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1.
Estima (Online) ; 19(1): e0421, jan.-dez. 2021.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1178058

RESUMEN

Objetivos:identificar na literatura científica o conhecimento produzido sobre lesões por fricção em idosos. Métodos: trata-se de uma revisão integrativa de literatura (2014-2019), realizada a partir de busca nas bases de dados/plataformas National Library of Medicine, Biomedical Answers e Biblioteca Virtual em Saúde, com descritores e os operadores booleanos "and" e "or". Resultados: a partir da busca bibliográfica, seleção e análise, oito artigos compuseram a amostra. Para lesão por fricção em idosos emergiram quatro pilares do cuidado: manutenção da homeostase orgânica e tissular com foco na nutrição e hidratação apropriada; evitar traumas na pele senil, proporcionando um ambiente seguro com dispositivos adequados; e a sistematização da assistência e educação em saúde do cuidado com a pele do idoso. Conclusão: como mecanismos de prevenção, encontram-se a realização da prevenção primária por meio de um plano de cuidados singular e as atividades de educação em saúde, focadas nos fatores de risco e nas vulnerabilidades, minimizando danos e complicações


Asunto(s)
Heridas y Lesiones , Anciano , Fricción , Enfermería Geriátrica
2.
Estima (Online) ; 19(1): e0921, jan.-dez. 2021.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1280948

RESUMEN

Objetivo:descrever o processo de implementação da Rede de Atenção à Saúde em Lesões Cutâneas no município de Divinópolis − MG. Método: trata-se de um relato de experiência sobre a implementação de uma Rede de Atenção à Saúde em Lesões Cutâneas a partir do Programa de Educação Pelo Trabalho para Saúde (PET-Saúde/GraduaSUS), no período de maio de 2016 a abril de 2018. Participaram das ações professores e alunos de uma universidade pública e profissionais enfermeiros vinculados à Secretaria Municipal de Saúde do município. Resultados: foi possível implementar a Rede de Atenção à Saúde para prevenção e tratamento de lesões cutâneas de maneira estruturada e sistematizada. Foi estabelecido um fluxo de atendimento, supervisão de casos e acompanhamento clínico por meio da construção de um protocolo assistencial. Conclusão: a habilidade prática e o conhecimento científico de alunos e profissionais de saúde para o tratamento e manejo de lesões cutâneas foram desenvolvidos fortalecendo, assim, a tríade ensino-serviço-comunidade.


Objective: describe the process of implementing the Rede de Atenção à Saúde em Lesões Cutâneas (Health Care Network for Skin Injuries) in the municipality of Divinópolis - MG. Method: it is an experience report on the implementation of a Health Care Network for Skin Injuries from the Programa de Educação Pelo Trabalho para Saúde (PET-Saúde/GraduaSUS) (Education Through Work for Health Program), from May 2016 to April 2018. Teachers and students from a public university and professional nurses linked to the Municipal Health Secretariat of the municipality participated in the actions. Results: it was possible to implement the Health Care Network for the prevention and treatment of skin lesions in a structured and systematic way. A flow of care, case supervision and clinical follow-up was established through the construction of an assistance protocol. Conclusion: the practical skill and scientific knowledge of students and health professionals for the treatment and management of skin lesions were developed, thus strengthening the teaching-service-community triad.


Asunto(s)
Heridas y Lesiones , Relaciones Comunidad-Institución , Atención a la Salud , Accesibilidad a los Servicios de Salud
4.
Adv Skin Wound Care ; 34(10): 517-524, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34546202

RESUMEN

GENERAL PURPOSE: To present a scoping review of preclinical and clinical trial evidence supporting the efficacy and/or safety of major alternative wound care agents to summarize their effects on validated elements of wound bed preparation and wound management paradigms. TARGET AUDIENCE: This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care. LEARNING OBJECTIVES/OUTCOMES: After participating in this educational activity, the participant will:1. Differentiate the effectiveness of the topical wound care agents included in this review.2. Compare the preventive efficacy of intravenous agents administered to trauma and surgical patients.3. Select the effectiveness of products in this review that are left in place after surgical procedures.4. Identify an oral agent that can be helpful in mitigating the effects of COVID-19.


