Trauma Prehospital Hypothermia Prevention and Treatment: An Observational Study.

BACKGROUND: Hypothermia in trauma patients causes increased morbidity and mortality. Swift recognition and treatment are important to prevent any further heat loss. In addition, patient discomfort from cold decreases satisfaction with care. The administration of active and passive rewarming measures is important in the prevention and treatment of hypothermia, but their use in prehospital trauma patients in Portugal has not been previously reported. OBJECTIVE: To assess the prevalence of hypothermia, the impact of rewarming measures, and the management of the discomfort caused by cold. METHODS: This is a prospective cohort study conducted in Immediate Life Support Ambulances in Portugal between March 1, 2019, and April 30, 2020. RESULTS: This study included records of 586 trauma patients; of whom, 66.2% were men. Cranioencephalic trauma was the most common trauma observed, followed by lower limb and thoracic traumas. Mean body temperature increased 0.12 °C between the first and last assessments (p < .05). Most patients experiencing a level of discomfort of 5 or more on a 0-10 scale reported improvement (from 17.2% to 2.4% after nurses' intervention). Warmed intravenous fluids proved to be effective (p < .05) in increasing body temperature, and passive rewarming measures were effective in preventing hypothermia. CONCLUSIONS: Hypothermia management has to consider the initial temperature, the season, the available rewarming measures, and the objectives to be achieved. The optimization of resources for the monitoring and treatment of hypothermia should be a priority in prehospital assistance. The implementation of rewarming measures improves patients' outcomes and decreases the discomfort caused by cold in prehospital care.

Costs and benefits of nursing clinical education for hospital institutions.

INTRODUCTION: The Nursing Degree Course (NDC) internships realization is assumed as a pertinent study problem for the teaching and hospital institutions, in a way to improve the learning processes and the efficiency of management. OBJECTIVE: To identify the clinical teaching formation costs of nursing students in hospital institutions it was decided to measure through the analysis of a structure indicator the material resources, through a process indicator the human resources on the time spent by nurses provisioning care to patients, and through a results indicator the degree of citizen satisfaction, always having in mind the comparative analysis of hospital costs between the presence and absence of nursing students in Clinical Teachings. MATERIAL AND METHOD: A descriptive-correlational and transversal study was realized on the Hospital, on the year 2011, involving Medicine and Surgery Services, where the Clinical Teachings of the Health School NDC take place. RESULTS: The research protocol included a "Documental Corpus" with a list of 26 consumed supplies of the year, an observation grid, for the registration of time of direct cares provided by nurses during 159 observations, and a Citizen Satisfaction Facing Nursing Care Scale, in a sample of 115 citizens inpatient in the services. CONCLUSION: The inferences show that the presence of students in Clinical Teachings in the hospitals leads to a positive balance of 21.57 € per day and service, with a positive reinforcement associated to the resulting citizens satisfaction facing student rendered cares.

The informal caregiver's socioeconomic prism and its implications on state of mind.

INTRODUCTION: The act of caring for a dependent elderly victim of cerebrovascular accident exerts different impacts on caregivers. Knowledge of their socioeconomic level by health professionals supports the planning and implementation of actions appropriate to the reality of the elderly and their caregivers. OBJECTIVE: To determine whether socioeconomic status predicts informal caregivers' state of mind (depression). DESIGN: Cross-sectional, descriptive study in the Dão Lafões sub-region. PARTICIPANTS: Non-probabilistic sample of 636 informal caregivers, aged 17-85 years (mean = 50.19±14.30). MEASURING INSTRUMENTS: The Beck Depression Inventory and the Graffar Socioeconomic Level Scale. RESULTS: We found class III (middle class family/reasonable socioeconomic status) was the most common (40.4%), class IV (upper lower class family/low socioeconomic level) with 37.7%. A majority of the sample (62.9%) does not have depressive symptoms, with their presence observed in 37.1% of informal caregivers, in which 24.3% are men and 39.6% women. The results sustain that socioeconomic level (P=.004) in the total sample predicts state of mind, inferring that caregivers with poorer socioeconomic status have a worse state of mind. CONCLUSIONS: The evidence found from the research show that informal caregivers with depressive symptoms have a poorer socioeconomic status, so that it is compulsory to consider these variables when planning interventions whose primary focus of attention is aimed at caregivers and elderly cerebrovascular accident victims experiencing situations of transition.

