is known to be dependent on various factors, including hindfoot alignment. We seek to evaluate how hindfoot alignment affects contact pressures in the ankle joint in the setting of supination external rotation (SER) type ankle fractures. METHODS SER fractures were created in 10 human cadaver lower extremity specimens, simulating progressive stages of injury: without fracture (step 0), SER fracture and intact deltoid ligament (step 1), superficial deltoid ligament disruption (step 2), and deep deltoid ligament disruption (step 3). At each step, varus and valgus alignment was simulated by displacing the calcaneal tuberosity 7 mm medial or lateral. Each limb was axially loaded following each osteotomy at a static load of 350 N. The center of force (COF), contact area (CA), and peak contact pressure (PP) under load were measured, and radiographs of the ankle mortise were taken to analyze the medial clear space (MCS) and talar tilt (TT). RESULTS The COF (5.3 mm, P = .030) and the CA (-188.4 mm2, P = .015) changed in step 3 in the valgus hindfoot alignment compared to baseline parameters, indicating the importance of deep deltoid ligament integrity in maintaining normal ankle joint contact stress in the valgus hindfoot. These changes were not seen in the setting of varus alignment (COF: 2.3 mm, P = .059; CA -121 mm2, P = .133). PP were found to not change significantly in either varus or valgus (varus: -4.9 N, P = .132; valgus: -4 N, P = .464).The MCS demonstrated widening in step 3 compared to step 2 (0.7 mm, P = .020) in both varus and valgus hindfoot. The TT increased significantly in step 3 in the valgus hindfoot (2.8 degrees, P = .020) compared to step 0. CONCLUSION SER-IV fractures with valgus hindfoot alignment showed significant changes in pressure distribution and radiographic parameters when compared to SER-IV fractures with varus hindfoot alignment. CLINICAL RELEVANCE Based on this cadaver modeling study, patients with SERIV fracture with varus hindfoot alignment and complete deltoid ligament lesion may not need fracture fixation, whereas those with valgus hindfoot alignment likely need fracture fixation.
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Affiliation(s)
- Angela Seidel
- Department of Orthopaedics, Civic Hospital, Ottawa, Canada
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland
| | - Amal Chidda
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland
| | - Virginie Perez
- Department of Orthopaedic Surgery and Traumatology, Fribourg Cantonal Hospital, University of Fribourg, Switzerland
| | - Fabian Krause
- Department of Orthopaedic Surgery and Traumatology, Inselspital and Orthopädie Sonnenhof, University of Berne, Bern, Switzerland
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
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Siddiqi N, Lammers D, Hu P, Stonko D, DuBose J, Hurst S, Hashmi Z, Morrison J, Betzold R. Comparison of Contralateral vs Ipsilateral Vein Graft for Traumatic Vascular Injury Repair: A Cohort From PROOVIT. Am Surg 2024:31348241246167. [PMID: 38621410 DOI: 10.1177/00031348241246167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
Traumatic injury leading to arterial damage has traditionally been repaired using autologous vein graft from the contralateral limb. This often requires a secondary surgical site and the potential of prolonged operative time for patients. We sought to assess the use of ipsilateral vs contralateral vein grafts in patients who experienced traumatic extremity vascular injury. A multicenter database was queried to identify arterial injuries requiring operative intervention with vein grafting. The primary outcome of interest was need for operative reintervention. Secondary outcomes included risk of thrombosis, infection, and intensive care unit length of stay. 358 patients (320 contralateral and 38 ipsilateral) were included in the analysis. The ipsilateral vein cohort did not display a statistically significant decrease in need for reoperation when compared to the contralateral group (11% vs 23%; OR 0.41, 95% CI -0.07-1.3; P = .14). Contralateral repair was associated with longer median intensive care unit (ICU) LOS (4.3 vs 3.1 days; P < .01).
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Affiliation(s)
- Noreen Siddiqi
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Daniel Lammers
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Parker Hu
- Department of Surgery, Chippenham Hospital, Richmond, VA, USA
| | - David Stonko
- Department of Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Joseph DuBose
- Department of Surgery and Perioperative Care, The University of Texas at Austin Dell Medical School, Austin, TX, USA
| | - Stuart Hurst
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Zain Hashmi
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
| | - Jonathan Morrison
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, MN, USA
| | - Richard Betzold
- Department of Surgery, The University of Alabama at Birmingham Hospital, Birmingham, AL, USA
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Peter L. Jointly enclosed in-between: the collective meaning of liminality in refugees' and other migrants' mental health care. Anthropol Med 2024:1-18. [PMID: 38618700 DOI: 10.1080/13648470.2024.2339705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
People on the move are increasingly immobilised between and within state borders, having left 'there' but not allowed to be fully 'here'. This paper presents a nuanced examination of this state of enforced in--betweenness, exploring how refugees and other migrants negotiate collective existence through, despite, and alongside liminality. Drawing on ethnographic data collected at a Swiss Red Cross psychotraumatology centre, the study identifies factors that impede and facilitate the formation of collective identities, with temporal and spatial liminality emerging as the most central collective experience for refugees and other migrants. The findings illustrate how therapists reinforce these bonds by fostering an idealised sense of therapeutic communitas that promotes unity in adversity. However, the paper refrains from reducing the collective significance of liminality to a mere act of defiance. Instead, it critically reflects on how refugees and other migrants forge collective connections within politically and legally imposed disconnection. It accounts for the paradox of refugees and other migrants making collective lives in liminality while confronting the always-imminent possibility of this very liminality dismantling their lives.
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Affiliation(s)
- Laura Peter
- Department of International Relations, London School of Economics and Political Science, London, UK
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Wendt S, Natalier K, Goudie S. Young Women's Experiences of Violence and Homelessness. Violence Against Women 2024:10778012241243053. [PMID: 38613403 DOI: 10.1177/10778012241243053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
This article explores the lived experience of young women navigating and surviving domestic and family violence (DFV) and homelessness. Promoting the voices of young women through in-depth interviews, this article considers their story of violence, abuse, homelessness, and sense of safety. Such stories enable reflection on the ability of services to provide personal, material, emotional, and cultural safety in a way that recognizes the intersecting impact of trauma before, during, and after experiences of DFV. We conclude by arguing that providing emotional and cultural safety through the relational aspects of service delivery is essential to developing a strong foundation for young women's futures.
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Affiliation(s)
- Sarah Wendt
- Department of Social Work, The University of Melbourne, Melbourne, Victoria, Australia
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
| | - Kristin Natalier
- College of Humanities, Arts and Social Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Sharyn Goudie
- College of Education, Psychology and Social Work, Flinders University, Adelaide, South Australia, Australia
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Rafaqat W, Abiad M, Lagazzi E, Argandykov D, Proaño-Zamudio JA, Velmahos GC, Hwabejire JO, Parks JJ, Luckhurst CM, DeWane MP. Analyzing the Impact of Concomitant COVID-19 Infection on Outcomes in Trauma Patients. Am Surg 2024:31348241246176. [PMID: 38613452 DOI: 10.1177/00031348241246176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
BACKGROUND The impact of COVID-19 infection at the time of traumatic injury remains understudied. Previous studies demonstrate that the rate of COVID-19 vaccination among trauma patients remains lower than in the general population. This study aims to understand the impact of concomitant COVID-19 infection on outcomes in trauma patients. METHODS We conducted a retrospective cohort study of patients ≥18 years old admitted to a level I trauma center from March 2020 to December 2022. Patients tested for COVID-19 infection using a rapid antigen/PCR test were included. We matched patients using 2:1 propensity accounting for age, gender, race, comorbidities, vaccination status, injury severity score (ISS), type and mechanism of injury, and GCS at arrival. The primary outcome was inpatient mortality. Secondary outcomes included hospital length of stay (LOS), Intensive Care Unit (ICU) LOS, 30-day readmission, and major complications. RESULTS Of the 4448 patients included, 168 (3.8%) were positive (COV+). Compared with COVID-19-negative (COV-) patients, COV+ patients were similar in age, sex, BMI, ISS, type of injury, and regional AIS. The proportion of White and non-Hispanic patients was higher in COV- patients. Following matching, 154 COV+ and 308 COV- patients were identified. COVID-19-positive patients had a higher rate of mortality (7.8% vs 2.6%; P = .010), major complications (15.6% vs 8.4%; P = .020), and thrombotic complications (3.9% vs .6%; P = .012). Patients also had a longer hospital LOS (median, 9 vs 5 days; P < .001) and ICU LOS (median, 5 vs 3 days; P = .025). CONCLUSIONS Trauma patients with concomitant COVID-19 infection have higher mortality and morbidity in the matched population. Focused interventions aimed at recognizing this high-risk group and preventing COVID-19 infection within it should be undertaken.
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Affiliation(s)
- Wardah Rafaqat
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - May Abiad
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Emanuele Lagazzi
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Dias Argandykov
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jefferson A Proaño-Zamudio
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - John O Hwabejire
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Jonathan J Parks
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Casey M Luckhurst
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
| | - Michael P DeWane
- Division of Trauma, Emergency General Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
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Shool S, Rahmani S, Habibi MA, Piri SM, Lotfinia M, Jashnani D, Asaadi S. Acute spinal cord injury serum biomarkers in human and rat: a scoping systematic review. Spinal Cord Ser Cases 2024; 10:21. [PMID: 38615029 PMCID: PMC11016077 DOI: 10.1038/s41394-024-00636-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 04/15/2024] Open
Abstract
STUDY DESIGN Scoping systematic review. OBJECTIVES To summarize the available experimental clinical and animal studies for the identification of all CSF and serum-derived biochemical markers in human and rat SCI models. SETTING Tehran, Iran. METHODS In this scoping article, we systematically reviewed the electronic databases of PubMed, Scopus, WOS, and CENTRAL to retrieve current literature assessing the levels of different biomarkers in human and rat SCI models. RESULTS A total of 19,589 articles were retrieved and 6897 duplicated titles were removed. The remaining 12,692 studies were screened by their title/abstract and 12,636 were removed. The remaining 56 were considered for full-text assessment, and 11 papers did not meet the criteria, and finally, 45 studies were included. 26 studies were human observational studies comprising 1630 patients, and 19 articles studied SCI models in rats, including 832 rats. Upon reviewing the literature, we encountered a remarkable heterogeneity in terms of selected biomarkers, timing, and method of measurement, studied models, extent, and mechanism of injury as well as outcome assessment measures. CONCLUSIONS The specific expression and distribution patterns of biomarkers in relation to spinal cord injury (SCI) phases, and their varied concentrations over time, suggest that cerebrospinal fluid (CSF) and blood biomarkers are effective measures for assessing the severity of SCI.
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Affiliation(s)
- Sina Shool
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Saeed Rahmani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Amin Habibi
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Seyed Mohammad Piri
- Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, 11365-3876, Tehran, Iran
| | - Mahmoud Lotfinia
- Resident of Neurosurgery, Department of Neurosurgery, Klinikum Saarbrücken, University of Saarland, Saarbrücken, Germany
| | - Delara Jashnani
- Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sina Asaadi
- Department of Surgery, Division of Acute Care Surgery, Loma Linda University, Loma Linda, CA, USA.
