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1.
Estima (Online) ; 19(1): e0921, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1280948

RESUMO

Objetivo:descrever o processo de implementacao da Rede de Atencao a Saude em Lesoes Cutaneas no municipio de Divinopolis − MG. Metodo: trata-se de um relato de experiencia sobre a implementacao de uma Rede de Atencao a Saude em Lesoes Cutaneas a partir do Programa de Educacao Pelo Trabalho para Saude (PET-Saude/GraduaSUS), no periodo de maio de 2016 a abril de 2018. Participaram das acoes professores e alunos de uma universidade publica e profissionais enfermeiros vinculados a Secretaria Municipal de Saude do municipio. Resultados: foi possivel implementar a Rede de Atencao a Saude para prevencao e tratamento de lesoes cutaneas de maneira estruturada e sistematizada. Foi estabelecido um fluxo de atendimento, supervisao de casos e acompanhamento clinico por meio da construcao de um protocolo assistencial. Conclusao: a habilidade pratica e o conhecimento cientifico de alunos e profissionais de saude para o tratamento e manejo de lesoes cutaneas foram desenvolvidos fortalecendo, assim, a triade ensino-servico-comunidade.


Objective: describe the process of implementing the Rede de Atencao a Saude em Lesoes Cutaneas (Health Care Network for Skin Injuries) in the municipality of Divinopolis - MG. Method: it is an experience report on the implementation of a Health Care Network for Skin Injuries from the Programa de Educacao Pelo Trabalho para Saude (PET-Saude/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.


Assuntos
Ferimentos e Lesões , Relações Comunidade-Instituição , Atenção à Saúde , Acesso aos Serviços de Saúde
2.
Estima (Online) ; 19(1): e0421, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1178058

RESUMO

Objetivos:identificar na literatura cientifica o conhecimento produzido sobre lesoes por friccao em idosos. Metodos: trata-se de uma revisao 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 Saude, com descritores e os operadores booleanos "and" e "or". Resultados: a partir da busca bibliografica, selecao e analise, oito artigos compuseram a amostra. Para lesao por friccao em idosos emergiram quatro pilares do cuidado: manutencao da homeostase organica e tissular com foco na nutricao e hidratacao apropriada; evitar traumas na pele senil, proporcionando um ambiente seguro com dispositivos adequados; e a sistematizacao da assistencia e educacao em saude do cuidado com a pele do idoso. Conclusao: como mecanismos de prevencao, encontram-se a realizacao da prevencao primaria por meio de um plano de cuidados singular e as atividades de educacao em saude, focadas nos fatores de risco e nas vulnerabilidades, minimizando danos e complicacoes


Assuntos
Ferimentos e Lesões , Idoso , Fricção , Enfermagem Geriátrica
3.
Can J Surg ; 64(6): E609-E612, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34759046

RESUMO

Trauma care delivery is a complex team-based task that requires deliberate practice. The COVID-19 pandemic has not diminished the importance of excellent trauma team dynamics. However, the pandemic hampers our ability to gather safely and train together. A mitigating solution is the provision of high-fidelity simulation training in a virtual setting. The Simulated Trauma and Resuscitation Team Training (S.T.A.R.T.T.) course has provided multidisciplinary trauma team members with skills in crisis resource management (CRM) for nearly 10 years. It has promoted collaborative learning from coast to coast, as the course typically runs at our national surgical and trauma meetings. In response to COVID-19 challenges, the course content has been modified to virtually connect 2 centres in different provinces simultaneously. High participant satisfaction suggests that the new virtual E-S.T.A.R.T.T course is able to continue to help providers develop important CRM skills in a multidisciplinary setting while remaining compliant with COVID-19 safety precautions.


Assuntos
COVID-19 , Educação à Distância , Treinamento com Simulação de Alta Fidelidade , Traumatologia/educação , Ferimentos e Lesões/terapia , Canadá , Competência Clínica , Gestão de Recursos da Equipe de Assistência à Saúde , Currículo , Treinamento com Simulação de Alta Fidelidade/métodos , Treinamento com Simulação de Alta Fidelidade/normas , Humanos , Pandemias , Equipe de Assistência ao Paciente , SARS-CoV-2 , Traumatologia/normas
4.
Accid Anal Prev ; 163: 106463, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34768139