Asunto(s)
Fármacos Dermatológicos/uso terapéutico , Cuidados de la Piel/métodos , Cicatrización de Heridas/fisiología , Heridas y Lesiones/terapia , Antiinfecciosos/uso terapéutico , COVID-19/epidemiología , Manejo de la Enfermedad , Humanos
5.
BMC Pediatr ; 21(1): 422, 2021 09 24.
Artículo en Inglés | MEDLINE | ID: mdl-34560850

RESUMEN

BACKGROUND: To explore the characteristics of unintentional childhood-injury during the COVID-19 pandemic and assess the association of unintentional-injury with maternal emotional status. METHODS: A cross-sectional survey was conducted with a convenience sample of 1300 children under 12-years-old from 21 schools (including nurseries/ kindergartens/ primary schools) in Wuhan and Shanghai during March to April 2020, and the mothers completed questionnaires online. Self-rating Depression/Anxiety Scales were used to evaluate maternal emotional status, questions on child unintentional-injury were based on the International-Statistical-Classification-of-Diseases-and-Related-Health-Problems-version-10 (ICD-10), and a total of 11 kinds of unintentional injuries were inquired. Information on socio-demographic and family-background factors was also collected. RESULTS: The children of 0-4, 5-9, and 10-12 years accounted for 29.2, 55.2 and 15.6%, respectively, the unintentional-injury rates were 10.29, 4.18 and 3.45%, respectively (P < 0.001), and boys had higher rates than girls. The three leading causes included "being struck by/against", falls and animal bites (traffic-injury accounted for a small proportion). Lower maternal educational, living in suburban/rural (vs. urban) areas, grandparents (vs. mothers) being main caregivers, more child exposure to secondhand smoke, close relatives being suspected/ confirmed COVID-19 cases were associated with a higher risk of child unintentional-injury. After adjusting for related confounders, higher maternal depression levels were associated with a higher risk of unintentional injury. CONCLUSIONS: The characteristics of unintentional childhood injury were different from those in non-pandemic periods. The main causes, risk factors and the association of unintentional injury with maternal depression deserve attention for development of effective measures for preventing children from unintentional injury during COVID-19 pandemic.


Asunto(s)
COVID-19 , Heridas y Lesiones , Niño , China/epidemiología , Estudios Transversales , Femenino , Humanos , Masculino , Madres , Pandemias , Factores de Riesgo , SARS-CoV-2 , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología
6.
Swiss Med Wkly ; 151(33-34)2021 08 27.
Artículo en Inglés | MEDLINE | ID: mdl-34495600

RESUMEN

INTRODUCTION: The COVID-19 pandemic and the associated restrictions may have modified the activities of the Swiss population and thus altered trauma patterns. MATERIALS AND PATIENTS: All adult patients with major trauma admitted to our institution in 2019 and 2020 were assessed using the Injury Severity Score (ISS), by body region involved, type of injury, age, admission to an intensive care unit and 30-day mortality. RESULTS: In 2020, 454 patients with major trauma were admitted to our institution, 17% fewer than in the previous year. The drop in the number of major trauma patients proceeded with and overlapped both the first and second peaks in incidence of the pandemic and the associated restrictions. The median ISS was higher in 2020 (25, interquartile range [IQR] 17-26.5) than in 2019 (22, IQR 16-26, p = 0.04). There were no significant differences in body region involved, type of injury or age (p >0.05). In 2020, a higher percentage of patients were admitted to an intensive care unit (86.5% vs 77.7%, p <0.001) and died within 30 days (8.8% vs 5.0%, p = 0.015). The 30-day mortality was higher in 2020 than in 2019, with an odds ratio of 1.80 (95% confidence interval 1.04-3.10, p= 0.036) after adjustment for the following potential confounders: ISS, age, gender and type of injury. CONCLUSION: In the first year of the COVID-19 pandemic, fewer patients with major trauma were admitted to our institution. However, the patients admitted were more severely injured and more often died within 30 days. Understanding the differences in injury patterns and admissions in major trauma patients under special conditions - such as a pandemic - could help to allocate rare resources adequately.


