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1.
Tunis Med ; 102(6): 354-359, 2024 Jun 05.
Artículo en Francés | MEDLINE | ID: mdl-38864199

RESUMEN

INTRODUCTION: The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol. AIM: To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them. METHODS: This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included. RESULT: Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%). We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients. CONCLUSION: These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Fracturas de Cadera , Hospitales Universitarios , Fracturas Periprotésicas , Humanos , Femenino , Estudios Retrospectivos , Fracturas Periprotésicas/epidemiología , Fracturas Periprotésicas/terapia , Fracturas Periprotésicas/cirugía , Fracturas Periprotésicas/etiología , Fracturas Periprotésicas/diagnóstico , Masculino , Marruecos/epidemiología , Anciano , Persona de Mediana Edad , Artroplastia de Reemplazo de Cadera/estadística & datos numéricos , Artroplastia de Reemplazo de Cadera/métodos , Hospitales Universitarios/estadística & datos numéricos , Fracturas de Cadera/epidemiología , Fracturas de Cadera/cirugía , Fracturas de Cadera/terapia , Anciano de 80 o más Años , Traumatología/normas , Traumatología/métodos , Ortopedia/estadística & datos numéricos , Prótesis de Cadera/estadística & datos numéricos , Adulto
2.
São Paulo; s.n; 2023. 36 p.
Tesis en Portugués | Coleciona SUS, Sec. Munic. Saúde SP, HSPM-Producao, Sec. Munic. Saúde SP | ID: biblio-1531816

RESUMEN

Introdução: As fraturas do tornozelo são lesões comuns, apesar de ocorrer em todas as idades, são mais comuns entre homens jovens e mulheres idosas, constituem cerca de 9% de todas as fraturas, com uma incidência de 107 a 187 por 100.000 pessoas por ano. A abordagem de tratamento selecionada ocorrerá de acordo com as condições do paciente e a opção do médico de acordo com cada situação em específico. Objetivo: Avaliar o desfecho do tratamento não cirúrgico e funcional de pacientes com fraturas estáveis e sem desvio do maléolo lateral tipo Weber B, com carga e mobilização articular imediatas. Método: estudo retrospectivo de uma série de pacientes com fratura estável e sem desvio do maléolo lateral tipo Weber B, que foram tratados de forma não cirúrgica com carga e mobilização articular imediatas, de janeiro 2016 a julho 2022. Os pacientes dessa pesquisa foram provenientes do Hospital do Servidor Público Municipal de São Paulo e da Clínica de Ortopedia e Traumatologia Ortocity. Resultados: Os pacientes tinham idade média de 54,7 anos, diagnosticados após eventos traumáticos (quedas, acidentes, etc.) por meio de exames radiográficos, 50% da amostra com comorbidades, especialmente HAS, 73,3% com desvio de 1mm, mais de 50% com consolidação em até 8 semanas, mais de 60% retornaram às atividades normais em até 16 semanas, as complicações ocorreram em aproximadamente 70% da amostra, porém todas leves e sem necessidade de nova abordagem de tratamento posterior. Conclusão: Nesse sentido, pode-se afirmar que a abordagem conservadora associado à mobilização e carga imediatas formam uma alternativa viável de tratamento, com bons resultados de recuperação funcional, semelhantes aos pacientes tratados por abordagens cirúrgicas, conforme a literatura levantada para este estudo. Palavras-chave: Fratura de tornozelo. Abordagem conservadora. Weber B. Resultados funcionais.


