Auswahl der wissenschaftlichen Literatur zum Thema „Injury situation“

Background: Trauma is a significant public health problem both in the UK and beyond. It can have a devastating impact on individuals, their family and society. The care of injured patients has long been thought to be sub-standard in the UK and patient outcomes were noted to be worse than other developed countries. Between 2010-12 regional trauma systems were introduced in England, with the aim of improving survival and long-term outcomes of injured patients. The aim of this study was to critically assess the implementation of these trauma systems on processes and outcomes of care in two regions of England. Methods: A systematic review was undertaken to identify studies evaluating the association between an inclusive trauma system and patient outcome. A mixed-methods approach was used for the study. Data on trauma deaths were obtained from the UK Office for National Statistics (ONS). The Trauma Audit and Research Network (TARN) database was interrogated to provide data on all patients who presented to hospital within two years before and two years after trauma system implementation. A time-series analysis and a before and after study, using a comparator region to control for temporal trends, was undertaken for each region. Twenty semi-structured interviews with Emergency Department (ED) staff were conducted to gain a broader understanding of the effect of this change. Data were then merged and areas of convergence and discrepancy highlighted. Results: The systematic review identified eight observational studies that all demonstrated a significant fall in the odds of death when patients presenting with traumatic injuries were treated within such a system. However, they were deemed to represent a very low-quality body of evidence. ONS data demonstrated that whilst trauma mortality rates were stable, between 30- 50% die outside of hospital. Analysis of TARN data demonstrated that, following system implementation, a greater proportion of injured patients were seen at Major Trauma Centres (MTCs), quality of care indices such as time to CT scan improved and mortality fell. Analysis of the interviews revealed seven main themes and whilst all staff welcomed the commitment to improve trauma care, some, especially outside of the MTCs, expressed concerns about disengagement and being unable to provide the level of care expected. Conclusions: This study adds to the body of evidence supporting the role of inclusive trauma systems in improving quality of care indices and patient outcomes. Contrary to some other studies, this study has shown improvements within two years, particularly at MTCs. Whilst most ED staff interviewed corroborated this view, some barriers to delivering high quality trauma care were felt to remain. Whilst trauma was once seen as a disease of young men and motor vehicle collisions, it is now dominated by falls in the elderly population and trauma systems must be able to meet their needs. Further research is warranted to learn more about the large population of trauma patients that do not survive to reach hospital. Perhaps some of the greatest future improvements of trauma systems are to be found here.

Situation awareness (SA) has been developed in occupations other than nursing to improve decision making (DM) for optimal performance and outcomes. There are some studies exploring the use of situation awareness by nurses in simulated settings but few have examined SA in clinical practice. Because of this paucity of evidence nurses’ use of situation awareness in practice is not fully understood. Studies examining decision making by nurses have indicated that clinical decisions arising from a lack of awareness of patient needs in busy, complex clinical environments can compromise care. In ward environments, compromised care often results in the omission of ‘basic’ nursing interventions which may include pressure injury prevention. This thesis explored the use of situation awareness by nurses in medical/surgical wards as the precursor to decision making and the influences on situation awareness whilst making pressure injury prevention decisions in practice.<br>Thesis (PhD Doctorate)<br>Doctor of Philosophy (PhD)<br>School of Nursing and Midwifery<br>Griffith Health<br>Full Text