Food consumption, body mass index and risk for oral health in adolescents.

OBJECTIVE: The food intake has great influence on the oral health of adolescents, being relevant to analyze the type of food consumed by adolescents and their relationship with the DMFT index (decayed, missing and filled), the plaque index (PI) and the body mass index (BMI). DESIGN: Epidemiological study conducted in public schools of the 3rd cycle of basic education, central Portugal. INSTRUMENTS: The sociodemographic and dietary habits and frequency characterization was obtained through a self-administered questionnaire completed by adolescents and validated for the population under study. The DMFT index was evaluated according to WHO criteria, oral hygiene was evaluated based on the plaque index and BMI through weight and height in adolescents. PARTICIPANTS: Random sample by clusters (schools) with 661 adolescents, 84.1% female and 15.9% male. RESULTS: Adolescents with mean age 13.22 years (± 1.139). The mean DMFT was 2.23 (± 2.484), the prevalence of PI was 96.4%, and ≥ 5 BMI <85. Adolescents with a higher DMFT index consume more cariogenic foods (r=0.160; P=.000). Adolescents with a higher BMI consume less cariogenic foods (r=-0.1343; P=.001). The value of t reveals that the consumption of cariogenic foods explains 1.8% of the variance of the BMI and 2.6% DMFT. CONCLUSION: The cariogenic foods are presented as a risk factor for dental caries. The results suggest that it is important to develop up actions for health education.

Sleep-wake patterns and their influence on school performance in Portuguese adolescents.

OBJECTIVE: To characterise sleep-wake patterns and their influence on academic performance for a sample of Portuguese adolescents. RESEARCH DESIGN: Cross-sectional, analytical-explanatory, correlational epidemiological research. The protocol includes the composite morningness questionnaire (Barton et al, 1985 adapted by Silva et al, 1985), the Epworth Sleepiness Scale (Murray, 1991), chronic fatigue scale (Smith et al, 1995), the Pittsburgh Sleep Quality Index (Buysse, 1988), Educational Achievement (Fermin, 2005), personal and academic data. PARTICIPANTS: 2094 students (55.3% girls; 16-23 years old; M=16.82±1.25) attending secondary school in central Portugal. Living in urban areas, living with their parents and about 57.1% are in a family with reasonable economic resources. RESULTS: Adolescents' sleep patterns reveal that they sleep on average between 8-9 hours a night, do not use medication to sleep, with sleep latency within the normal range, with good sleep efficiency, without daytime dysfunction and with undisturbed sleep, predominantly intermediate chronotype. Minor drowsiness, increased sleep efficiency, improved subjective sleep satisfaction, less sleep disturbance, less daytime dysfunction, not consuming hypnotic medications, associated with better academic performance. Morningness/eveningness, sleep efficiency, daytime dysfunction and sleep latency emerge as predictors of academic performance. The chronotype interacts to predict the quality of sleep enhancing it as a mediator of school performance. CONCLUSIONS: Sleep and associated individual characteristics should be considered in the diagnosis and intervention process in secondary education.

Implications of literacy for health for body mass index.

INTRODUCTION: Literacy for health (LH) may be considered a set of skills that people appropriate, understand, evaluate and use information and knowledge of health to make informed choices, reduce risks to their health, maintain a healthy nutritional status and enhance quality of life. OBJECTIVES: To assess the level of literacy for health; analyse the relationship of socio-demographic variables with LH; to classify the Body Mass Index (BMI) and to determine the effect of LH on BMI. DESIGN: a quantitative study with a descriptive and cross-sectional approach conducted in the centre and north of Portugal. Particnipants: a non-probabilistic sample of 508 Portuguese participants with a mean age 44.48 years (SD = 21 years). MEASURING INSTRUMENTS: LH was assessed by the European Questionnaire on Literacy for Health (LHS-EU-PT) validated in Portuguese by Saboga-Nunes and Sorensen (2013) and BMI classification followed the WHO reference accepted by Portugal, DGS (2013). RESULTS: It was found that overall, 73.62% of the participants have an inappropriate and problematic level of literacy for health; this was significantly lower in women (P=.000). Participants with inadequate LH, are those with higher BMI (χ(2)=78.09; P=.000), so are at risk of a sub-optimal state of health. CONCLUSIONS: The results suggest a significant relationship between the LH and BMI. It is found that, the better the LH, the more appropriate is the BMI. This evidence reinforces the importance of promoting literacy for health to the Portuguese population.