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Ortopedia/métodos , Heridas y Lesiones/rehabilitación , Traumatología/métodos , Accidentes/estadística & datos numéricos , Curación de Fractura/fisiología , Procedimientos Ortopédicos/métodos , Fracturas Óseas/rehabilitación , Ortesis del Pié , Fracturas de Tobillo/diagnóstico , Fracturas de Tobillo/rehabilitación , Tratamiento Conservador/métodos , Tobillo/cirugía
3.
Bone Joint J ; 103-B(12): 1754-1758, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34847720

RESUMEN

There is increasing popularity in the use of artificial intelligence and machine-learning techniques to provide diagnostic and prognostic models for various aspects of Trauma & Orthopaedic surgery. However, correct interpretation of these models is difficult for those without specific knowledge of computing or health data science methodology. Lack of current reporting standards leads to the potential for significant heterogeneity in the design and quality of published studies. We provide an overview of machine-learning techniques for the lay individual, including key terminology and best practice reporting guidelines. Cite this article: Bone Joint J 2021;103-B(12):1754-1758.


Asunto(s)
Investigación Biomédica/métodos , Reglas de Decisión Clínica , Aprendizaje Automático , Modelos Estadísticos , Ortopedia/métodos , Proyectos de Investigación , Traumatología/métodos , Humanos , Valor Predictivo de las Pruebas
5.
J Bone Joint Surg Am ; 103(18): e72, 2021 09 15.
Artículo en Inglés | MEDLINE | ID: mdl-33974580

RESUMEN

ABSTRACT: Medical decision-making for frail geriatric trauma patients is complex, especially toward the end of life. The goal of this paper is to review aspects of end-of-life decision-making, such as frailty, cognitive impairment, quality of life, goals of care, and palliative care. Additionally, we make recommendations for composing a patient-tailored treatment plan. In doing so, we seek to initiate the much-needed discussion regarding end-of-life care for frail geriatric patients.


Asunto(s)
Fracturas Óseas/terapia , Anciano Frágil , Evaluación Geriátrica , Salud Holística , Atención Dirigida al Paciente , Traumatología/métodos , Anciano , Toma de Decisiones , Humanos , Cuidados Paliativos , Calidad de Vida , Cuidado Terminal
6.
J Trauma Acute Care Surg ; 91(2S Suppl 2): S40-S45, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-33938509

RESUMEN

ABSTRACT: The objective of this project was to identify and develop software for an augmented reality application that runs on the US Army Integrated Visual Augmentation System (IVAS) to support a medical caregiver during tactical combat casualty care scenarios. In this augmented reality tactical combat casualty care application, human anatomy of individual soldiers obtained predeployment is superimposed on the view of an injured war fighter through the IVAS. This offers insight into the anatomy of the injured war fighter to advance treatment in austere environments.In this article, we describe various software components required for an augmented reality tactical combat casualty care tool. These include a body pose tracking system to track the patient's body pose, a virtual rendering of a human anatomy avatar, speech input to control the application and rendering techniques to visualize the virtual anatomy, and treatment information on the augmented reality display. We then implemented speech commands and visualization for four common medical scenarios including injury of a limb, a blast to the pelvis, cricothyrotomy, and a pneumothorax on the Microsoft HoloLens 1 (Microsoft, Redmond, WA).The software is designed for a forward surgical care tool on the US Army IVAS, with the intention to provide the medical caregiver with a unique ability to quickly assess affected internal anatomy. The current software components still had some limitations with respect to speech recognition reliability during noise and body pose tracking. These will likely be improved with the improved hardware of the IVAS, which is based on a modified HoloLens 2.


Asunto(s)
Realidad Aumentada , Medicina Militar , Traumatología , Heridas Relacionadas con la Guerra/cirugía , Diagnóstico por Imagen , Predicción , Humanos , Iluminación , Medicina Militar/métodos , Medicina Militar/tendencias , Programas Informáticos , Software de Reconocimiento del Habla , Traumatología/métodos , Traumatología/tendencias , Estados Unidos
7.
Artículo en Inglés | MEDLINE | ID: mdl-33995713

RESUMEN

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients.The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5619 patients were made with a lack of response of 19%The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department.Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement.Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually.Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests.Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.