La cognition sociale, i.e. notre capacité à attribuer des états mentaux à autrui et à identifier ses émotions, est souvent perturbée dans certaines pathologies telles que le traumatisme crânien (TC). Cette capacité est traditionnellement évaluée à l’aide de tâches sous format « papier-crayon » n’impliquant pas le participant dans une situation d’interaction sociale. Pourtant, la cognition sociale est fondamentale dans nos interactions sociales car elle nous permet de comprendre le discours et le comportement d’autrui. Ainsi, dans ce travail de thèse, nous avons évalué les capacités d’attribution d’états mentaux et de reconnaissance émotionnelle de personnes ayant subi un TC à l’aide de tâches les impliquant activement dans une situation de communication (tâche de communication référentielle et tâche EViCog), ce qui n’a jamais été fait dans cette pathologie. La tâche EViCog (Evaluation de la cognition sociale en interaction virtuelle), créée pour cette étude, permet d’avoir des conversations audio-visuelles avec des humains virtuels, qui expriment des émotions et produisent du discours nécessitant d’inférer leurs états mentaux. Les résultats ont montré que les difficultés des personnes TC étaient encore plus importantes pour la tâche en situation d’interaction (tâche EViCog) par rapport à des tâches traditionnelles au format « papier-crayon ». Par ailleurs, en situation d’interaction, les performances de cognition sociale semblent dépendre en partie des capacités mnésiques (mémoire autobiographique et du contexte), ainsi que des fonctions exécutives, alors que pour les tâches traditionnelles, les performances ne seraient expliquées que par certaines capacités exécutives<br>Social cognition, i.e. the ability to attribute mental states to others and to identify emotions, is often impaired in various pathologies, such as traumatic brain injury (TBI). This ability is traditionally assessed with “paper-and-pencil” tasks that do not involve the participant in a social interaction situation. However, social cognition is central in our daily social interactions, as it helps us understand others’ speech and behavior. Thus, in this study, we assessed mental state attribution and emotion recognition abilities of TBI participants, using tasks that involve the participant in a communication situation (referential communication task and EViCog task). The EViCog task (social cognition evaluation in virtual interaction), designed for this research, provides audio-visual conversations with virtual humans, which express emotions and produce speech requiring mental state inference. The results showed that the difficulties of the TBI participants were even more important for the task in interaction situation (EViCog task) compared to traditional tasks in paper-and-pencil format. Moreover, in interaction situation, social cognition performance seemed to rely on mnemonic abilities (autobiographical memory and context memory), and on executive functions, while for traditional tasks, performances were only explained by some executive abilities

La protection intégrée des cultures (PIC) apparaît comme une stratégie durable de protection des plantes contre les bioagresseurs, satisfaisant les exigences à la fois économiques, écologiques et sanitaires auxquelles est confrontée l’agriculture. L’amélioration des connaissances sur les interactions entre les bioagresseurs et les pratiques agricoles est indispensable afin de concevoir des méthodes de lutte plus économes en produits phytosanitaires Le modèle IPSIM (Injury Profile SIMulator), développé dans ce travail de thèse, vise à simuler l’effet des pratiques culturales, du pédoclimat et de l’environnement de la parcelle sur les dégâts causés par les bioagresseurs sur une culture. Ce modèle est basé sur une approche hiérarchique et agrégative. Ce travail décrit la base conceptuelle de la modélisation IPSIM et son application pour construire le modèle IPSIM-Wheat, simulant les profils de dégâts sur le blé en fonction des pratiques culturales et de l’environnement biotique et abiotique. Plusieurs modèles ont été conçus pour prédire les sévérités de six maladies, un ravageur et les plantes adventices du blé. Ces modèles contribuent ainsi au développement d’IPSIM-Wheat, dont une première version est présentée pour des bioagresseurs majeurs en interaction. Ce futur modèle pourra contribuer à concevoir des systèmes de culture incluant du blé, moins soumis aux pressions biotiques et moins dépendants des pesticides<br>Integrated pest management (IPM) appears as a sustainable strategy to protect plants against pest while answering the economical, ecological, and toxicological expectations that agriculture must face. The effects of cultural practices on pest dynamics have to be thoroughly analyzed in order to reduce the reliance of cropping systems on pesticides. A model, named IPSIM ((Injury Profile SIMulator), currently under development in this thesis, aims at simulating the effects of cropping practices, as well as soil, climate and field environment on the injuries caused by multiple pests of a given crop. This model is based on a hierarchical and aggregative approach. This study describes the conceptual basis of the modeling and its applications in order to develop IPSIM-Wheat, a model simulating injury profiles on wheat. Thus, several models have been designed to predict six diseases, one insect pest and weeds. This study thus contributes to the development of IPSIM-Wheat which will help design innovative sustainable wheat-based cropping system