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Lenart EK, Byerly SE, Gross MG, Ali YM, Evans CR, Easterday TS, Howley IW, Kerwin AJ, Fischer PE, Filiberto DM. Clinical Implications of Over- and Under-Triage Using Need for Trauma Intervention and Cribari Indices. Am Surg 2024:31348241246181. [PMID: 38613475 DOI: 10.1177/00031348241246181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/15/2024]
Abstract
BACKGROUND Need for Trauma Intervention (NFTI) score was proposed to help identify injured trauma patients while minimizing under (UT) and over triage (OT). Using a national database, we aimed to describe UT and OT of NFTI vs standard Cribari method (CM) and hypothesized triage sensitivity remains poor. METHODS The 2021 Trauma Quality Improvement Program (TQIP) database was queried. Demographics, mechanism, verification level, interfacility transfer (IF), and level of activation were collected. Patients were stratified by both NFTI [+ vs -] and CM [Injury severity score (ISS) < 15 vs > 15]. UT was defined as NFTI + or ISS >15 without full trauma activation. RESULTS 1,030,526 patients were identified in TQIP. 84,969 were UT and 97,262 were OT using NFTI while 94,020 were UT and 108,823 were OT using CM. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of NFTI is 49%, 89%, 45%, and 90%, respectively vs 43%, 87%, 39%, and 89% of CM, respectively. Age was higher in the UT group using both scores (52 vs 42, P < .0001 and 54 vs 42, P < .0001, respectively). Using MLR, level 2 and 3 verification, blunt mechanism, female, IF, and older age were associated with UT in both NFTI and CM. Level 1 verification, penetrating mechanism, male, no IF, and younger age were associated with OT. CONCLUSIONS Current prehospital triage criteria have poor sensitivity for identifying severely injured trauma patients by both NFTI and CM. UT increases as age of the patient increases. Further studies are needed to improve triage.
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Affiliation(s)
- Emily K Lenart
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Saskya E Byerly
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Megan G Gross
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Yasmin M Ali
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Cory R Evans
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Thomas S Easterday
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Isaac W Howley
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Andy J Kerwin
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Peter E Fischer
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Dina M Filiberto
- Department of Surgery, The University of Tennessee Health Science Center, Memphis, TN, USA
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Powell B, Cramb S. The shock index predicts in-flight blood transfusion in aeromedical trauma patients. Emerg Med Australas 2024. [PMID: 38602079 DOI: 10.1111/1742-6723.14413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 04/01/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE To define the utility of the Triage Revised Trauma Score (TRTS), GCS/Age/arterial Pressure (GAP) score, and shock index (SI) in predicting the need for in-flight blood product administration in civilian trauma patients transported by an aeromedical platform. METHODS A retrospective chart review of 3582 aeromedical trauma cases was conducted. An initial TRTS, GAP score and SI were calculated for each patient, and the administration of in-flight blood products was also recorded. Receiver operating characteristic (ROC) curves were used to quantify the predictive discrimination of the TRTS, GAP score and SI on the need for in-flight blood product administration. RESULTS The SI showed a superior predictive value compared to the TRTS and GAP score. The SI showed an area under the curve on the ROC curve of 0.85 in both primary and inter-hospital transfer cases, indicating reasonable predictive value. CONCLUSION The SI demonstrates favourable test characteristics for predicting the need for in-flight blood product administration. Prospective validation of these results is warranted.
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Affiliation(s)
- Benjamin Powell
- LifeFlight Retrieval Medicine, Brisbane, Queensland, Australia
- Emergency Department, Ipswich General Hospital, Ipswich, Queensland, Australia
- The University of Queensland, Brisbane, Queensland, Australia
| | - Susanna Cramb
- Australian Centre for Health Services Innovation, School of Public Health & Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
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Wei Y, Ren X, Yuan Z, Hong J, Wang T, Chen W, Xu Y, Ding J, Lin J, Jiang W, Zhang P, Wu Q. Trauma diagnostic-related target proteins and their detection techniques. Expert Rev Mol Med 2024; 26:e7. [PMID: 38602081 DOI: 10.1017/erm.2024.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Trauma is a significant health issue that not only leads to immediate death in many cases but also causes severe complications, such as sepsis, thrombosis, haemorrhage, acute respiratory distress syndrome and traumatic brain injury, among trauma patients. Target protein identification technology is a vital technique in the field of biomedical research, enabling the study of biomolecular interactions, drug discovery and disease treatment. It plays a crucial role in identifying key protein targets associated with specific diseases or biological processes, facilitating further research, drug design and the development of treatment strategies. The application of target protein technology in biomarker detection enables the timely identification of newly emerging infections and complications in trauma patients, facilitating expeditious medical interventions and leading to reduced post-trauma mortality rates and improved patient prognoses. This review provides an overview of the current applications of target protein identification technology in trauma-related complications and provides a brief overview of the current target protein identification technology, with the aim of reducing post-trauma mortality, improving diagnostic efficiency and prognostic outcomes for patients.
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Affiliation(s)
- YiLiu Wei
- Department of Trauma Center & Emergency Surgery, The First Affiliated Hospital of Fujian Medical University, 350004 Fuzhou, China
- Department of Trauma Center and Emergency Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, 350004 Fuzhou, China
| | - Xiaohan Ren
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Zhitao Yuan
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Jie Hong
- Department of Trauma Center & Emergency Surgery, The First Affiliated Hospital of Fujian Medical University, 350004 Fuzhou, China
- Department of Trauma Center and Emergency Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, 350004 Fuzhou, China
| | - Tao Wang
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Weizhi Chen
- Department of Trauma Center & Emergency Surgery, The First Affiliated Hospital of Fujian Medical University, 350004 Fuzhou, China
- Department of Trauma Center and Emergency Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, 350004 Fuzhou, China
| | - Yuqing Xu
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Jinwang Ding
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Jun Lin
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Wenqian Jiang
- Institute of Applied Genomics, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
- College of Biological Science and Engineering, Fuzhou University, No. 2 Xueyuan Road, 350108 Fuzhou, China
| | - Peng Zhang
- Institute of Molecular Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, 200127 Shanghai, China
| | - Qiaoyi Wu
- Department of Trauma Center & Emergency Surgery, The First Affiliated Hospital of Fujian Medical University, 350004 Fuzhou, China
- Department of Trauma Center and Emergency Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, 350004 Fuzhou, China
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Gross MG, Filiberto DM, Lehrman BH, Lenart EK, Easterday TS, Kerwin AJ, Byerly SE. Outcomes and Predictors of Delayed Intervention After Renal Trauma. Am Surg 2024:31348241246164. [PMID: 38605637 DOI: 10.1177/00031348241246164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
INTRODUCTION Historically, a zone II hematoma mandated exploration after penetrating trauma, but this has been challenged given potentially higher nephrectomy rates and the advent of therapeutic endovascular and endoscopic interventions. We hypothesized penetrating mechanism was not a predictor for delayed intervention in the modern era. METHODS This single-center, retrospective study included renal trauma patients from 3/2019 to 6/2022. Our institutional practice is selective exploration of zone II hematomas for active bleeding and expanding hematoma only, regardless of mechanism. Descriptive statistics and multivariable logistic regression (MLR) were performed. RESULTS One-hundred and forty-four patients were identified, with median age 32 years (IQR:23,49), 66% blunt mechanism, and injury severity score 17(IQR:11,26). Forty-three (30%) required operative intervention, and of the 20 that had a zone II exploration, 3 (15%) underwent renorrhaphy and 17 (85%) underwent nephrectomy. Penetrating patients more frequently underwent immediate operative intervention (67%vs10%,P < .0001), required nephrectomy (27%vs5%,P = .0003), and were less likely to undergo pre-intervention CT (51%vs96%,P < .0001) compared to blunt patients. Delayed renal interventions were higher in penetrating (33%vs13%,P = .004) with no difference in mortality or length of stay compared to blunt mechanism. Ureteral stent placement and renal embolization were the most common delayed interventions. On MLR, the only independent predictor for delayed intervention was need for initial operative intervention (OR 3.803;95%CI:1.612-8.975,P = .0023). Four (3%) required delayed nephrectomy, of which only one underwent initial operative intervention without zone 2 exploration. CONCLUSIONS The most common delayed interventions after renal trauma were renal embolization and ureteral stent. Penetrating mechanism was not a predictor of delayed renal intervention in a trauma center that manages zone II retroperitoneal hematomas similarly regardless of mechanism.
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Affiliation(s)
- Megan G Gross
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Dina M Filiberto
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Benjamin H Lehrman
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Emily K Lenart
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Thomas S Easterday
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Andrew J Kerwin
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
| | - Saskya E Byerly
- Department of Surgery, Division of Trauma & Surgical Critical Care, University of Tennessee Health Science University, Memphis, TN, USA
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Witting AB, Anderson SR, Johnson LN, Barrow BH, Peery A. The trajectory of anxiety in therapy: The role of ACEs. J Marital Fam Ther 2024. [PMID: 38602712 DOI: 10.1111/jmft.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/27/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
The connection between adverse childhood experiences (ACEs) and anxiety disorders is well-documented. Additionally, therapy has been shown to be effective at reducing anxiety symptoms. Yet more needs to be known about how ACEs may shape the process of therapy and the trajectory of anxiety symptoms. This study was designed to compare the trajectory of improvement in anxiety symptoms over the course of 12 sessions of therapy in adults (N = 472), who reported more (greater than four) and fewer (fewer than four) ACEs using a multigroup latent growth curve analysis. Data were drawn from the Marriage and Family Therapy Practice Research Network database. Results suggested that the rate of improvement in those with more and fewer ACEs was not significantly different; however, those with more ACEs had a significantly higher average starting point of anxiety symptoms.
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Affiliation(s)
| | | | - Lee N Johnson
- School of Family Life, Brigham Young University, Provo, Utah, USA
| | | | - Allie Peery
- School of Family Life, Brigham Young University, Provo, Utah, USA
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Riva HR, Polmear MM, Petersen C, Guillet JY, Yong TM, Adler AH, Rajani R, Singh V, Wang DCS. Spine Injuries Sustained After Falls While Crossing the U.S.-Mexico Border. Neurotrauma Rep 2024; 5:367-375. [PMID: 38655116 PMCID: PMC11035857 DOI: 10.1089/neur.2024.0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
This study is to report the demographics, incidence, and patterns of spinal injuries associated with border crossings resulting from a fall from a significant height. A retrospective cohort study was performed at a Level I trauma center from January 2016 to December 2021 to identify all patients who fell from a significant height while traversing the U.S.-Mexico border and were subsequently admitted. A total of 448 patients were identified. Of the 448 patients, 117 (26.2%) had spine injuries and 39 (33.3%) underwent operative fixation. Females had a significantly higher incidence of spine injuries (60% vs. 40%; p < 0.00330). Patients with a spine fracture fell from a higher median fall height (6.1 vs. 4.6 m; p < 0.001), which resulted in longer median length of stay (LOS; 12 vs. 7 days; p < 0.001), greater median Injury Severity Score (ISS; 20 vs. 9; p < 0.001), and greater relative risk (RR) of ISS >15 (RR = 3.2; p < 0.001). Patients with operative spine injuries had significantly longer median intensive care unit (ICU) LOS than patients with non-operative spine injuries (4 vs. 2 days; p < 0.001). Patients with spinal cord injuries and ISS >15 sustained falls from a higher distance (median 6.1 vs. 5.5 m) and had a longer length of ICU stay (median 3 vs. 0 days). All patients with operative spine injuries had an ISS >15 relative to 50% of patients with non-operative spine injuries (median ISS 20 vs. 15; p < 0.001). Patients with spine trauma requiring surgery had a higher incidence of head (RR = 3.5; p 0.0353) and chest injuries (RR = 6.0; p = 0.0238), but a lower incidence of lower extremity injuries (RR = 0.5; p < 0.001). Thoracolumbar injuries occurred in 68.4% of all patients with spine injuries. Patients with operative spine injuries had a higher incidence of burst fracture (RR = 15.5; p < 0.001) and flexion-distraction injury (RR = 25.7; p = 0.0257). All patients with non-operative spine injuries had American Spinal Injury Association (ASIA) D or E presentations, and patients with operative spine injuries had a higher incidence of spinal cord injury: ASIA D or lower at time of presentation (RR = 6.3; p < 0.001). Falls from walls in border crossings result in significant injuries to the head, spine, long bones, and body, resulting in polytrauma casualties. Falls from higher height were associated with a higher frequency and severity of spinal injuries, greater ISS, and longer ICU length of stay. Operative spine injuries, compared with non-operative spine injuries, had longer ICU length of stay, greater ISS, and different fracture morphology. Spine surgeons and neurocritical care teams should be prepared to care for injuries associated with falls from height in this unique population.