La pandemia COVID ha hecho de las consultas telemáticas una herramienta básica en la práctica diaria.El objetivo principal del estudio es valorar los resultados de la aplicación de consultas telemáticas para limitar la movilidad de los pacientes.Son objetivos operativos; proponer un plan de consultas, conocer como limita la asistencia a las consultas, definir qué patologías se benefician mas con este plan. MATERIAL Y MÉTODOS: Se propone un esquema con la creación de consultas previas a las agendadas para valorar idoneidad y posibilidad de realizarla en acto único no presencial. RESULTADOS: Se han realizado 5619 consultas con una falta de respuesta telefónica del 19%.El 74% de los pacientes fueron resueltos de forma virtual. Existe diferencia entre unidades, siendo mas probable la respuesta telefónica para las consulta de unidad, OR = 0.60 o de traumatología general, OR = 0.67 y menos para los derivados desde urgencias.El 20% de las consultas no se acompañaban de pruebas complementarias. Las consultas de traumatología general, OR = 0.34, control postoperatorio, OR = 0.49, y unidades, OR = 0.40, cumplieron mejor este requisito.De los pacientes restantes, las consultas de traumatología general, OR = 0.50, y las derivadas a unidades, OR = 0.54, fueron las que se mas se resolvieron sin acudir presencialmente. CONCLUSIONES: Se han resuelto de forma no presencial el 74% de los pacientes que atendieron a la llamada telefónica. El 20% de los pacientes acuden a la visita sin pruebas complementarias. Las consultas de seguimiento de osteosíntesis y postoperatorio de cirugía artroscópica son las que mas precisan de ser realizadas de forma presencial.


Asunto(s)
COVID-19 , Departamentos de Hospitales , Ortopedia/métodos , Consulta Remota , Traumatología/métodos , Humanos , Consulta Remota/organización & administración , Consulta Remota/estadística & datos numéricos
8.
J Trauma Acute Care Surg ; 91(2S Suppl 2): S146-S153, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-33797495

RESUMEN

INTRODUCTION: Although several centers have direct to operating room (DOR) resuscitation programs, there are no published prospective studies on optimal patient selection, interventions, outcomes, or real-time surgeon assessments. METHODS: Direct to operating room cases for 1 year were prospectively enrolled. Demographics, injury types/severity, triage criteria, interventions, and outcomes including Glasgow Outcome Scale score were collected. Detailed time-to-event and sequence data on initial lifesaving interventions (LSIs) or emergent surgeries were analyzed. A structured real-time attending surgeon assessment tool for each case was collected. Direct to operating room activation criteria were grouped into categories: mechanism, physiology, injury pattern, or emergency medical services (EMS) suspicion. RESULTS: There were 104 DOR cases: male, 84%; penetrating, 80%; and severely injured (Injury Severity Score, >15), 39%. The majority (65%) required at least one LSI (median of 7 minutes from arrival), and 41% underwent immediate emergent surgery (median, 26 minutes). Blunt patients were more severely injured and more likely to undergo LSI (86% vs. 59%) but less likely to require emergent surgery (19% vs. 47%, all p < 0.05). Analysis of DOR criteria categories showed unique patterns in each group for interventions and outcomes, with EMS suspicion associated with the lowest need for DOR. Surgeon assessment tool results found that DOR was indicated in 84% and improved care in 63%, with a small subset identified (9%) where DOR had a negative impact. CONCLUSION: Direct to operating room resuscitation facilitated timely emergent interventions in penetrating truncal trauma and a select subset of critically ill blunt patients. Unique intervention/outcome profiles were identified by activation criteria groups, with little utility among activations for EMS suspicion. Real-time surgeon assessment tool identified high- and low-yield DOR groups. LEVEL OF EVIDENCE: Prospective observational study, level III.


