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J Trauma ; 46(1): 80-86, Jan. 1999.
Artigo em Inglês | MedCarib | ID: med-1337


BACKGROUND: The 1997 edition of the Advanced Trauma Life Support (ATLS) course emphasized interactivity as its major change. The impact of this change is assessed in this study. METHODS: We compared two matched groups of 16 interns completing either the old (group I) or new (group II) ATLS course. Cognitive skills (40 standard ATLS questions plus 10 additional questions on airway and shock) and clinical trauma management skills (four trauma objective structured clinical examinations [OSCEs] on simulated trauma patients) were tested. OSCE station scores (standardized to a maximum of 20), priority scores (graded 1-7), organized approach global passing grades (graded 1-5), and initial assessment test station scores (graded 1-5) were compared. RESULTS: Using ATLS criteria, three interns failed in each group. Post-ATLS examination quesiton scores were similar (84.5 +/- 6.9 for group I, 85.9 +/- 7.1 for group II); scores for the airway and shock questions were higher but not different between the two groups. The four OSCE station mean scores varied between 13.9 +/- 2.0 and 15.4 +/- 2.1 for group I and were higher (P < 0.05) for group II (17.9 +/- 1.6 to 19.1 +/- 1.0). Priority scores were similar (group I, 6.3 +/- 1.1; group II, 6.4+/- 1.2), but approach scores (3.9 +/- 0.1 for group I and 4.9 +/- 0.8 for group II). There were 8 honors grades in group I and 40 (p < 0.05) in group II. Interactive teaching, adult education principles, opportunities for discussion, provision of feedback, and stimulation of self-learning were rated more highly in the new course. CONCLUSION: Using standard ATLS pass criteria, performance after the new and old ATLS courses was similar. Superior performances were measured using OSCE methodology for clinical trauma management skills after the new compared with the old ATLS course in this population of interns.(Au)

Humanos , Estudo Comparativo , Competência Clínica , Medicina de Emergência/educação , Internato e Residência/normas , Avaliação de Programas e Projetos de Saúde , Ensino/métodos , Cuidados para Prolongar a Vida , Inquéritos e Questionários , Trinidad e Tobago
World J Surg ; 22(12): 1192-6, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1341


We tested the effectiveness of a basic prehospital trauma life support (PHTLS) program by assessing cognitive performance and trauma management skills among prehospital trauma personnel. Fourteen subjects who completed a standard PHTLS course (group I) were compared to a matched group not completing a PHTLS program (group II). Cognitive performance was assessed on 50-item multiple choice examinations, and trauma skills management was assessed with four simulated trauma patients. Pre-PHTLS multiple choice questionnaire scores were similar (45 +/- 9.4 percent vs. 48.4 +/- 8.9 percent for groups I and II respectively), but the post-PHTLS scores were higher in group I (80.4 +/- 5.9 percent) than in group II (52.6 +/- 4.9 percent). Pre-PHTLS simulated trauma patient performance scores (standardized to a maximum total of 20 for each station) were similar at all four stations for both groups, ranging from 7.9 to 10.4. The post-PHTLS scores were statistically significantly higher at all four stations for group II (range 8.0 - 11.1). The overall mean pre-PHTLS score for all four stations was 8.3 +/- 2.1 for group I and 8.8 +/- 2.0 (NS) for group II; the group I post-PHTLS mean score for the four stations was 17.1 +/- 2.7 (p < 0.05) compared to 9.1 +/- 2.3 for group II. Pre-PHTLS Adherence to Priority scores on a scale of 1 to 7 were similar (1.1 +/- 0.9 for group I and 1.2 +/- 1.0 for group II). Post-PHTLS group I Priority scores increased to 5.9 +/- 1.1. Group II (1.1 +/- 1.0) did not improve their post-PHTLS scores. The pre-PHTLS Organized Approach scores in the simulated trauma patients on a scale of 1 to 5 were 2.1 +/- 1.0 for group I and 1.9 +/- 1.2 for group II (NS) compared to 4.2 +/- 0.9 (p < 0.05) in group I and 2.0 +/- 0.8 in group II after PHTLS. This study demonstrates improved cognitive and trauma management skills performance among prehospital paramedical personnel who complete the basic PHTLS program.(Au)