Nurses' perception of the impact of professional development sessions on their pre-hospital clinical practice with trauma victims.

Background: Continuing education is important for the quality of clinical practice because it complements it and focuses primarily on producing qualified pre-hospital nurses with operationally defined competence in nursing standards. The objective of this study was to assess pre-hospital nurses' opinion of the impact of professional development sessions on their clinical practice. Method: A descriptive and quantitative study was carried out involving Portuguese pre-hospital nurses. Six professional development sessions were presented in 2020 to pre-hospital registered nurses in four of Portugal's main cities. To collect the data, at the end of each session, we apply a questionnaire designed specifically for this study. This data collection instrument consists of 11 questions, six designed to evaluate the session and five designed to evaluate the trainer responsible for the session. A five-point Likert scale was used for each question, where 1 corresponds to very dissatisfied and 5 to extremely satisfied. Results: Two hundred and two nurses, which represents 55% of all Portuguese pre-hospital nurses, took part in the assessment of the professional development sessions. The nurses were from the Northern region of Portugal (51%; n = 102), the Centre region (29%; n = 59) and the Southern region of Portugal (20%; n = 41). Nurses found the session extremely satisfactory. All the assessment scores ranged between 4.4 and 4.7 points, on a scale of 1 to 5. 76.2% of the participants considered that the knowledge acquired could have a major impact [score = 5] on their future clinical practice. The majority of pre-hospital nurses (96.5%) felt that the session could have a major impact [score = 5; 76.2%, n = 154] or a very important impact [score = 4; 20.3%, n = 41] on their clinical practice. Conclusion: The professional development sessions provide pre-hospital nurses with the latest research findings and the majority of nurses considered that the training had a huge impact on their clinical practice. However, it is important that future research aims to explore the cause-effect relationship between training and improved clinical practice.

Analysis of food supplements and sports foods consumption patterns among a sample of gym-goers in Portugal.

BACKGROUND: Gym-goers usually seek methods to improve performance, muscle gain, and overall health. One of the main strategies is including food supplements (FS) into their routine as aids to enhance their athletic capabilities and satisfy their nutritional needs. Thus, this study aimed to investigate and characterize the main FS and Sports Foods (SF) currently consumed, as well as the main reasons for their use and the source of advice in a group of gym-goers in the Lisbon Metropolitan Area (Portugal). METHODS: A cross-sectional study was conducted, including 303 gym-goers from Lisbon, Portugal, who were 133 women and 170 males (30.8 ± 12.9 years old). Face-to-face interviews were used by qualified researchers to gather data. RESULTS: Most of the interviewed athletes (71.95 %) took FS/SF, being men the main consumers. On average, 1.59 supplements were consumed per athlete. Logistic regression models indicated significant associations between age, gender, and motivations for gym attendance. While men and younger groups attended mainly for hypertrophy, women and older groups were focused on well-being. Protein (59.17 %) was the most used FS/SF, followed by creatine (41.28 %) and multivitamins (27.06 %). Men and younger individuals preferred protein and creatine, while older individuals focused more on specific vitamins and minerals. Women seemed to prefer L-carnitine and protein yogurts. Main sources of information included the internet, friends, and dietitians with notable gender and age-based preferences. Online stores were the main place of purchase. Monthly expenditures on FS/SF were not significantly affected by age or gender, but motivations for use had an influence. CONCLUSION: Most of the athletes interviewed took FS/SF, being men the major consumers. Protein was the principal FS/SF used, with online stores being the main place of purchase and the internet the primary source of information. Age and gender were key factors in adopted training, in the FS/SF chosen, and in the source of information selected. It is crucial that health professionals take primary responsibility for providing this guidance.

Construction of the discomfort assessment scale for immobilized trauma victims (DASITV).

