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1.
World J Surg ; 43(10): 2426-2437, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31222639

RESUMO

BACKGROUND: The completeness of a trauma registry's data is essential for its valid use. This study aimed to evaluate the extent of missing data in a new multicentre trauma registry in India and to assess the association between data completeness and potential predictors of missing data, particularly mortality. METHODS: The proportion of missing data for variables among all adults was determined from data collected from 19 April 2016 to 30 April 2017. In-hospital physiological data were defined as missing if any of initial systolic blood pressure, heart rate, respiratory rate, or Glasgow Coma Scale were missing. Univariable logistic regression and multivariable logistic regression, using manual stepwise selection, were used to investigate the association between mortality (and other potential predictors) and missing physiological data. RESULTS: Data on the 4466 trauma patients in the registry were analysed. Out of 59 variables, most (n = 51; 86.4%) were missing less than 20% of observations. There were 808 (18.1%) patients missing at least one of the first in-hospital physiological observations. Hospital death was associated with missing in-hospital physiological data (adjusted OR 1.4; 95% CI 1.02-2.01; p = 0.04). Other significant associations with missing data were: patient arrival time out of hours, hospital of care, 'other' place of injury, and specific injury mechanisms. Assault/homicide injury intent and occurrence of chest X-ray were associated with not missing any of first in-hospital physiological variables. CONCLUSION: Most variables were well collected. Hospital death, a proxy for more severe injury, was associated with missing first in-hospital physiological observations. This remains an important limitation for trauma registries.


Assuntos
Sistema de Registros , Ferimentos e Lesões/epidemiologia , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Índia/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões/mortalidade
2.
BMJ Open ; 10(6): e033236, 2020 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-32565447

RESUMO

OBJECTIVES: To assess the effect of a mobile phone application for prehospital notification on resuscitation and patient outcomes. DESIGN: Longitudinal prospective cohort study with preintervention and postintervention cohorts. SETTING: Major trauma centre in India. PARTICIPANTS: Injured patients being transported by ambulance and allocated to red (highest) and yellow (medium) triage categories. INTERVENTION: A prehospital notification application for use by ambulance and emergency clinicians to notify emergency departments (EDs) of an impending arrival of a patient requiring advanced lifesaving care. MAIN OUTCOME MEASURES: The primary outcome was the proportion of eligible patients arriving at the hospital for which prehospital notification occurred. Secondary outcomes were the availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray, and ED and in-hospital mortality. RESULTS: Data from January 2017 to January 2018 were collected with 208 patients in the preintervention and 263 patients in the postintervention period. The proportion of patients arriving after prehospital notification improved from 0% to 11% (p<0.001). After the intervention, more patients were managed with a trauma call-out (relative risk (RR) 1.30; 95% CI: 1.10 to 1.52); a trauma bay was ready for more patients (RR 1.47; 95% CI: 1.05 to 2.05) and a trauma team leader present for more patients (RR 1.50; 95% CI: 1.07 to 2.10). There was no difference in time to the initial chest X-ray (p=0.45). There was no association with mortality at hospital discharge (RR 0.94; 95% CI: 0.72 to 1.23), but the intervention was associated with significantly less risk of patients dying in the ED (RR 0.11; 95% CI: 0.03 to 0.39). CONCLUSIONS: The prehospital notification application for severely injured patients had limited uptake but implementation was associated with improved trauma reception and reduction in early deaths. Quality improvement efforts with ongoing data collection using the trauma registry are indicated to drive improvements in trauma outcomes in India. TRIAL REGISTRATION NUMBER: NCT02877342.


Assuntos
Ambulâncias , Telefone Celular , Centros de Traumatologia , Triagem , Ferimentos e Lesões/epidemiologia , Adulto , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar , Humanos , Índia/epidemiologia , Estudos Longitudinais , Masculino , Estudos Prospectivos , Sistema de Registros
3.
BMJ Open ; 7(7): e014073, 2017 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-28716784

