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Sirén A, Syvänen J, Nyman M, Mattila K, Hirvonen J. Outcomes of Follow-up Imaging After Pediatric Spinal Trauma Confirmed With Magnetic Resonance Imaging. J Pediatr Orthop 2024; 44:e329-e334. [PMID: 38223936 PMCID: PMC10913857 DOI: 10.1097/bpo.0000000000002615] [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: 01/16/2024]
Abstract
BACKGROUND Imaging plays a crucial role in the diagnostic workup of pediatric spinal trauma. Computed tomography and conventional radiographs are widely used as the primary imaging methods. Magnetic resonance imaging (MRI) is a radiation-free alternative with high sensitivity for bony and soft tissue injuries. There is no consensus on the optimal use of follow-up imaging in pediatric spinal trauma without immediate surgical treatment, especially if the injury is primarily confirmed with MRI. This study aimed to assess the diagnostic value of follow-up imaging after MRI-confirmed spinal trauma in children. METHODS The medical records and the imaging data of children and adolescents with emergency spinal MRI and follow-up imaging over 8 years were retrospectively reviewed. The primary study outcome was the outcome of follow-up imaging and its effect on management. RESULTS The study population consisted of 127 patients. The follow-up imaging did not alter the management in any patient with presumably stable injury in emergency MRI. Short-term follow-up imaging showed no clinically significant progression in thoracolumbar compression fractures. Flexion-extension radiographs had no additional value in cases with stable cervical spinal injury on emergency MRI. CONCLUSIONS The clinical utility of short-term follow-up imaging is low in children with stable spinal injury on emergency MRI. LEVEL OF EVIDENCE Level III-retrospective observational study.
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Affiliation(s)
| | - Johanna Syvänen
- Pediatric Orthopedic Surgery, University of Turku and Turku University Hospital, Turku
| | | | | | - Jussi Hirvonen
- Departments of Radiology
- Department of Radiology, Medical Imaging Center, Tampere University and Tampere University Hospital, Tampere, Finland
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102
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Broderick M, Tripodi G, Dwyer K. Utility of Repeat Head Computed Tomography in Detecting Delayed Intracranial Hemorrhage in Falls on Direct Oral Anticoagulants. Am Surg 2024; 90:691-694. [PMID: 37853510 DOI: 10.1177/00031348231206582] [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: 10/20/2023]
Abstract
INTRODUCTION Ground level falls in the elderly often lead to complications due to use of anticoagulants (ACs). Intracranial hemorrhage (ICH), immediate or delayed, is a feared consequence of such falls. The rate of delayed ICH (dICH) in patients taking anticoagulants or antiplatelet (AP) agents ranges from .6% to 6%. Patients on warfarin have a persistent rate of dICH, leading to implementation of routine repeat head CTs at our institution. This policy was extended to direct oral anticoagulants (DOACs). This study aims to determine institutional incidence of DOAC-associated dICH. METHODS With IRB waiver approval, we conducted a retrospective review of trauma evaluations for falls on DOACs from 2016 to 2018. We reviewed records for neurologic status, DOAC use, and results of initial and delayed head CTs. Exclusion criteria included initial GCS ≤14, new neurologic deficits, traumatic findings on initial CT, concurrent use of additional AC/AP, or absence of repeat head CT. RESULTS Among 632 patients evaluated for falls on AC/AP therapy, 159 (25%) of patients were included in the review. The age range was 19-98 years old, with 99 females and 60 males. Half of the patients were on apixaban, with the rest on dabigatran or rivaroxaban. Ten patients presented with GCS of 14. No delayed hemorrhages were detected in this population. CONCLUSION The necessity of a repeat head CT in patients taking DOACs is debated in the literature. Our analysis failed to demonstrate any delayed hemorrhage in neurologically intact patients after head strike on DOAC, suggesting no indication for follow-up imaging in this group.
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Affiliation(s)
| | | | - Kevin Dwyer
- Department of Surgery, Stamford Hospital, Stamford, CT, USA
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Sjöblom A, Hedberg M, Gille A, Guerra A, Aanesen V, Forsberg IM, Fagerlund MJ. Pre-oxygenation using high-flow nasal oxygen versus tight facemask in trauma patients undergoing emergency anaesthesia. Acta Anaesthesiol Scand 2024; 68:447-456. [PMID: 38129931 DOI: 10.1111/aas.14368] [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] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/06/2023] [Accepted: 12/09/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Patients suffering from major traumatic injuries frequently require emergency anaesthesia. Due to often compromised physiology and the time-sensitive management, trauma patients may be more prone to desaturate during induction of anaesthesia. We hypothesised that pre-oxygenation using high-flow nasal oxygen would decrease the risk of desaturation during induction of anaesthesia in trauma patients and the study therefore aimed to compare the frequency of desaturation when pre-oxygenation was performed with high-flow nasal oxygen or a traditional facemask. METHODS This exploratory, prospective, before-and-after study was conducted at the Karolinska University Hospital, Sweden. Adult (≥18 years of age) patients suffering major traumatic injuries needing emergency anaesthesia were included around the clock. Patients were pre-oxygenated using a tight-fitting facemask during the first nine months of enrollment. High-flow nasal oxygen was then introduced as a method for pre-oxygenation of trauma patients. The primary outcome was the proportion of patients desaturating <93% during induction of anaesthesia, assessed from the start of pre-oxygenation until one minute after intubation. Secondary outcomes included perceived difficulty of pre-oxygenation among anaesthetists (assessed on a scale between 1 and 10) and safety outcomes, such as incidence of regurgitations and intracranial gas (assessed radiologically). RESULTS Data from 96 patients were analysed. Facemask pre-oxygenation was performed in 66 patients, while 30 patients were pre-oxygenated with high-flow nasal oxygen. The most frequent trauma mechanisms were stabbing injuries (n = 34 (35%)) and fall injuries (n = 21 (22%)). There were no differences in patient characteristics between the groups. Eight (12%) versus three (10%) patients desaturated <93% in the facemask and high-flow nasal oxygen group respectively, OR 0.81 (95% CI 0.20-3.28), p = .76. Anaesthetists assessed pre-oxygenation using high-flow nasal oxygen as easier compared to facemask pre-oxygenation. No patient in any group showed signs of regurgitation. Among patients with facial or skull fractures requiring anaesthesia before radiology was performed, intracranial gas was seen in four (40%) patients pre-oxygenated with a facemask and in no patient pre-oxygenated with HFNO (p = .23). CONCLUSION In this prospective study investigating trauma patients undergoing emergency anaesthesia, we could not see any difference in the number of patients desaturating when pre-oxygenation was performed with high-flow nasal oxygen compared to a tight-fitting facemask. Pre-oxygenation using high-flow nasal oxygen was assessed as easier compared to facemask pre-oxygenation.
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Affiliation(s)
- Albin Sjöblom
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Hedberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Anders Gille
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Andres Guerra
- Medical school, Karolinska Institutet, Stockholm, Sweden
| | - Vilde Aanesen
- Medical school, Karolinska Institutet, Stockholm, Sweden
| | - Ida-Maria Forsberg
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Malin Jonsson Fagerlund
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institutet, Stockholm, Sweden
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Pedersen ER, Davis JP, Canning L, Tucker JS, Prindle J, Seelam R, Dunbar MS, Siconolfi D, D'Amico EJ. Longitudinal associations among experiences of sexual assault, post traumatic stress disorder symptoms, and heavy drinking in young adults. J Trauma Stress 2024; 37:243-256. [PMID: 38109146 PMCID: PMC10984762 DOI: 10.1002/jts.23000] [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: 05/16/2023] [Revised: 11/03/2023] [Accepted: 11/04/2023] [Indexed: 12/19/2023]
Abstract
Prior research with young adults has demonstrated clear associations between experiences of sexual assault, symptoms of posttraumatic stress disorder (PTSD), and alcohol use, but most studies have been cross-sectional or have not considered multiple theoretical pathways to understand these associations. Using six waves of data from a longitudinal cohort sample of 1,719 young adults, we examined associations among experiences of past-year sexual assault (i.e., rape, unwanted sexual touching, and physical intimidation in a sexual way), PTSD symptoms, and the frequency of binge drinking over time, allowing for the exploration of symptom-induced, interpersonal risk, and substance-induced pathways for male and female participants. For both male, βs = 2.84 to 6.55, and female participants, βs = 2.96 to 10.1, higher prior levels of PTSD symptoms were associated with larger increases in binge drinking over time. For female participants, higher prior levels of sexual assault were associated with larger increases in PTSD symptoms over time, βs = 3.48 to 4.25, whereas for male participants, higher prior levels of past-year binge drinking were associated with decreases in PTSD symptoms over time, βs = -2.75 to -0.53. Continued efforts are needed to prevent sexual assault among young adults and address PTSD symptoms among those who experience sexual assault. Interventions that target binge drinking are also needed for individuals who experience PTSD symptoms, especially young adults, to address potentially hazardous drinking before problems escalate and become chronic.
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Affiliation(s)
- Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | | | - Liv Canning
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | | | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Flaaten N, Moslim H, Tang E, Varrall R. Scapular fractures: A regional and rural perspective. Aust J Rural Health 2024; 32:388-393. [PMID: 38480988 DOI: 10.1111/ajr.13100] [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: 08/23/2023] [Revised: 01/30/2024] [Accepted: 02/27/2024] [Indexed: 04/23/2024] Open
Abstract
INTRODUCTION Scapular fractures (SFs) have historically been associated with severe trauma and multiple injuries. Recent studies have demonstrated improved outcomes. However, SFs have never been studied from a strictly rural or Australian perspective. OBJECTIVE The study's objective was to assess whether associations still exist between a fractured scapula and trauma scores, mortality rates, and other commonly associated injuries in a regional Australian trauma centre. DESIGN The study design examined prospectively collected data from a regional hospital between the years 2012 to 2021 presenting to the emergency department with traumatic SFs. Primary outcomes of interest were mortality rate, method of injury, ISS scores, and associated injuries. FINDINGS One hundred and five patients had a SF. The median age was 49 with 93 (89%) being male. Most fractures were located in the body of the scapula (80%). The primary mechanism of injury was motorbike accidents (36%), falls (24%), and motor vehicle accidents (22%). Two patients died from their injuries (1.9%). Thirty-four percent demonstrated mild trauma scores, with 36% moderate, 28% severe, and 1.9% critical. Commonly observed associated injuries included chest wall fractures, vertebral fractures, thoracic injuries, brain injury, and abdominal trauma. DISCUSSION A minority of SFs were associated with severe or critical trauma, and overall, patients who sustained a SF had a low mortality rate. These findings suggest that patients from regional areas have similar outcomes to those from more urban centres in other parts of the world. CONCLUSION Given these results, a re-examination of whether SFs are a reliable marker of severe trauma should be considered.
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Affiliation(s)
- Nordan Flaaten
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopedic Department, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Huissan Moslim
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Eric Tang
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
| | - Ruth Varrall
- University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia
- Orthopaedic Department, Rockhampton Hospital, Rockhampton, Queensland, Australia
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de Smet S, Rousseau C, Stalpaert C, De Haene L. "It will always be Temporary": A qualitative study of Syrian young adults expressing histories of collective violence and forced displacement in participatory theatre. Transcult Psychiatry 2024; 61:194-208. [PMID: 38233739 DOI: 10.1177/13634615231213840] [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: 01/19/2024]
Abstract
Given the increased prevalence of mental health problems in Syrian refugee communities, there have been efforts to develop adequate mental health care for their well-being. Herein, clinical literature is increasingly emphasizing the importance of locating refugees' healing at the nexus of personal and social realities, understanding the process of trauma narration within social restorative spaces of witnessing and communal support. Alongside this debate, there is growing interest in the relevance of participatory theatre for refugees. This innovative approach understands how voicing narratives of life histories within a broader social sphere may support personal and socio-political transformation. In this article, we aim to further the understanding of participatory theatre's relevance to these issues, focusing on the reparative dimensions of trauma narration. Based on a case study of a theatre project with Syrian young adults resettled in Belgium, we explore the different ways participants expressed experiences of collective violence and displacement in dialogue with each other, their diasporic and home communities, and their host society, and consider how these processes relate to their construction and meaning and coping with trauma. In a final section, we discuss the implications of our findings, raising questions about the value of participatory theatre as a reparative space and outlining suggestions to introduce and mobilize reparative modes of trauma narration in therapeutic practices in refugee trauma care.
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Affiliation(s)
- Sofie de Smet
- Parental and Special Education Research Unit, Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven , Belgium
- S:PAM (Studies in Performing Arts & Media), Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium
| | - Cécile Rousseau
- Division of Social and Cultural Psychiatry, McGill University, Montréal, Quebec, Canada
| | - Christel Stalpaert
- S:PAM (Studies in Performing Arts & Media), Faculty of Arts and Philosophy, Ghent University, Ghent, Belgium
| | - Lucia De Haene
- Parental and Special Education Research Unit, Faculty of Psychology and Educational Sciences and Faculty Clinical Centre PraxisP, University of Leuven , Belgium
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Suglia SF, Clausing ES, Shelton RC, Conneely K, Prada-Ortega D, DeVivo I, Factor-Litvak P, Cirillo P, Baccarelli AA, Cohn B, Link BG. Cumulative Stress Across the Life Course and Biological Aging in Adulthood. Psychosom Med 2024; 86:137-145. [PMID: 38345302 PMCID: PMC11001534 DOI: 10.1097/psy.0000000000001284] [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] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Psychosocial stressors have been linked with accelerated biological aging in adults; however, few studies have examined stressors across the life course in relation to biological aging. METHODS In 359 individuals (57% White, 34% Black) from the Child Health and Development Studies Disparities study, economic (income, education, financial strain), social (parent-child relations, caretaker responsibilities) and traumatic (death of a sibling or child, violence exposure) stressors were assessed at multiple time points (birth and ages 9, 15, and 50 years). Experiences of major discrimination were assessed at age 50. Life period stress scores were then assessed as childhood (birth-age 15 years) and adulthood (age 50 years). At age 50 years, participants provided blood samples, and DNA methylation was assessed with the EPIC BeadChip. Epigenetic age was estimated using six epigenetic clocks (Horvath, Hannum, Skin and Blood age, PhenoAge, GrimAge, Dunedin Pace of Aging). Age acceleration was determined using residuals from regressing chronologic age on each of the epigenetic age metrics. Telomere length was assessed using the quantitative polymerase chain reaction-based methods. RESULTS In linear regression models adjusted for race and gender, total life stress, and childhood and adult stress independently predicted accelerated aging based on GrimAge and faster pace of aging based on the DunedinPace. Associations were attenuated after adjusting for smoking status. In sex-stratified analyses, greater childhood stress was associated with accelerated epigenetic aging among women but not men. No associations were noted with telomere length. CONCLUSIONS We found that cumulative stressors across the life course were associated with accelerated epigenetic age, with differences by sex (e.g., accelerated among women). Further research of this association in large and diverse samples is needed.