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Affiliation(s)
- Hannah R. Riva
- Paul L. Foster School of Medicine, El Paso, Texas, USA
- Division of Neurosurgery, University Medical Center, El Paso, Texas, USA
| | | | | | - June Y. Guillet
- Division of Neurosurgery, University Medical Center, El Paso, Texas, USA
| | | | - Adam H. Adler
- Division of Orthopaedic Surgery, El Paso, Texas, USA
| | - Rajiv Rajani
- Division of Orthopaedic Surgery, El Paso, Texas, USA
| | - Vishwajeet Singh
- Biostatistics and Epidemiology Consulting Lab; Texas Tech University Health Sciences Center, El Paso, Texas, USA
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Berthelot N, Larouche K, Garon-Bissonnette J, Deschênes K, Drouin-Maziade C, Lemieux R. Spillover effects on the relationship with the partner of a mentalization-based intervention for pregnant women. Infant Ment Health J 2024. [PMID: 38598747 DOI: 10.1002/imhj.22113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 02/09/2024] [Accepted: 03/20/2024] [Indexed: 04/12/2024]
Abstract
The birth of a child has been associated with a decline in couple satisfaction, which has implications for the child's social-emotional development. This study investigated the potential spillover effect on pregnant women's perceptions of their relationships with their partners of the Supporting the Transition to and Engagement in Parenthood (STEP) program, a brief trauma-informed mentalization-based prenatal group intervention. Participants (94% White) were recruited in prenatal clinics and through online advertisements in Quebec, Canada. Both quantitative and qualitative data were collected from participants assigned to the STEP program (n = 42) and those receiving treatment-as-usual (TAU; n = 125). Women participating in STEP reported significant improvements in their relationships with their partners compared to those assigned to TAU. More precisely, they reported higher couple satisfaction, enhanced communication, and increased interest in their partners' emotional experience. The qualitative analysis further substantiated these results, with participants reporting having involved their partners in their pregnancy, shared their insights about themselves with their partners and gained fresh perspectives on their relationships. Participants in STEP also expressed sharing program materials with their partners and considered that such interventions should be extended to expecting fathers. This study underscores the potential of mentalization-based interventions to indirectly contribute to couple relationships, which may have positive implications for parenting and the infant.
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Affiliation(s)
- Nicolas Berthelot
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivieres, Quebec, Canada
- CERVO Brain Research Center, Quebec City, Quebec, Canada
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivieres, Quebec, Canada
| | - Karl Larouche
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivieres, Quebec, Canada
- CERVO Brain Research Center, Quebec City, Quebec, Canada
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivieres, Quebec, Canada
| | - Julia Garon-Bissonnette
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivieres, Quebec, Canada
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivieres, Quebec, Canada
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Kim Deschênes
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivieres, Quebec, Canada
- CERVO Brain Research Center, Quebec City, Quebec, Canada
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivieres, Quebec, Canada
- Department of Psychology, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
| | - Christine Drouin-Maziade
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivieres, Quebec, Canada
- Interdisciplinary Research Center on Intimate Partner Relationship Problems and Sexual Abuse, Montreal, Quebec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivieres, Quebec, Canada
| | - Roxanne Lemieux
- Department of Nursing Sciences, Université du Québec à Trois-Rivières, Trois-Rivieres, Quebec, Canada
- Centre d'études interdisciplinaires sur le développement de l'enfant et la famille, Trois-Rivieres, Quebec, Canada
- Groupe de recherche et d'intervention auprès de l'enfant vulnérable et négligé, Trois-Rivieres, Quebec, Canada
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Fukushima H, Ushiku C, Akiyama S, Saito S, Wakiya H, Okuno K, Saito M. Trend differences in cervical spinal cord injuries before and after the coronavirus disease 2019 pandemic. Spinal Cord Ser Cases 2024; 10:19. [PMID: 38600098 PMCID: PMC11006934 DOI: 10.1038/s41394-024-00633-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/27/2024] [Accepted: 04/03/2024] [Indexed: 04/12/2024] Open
Abstract
STUDY DESIGN Cross-Sectional Study. OBJECTIVES To investigate the changes in the characteristics of cervical spinal cord injuries (CSCI) before and after the coronavirus disease 2019 (COVID-19) pandemic among patients transported to our hospital in Japan. SETTING Hospital with an emergency center in Chiba, Japan. METHODS Patients eligible for the study were those transported within 24 h of injury and diagnosed with cervical spinal cord injury between January 2018 and December 2021 at our hospital. Medical records were retrospectively examined to investigate the number and characteristics of patients with CSCI. The clinical variables of patients with CSCI were compared according to the time of admission as related to the COVID-19 pandemic: 2018-19 (before) or 2020-21 (after). RESULTS The total number of patients with CSCI from 2018 to 2021 was 108, with 57 before the COVID-19 pandemic and 51 after the COVID-19 pandemic. The number of severe cases with an injury severity score (ISS) of >16 decreased after COVID-19 (p < 0.05). Falls on level surfaces were the most common cause of injury both before and after COVID-19. Although the ranking of traffic accidents decreased after COVID-19, among those, the number of bicycle injuries tended to increase. CONCLUSIONS The number of serious cases with an ISS > 16 decreased, presumably because of the decline in high-energy trauma due to the background decrease in the number of traffic accidents.
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Affiliation(s)
- Hirotaka Fukushima
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Chikara Ushiku
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan.
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan.
| | - Shoshi Akiyama
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Shinji Saito
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Hiroki Wakiya
- Department of Orthopaedic Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
| | - Kenji Okuno
- Department of Emergency Medicine, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Mitsuru Saito
- Department of Orthopaedic Surgery, The Jikei University School of Medicine, Tokyo, Japan
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Murphy RC, Johnson TW, Mack TJ, Burke RE, Damiano NP, Heger L, Minner N, German E, Wilson A, Mount MG, Thurston BC, Mentzer CJ. Cost Savings of Whole Blood Versus Component Therapy at a Community Level 1 Trauma Center. Am Surg 2024:31348241241712. [PMID: 38591174 DOI: 10.1177/00031348241241712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
BACKGROUND Blood product component-only resuscitation (CORe) has been the standard of practice in both military and civilian trauma care with a 1:1:1 ratio used in attempt to recreate whole blood (WB) until recent data demonstrated WB to confer a survival advantage, leading to the emergence of WB as the contemporary resuscitation strategy of choice. Little is known about the cost and waste reduction associated with WB vs CORe. METHODS This study is a retrospective single-center review of adult trauma patients admitted to a community trauma center who received WB or CORe as part of their massive transfusion protocol (MTP) resuscitation from 2017 to 2021. The WB group received a minimum of one unit WB while CORe received no WB. Univariate and multivariate analyses were completed. Statistical analysis was conducted using a 95% confidence level. Non-normally distributed, continuous data were analyzed using the Wilcoxon rank sum test. RESULTS 576 patients were included (201 in WB and 375 in CORe). Whole blood conveyed a survival benefit vs CORe (OR 1.49 P < .05, 1.02-2.17). Whole blood use resulted in an overall reduction in products prepared (25.8%), volumes transfused (16.5%), product waste (38.7%), and MTP activation (56.3%). Cost savings were $849 923 annually and $3 399 693 over the study period. DISCUSSION Despite increased patient volumes over the study period (43.7%), the utilization of WB as compared to CORe resulted in an overall $3.39 million cost savings while improving mortality. As such, we propose WB should be utilized in all resuscitation strategies for the exsanguinating trauma patient.
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Affiliation(s)
- Rachel C Murphy
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Tyler W Johnson
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Thomas J Mack
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Rachel E Burke
- Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | | | - Laura Heger
- Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | - Nicholas Minner
- Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | - Emily German
- Edward Via College of Osteopathic Medicine, Spartanburg, SC, USA
| | - Angela Wilson
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Michael G Mount
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Brian C Thurston
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
| | - Caleb J Mentzer
- Department of Surgery, Spartanburg Regional Healthcare System, Spartanburg, SC, USA
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Kehyayan A, Thiel JP, Unterberg K, Salja V, Meyer-Wehrmann S, Holmes EA, Matura JM, Dieris-Hirche J, Timmesfeld N, Herpertz S, Axmacher N, Kessler H. The effect of a visuospatial interference intervention on post traumatic intrusions: a cross-over randomized controlled trial. Eur J Psychotraumatol 2024; 15:2331402. [PMID: 38591762 PMCID: PMC11028024 DOI: 10.1080/20008066.2024.2331402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 03/02/2024] [Indexed: 04/10/2024] Open
Abstract
Background: Intrusive memories form a core symptom of Posttraumatic Stress Disorder (PTSD). Based on concepts of visuospatial interference and memory-updating accounts, technological innovations aim to attenuate such intrusions using visuospatial interventions.Objective: This study aims to test the effect of a visuospatial Tetris-based intervention versus a verbal condition (Wiki) and a never-targeted control (no intervention) on intrusion frequency.Method: A randomized crossover trial was conducted including N = 38 PTSD patients who had at least 3 distinct intrusive memories of trauma. After both 2 weeks (intervention 1) and 4 weeks (intervention 2), one of the three memories was randomly selected and either the visuospatial intervention (memory reminder of a traumatic memory + Tetris) or verbal condition (reading a Wikipedia article + answering questions) was performed on their first memory in randomized order. In the week 4 session, the patient conducted the other intervention condition on their second memory (crossover). The third memory was never targeted (no intervention). Daily occurrence of intrusions over 8 weeks was collected using a diary and analysed using mixed Poisson regression models.Results: Overall, there was no significant reduction in intrusion frequency from either intervention compared to each other, and to no intervention control (relative risk Tetris/Wiki: 0.947; p = .31; relative risk no intervention/Tetris: 1.060; p = .15; relative risk no intervention/Wiki: 1.004; p = .92).Conclusions: There was no effect of either intervention on intrusions when administered in a crossover design where participants received both interventions. Design shortcomings and consequences for future studies are discussed.
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Affiliation(s)
- Aram Kehyayan
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Josephine P. Thiel
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Karl Unterberg
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Vanessa Salja
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Stefan Meyer-Wehrmann
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Emily A. Holmes
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Jan-Martin Matura
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jan Dieris-Hirche
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nina Timmesfeld
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University Bochum, Bochum, Germany
| | - Stephan Herpertz
- Department of Psychosomatic Medicine and Psychotherapy, LWL-University Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Nikolai Axmacher
- Department of Neuropsychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Henrik Kessler
- Department of Psychosomatic Medicine and Psychotherapy, Campus Fulda, University of Marburg, Fulda, Germany
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Rao AS, Scalea TM, Feliciano DV, Harfouche MN. More Harm Than Good: It is Time to Reconsider Prophylactic Fasciotomy in Lower-Extremity Vascular Injury. Am Surg 2024:31348241244629. [PMID: 38590003 DOI: 10.1177/00031348241244629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Four-compartment calf fasciotomy (CF) can be limb-saving. Prophylactic fasciotomy (PP) is advised in high-risk situations to prevent limb loss. Calf fasciotomy can cause significant morbidity, particularly if performed unnecessarily. We hypothesized that selective use of fasciotomies (SF) after lower-extremity vascular injury would lead to a lower rate of overall fasciotomies without an increase in limb complications than prophylactic fasciotomies (PFs). METHODS Trauma patients who sustained lower-extremity vascular injury that required operative repair at a high-volume trauma center were retrospectively reviewed and grouped by SF or PF (2016-2022). SF were individuals who were observed and underwent CF only if signs of compartment syndrome developed, whereas PF were individuals who underwent CF without signs of compartment syndrome. The primary outcome was amputation rate. Secondary outcomes were fasciotomy rate, need for reoperative vascular surgery, and clinical characteristics predisposing use of PF. RESULTS Of 101 overall patients, 30 patients (29.4%) had PF. Of the remaining 71 (SF group), 43.7% (n = 31) were spared CF. The median time from injury to vascular repair in both groups was the same (7 hours, P = .15). There was no difference in rate of vascular reoperation per group (PF = 26.7% vs SF = 23.9%, P = .77). The only clinical characteristic associated with PF was need for arterial shunt (OR 4.2, P = .028). CONCLUSIONS In trauma patients with lower-extremity vascular injury undergoing vascular repair, selective use of fasciotomy can spare almost half of patients the need for fasciotomy without an increase in limb complications.
