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Lapierre A, Bérubé M, Giroux M, Tardif PA, Turcotte V, Mercier É, Richard-Denis A, Williamson D, Moore L. Interprofessional interventions that impact collaboration and quality of care across inpatient trauma care continuum: A scoping review. Injury 2024; 55:111873. [PMID: 39303368 DOI: 10.1016/j.injury.2024.111873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/04/2024] [Accepted: 09/05/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Despite the recognized importance of interprofessional collaboration (IPC) in trauma care, healthcare professionals often work in silos. Interprofessional (IP) interventions are crucial for optimizing IPC and delivering high-quality care across clinical contexts, yet their effectiveness throughout the inpatient trauma care continuum is not well understood. Thus, this review aimed to examine the literature on the effectiveness of IP interventions on collaboration processes and related outcomes in inpatient trauma care. METHODS We conducted a scoping review following Joanna Briggs Institute's methodology. We searched six databases for studies from the last decade on IP interventions in inpatient trauma care. Two independent reviewers categorized IP interventions (education, practice, organization) and extracted their impact on IPC processes and related outcomes (team performance, patient, organization). RESULTS Of the 17,397 studies screened, 148 met the inclusion criteria. Most were cohort designs (72%), conducted in level I trauma centers (57%) and emergency departments (51%), and involved surgeons (56%) and nurses (53%). Studies focused on IP organization interventions (51%), such as clinical pathways; IP practice interventions (35%), such as trauma team activation protocols; and IP education interventions (14%) including multi-method education. IP practice interventions most effectively improved team performance results, while IP education interventions primarily improved IPC processes. Positive patient outcomes were limited, with few studies examining organizational effects. CONCLUSIONS Significant advancements are still required in IP interventions and trauma care research. Future studies should rigorously explore the effectiveness of interventions throughout the inpatient trauma care continuum and focus on developing robust measures for patient and organizational outcomes.
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Affiliation(s)
- Alexandra Lapierre
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada.
| | - Mélanie Bérubé
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Faculty of Nursing, Université Laval, Quebec, QC, Canada
| | - Marianne Giroux
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
| | - Pier-Alexandre Tardif
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada
| | - Valérie Turcotte
- Hôpital du Sacré-Cœur de Montréal, CIUSSS du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
| | - Éric Mercier
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada
| | - Andréane Richard-Denis
- Department of Physiatry and Research Center, CIUSSS du-Nord-de-l'Île-de-Montréal, Montreal, QC, Canada; Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - David Williamson
- Department of Pharmacy and Research Center, CIUSSS-Nord-de-l'Ile-de-Montréal, Montreal, QC, Canada; Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
| | - Lynne Moore
- Research Center CHU de Québec, Université Laval (Hôpital de l'Enfant-Jésus), Quebec, QC, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Quebec, QC, Canada
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Brunese MC, Avella P, Cappuccio M, Spiezia S, Pacella G, Bianco P, Greco S, Ricciardelli L, Lucarelli NM, Caiazzo C, Vallone G. Future Perspectives on Radiomics in Acute Liver Injury and Liver Trauma. J Pers Med 2024; 14:572. [PMID: 38929793 PMCID: PMC11204538 DOI: 10.3390/jpm14060572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/02/2024] [Accepted: 05/09/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Acute liver injury occurs most frequently due to trauma, but it can also occur because of sepsis or drug-induced injury. This review aims to analyze artificial intelligence (AI)'s ability to detect and quantify liver injured areas in adults and pediatric patients. Methods: A literature analysis was performed on the PubMed Dataset. We selected original articles published from 2018 to 2023 and cohorts with ≥10 adults or pediatric patients. Results: Six studies counting 564 patients were collected, including 170 (30%) children and 394 adults. Four (66%) articles reported AI application after liver trauma, one (17%) after sepsis, and one (17%) due to chemotherapy. In five (83%) studies, Computed Tomography was performed, while in one (17%), FAST-UltraSound was performed. The studies reported a high diagnostic performance; in particular, three studies reported a specificity rate > 80%. Conclusions: Radiomics models seem reliable and applicable to clinical practice in patients affected by acute liver injury. Further studies are required to achieve larger validation cohorts.