Asunto(s)
COVID-19 , Heridas y Lesiones , Adulto , Estudios de Cohortes , Humanos , Puntaje de Gravedad del Traumatismo , Pandemias , Estudios Retrospectivos , SARS-CoV-2 , Suiza/epidemiología , Centros Traumatológicos , Heridas y Lesiones/epidemiología
7.
N Z Med J ; 134(1540): 46-55, 2021 08 13.
Artículo en Inglés | MEDLINE | ID: mdl-34482388

RESUMEN

AIMS: To describe any change in the volume and mechanisms of injury of major trauma admissions during and after COVID-19 lockdown, and in doing so, to provide information for resource planning and identification of priority areas for injury prevention initiatives. METHODS: A retrospective, descriptive study conducted on Canterbury District Health Board trauma registry data. The study population consisted of all major trauma patients of all age groups admitted to Christchurch Hospital over three 33-day periods: before, during and after COVID-19 lockdown in New Zealand. Broadly speaking, major trauma is defined as having an injury severity score 13 or death following injury. RESULTS: There was a 42% reduction in the volume of major trauma admissions during lockdown. Falls were the most common injury during lockdown, and transport-related injuries after lockdown. Alcohol intoxication was associated with 19 to 33% of all injuries across the study periods. CONCLUSION: Major trauma inevitably occurred during lockdown, although at considerably lower volumes. After lockdown, once restrictions were eased, major trauma admissions reverted to pre-lockdown patterns. Injury prevention strategies can reduce avoidable pressures on hospitals at a time of pandemic. In New Zealand, focus should be placed on reducing alcohol- and transport-related injuries and increasing community awareness on falls prevention.


Asunto(s)
COVID-19/epidemiología , Hospitalización/estadística & datos numéricos , Pandemias , Heridas y Lesiones/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Accidentes de Tránsito/estadística & datos numéricos , Adulto , Anciano , Intoxicación Alcohólica/complicaciones , Intoxicación Alcohólica/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Distanciamiento Físico , Estudios Retrospectivos , SARS-CoV-2 , Heridas y Lesiones/etiología
8.
Br J Community Nurs ; 26(Sup9): S6-S11, 2021 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-34473537

RESUMEN

Wound bed preparation is the management of a wound in order to optimise healing and/or facilitate other therapeutic measures. It is the most pivotal step in healing wounds. Early referral to a specialist wound clinic can markedly improve the wound healing process. This overview will discuss the techniques involved in the preparation of the wound bed that will effectively accelerate the healing process. The process begins with a correct diagnosis of the wound and optimising the patient's medical condition. The TIMERS framework is discussed. Wound dressings, including the use of negative-pressure wound therapy, are discussed, along with debridement techniques and agents. The timing of wound intervention and evaluating progress will also be discussed, and wound bed preparation strategies will be included. There has been an added challenge of wound care in the community as a result of the COVID-19 pandemic. The present article provides an overview of how to prepare a wound bed in the community.


Asunto(s)
Enfermería en Salud Comunitaria , Heridas y Lesiones , Vendajes , COVID-19 , Desbridamiento/métodos , Desbridamiento/enfermería , Humanos , Heridas y Lesiones/enfermería
9.
J Trauma Nurs ; 28(5): 316-322, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34491949

RESUMEN

BACKGROUND: The Pediatric Trauma Society (PTS) is a multidisciplinary organization, with scientific presentations at its annual meeting addressing trauma care from prehospital through rehabilitation. OBJECTIVE: The purpose of this study was to identify and describe the scholarly areas of focus of presentations at the annual meeting over the society's first 5 years and evaluate research dissemination. METHODS: Data were collected on abstracts presented between 2014 and 2018, including titles, authors, and abstract classification. PubMed and Google Scholar searches identified abstracts that resulted in publications. Journal impact factors were identified. RESULTS: Over 5 years, 491 of 635 (77.3%) abstracts were accepted. The number of submitted and accepted abstracts increased, but the acceptance rate was stable (range = 72.1%-81.2%, p = NS [nonsignificant]). The most frequently accepted categories included "Epidemiology," "Abdominal or Thoracic Trauma," and "Neurosurgery or Traumatic Brain Injury (TBI)," whereas "Trauma Nursing" and "Quality Improvement" were less common. Among the 2014-2016 abstracts, 55.4% of podium and 24.3% of poster presentations were published. Abstracts categorized as "Epidemiology," "Education & Injury Prevention," and "Neurosurgery or TBI" were commonly presented but uncommonly published. The median journal impact factor of publications was 2.1 and 2.0 for podium and poster presentations, respectively (ranging from 0.11 to 10.25). CONCLUSION: Most of the scholarly effort presented at the PTS remains unpublished. Published work is mainly in low-impact factor journals. Mentorship in the publication process and encouragement of multidisciplinary collaboration within the society are needed to address limitations in the number and potential impact of the scientific content of the annual meeting. This type of analysis is relevant not only to the PTS but also to any professional society seeking to improve its impact.