RESUMO

Globally there are more than 350,000 PTW fatalities each year. Safety concepts to protect Powered Two-Wheeler (PTW) riders exist and are being developed further, but they need appropriate procedures and test tools (Anthropometric Test Devices (ATDs) for physical testing and Human Body Models (HBMs) for virtual testing) to direct and promote those developments. To aid further development of the tools, we aim to rank the frequency of specific injuries arising from the prevalent impact types, discuss how current ATDs and HBMs are equipped to assess these injuries, and suggest what further development should be prioritized. We analyzed a sample of injured riders from the German In-depth Accident Study (GIDAS) according to the Abbreviated Injury Scale (AIS) 2015 classification, using severity thresholds of at-least-moderate (AIS2+) and at-least-serious (AIS3+). PTW rider injuries were ranked by frequency for all crashes and also for sub-samples of specific impact types (impact with passenger cars, ground, and roadside furniture). The most frequent AIS3+ injuries were: femur fracture (17%), rib cage fracture (13%), lung injury (9%), tibia fracture (7%), and cerebrum injury (7%). In all impacts together and as for impacts with the road surface, injuries to the thorax were most frequent. In impacts with cars and road furniture, thorax injuries were also frequent, but outranked by lower extremity injuries. Considering both AIS2+ and AIS3+ injuries, the priorities for PTW rider safety interventions are: fracture of the rib cage, femur fracture, tibia fracture, radius fracture, cerebrum injury, and cerebral concussion. The ATD currently used most frequently, the Hybrid III, is unlikely to provide adequate rib fracture injury assessments, but HBMs are promising in this area. Rib injury assessment may also reasonably predict other injuries that were correlated or in proximity to rib fractures: clavicle, lung, and upper abdomen organ injury. Lower extremity, upper extremity, and head injuries are likely addressable to some extent with current ATDs while HBMs hold the promise of more detailed and mechanism-specific injury assessments. Both ATDs and HBMs need more validation for use in the PTW environment.


Assuntos
Traumatismos Craniocerebrais , Traumatismos Torácicos , Ferimentos e Lesões , Escala Resumida de Ferimentos , Acidentes de Trânsito/prevenção & controle , Automóveis , Humanos , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle
5.
Artigo em Inglês | MEDLINE | ID: mdl-34769650

RESUMO

Accidents involving electric bicycles, a popular means of transportation in China during peak traffic periods, have increased. However, studies have seldom attempted to detect the unique crash consequences during this period. This study aims to explore the factors influencing injury severity in electric bicyclists during peak traffic periods and provide recommendations to help devise specific management strategies. The random-parameters logit or mixed logit model is used to identify the relationship between different factors and injury severity. The injury severity is divided into four categories. The analysis uses automobile and electric bicycle crash data of Xi'an, China, between 2014 and 2019. During the peak traffic periods, the impact of low visibility significantly varies with factors such as areas with traffic control or without streetlights. Furthermore, compared with traveling in a straight line, three different turnings before the crash reduce the likelihood of severe injuries. Roadside protection trees are the most crucial measure guaranteeing riders' safety during peak traffic periods. This study reveals the direction, magnitude, and randomness of factors that contribute to electric bicycle crashes. The results can help safety authorities devise targeted transportation safety management and planning strategies for peak traffic periods.


Assuntos
Traumatismos por Eletricidade , Ferimentos e Lesões , Acidentes de Trânsito , Automóveis , Ciclismo , Humanos , Modelos Logísticos
6.
Artigo em Inglês | MEDLINE | ID: mdl-34769702

RESUMO

Over the past 12 years, Bloomberg Philanthropies (BP) and its partner organisations have implemented a global road safety program in low- and middle-income countries. The program was implemented to address the historically increasing number of road fatalities and the inadequate funding to reduce them. This study evaluates the performance of the program by estimating lives saved from road safety interventions implemented during the program period (2007-2018) through to 2030. We estimated that 311,758 lives will have been saved by 2030, with 97,148 lives saved up until 2018 when the evaluation was conducted and a further 214,608 lives projected to be saved if these changes are sustained until 2030. Legislative changes alone accounted for 75% of lives saved. Concurrent activities related to reducing drink driving, implementing legislative changes, and social marketing campaigns run in conjunction with police enforcement and other road safety activities accounted for 57% of the total estimated lives saved. Saving 311,758 lives with funding of USD $259 million indicates a cost-effectiveness ratio of USD $831 per life saved. The potential health gains achieved through the number of lives saved from the road safety initiatives funded by Bloomberg Philanthropies represent a considerable return on investment. This study demonstrates the extent to which successful, cost-effective road safety initiatives can reduce road fatalities in low- and middle-income countries.