Asunto(s)
Quirófanos , Resucitación/métodos , Heridas y Lesiones/cirugía , Adulto , Protocolos Clínicos , Femenino , Escala de Coma de Glasgow , Humanos , Puntaje de Gravedad del Traumatismo , Masculino , Estudios Prospectivos , Factores de Tiempo , Centros Traumatológicos , Traumatología/métodos , Heridas Penetrantes/cirugía
9.
J Trauma Acute Care Surg ; 91(2S Suppl 2): S154-S161, 2021 08 01.
Artículo en Inglés | MEDLINE | ID: mdl-33852560

RESUMEN

BACKGROUND: Damage-control resuscitation (DCR) improves trauma survival; however, consistent adherence to DCR principles through multiple phases of care has proven challenging. Clinical decision support may improve adherence to DCR principles. In this study, we designed and evaluated a DCR decision support system using an iterative development and human factors testing approach. METHODS: The phases of analysis included initial needs assessment and prototype design (Phase 0), testing in a multidimensional simulation (Phase 1), and testing during initial clinical use (Phase 2). Phase 1 and Phase 2 included hands-on use of the decision support system in the trauma bay, operating room, and intensive care unit. Participants included trauma surgeons, trauma fellows, anesthesia providers, and trauma bay and intensive care unit nurses who provided both qualitative and quantitative feedback on the initial prototype and all subsequent iterations. RESULTS: In Phase 0, 14 (87.5%) of 16 participants noted that they would use the decisions support system in a clinical setting. Twenty-four trauma team members then participated in simulated resuscitations with decision support where 178 (78.1%) of 228 of tasks were passed and 27 (11.8%) were passed with difficulty. Twenty-three (95.8%) completed a postsimulation survey. Following iterative improvements in system design, Phase 2 evaluation included 21 trauma team members during multiple real-world trauma resuscitations. Of these, 15 (71.4%) completed a formal postresuscitation survey. Device-level feedback on a Likert scale (range, 0-4) confirmed overall ease of use (median score, 4; interquartile range, 4-4) and indicated the system integrated well into their workflow (median score, 3; interquartile range, 2-4). Final refinements were then completed in preparation for a pilot clinical study using the decision support system. CONCLUSIONS: An iterative development and human factors testing approach resulted in a clinically useable DCR decision support system. Further analysis will determine its applicability in military and civilian trauma care. LEVEL OF EVIDENCE: Therapeutic/Care Management, Level V.


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Resucitación/métodos , Heridas y Lesiones/terapia , Humanos , Unidades de Cuidados Intensivos , Quirófanos , Centros Traumatológicos , Traumatología/métodos , Heridas y Lesiones/mortalidad , Heridas y Lesiones/cirugía
10.
Am Surg ; 87(2): 212-218, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33342252

RESUMEN

Introduction: The article "Changes in the Management of Injuries to the Liver and Spleen" was originally presented as the Scudder Oration on Trauma at the American College of Surgeons' (ACS) 90th Annual Clinical Congress in New Orleans, Louisiana, in October 2004. Charles L. Scudder, MD, a founding member of the College, was the originator and first Chairman of the Committee on the Treatment of Fractures from 1922 to 1933. The first "Fracture Oration" of the ACS by Dr Scudder was entitled "Oration on Fractures," was presented at the Clinical Congress in October 1929, and was published in Surg Gynecol Obstet 1930; 50:193-195. Fracture Orations were presented from 1929 to 1941 and 1946 to 1951, while an Oration on Trauma was presented from 1952 to 1962. From 1963 to present, the Scudder Oration on Trauma has been presented at the annual Clinical Congress by an individual with significant contributions to the field.


Asunto(s)
Hígado/lesiones , Bazo/lesiones , Traumatología/historia , Historia del Siglo XXI , Humanos , Índices de Gravedad del Trauma , Traumatología/métodos
11.
Am Surg ; 87(2): 204-208, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33342294

RESUMEN

Prehospital hypotension has been utilized for decades as a surrogate marker of injury severity. Several studies have discussed the correlation between injury and hypotension both in the field as well as in the emergency department. Increases have been noted in injury severity score and mortality. Resource utilization is higher in this patient population. This study revisits our original work from 2000 and reviews the current literature regarding hypotension and injury severity. We also examine the role of prehospital hypotension as an indicator of trauma team activation and resource allocation. This review serves as a part of a Literary Festschrift in honor of Dr J David Richardson's role as the Editor-in-Chief of The American Surgeon.