Asunto(s)
Sociedades Médicas , Heridas y Lesiones , Niño , Humanos , Pediatría
10.
J Trauma Nurs ; 28(5): 332-338, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34491952

RESUMEN

OBJECTIVE: Early assessment of the clinical status of trauma patients is crucial for guiding the treatment strategy, and it requires a rapid and systematic approach. The aim of this report is to critically review the assessment parameters currently used in the prehospital setting to quantify blood loss in trauma. DATA SOURCES: Studies regarding hemorrhagic shock in trauma were pooled from PubMed, EMBASE, and Cochrane databases using key words such as "hemorrhagic shock," "vital signs evaluation," "trauma," "blood loss," and "emergency medical service," alone or combined. STUDY SELECTION: Articles published since 2009 in English and Italian were considered eligible if containing data on assessment parameters in blood loss in adults. DATA EXTRACTION: Sixteen articles matching the inclusion criteria were considered in our study. DATA SYNTHESIS: Current prehospital assessment measures lack precise correlation with blood loss. CONCLUSIONS: Traditional assessment parameters such as heart rate, systolic blood pressure, shock index, and Glasgow Coma Scale score often lag in providing accurate blood loss assessment. The current literature supports the need for a noninvasive, continuously monitored assessment parameter to identify early shock in the prehospital setting.


Asunto(s)
Servicios Médicos de Urgencia , Choque Hemorrágico , Heridas y Lesiones , Adulto , Escala de Coma de Glasgow , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Monitoreo Fisiológico , Choque Hemorrágico/diagnóstico , Choque Hemorrágico/terapia , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapia
11.
Scand J Trauma Resusc Emerg Med ; 29(1): 133, 2021 Sep 10.
Artículo en Inglés | MEDLINE | ID: mdl-34507600

RESUMEN

BACKGROUND: With an aging population, the number of elderly individuals exposed to traumatic injuries is increasing. The elderly age criterion for traumatic injuries has been inconsistent in the literature. This study aimed at specifying the elderly age criterion when the traumatic mortality rate increases. METHODS: This is a multicenter retrospective cohort study that was conducted utilizing the data from the Emergency Department-based Injury In-depth Surveillance Registry of the Korea Disease Control and Prevention Agency, collected between January 2014 and December 2018 from 23 emergency departments. The outcome variable was in-hospital mortality. Multivariable logistic regression analysis was used to calculate the adjusted mortality rate for each age group. By using the shape-restricted regression splines method, the relationship between age and adjusted traumatic mortality was plotted and the point where the gradient of the graph had the greatest variation was calculated. RESULTS: A total of 637,491 adult trauma patients were included. The number of in-hospital deaths was 6504 (1.0%). The age at which mortality increased the most was 65.06 years old. The adjusted odds ratio for the in-hospital mortality rate with age in the ≤ 64-year-old subgroup was 1.038 (95% confidence interval (CI) 1.032-1.044) and in the ≥ 65-year-old subgroup was 1.059 (95% CI 1.050-1.068). The adjusted odds ratio for in-hospital mortality in the ≥ 65-year-old compared to the ≤ 64-year-old subgroup was 4.585 (95% CI 4.158-5.055, p < 0.001). CONCLUSIONS: This study found that the in-hospital mortality rate rose with increasing age and that the increase was the most rapid from the age of 65 years. We propose to define the elderly age criterion for traumatic injuries as ≥ 65 years of age.