Assuntos
Condução de Veículo , Dirigir sob a Influência , Ferimentos e Lesões , Acidentes de Trânsito/prevenção & controle , Países em Desenvolvimento , Humanos , Renda , Polícia , Segurança
7.
Adv Skin Wound Care ; 34(12): 638-644, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34807895

RESUMO

OBJECTIVE: To investigate the prevalence of anxiety and depression among hospitalized patients with a chronic wound and explore the influence of demographic factors, disease characteristics, social support, and coping styles on their mental status. METHODS: Investigators recruited 216 patients with a chronic wound. The Self-rating Anxiety Scale and Self-rating Depression Scale were used to measure anxiety and depression. Patients' coping style and their social support were assessed through face-to-face interviews. RESULTS: Overall, 36.6% of participants presented with symptoms of anxiety, and 37% showed depressive symptoms. Participants who typically had less than 5 hours of sleep; experienced more severe pain; or had an odorous wound, negative coping style, or lower level of social support had a higher prevalence of anxiety and depression (P < .05). Men with higher monthly incomes who lived in the city were more likely to develop anxiety than women with lower monthly incomes who lived outside the city (P < .05). Participants with fewer years of education and without spouses were more likely to experience depression than married participants with more education (P < .05). CONCLUSIONS: The prevalence of anxiety and depression among hospitalized patients with a chronic wound is high. Support from loved ones including a spouse and a positive coping style are key protective factors for mental health and well-being.


Assuntos
Ansiedade/etiologia , Depressão/etiologia , Ferimentos e Lesões/complicações , Adaptação Psicológica , Adulto , Ansiedade/psicologia , Depressão/psicologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Qualidade de Vida/psicologia , Apoio Social , Inquéritos e Questionários , Ferimentos e Lesões/psicologia
8.
Adv Skin Wound Care ; 34(12): 645-650, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34807896

RESUMO

OBJECTIVE: To determine the factors affecting the quality of life of patients with chronic wounds. METHODS: This descriptive cross-sectional study was conducted in a university hospital wound care unit in western Turkey with 134 patients. The data were collected via personal information form, Barthel Index for activities of daily living, visual analog scale, and Short Form-12 questionnaire. Descriptive statistics and Spearman correlation were used for data analysis. RESULTS: The mean age of the participants was 60.4 ± 10.7 years; 79.9% of the research group had diabetic foot wounds, and 56.7% had wounds on their right/left big toe. The mean duration of wounds was 9.4 ± 11.4 months, and 68.7% had previously been hospitalized because of wounds. The average visual analog scale pain level was 3.5 ± 2.5, and 45.5% of the patients were PEDIS (perfusion, extent, depth, infection, and sensation) classification grade II. A positive correlation was detected between Short Form-12 physical summary score and activities of daily living score. CONCLUSIONS: Patients with chronic wounds have a poor quality of life. Patient quality of life decreases as pain and PEDIS score increase and increases with their level of independence.


Assuntos
Extremidade Inferior/fisiopatologia , Qualidade de Vida/psicologia , Ferimentos e Lesões/complicações , Idoso , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ferimentos e Lesões/psicologia
9.
West J Emerg Med ; 22(6): 1374-1378, 2021 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-34787565