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Luke RD, Balio CP, Foley CK, Soult AP. Implementation of a Trauma Bay Checklist Improves Antibiotic Prophylaxis Compliance in Open Extremity Fractures. Am Surg 2024:31348241244648. [PMID: 38584500 DOI: 10.1177/00031348241244648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
BACKGROUND Best practice guidelines from the ACS recommend that patients with open fractures receive antibiotics within 1-hour of presentation. Checklists are effective mechanisms for improving safety and compliance in surgical settings. The current study investigates implementation of a trauma bay checklist, referred to as MARTY, to improve administration of antibiotics in open extremity fractures at a level I trauma center. METHODS Retrospective pre-post design. Population consisted of trauma alerts from January to December 2021 (pre-MARTY) and 2022 (post-MARTY) with open fractures. Outcome measures included antibiotics administered within 1-hour of presentation and in the trauma bay. Bivariate and multivariate analyses were performed to estimate differences in both measures. RESULTS Our sample included 339 encounters, 174 pre-MARTY and 165 post-MARTY implementation. In the pre-MARTY period, 57.5% of encounters received antibiotics within 1-hour of presentation with 46.0% occurring in the trauma bay, in comparison to 65.5% and 54.5% in the post-MARTY period. In adjusted models, there were greater odds of antibiotic administration within 1-hour (OR = 1.654, P = .038) and prior to leaving the trauma bay (OR = 1.660, P = .041) than pre-MARTY. Encounters with higher-grade fractures were more likely to receive timely antibiotics (P<=.001). DISCUSSION Our study estimates improved compliance of antibiotic administration after implementation of MARTY after adjusting for encounter characteristics. Findings from this study demonstrate improved compliance, but this compliance is often still lacking in those with higher injury severity scores. Findings from this study may be used to inform approaches to further improve trauma care.
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Affiliation(s)
- Robert D Luke
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Casey P Balio
- Center for Rural Health Research & Department of Health Services Management and Policy, East Tennessee State University, Johnson City, TN, USA
| | | | - Alexa P Soult
- Department of Surgery, Eastern Virginia Medical School, Norfolk, VA, USA
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Gao J, Chen G, O'Rourke AP, Caskey J, Carey KA, Oguss M, Stey A, Dligach D, Miller T, Mayampurath A, Churpek MM, Afshar M. Automated stratification of trauma injury severity across multiple body regions using multi-modal, multi-class machine learning models. J Am Med Inform Assoc 2024:ocae071. [PMID: 38587875 DOI: 10.1093/jamia/ocae071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/29/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024] Open
Abstract
OBJECTIVE The timely stratification of trauma injury severity can enhance the quality of trauma care but it requires intense manual annotation from certified trauma coders. The objective of this study is to develop machine learning models for the stratification of trauma injury severity across various body regions using clinical text and structured electronic health records (EHRs) data. MATERIALS AND METHODS Our study utilized clinical documents and structured EHR variables linked with the trauma registry data to create 2 machine learning models with different approaches to representing text. The first one fuses concept unique identifiers (CUIs) extracted from free text with structured EHR variables, while the second one integrates free text with structured EHR variables. Temporal validation was undertaken to ensure the models' temporal generalizability. Additionally, analyses to assess the variable importance were conducted. RESULTS Both models demonstrated impressive performance in categorizing leg injuries, achieving high accuracy with macro-F1 scores of over 0.8. Additionally, they showed considerable accuracy, with macro-F1 scores exceeding or near 0.7, in assessing injuries in the areas of the chest and head. We showed in our variable importance analysis that the most important features in the model have strong face validity in determining clinically relevant trauma injuries. DISCUSSION The CUI-based model achieves comparable performance, if not higher, compared to the free-text-based model, with reduced complexity. Furthermore, integrating structured EHR data improves performance, particularly when the text modalities are insufficiently indicative. CONCLUSIONS Our multi-modal, multiclass models can provide accurate stratification of trauma injury severity and clinically relevant interpretations.
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Affiliation(s)
- Jifan Gao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
| | - Ann P O'Rourke
- Department of Surgery, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - John Caskey
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Kyle A Carey
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Madeline Oguss
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Anne Stey
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, United States
- Center of Health Services and Outcomes Research, Institute for Public Health and Medicine, Chicago, IL 60611, United States
| | - Dmitriy Dligach
- Department of Computer Science, Loyola University Chicago, Chicago, IL 60660, United States
| | - Timothy Miller
- Computational Health Informatics Program, Boston Children's Hospital, Boston, MA 02115, United States
- Department of Pediatrics, Harvard Medical School, Boston, MA 02115, United States
| | - Anoop Mayampurath
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Matthew M Churpek
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
| | - Majid Afshar
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI 53726, United States
- Department of Medicine, University of Wisconsin-Madison, Madison, WI 53705, United States
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Taheri BD, Fisher AD, Eisenhauer IF, April MD, Rizzo JA, Guliani SS, Flarity KM, Cripps M, Bebarta VS, Wohlauer MV, Schauer SG. The employment of resuscitative endovascular balloon occlusion of the aorta in deployed settings. Transfusion 2024. [PMID: 38581267 DOI: 10.1111/trf.17823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024]
Abstract
BACKGROUND Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been often used in place of open aortic occlusion for management of hemorrhagic shock in trauma. There is a paucity of data evaluating REBOA usage in military settings. STUDY DESIGN AND METHODS We queried the Department of Defense Trauma Registry (DODTR) for all cases with at least one intervention or assessment available within the first 72 h after injury between 2007 and 2023. We used relevant procedural codes to identify the use of REBOA within the DODTR, and we used descriptive statistics to characterize its use. RESULTS We identified 17 cases of REBOA placed in combat settings from 2017 to 2019. The majority of these were placed in the operating room (76%) and in civilian patients (70%). A penetrating mechanism caused the injury in 94% of cases with predominantly the abdomen and extremities having serious injuries. All patients subsequently underwent an exploratory laparotomy after REBOA placement, with moderate numbers of patients having spleen, liver, and small bowel injuries. The majority (82%) of included patients survived to hospital discharge. DISCUSSION We describe 17 cases of REBOA within the DODTR from 2007 to 2023, adding to the limited documentation of patients undergoing REBOA in military settings. We identified patterns of injury in line with previous studies of patients undergoing REBOA in military settings. In this small sample of military casualties, we observed a high survival rate.
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Affiliation(s)
- Branson D Taheri
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
- Air Education and Training Command, Air Force Institute of Technology, Wright-Patterson Air Force Base, Dayton, Ohio, USA
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
- Texas Army National Guard, Austin, Texas, USA
| | - Ian F Eisenhauer
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Department of Emergency Medicine, Denver Health, Denver, Colorado, USA
- Navy Medicine Leader and Professional Development Command, Bethesda, Maryland, USA
| | - Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- 14th Field Hospital, Fort Stewart, Georgia, USA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Brooke Army Medical Center, JBSA, Fort Sam Houston, Texas, USA
| | - Sundeep S Guliani
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA
| | - Kathleen M Flarity
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Michael Cripps
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Vikhyat S Bebarta
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Max V Wohlauer
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steven G Schauer
- University of Colorado Center for Combat Medicine and Battlefield (COMBAT) Research, Aurora, Colorado, USA
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
- Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colorado, USA
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Horesh D, Lahav Y. When one tool is not enough: An integrative psychotherapeutic approach to treating complex PTSD. J Clin Psychol 2024. [PMID: 38577793 DOI: 10.1002/jclp.23688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
Complex posttraumatic stress disorder (CPTSD) is a term representing the psychopathological implications of exposure to chronic, inter-personal trauma. These include the main symptoms of PTSD, as well as changes in identity, emotion regulation, and inter-personal relationships. Self-harm and dissociation (i.e., disintegration of mental processes) are also quite common in CPTSD. Considering this complex and often severe clinical picture, mental health professionals often find it difficult to effectively treat CPTSD. In this paper, we present an integrative approach to the treatment of CPTSD based on a combination of techniques from several psychotherapy approaches. The case described here illustrates the need for therapeutic flexibility and eclecticism when treating individuals exposed to chronic trauma. We show the advantages of flexible therapeutic attunement, which enables the therapist to respond to the changing need of the patient, as well as her fluid clinical picture and symptom manifestation. The case also illustrates how interventions taken from psychodynamic therapy, Dialectical behavior therapy, and Eye Movement Desensitization and Reprocessing may be applicable in various stages of treatment, alleviating the patient's distress in several psychological and physical domains.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
- Department of Psychiatry, Grossman School of Medicine, New York University, New York, New York, USA
| | - Yael Lahav
- Department of Occupational Therapy, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Andriessen K, Snir J, Krysinska K, Rickwood D, Pirkis J. Supporting Adolescents Bereaved by Suicide or Other Traumatic Death: The Views of Counselors. Omega (Westport) 2024:302228241246031. [PMID: 38581106 DOI: 10.1177/00302228241246031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Adolescents bereaved by suicide and other traumatic death may experience strong grief reactions and increased risks of mental health problems and suicidal behaviour. As timely access to professional help can be critical, it is essential to understand how counselors perceive suicide bereavement in adolescents and how they work with this population. This study aimed to examine the perspectives of counselors (N = 34). Eleven participated in an individual semi-structured interview and 23 others in group interviews. Thematic analysis yielded three themes: (1) Building a relationship with the bereaved adolescent, (2) Offering support tailored to the needs of the grieving adolescent, and (3) Offering strengths-based and sustainable support. Counselors' skills, attitudes, content-related expertise, and approaching the adolescent's grief within their developmental context were deemed essential for building a therapeutic relationship and offering viable support. The findings may inform good practices in counseling bereaved adolescents to facilitate positive mental health outcomes.
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Affiliation(s)
- Karl Andriessen
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Jessica Snir
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karolina Krysinska
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Debra Rickwood
- Faculty of Health, University of Canberra, Canberra, ACT, Australia
| | - Jane Pirkis
- Centre for Mental Health and Community Wellbeing, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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McNamara IN, Wellman SM, Li L, Eles JR, Savya S, Sohal HS, Angle MR, Kozai TDY. Electrode sharpness and insertion speed reduce tissue damage near high-density penetrating arrays. J Neural Eng 2024; 21:026030. [PMID: 38518365 DOI: 10.1088/1741-2552/ad36e1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/22/2024] [Indexed: 03/24/2024]
Abstract
Objective. Over the past decade, neural electrodes have played a crucial role in bridging biological tissues with electronic and robotic devices. This study focuses on evaluating the optimal tip profile and insertion speed for effectively implanting Paradromics' high-density fine microwire arrays (FμA) prototypes into the primary visual cortex (V1) of mice and rats, addressing the challenges associated with the 'bed-of-nails' effect and tissue dimpling.Approach. Tissue response was assessed by investigating the impact of electrodes on the blood-brain barrier (BBB) and cellular damage, with a specific emphasis on tailored insertion strategies to minimize tissue disruption during electrode implantation.Main results.Electro-sharpened arrays demonstrated a marked reduction in cellular damage within 50μm of the electrode tip compared to blunt and angled arrays. Histological analysis revealed that slow insertion speeds led to greater BBB compromise than fast and pneumatic methods. Successful single-unit recordings validated the efficacy of the optimized electro-sharpened arrays in capturing neural activity.Significance.These findings underscore the critical role of tailored insertion strategies in minimizing tissue damage during electrode implantation, highlighting the suitability of electro-sharpened arrays for long-term implant applications. This research contributes to a deeper understanding of the complexities associated with high-channel-count microelectrode array implantation, emphasizing the importance of meticulous assessment and optimization of key parameters for effective integration and minimal tissue disruption. By elucidating the interplay between insertion parameters and tissue response, our study lays a strong foundation for the development of advanced implantable devices with a reduction in reactive gliosis and improved performance in neural recording applications.