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Affiliation(s)
- Maria Chiara Brunese
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Pasquale Avella
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Micaela Cappuccio
- Department of Clinical Medicine and Surgery, University of Naples Federico II, 80131 Naples, Italy
| | - Salvatore Spiezia
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Giulia Pacella
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Paolo Bianco
- Hepatobiliary and Pancreatic Surgery Unit, Pineta Grande Hospital, 81030 Castel Volturno, Italy
| | - Sara Greco
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | | | - Nicola Maria Lucarelli
- Interdisciplinary Department of Medicine, Section of Radiology and Radiation Oncology, University of Bari “Aldo Moro”, 70124 Bari, Italy
| | - Corrado Caiazzo
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
| | - Gianfranco Vallone
- Department of Medicine and Health Science “V. Tiberio”, University of Molise, 86100 Campobasso, Italy; (M.C.B.)
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Rajpurkar M, Rosovsky RP, Williams S, Chan AKC, van Ommen CH, Faustino EVS, White M, Parikh M, Sirachainan N, Biss T, Goldenberg NA. Considerations for instituting pediatric pulmonary embolism response teams: A tool kit. Thromb Res 2024; 236:97-107. [PMID: 38417301 DOI: 10.1016/j.thromres.2024.02.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/01/2024]
Abstract
The incidence of pediatric pulmonary embolism (PE) has increased by 200 % in the last decade, but at a single center, it is still infrequent. Given the unique epidemiologic features of pediatric PE, diagnosis is often delayed, and the management is empiric, based on individual physician experience or preference. Thus, there is a strong need for center-specific uniform management of pediatric PE patients. In adults, the development of pulmonary embolism response teams (PERTs) or PE critical care pathways has shortened the time to diagnosis and the initiation of definitive management. Evidence to support an improvement in PE outcomes after the development of PERTs does not exist in children. Nonetheless, we have summarized the practical practice guidelines that physicians and institutions can adopt to establish their institutional PERTs or critical pathways. We also provide strategies for resource-challenged institutions for partnering with centers with expertise in the management of pediatric PE.
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Affiliation(s)
- Madhvi Rajpurkar
- Department of Pediatrics, Division of Pediatric Hematology Oncology, Central Michigan University, Wayne State University, Children's Hospital of Michigan, Detroit, MI, USA.
| | - Rachel P Rosovsky
- Division of Hematology/Oncology, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Suzan Williams
- Division of Hematology/Oncology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Canada
| | | | - C Heleen van Ommen
- Department of Pediatric Hematology, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
| | - E Vincent S Faustino
- Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Melissa White
- Division of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Mihir Parikh
- Department of Pediatric Anesthesiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nongnuch Sirachainan
- Division of Hematology/Oncology, Department of Pediatrics, Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand
| | - Tina Biss
- Department of Haematology, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Neil A Goldenberg
- Department of Pediatrics and Medicine, Division of Hematology, Johns Hopkins, University School of Medicine, Baltimore, MD, USA; Johns Hopkins All Children's Institute for Clinical and Translational Research, Cancer and Blood Disorder Institute, and Heart Institute, Johns Hopkins All Children's, Hospital, St. Petersburg, FL, USA
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Botelho F, Truché P, Caddell L, de Campos Vieira Abib S, Bowder AN, Faria I, Zimmerman K, Alonso N, de Caux M, Bentes A, Buda A, Roa L, Mooney DP. Implementation of a checklist to improve pediatric trauma assessment quality in a Brazilian hospital. Pediatr Surg Int 2021; 37:1339-1348. [PMID: 34128087 DOI: 10.1007/s00383-021-04941-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Trauma is the leading cause of death among children and adolescents in Brazil. Measurement of quality of care is important, as well as interventions that will help optimize treatment. We aimed to evaluate adherence to standardized trauma care following the introduction of a checklist in one of the busiest Latin American trauma centers. MATERIAL AND METHODS A prospective, non-randomized interventional trial was conducted. Assessment of children younger than age 15 was performed before and after the introduction of a checklist for trauma primary survey assessment. Over the study period, each trauma primary survey was observed and adherence to each step of a standardized primary assessment protocol was recorded. Clinical outcomes including mortality, admission to pediatric intensive-care units, use of blood products, mechanical ventilation, and number of CT scans in the first 24 h were also assessed. RESULTS A total of 80 patients were observed (39 pre-intervention and 41 post-intervention). No statistically significant differences were observed between the pre- and post-intervention groups in regard to adherence to checklist by specialty (57.7% versus 50.5%, p = 0.115) and outcomes. No mortality was observed. CONCLUSION In our trauma center, the quality of the adherence to standardized trauma assessment protocols is poor among both surgical and non-surgical providers. The quality of this assessment did not improve after the introduction of a checklist. Further work aimed at organizing the approach to pediatric trauma including triage and trauma education specifically for pediatric providers is needed.