BACKGROUND: Immobilization is an intervention widely administered to trauma victims and aims to reduce the victim's movements, ensuring the alignment of anatomical structures suspected of being injured. Despite the benefits of immobilization, it is responsible for the occurrence of pressure injuries, increases in intercranial pressure, pain, and discomfort. AIM: To develop an instrument to assess the discomfort caused by immobilization in trauma victims - Discomfort Assessment Scale for Immobilized Trauma Victims (DASITV). METHODS: A sequential mixed-methods design was used, divided into three distinct but complementary phases: (1) Conceptualization Phase - Construction of the DASITV; (2) Focus Group with a Panel of ten Technical Experts in the care of immobilized trauma victims to approve the DASITV proposal; (3) Acceptance of the scale proposal using a modified e-Delphi technique with 30 pre-hospital health professionals. RESULTS: The first phase led to the construction of a scale made up of two sub-scales. The Numerical Discomfort Scale assesses the level of discomfort the person reports from 0 to 10, with 0 being no discomfort and 10 being maximum discomfort. The second evaluation parameter gives the level of pressure in mmHg that the body exerts on the surface where it is immobilized. The combined interpretation of these two sub-scales leads to 4 different possibilities - ordered by level of severity. The Focus Group made it possible to improve the scale, with input from the group of experts and, using the modified e-Delphi technique, a wider group of professionals showed agreement with the DASITV. CONCLUSION: This study allowed us to propose a preliminary scale to assess the discomfort felt by victims of trauma caused by immobilization.

Nutritional status in preschool children: current trends of mother's body perception and concerns.

BACKGROUND: Studies in several countries indicate that parents show little concern and aren't much aware of the nutritional status of their children, and have the tendency to underestimate the overweight which may present a difficulty when promoting healthier life styles. The aim of this study was to identify maternal body image perceptions in preschool children and analyze its relationship with nutritional status and family social demographic variables. METHODS: A transversal and descriptive study was developed in a sample of 1424 preschool children and their mothers living in several parts of Portugal. The children were weighted and measured by trained personnel, the BMI was calculated and the nutritional status was classified according to the NCHS referential (CDC, 2000).(1) Mother's real and ideal body image perception from their children was evaluated according to Collins' body image silhouettes (1991).(2) RESULTS: The ideal and real perception was translated in a negative index on both children's genders, however 67.2% of the mothers revealed accuracy of perception, while 22.3% had a negative and 12.8% a positive discrepancy, being this significant concerning gender and age of the children. Children's actual weight status (ie, 60.2% normal weight, 16.9% overweight, 17.4% obese and 5.5% underweight) was significantly different from their parents' perceptions (ie, 52.3% normal weight, 27.5% overweight 0,6% obesity and 19.6% underweight) explaining in 25.9% the variability of this perception. Globally 42.3% has no discrepancy but 44.3% thinks that children were thin and 13.4% heavier. This difference is significant concerning the age and scholarship of the mothers but has no relation with the income and residence. CONCLUSION: Despite signs of a positive trend, mothers continue to show difficulty in recognizing the children's nutritional status, so effective public health strategies to increase parents' awareness could be the first step in an effort to prevent childhood obesity.

Genetic heritage as a risk factor enabling chilhood obesity.

INTRODUCTION: Nowadays, it is an evidence that maternal obesity is an important predictor of obesity in the descendants, not being consensual if that influence comes from the interaction between genes and facilitators family contexts or both. OBJECTIVES: 1) To determinate the prevalence of the child overweight; 2) to classify the nutritional status and metabolic risk of the progenitors; 3) to analyze the effect of the markers of the family metabolic risk in the expression of the illness in the child. MATERIAL AND METHODS: Descriptive study composed by 1424 children, average age 4.58 years old and their mothers, average age 34.47 years old, living in several parts of Portugal. The children's anthropometric measures were evaluated and classified according to the NCHS referential (CDC, 2000)(1) and of the progenitors by the orientations of the WHO (2000)(2) and Portugal, DGS (2005).(3) Social demographic data was obtained by filling in the Food Frequency Questionnaire adapted from Rito (2007).(4) RESULTS: The overweight affected 34.3% of the children, (including 17.4% obesity), being the higher values on boys (36.8%) and in 5 year old children (39.5). In 41.9% of the progenitors overweight was noted (12.1% obesity), being higher in mothers with low scholarship, low income, older and living in a rural area. The probability of the child to be overweighted was 1.4 times higher when mothers were overweight, and close to 2 times in the relationship mother/daughter. Others enabling factors were revealed, like weight gain above recommended during pregnancy and a higher weight at birth. CONCLUSIONS: Due to the obtained interferences, it is accepted the existence of enabling factors of maternal and child markers in the development of overweight in the child, so that the prevention of child obesity should consider not only the environmental dimension but also the genetic heritage.

[Effectiveness of cleaning or disinfecting the urinary meatus before urinary catheterization: a systematic review]. / Eficácia da limpeza ou desinfeção do meato urinário antes da cateterização urinária: revisão sistemática.