RESUMO

INTRODUCTION: Traumatic injuries disproportionately affect populations in low and middle-income countries (LMIC) where head injuries predominate. The Rwandan Ministry of Health (MOH) has dramatically improved access to emergency services by rebuilding its health infrastructure. The MOH has strengthened the nation's acute emergency response by renovating emergency departments (ED), developing the field of emergency medicine as a specialty, and establishing a prehospital care service: Service d'Aide Medicale Urgente (SAMU). Despite the prevalence of traumatic injury in LMIC and the evolving emergency service in Rwanda, data regarding head trauma epidemiology is lacking. METHODS: We conducted this retrospective cohort study at the University Teaching Hospital of Kigali (UTH-K) and used a linked prehospital database to investigate the demographics, mechanism, and degree of acute medical interventions amongst prehospital patients with head injury. RESULTS: Of the 2,426 patients transported by SAMU during the study period, 1,669 were found to have traumatic injuries. Data from 945 prehospital patients were accrued, with 534 (56.5%) of these patients diagnosed with a head injury. The median age was 30 years, with most patients being male (80.3%). Motor vehicle collisions accounted for almost 78% of all head injuries. One in six head injuries were due to a pedestrian struck by a vehicle. Emergency department interventions included intubations (6.7%), intravenous fluids (2.4%), and oxygen administration (4.9%). Alcohol use was not evaluated or could not be confirmed in 81.3% of head injury cases. The median length of stay (LOS) in the ED was two days (interquartile range: 1,3). A total of 184 patients were admitted, with 13% requiring craniotomies; their median in-hospital care duration was 13 days. CONCLUSION: In this cohort of Rwandan trauma patients, head injury was most prevalent amongst males and pedestrians. Alcohol use was not evaluated in the majority of patients. These traumatic patterns were predominantly due to road traffic injury, suggesting that interventions addressing the prevention of this mechanism, and treatment of head injury, may be beneficial in the Rwandan setting.


Assuntos
Traumatismos Craniocerebrais , Serviços Médicos de Emergência , Ferimentos e Lesões , Acidentes de Trânsito , Adulto , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/terapia , Humanos , Masculino , Estudos Retrospectivos , Ruanda/epidemiologia , Centros de Atenção Terciária
10.
Air Med J ; 40(6): 441-445, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34794786

RESUMO

Early administration of blood products is emerging as best practice in selected trauma and medical patients. Blood products carried by critical care transport (CCT) teams are sometimes the first available to critically ill and injured patients. The purpose of this research was to evaluate the introduction of prehospital transfusion into a paramedic-led CCT program in Canada. A retrospective review of electronic patient care records for all patients who received a prehospital transfusion of uncrossmatched group O packed red blood cells between February 10, 2019, and September 30, 2020, was conducted. Forty-eight patients received a prehospital transfusion. The median age of the patients was 44 years, 81.3% were male, and most patients were victims of blunt trauma. Packed red blood cells were associated with a significant increase in systolic blood pressure (P < .001) and mean arterial pressure (P < .001), a decrease in shock index (P < .001), and a reduction in the time to first transfusion, with minimal waste, no patient-related adverse events, and complete traceability. The results of this service evaluation demonstrate the successful introduction of prehospital transfusion into a paramedic-led CCT program. Further prospective research is needed to assess the impact of such a protocol in this patient population.


Assuntos
Serviços Médicos de Emergência , Ferimentos e Lesões , Adulto , Pessoal Técnico de Saúde , Transfusão de Sangue , Colúmbia Britânica , Cuidados Críticos , Humanos , Masculino , Estudos Retrospectivos
11.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(8): 1380-1391, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814558

RESUMO

Objective: To landscape the contents, similarities, and differences of the objectives and strategies for unintentional injury prevention and control in the national and 31 provincial Children's Development Outlines from 2011 to 2020, and propose relevant suggestions. Methods: The content analysis method was used to extract, encode and classify the objective and strategy text of unintentional injury in all Children's Development Outlines and construct the theme of strategy text combined with the '5E' Injury Prevention Framework. Taking the national Children's Development Outline as the benchmark, the relevant contents of 31 provincial Children's Development Outlines in the same period were compared. Results: All Children's Development Outlines took child injury prevention and control as the primary objective set in health, environment, and safety. The national and most provincial Children's Development Outlines set this goal in health, while others put it in environment or safety. Reducing injury-induced death, disability and occurrence were designated as the main content in the objective of child injury prevention and control. However, there were no quantitative requirements for injury occurrence and disability in all the provincial outlines. The themes of unintentional injury prevention and control strategies in all Children's Development Outlines could be divided into the mechanism, law enforcement, education, environment, engineering, first aid, assessment, and economic strategies. Mechanism strategy was the primary domain, followed by law enforcement, education, environment, and engineering strategies, but less attention was put on first aid, assessment, and economic strategies. The unintentional injury prevention and control strategy in the provincial Children's Development Outlines was mainly based on the national outline. Still, it also varied with some emphasis and refinement in different items among all the provinces. Conclusions: Children's Development Outline is a vital policy guarantee for implementing child injury prevention and control work. Developing a system involving good primary data, mechanisms and strategies, law enforcement, and environmental and engineering-related strategies for more common types of child injuries has been attached to great importance. Actively carrying out assessments and encouraging the adoption of more economical strategies could further enrich and improve the unintentional injury prevention and control in Children's Development Outline and promote the progress of related work in China.


