Dissertations / Theses on the topic 'Trauma centers'
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Jansen, Jan Olaf. "Geospatial optimisation of trauma systems." Thesis, University of Aberdeen, 2016. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=231538.
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Ho, Chuen-tak Douglas. "Trauma Centre Prototype." Hong Kong : University of Hong Kong, 1999. http://sunzi.lib.hku.hk/hkuto/record.jsp?B25947813.
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Jollye, Katherine Alexandra. "Integrated wellness a healing centre for victims of trauma and abuse /." Diss., Pretoria : [s.n.], 2005. http://upetd.up.ac.za/thesis/available/etd-05182005-112433.
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Clark, Susan Ferguson. "Copper status in multiple trauma patients : measurement of copper balance, serum copper and ceruloplasmin /." This resource online, 1990. http://scholar.lib.vt.edu/theses/available/etd-09162005-115033/.
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何存德 and Chuen-tak Douglas Ho. "Trauma Centre Prototype." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1999. http://hub.hku.hk/bib/B31984575.
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Bowman, Stephen M. "Hospital characteristics associated with trauma outcomes /." Thesis, Connect to this title online; UW restricted, 2006. http://hdl.handle.net/1773/5411.
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Garwe, Tabitha. "Directness of transport to a level I trauma center impact on mortality in patients with major trauma /." Oklahoma City : [s.n.], 2010.
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Moloko, Salaminah S. "Nursing outcome standards for polytrauma patients with traumatic brain injuries in the Mafikeng district." Thesis, Stellenbosch : Stellenbosch University, 2001. http://hdl.handle.net/10019.1/52372.
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Thesis (MCUR)--University of stellenbosch, 2001.ENGLISH ABSTRACT: In trauma the priority is given to identifying the life-threatening injuries and immediately implementing treatment (Demetriades, 1993:3). Severe trauma resuscitation and assessment often have to be carried out simultaneously to detect and treat conditions that are rapidly fatal if not attended to immediately and according to priority. Urgent priorities in trauma management include maintaining a clear and patent airway to facilitate respiration and cervical spine protection by avoiding rough manipulation of the head and neck by supporting the neck with a neck immobiliser. Any external bleeding has to be controlled by applying direct pressure to the wound. Cardiovascular problems, for example shock or myocardial infarction, respiratory problems and hypoxia which are detrimental, particularly in the case of head injury, should be excluded. A detailed head-to-toe examination which includes the head, neck, chest, abdomen, back, musculo-skeletal system, rectum and vagina has to be performed. For the head-injured patient, correct any condition, which may complicate the existing head injury, for example hypoxia, shock, pneumothorax and fractures of long bones or pelvis. Implement the A (airway), B (breathing), C (circulation), D (disability, neurological and drugs) and E (environment) for structured management of the patient. Muller's, (1996) two-phase model was utilised to formulate and validate nursing outcome standards. In phase one literature was explored to develop provisional standards on polytrauma patients with traumatic brain injuries. In phase two the provisional standards were validated by experts (doctors and nurses) in critical care, trauma and emergency nursing including nurses and a doctor working in the casualty department of a provincial hospital in Mafikeng. Final standards were formulated and adapted accordingly. Standards for the management of a polytrauma patient with traumatic brain injuries included: A safe environment for patients, nurses and doctors Primary survey in casualty department which includes the maintenance of airway, breathing, circulation, disability/ neurological, drugs and exposure The secondary survey that includes the head to toe examination, definitive orthopaedic care and stabilisation before transfer to the intensive care unit A standard on all relevant equipment which might be needed in case the patient goes into cardiac arrest on the way to the intensive care unit, was also formulated. The standard on documentation included the primary and secondary survey in the casualty department, transport to the intensive care unit, activities and the condition of the patient. The final standards dealt with the accurate handing over of the patient to the intensive care personnel. The following recommendations were made: • Implement the outcome standard by means of a quality improvement programme through a top-down approach. • Provide training: Nurses and doctors have an obligation to render quality care, therefore they have the right to be trained in emergency procedures. • All registered nurses working in the casualty or emergency departmentsshould be trained in at least Basic Life Support (CPR), Advanced Cardiac Life Support (ACLS), Advanced Paediatric Life Support (APLS) and Advanced Trauma Life Support (ATLS) while waiting to be sent for the trauma-nursing course. • Improve infection control measures in the casualty department • Emergency drugs must always be available. • Improve the on-call system. • Formulate a policy on sharing of the equipment by both casualty and ICU staff. • Motivate for the necessary equipment. Implement procedures for debriefing of staff, the evaluation of actions during resuscitation and implement measures for psychological support of the family. • For further research, implement and test a training programme whereby nurses can formulate their own standards. • Evaluate whether the standards have improved the quality of trauma care, and develop standards for leu nursing of the brain injured patient and the rehabilitation of polytrauma patients with traumatic brain injuries The uniqueness of the study lies in the fact that no formal outcomes standard for trauma patients with traumatic brain injuries have been developed in any of the North West Provincial hospitals.