Humanos , Serviços Médicos de Emergência , Auxiliares de Emergência , Cuidados para Prolongar a Vida , Traumatologia/educação , Ferimentos e Lesões/terapia , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Trinidad e Tobago
J Trauma ; 36(3): 391-4, Mar. 1994.
Artigo em Inglês | MedCarib | ID: med-8332


Over a 9-year period (July 1981-December 1985--pre-ATLS period; January 1986-June 1990-post-ATLS period), the hospital charts of 813 trauma patients with ISS > or = 16 were reviewed (n = 413, pre-ATLS and n = 400, post-ATLS) in order to assess the impact of the ATLS program. The freqeuncy of endotracheal intubation (ET), nasogastric tube insertion (NG), intravenous access(i.V.), Foley catheterization of the bladder (Foley) and chest tube insertion (CT) were compared by Pearson Chi-square analysis. Overall, pre-ATLS vs. post-ATLS frequencies ( percent) were 83.5 vs. 65.3 for ET, 97.3 vs 98.0 for i.v., 74.6 vs. 96.3 for Foley, 68.3 vs. 91.3 for NG, and 18.4 vs. 47.0 for CT. In the emergency room these frequencies ( percent) were 26.1 vs. 36.4 for ET, 98.8 vs. 98.7 for i.v., 11.0 vs. 97.1 for Foley 3.2 vs. 95.9 for NG, and 3.9 vs for CT. The differences in the application of these life saving procedures between the pre-ATLS and the post ATLS periods were statistically significant (p < 0.05) except i.v. access, which showed no difference between the pre-ATLS and post-ATLS groups. Of the patientys with severe chest injuries (AIS > or = 3) 87.7 percent and chest tubes post ATLS (94.4 percent in ER) compared with 48>1 percent pre ATLS (3.2 percent in ER). These differences were associated with significant improvement in trauma patient outcome post ATLS. We conclude that the frequency of lifesaving interventions, particularly in the ER, was increased post ATLS (AU Truncated at 250 words)

Humanos , Cuidados para Prolongar a Vida , Ressuscitação/métodos , Ferimentos e Lesões/terapia , Cateterismo Periférico/estatística & dados numéricos , Tubos Torácicos/estatística & dados numéricos , Serviço Hospitalar de Emergência , Intubação Gastrointestinal/estatística & dados numéricos , Intubação Intratraqueal/estatística & dados numéricos , Avaliação de Processos e Resultados em Cuidados de Saúde , Trinidad e Tobago/epidemiologia , Cateterismo Urinário/estatística & dados numéricos
West Indian med. j ; 36(Suppl): 49, April 1987.
Artigo em Inglês | MedCarib | ID: med-5980


The Advanced Trauma Life Support (ATLS) Course for the american College of Surgeons was introduced to Trinidad in January, 1986. This study was undertaken to assess its potential value in Trinidad, its relevance to Third World countries as a whole and the method by which it might be introduced to other West Indian territories. Review of 2,126 road deaths in Trinidad between 1970 and 1979 showed an increase from 179 in 1970 to 252 in 1979. Most (69 percent) were males, mainly between 20 and 30 years and most fatal accidents occurred between 6:00 and 10:00 p.m. mainly on weekends. About 75 percent of road deaths occurred in hospital, 65 percent of these dying within 6 hours of arrival in hospital. Because most deaths occur at times when senior staff is not immediately availabe, within hospital because most deaths occur within 6 hours, the critical, initial trauma resuscitation and management are often handled by the junior staff. The ATLS course is directed to these doctors and, in Trinidad, local instructors (trained by an American College of Surgeons Trauma Faculty) can now conduct these courses. The course places emphasis on priorities in trauma care and the practical skill stations (with X-Rays, animal dissection, head injury assessment, airway management and simulated trauma patients) are especially valuable. Because it is relatively inexpensive to conduct, a well-planned ATLS course is likely to be very valuable anc cost-effective for almost any Third World country. In most Caribbean territories where trauma is on the increase, this course should be instituted (AU)

Humanos , Ferimentos e Lesões , Cuidados para Prolongar a Vida , Educação , Acidentes de Trânsito/mortalidade , Acidentes de Trânsito/tendências , Trinidad e Tobago