RESUMO

INTRODUCTION: Prehospital notification of injured patients enables prompt and timely care in hospital through adequate preparation of trauma teams, space, equipment and consumables necessary for resuscitation, and may improve outcomes. In India, anecdotal reports suggest that prehospital notification, in those few places where it occurs, is unstructured and not linked to a well-defined hospital response. The aim of this manuscript is to describe, in detail, a study protocol for the evaluation of a formalised approach to prehospital notification. METHODS AND ANALYSIS: This is a longitudinal prospective cohort study of injured patients being transported by ambulance to major trauma centres in India. In the preintervention phase, prospective data on patients will be collected on prehospital assessment, notification, inhospital assessment, management and outcomes and recorded in a new tailored multihospital trauma registry. All injured patients arriving by ambulance and allocated to a red or yellow priority category will be eligible for inclusion. The intervention will be a prehospital notification application to be used by ambulance clinicians to notify emergency departments of the impending arrival of a patient. The proportion of eligible patients arriving to hospital after notification will be the primary outcome measure. Secondary outcomes evaluated will be availability of a trauma cubicle, presence of a trauma team on patient arrival, time to first chest X-ray and inhospital mortality. PROGRESS: Ethical approval has been obtained from the All India Institute of Medical Sciences, New Delhi and site-specific approval granted by relevant trauma services. The trial has also been registered with the Monash University Human Research and Ethics Committee; Project number: CF16/1814 - 2016000929. Results will be fed back to prehospital and hospital clinicians via a series of reports and presentations. These will be used to facilitate discussions about service redesign and implementation. It is expected that evidence for improved outcomes will enable widespread adoption of this intervention among centres in all settings with less established tools for prehospital assessment and notification. TRIAL REGISTRATION NUMBER: NCT02877342; Pre-results.


Assuntos
Ambulâncias , Avaliação de Resultados em Cuidados de Saúde , Transporte de Pacientes , Ferimentos e Lesões/terapia , Serviços Médicos de Emergência/organização & administração , Humanos , Índia , Estudos Longitudinais , Estudos Prospectivos , Sistema de Registros , Projetos de Pesquisa , Centros de Traumatologia
4.
Indian J Pharmacol ; 48(6): 733-735, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-28066117

RESUMO

This is a report of four cases of possible suicidal ideation with the use of antidepressants in Indian population. The patients presented to emergency department of a tertiary care hospital with attempted suicide. All of them were prescribed at least one antidepressant. The association of increased suicidal attempts/ideation with antidepressant drugs themselves has been reported in the West, but data in the Indian population are lacking. Antidepressants are widely used not only for treatment of depression but also many other psychiatric illnesses; it is yet unclear whether suicidal ideation is because of these drugs or the progression of the disease. Hence, careful prescribing of these medicines is warranted.


Assuntos
Antidepressivos/efeitos adversos , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/psicologia , Overdose de Drogas/psicologia , Ideação Suicida , Overdose de Drogas/diagnóstico , Overdose de Drogas/prevenção & controle , Feminino , Humanos , Masculino , Fatores de Risco , Adulto Jovem
5.
Int J Appl Basic Med Res ; 6(3): 201-4, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27563588

RESUMO

BACKGROUND: Our existing undergraduate curriculum lacks developing competency for endotracheal intubation. Even though it is a lifesaving procedure, interns are exposed only during their posting in anesthesia or emergency medicine and so, when need arises, they fail to perform endotracheal intubation and it leads to catastrophes. AIMS AND OBJECTIVES: The aim of this study was to develop competency in interns for endotracheal intubation. MATERIALS AND METHODS: A study was conducted on fifty interns of medical college. Lecture and demonstration were used for cognitive domain and one-to-one training and practice on manikin for affective and psychomotor domains, respectively. Live demonstration on patients was done whenever possible. Gain in knowledge was evaluated by pre- and post-test using standardized validated questionnaire. Skills were assessed by direct observation of procedural skill on manikin, split in steps: Laryngoscopy, intubation, and ventilation. Session was evaluated using feedback questionnaire and Likert scale. RESULTS: Interns showed mean marks of 8.12 ± 1.63 in pretest compared to 13.86 ± 1.06 of posttest with a gain of 34.8% (P = 0.0001), which is highly significant. Twenty-two percent interns completed all steps correctly in the first attempt, 62% in the second attempt, while 16% required third attempt to correctly complete all steps. CONCLUSION: This training developed competency for basic knowledge and practice of endotracheal intubation in interns adequately on manikin. Training for endotracheal intubation should be carried out at the beginning of internship before they go for clinical practice and repeated during their rotation of Anesthesia and Emergency Medicine Department, so they can retain their competency for it and can do later on whenever required.

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