AFRIKAANSE OPSOMMING: Die identifisering van lewensbedreigende beserings en die onmiddellike implementering van behandeling, is in trauma 'n eerste prioriteit (Demetriades, 1993: 3). Resussitasie en die beraming van erge traumagevalle noodsaak in baie gevalle, gelyktydige hantering. Sou hierdie hantering nie gelyktydig en onmiddellik volgens prioriteit plaasvind nie, kan dit noodlottige gevolge inhou. Belangrike prioriteite in traumabehandeling sluit in, die instandhouding van 'n patente lugweg om asemhaling te onderhou asook die beskerming van die servikale rugmurgkolom, deur die ruwe manipulasie van die kop en nek te vermy deur die implementering van 'n nekimmobiliseerder. Kardiovaskulere probleme, byvoorbeeld skok of miokardiale infarksie, asook respiratoriese probleme wat lewensbedreigend vir die pasient met 'n hoofbeseering is, moet uitgesluit word. 'n Gedetailleerde van kop-tot-tone ondersoek, wat die kop, nek, borskas, abdomen, rug, muskulo-sketale stelsel, rektum en vagina insluit, moet uitgevoer word. In die pasient met hoofbeserings moet enige toestand byvoorbeeld frakture van die langbene of die pelvis, skok of 'n pneumothorax, eers behandel word. Implementeer die A (Iugweg - "airway"), B (asemhaling - "breathing"), C (sirkulasie -"circulation"), D (gestremdheid - "disability", neurologies- "neurological" en drogerye-"drugs") en E (omgewing - "environment") vir die gestruktureerde behandeling van die pasient. Die twee fase model van Muller (1996) is gebruik vir die formulering en validering van die verpleeguitkomsstandaarde. In fase een is die literatuur verken om die voorlopige standaarde vir polytrauma pasiente met traumatiese breinbeserings te ontwikkel. In fase twee is die voorlopige standaarde gevalideer deur kundiges (dokters en verpleegkundiges) in kritieke sorg, trauma en noodverpleging. Die verpleegkundiges en dokter wat werksaam is in die ongevalle-eenheid van 'n plaaslike provinsiale hospitaal in Mafikeng is ook ingesluit. Finale standaarde is geformuleer en dienooreenkomstig aanvaar. Die standaarde vir die politrauma pasient met traumatiese breinbeserings, sluit in: 'n Veilige omgewing vir pasiente, verpleegkundiges en dokters. Die prirnere beraming in ongevalle ten opsigte van instandhouding van die lugweg, asemhaling, sirkulasie, gestremdheid, drogerye en blootstelling. Die sekondere beraming: wat behels die kop-tot-tone ondersoek. Definitiewe ortopediese behandeling en stabilisering voor oorplasing na die intensiewe-sorg-eenheid. 'n Standaard met betrekking tot die nodige toerusting wat benodig mag word tydens 'n hart stilstand, oppad na die intensiewe-sorg-eenheid, is ook geformuleer. Die standaard ten opsigte van dokumentasie sluit die primere, en sekondere beraming, vervoer na die intensiewe-sorg-eenheid, aktiwiteite en toestand van die pasient, in. Die finale standaarde is gebaseer op die oorhandiging van die pasient aan die intensiewe-sorg-personeel. Die volgende aanbevelings word gemaak: • Implementeer die uitkomsstandaarde deur middel van 'n gehalteverbeteringsprogram deur gebruik te maak van 'n "top-down" benadering -, • Voorsien opleiding: Verpleegkundiges en dokters het 'n verpligting om gehaltesorg te lewer, hulle het dus 'n reg om onderrig te ontvang in noodprosedures, en verder het die pasient die req op gehalter noodbehandeling. • Aile geregistreerde verpleegkundiges wat in die ongevalle en die noodafdeling werk, behoort opgelei word in ten minste basiese lewensondersteuning (CPR), Gevorderde Trauma Lewens Ondersteuning (ACLS), Gevorderde Pediatriese lewensondersteuning (APLS) en Gevorderde Trauma lewensondersteuning (ATLS), terwyl gewag word om die trauma verpleegkundigekursus te deurloop. • Verbeter mteksiebeheermaatreels in ongevalle. • Noodmedikasie moet ten aile tye beskikbaar wees. • Verbeter die op-roepstelsel ("on cali"). • Formuleer 'n beleid oor die gesamentlike gebruik van toerusting deur beide ongevalle- en intensiewe-sorg-eenheid-personeel. • Motiveer vir die nodige toerusting. • Implementeer prosedures om personeel to te laat vir ontlonting (debriefing), die evaluering van aksies tydens die resusitasie prosedure en implementeer metodes vir die sielkundige ondersteuning van die familie. • Ten opsigte van verdere narvorsing behoort 'n opleidingsprogram qeunplernenteer en getoets te word met betrekking tot verpleegkundiges wat hulle eie standaarde will formuleer. • Evalueer of die standaarde die gehalte van traumasorg verbeter het en ontwikkel standaarde vir intensierwe-sorg-verpleging van die breinbeseerde pasient asook die rehabilitasie van politrauma pasiente met traumatise breinbeesering. Die unieke bydra van die studie word gevind in die feit dat daar nog geen gerformaliseerde uitkomstandaarde vir traumapasiente met breinbeseerings in enige van die Noord Wes Provinsie se hospitale ontwikkel is nie.
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Curtis, Kathleen Anne Public Health & Community Medicine Faculty of Medicine UNSW. "Trauma nursing case management: impact on patient outcomes." Awarded by:University of New South Wales. School of Public Health and Community Medicine, 2006. http://handle.unsw.edu.au/1959.4/33367.