The urinary tract infections associated with catheterization are very common in hospital and home care contexts. Currently there are several recommendations for its prevention, however, when approaching the kind of solute used in the urinary meatus prior to catheterization doubts continue to persist. Thus this study aimed at determining the effectiveness of cleaning the urinary meatus with water or saline comparing to its sterilization through a systematic review and meta-analysis. In order to do so, the principles proposed by the Cochrane Handbook were followed, a critical analysis was conducted by two researchers and the statistical analysis was performed with the use of STATA 11.1. We concluded that the cleaning or disinfection of the urinary canal prior to bladder catheterization is not statistically significant (OR=1.07, CI 95%=0.68-1.68, p=0.779) and that there is some evidence that the use of water/saline reduces rates of UTI (urinary tract infection).

[Prevalence of pressure ulcers in person victim of trauma: predisposing factors]. / Prevalencia de úceras de pressão em pessoa vítima de trauma: factores predisponentes.

INTRODUCTION: Pressure ulcers [PrUs], recognized as a complex problem of multifactorial cause, with high costs at individual, family and socioeconomic level, are also taken as an indicator of quality in nursing care. Knowing that the Person Victim of Trauma involves high risk of developing PrUs, it is imperative to investigate the factors that lead to it OBJECTIVES: To determine the prevalence of PrUs in Person Victim of Trauma; to identify predisposing factors for the development of PrUs. MATERIALS AND METHODS: Observational study conducted in a non-probabilistic sample of convenience, with 500 trauma victims as participants, admitted to the Hospital Infante D. Pedro, in Aveiro, in 2010. Data were collected based on the Clinic Grid (Cunha & Costa, 2011) RESULTS: The prevalence of Pressure Ulcer [PrU] was 4% and the statistically significant factors of its development were : advanced age, greater length of stay, lower diastolic blood pressure, higher pain intensity; dependence in self-care: eating and drinking; presence of diabetes, presence of urinary catheter on admission and during hospitalization, use of diaper; dependence on hygiene and protection of integuments; presence of dry skin; need for physical restraint; taking antibiotics and anti-inflammatory medicine; longer time from admission to the first application of the Braden Scale; higher risk of PrU in the first assessment CONCLUSIONS: This confirms the multifactorial development of PrUs, which makes it relevant for the nurses to consider factors such as length of stay, age, blood pressure, pain, reliance on self-care, physical restraint; antibiotics, assessment and risk level in their planning / implementation of preventive measures against that development and the consequent improvement of the quality of their care.

The relationship between acute pain and other types of suffering in pre-hospital trauma victims: An observational study.

BACKGROUND: Acute pain is an important complaint reported by trauma victims, however, the relationship between it and other types of discomfort, such as discomfort caused by cold, discomfort caused by immobilization, and psychological distress such as fear, anxiety, and sadness is limitedly studied and documented. AIM: To assess the relationship between acute trauma pain and other types of suffering in pre-hospital trauma victims. METHODS: This is a prospective multicentre cohort study conducted in Immediate Life Support Ambulances in Portugal. All adult trauma victims with a mechanism of blunt and penetrating injuries, falls, road accidents and explosions, were included. RESULTS: 605 trauma victims were included, mainly male, with a mean age of 53.4 years. Before the intervention of the rescue teams, 90.5 % of the victims reported some level of pain, 39.0 % reported discomfort caused by cold, while 15.7 % felt fear, 8.4 % sadness, 49.8 % anxiety and 4.5 % apathy. Victims with high discomfort caused by cold tend to have higher pain levels. Significantly higher pain intensity were observed in victims with fear and anxiety. Univariate and multivariate analysis indicates that immobilization is associated with increased pain levels. CONCLUSIONS: There is a statistically significant relationship between acute trauma pain, anxiety, fear, cold and immobilization.

Impact of emergent coronary angiography after out-of-the-hospital cardiac arrest without ST-segment elevation - A systematic review and meta-analysis.