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Affiliation(s)
- Shakira F Suglia
- From the Department of Epidemiology (Suglia), Rollins School of Public Health, Emory University, Atlanta, Georgia; School of Global Integrative Studies (Clausing) and Center for Brain, Biology, and Behavior (Clausing), University of Nebraska-Lincoln, Lincoln, Nebraska; Department of Sociomedical Sciences (Shelton), Mailman School of Public Health, New York, New York; Department of Human Genetics (Conneely, Baccarelli), School of Medicine, Emory University, Atlanta, Georgia; Department of Environmental Health (Prada-Ortega), Mailman School of Public Health, New York, New York; Department of Epidemiology (DeVivo), Harvard T. H. Chan School of Public Health; Channing Division of Network Medicine (DeVivo), Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Department of Epidemiology (Factor-Litvak), Mailman School of Public Health, New York, New York; Child Health and Development Studies (Cirillo, Cohn), Public Health Institute, Berkeley; and Department of Sociology (Link), University of California Riverside, Riverside, California
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108
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van Zyl T, Ho AMH, Klar G, Haley C, Ho AK, Vasily S, Mizubuti GB. Analgesia for rib fractures: a narrative review. Can J Anaesth 2024; 71:535-547. [PMID: 38459368 DOI: 10.1007/s12630-024-02725-1] [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: 08/15/2023] [Revised: 10/11/2023] [Accepted: 12/27/2023] [Indexed: 03/10/2024] Open
Abstract
PURPOSE Rib fracture(s) is a common and painful injury often associated with significant morbidity (e.g., respiratory complications) and high mortality rates, especially in the elderly. Risk stratification and prompt implementation of analgesic pathways using a multimodal analgesia approach comprise a primary endpoint of care to reduce morbidity and mortality associated with rib fractures. This narrative review aims to describe the most recent evidence and care pathways currently available, including risk stratification tools and pharmacologic and regional analgesic blocks frequently used as part of the broadly recommended multimodal analgesic approach. SOURCE Available literature was searched using PubMed and Embase databases for each topic addressed herein and reviewed by content experts. PRINCIPAL FINDINGS Four risk stratification tools were identified, with the Study of the Management of Blunt Chest Wall Trauma score as most predictive. Current evidence on pharmacologic (i.e., acetaminophen, nonsteroidal anti-inflammatory drugs, gabapentinoids, ketamine, lidocaine, and dexmedetomidine) and regional analgesia (i.e., thoracic epidural analgesia, thoracic paravertebral block, erector spinae plane block, and serratus anterior plane block) techniques was reviewed, as was the pathophysiology of rib fracture(s) and its associated complications, including the development of chronic pain and disabilities. CONCLUSION Rib fracture(s) continues to be a serious diagnosis, with high rates of mortality, development of chronic pain, and disability. A multidisciplinary approach to management, combined with appropriate analgesia and adherence to care bundles/protocols, has been shown to decrease morbidity and mortality. Most of the risk-stratifying care pathways identified perform poorly in predicting mortality and complications after rib fracture(s).
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Affiliation(s)
- Theunis van Zyl
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Anthony M-H Ho
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Gregory Klar
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Christopher Haley
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Adrienne K Ho
- Department of Public Health Sciences (Epidemiology), School of Medicine, Queen's University, Kingston, ON, Canada
| | - Susan Vasily
- Department of Anesthesiology and Perioperative Medicine, Queen's University, Kingston, ON, Canada
| | - Glenio B Mizubuti
- Department of Anesthesiology & Perioperative Medicine, Queen's University, Kingston General Hospital, Victory 2 Wing, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada.
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Munley JA, Willis ML, Gillies GS, Kannan KB, Polcz VE, Balch JA, Barrios EL, Wallet SM, Bible LE, Efron PA, Maile R, Mohr AM. Exosomal microRNA following severe trauma: Role in bone marrow dysfunction. J Trauma Acute Care Surg 2024; 96:548-556. [PMID: 38151766 PMCID: PMC10978306 DOI: 10.1097/ta.0000000000004225] [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] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
INTRODUCTION Severe trauma disrupts bone marrow function and is associated with persistent anemia and altered hematopoiesis. Previously, plasma-derived exosomes isolated after trauma have been shown to suppress in vitro bone marrow function. However, the cargo contained in these vesicles has not been examined. We hypothesized that trauma plasma-derived exosomes exhibit microRNA (miRNA) changes that impact bone marrow function after severe injury. METHODS Plasma was collected from a prospective cohort study of trauma patients (n = 15; 7 males, 8 females) with hip and/or femur fractures and an Injury Severity Score of ≥15; elective total hip arthroplasty (THA) patients (n = 8; 4 males, 4 females) served as operative controls. Exosomes were isolated from plasma with the Invitrogen Total Exosome Isolation Kit (Thermo Fisher Scientific, Waltham, MA), and RNA was isolated using a miRNeasy Mini Kit (Qiagen, Hilden, Germany). Direct quantification of miRNA was performed by NanoString Technologies on a human miRNA gene panel and analyzed with nSolver with significance defined as p < 0.05. RESULTS There were no differences in age or sex distribution between trauma and THA groups; the average Injury Severity Score was 23. Trauma plasma-derived exosomes had 60 miRNA identities that were significantly downregulated and 3 miRNAs that were upregulated when compared with THA ( p < 0.05). Twelve of the downregulated miRNAs have a direct role in hematopoiesis regulation. Furthermore, male trauma plasma-derived exosomes demonstrated downregulation of 150 miRNAs compared with male THA ( p < 0.05). Female trauma plasma-derived exosomes demonstrated downregulation of only four miRNAs and upregulation of two miRNAs compared with female THA ( p < 0.05). CONCLUSION We observed downregulation of 12 miRNAs linked to hematopoiesis along with sexual dimorphism in miRNA expression from plasma-derived exosomes following severe trauma. Understanding sexually dimorphic miRNA expression provides new insight into sex-based changes in postinjury systemic inflammation, immune system dysregulation, and bone marrow dysfunction and will aid us in more precise future potential therapeutic strategies. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level III.
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Affiliation(s)
- Jennifer A. Munley
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Micah L. Willis
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Gwendolyn S. Gillies
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Kolenkode B. Kannan
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Valerie E. Polcz
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Jeremy A. Balch
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Evan L. Barrios
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Shannon M. Wallet
- Department of Oral Biology, University of Florida College of Medicine, Gainesville, Florida
| | - Letitia E. Bible
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Philip A. Efron
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Robert Maile
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
| | - Alicia M. Mohr
- Department of Surgery and Sepsis and Critical Illness Research Center, University of Florida College of Medicine, Gainesville, Florida
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Lovászi M, Németh ZH, Kelestemur T, Sánchez IV, Antonioli L, Pacher P, Wagener G, Haskó G. EVALUATION OF COMPONENTS OF THE EXTRACELLULAR PURINERGIC SIGNALING SYSTEM IN HUMAN SEPSIS. Shock 2024; 61:527-540. [PMID: 37752081 PMCID: PMC10963342 DOI: 10.1097/shk.0000000000002230] [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] [Subscribe] [Scholar Register] [Indexed: 09/28/2023]
Abstract
ABSTRACT Objective: Extracellular purines such as adenosine triphosphate (ATP), uridine triphosphate (UTP), and uridine diphosphate (UDP) and the ATP degradation product adenosine are biologically active signaling molecules, which accumulate at sites of metabolic stress in sepsis. They have potent immunomodulatory effects by binding to and activating P1 or adenosine and P2 receptors on the surface of leukocytes. Here we assessed the levels of extracellular purines, their receptors, metabolic enzymes, and cellular transporters in leukocytes of septic patients. Methods: Peripheral blood mononuclear cells (PBMCs), neutrophils, and plasma were isolated from blood obtained from septic patients and healthy control subjects. Ribonucleic acid was isolated from cells, and mRNA levels for purinergic receptors, enzymes, and transporters were measured. Adenosine triphosphate, UTP, UDP, and adenosine levels were evaluated in plasma. Results: Adenosine triphosphate levels were lower in septic patients than in healthy individuals, and levels of the other purines were comparable between the two groups. Levels of P1 and P2 receptors did not differ between the two patient groups. mRNA levels of ectonucleoside triphosphate diphosphohydrolase (NTPDase) 1 or CD39 increased, whereas those of NTPDase2, 3, and 8 decreased in PBMCs of septic patients when compared with healthy controls. CD73 mRNA was lower in PBMCs of septic than in healthy individuals. Equilibrative nucleoside transporter (ENT) 1 mRNA concentrations were higher and ENT2, 3, and 4 mRNA concentrations were lower in PBMCs of septic subjects when compared with healthy subjects. Concentrative nucleoside transporter (CNT) 1 mRNA levels were higher in PBMCs of septic versus healthy subjects, whereas the mRNA levels of CNT2, 3, and 4 did not differ. We failed to detect differences in mRNA levels of purinergic receptors, enzymes, and transporters in neutrophils of septic versus healthy subjects. Conclusion: Because CD39 degrades ATP to adenosine monophosphate (AMP), the lower ATP levels in septic individuals may be the result of increased CD39 expression. This increased degradation of ATP did not lead to increased adenosine levels, which may be explained by the decreased expression of CD73, which converts AMP to adenosine. Altogether, our results demonstrate differential regulation of components of the purinergic system in PBMCs during human sepsis.
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Affiliation(s)
- Marianna Lovászi
- Department of Anesthesiology, Columbia University, New York, NY, USA
| | - Zoltán H Németh
- Department of Anesthesiology, Columbia University, New York, NY, USA
- Department of Surgery, Morristown Medical Center, Morristown, NJ, USA
| | - Taha Kelestemur
- Department of Anesthesiology, Columbia University, New York, NY, USA
- Department of Physiology, Faculty of Medicine, Istanbul Medipol University, Istanbul, Turkiye
| | - Itzel V. Sánchez
- Department of Anesthesiology, Columbia University, New York, NY, USA
| | - Luca Antonioli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pál Pacher
- Laboratory of Cardiovascular Physiology and Tissue Injury, National Institutes of Health/NIAAA, Bethesda, MD, USA
| | - Gebhard Wagener
- Department of Anesthesiology, Columbia University, New York, NY, USA
| | - György Haskó
- Department of Anesthesiology, Columbia University, New York, NY, USA
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Sobhy MM, Brand M, Henshall K, MacCormick AD. Investigating major trauma in Māori youth at Te Whatu Ora Counties Manukau. ANZ J Surg 2024; 94:580-584. [PMID: 38486439 DOI: 10.1111/ans.18948] [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] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/25/2024] [Accepted: 03/06/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND The Ninth Perioperative Mortality Review Committee (POMRC) report found the likelihood of death was over three times higher in Māori youth compared to non-Māori (age: 15-18 years) in the 30-days following major trauma. The aim of our study is to investigate variations in care provided to Māori youth presenting to Te Whatu Ora Counties Manukau (TWO-CM) with major trauma, to inform policies and improve care. METHODS This was a retrospective, observational study of 15-18-year-olds admitted to Middlemore Hospital from January 2018 to December 2021 following major trauma (Injury Severity Score (ISS) >12 or with (ISS) <12 who died). Data were obtained from the New Zealand Trauma Registry (NZTR). Six key performance indicators were studied against hospital guidelines/international consensus: Deaths, Cause-of-death, trauma call, RedBlanket activations, time-to-computed tomography (CT), and time-to-operating theatre (OT). RESULTS Of 77 patients, five deaths occurred, four non-Māori, and one Māori (P = 0.645). Five trauma calls were not activated (P = 0.642). There was no statistically significant difference for both median time to CT (P = 0.917) and time to CT for patients with GCS >13 (P = 0.778) between Māori and non-Māori. Five patients did not meet guidelines for time-to-OT (three non-Māori and two Māori) (P = 0.377). CONCLUSION No statistically significant variations in care were present for Māori youth presenting with major trauma, these findings did not match the national trend.