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Affiliation(s)
- Ingrid N McNamara
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Steven M Wellman
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Lehong Li
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - James R Eles
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Sajishnu Savya
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
| | | | | | - Takashi D Y Kozai
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center of the Basis of Neural Cognition, Pittsburgh, PA, United States of America
- McGowan Institute of Regenerative Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
- NeuroTech Center, University of Pittsburgh Brain Institute, Pittsburgh, PA, United States of America
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Arch JJ, Slivjak ET, Finkelstein LB. A Novel Intervention to Reduce Fear of Progression and Trauma Symptoms in Advanced Cancer Using Written Exposure to Worst-Case Scenarios. J Palliat Med 2024. [PMID: 38579139 DOI: 10.1089/jpm.2023.0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Background: Adults with advanced cancer experience profound future uncertainty, reflected in elevated fear of cancer progression (FoP) and cancer-related trauma symptoms. These symptoms are associated with physical symptom burden and poorer quality of life, and few interventions exist to manage them. Objective: To develop and pilot a written exposure-based coping intervention (EASE) focused on worst-case scenarios among adults with advanced cancer reporting elevated cancer-related trauma symptoms or FoP. Design: A single-arm intervention development and pilot trial. Participants: The trial enrolled 29 U.S. adults with stage III or stage IV solid tumor cancer (n = 24) or incurable or higher-risk blood cancer (n = 5) reporting elevated cancer-related trauma symptoms or FoP. Among those screened, 74% were eligible, with an eligible-to-enrolled rate of 85%. Design/Measurements: EASE was delivered over five 1:1 videoconferencing sessions. Feasibility and acceptability were evaluated via attendance, surveys, and exit interviews. Outcomes were assessed at five time points through 3-month (FU1, main assessment of interest) and 4.5-month (FU2) follow-up. Results: Participant and interventionist feedback was used to iteratively refine EASE. Among participants, 86% (25/29) completed all five sessions and FU1; surveys and exit interviews indicated high acceptability. Primary outcomes of cancer-related trauma symptoms and FoP improved significantly from pre to both follow-ups by predominantly large effect sizes. Secondary outcomes of anxiety, depression, hopelessness, fear of death/dying, and fatigue, and most process measures improved significantly by FU1 or FU2. Conclusions: EASE, a novel adaptation of written exposure therapy, is a promising approach to reducing FoP and cancer-related trauma symptoms among adults with advanced cancer that warrants further study.
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Affiliation(s)
- Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Elizabeth T Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Lauren B Finkelstein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
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Lampe A, Riedl D, Kampling H, Nolte T, Kirchhoff C, Grote V, Fischer MJ, Kruse J. Improvements of complex post- traumatic stress disorder symptoms during a multimodal psychodynamic inpatient rehabilitation treatment - results of an observational single-centre pilot study. Eur J Psychotraumatol 2024; 15:2333221. [PMID: 38577992 PMCID: PMC11000601 DOI: 10.1080/20008066.2024.2333221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 03/11/2024] [Indexed: 04/06/2024] Open
Abstract
Background: Complex post-traumatic stress disorder (CPTSD) describes chronic disturbances in self-organization (i.e. affect dysregulation; negative self-concept; severe difficulties in relationships) which are frequently observed in survivors of prolonged, repeated or multiple traumatic stressors. So far, evidence of psychodynamic treatment approaches for CPTSD is scarce.Methods: In this single-centre observational pilot study, symptom change during a 6-week psychodynamic inpatient treatment in a multimodal psychosomatic rehabilitation centre was evaluated using repeated measures analyses of variance (ANOVAs). Patients completed questionnaires on PTSD and CPTSD symptoms (ITQ), anxiety, depression and somatization (BSI-18), functional impairment (WHODAS) and epistemic trust, mistrust and credulity (ETMCQ) before (T1) and at the end of treatment (T2). A hierarchical linear regression analysis was calculated to identify factors associated with improved CPTSD symptoms.Results: A total of n = 50 patients with CPTSD were included in the study, of whom n = 40 (80%) completed treatment. Patients reported a significant reduction of CPTSD symptoms during treatment with a large effect size (-3.9 points; p < .001; η2 = .36), as well as a significant reduction of psychological distress (p < .001; η2 = .55) and functional impairment (p < .001; η2 = .59). At the end of treatment, 41.0% of patients no longer fulfilled the diagnostic criteria for CPTSD. Changes in epistemic stance included improved epistemic trust (β = -.34, p = .026) and decreased epistemic credulity (β = .37, p = .017), which together with lower age (β = .43, p = .012) and lower depression levels at baseline (β = .35, p = .054) were significantly associated with baseline adjusted mean change of CPTSD symptoms during therapy and explained 48% of its variance.Discussion: In our study, patients reported a significant reduction of CPTSD symptoms and comorbid symptoms during a multimodal psychodynamic inpatient rehabilitation treatment. Improved epistemic trust may facilitate the establishment of a trusting therapeutic relationship, thus fostering an environment of openness for knowledge transfer (i.e. social learning) and the exploration of diverse viewpoints and perspectives in the therapeutic process.
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Affiliation(s)
- A. Lampe
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Montafon, Schruns, Austria
| | - D. Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - H. Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - T. Nolte
- Anna Freud National Centre for Children and Families, London, UK
- Research Department for Clinical, Educational and Heath Psychology, UCL, London, UK
| | - C. Kirchhoff
- University Hospital of Psychiatry II, Department of Psychiatry, Psychotherapy Psychosomatics and Medical Psychology, Medical University of Innsbruck, Innsbruck, Austria
| | - V. Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
| | - M. J. Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Vienna, Austria
- VAMED Rehabilitation Center Kitzbuehel, Kitzbuehel, Austria
| | - J. Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
- Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany
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81
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Travis HJ, Andry GV, Rutner CC, Lacy E, Derouen KJ, Maristany M, Smith AA, Greiffenstein PP. Prehospital Needle Decompression of Suspected Tension Pneumothorax: Outcomes and Consequences. Am Surg 2024:31348241241739. [PMID: 38578102 DOI: 10.1177/00031348241241739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Tension pneumothorax (TPT) identified in the prehospital setting requires prehospital needle decompression (PHND). This study aimed to evaluate complications from PHND when it was performed without meeting clinical criteria. A retrospective review was performed of patients undergoing (PHND) from 2016 through 2022 at a level 1 trauma center. Patient data who received PHND were reviewed. Of 115 patients, 85 did not meet at least one clinical criterion for PHND. The majority of patients in this cohort 76 (89%) required a chest tube and 22 (25%) had an iatrogenic pneumothorax from PHND. 5 patients (6%) were admitted due to iatrogenic PHND. Two vascular injuries in this population were directly due to PHND and required emergency operative repair. This study shows the negative consequences of PHND when performed without clear indications. Several patients underwent unnecessary procedures with significant clinical consequences.
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Affiliation(s)
- Harrison J Travis
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Gilbert V Andry
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Colin C Rutner
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Elizabeth Lacy
- Division of Trauma/Critical Care Surgery Department, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Kaleb J Derouen
- School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Michael Maristany
- Department of Radiology, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Alison A Smith
- Division of Trauma/Critical Care Surgery Department, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Patrick P Greiffenstein
- Division of Trauma/Critical Care Surgery Department, Louisiana State University Health Sciences Center, New Orleans, LA, USA
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82
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Vicars M, Milenkovic J. Interrogating global narratives of trans queerness. Well-being and agency? Or more stories of trans trauma? Front Sociol 2024; 9:1343117. [PMID: 38645897 PMCID: PMC11027737 DOI: 10.3389/fsoc.2024.1343117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/12/2024] [Indexed: 04/23/2024]
Abstract
In the international contemporary discourse transgender individuals arguably have an increased presence within public media highlighting the visible diversity that constitutes the LGBTQI2S+ community. However, in response to the challenging of cisgendered normative assumptions there has been an unprecedented swathe of anti-trans measures executed through the frenzied repealing of rights and freedoms within the key arenas of legal, medical, sporting, and educative domains. This paper explores the intersections of pathologizing rhetoric that emplotted anti-trans and transphobic discourses within and across public consciousness. The quotidian presence of these discourses provoked in us a wondering about how evolving conceptual debate is constructing a trans inclusive global imaginary. In this paper we situate trans safety not as a singular concept, but rather a differentially experienced phenomenon that is related to and embedded in questions of bio power and privilege. As such, when we refer to a trans safety imaginary, we are not solely addressing protection from physical violence but also safeguarding against psychological and emotional vulnerability.
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Affiliation(s)
- Mark Vicars
- Institute for Sustainable Industries and Liveable Cities, Victoria University, Melbourne, VIC, Australia
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83
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Eghzawi A, Alsabbah A, Gharaibeh S, Alwan I, Gharaibeh A, Goyal AV. Mortality Predictors for Adult Patients with Mild-to-Moderate Traumatic Brain Injury: A Literature Review. Neurol Int 2024; 16:406-418. [PMID: 38668127 PMCID: PMC11053597 DOI: 10.3390/neurolint16020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/30/2024] [Accepted: 04/03/2024] [Indexed: 04/29/2024] Open
Abstract
Traumatic brain injuries (TBIs) represent a significant public health concern, with mild-to-moderate cases comprising a substantial portion of incidents. Understanding the predictors of mortality among adult patients with mild-to-moderate TBIs is crucial for optimizing clinical management and improving outcomes. This literature review examines the existing research to identify and analyze the mortality predictors in this patient population. Through a comprehensive review of peer-reviewed articles and clinical studies, key prognostic factors, such as age, Glasgow Coma Scale (GCS) score, the presence of intracranial hemorrhage, pupillary reactivity, and coexisting medical conditions, are explored. Additionally, this review investigates the role of advanced imaging modalities, biomarkers, and scoring systems in predicting mortality following a mild-to-moderate TBI. By synthesizing the findings from diverse studies, this review aims to provide clinicians and researchers with valuable insights into the factors influencing mortality outcomes in adult patients with a mild-to-moderate TBI, thus facilitating more informed decision making and targeted interventions in clinical practice.
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Affiliation(s)
- Ansam Eghzawi
- Insight Research Institute, Flint, MI 48507, USA; (A.E.); (A.A.); (S.G.); (I.A.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
- Department of Research, Insight Hospital and Medical Center, Chicago, IL 60616 USA
| | - Alameen Alsabbah
- Insight Research Institute, Flint, MI 48507, USA; (A.E.); (A.A.); (S.G.); (I.A.)
| | - Shatha Gharaibeh
- Insight Research Institute, Flint, MI 48507, USA; (A.E.); (A.A.); (S.G.); (I.A.)
- Center for Cognition and Neuroethics, University of Michigan-Flint, Flint, MI 48502, USA
| | - Iktimal Alwan
- Insight Research Institute, Flint, MI 48507, USA; (A.E.); (A.A.); (S.G.); (I.A.)
- Department of Research, Insight Hospital and Medical Center, Chicago, IL 60616 USA
| | - Abeer Gharaibeh
- Insight Research Institute, Flint, MI 48507, USA; (A.E.); (A.A.); (S.G.); (I.A.)
