Resource Deployment in Response to Trauma Patients

Background Variance in the deployment of the trauma team to the emergency department (ED) can result in patient treatment delays and excess burden on ED personnel. Characteristics of trauma patients, including mechanism of injury, injury type, and age, have been associated with differences in trauma resource deployment. Therefore, this retrospective, single-site study aimed to examine the deployment patterns of trauma resources, the characteristics of the trauma patients associated with levels of trauma resource deployment, and the deployment impact on ED workforce utilization and non-trauma ED patients. Methodology This was an investigator-initiated, single-institution, retrospective cohort study of all patients designated as a trauma response and admitted to a community hospital's ED from July 01, 2019, through July 01, 2022. Results Resource deployment for trauma patients varied by mechanism of injury (p < 0.001), injury type (p < 0.001), and patient age groups (p < 0.001). Specifically, there was a lower average trauma activation for geriatric trauma patients with a fall as a mechanism of injury compared to all younger patient groups with any mechanism of injury (F(5) = 234.49, p < 0.001). In the subsample, there was an average of 3.35 ED registered nurses (RNs) allocated to each trauma patient. Additionally, the ED RNs were temporarily reallocated from an average of 4.09 non-trauma patients to respond to trauma patients, despite over a third of the trauma patients in the subsample being the trauma patients being discharged home from the ED. Conclusions Trauma activation responses need to be standardized with a specific plan for geriatric fall patients to ensure efficient use of trauma and ED personnel resources.

Measuring Emergency Department Staff Perceptions of Causes and Management of Violence

BACKGROUND

Half of all reported violent incidents in health care settings occur in the emergency department (ED) placing all staff members at risk. However, research typically does not include all ED work groups or validated measures beyond nurses and physicians.

OBJECTIVE

The aims of this study were to (a) validate an established instrument measuring perceptions of causes of violence and attitudes toward managing violence within an inclusive workforce sample; and (b) explore variation in perceptions, attitudes, and incidence of violence and safety to inform a violence prevention program.

METHODS

This is an investigator-initiated single-site cross-sectional survey design assessing the psychometric properties of the Management of Aggression and Violence Attitude Scale (MAVAS) within a convenience sample (n = 134). Construct validity was assessed using exploratory factor analysis and reliability was evaluated by the Cronbach's α estimation. Descriptive, correlational, and inferential estimates explored differences in perceptions, attitudes, and incidence of violence and safety.

RESULTS

Exploratory factor analysis indicated validity of the MAVAS with a seven-factor model. Its internal consistency was satisfactory overall (Cronbach's α= 0.87) and across all subscales (Cronbach's α values = 0.52-0.80). Significant variation in incidence of physical assault, perceptions of safety, and causes of violence was found between work groups.

CONCLUSIONS

The MAVAS is a valid and reliable tool to measure ED staff members' perceptions of causes of violence and attitudes toward managing violence. In addition, it can inform training according to differences in work group learner needs.

Two cases of colon LST in transplanted liver patients

Long-life immunosuppressive therapy increases the risk of de novo tumors in liver transplant recipients by decreasing the immune surveillance against malignant cells and oncogenic viruses. However, no cases of colon precancerous lesions have been reported in these subjects. Patient n. 1, a 73 yrs old male treated with calcineurin and purine synthesis inhibitors, showed at a per-protocol colono-scopy a 3 cm laterally spreading tumor (LST). Patient n. 2, a 73 yrs old male treated with calcineurin inhibitors, showed at a screening colonoscopy an LST occupying one third of the lumen circumference. Both subjects were asymptomatic, had been transplanted 14 years before, and in both cases, lesions showed severe dysplasia. LSTs represent 17.2% of advanced colorectal neoplasia (CRC) and risk factors are multifactorial. Immunosuppression may play a role which is however not completely understood. Based on this report, surveillance colonoscopy in liver transplanted patients should be considered.

A facebook survey to obtain alcohol-related information by young people and adolescents. An Italian study

BACKGROUND

Alcohol consumption by adolescents and young adults is an issue of significant public concern. Internet-based Social Networking sites, such as Facebook, are potential avenues to reach young people easily.

OBJECTIVE

to underline the innovation in proposing surveys to collect health-related information regarding young people alcohol consumption and other substances abuse by using Social Networking Websites, particularly Facebook.

METHODS

A questionnaire investigating modalities of alcohol consumption, drinking patterns' risk behaviors and other substances abuse was proposed through a "Facebook event" to young Italian Facebook users aged between 16 and 32. Each Facebook user invited to the event was free to participate, to answer to the questionnaire and to invite his "Facebook friends".