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Affiliation(s)
- Mira M Sobhy
- Department of Surgery, Te Waipapa Taumata Rau (University of Auckland), Tāmaki Makaurau, Aotearoa, New Zealand
- Dunedin School of Medicine, Ōtākou Whakaihu Waka (University of Otago), Dunedin, Aotearoa, New Zealand
| | - Maria Brand
- Department of Surgery, Te Waipapa Taumata Rau (University of Auckland), Tāmaki Makaurau, Aotearoa, New Zealand
- Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, Aotearoa, New Zealand
| | - Kevin Henshall
- Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, Aotearoa, New Zealand
| | - Andrew D MacCormick
- Department of Surgery, Te Waipapa Taumata Rau (University of Auckland), Tāmaki Makaurau, Aotearoa, New Zealand
- Department of Surgery, Te Whatu Ora Counties Manukau, Auckland, Aotearoa, New Zealand
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112
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Cornell S, Brander RW, Roberts A, Koon W, Peden AE, Lawes JC. 'I actually thought that I was going to die': Lessons on the rip current hazard from survivor experiences. Health Promot J Austr 2024; 35:551-564. [PMID: 37549041 DOI: 10.1002/hpja.785] [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] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 07/04/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Rip currents are strong, narrow, fast-flowing currents of water that occur on many beaches and in Australia contributing to 26 drowning deaths and several thousand lifeguard/lifesaver rescues each year. Educating the public about the rip current hazard is a primary focus of beach safety practitioners, but there has been a lack of qualitative research exploring the firsthand experiences of being caught in a rip current to assist in this regard. The aim of this study was to analyse interviews of rip current survivors to understand more about how people react when unintentionally caught in a rip current in order to help guide future public education to mitigate rip current drowning. METHODS Semi-structured interviews were conducted with 56 individuals (primarily Australian-born) about their experience of being caught in a rip current. Interviewees were recruited via an online survey and varied in age and self-reported swimming ability. RESULTS Thematic analysis revealed three key temporal elements to the rip current experience: Before the Rip in which lack of awareness and knowledge, complacency, over-confidence, and attitude were prevalent themes; During the Rip which identified panic and temporary inhibition of decision-making, physical response, prior experience, and relationships with other beach users as themes; and After the Rip where post-rip effects and rip safety messaging and education were key themes. The importance of experiential immersion was a prevalent thread throughout all phases of the thematic analysis. DISCUSSION Our research shows that being caught in a rip current can be an intense and traumatic experience and that lessons learned from survivors have significant implications for improving existing and future rip current education efforts. In this regard, we provide several recommendations based on evidence-based insights gained from our interviews including the development of immersive rip current experience using virtual reality. SO WHAT Despite the prevalence of rip currents causing drowning deaths and rescues, there has been a lack of qualitative research on firsthand experiences to aid in public education. These interviews emphasise the intense and traumatic nature of being caught in a rip current, underscoring the need for improved rip current education to aid in prevention of this, often harrowing, experience.
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Affiliation(s)
- Samuel Cornell
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
| | - Robert W Brander
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amelia Roberts
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
| | - William Koon
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amy E Peden
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Population Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jasmin C Lawes
- Beach Safety Research Group, UNSW Sydney, Sydney, New South Wales, Australia
- School of Biological, Earth and Environmental Sciences, UNSW Sydney, Sydney, New South Wales, Australia
- Surf Life Saving Australia, Sydney, New South Wales, Australia
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El-Menyar A, Khan NA, Asim M, Rizoli S, Al-Thani H. Beta-Adrenergic Receptor Polymorphism and Patho-Genetics of Trauma: A Transformational Frontier of Personalized Medicine in Neurotrauma. J Neurotrauma 2024; 41:771-788. [PMID: 38117124 DOI: 10.1089/neu.2023.0432] [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: 12/21/2023] Open
Abstract
Trauma is a serious public health issue, and remains a major cause of mortality and disability worldwide. The notion that genetic factors contribute to an individual's response to traumatic injury has advanced significantly. Genetic variations in severely injured patients have been linked to mortality, morbidity, and psychological outcomes. We conducted a comprehensive review of beta-adrenergic receptor polymorphisms and their impact on the pathogenetics of traumatic injuries, which could pave the way for a transformational frontier of personalized medicine in neurotrauma. It remains unclear why some individuals are vulnerable to worse outcomes, whereas others are resilient. Although genetic factors may be significant, the intricate interplay between environmental and genetic factors may be responsible for variations in the presentation and outcome after injury. Recent advancements in genetic analysis and molecular physiology have helped to shed light on the causes of such variability. Although exposure to trauma can initiate a cascade of stress-related responses, these responses alone are insufficient to explain etiopathogenesis. Therefore, gaining insights into how trauma and genetic predispositions to adrenergic variations interact at the molecular level to affect an individual's susceptibility and recuperation could provide an essential understanding of the molecular pathogenesis of traumatic injuries. Therefore, it is imperative to identify potential genetic and physiological markers to guide early management and prognosis of trauma. Such knowledge could pave the way for the discovery of novel biomarkers that can identify a transdiagnostic subgroup that is at high risk and requires early intervention. This could lead to the adoption of personalized medical approaches in neurotrauma care.
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Affiliation(s)
- Ayman El-Menyar
- Trauma and Vascular Surgery, Clinical Research, and Hamad Medical Corporation, Doha, Qatar
- Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Naushad Ahmad Khan
- Trauma and Vascular Surgery, Clinical Research, and Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Asim
- Trauma and Vascular Surgery, Clinical Research, and Hamad Medical Corporation, Doha, Qatar
| | - Sandro Rizoli
- Trauma Surgery, Hamad Medical Corporation, Doha, Qatar
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Schofield H, Rossetto A, Armstrong PC, Allan HE, Warner TD, Brohi K, Vulliamy P. Immature platelet dynamics are associated with clinical outcomes after major trauma. J Thromb Haemost 2024; 22:926-935. [PMID: 38101576 DOI: 10.1016/j.jtha.2023.12.002] [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] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/24/2023] [Accepted: 12/02/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Major trauma results in dramatic changes in platelet behavior. Newly formed platelets are more reactive than older platelets, but their contributions to hemostasis and thrombosis after severe injury have not been previously evaluated. OBJECTIVES To determine how immature platelet metrics and plasma thrombopoietin relate to clinical outcomes after major injury. METHODS A prospective observational cohort study was performed in adult trauma patients. Platelet counts and the immature platelet fraction (IPF) were measured at admission and 24 hours, 72 hours, and 7 days after injury. Thromboelastometry was performed at admission. Plasma thrombopoietin, c-Mpl, and GPIbα were quantified in a separate cohort. The primary outcome was in-hospital mortality; secondary outcomes were venous thromboembolic events and multiple organ dysfunction syndrome (MODS). RESULTS On admission, immature platelet counts (IPCs) were significantly lower in nonsurvivors (n = 40) than in survivors (n = 236; 7.3 × 109/L vs 10.6 × 109/L; P = .009), but IPF did not differ. Similarly, impaired platelet function on thromboelastometry was associated with lower admission IPC (9.1 × 109/L vs 11.9 × 109/L; P < .001). However, at later time points, we observed significantly higher IPF and IPC in patients who developed venous thromboembolism (21.0 × 109/L vs 11.1 × 109/L; P = .02) and prolonged MODS (20.9 × 109/L vs 11 × 109/L; P = .003) than in those who did not develop complications. Plasma thrombopoietin levels at admission were significantly lower in nonsurvivors (P < .001), in patients with MODS (P < .001), and in those who developed venous thromboembolism (P = .04). CONCLUSION Lower levels of immature platelets in the acute phase after major injury are associated with increased mortality, whereas higher immature platelet levels at later time points may predispose to thrombosis and MODS.
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Affiliation(s)
- Henry Schofield
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Andrea Rossetto
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Paul C Armstrong
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - Harriet E Allan
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - Timothy D Warner
- Centre for Immunobiology, Blizard Institute, Queen Mary University of London, London, UK
| | - Karim Brohi
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK
| | - Paul Vulliamy
- Centre for Trauma Sciences, Blizard Institute, Queen Mary University of London, London, UK.
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Ko SH, Cha JR, Lee CC, Kim MS, Park KB. Musculoskeletal Injuries in Table Tennis during Competition: A Systematic Review. Int J Sports Med 2024; 45:267-271. [PMID: 37871618 PMCID: PMC10987229 DOI: 10.1055/a-2175-6509] [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: 04/10/2023] [Accepted: 08/29/2023] [Indexed: 10/25/2023]
Abstract
The study aimed to investigate the incidence of musculoskeletal injuries among table tennis players and identify their associated risk factors. We conducted a literature search in online databases using relevant search terms related to "table tennis" and "injury". To compare the rate of injuries according to player-related variables, we extracted information on sex, level of games, circumstances of injury, and duration of sport absence after injury. Furthermore, we calculated the odds ratios based on the number of injuries according to variables. Eight articles included 873 professional table tennis players, revealing an overall musculoskeletal injury rate of 3.6% (31 musculoskeletal injuries). The incidence was 10.0 injuries per 1,000 playing hours (range, 0-27.0). The rate of musculoskeletal injuries for female and male players were 3.2% and 3.8%, respectively, and those for Summer Olympic Games, Asian Games, and domestic national games was 4.8%, 15.4%, and 0%, respectively. More than half (52%) of injuries occurred during training, and most injuries (64%) were of a nature that did not cause time loss. This review provides valuable information about the incidence of musculoskeletal injuries in table tennis competitions. However, owing to the limitations of this study in identifying injury-related risk factors, future studies analyzing comprehensive variables are required.
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Affiliation(s)
- Sang-Hun Ko
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan,
Korea (the Republic of)
| | - Jae-Ryong Cha
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan,
Korea (the Republic of)
| | - Chae-Chil Lee
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan,
Korea (the Republic of)
| | - Min-Seok Kim
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan,
Korea (the Republic of)
| | - Ki-Bong Park
- Department of Orthopedic Surgery, Ulsan University Hospital, Ulsan,
Korea (the Republic of)
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Skiendzielewski K, Forke CM, Sarwer DB, Noll JG, Wheeler DC, Henry KA, Schroeder K. The intersection of adverse childhood experiences and neighborhood determinants of health: An exploratory spatial analysis. Psychol Trauma 2024; 16:S125-S132. [PMID: 35834220 PMCID: PMC9839886 DOI: 10.1037/tra0001320] [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: 01/17/2023]
Abstract
OBJECTIVE Adverse childhood experiences (ACEs) are associated with elevated risk for poor physical and psychological health outcomes. Nearly all of the literature on the association between ACEs and poor health focuses on the individual and family level; the potential role of neighborhood environment is overlooked. Understanding the relationship between ACEs and characteristics of the neighborhood environment is a necessary first step in determining if and how place-based, trauma-informed interventions might mitigate the negative effects of ACEs. The purpose of this exploratory study was to describe the neighborhood environment of adults who have experienced ≥ 4 versus ≤ 3 ACEs. METHOD An exploratory secondary analysis of cross-sectional and geospatial data was conducted during 2021. Data sources included 2011/2012 Philadelphia ACE Survey data, a telephone survey of 1,784 randomly sampled Philadelphia adults, linked with geospatial data on 21 neighborhood-level determinants of health. Neighborhood was defined as participant's home census tract at the time of survey. The sample for this secondary analysis included the 1,679 Philadelphia ACE Survey participants for whom home census tract was available. Bivariate logistic regression examined differences between groups (≤ 3 ACEs vs. ≥ 4 ACEs). RESULTS Individuals with ≥ 4 ACEs lived in neighborhoods with higher neighborhood poverty rates, less socioeconomic resources, worse food access, poorer perceived physical and mental health, more substance overdose deaths, higher crime, and less green space. CONCLUSIONS Findings suggest future work may benefit from considering neighborhood environments when examining and intervening upon the association between ACEs and poor physical and psychological health. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
| | - Christine M. Forke
- Master of Public Health Program, Perelman School of Medicine, University of Pennsylvania
- Center for Violence Prevention, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - David B. Sarwer
- Department of Social and Behavioral Sciences, College of Public Health, Center for Obesity Research and Education, Temple University
| | - Jennie G. Noll
- Department of Human Development and Family Studies, College of Health and Human Development, Pennsylvania State University
| | - David C. Wheeler
- Department of Biostatistics, School of Medicine, Virginia Commonwealth University
| | - Kevin A. Henry
- Department of Geography and Urban Studies, College of Liberal Arts, Temple University
| | - Krista Schroeder
- Department of Nursing, College of Public Health, Temple University
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Suslovic B, Lett E. Resilience is an Adverse Event: A Critical Discussion of Resilience Theory in Health Services Research and Public Health. Community Health Equity Res Policy 2024; 44:339-343. [PMID: 36856261 PMCID: PMC10919062 DOI: 10.1177/2752535x231159721] [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] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Resilience, the individual trait of being able to persist and cope with, often recurrent, negative experiences, has experienced an explosion in recent years as a topic of study. In this commentary, we critique this surge and problematize the co-occurring development of the "resilience as treatment" paradigm. We show that resilience is an expectation foisted primarily on historically and contemporarily oppressed and excluded populations often in response to systemic and structural forms of discrimination. We argue that this represents a fundamental mismatch of intervention and problem; offering an individual-level solution to a structural toxin. In doing so, we re-contextualize resilience as an adverse event, more analogous to scar tissue than a reliable treatment paradigm. Our essay concludes with offering alternatives to resilience that originate with the holistic trauma and liberation health frameworks. These paradigms are united in that, in contrast to resilience, they emphasize healing from structural violence, rather than adapting to it.
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Affiliation(s)
- Brianna Suslovic
- The Crown Family School of Social Work, Policy, and Practice, University of Chicago, Chicago, IL, USA
| | - Elle Lett
- Computational Health Informatics Program, Boston Children’s Hospital, Boston, MA, USA
- Center for Applied Transgender Studies, Chicago, IL, USA
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Koh S, Kenji D, Franklin R. Working towards 2030 road safety targets, the need for specific rural and remote children strategies. Aust J Rural Health 2024; 32:320-331. [PMID: 38375971 DOI: 10.1111/ajr.13091] [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: 08/21/2023] [Revised: 12/24/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Despite the importance of child road traffic death, the knowledge about rural child road traffic death in Australia is limited. OBJECTIVE To explore the difference of child road traffic death between urban and rural areas. DESIGN This study was a retrospective analysis of road traffic death in Australia among children and adolescents aged 0-19 registered between 1 January 2009 and 30 June 2019. RESULTS During the study period, there were 1757 child road traffic death in Australia, and the crude mortality rate was 2.96 per 100 000 population. The crude mortality rate in remote (8.83 per 100 000 population) and very remote (11.08 per 100 000 population) areas was much higher than major cities (1.83 per 100 000 population), inner regional (5.14 per 100 000 population) and outer regional (5.91 per 100 000 population). CONCLUSIONS Specific targets are needed to address the burden of child road traffic death in Australia around rurality, as it is a significant risk factor of child road traffic death.