Asunto(s)
Hipotensión/historia , Centros Traumatológicos/historia , Triaje/historia , Servicios Médicos de Urgencia/historia , Historia del Siglo XXI , Humanos , Hipotensión/etiología , Puntaje de Gravedad del Traumatismo , Kentucky , Traumatología/historia , Traumatología/métodos , Triaje/métodos , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/historia , Heridas y Lesiones/terapia
12.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33277229

RESUMEN

The COVID pandemic has made telematic consultations a basic tool in daily practice. AIMS: The main objective of the study is to assess the results of the application of telematic consultations to limit the mobility of patients. The operational objectives are; to propose a consultation plan, to know how attendance limits consultations and to define which pathologies benefit the most from this plan. METHODS: A scheme is proposed with the creation of pre-scheduled clinic to assess suitability and the possibility of carrying them out in a single non face-to-face act. RESULTS: Phone call to 5,619 patients were made with a lack of response of 19%. The cases of 74% of the patients that answered were resolved virtually. There is a difference between units, obtaining a higher answering rate from patients appointed to specific clinic units, OR = 0.60, or to general trauma ones, OR = 0.67. The lowest answering rate was obtained from those derived from the emergency department. Twenty per cent of the consultations were not accompanied by complementary tests that would have favored the resolution in a single act. The general trauma consultations, OR = 0.34, postoperative control, OR = 0.49, and specific unit ones, OR = 0.40, were the ones that better met this requirement. Out of the remaining patients, the general trauma consultations, OR = 0.50, and those referred to units, OR = 0.54, were the ones that had a higher resolution rate without in- person consultation. CONCLUSIONS: The cases of 74% of the patients who answered the phone call were resolved virtually. Cases of 20% of the patients cannot be solved in a single act because they are derived without complementary tests. Osteosynthesis and postoperative arthroscopic follow-up consultations are the ones that need to be carried out in person the most.


Asunto(s)
COVID-19 , Procedimientos Ortopédicos , Ortopedia/métodos , Consulta Remota/organización & administración , Traumatología/métodos , Humanos , Laparoscopía , España
13.
J Trauma Acute Care Surg ; 90(1): 122-128, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-32925572

RESUMEN

INTRODUCTION: A balance between work and life outside of work can be difficult for practicing physicians to achieve, especially for trauma surgeons. Work-life balance (WLB) has been associated with burnout and career changes. The specific aim of this study was to investigate factors associated with WLB for trauma surgeons. We hypothesized that trauma surgeons are dissatisfied with their WLB, and there are modifiable factors that can be adjusted to improve and maintain WLB. METHODS: Survey study of AAST members including detailed questions regarding demographics, clinical practice, family, lifestyle, and emotional support. Primary outcome was WLB, while the secondary outcome was surgeon burnout. RESULTS: A total of 1,383 American Association for the Surgery of Trauma members received an email with the survey, and 291 (21%) completed the survey. There was a total of 125 members (43%) satisfied with their WLB, and 166 (57%) were not. Factors independently associated with satisfying WLB included hobbies (2.3 [1.1-4.7], p = 0.03), healthy diet (2.6 [1.2-4.4], p = 0.02), exercise (2.6 [1.3-5.1], p = 0.006), vacation weeks off (1.3 [1.0-1.6], p = 0.02), and fair compensation (2.6 [1.3-5.3], p = 0.008). Conversely, factors independently associated with a poor WLB included being midcareer (0.3 [0.2-0.7], p = 0.002), more work hours (0.4 [0.2-0.7], p = 0.006), fewer awake hours at home (0.2 [0.1-0.6], p = 0.002), and feeling that there is a better job (0.4 [0.2-0.9], p = 0.02]. Risk factors for burnout were the same as those for poor WLB. CONCLUSION: Only 43% of trauma surgeons surveyed were satisfied with their WLB, and 61% reported burnout. Modifiable factors independently associated with a satisfying WLB were related to lifestyle and fair compensation. Factors independently associated with poor WLB and suffering burnout were being midcareer, increased hours at work, decreased awake hours at home, and feeling that there was a better job for yourself. Many factors associated with trauma surgeon WLB are modifiable. Trauma surgeons, as well as trauma leaders, should focus on these modifiable factors to optimize WLB and minimize burnout. LEVEL OF EVIDENCE: Care management, Level III.