RESULTS

During the 89 days of permanence on the Social Network, 1846 Facebook users participated the event and 732 of them decided spontaneously to answer the questionnaire. The frequency of answering was 8.2 people per day. About 200 users wrote a positive comment to the initiative on the wall of the event. Sixty% of subjects participating the survey were females. Ninety-one% of people answering the questionnaire were alcohol consumers. More than 50% of alcohol consumers were also smokers. Approximately 50% of subjects were binge drinkers. Illegal drugs were used by the 22.2% of the interviewed people.

CONCLUSIONS

Facebook resulted an efficient and rapid tool to reach young people from all over Italy and to propose surveys in order to investigate alcohol consumption and alcohol-related health problems in the youth.

Differential regulation of transcripts for dystrophin Isoforms, dystroglycan, and alpha3AChR subunit in mouse sympathetic ganglia following postganglionic nerve crush

Previous data suggest that in mouse superior cervical ganglion (SCG) the dystrophin-dystroglycan complex may be involved in the axotomy-induced intraganglionic synapse remodeling. Here we analyzed the levels of mRNAs encoding dystrophins, dystroglycan (Dg), and the alpha3 subunit of the nicotinic acetylcholine receptor (alpha3AChR) in mouse SCG at various postaxotomy intervals. We found that axotomy downregulates the levels of transcripts for molecules related to synaptic transmission (alpha3AChR) and those presumably involved in postsynaptic apparatus organization (dystrophin isoforms) and upregulates the transcript encoding Dg, which, by binding dystrophin, bridges the actin cytoskeleton and several extracellular matrix proteins and may thus be involved in postaxotomy neuronal recovery. The observed transcriptional modulation of the components of dystrophin-dystroglycan complexes indicates their involvement in injury-induced neuronal plasticity and suggests a role in other forms of plasticity such as those required in learning and memory, functions often impaired in Duchenne muscular dystrophy patients.

[Experimental models of acute pancreatitis. Critical review]

Experimental models of acute pancreatitis have been developed for more than a century. Although not closely comparable to human disease, they have contributed to our understanding of the physiopathology and cell biology of the disease. The methods used for the induction are subjected to critical examination. In the relevant literature findings, the advantages of each group are underscored, and reference is made to their defects with regard to reproducibility and reliability, with a view to extending the results obtained to human pathology. A proper understanding and standardization of these models may enable us to choose the most suitable model for studying a given aspect of the disease or for evaluating new treatment protocols. The data collected has made it possible to select standardization criteria for a comparative experimental study in the laboratory.

Action of gastrointestinal hormones on the myoelectric activity of the sphincter of Oddi in living rabbit

The aim of this work was to compare the action of gastrointestinal (GI) hormones on the myoelectrical activity of the sphincter of Oddi. Using an experimental design previously described, we studied the electrical activity of the sphincter of Oddi and compared the percentage variation in the number of spikes before and after injection of hormones. Increasing doses of the following hormones were injected i.v. at random: CCK, OP-CCK, caerulein, bombesin, gastrin, secretin and glucagon. CCK and caerulein (as previously found), and also bombesin, OP-CCK and gastrin increased the spikes activity of the sphincter of Oddi. Secretin had no effect and glucagon decreased this activity. There was no tachyphylaxis, but a good dose-effect relationship for each hormone. Compared on a molar basis caerulein is 8 times more effective than CCK and OP-CCK which in turn are more potent than bombesin. Gastrin acts only at pharmacological doses.

[Treatment of hepatic metastases in tumors of the gastrointestinal tract. Considerations on 25 cases]

Results with liver resection over a period of 3 yr in the treatment of metastases derived from tumours of the gastroenteric tube are reported. An account is given of the data and the techniques used by Italian and foreign workers for this purpose. A personal series of 25 cases is presented and its 2-yr survival figure is stated.

[Influence of cholestasis on enzymatic induction with phenobarbital and other enzymatic aspects: experimental studies on guinea pigs]

Investigations in guinea pigs to evaluate interferences between cholestasis and enzymatic induction by phenobarbital, and influences that both experimental conditions exert on the levels of gamma-glutamyl transpeptidase in microsomes and other subcellular fractions, have shown that: 1) cholestasis inhibits inductions of cytochrome P-450 from phenobarbital; 2) gamma-glutamyl transpeptidase is not an inducible enzyme in guinea pig; 3) rises or ferum gamma-glutanyl transpeptidase produced either by cholestasis or phenobarbital administration, are not related to an increased enzymatic synthesis in the various subcellular fractions of liver cell.