Assuntos
Ferimentos e Lesões , Criança , China , Escolaridade , Humanos , Ferimentos e Lesões/prevenção & controle
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(8): 1392-1400, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814559

RESUMO

Objective: To investigate the incidence of injuries among children aged 0-17 years from 28 counties in six provinces. Methods: According to the earlier study on data in different local areas and the current work plan, we selected the survey objects for a general survey on child injury prevalence in the last 12 months. The subjects included guardians of children who did not attend kindergartens, children from kindergartens, and primary school grades 1-3. Children from grades 4-6 primary school, junior high school, and senior high school were also included. Results: The overall rate of injured children was 4.83%, with the incidence of injuries as 5.75% in the last 12 months before the survey. Both the rate of injured children and incidence of injuries were higher in boys than that in girls. Children whose primary caregivers were relatives, grandparents, minors, or with an education level below the primary school had a relatively higher rate of both injured children and incidence of injuries. The first cause of child injury was fall. The time of child injury was mainly from June to October, mainly at home, with the main activity as playing. The significant injuries in children were contusion and abrasion, and the main parts injured were lower limbs, upper limbs, and head. Most of the injuries were cured, and the primary treatment was outpatient and emergency treatment. Conclusions: Boys and children whose parents can not take care of are the priority population for child injury prevention and control. Targeted prevention and control measures should be implemented according to the characteristics of injuries among children of different ages.


Assuntos
Cuidadores , Ferimentos e Lesões , Criança , China/epidemiologia , Feminino , Humanos , Incidência , Masculino , Prevalência , Instituições Acadêmicas , Ferimentos e Lesões/epidemiologia
13.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(8): 1407-1412, 2021 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814561

RESUMO

Objective: To investigate the incidence of traffic injuries among children aged 0-17 years in 28 counties of 6 provinces and to provide prevention suggestions. Methods: Using the general survey method, a questionnaire survey was conducted on the road traffic injuries of children in 28 counties of 6 provinces in 2017. Results: A total of 204 628 students were surveyed, 908 of whom had experiences of road traffic injuries. Road traffic injuries were 0.44% among children in 28 counties of 6 provinces in China and 0.94% among children who did not attend kindergartens. July is a high incidence period of road traffic injuries among children (12.92%). When children suffer from road traffic injuries, the first three activities were playing (21.61%), riding an electric bicycle (20.40%), walking (20.07%). Most injuries appeared as contusion/abrasion, accounting for 42.26% of the total cases. The injured parts were mainly lower limbs, upper limbs, and heads, accounting for 38.85%, 23.29%, and 20.20%. Most children with road traffic injuries recovered after related treatments, accounting for 85.43% of all cases. The median length of hospital stay of children with road traffic injuries was seven days, and the median expense in hospitals was 3 000 Yuan (RMB). Conclusions: The incidence of road traffic injuries among males appeared higher than females, and the children who did not attend the kindergartens were the highest. During playing, riding an electric bicycle and walking were the top three activities prone to road traffic injuries.


Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Acidentes de Trânsito/prevenção & controle , Criança , China/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Instituições Acadêmicas , Caminhada , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controle
14.
Can J Surg ; 64(6): E588-E593, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34728524

RESUMO

BACKGROUND: Given the rising prevalence of subways in combination with an increasing incidence of subway-related injuries, understanding subway-related trauma is becoming ever more relevant. The aim of this study was to characterize the potential causes, injury characteristics and outcomes of subway-related trauma at a level 1 adult trauma centre in Toronto, Ontario. METHODS: We conducted a retrospective cohort study to identify patients who presented to the emergency department a level 1 adult trauma centre with a subway-related injury between Jan. 1, 2010, and Dec. 31, 2018. Patients were identified via International Statistical Classification of Diseases and Related Health Problems, 10th Revision E-codes (X81, Y02, V050, V051 and W17). We then further screened for descriptions of subway-related injuries. Patients whose injuries did not involve a moving subway train were excluded. RESULTS: We identified 51 patients who presented to the emergency department after being hit by a moving subway train. The majority of incidents (39 [76%]) were due to self-harm, 10 (20%) were unintentional injuries, and 2 (4%) were due to assault. The presence of alcohol was detected in 8 patients (80%) with unintentional injuries and 3 (8%) of those with self-inflicted injuries. Thirteen patients (25%) had a systolic blood pressure less than 90 mm Hg. The median Injury Severity Score was 17 (interquartile range 9-29). Seventeen patients (33%) presented with severe injuries (Abbreviated Injury Scale score ≥ 3) in 1 body region, and 19 (37%) had severe injuries in 2 or more body regions. The most common isolated severe injury was in the lower extremity, and the most common combinations of severe injuries were in the head and lower extremity, and head and thorax. Ten patients (20%) were declared dead in the emergency department. Of the 41 patients who survived their initial presentation, 12 (29%) went directly to the operating room, and 17 (41%) were transferred to the intensive care unit. The overall mortality rate was 29%. CONCLUSION: Patients with subway-related injuries experienced high mortality rates and severe injuries. Most incidents were due to self-harm or alcohol-related. Further research into early identification of those at risk and optimal prevention strategies is necessary to curb further incidents.


