Impact of an acute care surgery model with a dedicated daytime operating room on outcomes and timeliness of care in patients with biliary tract disease.

BACKGROUND: Although many acute care surgery (ACS) formats exist, the model established in 2006 at our academic, level 1 trauma center includes a dedicated daytime operating room. The goal of the present study was to evaluate the effect that an ACS model with a dedicated daytime operating suite would have on outcomes and timeliness of care in patients with biliary tract disease. METHODS: A retrospective cohort study was performed on all patients with biliary tract disease admitted to the University of Alberta Hospital pre- and post-ACS. Data collected included demographic information, medical diagnoses, procedures performed, and complications. Time points included the time from admission to operation, operative time, and length of hospital stay. Pre- and post-ACS groups were compared with the Pearson Chi square test and Student's t test (α = 0.05). RESULTS: There were 72 patients pre-ACS and 172 post-ACS. The two groups had similar demographics and co-morbidities. The post-ACS group had a shorter time from admission to operation (34.1 vs 24.8 h; p < 0.05). There was a decrease in the number of patients awaiting daytime operating room availability (95.8 vs 60.7 %; p < 0.05), with most surgeries being done within a 24 h period versus patients waiting upwards of 3 days pre-ACS. CONCLUSIONS: We observed a significant decrease in preoperative time by 10 h with increased access to a readily available operating room. Having a dedicated ACS team is important, but it is equally important to have a dedicated operating room with disposable time to care for unpredictable, emergent cases to realize the full potential benefit of the ACS model.

What does coping mean to the worker with pain-related disability? A qualitative study.

PURPOSE: Pain coping is important in health outcomes. In the current literature, pain coping usually means those goal-directed strategies to manage pain. The study goal was to explore what personal meaning "coping" has for work-disabled individuals in pain. METHOD: Qualitative, in depth interviews with follow-up verification interviews were conducted with 13 volunteers who were off work and in rehabilitation for chronic pain from a musculoskeletal injury. The two main questions were: (1) How did participants understand the term "coping with pain"; and (2) how did they come to this understanding of coping. The theoretical approach was social phenomenology and data were analyzed using thematic analysis. RESULTS: The dominant theme was that pain coping is an intrinsic and life-defining attitude and belief. This understanding primarily arose through early modeling by parents and significant others. Secondary theme was that coping is practical strategies to manage or eliminate pain. This arose through more current interactions with health care providers and others in the social network. CONCLUSIONS: Researchers' and clinicians' view of coping may not always match the views held by individuals with chronic pain. This might impact on the effectiveness of interventions designed to modify coping behaviors, and alternative ways of intervening may be needed.

Differences in incidence of injury between rural and urban children in Canada and the USA: a systematic review.

OBJECTIVE: The goal of the study was to systematically review available evidence regarding differences in injury incidence between rural and urban paediatric populations in Canada and the USA. DATA SOURCE: Eight electronic databases, institutional websites and reference lists of relevant studies including published and unpublished reports. SELECTION CRITERIA: Population-based observational studies or surveys published from 1970 to February 2011 that compared injury incidence or injury-related healthcare outcomes between rural and urban children (<18) living in Canada or the USA. DATA COLLECTION AND ANALYSIS: Two reviewers independently applied selection criteria and assessed methodological quality of studies. Data were extracted by one author and independently verified by the second author. Injury rate ratios for rural and urban children were extracted or calculated. Data were synthesised descriptively due to substantial heterogeneity among studies. RESULTS: A total of 41 studies were included for this review (seven surveys and 34 studies using administrative health databases). Internal validity of included studies was moderate. Rural children were at higher risk of overall injury, motor vehicle crash injury and suicide, whereas urban children in the USA experienced higher rates of firearm-related homicides. Greater rural-urban injury disparities were likely to be found between more extreme rural and urban areas. In particular, children in remote rural areas are at increased risk of severe injuries than urban counterparts. Overall, healthcare costs per child for injury were higher for rural children. CONCLUSION: These findings indicate the need of developing geographic area-specific injury-prevention strategies. Future research is required to investigate rural-urban disparity for less-studied injuries and related health outcomes (eg, disability). Systematic review registration number CRD42011001244 (PROSPERO 2011).