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Aim The purpose of the study was to formally identify trauma care delivery problems at the study institution, implement a solution in the form of trauma case management (TCM), and measure the effect of TCM on staff satisfaction, clinical coding accuracy and patient outcomes, using practice-specific outcome variables such as in-hospital complication rates, length of stay, resource use and allied health service intervention rates. This research also aimed to make a unique contribution to the international trauma literature by addressing the lack of any evidence specifically measuring the impact of trauma case management intervention. Methods St George Hospital is a 600 bed urban Teaching Hospital of the University of NSW. It is a designated Trauma Centre, seeing around 200 severely injured patients and around 2500 injury admissions per year. A series of focus groups and a staff satisfaction survey identified perceived problems associated with trauma care, and a trauma case management program was implemented. A preliminary study was conducted with positive results and funding was obtained to provide TCM seven days a week to all trauma patient admissions. A larger clinical trial was conducted and data from 754 patients were collected over fourteen months after TCM was introduced at the study hospital. These data were compared with 777 matched patients from the previous 14 months as a control group. An audit was conducted on trauma patient clinical coding using the daily progress record kept by the trauma case manager. The data were analysed with SPSS. The statistical tests used were Mann-Whitney U, chi-squared (2) logistic regression and generalised linear models. Results Focus groups and the staff satisfaction survey identified communication and coordination as the main problems associated with trauma care delivery. Following the initial implementation of the program, staff support for TCM was overwhelming. TCM greatly improved the rate of and time to Allied Health intervention (p<0.0001). Results demonstrated a decrease in the occurrence of deep vein thrombosis (p<0.038), coagulopathy (p=0.041) and respiratory failure. A reduced hospital length of stay (LOS), particularly in the paediatric (p<0.05) and 45 - 64 years age group was noted. There were 6621 fewer pathology tests performed (p<0.0001) and the total number of bed days was 483 days less than predicted from the control group. Many hospital clinical coding errors and omissions were highlighted by the TCM record comparison. The use of TCM records resulted in Twenty eight percent of recoded records having their Australian national diagnostic related group (AN-DRG) changed, which resulted in the identification over $39,000 in unidentified funding. Conclusion TCM improves staff satisfaction, communication and clinical coding accuracy. The introduction of TCM improved the efficiency and effectiveness of trauma patient care in our institution. This initiative demonstrates that TCM results in improvements to quality of care, trauma patient morbidity, financial performance and resource use. This research makes an important and original contribution to the international trauma literature by providing the results of a clinical trial formally measuring the impact of trauma nursing case management intervention.
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Clark, Susan F. "Copper status in multiple trauma patients: measurement of copper balance, serum copper and ceruloplasmin." Diss., Virginia Tech, 1990. http://hdl.handle.net/10919/39376.
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see documentChanges in copper metabolism have been reported in both thermal injury and skeletal trauma; data regarding copper status in multiple trauma patients (MTP) are nonexistent. Hypercatabolism following multiple trauma may increase copper utilization, deplete copper stores and compromise cuproenzyme synthesis and function. The purpose of this study was to provide information on copper status in MTP and determine whether age, injury severity, clinical outcome or nutritional intake influenced copper status. Twenty-four hour copper losses, serum copper and ceruloplasmin were measured in 11 MTP with Injury Severity Scores (ISS) >12 at 24-48 hours post admission. Collections of biological fluids (urine, nasogastric, chest tube, drains, stools) were analyzed for copper using atomic absorption spectrophotometry (AAS) and quantified over 5 days. Serial serum copper and ceruloplasmin were determined on days 1,3,5,10,15 and patient discharge by ASS and rate nephelometry inmunoprecipition, respectively. Eight patients received parenteral nutrition (PN). Three received intravenous glucose/electrolyte infusions (IV). urine (n=11) and nasogastric losses (n=8) were statistically greater than normal (p<.001). The mean ± SEM cumulative copper losses of urine, chest tube drainage, nasogastric secretions and other drains were 790 ± 116 (n=11), 833 ± 130 (n=7), 261 ± 46 (n+8), and 150 ± 58 μg/5 d (n=8), respectively. Urinary losses represented 10 to 12 times the normal copper excretion. Serum copper on day 1 and ceruloplasmin day 3 were significantly higher than normal (p<.025). Cumulative copper balance in the IV group was - 2266 μg and -440 μg in the PN group. No relationship was found between copper loss and ISS. Patients in their twenties demonstrated the greatest urinary copper loss. The physiological and biochemical effects of extensive copper loss in the MTP require further evaluation. These patients may have a predisposition to copper deficiency due to excessive copper losses and may require increased copper supplementation.
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Pepe, Linda R. "Optimally Locating Level I Trauma Centers and Aeromedical Depots for Rural Regions of the State of Ohio." University of Toledo / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1493197364277033.
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Padovani, Cauê. "Avaliação da capacidade funcional de pacientes vítimas de trauma um ano após alta hospitalar." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/5/5170/tde-20052016-145403/.