- Department of Research, Insight Hospital and Medical Center, Chicago, IL 60616 USA
| | - Anita V. Goyal
- Department of Emergency Medicine, Insight Hospital and Medical Center, Chicago, IL 60616, USA
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84
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Misaghian K, Lugo JE, Faubert J. Immediate fall prevention: the missing key to a comprehensive solution for falling hazard in older adults. Front Aging Neurosci 2024; 16:1348712. [PMID: 38638191 PMCID: PMC11024377 DOI: 10.3389/fnagi.2024.1348712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 03/18/2024] [Indexed: 04/20/2024] Open
Abstract
The world is witnessing an unprecedented demographic shift due to increased life expectancy and declining birth rates. By 2050, 20% of the global population will be over 60, presenting significant challenges like a shortage of caregivers, maintaining health and independence, and funding extended retirement. The technology that caters to the needs of older adults and their caregivers is the most promising candidate to tackle these issues. Although multiple companies and startups offer various aging solutions, preventive technology, which could prevent trauma, is not a big part of it. Trauma is the leading cause of morbidity, disability, and mortality in older adults, and statistics constitute traumatic fall accidents as its leading cause. Therefore, an immediate preventive technology that anticipates an accident on time and prevents it must be the first response to this hazard category to decrease the gap between life expectancy and the health/wellness expectancy of older adults. The article outlines the challenges of the upcoming aging crisis and introduces falls as one major challenge. After that, falls and their mechanisms are investigated, highlighting the cognitive functions and their relation to falls. Moreover, since understanding predictive cognitive mechanisms is critical to an effective prediction-interception design, they are discussed in more detail, signifying the role of cognitive decline in balance maintenance. Furthermore, the landscape of available solutions for falling and its shortcomings is inspected. Finally, immediate fall prevention, the missing part of a wholesome solution, and its barriers are introduced, and some promising methodologies are proposed.
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Affiliation(s)
- Khashayar Misaghian
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- OIST Innovation, Okinawa Institute of Science and Technology Graduate University, Onna, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
| | - Jesus Eduardo Lugo
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
- Facultad de Ciencias Físico Matemáticas, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Jocelyn Faubert
- Sage-Sentinel Smart Solutions, Kunigami-gun, Okinawa, Japan
- Faubert Lab, School of Optometry, Université de Montréal, Montreal, QC, Canada
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85
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Wang M, Falank C, Simboli V, Ontengco JB, Spurling B, Rappold J, Chung B, Smith KE. "Should We Phenobarb-it-All?" A Phenobarbital-Based Protocol for Non-Intensive Care Unit Trauma Patients at High Risk of or Experiencing Alcohol Withdrawal. Am Surg 2024:31348241244639. [PMID: 38574377 DOI: 10.1177/00031348241244639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Alcohol use is frequent in trauma patients and alcohol withdrawal syndrome (AWS) is associated with significant morbidity. Benzodiazepines are commonly used for AWS, but may cause neurologic and respiratory adverse events (AEs). The objective was to evaluate the effectiveness and safety of a phenobarbital-based protocol for the treatment of AWS in non-intensive care unit (ICU) trauma patients. METHODS Adult non-ICU trauma patients at high risk of or experiencing AWS PRE and POST implementation of a phenobarbital-based protocol were included. Outcomes were AWS-related complications (AWS-RC), benzodiazepine use, adjunctive medication use, hospital length of stay (HLOS), and medication-related AEs. Subgroup analyses were performed on patients with traumatic brain injury (TBI), rib fractures, and at high risk of severe AWS. RESULTS Overall, 110 patients were included (51 PRE, 59 POST). AWS-RC developed in 17 PRE patients compared to 10 POST patients (33% vs 17%; P = .05). PRE patients were more likely to receive benzodiazepines (88% vs 42%, P < .0001) and higher total dose (11 vs 4 mg lorazepam equivalent; P = .001). No difference noted in HLOS (8 vs 8 days, P = .27), adjunctive medication use (49% vs 54%, P = .60), or AEs (57% vs 39%, P = .06). There was no difference in AWS-RC in the TBI subgroup (P = .19), less AEs in the rib fracture POST subgroup (P = .04), and less AWS-RC in the high risk of severe AWS POST subgroup (P = .03). DISCUSSION A phenobarbital-based protocol in trauma patients is effective in preventing AWS-RC and decreasing benzodiazepine use without increasing AEs.
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Affiliation(s)
- Michelle Wang
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Carolyne Falank
- Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Vincent Simboli
- Department of Pharmacy, Maine Medical Center, Portland, ME, USA
| | | | - Brandi Spurling
- Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Joseph Rappold
- Department of Surgery, Maine Medical Center, Portland, ME, USA
| | - Bruce Chung
- Department of Surgery, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
| | - Kathryn E Smith
- Department of Pharmacy, Maine Medical Center, Portland, ME, USA
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86
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McCullagh J, Basham P, Davies J, Hicks V, Hunter A, Lancut J, Green L. The feasibility of introducing a whole blood component for traumatic haemorrhage in the UK. Transfus Med 2024. [PMID: 38576265 DOI: 10.1111/tme.13039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 02/24/2024] [Accepted: 03/19/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND The interest in re-introducing whole blood (WB) transfusion for the management of traumatic major haemorrhage is increasing. However, due to the current leucodepletion filters used in the UK a WB component was not readily available. Instead, an alternative but similar component, leucocyte depleted red cell and plasma (LD-RCP), which provided a unique experience in assessing the feasibility of a WB component was used whilst a WB component was being manufactured. STUDY DESIGN AND METHODS Between November 2018 and October 2020, LD-RCP replaced RBC as standard of care for all trauma patients with major haemorrhage in London. The aims of the study were to assess (a) deliverability, (b) component wastage and (c) safety. RESULTS Over the study period a total of 1208 LD-RCP units were delivered, of which 96.5% were delivered 'On Time In Full' (OTIF). Of the 1208 units, 733 (60.68%) were transfused and 475 (39.3%) units were wasted. Component wastage reduced significantly throughout the study (p = 0.001). A total of 177 patients had a blood group recorded, 86 were group O and 91 were non-group O. There was no statistically significantly difference between haemoglobin (p = 0.422), or bilirubin levels (p = 0.084) between group O and non-group O patients. DISCUSSION It was feasible for NHS Blood and Transplant to deliver LD-RCP on time in full, however component wastage was high due to short shelf life and limited use of the component. Low titre group O LD-RCP units were not associated with clinical evidence of haemolysis.
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Affiliation(s)
- Josephine McCullagh
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Red Cell Immunoheamatology, NHS Blood and Transplant (NHSBT), London, UK
| | - Peter Basham
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Jane Davies
- Manufacturing, NHS Blood and Transplant, London, UK
| | - Vicky Hicks
- Manufacturing, NHS Blood and Transplant, London, UK
| | | | - Julia Lancut
- Blood Transfusion, East and Southeast London Pathology Partnership, London, UK
| | - Laura Green
- Clinical Haematology, Barts Health NHS Trust, London, UK
- Blizard Institute, Queen Mary University of London, London, UK
- Blood Transfusion and Components, NHS Blood and Transplant, London, UK
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87
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Jackson ML, Thomas SC, Joyner MR, Hu M, Larry Lee YL, Capasso T, Polite NM, Kinnard CM, Mbaka MI, Williams A, Simmons JD, Butts CC. Time to Mobility Is Associated With Pulmonary Complications in Patients With Spine Fractures. Am Surg 2024:31348241241702. [PMID: 38566605 DOI: 10.1177/00031348241241702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Treatment of spine fractures may require periods of prolonged immobilization which prevents effective pulmonary toileting. We hypothesized that patients with longer time to mobilization, as measured by time to first physical therapy (PT) session, would have higher pulmonary complications. METHODS We performed a retrospective review of all trauma patients with cervical and thoracolumbar spinal fractures admitted to a level 1 trauma center over a 12-month period. Demographic data collection included age, gender, BMI, pulmonary comorbidities, concomitant rib fractures, admission GCS, Injury Severity Score (ISS), GCS at 24 h, treatment with cervical or thoracolumbar immobilization, and time to first PT evaluation. The primary outcome was the presence of any one of the following complications: unplanned intubation, pneumonia, or mortality at 30 days. Multivariable logistic regression analysis was used to assess significant predictors of pulmonary complication. RESULTS In total, 491 patients were identified. In terms of overall pulmonary complications, 10% developed pneumonia, 13% had unplanned intubation, and 6% died within 30 days. In total, 19% developed one or more complication. Overall, 25% of patients were seen by PT <48 h, 33% between 48 and 96 h, 19% at 96 h to 1 week, and 7% > 1 week. Multivariable logistic regression analysis showed that time to PT session (OR 1.010, 95% CI 1.005-1.016) and ISS (OR 1.063, 95% CI 1.026-1.102) were independently associated with pulmonary complication. CONCLUSION Time to mobility is independently associated with pulmonary complications in patients with spine fractures.
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Affiliation(s)
- Michael L Jackson
- General Surgery Residency Program, University of South Alabama, Mobile, AL, USA
| | - Samuel C Thomas
- General Surgery Residency Program, Brookwood Baptist Health, Birmingham, AL, USA
| | - Matthew R Joyner
- General Surgery Residency Program, University of Tennessee Knoxville, Knoxville, TN, USA
| | - Mengjie Hu
- Anesthesiology Residency Program, Wake Forest University, Winston-Salem, NC, USA
| | | | - Thomas Capasso
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Nathan M Polite
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | | | - Maryann I Mbaka
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Ashley Williams
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Jon D Simmons
- Department of Surgery, University of South Alabama, Mobile, AL, USA
| | - Charles C Butts
- Department of Surgery, University of South Alabama, Mobile, AL, USA
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88
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Epperson RT, Isaacson BM, Rothberg DL, Olsen RE, Kawaguchi B, Rasmussen RM, Dickerson M, Pasquina PF, Shero J, Williams DL. Determining Which Combinatorial Combat-Relevant Factors Contribute to Heterotopic Ossification Formation in an Ovine Model. Bioengineering (Basel) 2024; 11:350. [PMID: 38671772 PMCID: PMC11048030 DOI: 10.3390/bioengineering11040350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/20/2024] [Accepted: 03/28/2024] [Indexed: 04/28/2024] Open
Abstract
Traumatic heterotopic ossification (HO) is frequently observed in Service Members following combat-related trauma. Estimates suggest that ~65% of wounded warriors who suffer limb loss or major extremity trauma will experience some type of HO formation. The development of HO delays rehabilitation and can prevent the use of a prosthetic. To date there are limited data to suggest a standard mechanism for preventing HO. This may be due to inadequate animal models not producing a similar bone structure as human HO. We recently showed that traumatic HO growth is possible in an ovine model. Within that study, we demonstrated that 65% of sheep developed a human-relevant hybrid traumatic HO bone structure after being exposed to a combination of seven combat-relevant factors. Although HO formed, we did not determine which traumatic factor contributed most. Therefore, in this study, we performed individual and various combinations of surgical/traumatic factors to determine their individual contribution to HO growth. Outcomes showed that the presence of mature biofilm stimulated a large region of bone growth, while bone trauma resulted in a localized bone response as indicated by jagged bone at the linea aspera. However, it was not until the combinatory factors were included that an HO structure similar to that of humans formed more readily in 60% of the sheep. In conclusion, data suggested that traumatic HO growth can develop following various traumatic factors, but a combination of known instigators yields higher frequency size and consistency of ectopic bone.
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Affiliation(s)
- Richard T. Epperson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
| | - Brad M. Isaacson
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- The Geneva Foundation, Tacoma, WA 98402, USA
| | - David L. Rothberg
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
| | - Raymond E. Olsen
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
| | - Brooke Kawaguchi
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
| | - Ryan M. Rasmussen
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
| | - Mary Dickerson
- Office of Comparative Medicine, University of Utah, Salt Lake City, UT 84112, USA;
| | - Paul F. Pasquina
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20910, USA
| | - John Shero
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- Extremity Trauma Center of Excellence, Joint Base San Antonio Fort Sam Houston, San Antonio, TX 78240, USA
| | - Dustin L. Williams
- Department of Orthopaedics, University of Utah, Salt Lake City, UT 84108, USA; (B.M.I.); (D.L.R.); (R.E.O.); (B.K.); (R.M.R.); (D.L.W.)
- Bone & Biofilm Research Laboratory, University of Utah, Salt Lake City, UT 84112, USA
- The Center for Rehabilitation Sciences Research, Uniformed Services University, Bethesda, MD 20814, USA; (P.F.P.); (J.S.)