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Affiliation(s)
- Soonho Koh
- Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
| | - Doma Kenji
- College of Healthcare Science, Sports and Exercise Science, James Cook University, Townsville, Queensland, Australia
| | - Richard Franklin
- Public Health and Tropical Medicine, James Cook University, Townsville, Queensland, Australia
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Yari A, Hasheminasab M, Fasih P, Nouralishahi A, Arianezhad SM. The pattern of maxillofacial fractures associated with rollover accidents: A 7-year retrospective study. Dent Traumatol 2024; 40:213-220. [PMID: 37881161 DOI: 10.1111/edt.12900] [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: 08/16/2023] [Revised: 09/18/2023] [Accepted: 10/08/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND/AIM This study aimed to assess the incidence and pattern of maxillofacial fractures and related demographic data in the victims of rollover crashes. PATIENTS AND METHODS This retrospective study was based on medical records of patients who sustained maxillofacial injuries following rollover accidents. Investigated data included age, gender, accident date and time, accident cause, seat belt usage, airbag deployment, road type, anatomical location of the facial fracture, and treatment approach. RESULTS Among the 147 patients who met the inclusion criteria, the most prevalent age groups were 20-30 (36.7%) and 30-40 (32.7%) years, with a mean age of 33.6 ± 9.7 years. The male-to-female ratio was 6:1. Most crashes occurred in March, August, and July. These accidents involved 69.4% light vehicles and 39.6% heavy vehicles. The leading causes of rollover crashes were speeding (58.5%) followed by distracted driving (21.1%) and traffic rule violations (13.6%). The most prevalent injuries were fractures of the maxillary sinus wall (40.8%), nasal bones (39.5%), zygomaticomaxillary complex (36.1%), and the mandible (32.6%). Surgical intervention was necessary for 44.2% of patients, while 12.9% of cases underwent close reduction, and 42.9% did not require any surgical intervention. The occurrence of nasal bone fractures was significantly lower in cases where seat belts were worn and zygomatic arch fractures were less frequent in incidents with airbag deployment. CONCLUSIONS In rollover crashes, the midface is the most vulnerable anatomical location. Utilization of seat belts and airbag deployment has the potential to prevent nasal bone and zygomatic arch fractures.
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Affiliation(s)
- Amir Yari
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahboube Hasheminasab
- Department of Oral and Maxillofacial Surgery, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
- Department of Orthodontics, Dugoni School of Dentistry, University of the Pacific, San Francisco, California, USA
| | - Paniz Fasih
- Department of Prosthodontics, School of Dentistry, Kashan University of Medical Sciences, Kashan, Iran
| | - Atieh Nouralishahi
- Sub-Department of Operations and Analytics, Department of Management, Faculty of Environment, Science and Economy, University of Exeter, Exeter, UK
| | - S Marjan Arianezhad
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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O' Reilly M, Wallace E, Merghani K, Conlon B, Breathnach O, Sheehan E. Trauma Assessment Clinic: A virtual fracture clinic model that delivers on its PROMise! J Telemed Telecare 2024; 30:579-588. [PMID: 35285739 DOI: 10.1177/1357633x221076695] [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: 11/16/2022]
Abstract
BACKGROUND The use of virtual fracture clinics across the United Kingdom and Ireland is growing and have been shown in an increasing number of studies to be safe, cost-effective and associated with good functional outcomes and patient satisfaction rates for certain fracture types. Initially pioneered at Glasgow Royal Infirmary, many centres have adopted similar templates, or variations of, and the overall aim of this study was to assess functional outcomes and injury recovery satisfaction rates of patients discharged directly following review in a specific virtual fracture clinic model known as the Trauma Assessment Clinic (TAC). METHODS A prospective observational study was carried out of paediatric (aged <17 years) and adult (aged >17 years) patients, with the five most commonly observed fracture types, who were discharged directly following review at the TAC in a single hospital centre over a 12 month period from January to December 2018. Primary and secondary outcomes were assessed via telephone administered questionnaires and patient reported outcome measures (PROMs). RESULTS A total of 198 patients were included in the study (n = 98 paediatric and n = 100 adult). Overall, 192 (97%) patients or parents/guardians of patients stated that they either strongly agreed (n = 148, 74.9%) or agreed (n = 44, 22.1%) that they were satisfied with their own or their child's recovery from their injury at a median follow-up of 9 months post direct discharge from the TAC. Adult patients had an EQ-5D-5L index median value of 1 (range 0-1), an EQ-VAS median of 87 (range 0-100), a QuickDASH median score of 0 (range 0-100) and a median LEFS of 80 (range 0-80). CONCLUSION The virtual management of trauma patients via the TAC model is a safe and patient-centred approach to treating certain injuries and fracture patterns. This study reports excellent patient reported outcome measures and patient injury recovery satisfaction rates. The use of current available technology in tandem with up-to-date best clinical practice and guidelines play a central role in this novel care pathway.
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Affiliation(s)
- Marc O' Reilly
- Department of Trauma and Orthopaedic Surgery, Midlands Regional Hospital, Tullamore, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Khalid Merghani
- Department of Trauma and Orthopaedic Surgery, Midlands Regional Hospital, Tullamore, Ireland
| | - Breda Conlon
- Department of Trauma and Orthopaedic Surgery, Midlands Regional Hospital, Tullamore, Ireland
| | - Oisin Breathnach
- Department of Trauma and Orthopaedic Surgery, Midlands Regional Hospital, Tullamore, Ireland
| | - Eoin Sheehan
- Department of Trauma and Orthopaedic Surgery, Midlands Regional Hospital, Tullamore, Ireland
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Milasan LH, Farr A, Turnbull I, Scott-Purdy D. Behind the creative canvas: An innovative trauma-informed art-based educational approach using an immersive learning pedagogy. Int J Ment Health Nurs 2024; 33:431-441. [PMID: 37949831 DOI: 10.1111/inm.13250] [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: 09/02/2023] [Revised: 10/13/2023] [Accepted: 10/26/2023] [Indexed: 11/12/2023]
Abstract
Trauma has been increasingly considered in mental health policies and strategies worldwide. However, the implementation of such initiatives into practice remains inconsistent resulting in a fragmented approach to trauma-informed care. One explanation for the current state of trauma services is the unpreparedness of mental health nurses in line with emerging traumagenic theoretical frameworks. We addressed this gap by implementing an innovative pedagogic project co-produced with people with lived experience of trauma. The aim of this qualitative study was to explore mental health nursing students' perspective on the usefulness of an art-based approach to learning about, and working with, trauma in a non-interactive virtual reality (VR) environment. Ten mental health nursing students have been conveniently selected to take part in a focus group. The thematic analysis revealed authenticity, the power of arts, and underutilisation of arts in mental health nursing as key themes following students' reflections and critical discussions. Recommendations to enhance trauma-informed nursing education and practice are made to support an approach that has the potential to instil positive changes in the way mental health nursing students perceive and work with trauma in their practice.
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Affiliation(s)
- Lucian H Milasan
- Nottingham Trent University, Institute of Health and Allied Professions, Mansfield, UK
| | - Andy Farr
- Independent Visual Artist, Coventry, UK
| | - Isabel Turnbull
- Nottingham Trent University, Institute of Health and Allied Professions, Mansfield, UK
| | - Daniel Scott-Purdy
- Nottingham Trent University, Institute of Health and Allied Professions, Mansfield, UK
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Rodriguez VI, Perez B, Fernandez A, Varela C, Teran A. Hollow viscus perforation in blunt abdominal trauma: A 14-year experience from a trauma center. World J Surg 2024; 48:855-862. [PMID: 38353292 DOI: 10.1002/wjs.12096] [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: 09/23/2023] [Accepted: 01/15/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Isolated perforations of hollow viscus (HV) represent less than 1% of injuries in blunt abdominal trauma (BAT). When they do present, they are generally due to high-impact mechanisms in the segments of the intestine that are fixed. The aim of this study is to determine the incidence of major HV injuries in BAT at the "Dr. Domingo Luciani" General Hospital (HDL), and address the literature gap regarding updated HV perforations following BAT, especially in low-income settings. METHODS A retrospective review was conducted on the medical records of patients admitted to our trauma center with a diagnosis of complicated BAT with HV perforation over 14 years. RESULTS AND DISCUSSION Seven hundred sixty-one patients were admitted under the diagnosis of BAT. Of them, 36.79% underwent emergency surgical resolution, and 6.04% had HV perforation as an operative finding. Almost half (44.44%) of these cases presented as a single isolated injury, while the remaining were associated with other intra-abdominal organ injuries. The most common lesions were Grade II-III jejunum and Grade I transverse colon, affecting an equal proportion of patients at 13.33%. In recent years, an increased incidence of HV injuries secondary to BAT has been observed. Despite this, in many cases, the diagnosis is delayed, so even in the presence of negative diagnostic studies, the surgical approach based on the trauma mechanism, hemodynamic status, and systematic reevaluation of the polytraumatized patient should prevail.
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Affiliation(s)
- Veronica I Rodriguez
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
- Catherine and Joseph Aresty Department of Urology, Keck Medicine of USC, Los Angeles, California, USA
| | - Barbara Perez
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
| | - Andrea Fernandez
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
| | - Cristopher Varela
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
| | - Adrian Teran
- Department of General Surgery, Hospital General del Este "Dr. Domingo Luciani", Universidad Central de Venezuela, Caracas, Venezuela
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Lyons HS, Sassani M, Hyder Y, Mitchell JL, Thaller M, Mollan SP, Sinclair AJ, Blanch RJ. A systematic review of optical coherence tomography findings in adults with mild traumatic brain injury. Eye (Lond) 2024; 38:1077-1083. [PMID: 38238577 PMCID: PMC11009235 DOI: 10.1038/s41433-023-02845-w] [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] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/20/2023] [Accepted: 11/13/2023] [Indexed: 03/21/2024] Open
Abstract
Mild traumatic brain injury (mTBI) is common with many patients suffering disabling long-term sequelae, with visual symptoms frequently reported. There are no objective biomarkers of mTBI that are routinely used in clinical practice. Optical coherence tomography (OCT) has been used in mTBI research, as it enables visualisation of the neuroretina, allowing measurement of the retinal nerve fibre layer and ganglion cell layer. This systematic review aims to appraise the available literature and assess whether there are significant changes within the retinal nerve fibre layer and ganglion cell layer in subjects after mTBI. A systematic review was carried out in accordance with PRISMA guidelines and registered with PROSPERO (Number: CRD42022360498). Four databases were searched for relevant literature published from inception until 1 September 2022. Abstracts and full texts were screened by three independent reviewers. Initial screening of databases yielded 341 publications, of these, three fulfilled all the criteria for inclusion. All three studies showed thinning of the retinal nerve fibre layer, whereas there were no significant changes in the ganglion cell layer. This systematic review demonstrated that thinning of the retinal nerve fibre layer (but not of the ganglion cell layer) is associated with mTBI. It provides preliminary evidence for the use of the retinal nerve fibre layer as a potential biomarker of damage to the visual system in mTBI. Further prospective longitudinal studies ensuring uniform diagnosis and accurate phenotyping of mTBI are needed to understand the effects on the visual system and potential of OCT as a prognostic biomarker.
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Affiliation(s)
- Hannah S Lyons
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Matilde Sassani
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Yousef Hyder
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - James L Mitchell
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
- Academic Department of Medical Rehabilitation, Defence Medical Rehabilitation, Stanford Hall, Loughborough, UK
| | - Mark Thaller
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Susan P Mollan
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK
| | - Alexandra J Sinclair
- Translational Brain Science, Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, B15 2WB, UK
| | - Richard J Blanch
- Department of Ophthalmology, University Hospitals Birmingham NHS Foundation Trust, West Midlands, UK.
- Royal Centre for Defence Medicine, Birmingham, UK.
- Neuroscience and Ophthalmology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.
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Ayalon L, Cohn-Schwartz E, Sagi D. Global Conflict and the Plight of Older Persons: Lessons From Israel. Am J Geriatr Psychiatry 2024; 32:509-511. [PMID: 38135594 DOI: 10.1016/j.jagp.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 11/29/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Liat Ayalon
- Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.
| | - Ella Cohn-Schwartz
- Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel
| | - Doron Sagi
- Gerontology Department, Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University, Beer-Sheba, Israel; Applied Gerontology internship, College of Law and Business, Ramat Gan, Israel; AMCHA National Israeli Center for Psychosocial Support of Survivors of the Holocaust and the Second Generation, Israel
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Weaver AJ, McIntosh CS, Kelly SG, Barrera GD, Lizarraga S, Hildreth KE, Williams CE, Grantham L, Yoshida T, Omert L, Bynum JA, Meledeo MA, Reddoch-Cardenas KM. Evaluating the effects of hypoxic storage on platelet function and health using a novel storage system. Transfusion 2024; 64:693-704. [PMID: 38511850 DOI: 10.1111/trf.17784] [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] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 01/14/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Thousands of units of whole blood (WB) and blood components are transfused daily to treat trauma patients. Improved methods for blood storage are critical to support trauma-related care. The Hemanext ONE® system offers a unique method for hypoxic storage of WB, with successfully demonstrated storage of clinically viable RBCs. This work evaluated the system for the storage of WB, focusing on platelet health and function. STUDY DESIGN AND METHODS WB was collected from healthy donors and processed through the Hemanext ONE® system. Hemoglobin oxygen saturation (HbSO2) levels of WB were depleted to 10%, 20%, or 30% of total HbSO2 and then stored in PVC bags sealed in oxygen-impermeable bags (except for normoxic control) with samples collected on days 1, 7, and 14 post-processing. Flow cytometry assessed the activation and apoptosis of platelets. Clot dynamics were assessed based on aggregometry and thromboelastography assays, as well as thrombin generation using a calibrated-automated thrombogram method. RESULTS Hypoxic storage conditions were maintained throughout the storage period. Hypoxia triggered increased lactate production, but pH changes were negligible compared to normoxic control. Storage at 10% HbSO2 had a significant impact on platelet function, resulting in increased activation and reduced clot formation and aggregation. These effects were less significant at 20% and 30% HbSO2. DISCUSSION This study indicates that platelets are sensitive to hypoxic storage and suffer significant metabolic and functional deterioration when stored at or below 10% HbSO2.