Assuntos
Acidentes/estatística & dados numéricos , Consumo de Bebidas Alcoólicas/epidemiologia , Abuso Físico/estatística & dados numéricos , Ferrovias , Comportamento Autodestrutivo/epidemiologia , Índices de Gravidade do Trauma , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adolescente , Adulto , Idoso , Pressão Sanguínea/fisiologia , Traumatismos Craniocerebrais/epidemiologia , Traumatismos Craniocerebrais/etiologia , Traumatismos Craniocerebrais/terapia , Cuidados Críticos/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Escala de Coma de Glasgow , Humanos , Escala de Gravidade do Ferimento , Extremidade Inferior/lesões , Masculino , Pessoa de Meia-Idade , Ontário/epidemiologia , Estudos Retrospectivos , Comportamento Autodestrutivo/complicações , Comportamento Autodestrutivo/mortalidade , Comportamento Autodestrutivo/terapia , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/mortalidade , Ferimentos e Lesões/terapia , Adulto Jovem
15.
Wounds ; 33(10): 253-259, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34735362

RESUMO

INTRODUCTION: Topical antimicrobial treatment of wounds in pediatric, and especially neonatal, patients can be challenging due to increased systemic absorption, damaging inflammatory cytokines, and oxygen radicals released by bacterial death. A product combining all wound bed preparation principles is desired. Methylene blue and gentian violet (MB/GV) foam dressings can keep wound beds moist, decrease ongoing inflammation, provide antibacterial coverage, and promote healthy wound edges. OBJECTIVE: This article examines the use of MB/GV antibacterial foams in pediatric patients. Cases included infants with giant omphalocele epidermal stripping, dehisced abdominal wounds, peristomal dermatitis, and peripheral intravenous extravasations and adolescents with stage 4 pressure injuries. The treatment goals were to optimize the wound bed through debridement, elimination of bioburden, providing moisture balance, and enhancement of granulation tissue growth. MATERIALS AND METHODS: Eight patients (6 infants and 2 adolescents) received MB/GV foam dressings every 2 to 3 days along with standard of care (SOC) management. RESULTS: Effective debridement, bioburden elimination, moisture balance, and edge enhancement were achieved in all wounds. All wound beds were well-prepared to receive other SOC products as needed. Three cases were considered for negative pressure wound therapy (NPWT), but NPWT was not used because of challenging clinical characteristics and wound locations. Instead, MB/GV polyvinyl alcohol foam provided capillary wicking action that enhanced wound closure without NPWT. No side effects were observed. CONCLUSIONS: Methylene blue and gentian violet foam dressings appear to be a safe clinical option for antibacterial coverage, moisture management, and debridement in neonatal and pediatric patients.


Assuntos
Tratamento de Ferimentos com Pressão Negativa , Ferimentos e Lesões , Adolescente , Bandagens , Criança , Violeta Genciana , Humanos , Azul de Metileno , Resultado do Tratamento , Cicatrização
16.
Trials ; 22(1): 769, 2021 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-34736498