- Department of Pathology, University of Utah, Salt Lake City, UT 84112, USA
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT 84112, USA
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McAlexander HW, Grimes JA, Ullman SL, Lai GPC, Davis M, Darrow BG, Dickerson VM. Diagnostic and surgical treatment for traumatic bile peritonitis in dogs and cats. J Am Vet Med Assoc 2024:1-6. [PMID: 38569535 DOI: 10.2460/javma.24.01.0049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/21/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE To describe short-term outcomes of dogs and cats undergoing surgery for traumatic bile peritonitis. ANIMALS 13 dogs and 4 cats. METHODS Multi-institutional, retrospective study. Medical records from 6 institutions were reviewed for cases of traumatic bile peritonitis between 2006 and 2022. Clinical presentation, additional injuries, surgical treatment, and outcome were recorded. RESULTS Trauma occurred a median of 2 (range, 1 to 22) and 4 (range, 1 to 22) days prior to presentation in dogs and cats, respectively. Total bilirubin was increased in 11 of 13 dogs and 2 of 4 cats. Rupture occurred at the common bile duct (CBD) in 10 dogs and 1 cat, gallbladder in 3 dogs, cystic duct in 2 cats, and hepatic duct in 1 dog and 1 cat. The most common surgeries were cholecystoduodenostomy and CBD repair in dogs and cholecystectomy in cats. Eleven of 13 dogs and all cats survived to hospital discharge (88.2% overall survival). Median follow-up in surviving dogs and cats was 35 days (range, 14 to 401) and 30 days (range, 14 to 90), respectively. One dog that underwent cholecystectomy experienced recurrent bile peritonitis 20 days postoperatively. Short-term survival following surgical treatment of traumatic bile peritonitis was excellent and recurrence appears uncommon. The most frequent site of rupture was the CBD in dogs and the cystic duct in cats. CLINICAL RELEVANCE Measurement of peritoneal bilirubin should be considered in dogs and cats with peritoneal effusion following trauma. Surgeons should be prepared to identify and address ruptures in locations other than the gallbladder.
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Affiliation(s)
- Heath W McAlexander
- 1Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
| | - Janet A Grimes
- 2Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA
| | | | - Grace Pei-Chun Lai
- 4Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Hong Kong
| | | | | | - Vanna M Dickerson
- 1Department of Small Animal Clinical Sciences, School of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX
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90
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Fabien J, Burgess C, Taylor D, Hill R, Antoine A, Woolery S, Agyekum-Yamoah A, Meyer C, Dougherty S, Nguyen J, Smith R, Sciarretta J, Todd SR, Castater C. Rarely Seen Compartment Syndrome of the Shoulder and Back: Diagnosis and Management. Am Surg 2024:31348241241741. [PMID: 38567401 DOI: 10.1177/00031348241241741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Compartment syndrome (CS) is a well-known surgical emergency with high morbidity including potential long-term disability and limb loss. The most important factor determining the degree of morbidity with CS is time to treatment; therefore, early diagnosis and surgery are vital. We present a patient who fell off his bicycle and sustained cervical spine fractures causing near complete quadriplegia. He was found by the road over 12 hours later, so his creatine phosphokinase (CPK) was trended and serial examinations were performed. We identified tight deltoid, trapezius, and latissimus compartments and brought him to the operating room for fasciotomies. Although lab values and compartment pressures can be helpful, they should not guide treatment. It is important to consider atypical sites for CS and complete a head to toe physical examination. Patients should proceed to the operating room if clinical suspicion exists for CS because of the morbidity associated with a missed diagnosis.
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Affiliation(s)
- Jamesa Fabien
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Ciara Burgess
- Philadelphia College of Osteopathic Medicine Georgia, Suwanee, GA, USA
| | - Douglas Taylor
- Philadelphia College of Osteopathic Medicine Georgia, Suwanee, GA, USA
| | - Raven Hill
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Andreya Antoine
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Samantha Woolery
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | | | - Courtney Meyer
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
| | - Stacy Dougherty
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Jonathan Nguyen
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Randi Smith
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Jason Sciarretta
- Emory University School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
| | - S Rob Todd
- Grady Memorial Hospital, Atlanta, GA, USA
| | - Christine Castater
- Morehouse School of Medicine, Grady Memorial Hospital, Atlanta, GA, USA
- Grady Memorial Hospital, Atlanta, GA, USA
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91
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Dawood R, Vosper J, Irons C, Gibson S, Brown G. Exploring the roles of compassion and post- traumatic stress disorder on global distress after sexual trauma. Br J Clin Psychol 2024. [PMID: 38563456 DOI: 10.1111/bjc.12465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/02/2024] [Accepted: 03/18/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVES Recovery from sexual trauma can be complex and multi-faceted. Most current psychological treatment protocols for trauma use a cognitive model of post-traumatic stress disorder (PTSD). However, sexual trauma may include specific complexities beyond that of a cognitive model of PTSD, such as relational factors. The distress experienced after sexual abuse may involve variables not exclusive to a PTSD model. Compassion focused therapy (CFT) is an approach that incorporates evolutionary, relational and social perspectives. This study explored the relationships between variables associated with CFT, PTSD and distress in survivors of sexual abuse to determine the role of CFT-related variables. METHODS 155 adults who had experienced sexual abuse or any unwanted sexual experience at any point in their lives completed online questionnaires pertaining to various CFT variables (self-compassion, receiving compassion from others, having a fear of compassion from others, having a fear of compassion from the self, shame and self-criticism) and questionnaires measuring global distress as the outcome of sexual abuse and PTSD symptoms. RESULTS An exploratory model involving CFT-related variables explained significantly more of the variance (4.4%) in global distress than PTSD symptomology alone. Self-criticism was found to be the variable with significant contribution. CONCLUSIONS That CFT treatments, targeting self-criticism, should be developed alongside the standard cognitive model of PTSD based treatments for survivors of sexual abuse was supported. Future research may explore experimental designs utilizing CFT in this population, as well as further investigations on the roles of these specific CFT variables.
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Affiliation(s)
- Runa Dawood
- Department of Clinical Psychology, Life and Environmental Sciences, Royal Holloway University of London, Egham, UK
| | - Jane Vosper
- Department of Clinical Psychology, Life and Environmental Sciences, Royal Holloway University of London, Egham, UK
- Infection and Immunity Psychology Service, Barts Health NHS Trust, London, UK
| | | | - Stuart Gibson
- Infection and Immunity Psychology Service, Barts Health NHS Trust, London, UK
| | - Gary Brown
- Department of Clinical Psychology, Life and Environmental Sciences, Royal Holloway University of London, Egham, UK
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92
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Hernandez J, Quintero LA, Shatawi Z, Ngo L, Romero D, Heath R, Redden A, Levene T, Lao O, Parreco JP. Venous Thromboembolism in Children and Teenagers Admitted for Trauma: A 5-Year Nationwide Perspective. Am Surg 2024:31348241241687. [PMID: 38565168 DOI: 10.1177/00031348241241687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Venous thromboembolism (VTE) in pediatric trauma patients is under-investigated. The purpose of this study was to perform an evaluation of the risk factors for VTE after pediatric trauma, including readmissions across the United States. The Nationwide Readmissions Database for 2016-2020 was queried for all patients under the age of 18 years admitted for trauma. 276 670 patients were identified; 2063 (.8%) were diagnosed with VTE. Among those with VTE, 300 (15%) were identified during a readmission. Higher rates of VTE were seen in ages 15-17 years (n = 1,294, 1.3%, P < .001), penetrating injuries (n = 478, .9%, P < .001), and assault (n = 271, 2.7%, P < .001). The strongest risk factor for VTE was prolonged mechanical ventilation (OR 5.5 [4.9-6.3] P < .001). Our study found that a significant portion of post-traumatic VTE in children and teenagers occur during readmissions. A deeper understanding of the risk factors outlined here can guide enhanced clinical protocols, ensuring early detection and prevention of this complication.
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Affiliation(s)
- Jennifer Hernandez
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Luis A Quintero
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Zaineb Shatawi
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Lisa Ngo
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Dino Romero
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Rainya Heath
- General Surgery Residency, Memorial Healthcare System, Hollywood, FL, USA
| | - Anna Redden
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Tamar Levene
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Oliver Lao
- Pediatric Surgery, Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | - Joshua P Parreco
- Trauma Critical Care Surgery, Memorial Healthcare System, Hollywood, FL, USA
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93
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Yan A, Torpey A, Morrisroe E, Andraous W, Costa A, Bergese S. Clinical Management in Traumatic Brain Injury. Biomedicines 2024; 12:781. [PMID: 38672137 PMCID: PMC11048642 DOI: 10.3390/biomedicines12040781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/28/2024] Open
Abstract
Traumatic brain injury is one of the leading causes of morbidity and mortality worldwide and is one of the major public healthcare burdens in the US, with millions of patients suffering from the traumatic brain injury itself (approximately 1.6 million/year) or its repercussions (2-6 million patients with disabilities). The severity of traumatic brain injury can range from mild transient neurological dysfunction or impairment to severe profound disability that leaves patients completely non-functional. Indications for treatment differ based on the injury's severity, but one of the goals of early treatment is to prevent secondary brain injury. Hemodynamic stability, monitoring and treatment of intracranial pressure, maintenance of cerebral perfusion pressure, support of adequate oxygenation and ventilation, administration of hyperosmolar agents and/or sedatives, nutritional support, and seizure prophylaxis are the mainstays of medical treatment for severe traumatic brain injury. Surgical management options include decompressive craniectomy or cerebrospinal fluid drainage via the insertion of an external ventricular drain. Several emerging treatment modalities are being investigated, such as anti-excitotoxic agents, anti-ischemic and cerebral dysregulation agents, S100B protein, erythropoietin, endogenous neuroprotectors, anti-inflammatory agents, and stem cell and neuronal restoration agents, among others.
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Affiliation(s)
- Amy Yan
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Andrew Torpey
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Erin Morrisroe
- Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA;
| | - Wesam Andraous
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Ana Costa
- Department of Anesthesiology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA; (A.Y.); (A.T.); (W.A.); (A.C.)
| | - Sergio Bergese
- Department of Anesthesiology and Neurological Surgery, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
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94
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Sumner JA, Kim ESH, Wood MJ, Chi G, Nolen J, Grodzinsky A, Gornik HL, Kadian-Dodov D, Wells BJ, Hess CN, Lewey J, Tam L, Henkin S, Orford J, Wells G, Kumbhani DJ, Lindley KJ, Gibson CM, Leon KK, Naderi S. Post traumatic Stress Disorder After Spontaneous Coronary Artery Dissection: A Report of the International Spontaneous Coronary Artery Dissection Registry. J Am Heart Assoc 2024; 13:e032819. [PMID: 38533943 DOI: 10.1161/jaha.123.032819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Accepted: 02/06/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Myocardial infarction secondary to spontaneous coronary artery dissection (SCAD) can be traumatic and potentially trigger posttraumatic stress disorder (PTSD). In a large, multicenter, registry-based cohort, we documented prevalence of lifetime and past-month SCAD-induced PTSD, as well as related treatment seeking, and examined a range of health-relevant correlates of SCAD-induced PTSD. METHODS AND RESULTS Patients with SCAD were enrolled in the iSCAD (International SCAD) Registry. At baseline, site investigators completed medical report forms, and patients reported demographics, medical/SCAD history, psychosocial factors (including SCAD-induced PTSD symptoms), health behaviors, and health status via online questionnaires. Of 1156 registry patients, 859 patients (93.9% women; mean age, 52.3 years) completed questionnaires querying SCAD-induced PTSD. Nearly 35% (n=298) of patients met diagnostic criteria for probable SCAD-induced PTSD in their lifetime, and 6.4% (n=55) met criteria for probable past-month PTSD. Of 811 patients ever reporting any SCAD-induced PTSD symptoms, 34.8% indicated seeking treatment for this distress. However, 46.0% of the 298 patients with lifetime probable SCAD-induced PTSD diagnoses reported never receiving trauma-related treatment. Younger age at first SCAD, fewer years since SCAD, being single, unemployed status, more lifetime trauma, and history of anxiety were associated with greater past-month PTSD symptom severity in multivariable regression models. Greater past-month SCAD-induced PTSD symptoms were associated with greater past-week sleep disturbance and worse past-month disease-specific health status when adjusting for various risk factors. CONCLUSIONS Given the high prevalence of SCAD-induced PTSD symptoms, efforts to support screening for these symptoms and connecting patients experiencing distress with empirically supported treatments are critical next steps. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT04496687.