Asunto(s)
Cirujanos/organización & administración , Traumatología/organización & administración , Equilibrio entre Vida Personal y Laboral , Agotamiento Profesional/prevención & control , Humanos , Satisfacción en el Trabajo , Admisión y Programación de Personal , Factores de Riesgo , Salarios y Beneficios , Cirujanos/psicología , Encuestas y Cuestionarios , Traumatología/métodos , Equilibrio entre Vida Personal y Laboral/métodos , Equilibrio entre Vida Personal y Laboral/organización & administración
14.
Surgeon ; 19(2): e42-e48, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32883580

RESUMEN

PURPOSE: COVID-19 pandemic has created havoc all over the globe and spared no one regardless of status, gender, location and ethnicity. There were questions raised if trauma and orthopaedic (T&O) procedures actually generated aerosols? The need for a review of literature highlighting the nature and impact of aerosol generation within T&O surgery was noted. METHODS: A comprehensive online search was performed for all published articles in the English language, evaluating AGPs in T&O surgery and the relevant personal protection equipment used. RESULTS: The search strategy populated 43 studies. Six studies were identified as duplicates. The shortlisted 37 studies were screened and nine studies were included in the review. An additional four studies were included from the bibliography review. CONCLUSION: Most orthopaedic procedures are high-risk aerosol generating procedures (AGPs). Conventional surgical masks do not offer protection against high-risk AGPs. In the current era of COVID-19 pandemic, there is a significant risk to the transmission of infection to the theatre staff. For protection against airborne transmission, appropriate masks should be used. These need proper fitting and sizing to ensure full protection when used.


Asunto(s)
Aerosoles/efectos adversos , COVID-19/prevención & control , COVID-19/transmisión , Control de Infecciones/métodos , Transmisión de Enfermedad Infecciosa de Paciente a Profesional/prevención & control , Procedimientos Ortopédicos/métodos , Traumatología/métodos , COVID-19/epidemiología , Salud Global , Humanos , Control de Infecciones/instrumentación , Pandemias , Equipo de Protección Personal
15.
J Trauma Acute Care Surg ; 90(1): 129-136, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-33009339

RESUMEN

BACKGROUND: Inequity exists in surgical training and the workplace. The Eastern Association for the Surgery of Trauma (EAST) Equity, Quality, and Inclusion in Trauma Surgery Ad Hoc Task Force (EAST4ALL) sought to raise awareness and provide resources to combat these inequities. METHODS: A study was conducted of EAST members to ascertain areas of inequity and lack of inclusion. Specific problems and barriers were identified that hindered inclusion. Toolkits were developed as resources for individuals and institutions to address and overcome these barriers. RESULTS: Four key areas were identified: (1) harassment and discrimination, (2) gender pay gap or parity, (3) implicit bias and microaggressions, and (4) call-out culture. A diverse panel of seven surgeons with experience in overcoming these barriers either on a personal level or as a chief or chair of surgery was formed. Four scenarios based on these key areas were proposed to the panelists, who then modeled responses as allies. CONCLUSION: Despite perceived progress in addressing discrimination and inequity, residents and faculty continue to encounter barriers at the workplace at levels today similar to those decades ago. Action is needed to address inequities and lack of inclusion in acute care surgery. The EAST is working on fostering a culture that minimizes bias and recognizes and addresses systemic inequities, and has provided toolkits to support these goals. Together, we can create a better future for all of us.