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Affiliation(s)
- Fabio Botelho
- Departamento de Cirurgia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Alfredo Balena 110, 6 Oeste, Belo Horizonte, MG, Brazil. .,Harvey E. Beardmore Division of Pediatric Surgery, Montreal Children's Hospital, Montreal, Canada.
| | - Paul Truché
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | | | - Alexis N Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Isabella Faria
- Departamento de Cirurgia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Alfredo Balena 110, 6 Oeste, Belo Horizonte, MG, Brazil
| | - Kathrin Zimmerman
- Departamento de Cirurgia Pediátrica, Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Alfredo Balena 110, 6 Oeste, Belo Horizonte, MG, Brazil
| | - Nivaldo Alonso
- Departamento de Cirurgia Plastica, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana de Caux
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Aline Bentes
- Fundação Hospitalar do Estado de Minas Gerais, Belo Horizonte, Brazil
| | - Alexandra Buda
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
| | - David P Mooney
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, USA
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Botelho F, Truche P, Mooney DP, Caddell L, Zimmerman K, Roa L, Alonso N, Bowder A, Drumond D, Abib SDCV. Pediatric trauma primary survey performance among surgical and non-surgical pediatric providers in a Brazilian trauma center. Trauma Surg Acute Care Open 2020; 5:e000451. [PMID: 32724859 PMCID: PMC7375395 DOI: 10.1136/tsaco-2020-000451] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/05/2020] [Accepted: 06/13/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Trauma is the leading cause of death and disability among Brazilian children and adolescents. Trauma protocols such as those developed by the Advanced Trauma Life Support course are widely taught, but few studies have assessed the degree to which the use of protocolized trauma assessment improves outcomes. This study aims to quantify the adherence of trauma assessment protocols among different types of frontline trauma providers. METHODS A prospective observational study of pediatric trauma care in one of the busiest Latin American trauma centers was conducted during 6 months. Trauma primary survey assessments were observed and adherence to each step of a standardized primary assessment protocol was recorded. Adherence to the assessment protocol was compared among different types of providers, the time of presentation and severity of injury. The relationship between protocol adherence and clinical outcomes including mortality, length of hospital stay, admission to pediatric intensive care unit, use of blood components, mechanical ventilation and number of imaging exams performed in the first 24 hours were also assessed. RESULTS Emergency department evaluations of 64 patients out of 274 pediatric admissions were observed over a period of 6 months. 50% of the primary assessments were performed by general surgeons, 34.4% by residents in general surgery and 15.6% by pediatricians. There was an average adherence rate of 34.1% to the trauma protocol. Adherence among each specific step included airway: 17.2%; breathing: 59.4%; circulation: 95.3%; disability: 28.8%; exposure: 18.8%. No differences between specialties were observed. Patients with a more thorough primary assessment underwent fewer CT scans (receiver operating characteristic curve area: 0.661; p=0.027). CONCLUSIONS Our study demonstrates that trauma assessment protocol adherence among trauma providers is low. Thorough initial assessment reduced the use of CT scans suggesting that standardized pediatric trauma assessments may be a way to reduce unnecessary radiological imaging among children. LEVEL OF EVIDENCE IV. STUDY TYPE Pediatric and global trauma.
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Affiliation(s)
- Fabio Botelho
- Cirurgia Pediatrica, Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Paul Truche
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - David P Mooney
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Luke Caddell
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Kathrin Zimmerman
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Lina Roa
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
| | - Nivaldo Alonso
- Cirurgia Plastica, Universidade de São Paulo, São Paulo, Brazil
| | - Alexis Bowder
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, Massachusetts, USA
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