INTRODUCTION: Coronary artery disease is a leading cause of out-of-the-hospital cardiac arrest (OHCA). However, there is no consensus on whether OHCA patients without ST-segment elevation (STE) benefit from emergent (ie < 2 h) coronary angiography (CAG). Our aim was to assess the impact of emergent CAG in no-STE OHCA patients. METHODS: We performed a systematic review and meta-analysis by searching the MEDLINE, Cochrane, Scopus, CINAHL and JBI databases for randomized controlled trials (RCTs) comparing emergent CAG versus standard of care (ie CAG >2 h after OHCA or not performed) in no-STE OHCA patients of presumed cardiac aetiology. The primary outcome was short term survival. Secondary outcomes included survival with good neurological outcome, mid-term survival, left ventricle ejection fraction (LVEF), acute kidney injury (AKI) and renal replacement therapy (RRT), ventricular arrhythmias and major bleeding during hospital stay. RESULTS: Seven RCTs met the inclusion and exclusion criteria and were included; one was included only in the analysis of mid-term survival and another in the LVEF analysis. Five studies (1278 patients, 643 with early CAG and 635 with no early CAG) were included in the analysis of the primary endpoint. The groups were balanced for all baseline characteristics but previous PCI, which was more frequent in the standard of care groups. There were no significant differences between groups for short-term survival (57 vs 61%; OR0.85, 95% CI0.68-1.07; I2 = 0%). There were also no differences for any of the secondary endpoints. CONCLUSION: Routine emergent CAG did not improve survival in comatose survivors of OHCA with shockable rhythm and no-STE.

Prehospital interventions to reduce discomfort caused by immobilization in adult trauma victims: a scoping review protocol.

OBJECTIVE: The objective of this review is to identify the level of discomfort caused by immobilization as reported by trauma victims, and to map all the interventions in the prehospital context where they have been implemented and evaluated in order to reduce discomfort in adult victims of trauma. INTRODUCTION: Immobilization is a cause of discomfort for trauma victims, which has important implications for the deterioration of vital signs and quality of life. However, discomfort caused by immobilization remains an under-explored topic by the scientific community. INCLUSION CRITERIA: This scoping review will consider studies of adult victims of trauma, aged 18 years or over, in prehospital emergency care. Studies that focus on interventions designed to reduce immobilization discomfort, implemented and evaluated by health professionals, of any form, duration, frequency, and dose will be considered. METHODS: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies without time restrictions, in major health care-related electronic databases. Studies in English, French, Spanish, and Portuguese will be included. Data extraction will be performed independently by 2 reviewers in a tabular format and will include details about the level of discomfort, interventions, populations, study methods, and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives. REVIEW REGISTRATION NUMBER: OSF https://osf.io/4scg5/.

Non-pharmacological interventions for acute pain management in adult trauma victims: a scoping review.

OBJECTIVE: This scoping review aimed to map non-pharmacological interventions to reduce acute pain in adult trauma victims. INTRODUCTION: Acute pain is a consequence of a pathological or traumatic event, and a result of invasive or non-invasive health care procedures. Acute trauma pain, as well as its treatment, is one of the least-studied areas of acute pain. Although non-pharmacological interventions are responsible for pain relief among a significant number of patients, only a small percentage of patients receive non-pharmacological interventions. INCLUSION CRITERIA: This scoping review considered all studies conducted on adult victims of trauma, aged 18 years or over, in pre-hospital emergency care, emergency rooms, and trauma-center settings. Studies were considered if they focused on non-pharmacological interventions designed to reduce acute pain, and were implemented and evaluated by health professionals. Non-pharmacological interventions of any type, duration, frequency, and intensity were considered. METHODS: A comprehensive search strategy across 11 bibliometric databases and gray literature sources was developed. Full texts of selected citations were assessed in detail for eligibility by two independent reviewers. No other relevant studies were identified by searching the references of the included articles. Data extraction was performed independently by two reviewers using an instrument previously developed, and those reviewers were later responsible for its validation. Findings were then extracted directly into tables that are accompanied by a narrative summary to show how they relate to the objectives of the review conducted. RESULTS: This scoping review included nine studies: two retrospective cohort studies, five randomized controlled trials, one case report, and one literature review for five different countries. Non-pharmacological interventions identified and administered to trauma victims in pre-hospital settings, emergency services, and trauma centers were as follows: acupressure, auricular acupressure, auricular acupuncture, transcutaneous electrical nerve stimulation, repositioning, use of pressure relief devices, massage, heat therapy, music therapy, relaxation therapy, immobilization, ice therapy, compression, elevation, and bandage. Non-pharmacological interventions were mainly developed by nurses, physicians, and paramedics. They were, in most studies, poorly described in terms of their efficacy and were mostly reported in minor traumas, such as simple fractures or small wounds. CONCLUSIONS: Currently, there is no consensus for the implementation of non-pharmacological interventions in the treatment of acute trauma pain. Their application is primarily used for minor traumas, and their potential for the treatment of major traumas is yet unknown. No studies on the use of non-pharmacological interventions aimed at reducing the impact of traumatic adverse environments were identified. Further investigation on the effects of these interventions should be encouraged so that robust decisions and recommendations can be made.