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Objetivos: Avaliar a capacidade funcional de pacientes vítimas de trauma um ano após alta hospitalar e verificar associação da capacidade funcional com fatores relacionados ao trauma e à internação hospitalar. Metodologia: Estudo de coorte prospectivo, com pacientes vítimas de trauma grave (Injury Severity Score - ISS >=16), internados entre Junho e Setembro de 2010 em unidade de terapia intensiva (UTI) cirúrgica especializada em paciente politraumatizado de um hospital público de grande porte na cidade de São Paulo, Brasil. Variáveis de interesse como idade, sexo, escore de Glasgow, Acute Physiology and Chronic Health Disease Classification System II (APACHE II), mecanismos de trauma, número de lesões, região corpórea afetada, número de cirurgias, duração da ventilação mecânica (VM) e tempo de internação hospitalar foram coletadas dos prontuários médicos. A capacidade funcional foi avaliada um ano após alta hospitalar utilizando as escalas Glasgow Outcome Scale (GOS) e Escala de Atividades Instrumentais de Vida Diária de Lawton (AIVDL). Os pacientes também foram questionados se haviam retornado ao trabalho ou estudo. Resultados: O seguimento um ano após trauma foi completo em 49 indivíduos, a maioria composta por jovens (36±11 anos), do sexo masculino (81,6%) e vítimas de acidentes de trânsito (71,5%). Cada indivíduo sofreu aproximadamente 4 lesões corporais, acarretando uma média no ISS de 31 ± 14,4. O traumatismo cranioencefálico foi o tipo de lesão mais comum (65,3%). De acordo com a GOS, a maioria dos pacientes apresentou disfunção moderada (43%) ou disfunção leve ou ausente (37%) um ano após o trauma. A escala AIVDL apresentou pontuação média de 12±4 com aproximadamente 60- 70% dos indivíduos capazes de realizar de forma independente a maioria das atividades avaliadas. Escore de Glasgow, APACHE II, duração da VM e tempo de internação hospitalar foram associadas com a capacidade funcional um ano após lesão. A regressão linear múltipla considerando todas as variáveis significativas revelou associação entre a pontuação da escala AIVDL e o tempo de internação hospitalar. Apenas 32,6% dos indivíduos retornaram ao trabalho ou estudo. Conclusões: A maioria dos pacientes vítimas de trauma grave foi capaz de realizar as atividades avaliadas com independência; apenas um terço deles retornou ao trabalho e/ou estudo um ano após alta hospitalar. O tempo de internação hospitalar foi revelado como preditor significativo para a recuperação da capacidade funcional um ano após lesão graveObjectives: To investigate the functional capacity of trauma survivors at one year after hospital discharge and to verify the association between functional capacity and trauma-related aspects and hospital stay. Methods: This prospective cohort study included severe trauma patients (Injury Severity Score - ISS >= 16) admitted between June and September 2010 to a surgical intensive care unit (ICU) of a large public hospital in São Paulo, Brazil. Variables of interest such as age, gender, Acute Physiology and Chronic Health Disease Classification System II (APACHE II), trauma mechanisms, number of injuries, body region injured, number of surgeries, mechanical ventilation (MV) duration and hospital length of stay (LOS) were collected from patient records. Functional capacity was assessed one year after hospital discharge using the Glasgow Outcome Scale (GOS) and the Lawton Instrumental Activities of Daily Living Scale (LIADL). Patients were also asked if they had returned to work or school. Results: A total of 49 trauma survivors completed 1 year of follow-up. Most subjects were young (36±11 years), male (81.6%) and victims of traffic accidents (71.5%). Each patient suffered approximately 4 injuries, with a mean ISS of 31 ± 14.4. Traumatic brain injury was the most common type of injury (65.3%). According to the GOS, most patients were classified into two categories, indicating moderate dysfunction (43%) or mild or no dysfunction (37%) at one year after trauma. Additionally, the LIADL also showed favorable functional outcomes (average score 12 ± 4); approximately 60-70% of the subjects were able to perform most activities independently. Glasgow score, APACHE II score, MV duration and hospital LOS were factors related to the recovery of functional capacity one year after injury. Multiple linear regression analysis including all variables with statistical power revealed a significant association between the LIADL score and hospital LOS. Only 32.6% of the subjects had returned to work or school. Conclusions: Most severe trauma patients were able to perform the assessed activities independently, although only a third had returned to work or school one year after hospital discharge. Hospital LOS was identified as a significant predictor of functional capacity recovery one year after severe injury
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Thayer, Jenny P. "Evaluation of the Inland Counties trauma patient data collection, management, and analysis." CSUSB ScholarWorks, 1986. https://scholarworks.lib.csusb.edu/etd-project/378.
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Mutti, Camila Gondim. "Avaliação das capacidades funcionais de pacientes paraplégicos por trauma raquimedular que freqüentaram e que não freqüentaram um centro de reabilitação." Universidade de São Paulo, 2008. http://www.teses.usp.br/teses/disponiveis/5/5160/tde-16122008-100529/.
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O objetivo deste estudo foi comparar a condição funcional dos pacientes paraplégicos internados no HC- IOT FMUSP entre 2000 a 2004, que realizaram tratamento nos centros de reabilitação e os que não realizaram e identificar os fatores que interferiram na acessibilidade ao centro de reabilitação. Os dados foram coletados na cidade de São Paulo, entre 2005 a 2007. Foram entrevistados 39 indivíduos paraplégicos por traumatismo raquimedular. A média de idade do grupo estudado foi de 33,4 ± 12,7 anos (15 - 66), sendo 35 (89,7%) pessoas do gênero masculino e quatro (10,3%) do sexo feminino. Estes pacientes foram divididos em dois grupos: Grupo Centro de Reabilitação (GCR), com 24 pacientes (62%) e Grupo Não Centro de Reabilitação (GNCR) com 15 pacientes (38%). Os resultados mostraram que o tempo de espera e falta de transporte para tratamento foram fatores que interferiram na não adesão ao tratamento em centros de reabilitação, levando à opção de reallizar fisioterapia em clínicas mais próximas. A ocorrência de problemas clínicos foi um dos fatores que contribuiu para a demora (média de seis meses) de iniciar o programa de reabilitação no GCR. Os pacientes solteiros e com lesões mais graves foram os que mais procuraram o centro de reabilitação. Não houve diferença quanto a capacidade funcional, avaliada através da MIF (Medida da Independência Funcional), e quanto a inserção social, avaliada pelo retorno dos pacientes ao trabalhoThe objective of this article was to compare the functional condition of paraplegic by traumatic spinal cord injured patients hospitalized in HC-IOT FMUSP from 2000 to 2004, that were undergone and not rehabilitation center and identify interfering factors in this accessibility. All data was collected in São Paulo city, since 2005 to 2007. Thirty-nine SCI patients were interviewed. The average age was 33, 4 ± 12, 7 years (15-36), 35 (89, 7%) males and four (10,3%) females. Those patients were divided in two groups: Rehabilitation Center Group (RCG), 24 (62%) patients, and No Rehabilitation Center Group (NRCG), 15 (38%) patients. The results have showed that delay and transport problems were interfering factors beginning and maintenance of treatment in Rehabilitation Center, making them looking for rehabilitation at close clinics. Clinical problems was one of the factors that contribute to delay (average = 6 months) rehabilitation program in RCG. The single patients and the serious injured patients have undergone more to rehab center than the other group. There is no difference in functional ability evaluated by FIM (Functional Independence Measure), and in social integration evaluated by work return between groups
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Gonak, Anton. "Asmens sveikatos priežiūros įstaigų tinklo, teikiančio pagalbą traumas patyrusiems pacientams, optimizavimo galimybių ir poreikių vertinimas." Master's thesis, Lithuanian Academic Libraries Network (LABT), 2008. http://vddb.library.lt/obj/LT-eLABa-0001:E.02~2008~D_20080620_142458-20506.