Asunto(s)
Discriminación Social , Traumatología/organización & administración , Adulto , Femenino , Homofobia/prevención & control , Humanos , Masculino , Persona de Mediana Edad , Racismo/prevención & control , Sexismo/prevención & control , Discriminación Social/prevención & control , Sociedades Médicas/organización & administración , Encuestas y Cuestionarios , Traumatología/educación , Traumatología/métodos , Estados Unidos
16.
Am Surg ; 86(11): 1441-1444, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33153269

RESUMEN

A 55-year-old man undergoes emergent exploratory laparotomy and splenectomy following a motorcycle collision. Following surgery, he is found to have a traumatic brain injury requiring decompressive craniectomy and intracranial pressure monitoring. The patient then continues to have complications throughout his hospital course. Using the American College of Surgeons Trauma Quality Improvement Program guidelines, the surgical team has early and ongoing primary palliative care discussions to foster communication and determine goals of care for the patient. As the patient deteriorates, the surgical team continues meeting with the patient's surrogate decision makers to discuss the best case and worst case scenarios regarding the patient's prognosis and expected quality of life.


Asunto(s)
Traumatismo Múltiple/cirugía , Cuidados Paliativos/métodos , Toma de Decisiones Clínicas , Deterioro Clínico , Comunicación , Toma de Decisiones Conjunta , Familia , Resultado Fatal , Humanos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/terapia , Planificación de Atención al Paciente , Traumatología/métodos
17.
J Trauma Acute Care Surg ; 89(2S Suppl 2): S32-S38, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32355102

RESUMEN

BACKGROUND: Trauma is the leading cause of death among casualties between 1 and 44 years. A large proportion of trauma deaths occurs even before arriving at a medical facility. The paucity of prehospital data is a major reason for the lagging development of prehospital trauma care research. This study aims to describe the Israel Defense Forces Prehopistal Trauma Registry, the steps taken to improve data collection and quality, the resulting trends, and the registry's contribution to policymaking. METHODS: This study explores the quantity and quality of point of injury and prehospital data in the registry between the years 1997 and 2018. We assessed the number of recorded casualties per year, casualties characteristics, and documentation variables in the registry, with a specific focus on documentation of vital signs throughout the years. RESULTS: Overall, 17,905 casualties were recorded. Most casualties were young males (88.6%)-military personnel (52.7%), Syrian refugees (16.2%), Israeli civilians (11.5%), and Palestinians (9.0%). The median number of annual records from 2006 onward was significantly higher compared with before 2006 (1,000 [IQR, 792-1,470] vs. 142 [IQR, 129-156]). Between 2010 and 2018, documentation rate increased in all vital signs investigated including heart rate (56.3% vs. 1.0%), level of consciousness (55.1% vs. 0.3%), respiratory rate (51.8% vs. 0.3%), blood oxygen saturation (50.0% vs. 1.0%), Glasgow Coma Scale (48.2% vs. 0.4%), systolic blood pressure (45.7% vs. 0.8%), and pain (19.1% vs. 0.5%). CONCLUSION: Point of injury and prehospital documentation are rare yet essential for ongoing improvement of combat casualty care. The Israel Defense Forces Trauma Registry is one of the largest and oldest prehospital computerized military trauma registries in the world. This study shows a major improvement in the quantity and then in the quality of prehospital documentation throughout the years that affected guidelines and policy. Further work will focus on improving data completeness and accuracy. LEVEL OF EVIDENCE: Retrospective study, level III.