Asunto(s)
Servicio de Urgencia en Hospital , Mortalidad Hospitalaria , Heridas y Lesiones , Adulto , Anciano , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Sistema de Registros , Estudios Retrospectivos , Centros Traumatológicos
12.
Pediatr Emerg Care ; 37(10): e589-e593, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34570078

RESUMEN

OBJECTIVES: Current childhood injury prevention guidance is anchored by a child's age. For example, children are considered at high risk for falls at ages 4 years and less, and guidance for prevention focuses on these ages. However, these guidelines may not be adequate for children with autism spectrum disorders (ASD). METHODS: This retrospective chart review examined injury characteristics for children with ASD receiving treatment in a pediatric emergency department between 2014 and 2016. Bivariate statistics determined injury demographic correlates. Chart narratives were also coded using traditional content analysis to determine the mechanism that caused the home injury. RESULTS: The sample (27 cases) was mostly male (89%), Black (48%), with a mean age of 7.8 (SD, 4.9) years. The most common mechanism was a fall (44%), followed by self-injurious behavior (33%), and then burns (22%). All cases identified at least 1 mechanism contributing to the injury, in 2 cases, 2 items were mentioned. Of the 29 items identified, most involved a house feature that was not stairs (24%); some included stairs, furniture, or a combination of foreign object and grill (21%); and few identified food/beverage/liquid (11%). CONCLUSIONS: Analyses suggest that unintentional home injury prevention for children with ASD may require prevention guidance extended through older ages.


Asunto(s)
Trastorno del Espectro Autista , Quemaduras , Heridas y Lesiones , Accidentes por Caídas/prevención & control , Anciano , Trastorno del Espectro Autista/epidemiología , Niño , Preescolar , Servicio de Urgencia en Hospital , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Heridas y Lesiones/epidemiología , Heridas y Lesiones/prevención & control
13.
BMC Emerg Med ; 21(1): 102, 2021 09 09.
Artículo en Inglés | MEDLINE | ID: mdl-34503453

RESUMEN

BACKGROUND: The COVID-19 pandemic has had profound effects on the utilization of health care services, including Emergency Medical Services (EMS). Social distancing measures taken to prevent the spread of the disease have greatly affected the functioning of societies and reduced or halted many activities with a risk of injury. The aim of this study was to report the effects of lockdown measures on trauma-related EMS calls in the Finnish capital area. METHODS: We conducted a retrospective cohort study of all EMS calls in the Helsinki University Hospital (HUH) catchment area between 1 January and 31 July 2020. Calls were identified from the HUH EMS database. Calls were grouped into pre-lockdown, lockdown, and post-lockdown periods according to the restrictions set by the Finnish government and compared to the mean number of calls for the corresponding periods in 2018 and 2019. Statistical comparisons were performed using Mann-Whitney U-test for weekly numbers and percentages. RESULTS: During the study period there was a total of 70,705 EMS calls, of which 14,998 (21.2%) were related to trauma; 67,973 patients (median age 61.6 years; IQR 35.3-78.6) were met by EMS. There was no significant change in the weekly number of total or trauma-related EMS calls during the pre-lockdown period. During the lockdown period, the number of weekly total EMS calls was reduced by 12.2% (p = 0.001) and the number of trauma-related calls was reduced by 23.3% (p = 0.004). The weekly number of injured patients met by EMS while intoxicated with alcohol was reduced by 41.8% (p = 0.002). During the post-lockdown period, the number of total and trauma-related calls and the number of injured patients intoxicated by alcohol returned to previous years' levels. CONCLUSIONS: The COVID-19 pandemic and social distancing measures reduced the number of trauma-related EMS calls. Lockdown measures had an especially significant effect on the number of injured patients intoxicated by alcohol met by the EMS. TRIAL REGISTRATION: Not applicable.


Asunto(s)
COVID-19 , Servicios Médicos de Urgencia , Heridas y Lesiones/epidemiología , Control de Enfermedades Transmisibles , Servicios Médicos de Urgencia/estadística & datos numéricos , Finlandia/epidemiología , Humanos , Persona de Mediana Edad , Pandemias , Estudios Retrospectivos
14.
BMC Pediatr ; 21(Suppl 1): 311, 2021 09 08.
Artículo en Inglés | MEDLINE | ID: mdl-34496772