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Darbo tikslas. Įvertinti asmens sveikatos priežiūros įstaigų (toliau ASPĮ), teikiančių ortopedijos traumatologijos ir/arba chirurgijos paslaugas, galimybes teikti kvalifikuotą pagalbą ir jų infrastruktūros atnaujinimo poreikius.
Tyrimo metodika. Tyrimo objektas – ASPĮ, teikiančios pagalbą traumas patyrusiems pacientams bei GMP įstaigos. Tyrimo metodai: Mokslinės literatūros analizė, respondentų apklausa, statistinė duomenų analizė naudojant SPSS 13 versiją bei MS Excel, geografinės informacinės sistemos „Arc View 9.11” programinę įranga.
Rezultatai. Esant vienam traumos centrui apskrityje (i��� viso 10 centrų), visiems Lietuvos gyventojams pagalba būtų prieinama per 1 val. Šiuo metu GMP per 15 minučių prieinama pusei LR teritorijos. Iš viso į 0 lygio traumos centrus kreipiasi beveik trečdalis visų traumą patyrusių pacientų, tačiau vienas šio lygio centras vidutiniškai aptarnauja 13,5 kartų mažiau pacientų, nei trečiojo lygio (p<0,005). Nulinio lygio centre vidutiniškai teikiama 9 kartų mažiau stacionarių paslaugų, lyginant su III lygio traumos centru (p<0,005). Nulinio lygio įstaigose traumos pacientų srautas yra nepakankamas lyginant su kitų lygių ASPĮ srautais. Dalis 0 lygio traumos centrų neturi pakankamo specialistų (ortopedų traumatologų, anesteziologų ir reanimatologų) skaičiaus, kurie užtikrintų nenutrūkstamą 24 valandų pagalbos teikimo ciklą. Didžiausias investicijų poreikis yra III lygio traumos centrų, tačiau investicijų poreikis 1 ligoniui šio lygio centre - 6,5... [toliau žr. visą tekstą]The aim - to evaluate possibilities of the health care institutions which provides orthopaedic traumatology and/or surgery services, to provide qualified medical care and their infrastructure renewal needs. Methods. The object of the study is health care institutions which provide services for patients after trauma and also emergency service providers. Methods of the study: the analysis of the academic literature, respondents surveys, analysis of the statistical data using „SPPS“ 13th version, MS Excell program and geographical information system as well as Arc View 9.11 software program. Results. If there is one trauma centre in the area (there are 10 centres overall), all residents of Lithuania would have the access to the health care institutions in one hour. At this time emergency service is available in 15 minutes in the half of the Lithuanian territory. Overall, third part of the patients are maintained by zero level hospitals. Unfortunately, one of these centres (hospital) service 13.5 times less patients than third level canters (p < 0.005). On average, zero level centres provide service for the stationary care 9 times less compared to the third level hospitals (p<0.005). The demand for the zero level centres is insufficient compared to demand for university level care (hospitals). Part of the zero level trauma centres don‘t have sufficient number of specialists of anaesthesiology, reanimatology and traumatology disciplines that could provide continues 24 hour... [to full text]
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Moser, Michelle, K. Dean, M. Hoffman, and J. Ebert. "Addressing the Impact of Trauma in the Child Welfare System: Perspectives from the Centers of Excellence for Children in State Custody. The Healthiest TN Enduring Accomplishments that Matter four Our Future." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/7691.
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Azevedo, Ana Lidia de Castro Sajioro. "Aspectos facilitadores e dificultadores do trabalho em equipe de assistência ao paciente em Unidade Hospitalar de Urgências Traumáticas." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/83/83131/tde-27072015-182158/.