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Affiliation(s)
- A J Weaver
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - C S McIntosh
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - S G Kelly
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - G D Barrera
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - S Lizarraga
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - K E Hildreth
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - C E Williams
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - L Grantham
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
| | - T Yoshida
- Hemanext Inc., Lexington, Massachusetts, USA
| | - L Omert
- Hemanext Inc., Lexington, Massachusetts, USA
| | | | - M A Meledeo
- United States Army Institute of Surgical Research, Fort Sam Houston, Texas, USA
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Cevik J, Read D, Putland M, Fazio T, Gumm K, Varma A, Santos R, Ramakrishnan A. The impact of electric scooters in Melbourne: data from a major trauma service. ANZ J Surg 2024; 94:572-579. [PMID: 38087881 DOI: 10.1111/ans.18814] [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: 10/19/2023] [Revised: 11/14/2023] [Accepted: 11/22/2023] [Indexed: 04/17/2024]
Abstract
BACKGROUND The proliferation of electric scooters globally has been associated with an increase in related injuries and consequent economic burden. This study aims to assess the injury patterns and the economic impact associated with electric scooter use in Melbourne, Australia. METHODS A retrospective cohort study was conducted using hospital and registry data from January 2022 to January 2023. Data collected included demographic details, alcohol and helmet use, injury type and severity, operative treatment provided, and direct medical costs. The economic impact (in AUD) of the patient's emergency presentation and hospital admission was calculated. RESULTS During the study period, 256 electric scooter related injuries were recorded, comprising 247 riders and nine pedestrians. The majority of patients were males (69%) with a median age of 29.5 (15-78). Alcohol use was reported by 34% and helmet use by 33%. Injuries most commonly affected the upper limb (53%) and head (50%), with abrasions (75%) and fractures (48%) being the most common type of injury sustained. The total hospital cost was $1 911 062, and the median cost was $1321.66 per patient (IQR: $479.37-$5096.65). CONCLUSION Electric scooter usage, as observed through patient presentations to the Royal Melbourne Hospital, is associated with a considerable number of injuries, primarily among young males, and an ensuing substantial economic burden. The findings underscore the urgent need for improved safety measures to minimize electric scooter-related injuries and their clinical and economic repercussions.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Read
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Putland
- Emergency Department, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Critical Care, The University of Melbourne, Melbourne, Victoria, Australia
| | - Timothy Fazio
- Health Intelligence Unit, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kellie Gumm
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amrita Varma
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Roselyn Santos
- Trauma Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic Surgery, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
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Chee E, Mihalko E, Nellenbach K, Sollinger J, Huang K, Hon M, Pandit S, Cheng K, Brown A. Wound-triggered shape change microgels for the development of enhanced biomimetic function platelet-like particles. J Biomed Mater Res A 2024; 112:613-624. [PMID: 37846887 DOI: 10.1002/jbm.a.37625] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/14/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
Platelets play a pivotal role in hemostasis and wound healing and conditional shape change is an important component of platelet functionality. In normal circumstances, platelets travel through the circulatory system in an inactive rounded state, which enables platelets to easily move to vessel walls for attachment. When an injury occurs, platelets are prompted by molecules, such as thrombin, to shift into a stellate shape and increase exposure of fibrin-binding receptors. When active, platelets promote hemostasis and clot retraction, which enhances clot stability and promotes healing. However, in conditions where platelets are depleted or hyporeactive, these functions are diminished and lead to inhibited hemostasis and healing. To treat platelet depletion, our group developed platelet-like particles (PLPs) which consist of highly deformable microgels coupled to fibrin binding motif. However, first generation PLPs do not exhibit wound-triggered shape change like native platelets. Thus, the objective of these studies was to develop a PLP formulation that changes shape when prompted by thrombin. To create thrombin-sensitive PLPs (TS-PLPs), we incorporated a thrombin-cleavable peptide into the microgel body and then evaluated PLP properties before and after exposure to thrombin including morphology, size, and in vitro clot retraction. Once thrombin-prompted shape change ability was confirmed, the TS-PLPs were tested in vivo for hemostatic ability and subsequent wound healing outcomes in a murine liver trauma model. We found that TS-PLPs exhibit a wound-triggered shape change, induce significant clot retraction following exposure to thrombin and promote hemostasis and healing in vivo after trauma.
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Affiliation(s)
- Eunice Chee
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Emily Mihalko
- Trauma and Transfusion Medicine Research Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kimberly Nellenbach
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Jennifer Sollinger
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA
| | - Ke Huang
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Mason Hon
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA
| | - Sanika Pandit
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
| | - Ke Cheng
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Ashley Brown
- Joint Department of Biomedical Engineering, North Carolina State University and University of North Carolina-Chapel Hill, Raleigh, North Carolina, USA
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina, USA
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Silva R, Barreto J, Ferreira F, Areias M, Oliveira C, Alpoim B. Tibial Eminence Avulsion in a Tibial Plateau Fracture - Our Approach: A Clinical Case. Rev Bras Ortop 2024; 59:e318-e322. [PMID: 38606129 PMCID: PMC11006521 DOI: 10.1055/s-0041-1726067] [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: 10/13/2020] [Accepted: 12/01/2020] [Indexed: 10/21/2022] Open
Abstract
A middle-aged female patient with a tibial plateau fracture combined with an avulsion of the tibial eminence was treated with a combination of medial plate fixation for the plateau and an arthroscopic aided nonabsorbable suture of the eminence. Our technique for tibial eminence avulsion fractures has no interference with tibial plateau osteosynthesis materials and has proven, once again, to have good results in the treatment of combined and complex injuries of the knee.
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Affiliation(s)
- Rómulo Silva
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - José Barreto
- Departamento de Medicina Física e Reabilitação, Centro Hospitalar Entre Douro e Vouga (CHEDV), Santa Maria da Feira, Portugal
| | - Filomena Ferreira
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Margarida Areias
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Carolina Oliveira
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
| | - Bruno Alpoim
- Departamento de Ortopedia e Traumatologia, Unidade Local de Saúde do Alto Minho (ULSAM), Viana do Castelo, Portugal
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Meyer CH, Aworanti E, Santos A, Castater C, Bauman ZM, Archer-Arroyo K, Sola R, Grant A, Smith RN, Sciarretta JD, Nguyen JH. Is Traumatic Anterior Stove-In Chest Truly so Rare? A Single Institution Experience. Am Surg 2024; 90:695-702. [PMID: 37853722 PMCID: PMC10922850 DOI: 10.1177/00031348231209530] [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] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION The anterior stove-in chest (ASIC) is a rare form of flail chest involving bilateral rib or sternal fractures resulting in an unstable chest wall that caves into the thoracic cavity. Given ASIC has only been described in a handful of case reports, this study sought to review our institution's experience in the surgical management of ASIC injuries. METHODS A retrospective review of patients with ASIC was conducted at our level I trauma center from 1//2021 to 3//2023. Information pertaining to patient demographics, fracture pattern, operative management, and outcomes was obtained and compared across patients in the case series. RESULTS 6 patients met inclusion criteria, all males aged 37-78 years. 5 suffered motor vehicle collisions, and 1 was a pedestrian struck by an automobile. The median injury severity score was 28. All received ORIF within 5 days of admission, most commonly for ongoing respiratory distress. Patients 2 and 4 underwent bilateral ORIF of the ribs and sternum while patients 1, 5, and 6 underwent left-sided repair. Patient 3 required ORIF of left ribs and the sternum to stabilize their injuries. 5 of 6 patients were liberated from the ventilator and survived to discharge. CONCLUSIONS This study demonstrates successful operative management of 6 patients with ASIC and suggests that early operative intervention with ORIF for affected segments may improve respiratory mechanics, ability to wean from the ventilator, and overall survival. Further research is needed to generate standardized guidelines for the management of this uncommon and complex thoracic injury.
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Affiliation(s)
- Courtney H. Meyer
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Adora Santos
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Christine Castater
- Grady Health System, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
| | | | - Krystal Archer-Arroyo
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | | | | | - Randi N. Smith
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Jason D. Sciarretta
- Emory University School of Medicine, Atlanta, GA, USA
- Grady Health System, Atlanta, GA, USA
| | - Jonathan H. Nguyen
- Grady Health System, Atlanta, GA, USA
- Morehouse School of Medicine, Atlanta, GA, USA
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Gomez GI, Li GQ, Valido AA, Stoner AJ, Bromley-Dulfano RA, Sheira D, Gonzalez CA, Khan SI, Choi J, Zygourakis CC, Weiser TG. Thoracic and Lumbar Spine Injury: Evidence-Based Diagnosis, Management, and Outcomes. Am Surg 2024; 90:902-910. [PMID: 37983195 DOI: 10.1177/00031348231216479] [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: 11/22/2023]
Abstract
BACKGROUND Traumatic thoracolumbar spine injuries are associated with significant morbidity and mortality. Targeted for non-spine specialist trauma surgeons, this systematic scoping review aimed to examine literature for up-to-date evidence on presentation, management, and outcomes of thoracolumbar spine injuries in adult trauma patients. METHODS This review was reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. We searched four bibliographic databases: PubMed, EMBASE, Web of Science, and the Cochrane Library. Eligible studies included experimental, observational, and evidence-synthesis articles evaluating patients with thoracic, lumbar, or thoracolumbar spine injury, published in English between January 1, 2010 and January 31, 2021. Studies which focused on animals, cadavers, cohorts with N <30, and pediatric cohorts (age <18 years old), as well as case studies, abstracts, and commentaries were excluded. RESULTS A total of 2501 studies were screened, of which 326 unique studies were fully text reviewed and twelve aspects of injury management were identified and discussed: injury patterns, determination of injury status and imaging options, considerations in management, and patient quality of life. We found: (1) imaging is a necessary diagnostic tool, (2) no consensus exists for preferred injury characterization scoring systems, (3) operative management should be considered for unstable fractures, decompression, and deformity, and (4) certain patients experience significant burden following injury. DISCUSSION In this systematic scoping review, we present the most up-to-date information regarding the management of traumatic thoracolumbar spine injuries. This allows non-specialist trauma surgeons to become more familiar with thoracolumbar spine injuries in trauma patients and provides a framework for their management.
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Affiliation(s)
- Giselle I Gomez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Guan Q Li
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Austin A Valido
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | | | - Rebecca A Bromley-Dulfano
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Dina Sheira
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Cayo A Gonzalez
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Suleman I Khan
- Stanford University School of Medicine, Stanford, CA, USA
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
| | - Jeff Choi
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
| | | | - Thomas G Weiser
- Surgeons Writing About Trauma, Stanford University, Stanford, CA, USA
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, CA, USA
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Puppalla P, Pick C, Graves J, Harfouche M. Youth Violence Does not Discriminate: Inclusive Violence Prevention Support Services Focused on Counseling and Peer Support are Essential for Youth and Young Adults. Am Surg 2024:31348241244640. [PMID: 38557219 DOI: 10.1177/00031348241244640] [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 Violence disproportionately affects individuals of low socioeconomic status, and rates of injury amongst youth and young adults (YYAs) are rising. Little is known about how the social needs of this high-risk subgroup compared to the overall violently injured population. METHODS This is a retrospective review of an intake assessment of violently injured victims admitted to a level I trauma center (Jan 2022-Aug 2023). Data collected include race, age, mechanism of injury, and protective and predisposing factors for violent injury. We compared the risk factors of YYAs (=≤ 24 years) to those of adults (>24) and evaluated rates and types of violence prevention services requested by age group. RESULTS Of 350 individuals surveyed, 94 (27%) were <= 24 years and 256 (73%) were >24 years. Younger patients were less likely to be male (77% vs 86%, P = .03) and experienced more firearm injury (76% vs 51%, P < .001). They reported less alcohol use (20% vs 38%, P < .001), similar rates of mental illness (25% vs 26%, P = .62), less housing instability (5% vs 22%, P < .001), and similar access to government benefits (20% vs 29%, P = .2) compared to the older cohort. Services were requested by 41% of the study population (N = 142); the younger cohort was 2.9 times more likely to request non-financial services (P = .042). DISCUSSION Violently injured youth and young adults (YYAs) experience disproportionately high rates of gun violence. Efforts should be made to prioritize legal, peer support, and mental health services over financial services for this population.