RESUMEN

We looked at existing recommendations for preventing unintentional injuries in children under five years of age, and we attempted to identify the main sources used as evidence for formulating these recommendations.We conducted a literature search up to the 18th October 2019 by using key terms and manual search in selected sources. We summarized the recommendations and source of the evidence in tables for each of five areas of unintentional injuries: road traffic injuries, drowning, poisoning, thermal injuries, falls.In 2008, the World Health Organization (WHO) published a comprehensive report with strategies for child injury prevention for the European region. More recently, the WHO published several guidance documents focused on one area such as drowning, usually with a global focus. The PrevInfad workgroup (Spanish Association of Primary Care Pediatrics) updated their document on road safety in April 2019, providing recommendations and a summary of the existing evidence. Preventive strategies for injuries in childhood are mainly based on surveillance data and the identification of risk factors. The key strategies for preventing unintentional injuries are a combination of environmental and behaviour modification, that can be achieved through engineering, enforcement and education. Consequently, for this kind of strategies, it is important to evaluate the effectiveness of both the intervention itself, and the way the intervention is advised to parents and caretakers so that there is good compliance of the recommendation.


Asunto(s)
Lesiones Accidentales , Quemaduras , Ahogamiento , Heridas y Lesiones , Accidentes por Caídas , Accidentes de Tránsito , Niño , Preescolar , Ahogamiento/epidemiología , Ahogamiento/prevención & control , Humanos , Lactante , Factores de Riesgo , Heridas y Lesiones/epidemiología , Heridas y Lesiones/etiología , Heridas y Lesiones/prevención & control
15.
Ann Surg ; 274(4): 565-571, 2021 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-34506311

RESUMEN

OBJECTIVE: Evaluate the effect of age on opioid consumption after traumatic injury. SUMMARY BACKGROUND DATA: Older trauma patients receive fewer opioids due to decreased metabolism and increased complications, but adequacy of pain control is unknown. We hypothesized that older trauma patients require fewer opioids to achieve adequate pain control. METHODS: A secondary analysis of the multimodal analgesia strategies for trauma Trial evaluating the effectiveness of 2 multimodal pain regimens in 1561 trauma patients aged 16 to 96 was performed. Older patients (≥55 years) were compared to younger patients. Median daily oral morphine milligram equivalents (MME) consumption, average numeric rating scale pain scores, complications, and death were assessed. Multivariable analyses were performed. RESULTS: Older patients (n = 562) had a median age of 68 years (interquartile range 61-78) compared to 33 (24-43) in younger patients. Older patients had lower injury severity scores (13 [9-20] vs 14 [9-22], P = 0.004), lower average pain scores (numeric rating scale 3 [1-4] vs 4 [2-5], P < 0.001), and consumed fewer MME/day (22 [10-45] vs 52 [28-78], P < 0.001). The multimodal analgesia strategies for trauma multi-modal pain regimen was effective at reducing opioid consumption at all ages. Additionally, on multivariable analysis including pain score adjustment, each decade age increase after 55 years was associated with a 23% reduction in MME/day consumed. CONCLUSIONS: Older trauma patients required fewer opioids than younger patients with similar characteristics and pain scores. Opioid dosing for post-traumatic pain should consider age. A 20 to 25% dose reduction per decade after age 55 may reduce opioid exposure without altering pain control.


Asunto(s)
Analgésicos Opioides/uso terapéutico , Dolor/tratamiento farmacológico , Dolor/etiología , Heridas y Lesiones/complicaciones , Adulto , Factores de Edad , Anciano , Anciano de 80 o más Años , Terapia Combinada , Quimioterapia Combinada , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dolor/diagnóstico , Dimensión del Dolor , Pautas de la Práctica en Medicina , Heridas y Lesiones/terapia , Adulto Joven
16.
J Spec Oper Med ; 21(3): 66-70, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34529808