Asunto(s)
Personal Militar/estadística & datos numéricos , Sistema de Registros , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Conflictos Armados , Bases de Datos Factuales , Femenino , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Israel/epidemiología , Masculino , Refugiados/estadística & datos numéricos , Estudios Retrospectivos , Traumatología/métodos , Heridas Relacionadas con la Guerra/epidemiología , Heridas Relacionadas con la Guerra/mortalidad , Heridas y Lesiones/terapia , Adulto Joven
18.
J Trauma Acute Care Surg ; 88(6): 875-887, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32176167

RESUMEN

BACKGROUND: Blunt cerebrovascular injuries (BCVIs) are associated with significant morbidity and mortality. This guideline evaluates several aspects of BCVI diagnosis and management including the role of screening protocols, criteria for screening cervical spine injuries, and the use of antithrombotic therapy (ATT) and endovascular stents. METHODS: Using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology, a taskforce of the Practice Management Guidelines Committee of the Eastern Association for the Surgery of Trauma performed a systematic review and meta-analysis of currently available evidence. Four population, intervention, comparison, and outcome questions were developed to address diagnostic and therapeutic issues relevant to BCVI. RESULTS: A total of 98 articles were identified. Of these, 23 articles were selected to construct the guidelines. In these studies, the detection of BCVI increased with the use of a screening protocol versus no screening protocol (odds ratio [OR], 4.74; 95% confidence interval [CI], 1.76-12.78; p = 0.002), as well as among patients with high-risk versus low-risk cervical spine injuries (OR, 12.7; 95% CI, 6.24-25.62; p = 0.003). The use of ATT versus no ATT resulted in a decreased risk of stroke (OR, 0.20; 95% CI, 0.06-0.65; p < 0.0001) and mortality (OR, 0.17; 95% CI, 0.08-0.34; p < 0.0001). There was no significant difference in the risk of stroke among patients with Grade II or III injuries who underwent stenting as an adjunct to ATT versus ATT alone (OR, 1.63; 95% CI, 0.2-12.14; p = 0.63). CONCLUSION: We recommend using a screening protocol to detect BCVI in blunt polytrauma patients. Among patients with high-risk cervical spine injuries, we recommend screening computed tomography angiography to detect BCVI. For patients with low-risk risk cervical injuries, we conditionally recommend performing a computed tomography angiography to detect BCVI. We recommend the use of ATT in patients diagnosed with BCVI. Finally, we recommend against the routine use of endovascular stents as an adjunct to ATT in patients with Grade II or III BCVIs. LEVEL OF EVIDENCE: Guidelines, Level III.


Asunto(s)
Traumatismos Cerebrovasculares/terapia , Traumatismos Cerrados de la Cabeza/terapia , Traumatismo Múltiple/terapia , Sociedades Médicas/normas , Traumatología/normas , Traumatismos Cerebrovasculares/diagnóstico , Traumatismos Cerebrovasculares/etiología , Angiografía por Tomografía Computarizada/normas , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/normas , Fibrinolíticos/uso terapéutico , Traumatismos Cerrados de la Cabeza/diagnóstico , Traumatismos Cerrados de la Cabeza/etiología , Humanos , Tamizaje Masivo/normas , Traumatismo Múltiple/complicaciones , Traumatismo Múltiple/diagnóstico , Stents , Traumatología/métodos , Estados Unidos
19.
J Trauma Acute Care Surg ; 89(2S Suppl 2): S83-S87, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32176174

RESUMEN

We believe that the rapid and widespread adoption of resuscitative endovascular balloon occlusion of the aorta as well as enthusiasm for catheter-based strategies has led to increased interest in basic endovascular techniques among trauma surgeons. The aim of this article was to describe the most commonly performed endovascular procedures for trauma patients, the basic capital equipment and room set up, and a parsimonious inventory of disposable supplies needed to perform each procedure. Together, these make a standardized trauma-specific endovascular inventory. LEVEL OF EVIDENCE: Economic/decision, level V.


Asunto(s)
Oclusión con Balón/instrumentación , Procedimientos Endovasculares/instrumentación , Traumatología/instrumentación , Aorta/diagnóstico por imagen , Aortografía , Oclusión con Balón/métodos , Procedimientos Endovasculares/métodos , Humanos , Resucitación/métodos , Traumatología/educación , Traumatología/métodos
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