Non-pharmacological interventions for pain management in adult victims of trauma: a scoping review protocol.

OBJECTIVE: This scoping review aims to map non-pharmacological interventions for reducing acute pain for adult victims of trauma. INTRODUCTION: Acute pain, as a consequence of either a pathological or traumatic event or even due to invasive and non-invasive healthcare procedures, is highly prevalent in critically ill patients. However, specific acute pain as a direct consequence of trauma is one of the least studied areas of acute pain. INCLUSION CRITERIA: This scoping review will consider studies on adult victims of trauma, aged 18 years or over, in prehospital emergency care, emergency departments and trauma centers. All studies that focus on non-pharmacological interventions designed to reduce acute pain, implemented and evaluated by health professionals in any form, duration, frequency and intensity, will be considered. METHODS: An initial search of PubMed and CINAHL will be undertaken, followed by a second search for published and unpublished studies from 2000 to the present in major healthcare related electronic databases. Studies in English, French, Spanish and Portuguese will be included. Data extraction will be performed independently by two reviewers in tabular form and include details about the interventions, populations, study methods and outcomes of interest. A narrative synthesis will accompany the results and will describe how they relate to the review objectives.

Effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium: a systematic review.

BACKGROUND: Delirium is associated with increased intensive care unit and hospital length of stay, prolonged duration of mechanical ventilation, unplanned removal of tubes and catheters, and increased morbidity and mortality. Prophylactic treatment with low-dose haloperidol may have beneficial effects for critically ill patients with a high risk of delirium. OBJECTIVES: To identify the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk for delirium. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Patients with a predicted high risk of delirium, aged 18 years or over, and in intensive care units. Patients with a history of concurrent antipsychotic medication use were excluded. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: Haloperidol prophylaxis for preventing delirium. TYPES OF STUDIES: Experimental and epidemiological study designs. OUTCOMES: Primary outcome is the incidence of delirium. Secondary outcomes are duration of mechanical ventilation, incidence of re-intubation, incidence of unplanned/accidental removal of tubes/lines and catheters, intensive care unit and hospital length of stay, and re-admissions to both settings. SEARCH STRATEGY: An initial search of MEDLINE and CINAHL was undertaken, followed by a second search for published and unpublished studies from January 1967 to September 2015 in major healthcare-related electronic databases. Studies in English, Spanish and Portuguese were included. METHODOLOGICAL QUALITY: Two independent reviewers assessed the methodological quality of five studies using the standardized critical appraisal instrument from the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument. There was general agreement among the reviewers to exclude one relevant study due to methodological quality. DATA EXTRACTION: Data were extracted using the JBI data extraction form for experimental studies and included details about the interventions, populations, study methods and outcomes of significance to the review questions. DATA SYNTHESIS: Significant differences were found between participants, interventions, outcome measures (clinical heterogeneity) and designs (methodological heterogeneity). For these reasons, we were unable to perform a meta-analysis. Therefore, the results have been described in a narrative format. RESULTS: Five studies met the inclusion criteria. One of these studies was excluded due to poor methodological quality. The remaining four original studies (total of 1142 patients) were included in this review. Three studies were randomized controlled trials and one was a cohort study.Two studies confirmed the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium. These studies showed that short-term prophylactic administration of low-dose intravenous haloperidol significantly decreased the incidence of delirium in elderly patients admitted to intensive care units after non-cardiac surgery and in general intensive care unit patients with a high risk of delirium.However, the two remaining studies showed contradictory results in mechanically ventilated critically ill adults, revealing that the administration of haloperidol reduced delirium prevalence, delayed its occurrence, and/or shorten its duration. CONCLUSIONS: The evidence related to the effectiveness of haloperidol prophylaxis in critically ill patients with a high risk of delirium is contradictory. However, balancing the benefits and low side effects associated with haloperidol prophylaxis, this preventive intervention may be useful to reduce the incidence of delirium in critically ill adults in intensive care units.