RESUMEN

BACKGROUND: United States Africa Command (US AFRICOM) is one of six US Defense Department's geographic combatant commands and is responsible to the Secretary of Defense for military relations with African nations, the African Union, and African regional security organizations. A full-spectrum combatant command, US AFRICOM is responsible for all US Department of Defense operations, exercises, and security cooperation on the African continent, its island nations, and surrounding waters. We seek to characterize blood product administration within AFRICOM using the in-transit visibility tracking tool known as TRAC2ES (TRANSCOM Regulating and Command & Control Evacuation System). METHODS: We performed a retrospective review of TRAC2ES medical evacuations from the AFRICOM theater of operations conducted between 1 January 2008 and 31 December 2018. RESULTS: During this time, there were 963 cases recorded in TRAC2ES originating within AFRICOM, of which 10 (1%) cases received blood products. All patients were males. One was a Department of State employee, one was a military working dog, and the remainder were military personnel. Of the ten humans, seven were the result of trauma, most by way of gunshot wound, and three were due to medical causes. Among human subjects receiving blood products for traumatic injuries, a total of 5 units of type O negative whole blood, 29 units of packed red blood cells (pRBCs), and 9 units of fresh frozen plasma (FFP) were transfused. No subjects underwent massive transfusion of blood products, and only one subject received pRBCs and FFP in 1:1 fashion. All subjects survived until evacuation. CONCLUSIONS: Within the TRAC2ES database, blood product administration within AFRICOM was infrequent, with some cases highlighting lack of access to adequate blood products. Furthermore, the limitations within this database highlight the need for systems designed to capture medical care performance improvement, as this database is not designed to support such analyses. A mandate for performance improvement within AFRICOM that is similar to that of the US Central Command would be beneficial if major improvements are to occur.


Asunto(s)
Personal Militar , Heridas y Lesiones , Heridas por Arma de Fuego , Animales , Transfusión Sanguínea , Perros , Humanos , Masculino , Plasma , Estudios Retrospectivos , Estados Unidos , Heridas por Arma de Fuego/terapia
17.
Dan Med J ; 68(10)2021 Sep 08.
Artículo en Inglés | MEDLINE | ID: mdl-34498585

RESUMEN

INTRODUCTION: The epidemiology of children admitted to Scandinavian trauma centres remains largely unknown. This study aimed to describe the characteristics of severe injuries in children admitted to a Danish university-level trauma centre. METHODS: A descriptive study of all severely injured (Injury Severity Score ≥ 16) children aged 0-15 years who were admitted to the university level trauma centre at Odense University Hospital, Denmark, in the 2002-2018 period. Data were extracted from the South Danish Register and from medical records. RESULTS: A total of 152 children were included. The median age was 11 (range: 0-15) years. Boys accounted for 57% of the cases. Accidents accounted for 99% of the cases. In the youngest age group (0-4 years), the majority of injuries occurred in domestic areas, in the daytime, in the summer and around the weekends. In the oldest age group (11-15 years), most injuries occurred in traffic areas, in the autumn, on weekdays and in the afternoon. In all age groups, the majority of lesions were sustained to the head/face/neck, limbs and thorax. The overall median number of days in hospital was six. Overall, 39 (26%) children died. Almost half of the injuries were traffic related and this proportion increased with increasing age group. One-third of the traffic injured children died. CONCLUSIONS: Based on a regional trauma register, we described the characteristics of severely injured children. The study included several aspects regarding injury pattern and severity, which may be useful for risk identification, prevention of accidents and for hospital resource planning. FUNDING: none TRIAL REGISTRATION: not relevant.


Asunto(s)
Centros Traumatológicos , Heridas y Lesiones , Accidentes de Tránsito , Adolescente , Niño , Preescolar , Dinamarca/epidemiología , Hospitalización , Humanos , Lactante , Recién Nacido , Puntaje de Gravedad del Traumatismo , Masculino , Estudios Retrospectivos , Estaciones del Año , Heridas y Lesiones/epidemiología
18.
Nutrients ; 13(8)2021 Jul 28.
Artículo en Inglés | MEDLINE | ID: mdl-34444761

RESUMEN

Both dietary and exercise behaviors need to be considered when examining underlying causes of low energy availability (LEA). The study assessed if exercise dependence is independently related to the risk of LEA with consideration of disordered eating and athlete calibre. Via survey response, female (n = 642) and male (n = 257) athletes were categorized by risk of: disordered eating, exercise dependence, disordered eating and exercise dependence, or if not presenting with disordered eating or exercise dependence as controls. Compared to female controls, the likelihood of being at risk of LEA was 2.5 times for female athletes with disordered eating and >5.5 times with combined disordered eating and exercise dependence. Male athletes with disordered eating, with or without exercise dependence, were more likely to report signs and symptoms compared to male controls-including suppression of morning erections (OR = 3.4; p < 0.0001), increased gas and bloating (OR = 4.0-5.2; p < 0.002) and were more likely to report a previous bone stress fracture (OR = 2.4; p = 0.01) and ≥22 missed training days due to overload injuries (OR = 5.7; p = 0.02). For both males and females, in the absence of disordered eating, athletes with exercise dependence were not at an increased risk of LEA or associated health outcomes. Compared to recreational athletes, female and male international caliber and male national calibre athletes were less likely to be classified with disordered eating.