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Affiliation(s)
| | - Carly Pick
- University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
| | - Justin Graves
- University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA
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Zargari M, Jo J, Williams K, Yengo-Kahn AM, Vance EH, Bonfield CM, Terry DP, Zuckerman SL. Sport-related concussion in 8- to 12-year-olds: an understudied population. J Neurosurg Pediatr 2024; 33:390-397. [PMID: 38306638 DOI: 10.3171/2023.10.peds23410] [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: 09/05/2023] [Accepted: 10/26/2023] [Indexed: 02/04/2024]
Abstract
OBJECTIVE Most studies regarding sport-related concussion (SRC) focus on high school and collegiate athletes; however, little has been published on children younger than 12 years of age. In a cohort of children aged 8-12 years with SRC, the authors sought to describe demographics, initial presentation, and recovery in this understudied population. METHODS A retrospective cohort study of children aged 8-12 years who sustained an SRC between November 2017 and April 2022 and were treated at a regional sports concussion center was conducted. Demographic information, injury characteristics, traditional Sport Concussion Assessment Tool 5 (SCAT5) and Child/Parent SCAT5 scores, and outcomes, defined as days to return to learn (RTL), symptom resolution, and return to play (RTP), were reported. Outcomes in boys and girls were compared using effect size analyses given sample size constraints. RESULTS Forty-seven athletes were included. The mean age was 11.0 ± 0.8 years, and the majority were male (34, 72.3%). A sizable proportion of patients visited an emergency department (19, 40.4%), and many received head imaging (16, 34.0%), mostly via CT (n = 13). The most common sport for boys was football (15, 44.1%), and the most common sports for girls were soccer (4, 30.8%) and cheerleading (4, 30.8%). These athletes reported a variety of symptoms on presentation. It took a mean of 8.8 ± 10.8 days to RTL, 27.3 ± 38.3 days to reach symptom resolution, and 35.4 ± 41.9 days to RTP. When comparing boys versus girls, there appeared to be moderate differences in symptom severity scores (Cohen's d = 0.44 for SCAT5, 0.13 for Child SCAT5, and 0.38 for Parent SCAT5) and minimal differences in recovery (Cohen's d = 0.11 for RTL, n = 35; 0.22 for symptom resolution, n = 22; and 0.12 for RTP, n = 21). CONCLUSIONS In this cohort of concussed athletes aged 8-12 years, a little less than half of the athletes initially presented to the emergency department, and approximately one-third received acute head imaging. Across all athletes, the mean RTL was slightly more than a week and the mean symptom resolution and RTP were both approximately 1 month; however, much of the cohort is missing recovery outcome measures. This study demonstrated a strong positive correlation between Child SCAT5 and Parent SCAT5 symptom reporting. Future efforts are needed to evaluate differences in clinical presentation and outcomes following SRC between children and older populations.
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Affiliation(s)
| | - Jacob Jo
- 1Vanderbilt University School of Medicine, Nashville
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kristen Williams
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aaron M Yengo-Kahn
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - E Haley Vance
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Christopher M Bonfield
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Douglas P Terry
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Scott L Zuckerman
- 2Department of Neurological Surgery, Vanderbilt Sports Concussion Center, Vanderbilt University Medical Center, Nashville; and
- 3Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Dahman M, Abusulayman L, Alharbi N, Joueidi F, Abdulrahim O, Al-Omran M. Open repair of transverse cervical pseudoaneurysm. J Surg Case Rep 2024; 2024:rjae216. [PMID: 38572277 PMCID: PMC10989297 DOI: 10.1093/jscr/rjae216] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
A 40-year-old woman was referred to the vascular surgery clinic complaining of right shoulder pain and swelling secondary to blunt trauma 4 months ago. Computed tomography angiography showed a partially thrombosed supraclavicular pseudoaneurysm adjacent to the subclavian artery measuring 4.5 × 4 × 3.1 cm. Open repair surgery with resection of the pseudoaneurysm was successfully performed without injury to the capsule. Patient was stable and discharged 2 days later with no complications.
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Affiliation(s)
- Mohammed Dahman
- Department of Vascular Surgery and Endovascular Therapy, Department of Surgery, King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh 12713, Saudi Arabia
| | - Lina Abusulayman
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Norah Alharbi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Faisal Joueidi
- College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia
| | - Omer Abdulrahim
- Department of Vascular Surgery and Endovascular Therapy, Department of Surgery, King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh 12713, Saudi Arabia
| | - Mohammed Al-Omran
- Department of Vascular Surgery and Endovascular Therapy, Department of Surgery, King Faisal Specialist Hospital and Research Center (KFSH&RC), Riyadh 12713, Saudi Arabia
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Koppelmaa K, Yde Ohki CM, Walter NM, Walitza S, Grünblatt E. Stress as a mediator of brain alterations in attention-deficit hyperactivity disorder: A systematic review. Compr Psychiatry 2024; 130:152454. [PMID: 38281339 DOI: 10.1016/j.comppsych.2024.152454] [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: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/20/2024] [Indexed: 01/30/2024] Open
Abstract
OBJECTIVE Stress is a known risk factor for numerous psychopathologies, whereas evidence is lacking regarding the specific consequences of stress on the neural basis of attention-deficit hyperactivity disorder (ADHD). A systematic literature review was thus conducted to clarify the role of stress in the association between the resulting alterations of brain structure, connectivity, and function in ADHD. METHODS The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under identifier CRD42023379809. A systematic search of the PubMed and CINAHL databases was conducted for articles published prior to December 22nd, 2022. Retrieved literature was screened in Rayyan and data extraction was performed with respect to neuroimaging, stress exposure, and ADHD outcomes. The Quality in Prognosis Studies (QUIPS) tool was adapted based on the Conducting Systematic Reviews and Meta-Analyses of Observational Studies of Etiology (COSMOS-E) guidance article to assess risk of bias and quality of studies. Strength of the evidence was assessed under the guidance of the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. RESULTS Screening 25,026 non-duplicate articles yielded 20 eligible studies for inclusion. Exposure to early life trauma, institutionalization, prenatal smoking or alcohol consumption, air pollution, low socioeconomic status, or low birth weight were associated with alterations in brain structure, function, and connectivity in ADHD. However, most studies did not provide strong evidence due to small sample sizes and lack of statistical approaches to determine a direct mediation of the association between stress and ADHD by neural outcomes. CONCLUSION This systematic review was the first to summarize evidence of structural and functional stress-associated alterations in the brain, which were found to be directly and indirectly associated with ADHD outcomes. Overall, stress requires consideration as a significant determinant of neurodevelopmental outcomes in ADHD. However, extensive further research is warranted due to little available evidence and the difficulty of obtaining clear results. In light of such a complex research question, in order to confirm findings, provide further evidence, and establish causality systematic longitudinal studies would be required. Investigating the topic may provide invaluable information when it comes to tailoring prevention and treatment strategies in ADHD, and should be pursued in order to integrate the factor of stress into a more comprehensive understanding of ADHD.
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Affiliation(s)
- Kristin Koppelmaa
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Department of Health Sciences and Technology, ETH, Zurich, Zurich, Switzerland
| | - Cristine Marie Yde Ohki
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Natalie Monet Walter
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and the ETH, Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland
| | - Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and the ETH, Zurich, Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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Polhill SE, Lape EC, Deyo AG, Smit T, Zvolensky MJ, Zale EL, Ditre JW. Pain Intensity, Pain-Related Anxiety, and Hazardous Drinking Among Individuals With PTSD. J Dual Diagn 2024; 20:122-131. [PMID: 38408374 DOI: 10.1080/15504263.2024.2319034] [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: 02/28/2024]
Abstract
OBJECTIVE Evidence suggests that pain intensity may be indirectly linked to hazardous drinking and PTSD symptom severity via pain-related anxiety. The goal of this analysis was to test the hypotheses in a population with PTSD symptoms that pain intensity would be positively and indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via pain-related anxiety. METHODS Heavy drinkers with probable PTSD were recruited via Qualtrics panels (N = 371, 53% Female, Mage = 39.68, SD = 10.86). Linear regression and conditional process models were conducted to examine indirect associations between pain intensity and primary outcomes via pain-related anxiety. RESULTS Pain intensity was found to be indirectly associated with hazardous drinking, alcohol dependence, alcohol-related problems, and PTSD symptom severity via greater pain-related anxiety. CONCLUSION These initial findings suggest that pain-related anxiety may play an important role in relations between the experience of pain and hazardous patterns of alcohol consumption among individuals with probable PTSD. Future research is needed to determine the temporal nature of these associations and to examine the potential utility of treatments that address pain-related anxiety in the context of comorbid pain, PTSD, and hazardous drinking.
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Affiliation(s)
- Sarah E Polhill
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Emma C Lape
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - Alexa G Deyo
- Department of Psychology, Syracuse University, Syracuse, NY, USA
| | - T Smit
- Department of Psychology, University of Houston, Houston, TX, USA
| | - M J Zvolensky
- Department of Psychology, University of Houston, Houston, TX, USA
- HEALTH Institute, University of Houston, Houston, TX, USA
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Emily L Zale
- Department of Psychology, Binghamton University, Binghamton, NY, USA
| | - Joseph W Ditre
- Department of Psychology, Syracuse University, Syracuse, NY, USA
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April MD, Fisher AD, Rizzo JA, Wright FL, Winkle JM, Schauer SG. Early Vital Sign Thresholds Associated with 24-Hour Mortality among Trauma Patients: A Trauma Quality Improvement Program (TQIP) Study. Prehosp Disaster Med 2024; 39:151-155. [PMID: 38563282 DOI: 10.1017/s1049023x24000207] [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: 04/04/2024]
Abstract
BACKGROUND Identifying patients at imminent risk of death is critical in the management of trauma patients. This study measures the vital sign thresholds associated with death among trauma patients. METHODS This study included data from patients ≥15 years of age in the American College of Surgeons Trauma Quality Improvement Program (TQIP) database. Patients with vital signs of zero were excluded. Documented prehospital and emergency department (ED) vital signs included systolic pressure, heart rate, respiratory rate, and calculated shock index (SI). The area under the receiver operator curves (AUROC) was used to assess the accuracy of these variables for predicting 24-hour survival. Optimal thresholds to predict mortality were identified using Youden's Index, 90% specificity, and 90% sensitivity. Additional analyses examined patients 70+ years of age. RESULTS There were 1,439,221 subjects in the 2019-2020 datasets that met inclusion for this analysis with <0.1% (10,270) who died within 24 hours. The optimal threshold for prehospital systolic pressure was 110, pulse rate was 110, SI was 0.9, and respiratory rate was 15. The optimal threshold for the ED systolic was 112, pulse rate was 107, SI was 0.9, and respiratory rate was 21. Among the elderly sub-analysis, the optimal threshold for prehospital systolic was 116, pulse rate was 100, SI was 0.8, and respiratory rate was 21. The optimal threshold for ED systolic was 121, pulse rate was 95, SI was 0.8, and respiratory rate was 0.8. CONCLUSIONS Systolic blood pressure (SBP) and SI offered the best predictor of mortality among trauma patients. The SBP values predictive of mortality were significantly higher than the traditional 90mmHg threshold. This dataset highlights the need for better methods to guide resuscitation as initial vital signs have limited accuracy in predicting subsequent mortality.
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Affiliation(s)
- Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
- 14th Field Hospital, Fort Stewart, GeorgiaUSA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New MexicoUSA
| | - Julie A Rizzo
- Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
- Brooke Army Medical Center, JBSA Fort Sam Houston, TexasUSA
| | - Franklin L Wright
- University of Colorado School of Medicine, Department of Surgery, Aurora, ColoradoUSA
| | - Julie M Winkle
- University of Colorado School of Medicine, Departments of Anesthesia and Emergency Medicine, Aurora, ColoradoUSA
| | - Steven G Schauer
- Uniformed Services University of the Health Sciences, Bethesda, MarylandUSA
- University of Colorado School of Medicine, Departments of Anesthesia and Emergency Medicine, Aurora, ColoradoUSA
- University of Colorado School of Medicine Center for Combat and Battlefield (COMBAT) Research, Aurora, ColoradoUSA
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Stoddart MT, Panagopoulos GN, Craig RS, Falworth M, Butt D, Rudge W, Higgs D, Majed A. A systematic review of the treatment of distal humerus fractures in older adults: A comparison of surgical and non-surgical options. Shoulder Elbow 2024; 16:175-185. [PMID: 38655404 PMCID: PMC11034469 DOI: 10.1177/17585732221099845] [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] [Received: 02/04/2022] [Revised: 04/24/2022] [Accepted: 04/24/2022] [Indexed: 04/26/2024]
Abstract
Background Fractures of the distal humerus are a common fragility fracture in older adults. The purpose of this study was to systematically review the literature to produce pooled estimates of the outcomes of treatment using total elbow arthroplasty (TEA), open reduction and locking plate fixation (ORIF), hemiarthroplasty or with conservative management. Methods A systematic review of PUBMED and EMBASE databases was conducted for studies reporting outcomes of intra-articular fractures in older adults. Data extracted included patient-reported outcome measures as well as clinical outcomes including ROM, adverse events and all-cause reoperation rates. Results Forty-eight studies met the inclusion criteria and included 1838 acute, intra-articular distal humeral fractures. There was no clinically important difference in patient-reported pain and function measured on the Mayo Elbow Performance Score (TEA = 89.3 (SD 20.0), Hemi = 88.4 (SD 10.6), internal fixation = 85.0 (SD 14.7), non-operative = 85.1 (SD 11.0)). Discussion Each of the treatment modalities studies resulted in a reasonable level of elbow function. The included studies were largely non-comparative and at considerable risk of bias. As elbow replacement surgery becomes centralised in the UK, there is a real need for high-quality comparative research studies to inform practice.