Les constructeurs automobiles sont tenus de respecter des minima sécuritaires vérifiés lors de crash-tests normalisés, d'où un nombre de scénarios de tests limité ne tenant pas compte des particularités individuelles. Ce mémoire propose d'évaluer le comportement humain réel en phase de pré-crash sur simulateur de conduite. L'expérimentation, intégrant un scénario d'accident difficilement évitable, a permis d'étudier le comportement de 76 conducteurs dont 40 sur simulateur dynamique. Pour ce groupe, 43 voies de mesures centrées sur le conducteur ont été intégrées au protocole. Parmi les résultats obtenus, on retiendra la possible détection précoce de l'accident, pour la moitié des conducteurs, sur la base de leur interaction avec le véhicule. Les manœuvres d’évitement amènent 25% des sujets à positionner l'avant-bras devant le volant au moment de l’impact. Cette situation peut compromettre l'efficacité des airbags, ce qui est vérifié sur banc statique, par le déploiement d'airbags face à un mannequin de type Hybrid III-50%. La projection du bras entraine un impact de 120g à la tête. De plus, l'intégration de membres supérieurs issus de SHPM montre que la situation provoque des fractures de l'avant-bras. Un modèle numérique a été conçu pour estimer les effets de la position atypique lors d'un crash frontal à 50km/h. L'accélération de la tête atteint 270g, synonyme de risques lésionnels élevés. Enfin, une modification technologique des airbags est proposée, basée sur l'hypothèse que la détection à distance peut permettre un déclenchement anticipé et plus lent des airbags. Testée expérimentalement et numériquement, cette évolution permet de respecter les critères lésionnels<br>Automakers are lawfully required to achieve a minimum level of security which is checked during standardized crash tests. This results in a limited number of scenarios, which do not take individual specificities into account. This dissertation evaluates real human behaviour during the pre-crash phase, by means of a driving simulator. The experiment, integrating an unavoidable accident, studied the behaviour of 76 drivers, of which 40 drivers on a dynamic simulator. Concerning this group, 43 acquisition channels dedicated to drivers were added. From the results, one can retain that the crash can be predicted for half of the drivers through the observation of their behaviour and their interaction with the car. Due to swerving manoeuvres, 25% of the drivers have their forearm just in front of the steering wheel at the time of crash. This situation may compromise the efficiency of the airbags, that is verified experimentally on a static bench, by the deployment of airbags in front of a Hybrid III-50% dummy. The throwing of the arm causes an impact of 120 g to the head. In a second stage, the integration of left upper limbs from PMHS reveals that the situation is likely to generate fractures in the forearm. A numerical model has been designed to estimate the consequences of the atypical position during a frontal crash at 50km/h. The head acceleration reaches 270 g, synonymous with high lesion risks. Finally, a technological modification of the airbags is proposed to reduce this risk. The assumption is made that the use of remote sensors technologies can allow an early detection of the crash and therefore slower triggering of airbags. Tested experimentally and then numerically, this technical evolution reduces the violence of the impact to respect the injury criteria