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O conhecimento do trabalho em equipe de assistência ao paciente, em unidade hospitalar de atendimento ao trauma, tanto no que se refere aos aspectos facilitadores quanto aos dificultadores desse processo, é imprescindível, diante da importância desse tipo de atendimento no contexto de atenção à saúde. Este estudo teve como objetivo analisar os aspectos que facilitam e dificultam o trabalho em equipe de assistência ao paciente em unidade hospitalar de urgências traumáticas. Trata-se de estudo descritivo, de abordagem quantitativa, utilizando a Técnica do Incidente Crítico. O estudo foi realizado em um hospital de ensino no interior do Estado de São Paulo, SP. Utilizou-se como técnica de coleta de dados a entrevista. Participaram 64 profissionais da equipe de assistência ao paciente da unidade. Os resultados evidenciaram 107 situações, sendo 56 positivas e 51 negativas, que envolveram 614 comportamentos e 267 consequências vinculadas ao trabalho em equipe na unidade. A análise dos incidentes relatados destacou que a dinâmica do trabalho em equipe é percebida como positiva no cenário. Os resultados evidenciam a necessidade de diferentes agentes dessa equipe realizarem ações integradas/articuladas e compartilhadas, nas quais sejam claras a noção de complementariedade de saberes em busca de objetivos comuns que atendam as necessidades imediatas de saúde do paciente politraumatizado. Os resultados também revelam que atendimentos aos pacientes, vítimas de trauma grave/moderado, facilitam a dinâmica do trabalho em equipe na unidade. Entende-se que isso pode decorrer de investimentos de políticas públicas e pelas diretrizes do Advanced Trauma Life Support, nos quais têm sido envidados esforços, capacitando profissionais, os quais reconhecem a finalidade que orienta o processo de trabalho e o atendimento de casos de alta gravidade com demanda imprevisível, que exigem alta tecnologia, pessoal com formação e competência técnica especializada para assistir, de forma integrada, articulada e assertiva, os casos. A integração, interação, articulação e comunicação entre a própria equipe e entre os diversos setores intra e extra-hospitalares favorecem a continuidade e integralidade do cuidado, bem como o produto final do processo de trabalho. É inegável a relevância e a clareza que os participantes dão ao trabalho em equipe nessa unidade, em especial as ações articuladas e integradas durante os atendimentos a politraumatizados graves/moderados. Fragilidades na articulação, integração e comunicação, bem como na imprevisibilidade da demanda e no despreparo de alguns profissionais foram destacados como dificultadores do trabalho em equipe no contexto da sala de traumaThe knowledge of work in patient care team, in a hospital trauma care unit, both regarding the facilitating aspects as well as the constraints of this process, is crucial, given the importance of this type of assistance in the health care context. This descriptive and quantitative study aimed to analyze the aspects that facilitate and hinder the work in patient care team in hospital emergency trauma unit, using the Critical Incident Technique. The study was conducted in a teaching hospital in the interior of the state of São Paulo, Brazil. Interview was used as data collection technique. In total, 64 professionals from the patient care team of the unit participated in study. Results evidenced 107 cases, of which 56 positive and 51 negative, involving 614 behaviors and 267 consequences linked to team work in the unit. The analysis of the reported incidents highlighted that the dynamics of team work is perceived as positive in the scenario. Results evidenced the need for different agents of the team to perform integrated/shared and coordinated actions, in which the concept of complementarity of knowledge in pursuit of common goals that meet the immediate health needs of polytrauma patients, is clear. Results also reveal that care provided to patients, victims of severe/moderate trauma, facilitate the dynamics of the team work in the unit. This may occur due to public policies\' investments and due to the guidelines of the Advanced Trauma Life Support, in which efforts have been made to train professionals, who recognize the aim that guides the work process and the provision of care in high-severity cases with unpredictable demand, which require high technology, trained staff with specialized technical competence to assist cases in an integrated, coordinated and assertive way. The integration, interaction, coordination and communication among the team itself and among the various intra and extra-hospital sectors favor the continuity and comprehensiveness of care, as well as the final product of the work process. The relevance and clarity that participants give to the team work in this unit is undeniable, especially as to coordinated and integrated actions during care to severe/moderate polytrauma patients. Weaknesses in coordination, integration and communication, as well as demand unpredictability and the unpreparedness of some professionals were highlighted as constraints of the team work in the context of trauma center
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Azevedo, Ana Lídia de Castro Sajioro. "Gerencimento do cuidado de enfermagem em unidade de urgência traumática." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/22/22132/tde-27092010-160805/.