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Affiliation(s)
| | | | - Richard S. Craig
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Botnar Research Centre, University of Oxford, Oxford, UK
| | - Mark Falworth
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - David Butt
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Will Rudge
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Deborah Higgs
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Addie Majed
- Shoulder & Elbow Service, Royal National Orthopaedic Hospital, Stanmore, UK
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Tejuoso A, George A, Johnson S, Geller AE, Kapple P, Ziegler C, Miller K, Choi K. Gunshot wound injury to the genitourinary tract: a 4-year retrospective review at an academic level 1 trauma center. Transl Androl Urol 2024; 13:406-413. [PMID: 38590963 PMCID: PMC10999030 DOI: 10.21037/tau-23-466] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/18/2024] [Indexed: 04/10/2024] Open
Abstract
Background Firearm injuries increased significantly during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to describe our experience with patients admitted to a level 1 trauma center with gunshot-related trauma to the genitourinary (GU) tract before and during COVID-19 pandemic. Methods Patients sustaining gunshot-related trauma to the adrenals, kidneys, ureters, bladder, scrotum, testicles, penis, and urethra between January 1, 2018 and December 31, 2021 were identified from our institutional trauma database. Patient charts were queried to extract demographic information, management, and follow-up. Results A total of 117 patients met inclusion criteria with 39 (33%) of GU injuries occurring pre-COVID, and 78 (67%) occurring during or post-COVID. Seventy-two (62%) presented with kidney injury. Patients injured in the pre-COVID period were more likely to participate in a follow-up visit by 2.17 times at 60 days (P=0.017), 1.98 times at 90 days (P=0.030), and 2.04 times at 1-year (P=0.014) than during COVID. Pre-COVID, 46% of patients were injured in the city's northwestern region and 54% from other areas, during COVID 24% of patients came from the northwestern region compared to 76% from other areas (P=0.029). Conclusions Gunshot wounds (GSW) involving the GU tract increased during the COVID-19 pandemic, with renal injury most frequent. Follow-up visits declined by around half during the pandemic, primarily at 60 days, 90 days, and 1 year post-injury. The number of patients admitted with urologic injuries pre-COVID versus during COVID was significantly different depending on the patient's area of residence. More work is needed to evaluate the outcomes of traumatic GU injuries due to GSW pre- and post-pandemic.
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Affiliation(s)
| | - Abigail George
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Sarah Johnson
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Anne E. Geller
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Parris Kapple
- University of Louisville School of Medicine, Louisville, KY, USA
| | - Craig Ziegler
- Office of Graduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Keith Miller
- Department of General Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kellen Choi
- Department of Urology, University of Louisville School of Medicine, Shelbyville, KY, USA
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Kiiroja L, Stewart SH, Gadbois S. Can scent-detection dogs detect the stress associated with trauma cue exposure in people with trauma histories? A proof-of-concept study. Front Allergy 2024; 5:1352840. [PMID: 38606088 PMCID: PMC11006987 DOI: 10.3389/falgy.2024.1352840] [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: 12/09/2023] [Accepted: 02/02/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Post-traumatic stress disorder (PTSD) is an impairing mental health condition with high prevalence among military and general populations alike. PTSD service dogs are a complementary and alternative intervention needing scientific validation. We investigated whether dogs can detect putative stress-related volatile organic compounds (VOCs) in the breath of people with trauma histories (54% with PTSD) exposed to personalized trauma cues. Methods Breath samples were collected from 26 humans over 40 experimental sessions during a calm (control breath sample) and stressed state induced by trauma cue exposure (target breath sample). Two scent detection canines were presented with the samples in a two alternative forced choice (2AFC) discrimination and yes/no detection task. The 2AFC task assessed the dogs' ability to discriminate between the two states within the breath samples of one individual. The detection task determined their ability to generalize the target odour across different individuals and different stressful events of one individual. Signal Detection Theory was applied to assess dogs' sensitivity, specificity, precision, and response bias. Results The dogs performed at ∼90% accuracy across all sample sets in the discrimination experiment, and at 74% and 81% accuracy, respectively, in the detection experiment. Further analysis of dog olfactory performance in relation to human donor self-reported emotional responses to trauma cue exposure suggested the dogs may have been detecting distinct endocrine stress markers. One dog's performance correlated with the human donors' self-reported fear responses and the other dog's performance correlated with the human donors' self-reported shame responses. Based on these correlations between dog performance and donor self-report measures, we speculate that the VOCs each dog was detecting likely originated from the sympathetico-adreno-medullary axis (SAM; adrenaline, noradrenaline) in the case of the first dog and the hypothalamo-pituitary-adrenal axis (HPA; glucocorticoids) in the case of the second dog. Conclusion Our proof-of-concept study is the first to demonstrate that some dogs can detect putative VOCs emitted by people with trauma histories when experiencing distress theoretically associated with the intrusion and arousal/reactivity symptoms of PTSD. Results have potential to improve the effectiveness and training protocol of PTSD service dogs with a focus on enhancing their alert function.
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Affiliation(s)
- Laura Kiiroja
- Canine Olfaction Lab, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Sherry H. Stewart
- Canine Olfaction Lab, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
- Mood, Anxiety, and Addictions Comorbidity (MAAC) Lab, Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Simon Gadbois
- Canine Olfaction Lab, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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Ahmed Pihlgren S, Johansson L, Holmes EA, Kanstrup M. Exploring healthcare workers' experiences of a simple intervention to reduce their intrusive memories of psychological trauma: an interpretative phenomenological analysis. Eur J Psychotraumatol 2024; 15:2328956. [PMID: 38533843 PMCID: PMC10977018 DOI: 10.1080/20008066.2024.2328956] [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: 12/07/2023] [Accepted: 03/02/2024] [Indexed: 03/28/2024] Open
Abstract
ABSTRACTBackground: Many healthcare workers (HCWs) endured psychologically traumatic events at work during the coronavirus disease 2019 (COVID-19) pandemic. For some, these events are re-experienced as unwanted, recurrent, and distressing intrusive memories. Simple psychological support measures are needed to reduce such symptoms of post-traumatic stress in this population. A novel intervention to target intrusive memories, called an imagery-competing task intervention (ICTI), has been developed from the laboratory. The intervention includes a brief memory reminder cue, then a visuospatial task (Tetris® gameplay using mental rotation instructions for approximately 20 min) thought to interfere with the traumatic memory image and reduce its intrusiveness. The intervention has been adapted and evaluated in a randomized controlled trial (RCT) with Swedish HCWs (ClinicalTrials.gov identifier: NCT04460014).Objective: We aimed to explore how HCWs who worked during the COVID-19 pandemic experienced the use of a brief intervention to reduce their intrusive memories of work-related trauma.Method: Interpretative phenomenological analysis was used for in-depth understanding of the lived experiences of HCWs who used the intervention. Seven participants from the RCT were interviewed by an independent researcher without prior knowledge of the intervention. Interviews were conducted via telephone and transcribed verbatim.Results: Four general themes were generated: 'Triggers and troublesome images', 'Five Ws regarding support - what, when, why, by/with who, for whom', 'Receiving it, believing it, and doing it' and 'The intervention - a different kind of help'; the last two included two subthemes each. The results reflect participants' similarities and differences in their lived experiences of intrusive memories, support measures, and intervention impressions and effects.Conclusion: HCWs' experiences of the novel ICTI reflect a promising appraisal of the intervention as a potential help measure for reducing intrusive memories after trauma, and gives us a detailed understanding of HCWs' needs, with suggestions for its adaption for future implementation.Trial registration: ClinicalTrials.gov identifier: NCT04460014.
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Affiliation(s)
- Sara Ahmed Pihlgren
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lotta Johansson
- The Neurosurgical Intensive Care Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Caring Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Emily A. Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marie Kanstrup
- Department of Psychology, Uppsala University, Uppsala, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Theme Women’s Health and Allied Health Professionals, Medical Unit for Medical Psychology, Karolinska University Hospital, Solna, Sweden
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Jaume-Feliciosi N, Benca-Bachman CE, Holliday E, Palmer RH. Individual Differences in Substance Use Motives, Trauma, and Stress Among College-Based Polysubstance Users. Subst Use Misuse 2024; 59:1228-1239. [PMID: 38544304 DOI: 10.1080/10826084.2024.2330911] [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: 04/26/2024]
Abstract
Background: Co-use of alcohol and other drugs within a certain time frame (i.e., polysubstance use) has become increasingly prevalent, particularly among college-aged individuals, but understanding motives for co-use remains limited. Polysubstance use has been associated with a higher likelihood of negative health consequences as compared to single substance use. Objectives: The current study examined associations between motivations for using alcohol, tobacco, and cannabis among college students who use multiple substances versus students using only one substance or no substances. Additionally, we examined the effect of trauma and daily stress on polysubstance use in self-report data from individuals (N=134) participating in the MAPme Study. Results: First, the observed prevalence of polysubstance use was greater than expected by chance, with most individuals co-using alcohol and cannabis. "Alcohol and Other Drug Users" were more frequently motivated to drink for social (β=0.27, CI=[0.07, 0.44]), enhancement (β=0.26, CI=[0.01, 0.42]) and coping (β=0.21, CI=[0.06, 0.47]) reasons compared to individuals who consumed alcohol alone. Conclusions: Individual differences in motivations for use were partly explained by frequency of alcohol use and alcohol problem severity, but not by history of trauma or stress. Finally, while patterns of correlations among motivations for use across substances suggested a general tendency to be motivated to use substances for similar reasons, this was not supported by confirmatory factor models. Overall, shared motives may inform potential behavioral patterns for co-use of substances during college and might advise future treatment efforts.
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Affiliation(s)
- N Jaume-Feliciosi
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, GA, USA
| | - C E Benca-Bachman
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, GA, USA
| | - E Holliday
- Neuropsychology of Emerging Adulthood, Addiction, Recovery and Related Disorders Lab, Department of Psychology at Kennesaw State University & Center for Young Adult Addiction and Recovery, Kennesaw, GA, USA
| | - R H Palmer
- Behavioral Genetics of Addiction Laboratory, Department of Psychology at Emory University, Atlanta, GA, USA
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142
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Grimsley EA, Lippincott M, Read MD, Lorch S, Farach SM, Kuo PC, Diaz JJ. Cirrhosis Increases the Rate of Failure of Nonoperative Management in Blunt Liver Injuries. Am Surg 2024:31348241241631. [PMID: 38531784 DOI: 10.1177/00031348241241631] [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: 03/28/2024]
Abstract
Pre-existing cirrhosis is associated with increased mortality in blunt liver injury. Despite widespread use of nonoperative management (NOM) for blunt liver injury, there is a relative paucity of data regarding how pre-existing cirrhosis impacts the success of NOM. Herein, we perform a retrospective cohort study using ACS TQIP 2017-2020 data to assess the relationship between cirrhosis and failure of NOM for adult patients with blunt liver injury. 37,176 patients were included (342 cirrhosis and 36,834 without cirrhosis). After propensity-score matching, patients with pre-existing cirrhosis had higher rates of failure of NOM (32.2 vs 14.1%, p < 0.01) and in-hospital mortality (36.3 vs 10.8%, p < 0.01) than patients without cirrhosis. Hesitancy to operate on patients with pre-existing cirrhosis and trauma, as well as significant underlying coagulopathy, may explain these findings.
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Affiliation(s)
- Emily A Grimsley
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Michelle Lippincott
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Meagan D Read
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Steven Lorch
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Sandra M Farach
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Paul C Kuo
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Jose J Diaz
- Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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143
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Bethurum AJ, Zeng K, Puzdrakiewicz T, Goenka P, Collins H, Burns JB, Roche K. Antithrombotics in the Fall Patient: Appropriateness and Risk-Benefit Analysis. Am Surg 2024:31348241241733. [PMID: 38532271 DOI: 10.1177/00031348241241733] [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: 03/28/2024]
Abstract
Falls are the leading cause of hospitalizations following trauma nationwide, resulting in over 3 million admissions in 2020. This population is typically aged, and many are prescribed antithrombotic (AT) therapy. In this prospective study, we aimed to analyze fall history while assessing appropriateness of AT regimen relative to fall risk. Patients presenting following ground level fall (GLF) and meeting inclusion criteria during the study period were enrolled. Primary outcome was the relationship between AT therapy necessity (CHA2DS2-VASc) and fall risk (Morse Fall Risk). The cohort of 30 patients had an average age of 77. CHA2DS2-VASc and Morse Fall Risk showed a moderate-positive correlation (r = 0.47; P = 0.012); however, 17% of patients categorized as high fall risk had a <5% 1-year risk of VTE. This study demonstrates that risks of hemorrhage may outweigh thromboembolism prophylaxis in a significant number of patients and sheds light on the astonishing fall volume in this population.
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Affiliation(s)
- A J Bethurum
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Kevin Zeng
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | | | - Parth Goenka
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Hannah Collins
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - J Bracken Burns
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Keelin Roche
- Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
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144
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Bedard-Gilligan M, Lindgren K, Dworkin E, Tristao T, Kaysen D, Rhew I. A randomized controlled trial testing theory-driven enhancements to increase the efficacy of and engagement in a brief cognitive-behavioural therapy text-message intervention for co-occurring post traumatic stress disorder symptoms and alcohol misuse. Br J Clin Psychol 2024. [PMID: 38532251 DOI: 10.1111/bjc.12463] [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: 10/31/2023] [Revised: 02/27/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVE Engaging individuals with co-occurring posttraumatic stress disorder (PTSD) and alcohol misuse (AM) in effective treatments is difficult. Brief, self-directed approaches that deliver empirically supported intervention techniques, such as cognitive-behavioural therapy (CBT) strategies, via technology may be effective and easier-to-access alternatives to traditional in-person therapy approaches for PTSD + AM. This paper describes the protocol for an intervention development study (NCT05372042) that evaluates a text-message intervention combining CBT texts with techniques from cognitive psychology (message framing) and social psychology (growth mindsets) for treatment of PTSD + AM. METHOD The study uses a 3 (message framing: gain vs. loss vs. no framing) × 2 (mindset: growth mindsets vs. not) factorial design to test enhancements to CBT texts. Individuals age 18+, who report symptoms of PTSD and AM, will be recruited to participate. Participants will complete screening, verification, and baseline measures. They will be randomized to condition and receive 3 text messages per week for 4 weeks. Participants will be assessed at post-, 1-, and 3-month follow-up. RESULTS Analyses will evaluate whether framing and growth mindsets enhance the efficacy of CBT texts. A priori decision rules will be applied to select the intervention condition that is both the most effective and the simplest, which will be tested in a follow-up randomized controlled trial. CONCLUSIONS This study will identify the simplest, most efficacious CBT intervention for PTSD + AM. Its use of cognitive and social psychology-based enhancement and of a factorial decision can serve as examples of how to enhance and increase engagement in brief, self-directed CBT interventions.