Background: The anterior cruciate ligament (ACL) is the most commonly injured ligament in the human body. The injury often occurs in pivoting sports. A common consequence after ACL injury is kinesiophobia, which can contribute to prolonged rehabilitation and delayed return to sport. Increased understanding of psychological factors such as kinesiophobia could facilitate the rehabilitation process for ACL-patients. Objectives: To explore in which situations and movements ACL-injured individuals experience kinesiophobia, and which are most common. The associations between the number of fearful situations described and the scores in questionnaires regarding kinesiophobia were also evaluated.  Methods: Tampa Scale of Kinesiophobia (TSK), Anterior Cruciate Ligament - Return to Sports after Injury (ACL-RSI) and a custom made Kinesiophobia after ACL injury (KAAI) questionnaire were used. Data were analysed using Spearman’s Rho test. Answers to open-ended questions were categorized and provided qualitative input. Results: Common situations and movements considered fearful by ACL-injured persons were pivoting movements, situations with increased load on the injured knee, and walking on slippery/uneven ground. Significant correlations were seen between TSK and KAAI_TOTAL scores (rho = 0.728; p = 0.007), ACL-RSI and KAAI_TOTAL scores (rho = -0.755; p = 0.003), and ACL-RSI and TSK scores (rho= -0.828; p&lt; 0.001).  Conclusion: This study shows that a higher number of situations and movements considered fearful might associate with higher levels of kinesiophobia in ACL-injured persons. Higher self-efficacy and readiness to return to sport might associate with fewer situations and movements considered fearful, e.g. pivoting movements and walking on slippery ground. Knowledge of this may improve rehabilitation in this field.<br>Bakgrund: Främre korsbandet är det mest frekvent skadade ligamentet i människokroppen. Skadan sker ofta i sporter med pivoterande rörelser. En vanlig psykologisk konsekvens efter främre korsbandsskada är rörelserädsla, vilket kan orsaka förlängd rehabilitering och försenad återgång till idrott. Ökad kunskap om faktorer som rörelserädsla kan underlätta rehabiliteringsprocessen för personer med främre korsbandsskada. Syfte: Att undersöka i vilka situationer och rörelser som personer med främre korsbandsskada upplever rörelserädsla, samt vilka som är vanligast förekommande. Dessutom, att beräkna sambandet mellan poängen från enkäter angående rörelserädsla. Metod: Tampa Scale of Kinesiophobia (TSK), Anterior Cruciate Ligament - Return to Sports after Injury (ACL-RSI), och en specialutformad enkät (KAAI) skickades till deltagarna. Insamlad data analyserades med hjälp av korrelationstestet Spearman’s rho. Svar på öppna frågor kategoriserades och bidrog med ett kvalitativt perspektiv. Resultat: Pivoterande rörelser, situationer med ökad belastning på det skadade knäet och gång på halt/ojämnt underlag var de vanligast förekommande befarade situationer och rörelser hos deltagarna. Signifikanta korrelationer påvisades mellan TSK och KAAI_TOTAL poäng (rho = 0.728; p = 0.007), ACL-RSI och KAAI_TOTAL poäng(rho = -0.755; p = 0.003) samt ACL-RSI och TSK poäng (rho= -0.828; p&lt; 0.001). Slutsats: Denna studie visar att ett större antal befarade situationer och rörelser kan associeras till högre nivåer av rörelserädsla hos personer med främre korsbandsskada. Högre tilltro till sin egen förmåga och större beredskap att återgå till idrott kan associeras med färre befarade situationer och rörelser. Exempel på dessa är pivoterande rörelser och gång på halt underlag. Kunskap om detta kan underlätta rehabilitering inom detta område.

ABSTRACT This thesis investigates a range of everyday interactions of traumatic brain injury (TBI) subjects when compared with control subjects to examine whether there are differences in the overall structure of interactions, in the way information is exchanged and in the wording which is used. Analyses from systemic functional linguistics including generic structure potential analysis, exchange structure analysis and analysis of politeness markers were used to examine the interactional impairments reported to follow TBI. Results indicated that TBI subjects differed from controls in their use of interpersonal language resources. These differences were exaggerated when subjects were interacting with someone in authority. When placed in a more powerful role, TBI subjects were able to utilise language resources to a similar extent to controls across the three levels of analysis. This thesis has important implications for the assessment and management of interactional communication impairments which may follow TBI, including suggestions for therapy with the person with TBI and for communication partners of people with TBI including therapists, family members and the community.