Retrospective review of all-terrain vehicle accidents in Alberta.

BACKGROUND: All-terrain vehicles (ATVs) are frequently associated with injuries and deaths. In spite of this, very few guidelines, let alone legal restrictions, exist to guide users of these machines. METHODS: We conducted a standardized review of prospectively collected data from the Alberta Trauma Registry. All patients who were involved in ATV-related traumas from 2003 to 2008 with an Injury Severity Score (ISS) greater than 12 were included. The variables studied were age, sex, type of vehicle, purpose of use, person injured (driver or passenger), ISS, distribution of injuries, length of hospital stay, helmet use and death. RESULTS: We evaluated 435 patients with ATV-related injuries and ISS greater than 12. The average ISS was 22.8, with an overall mortality of 4.6%; 55% of patients were not wearing helmets, and most of the deaths (85%) occurred among these individuals. Helmet use was associated with a lower risk of mechanical ventilation and of injury to the head and/or cervical spine. Children accounted for 18.9% of all patients and 15% of deaths; 57% of them were wearing helmets at the time of their accidents. CONCLUSION: All-terrain vehicle use in Alberta carries a significant risk of injury and death, and there is an association between death and lack of helmet use. A minimum age for ATV use of at least 16 years and a legal requirement for helmet use may increase public awareness of these risks and decrease morbidity and mortality.

How well are you recovering? The association between a simple question about recovery and patient reports of pain intensity and pain disability in whiplash-associated disorders.

PURPOSE: There is potential value in developing a brief assessment tool for assessing recovery after musculoskeletal injuries. Our goal was to investigate the association between a one-item global self-assessment of recovery and commonly used measures of recovery status. METHOD: We followed a cohort of 6,021 adults with acute whiplash-associated disorders for six months. Pain, depression, work status and physical health were assessed at baseline and follow-up. The question "How do you feel you are recovering from your injury?" (six response options from "all better" to "getting much worse") and functional limitations were administered at follow-up. RESULTS: Responses to the recovery question was associated with our other indices of recovery. Those "all better" had the lowest pain intensity, pain-related limitations, depression and work disability, and the best general physical health. Incrementally poorer recovery ratings on the recovery question were associated with greater pain, functional limitations and depression, poorer physical health and being off work, although "no improvement" and "getting a little worse" were similar. Recovery categories also reflected different degrees of actual improvements over the preceding follow-up period. CONCLUSIONS: Our findings suggest that a single recovery question is a useful tool for conducting brief global assessments of recovery of musculoskeletal injuries.

What we are not talking about: an evaluation of prevention messaging in print media reporting on agricultural injuries and fatalities.

BACKGROUND: Agricultural injury and fatality pose a significant burden on farmers, families, health care systems, and economies. One way of increasing knowledge of this problem and promoting prevention is the use of printed mass media such as newspapers. METHODS: We conducted a scan of all media reports contained in the Canadian Agricultural Safety Association (CASA) archives for the period January, 2007 to September, 2009, inclusive, for injury and fatality and analyzed newspaper articles for prevention messages. RESULTS: Of the 409 articles in the database, 392 met the inclusion criteria. Ninety-three of the articles (24%) contained a prevention message, and 39 (10%) of these were considered to be strong. Urban papers were two times more likely to have a safety message (OR = 2.03) while adult-related events were less likely to have a safety message included (OR = 0.49). CONCLUSION: Print media reporting of agricultural injury and fatality represents a missed opportunity to provide a prevention message. More can be done to improve linkages between news media outlets and injury prevention specialists to improve prevention content in newsprint.

What influences positive return to work expectation? Examining associated factors in a population-based cohort of whiplash-associated disorders.