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O conhecimento da prática dos enfermeiros em unidades de atendimento a agravos traumáticos, tanto no que se refere ao cuidado, quanto às atividades gerenciais é imprescindível diante da importância das urgências traumáticas no contexto de atenção à saúde. Este estudo teve como objetivo geral analisar a prática do enfermeiro em uma unidade de trauma, no âmbito do gerenciamento do cuidado bem como, caracterizar os agravos traumáticos atendidos, no ano de 2007, segundo variáveis demográficas, epidemiológicas e organizacionais, considerando os mecanismos do trauma. Trata-se de estudo descritivo, utilizando dados quanti e qualitativos. O estudo foi realizado em um hospital de ensino no interior do Estado de São Paulo-SP. Para a abordagem quantitativa utilizou-se como técnica de coleta de dados a pesquisa documental em base de dados secundários; a etapa qualitativa desenvolveu-se segundo as premissas de estudo de caso, utilizando técnicas de coleta de dados: observação participante e entrevista semi-estruturada. Os resultados evidenciaram como perfil dos agravos atendidos, homens na faixa etária de 20 a 30 anos, procedentes de Ribeirão Preto, vítimas de acidentes de transporte, nos finais de semana, entre 13h00min e 18h59min, o tempo de permanência hospitalar foi de 24 horas ou menos. Em relação aos índices de gravidade de trauma os casos de ISS com escore de 1-15 (trauma leve), decorrentes de acidentes de transporte, e o RTS superior a seis relacionados à maior probabilidade de sobrevida. A análise dos casos observados evidenciou aspectos importantes no tocante ao atendimento do paciente vítima de trauma, a saber: condições de acesso, organização da unidade, assistência/gerência de enfermagem. Evidenciou-se na sala de trauma, o gerenciamento do cuidado, centrado em atividades assistenciais e gerenciais. Assistenciais focadas no cuidado prestado ao usuário no microespaço da unidade e gerenciais que incluem a organização do acesso do paciente, da unidade, da equipe, de materiais e equipamentos. Cabe destacar que a abordagem assistêncial aparece de forma articulada às atividades gerenciais, caracterizando então o gerenciamento do cuidado exercido na unidade estudada. O enfermeiro tem importante papel na articulação de profissionais de saúde e de enfermagem bem como na mobilização de recursos para atenção ao paciente. Fragilidades na articulação, integração e comunicação, bem como nas limitações no uso da supervisão enquanto instrumento gerencial são aspectos que foram destacados como dificultadores do trabalho em equipe no contexto da sala de trauma.The knowledge of nurses\' practice at units of attendance to traumatic injuries, both when it comes to care, and to management activities is indispensable due to the importance of traumatic emergencies in health care. This study\'s main goal was to analyze the practice of a nurse at a trauma unit, at care management, and also to report traumatic injuries treated, in 2007, under demographic, epidemiological and organizational parameters, considering trauma mechanisms. This is a descriptive study that uses quantitative and qualitative data. It was performed at a university hospital in the State of São Paulo-SP. For quantitative analysis, the documentary research of secondary data base was used as the data collection technique; the qualitative stage was developed under the case study rules, using data collection techniques: participative observation and semi structured interview. The results have shown as an average of injuries treated, men between 20 and 30 years old, from Ribeirão Preto, victims of traffic accidents, on weekends, between 13h00min e 18h59min, with hospitalization time of 24 hours or less. Regarding the trauma severity scores, cases with ISS scores of 1-15 (mil trauma), resulting from traffic accidents, and RTS higher than six related to higher survival probability. The analysis of observed cases has shown important aspects of the trauma victims\' care: access conditions, unit\'s organization, nursing assistance/management. In the trauma room, care management focused on assistance and management activities was noticed. Assistance activities are related to care given to the patient inside the space of the unit. And management activities that include the organization of: the patient\'s access, the unit itself, the staff, materials and equipment. It\'s important to note that the assistance approach comes related to management activities, though featuring the care management provided at the unit studied. Nurse plays an important role on linking health professionals and nurses themselves, and also on resource mobilization to patient care. Weaknesses on articulation, integration, communication, as much as limitations on using supervision as a management instrument, are aspects seen as hindering the team work at the trauma room.
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Pykare, Justin D. "Screening for Adverse Childhood Experiences in Medication-Assisted Treatment." Kent State University / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=kent1617798934883737.
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Wijdenes, Kati. "Compassion Fatigue Prevalence in an Urban Trauma Center." Diss., The University of Arizona, 2015. http://hdl.handle.net/10150/593613.
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Background: Compassion Fatigue (CF) describes the emotional, spiritual, intellectual and physical exhaustion that results from untreated distress among nurses, stemming from exposure to traumatic events and work environment stressors. Comprised of Burnout (BO), Secondary Traumatic Stress (STS) and Compassion Satisfaction (CS), CF results when BO and STS outweigh CS. CF leads to physical and emotional problems including fatigue, hopelessness, anger, and an increased use of sick days. For hospitals, this means poor morale, increased medication errors and higher turnover. Objective: The purpose of this study was to determine the prevalence and severity of CF risk among the nursing staff at Maricopa Medical Center (MMC).Design: Descriptive study completed to determine: 1) What is the prevalence and severity of CF risk among nurses at MMC; and 2) compared to nurses with low CF risk, do nurses with high CF risk have differences in demographic and workplace characteristics? Setting: Maricopa Medical Center between April 14, 2015 and May 26, 2015 Participants: 315 full-time nurses at MMC in Phoenix. Measurements: Nurses were surveyed using the Professional Quality of Life Scale-5 (ProQOL-5) measuring the three components of CF: BO, STS and CS. Results: 46% of nurses reported moderate to high risk of CF. Nurses who worked in Labor and Delivery, Psychiatric Annex/Desert Vista, Emergency Departments, Intensive Care Units and Rapid Response units reported the highest risk. Risk increased significantly after their first year working at MMC. More frequent job changes outside of MMC correlated with lower risk profiles. Lower risk was seen in nurses with advanced degrees. Trends indicated that younger nurses, Clinical Resource Leaders, and nurses who had taken nine or more sick days in the previous six months were more at risk. Conclusion: Almost half of nurses were at moderate to high risk of CF. Unique findings were reported, including possible links between CF risk and job changes, and years working at a single facility. These links were previously unstudied. It was determined that the focus of interventions should be on nurses who work in the units most at risk and on new hire nurses, regardless of their years of nursing experience.
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Rayamajhi, Shreya. "Penetrating femoral artery injuries : an urban trauma center experience." Master's thesis, University of Cape Town, 2017. http://hdl.handle.net/11427/27416.