RESUMO

BACKGROUND: Trauma is the leading cause of death and disability in children in the USA. Tranexamic acid (TXA) reduces the blood transfusion requirements in adults and children during surgery. Several studies have evaluated TXA in adults with hemorrhagic trauma, but no randomized controlled trials have occurred in children with trauma. We propose a Bayesian adaptive clinical trial to investigate TXA in children with brain and/or torso hemorrhagic trauma. METHODS/DESIGN: We designed a double-blind, Bayesian adaptive clinical trial that will enroll up to 2000 patients. We extend the traditional Emax dose-response model to incorporate a hierarchical structure so multiple doses of TXA can be evaluated in different injury populations (isolated head injury, isolated torso injury, or both head and torso injury). Up to 3 doses of TXA (15 mg/kg, 30 mg/kg, and 45 mg/kg bolus doses) will be compared to placebo. Equal allocation between placebo, 15 mg/kg, and 30 mg/kg will be used for an initial period within each injury group. Depending on the dose-response curve, the 45 mg/kg arm may open in an injury group if there is a trend towards increasing efficacy based on the observed relationship using the data from the lower doses. Response-adaptive randomization allows each injury group to differ in allocation proportions of TXA so an optimal dose can be identified for each injury group. Frequent interim stopping periods are included to evaluate efficacy and futility. The statistical design is evaluated through extensive simulations to determine the operating characteristics in several plausible scenarios. This trial achieves adequate power in each injury group. DISCUSSION: This trial design evaluating TXA in pediatric hemorrhagic trauma allows for three separate injury populations to be analyzed and compared within a single study framework. Individual conclusions regarding optimal dosing of TXA can be made within each injury group. Identifying the optimal dose of TXA, if any, for various injury types in childhood may reduce death and disability.


Assuntos
Antifibrinolíticos , Ácido Tranexâmico , Ferimentos e Lesões , Antifibrinolíticos/uso terapêutico , Teorema de Bayes , Criança , Método Duplo-Cego , Hemorragia/tratamento farmacológico , Humanos , Ácido Tranexâmico/uso terapêutico , Índices de Gravidade do Trauma , Ferimentos e Lesões/tratamento farmacológico
17.
Urologiia ; (5): 15-25, 2021 Nov.
Artigo em Russo | MEDLINE | ID: mdl-34743427

RESUMO

INTRODUCTION: Damage to the organs of the urinary system (UMS) in road trauma (DT) is 4%, of which multiple and combined - over 70%. The aim of the study is to determine the main organizational and clinical directions for improving the EMC in case of trauma OMS in a trauma center of the 1st level. MATERIAL AND METHODS: For the period from 2017 to 2020. 508 injured with road polytrauma were admitted to the hospital. Of these, trauma and secondary injuries were diagnosed in 108 people (21.3%), which were divided into three groups: the first - 73 (67.6%) victims with the injury of the OMVS, the second - 25 (23.1%) with secondary damage kidney, the third - 10 (9.3%) patients with "neurogenic bladder" with spinal trauma. The assessment of the severity of damage was carried out using the ISS scales and tables of the IH P and IH C. RESULTS: It has been shown that the introduction of an interdisciplinary approach to the organization of in-hospital routing and differentiated algorithms of medical and diagnostic tactics based on the concept of traumatic disease, led to the establishment of a final diagnosis in every third victim in the early stages, as well as to a decrease in the overall mortality rate by 3.7%, the overall mortality rate was 12,2%. The key directions for improving the efficiency and quality of care in case of dominant and concomitant trauma of the urinary system have been identified, based on the tactics of programmed multistage surgical treatment (Damage Control Urological). CONCLUSION: In the FSBI "3CVKG A.A. Vishnevsky "developed, organized and implemented a system and algorithm for the provision of specialized medical care for trauma to the Ministry of Railways, including high-tech assistance to victims of road accidents, associated with the regional and federal services of disaster medicine.


Assuntos
Traumatismo Múltiplo , Ferimentos e Lesões , Acidentes de Trânsito , Hospitais , Humanos , Traumatismo Múltiplo/diagnóstico , Traumatismo Múltiplo/terapia
18.
J Trauma Nurs ; 28(6): 341-349, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34766927