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Affiliation(s)
- Jennifer A Sumner
- Department of Psychology University of California, Los Angeles Los Angeles CA USA
| | - Esther S H Kim
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - Malissa J Wood
- Division of Cardiology Massachusetts General Hospital and Harvard Medical School Boston MA USA
| | - Gerald Chi
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Anna Grodzinsky
- Saint Luke's Mid America Heart Institute, Muriel I. Kauffman Women's Heart Center University of Missouri-Kansas City Kansas City MO USA
| | - Heather L Gornik
- Harrington Heart & Vascular Institute, University Hospitals, Division of Cardiovascular Medicine Case Western Reserve University Cleveland OH USA
| | - Daniella Kadian-Dodov
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health Icahn School of Medicine at Mount Sinai New York NY USA
| | - Bryan J Wells
- Division of Cardiology, Department of Medicine Emory University School of Medicine Atlanta GA USA
| | - Connie N Hess
- Division of Cardiology, Department of Medicine University of Colorado School of Medicine Aurora CO USA
| | - Jennifer Lewey
- Division of Cardiovascular Medicine University of Pennsylvania Perelman School of Medicine Philadelphia PA USA
| | - Lori Tam
- Providence Heart Institute Portland OR USA
| | - Stanislav Henkin
- Heart and Vascular Center Dartmouth-Hitchcock Medical Center Lebanon NH USA
| | - James Orford
- Intermountain Heart Institute, Intermountain Medical Center Murray UT USA
| | - Gretchen Wells
- Division of Cardiovascular Medicine, Department of Medicine University of Kentucky Lexington KY USA
| | - Dharam J Kumbhani
- Division of Cardiology, Department of Internal Medicine UT Southwestern Medical Center Dallas TX USA
| | - Kathryn J Lindley
- Division of Cardiovascular Medicine, Department of Medicine Vanderbilt University Medical Center Nashville TN USA
| | - C Michael Gibson
- PERFUSE Study Group, Cardiovascular Division, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School Boston MA USA
| | | | - Sahar Naderi
- Division of Cardiology Kaiser Permanente San Francisco CA USA
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95
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Jensen S, Gallagher R, Sing R, Torres Fajardo R. Causes and Timing of Unplanned ICU Admissions Among Trauma Patients at a Level 1 Trauma Center. Am Surg 2024:31348241241659. [PMID: 38563045 DOI: 10.1177/00031348241241659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
BACKGROUND Unexpected ICU admissions are a key quality metric in trauma care. The purpose of this study is to identify the most common causes of unplanned ICU admissions among trauma patients at an ACS-verified level 1 trauma center. METHODS A retrospective review was conducted of all trauma patients with unplanned admission to the ICU at a level 1 trauma center between 2019 and 2021. Unplanned ICU admissions were categorized into (1) "bounce-backs," patients previously admitted to the ICU and (2) "upgrades," patients who had not previously been cared for in the ICU. RESULTS Of 300 unexpected ICU transfers, bounce-backs accounted for 69% and upgrades 31%. The most common injuries were traumatic brain injuries (40%) and rib fractures (41.3%). In-hospital mortality rate was 10% and did not significantly differ between bounce-backs and upgrades (12 vs 5%, P = .92). Respiratory distress was the most common cause of transfer (41.1%), followed by neurologic (29.6%) and cardiovascular decline (21.2%). Patients were on average 928 mL fluid positive 72 hours prior to transfer (t > 0, P < .0001), and 295 mL fluid positive in the 24 hours prior to transfer (t > 0, P .0003). Patients transferred for respiratory distress were no more fluid over-balanced than those transferred for other reasons. CONCLUSION We found a large percent of unplanned transfers occurring within 48 hours of admission or transfer out of the ICU suggesting under-triage as a leading cause of bounce-backs and upgrades. Respiratory distress was the leading cause of transfer. These findings highlight opportunities for targeted interventions.
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Affiliation(s)
- Stephanie Jensen
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - Robert Gallagher
- School of Medicine, Des Moines University Medical School, West Des Moines, IA, USA
| | - Ronald Sing
- Department of Surgery, Carolinas Medical Center, Charlotte, NC, USA
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96
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Hodges ZH, Bright M, Carpenter AM, Neal DW, Vanzant EL, Johnson-Mann CN, Taylor JE. Obesity and Associated Outcomes for Blunt vs Penetrating Mechanism in Trauma Laparotomy Patients. Am Surg 2024:31348241241725. [PMID: 38565208 DOI: 10.1177/00031348241241725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Obesity in trauma patients is an established risk factor contributing to postoperative complications, but the relationship between body mass index (BMI) and trauma patient outcomes is not well-defined, especially when stratified by mechanism of injury. We surveyed the trauma laparotomy registry at an academic level 1 trauma center over a 3-year period to identify mortality, injury severity score, and hospital length of stay (hLOS) outcome measures across BMI classes, with further stratification by mechanism of injury: blunt vs penetrating trauma. A total of 442 patients were included with mean age 44.6 (SD = 18.7) and mean BMI 28.55 (SD = 7.37). These were subdivided into blunt trauma (n = 313) and penetrating trauma (n = 129). Within the blunt trauma subgroup, the hLOS among patients who survived hospitalization significantly increased 9% for each successive BMI class (P = .022, 95% CI = 1.29-17.5). We conclude that successive increase in BMI class is associated with longer hospital stay for blunt trauma patient survivors requiring laparotomy, though additional analysis is needed to establish this relationship to other outcome measures and among penetrating trauma patients.
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Affiliation(s)
- Zachary H Hodges
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Michael Bright
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Anne-Marie Carpenter
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Daniel W Neal
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | - Erin L Vanzant
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
| | | | - Jessica E Taylor
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, USA
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97
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Prihadi JC, Hengky A, Lionardi SK. Conservative management in high-grade renal trauma: a systematic review and meta-analysis. BJU Int 2024. [PMID: 38566265 DOI: 10.1111/bju.16343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
OBJECTIVE To systematically investigate and analyse the aggregated data from recent studies to provide a quantitative synthesis for a conservative approach to the management of high-grade kidney trauma, as accumulating evidence supports the favourable outcomes of a conservative approach. METHODS A comprehensive search was performed using databases, including PubMed, EBSCO, ProQuest, Google Scholar, and Cochrane Library, to identify studies relevant to high-grade renal trauma in both adult and paediatric populations. The compare review focused on comparing conservative management interventions, such as observation, rest, resuscitation, transfusion, symptomatic management, and angioembolisation, with operative management interventions. Search strategies incorporated specific medical subject headings and keywords related to conservative management, kidney trauma, mortality, and renal preservation. Random and fixed-effect meta-analyses were conducted to estimate the rates of nephrectomy and mortality, respectively. RESULTS A total of 36 and 29 studies were included for qualitative and quantitative synthesis, respectively. The aggregated data showed a cumulative risk difference of 0.52 (95% confidence interval [CI] 0.38-0.66, P < 0.001), indicating a higher likelihood of nephrectomy in cases where operative management was used instead of conservative management. In terms of mortality, conservative management demonstrated a lower risk difference of 0.09 (95% CI 0.05-0.13, P < 0.001). CONCLUSION The results indicate that opting for conservative management in cases of high-grade renal trauma, particularly for haemodynamically stable patients, presents a lower risk of mortality and reduced probability of requiring nephrectomy when compared to operative management. These findings provide strong evidence in favour of considering conservative management as a viable and effective treatment option for high-grade renal trauma.
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Affiliation(s)
- Johannes Cansius Prihadi
- Division of Urology, Department of Surgery, Atma Jaya Catholic University of Indonesia/Atma Jaya Hospital, Jakarta, Indonesia
| | - Antoninus Hengky
- Center of Health Research, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Fatima Hospital, Ketapang Regency, Indonesia
| | - Stevan Kristian Lionardi
- School of Medicine and Health Science, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
- Sultan Syarif Mohamad Alkadrie Hospital, Pontianak, Indonesia
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98
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Kazlauskas E, Kairyte A, Zelviene P. Complex post traumatic stress disorder in adolescence: A two-year follow-up study. Clin Child Psychol Psychiatry 2024; 29:466-478. [PMID: 37402474 PMCID: PMC10945978 DOI: 10.1177/13591045231187975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
BACKGROUND Complex posttraumatic stress disorder is a new diagnosis in the 11th edition of the International Classification of Diseases (ICD-11). There is a need for a better understanding of complex PTSD in children and adolescents. OBJECTIVE The study aimed to estimate the factors associated with chronic complex PTSD versus recovery of complex PTSD in adolescents in a 2-year follow-up study. METHOD In total, 66 adolescents, mean age 14.5, 73% female, identified as having complex PTSD using self-report at baseline recruited from a general population sample, were included in the study. The International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA) was used for the assessment of complex PTSD. RESULTS Overall, 36% of the study sample has been identified as having chronic complex PTSD over 2 years, 10% met the criteria for PTSD at a 2-year follow-up, and 54% recovered. A higher risk for chronic complex PTSD was associated with exposure to more traumatic events and more life-stressors over the 2 years, low social network, low positive social support, bullying at school, and loneliness. CONCLUSION The study found that around one-third of the traumatized youth had a prolonged trajectory of complex PTSD symptoms, which were associated with negative life experiences and social difficulties.
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Affiliation(s)
- Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Agniete Kairyte
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Bertram L, Gerken K, Jukier T. Opisthotonos in a Yorkshire Terrier. J Am Vet Med Assoc 2024; 262:562-564. [PMID: 38266385 DOI: 10.2460/javma.23.10.0597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024]
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100
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Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. Trauma Violence Abuse 2024; 25:947-964. [PMID: 37125723 PMCID: PMC10913314 DOI: 10.1177/15248380231167399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
There is growing evidence of prior experiences of trauma and trauma-related symptoms among people with eating disorders; however, there is little understanding as to how post-traumatic stress disorder (PTSD) and exposure to traumatic events affect treatment outcomes. Without this knowledge, eating disorder clinicians are unable to tailor treatment to ensure good outcomes for the large percentage of this population that is affected by PTSD and trauma. This systematic review aimed to identify how PTSD and trauma exposure influence outcomes in eating disorder treatment. Systematic searches of PsycINFO, MEDLINE, PubMed, and Scopus databases identified 16 articles that met the inclusion criteria. The results indicated a negative effect on rates of eating disorder treatment completion and eating disorder psychopathology posttreatment. These findings were evident across studies that investigated the impact of a history of traumatic events as well as studies that investigated the impact of the presence of trauma-related symptoms seen in PTSD. Several methodological limitations were identified in the literature. These include: heterogeneous and unstandardized measures of PTSD and trauma, high attrition rates with follow-up, and insufficient data to enable comparisons by treatment setting, diagnostic presentation, and type of trauma exposure. The findings of this review have implications for future research and clinical care, including the importance of considering PTSD and trauma in assessment, treatment planning, and provision of both trauma-informed care and trauma-focused treatments for individuals with eating disorders.
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Affiliation(s)
- Sinead Day
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Phillipa Hay
- Translational Health Research Institute, School of Medicine, Western Sydney University, Penrith, NSW, Australia
- Mental Health Services Camden and Campbelltown Hospitals, South West Sydney Local Health District, NSW, Australia
| | - Wadad. Kathy Tannous
- Translational Health Research Institute, School of Business, Western Sydney University, Penrith, NSW, Australia
| | - Scott J. Fatt
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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