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Affiliation(s)
- Michele Bedard-Gilligan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Kristen Lindgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Emily Dworkin
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Ty Tristao
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, California, USA
| | - Isaac Rhew
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
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145
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Sawyers RG, Tackett N, McMandon AA, Mack TJ, Evangelista ME, Bendyk H, Lombardozzi KA. Interpersonal Violence and Social Determinants of Health. Am Surg 2024:31348241241677. [PMID: 38531840 DOI: 10.1177/00031348241241677] [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: 03/28/2024]
Abstract
Social determinants of health (SDOH) influence patient outcomes and risk assessment. This study focuses on interpersonal violence, trauma outcomes, and SDOH. We hypothesized patients with lower SDOH experience worse trauma outcomes and present from higher-risk communities. Demographics, SDOH, and outcomes for patients admitted to surgical trauma suffering interpersonal violence were collected and analyzed. Home addresses were plotted, identifying areas of need compared with Area Deprivation Index (ADI). Only 18.8% of patients had documented SDOH, yielding small sample size. Analysis revealed no statistically significant associations (P < .05) between SDOH and trauma outcomes, including ICU length of stay and stress concern (P = .0804). Heat mapping revealed several hot spots across our catchment area, correlating with higher-ranked ADIs and increased deprivation. This study demonstrated SDOH can bring value in determining patient risk, emphasizing resource dedication to documenting these factors. Home addresses in conjunction with ADIs can ascertain areas for resource allocation within communities.
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Affiliation(s)
| | | | | | - Thomas J Mack
- Department of Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
| | - Meagan E Evangelista
- Department of Surgery, Novant New Hanover Regional Medical Center, Wilmington, NC, USA
| | | | - Kristine A Lombardozzi
- VCOM-Carolinas, Spartanburg, SC, USA
- Department of Surgery, Spartanburg Medical Center, Spartanburg, SC, USA
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146
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Spota A, Granieri S, Ferrario L, Zamburlini B, Frassini S, Reitano E, Cioffi SP, Altomare M, Bini R, Virdis F, Chiara O, Cimbanassi S. Injury Patterns of Electric-Scooter Related Trauma: A Systematic Review With Proportion Meta-Analysis. Am Surg 2024:31348241241682. [PMID: 38532248 DOI: 10.1177/00031348241241682] [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: 03/28/2024]
Abstract
Electric scooter (ES)-related injuries are increasing but poorly described. Clinicians need more information to be prepared for these patients. We supposed two prevalent patterns of patients: mildly injured (predominant upper-limb injuries) and severely injured (predominant head trauma). This study aims to understand the frequency of ES-related injuries and patients' characteristics despite the heterogeneity of data currently available. A systematic review with a proportion meta-analysis was conducted on studies with a multidisciplinary description of ES-related injuries in adult patients (PROSPERO-ID: CRD42022341241). Articles from inception to April 2023 were identified in MEDLINE, Embase, and Cochrane's databases. The risk of bias was evaluated using ROBINS-I. Twenty-five observational studies with 5387 patients were included in the meta-analysis, depending on reported data. Upper-limb (31.8%) and head (19.5%) injuries are the most frequent (25/25 studies included). When injured while riding, 19.5% of patients are intoxicated with drugs/alcohol, and only 3.9% use a helmet, increasing the possibility of severe injuries. About 80% of patients are victims of spontaneous falls. Half of the patients self-present to the ED, and 69.4% of cases are discharged directly from the ED. Studies' limitations include an overall moderate risk of bias and high heterogeneity. Electric scooter-related accidents are commonly associated with upper-limb injuries but often involve the head. Spontaneous falls are the most common mechanism of injury, probably related to frequent substance abuse and helmet misuse. This hot topic is not adequately investigated due to a lack of data. A prospective registry could fill this gap.
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Affiliation(s)
- Andrea Spota
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Tissue Bank and Therapy, ASST GOM Niguarda, Milan, Italy
| | - Stefano Granieri
- General Surgery Unit, ASST-Brianza, Vimercate Hospital, Vimercate, Italy
| | - Luca Ferrario
- General Surgery Department, ASST Fatebenefratelli-Sacco, Luigi Sacco University Hospital, Milano, Italy
- Department of Biomedical and Clinical Sciences "Luigi Sacco," Università Degli Studi di Milano, Milano, Italy
| | | | - Simone Frassini
- Unit of General Surgery I, Fondazione I.R.C.C.S. Policlinico San Matteo, Pavia, Italy
- General Surgery Residency Program, University of Pavia, Pavia, Italy
| | - Elisa Reitano
- Department of General Surgery, Nouvel Hôpital Civil, CHRU-Strasbourg, Strasbourg, France
| | - Stefano Pb Cioffi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Roma, Italy
| | - Michele Altomare
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Surgical Sciences, University of Rome Sapienza, Roma, Italy
| | - Roberto Bini
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
| | | | - Osvaldo Chiara
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milano, Italy
| | - Stefania Cimbanassi
- Acute care surgery and trauma, ASST GOM Niguarda, Milan, Italy
- Department of Pathophysiology and Transplantation, State University of Milan, Milano, Italy
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147
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Ngo LC, Carroll HM, Massimilian SS, Garapaty N, Palladino K, Samuels SK, Lao OB, Parreco JP, Levene T. Optimizing Triage Practice in Pediatric Trauma: Lessons From Under-triage and Over-triage Rates and Risk Factors. Am Surg 2024:31348241241693. [PMID: 38532308 DOI: 10.1177/00031348241241693] [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: 03/28/2024]
Abstract
BACKGROUND Triage accuracy is essential for delivering effective trauma care, especially in the pediatric population where unique challenges exist. The purpose of this study was to investigate risk factors contributing to under-triage and over-triage in an urban pediatric trauma center. METHODS This retrospective cohort study included all trauma activations at an urban level 1 trauma center between January 1, 2021, and July 31, 2023 (patients <18 years old.) Patients who were under- or over-triaged were identified based on the level of trauma activation and injury severity score. RESULTS There were 1094 trauma activations included in this study. The rate of under-triage was 3.8% (n = 42) and over-triage was 13.6% (n = 149). Infants aged 0-1 years had the highest rate of under-triage (10.9%, n = 19, P < .001), while those aged 11-17 had the highest rate of over-triage (17.0%, n = 82, P = .003). Non-accidental trauma was the strongest risk factor for under-triage (OR 30.2 [6.4-142.8] P < .001). Penetrating mechanism was the strongest risk factor for over-triage (OR 12.2 [5.6-26.2] P < .001). DISCUSSION This study reveals the complexity of trauma triage in the pediatric population. We identified key predictive factors, such as age, comorbidities, and mechanism of injury, that can be used to refine triage practices and improve the care of pediatric trauma patients.
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Affiliation(s)
- Lisa C Ngo
- Memorial Regional Hospital, Hollywood, FL, USA
| | | | | | - Nikitha Garapaty
- Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, FL, USA
| | | | - Shenae K Samuels
- Memorial Healthcare System Office of Human Research, Hollywood, FL, USA
| | - Oliver B Lao
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
| | | | - Tamar Levene
- Joe DiMaggio Children's Hospital, Hollywood, FL, USA
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148
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Giordano NA, Zhao G, Kalicheti M, Schenker ML, Wimberly Y, Rice CW, Serban N. Opioid utilization after orthopaedic trauma hospitalization among Medicaid-insured adults. Front Public Health 2024; 12:1327934. [PMID: 38596512 PMCID: PMC11003548 DOI: 10.3389/fpubh.2024.1327934] [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: 10/25/2023] [Accepted: 02/15/2024] [Indexed: 04/11/2024] Open
Abstract
Opioids are vital to pain management and sedation after trauma-related hospitalization. However, there are many confounding clinical, social, and environmental factors that exacerbate pain, post-injury care needs, and receipt of opioid prescriptions following orthopaedic trauma. This retrospective study sought to characterize differences in opioid prescribing and dosing in a national Medicaid eligible sample from 2010-2018. The study population included adults, discharged after orthopaedic trauma hospitalization, and receiving an opioid prescription within 30 days of discharge. Patients were identified using the International Classification of Diseases (ICD-9; ICD-10) codes for inpatient diagnosis and procedure. Filled opioid prescriptions were identified from National Drug Codes and converted to morphine milligram equivalents (MME). Opioid receipt and dosage (e.g., morphine milligram equivalents [MME]) were examined as the main outcomes using regressions and analyzed by year, sex, race/ethnicity, residence rurality-urbanicity, and geographic region. The study population consisted of 86,091 injured Medicaid-enrolled adults; 35.3% received an opioid prescription within 30 days of discharge. Male patients (OR = 1.12, 95% CI: 1.07-1.18) and those between 31-50 years of age (OR = 1.15, 95% CI: 1.08-1.22) were found to have increased odds ratio of receiving an opioid within 30 days of discharge, compared to female and younger patients, respectively. Patients with disabilities (OR = 0.75, 95% CI: 0.71-0.80), prolonged hospitalizations, and both Black (OR = 0.87, 95% CI: 0.83-0.92) and Hispanic patients (OR = 0.72, 95% CI: 0.66-0.77), relative to white patients, had lower odds ratio of receiving an opioid prescription following trauma. Additionally, Black and Hispanic patients received lower prescription doses compared to white patients. Individuals hospitalized in the Southeastern United States and those between the ages of 51-65 age group were found to be prescribed lower average daily MME. There were significant variations in opioid prescribing practices by race, sex, and region. National guidelines for use of opioids and other pain management interventions in adults after trauma hospitalization may help limit practice variation and reduce implicit bias and potential harms in outpatient opioid usage.
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Affiliation(s)
- Nicholas A. Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, United States
| | - Guantao Zhao
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Manvitha Kalicheti
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, United States
| | - Mara L. Schenker
- Department of Orthopaedics, School of Medicine, Emory University, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | | | | | - Nicoleta Serban
- H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, GA, United States
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149
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Levi-Belz Y, Levinstein Y, Zerach G. The impact of moral injury on trajectories of depression: a five-year longitudinal study among recently discharged Israeli veterans. Anxiety Stress Coping 2024:1-12. [PMID: 38529565 DOI: 10.1080/10615806.2024.2333374] [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: 11/09/2023] [Accepted: 03/08/2024] [Indexed: 03/27/2024]
Abstract
BACKGROUND Perpetrating or witnessing acts that violate one's moral code are frequent among military personnel and active combatants. These events, termed potentially morally injurious events (PMIEs), were found to be associated with an increased risk of depression, in cross-sectional studies. However, the longitudinal contribution of PMIEs to depression among combatants remains unclear. METHOD Participants were 374 active-duty combatants who participated in a longitudinal study with four measurement points: T1-one year before enlistment, T2-at discharge from army service, and then again 6- and 12-months following discharge (T3 and T4, respectively). At T1, personal characteristics assessed through semi-structured interviews. At T2-T4, PMIEs and depressive symptoms were assessed. RESULTS At discharge (T2), a total of 48.7% of combatants reported experiencing PMIEs incident, compared with 42.4% at T3 and 30.7% at T4. We found a significant interaction effect in which combatants endorsing PMIEs at discharge reported higher severity of depression symptoms at discharge (T2) than combatants who reported no PMIEs. This effect decreased over time as depression levels were lower at T3 and T4. CONCLUSIONS PMIE experiences, and especially PMIE-Betrayal experiences, were found to be valid predictors of higher severity of depression symptoms after the first year following discharge.
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Affiliation(s)
- Yossi Levi-Belz
- The Lior Tsfaty Center for Suicide and Mental Pain Studies, Ruppin Academic Center, Emek Hefer, Israel
| | - Yoav Levinstein
- Department of Social Work, Bar -Ilan University, Ramat Gan, Israel
- Department of Health and Well-being, Medical Corps, IDF, Ramat Gan, Israel
| | - Gadi Zerach
- Department of Psychology, Ariel University, Ariel, Israel
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150
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Nadaud J, Heidel E, Daley B, McKnight C. The Effect of a Hip Fragility Pathway on Outcomes of Ground Level Falls in the Elderly. Am Surg 2024:31348241241685. [PMID: 38532264 DOI: 10.1177/00031348241241685] [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: 03/28/2024]
Abstract
Fragility hip fractures result from low energy mechanisms and are associated with morbidity and mortality, especially in the elderly. We examined outcomes 2 years before and after implementation of a fragility fracture program. The pathway involves emergency department clearance and admission by a medical service with orthopedic consultation. Demographics include age, gender, fracture location, injury severity score (ISS), and ASA. Outcomes include DVT/PE, mortality, disposition, non-operative rate, ICU admission, time to surgery (TTS), length of stay (LOS), and admission service. 777 patients were included (383 PRE/394 POS). POS patients were slightly younger. Trauma admission decreased and LOS and TTS increased. There were no other demographic or outcome differences. Although TTS increased, it remained under 48 hours. Length of stay increase was possibly a reflection of COVID-19. Decreased trauma admission demonstrates pathway adherence. Further studies need to be conducted to verify that quality care can be maintained after initiation of a hip fragility pathway.
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Affiliation(s)
- Jack Nadaud
- University of Tennessee Health Science Center College of Medicine, Memphis, TN, USA
| | - Eric Heidel
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Brian Daley
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Catherine McKnight
- Department of Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
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