STUDY DESIGN: Cross-sectional study of population-based traffic cohort. OBJECTIVE: To determine which factors are associated with both positive and negative expectations for returning to work after vehicle collision resulting in neck pain. SUMMARY OF BACKGROUND DATA: Positive expectations predict better outcomes for a variety of health conditions, including return to work from soft-tissue injury (including whiplash-associated disorders [WADs]). However, we know little about those with negative expectations who may be at risk for poor WAD outcomes. METHODS: We assessed expectations for return to work in a population-based cohort of 2335 individuals with traffic-related WAD. We used logistic regression analysis to model factors associated with expecting to return to work (compared with not expecting to return to work or being unsure). RESULTS: Depressive symptomatology, lower education, lower income, male sex, and greater initial pain (greater percentage of body in pain and greater intensity of neck pain) were associated with lower return-to-work expectation. CONCLUSION: A number of demographic, socioeconomic, and injury-related factors were associated with expectations for return to work in WAD. Two of the strongest associated factors were depressive symptomatology and postcollision initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

Factors associated with recovery expectations following vehicle collision: a population-based study.

OBJECTIVE: Positive expectations predict better outcomes for a variety of health conditions including recovery from whiplash-associated disorders, but we know little about which individuals have negative expectations, and therefore may be at risk for poor whiplash-associated disorders recovery. METHODS: We assessed expectations for global recovery in a population-based cohort of 6015 individuals with traffic-related whiplash-associated disorders. We used multinomial logistic regression analysis to model factors associated with expecting to recover slowly, or not recover at all, as opposed to expecting to recover quickly. RESULTS: Depressive symptomatology, lower education, lower income, male gender, younger age, being a passenger in the vehicle, history of neck pain, and greater initial pain (greater percentage of body in pain, greater intensity of neck pain and presence of low back and/or headache pain) were associated with poor expectations for recovery. CONCLUSION: A number of demographic, socioeconomic and injury-related factors were associated with expectations for recovery in whiplash-associated disorders. Two of the strongest associated factors were depressive symptomatology and initial neck pain intensity. These results support using a biopsychosocial approach to evaluate expectancies and their influence on important health outcomes.

Does expecting mean achieving? The association between expecting to return to work and recovery in whiplash associated disorders: a population-based prospective cohort study.

To determine the association between expectations to return to work and self-assessed recovery. Positive expectations predict better outcomes in many health conditions, but to date the relationship between expecting to return to work after traffic-related whiplash-associated disorders and actual recovery has not been reported. We assessed early expectations for return to work in a cohort of 2,335 individuals with traffic-related whiplash injury to the neck. Using multivariable Cox proportional hazard analysis we assessed the association between return to work expectations and self-perceived recovery during the first year following the event. After adjusting for the effects of sociodemographic characteristics, initial pain and symptoms, post-crash mood, prior health status and collision-related factors, those who expected to return to work reported global recovery 42% more quickly than those who did not have positive expectations (HRR = 1.42, 95% CI 1.26-1.60). Knowledge of return to work expectation provides an important prognostic tool to clinicians for recovery.

Recovery in whiplash-associated disorders: do you get what you expect?

OBJECTIVE: Positive expectations predict better outcome in a number of health conditions, but the role of expectations in predicting health recovery after injury is not well understood. We investigated whether early expectations of recovery in whiplash associated disorders (WAD) predict subsequent recovery, and studied the role of "expectations" to predict recovery as determined by pain cessation and resolution of pain-related limitations in daily activities. METHODS: A cohort of 6,015 adults with traffic-related whiplash injuries was assessed, using multivariable Cox proportional hazards analysis, for association between these expectations and self-perceived recovery over a 1-year period following the injury. Recovery was assessed using 3 indices: self-perceived global recovery (primary outcome); resolution of neck pain severity; and resolution of pain-related limitations in daily activities. RESULTS: After adjusting for the effect of sociodemographic characteristics, post-crash symptoms and pain, prior health status and collision-related factors, those who expected to get better soon recovered over 3 times as quickly (hazard rate ratio = 3.62, 95% confidence interval 2.55-5.13) as those who expected that they would never get better. Findings were similar for resolution of pain-related limitations and resolution of neck pain intensity, although the effect sizes for the latter outcome were smaller. CONCLUSION: Patients' early expectations for recovery are an important prognostic factor in recovery after whiplash injury, and are potentially modifiable. Clinicians should assess these expectations in order to identify those patients at risk of chronic whiplash, and future studies should focus on the effect of changing these early expectations.