RESUMO

BACKGROUND: Hemorrhage is a leading cause of early mortality following trauma. A massive transfusion protocol (MTP) to guide resuscitation while bleeding is definitively controlled may improve outcomes. Prompts to initiate massive transfusion (MT) include shock index (SI) and the Assessment of Blood Consumption (ABC) score. OBJECTIVE: To compare SI with the ABC score for association with transfusion requirement, need for emergency hemorrhage interventions, and early mortality. METHODS: A retrospective cohort analysis of trauma MTP activations at our Level I trauma center was conducted from January 1, 2012, to December 31, 2016. The study data were obtained from the Trauma Registry and the blood bank. An SI cutoff of 1.0 was chosen for comparison with the positive ABC score. RESULTS: The study cohort included 146 patients. Shock index ≥ 1 had significant association with MT requirement (p = .002) whereas a positive ABC score did not (p = .65). More patients with SI ≥ 1 required bleeding control interventions (67% surgery, 47% interventional radiology) than patients having a positive ABC score (49% surgery, 29% interventional radiology). For geriatric patients who received MT, 65% had SI ≥ 1 but only 30% had a positive ABC score. Three-hour mortality following emergency department arrival was similar (60% SI ≥ 1, 62% positive ABC score). CONCLUSION: Shock index ≥ 1 outperformed a positive ABC score for association with MT requirement. Shock index is a simple tool registered nurses can independently utilize to anticipate MT.


Assuntos
Transfusão de Sangue , Ferimentos e Lesões , Idoso , Serviço Hospitalar de Emergência , Hemorragia/diagnóstico , Hemorragia/terapia , Humanos , Estudos Retrospectivos , Centros de Traumatologia , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/terapia
19.
Artigo em Inglês | MEDLINE | ID: mdl-34769922

RESUMO

Road trauma remains a significant public health problem. We aimed to identify sub-groups of motor vehicle collisions in Victoria, Australia, and the association between collision characteristics and outcomes up to 24 months post-injury. Data were extracted from the Victorian State Trauma Registry for injured drivers aged ≥16 years, from 2010 to 2016, with a compensation claim who survived ≥12 months post-injury. People with intentional or severe head injury were excluded, resulting in 2735 cases. Latent class analysis was used to identify collision classes for driver fault and blood alcohol concentration (BAC), day and time of collision, weather conditions, single vs. multi-vehicle and regional vs. metropolitan injury location. Five classes were identified: (1) daytime multi-vehicle collisions, no other at fault; (2) daytime single-vehicle predominantly weekday collisions; (3) evening single-vehicle collisions, no other at fault, 36% with BAC ≥ 0.05; (4) sunrise or sunset weekday collisions; and (5) dusk and evening multi-vehicle in metropolitan areas with BAC < 0.05. Mixed linear and logistic regression analyses examined associations between collision class and return to work, health (EQ-5D-3L summary score) and independent function Glasgow Outcome Scale - Extended at 6, 12 and 24 months. After adjusting for demographic, health and injury characteristics, collision class was not associated with outcomes. Rather, risk of poor outcomes was associated with age, sex and socioeconomic disadvantage, education, pre-injury health and injury severity. People at risk of poor recovery may be identified from factors available during the hospital admission and may benefit from clinical assessment and targeted referrals and treatments.


Assuntos
Concentração Alcoólica no Sangue , Ferimentos e Lesões , Acidentes de Trânsito , Humanos , Veículos Automotores , Sobreviventes , Vitória/epidemiologia , Ferimentos e Lesões/epidemiologia
20.
Rev Lat Am Enfermagem ; 29: e3493, 2021.
Artigo em Inglês, Espanhol, Português | MEDLINE | ID: mdl-34755774

RESUMO

OBJECTIVE: to evaluate evidence on effectiveness support surfaces for pressure injury prevention in the intraoperative period. METHOD: systematic review. The search for primary studies was conducted in seven databases. The sample consisted of 10 studies. The synthesis of the results was carried out descriptively and through meta-analysis. RESULTS: when comparing low-tech support surfaces with regular care (standard surgical table mattress), the meta-analysis showed that there is no statistically significant difference between the investigated interventions (Relative Risk = 0.88; 95%CI: 0.30-2.39). The Higgins inconsistency test indicated considerable heterogeneity between studies (I2 = 83%). The assessment of the certainty of the evidence was very low. When comparing high-tech and low-tech support surfaces, the meta-analysis showed that there is a statistically significant difference between the interventions studied, with high-tech being the most effective (Relative Risk = 0.17; 95%CI: 0.05-0.53). Heterogeneity can be classified as not important (I2 = 0%). The assessment of certainty of evidence was moderate. CONCLUSION: the use of high-tech support surfaces is an effective measure to prevent pressure injuries in the intraoperative period.


Assuntos
Leitos , Complicações Intraoperatórias/prevenção & controle , Ferimentos e Lesões/prevenção & controle , Humanos
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