Asunto(s)
Dieta , Ingestión de Energía , Ejercicio Físico , Trastornos de Alimentación y de la Ingestión de Alimentos , Adulto , Atletas , Femenino , Fracturas Óseas , Tracto Gastrointestinal/fisiopatología , Humanos , Masculino , Fenómenos Fisiológicos en la Nutrición Deportiva , Encuestas y Cuestionarios , Heridas y Lesiones , Adulto Joven
19.
Accid Anal Prev ; 161: 106359, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34455340

RESUMEN

While there is a large quantity of prior research on speed and road safety, no previous studies have quantified the absolute risk of serious injury in a crash relative to travel speed. This study aimed to produce risk curves that relate travel speed to the risk of serious injury in light vehicle impacts in order to contribute to the process of selecting acceptable travel speeds. Serious injury was defined in this study as any injury having a maximum abbreviated injury scale (MAIS) of three or greater, or a fatal injury (MAIS3+F). In the context of a crash, travel speed is defined as the vehicle's speed before the driver reacts to the crash situation. Travel speed was determined by selecting the highest pre-impact speed recorded by an Event Data Recorder (EDR) in the seconds before the crash. A total of 1,618 light vehicle impacts were analysed using logistic regression. Individual risk curves were produced for front, head on, side, rear and single vehicle impacts. The analysis found significant positive relationships between the risk of serious injury and travel speed for all of these impact types. The travel speeds at which the risk of serious injury reached one per cent were 63 km/h across all impacts, 17 km/h for head on impacts, 48 km/h for single vehicle impacts, 58 km/h for side impacts, 81 km/h for front impacts and 96 km/h for rear impacts. These results have implications for the setting of speed limits and other measures that influence the speed at which vehicles travel.


Asunto(s)
Accidentes de Tránsito , Heridas y Lesiones , Escala Resumida de Traumatismos , Humanos , Modelos Logísticos , Registros , Viaje , Heridas y Lesiones/epidemiología
20.
Accid Anal Prev ; 161: 106357, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34464840

RESUMEN

It is widely believed that with higher levels of vehicle automation and especially with the advent of fully automatic vehicles, the currently typical forward-facing, upright position will give way to a more relaxed and reclined seating posture. Therefore, the current study investigates the influence of a reclined sitting position on crash injury severity by analyzing real-world crash data from the German in-depth accident study (GIDAS). We compared reclined to upright occupants and focused on effect sizes regarding odds ratios at different injury severity levels. We used the abbreviated injury scale (AIS 2015) for injury scaling and the maximum AIS (MAIS) at the levels 2+, 3+, and 4+ to convert injury severity into a dichotomous metric. Two different analyses were conducted, one looking at the occupant MAIS and one focusing on selected body regions. The body regions investigated are head/face/neck (HFN), thorax, abdomen, pelvis/hip/lower extremities (PHL), and upper extremities. We computed odds ratios greater than one indicating a higher odds of injury at a given injury severity level in the reclined group compared to the upright group. The odds ratios for belted, reclined occupants compared to belted, upright sitting occupants are 2.07, 3.09, and 3.66 for the injury severity levels MAIS2+, MAIS3+, and MAIS4+, respectively. When looking at the body regions, the spread of the odds ratios is wider: At the MAIS2+ level, the odds ratios range between 1.6 and 7.1; at the MAIS3+ level, the odds ratios span from 1.5 to 8.7, with the latter value representing the PHL region. No odds ratio could be computed for the upper extremity injuries at this level. At the MAIS4+ injury severity level, only the HFN odds ratio was statistically significant with a value of 5.6. This study is among the first to show an association between body posture and injury severity at MAIS3+ and MAIS4+ injury level in real-world crashes for reclined seating postures.


Asunto(s)
Accidentes de Tránsito , Heridas y Lesiones , Escala Resumida de Traumatismos , Automatización , Humanos , Oportunidad Relativa , Sedestación , Heridas y Lesiones/epidemiología
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