The History and Evolution of the Trauma Program Manager/Coordinator.

The role of the trauma program manager (TPM) has evolved since the early 1980s. Duties of TPM historically included broad responsibilities such as education, data collection, system, EMS, clinical activities, research, and quality assurance. The purpose of this study was to use survey sampling to evaluate self-perceived functions and scope of work of TPMs in the United States. Results show that TPMs from higher volume centers spend more time on program administration duties whereas TPMs from lower volume centers focus more on registry and clinical duties. Across time, the role has been expanded, refined, and customized, but much role variability remains.

Patients with rib fractures: use of incentive spirometry volumes to guide care.

Rib fractures pose significant risk to trauma patients. Effective pain control and the ability to take deep breaths are crucial for optimal recovery, and these are key elements in current clinical guidelines. These guidelines use incentive spirometry volumes along with other assessment values to guide patient care. However, despite current guidelines, nurses do not routinely document inspired respiratory volumes. This article provides trauma nurses with the rationale for documenting and tracking incentive spirometry volumes to improve outcomes for patients with rib fractures. This promotes early detection of respiratory decline and early interventions to improve pain control and pulmonary function.

Senior lifestyles and injury prevention: evaluating the effectiveness of an injury prevention program for older adults.

The purpose of this multicenter, before-and-after observational study was to determine whether a short educational intervention was associated with improvement in self-reported safety behavior in older adults. We developed 4 original injury prevention presentations with companion testing materials: Motor Vehicle Safety, Fall Prevention, Pedestrian Safety, and Home Safety. Participants also completed pre-post Short Form Health Survey Instrument (SF-12) quality-of-life surveys. Of 414 participants, 226 completed follow-up testing and SF-12 surveys, for a 54.6% response rate. Those who completed either Pedestrian or Home Safety program showed no significant changes (P > .05) in either test scores or SF-12, and they comprised 61.9% of the final sample. Participants in the Motor Vehicle Safety and Fall Prevention programs accounted for 38.1% of the final sample and did show significant improvements between pre-post test scores. Only Fall Prevention participants showed significant differences in pre-post SF-12 scores. In the Fall Prevention group, numerous SF-12 subscores from the initial survey were significantly inversely correlated with pretest scores, and improvements in some SF-12 subscores correlated with improvements in test scores. Findings from the Fall Prevention group suggest that seniors with quality-of-life limitations may be aware of their increased risk and more willing to make changes to enhance safety. Further study is needed because many questions regarding optimal approaches to injury prevention in the aging demographic remain unanswered.

Blood transfusion is an independent predictor of mortality after blunt trauma.

Allogeneic blood transfusion is associated with increased morbidity and mortality. The authors evaluated the affect of blood transfusion, independent of injury severity on mortality. The authors conducted a retrospective review of all patients, age > or =18 years with blunt injury admitted to their Level 2 trauma center from 1994 to 2004 by query of the NTRACS trauma registry. Initial systolic blood pressure and heart rate determined the shock index. Logistic regression was used to model the affect of blood transfusion on mortality. Transfusion requirements were categorized as follows: A, 0 U; B, 1 to 2 U; C, 3 to 5 U; D, > or =6 U blood. In this sample of 8215 blunt trauma patients, 324 patients received blood transfusion. Mortality rates between the transfused and nontransfused groups were 15.12 per cent and 1.84 per cent (P < 0.000) respectively. In the logistic regression model, transfusion category B did not have a significant affect on the odds of death (P = 0.176); the affect of transfusing 3 to 5 U and > or =6 U had a mortality odds ratio of 3.22 (P = 0.002). and 4.87 (P = 0.000) respectively. Transfusing > or =2U blood was strongly associated with mortality in this blunt trauma population. There must be a continuous attempt to limit blood transfusion when feasible and physiologically appropriate.

Through the looking glass: 21st century trauma registry innovations.

Trauma registries can be invaluable tools for improving quality of care and monitoring patient outcomes, but many function below their full potential. Reliance on low-tech, manual data management methods, such as the retyping of demographic information, can lead to inefficiency, increased personnel costs, and potential error. One low-cost solution is a digital interface between the medical records coding database and the trauma registry, allowing the registrar to pull demographic information and ICD-9 diagnostic and procedure codes directly from a reliable source without re-keying them. We created a batch interface for that purpose, reducing the burden of manual data entry and decreasing the time needed to complete patient records in the registry. The interface has eliminated our backlog and allowed the trauma registrar to focus on creating timely reports to track quality indicators.

The prevalence of negative studies with inadequate statistical power: an analysis of the plastic surgery literature.

Studies published in the medical literature often neglect to consider the statistical power needed to detect a meaningful difference between study groups. Small sample sizes tend to produce negative results because of low statistical power. Studies that cannot make conclusive statements about their hypotheses can waste resources, deter further research, and impede advances in clinical treatment. The current study reviewed three of the most frequently read plastic surgery journals from 1976 to 1996 to determine the prevalence of inadequately (<80 percent) powered clinical trials and experimental studies that found no difference (negative studies) in the response variable of interest between comparison groups. The statistical power of 54 negative studies using continuous response variables was calculated to detect a difference of 1 SD (+/-1 SD) in means between the comparative groups. The power of another 57 negative studies with dichotomous response (yes/no) variables was calculated to detect a relative change in proportions of 25 percent and 50 percent from the experimental to the control group. It was found that 85 percent of the studies with continuous response variables had inadequate power to detect the desired mean difference of +/-1 SD. In studies with dichotomous response variables, 98 percent had inadequate power to detect a desired 25 percent relative change in proportions, and 74 percent had inadequate power to detect a desired 50 percent relative change in proportions. These results indicate that many of the studies in the plastic surgery literature lack adequate power to detect a moderate-to-large difference between groups. The lack of power makes the interpretation of the studies with negative findings inconclusive. Proper study design dictates that investigators consider a priori the difference between groups that is of clinical interest, and the sample size per group that is needed to provide adequate statistical power to detect the desired difference.

Are plastic surgery advertisements conforming to the ethical codes of the american society of plastic surgeons?

Cosmetic surgeons have increasingly come under fire for using advertisements that may be deceptive or intended for the solicitation of vulnerable consumers. However, aesthetic surgery is a growing business that relies heavily on advertising to survive. To prevent the use of deceptive advertisements, the American Society of Plastic Surgeons has developed a code of ethics for its physician members. We conducted a study to determine the prevalence of cosmetic surgery advertisements considered objectionable by the lay public. These advertisements were published in the Yellow Pages of the 10 largest U.S. cities. Because all of the advertisements in this study contained the American Society of Plastic Surgeons logo, we also determined whether its members are upholding the ethical code of advertising. We asked a convenience sample of 50 participants to rate 104 advertisements using four yes/no questions derived from the code of ethics and one overall yes/no question regarding whether the advertisement was objectionable. We obtained the mean percentage of "yes" responses for each advertisement, from the total sample, for each question. We found that the study participants felt that 25 percent of the advertisements used images of persons or facsimiles that falsely and deceptively created unjustified expectations of favorable results. The participants responded that 22 percent of the advertisements appealed primarily to the layperson's fears, anxieties, or emotional vulnerabilities. In addition, 18 percent of the advertisements were considered to be objectionable. Discretion is currently left up to physicians as to the ethical nature of their advertisements. Although the majority of American Society of Plastic Surgeons members uphold the ethical code of advertising, there are still a substantial number of published advertisements that the average consumer considers to be in violation of this code.