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INTRODUCTION: The femoral artery (FA) is the most common peripheral vessel injured in trauma. The incidence has been as high as 70%. Most experience with vascular trauma comes from the military where the incidence of FA injury is 67% of all vascular injuries. Up to 88% of these injuries are as a result of penetrating trauma. The Groote Schuur hospital trauma unit is a level one centre. It is a quaternary hospital and a referral center for all surrounding secondary level hospitals. Femoral vessel injuries are the second most common peripheral vascular injury (18.8%) seen after brachial artery injuries (48.2%) at our unit. AIM: This study aims to review a single centre experience with femoral artery injuries and identify factors associated with limb loss. METHOD: A 11 year retrospective chart review of patients with femoral artery injuries managed from 1 January 2002 to 31 December 2012 at the trauma unit, GSH. RESULTS: There were 158 patients with femoral artery injuries, 144 men and 14 women with a mean age of 28. Ninty-five percent had penetrating injuries. The most common artery injured was the superficial femoral artery (87%). The most common type of arterial injury was a laceration (39%) and transection (37%). Eighty-one patients had a primary repair (51%), fifty-three patients had a vein interposition graft (33.5%) and sixteen patients (10%) had a prosthetic graft. There were 78 (51%) concomitant venous injuries, 11 were repaired and 1 vein patch was done (15.4%). The rest were ligated (84.6%). There were 4 (2.5%) primary amputations and 10 (6.5%) secondary amputations. One primary amputation resulted from a delay to theatre with a threatened limb. The other three presented with a non-viable limb. Nine of the ten secondary amputations presented with a threatened limb. One viable limb was lost due to bleeding from a false aneurysm secondary to sepsis. One secondary amputation was the result of a delayed fasciotomy for compartment syndrome post revascularisation of a threatened limb. The rest were due to prolonged ischemic time despite attempted revascularization. There were no deaths in this study. Univariate analysis showed that statistically significant risk factors for secondary amputation were: presentation with signs of a threatened (ischemic) limb (p<0.0001), the temporary vascular shunt group (p<0.001) and the lack of a palpable distal pulse post repair (p<0.01). Statistically insignificant factors were: concomitant femur fracture, compartment syndrome, fasciotomy, unstable hemodynamics on presentation, venous ligation and 'In hospital ischemia time'. CONCLUSION: The outcome of threatened limbs due to femoral vessel injury is good provided there is no delay to surgery. This study has a primary amputation rate of 2.5% and secondary amputation rate of 6.5%, 91% of the limbs were salvaged.
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Jayarajan, Senthil Nathan. "IMPACT OF SETTING OF INJURY AND LEVEL OF TRAUMA CENTER ON TRAUMA MORTALITY AFTER FIELD INTUBATION." Master's thesis, Temple University Libraries, 2012. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/161015.
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Public HealthM.S.
Purpose: Pre-hospital intubation (PHI) in major trauma is associated with increased mortality. The goal of this study was to determine if PHI is protective in patients injured in rural vs. urban locations or patients transferred to level II vs. level I trauma centers. Methods: The Pennsylvania Trauma Outcomes Study database from 2006 - 2011 was reviewed. Pediatric patients, burns, patients dead on arrival, and transfers were excluded. Patients receiving PHI were compared to those immediately transported. Results: Of 63264 trauma patients, 2725 (4.31%) were intubated in the field. Mortality was higher among the intubated than those not intubated (28.22% vs. 4.11%, p<0.0001). The intubated cohort had greater mean Injury Severity Score (ISS) (27.77 vs.13.33, p<0.0001). Factors associated with mortality on multivariate logistic regression included PHI (OR 6.284, p<.0001), ISS>25 (OR 35.384, p<.0001), penetrating trauma (OR 5.685, p<.0001), transport to level II trauma center (OR 1.151, p=
Temple University--Theses
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Mussi, Gisele. "Prevalência de distúrbios osteomusculares relacionados ao trabalho (LER/DORT) em profissionais cabeleireiras de institutos de beleza de dois distritos da cidade de São Paulo." Universidade de São Paulo, 2005. http://www.teses.usp.br/teses/disponiveis/5/5137/tde-23082007-153632/.
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Uma das atividades pouco estudadas no âmbito da Saúde do Trabalhador no Brasil é a dos profissionais de Institutos de Beleza, função historicamente vinculada ao gênero feminino e que foi sujeita a grandes mudanças no processo de trabalho ao longo dos últimos anos. Nesse estudo, optou-se por analisar o trabalho das cabeleireiras, pois estas profissionais estão sujeitas a diferentes agravos à saúde devido aos fatores de risco inerentes às suas atividades. Os objetivos do estudo foram verificar a prevalência dos Distúrbios Osteomusculares Relacionados ao Trabalho (LER/DORT) em cabeleireiras por meio de relatos de sintomas, caracterizar as regiões anatômicas mais acometidas e identificar e analisar os fatores de risco para LER/DORT existentes no trabalho dessas profissionais. Foi utilizado um estudo epidemiológico transversal e também o embasamento teórico do método de avaliação da situação de trabalho e repercussões na saúde, desenvolvido pela teoria da Ergonomia Francesa, para se discutir determinadas associações entre condições de trabalho e morbidade referida. Foram estudadas, no período de abril de 2002 a fevereiro de 2004, 220 cabeleireiras e auxiliares que trabalhavam em Institutos de Beleza localizados nos distritos de Pinheiros e Jardim Paulista da cidade de São Paulo. Identificou-se, a partir de relato de sintomas, uma prevalência de LER/DORT de 70,5%. A localização corporal mais freqüente de relato de sintomas para LER/DORT foi ombro (48,6%), seguida pelo pescoço (47,3%) e coluna (38,6%). Verificou-se que os fatores de risco associados à ocorrência dos Distúrbios Osteomusculares Relacionados ao Trabalho (LER/DORT) em cabeleireiras estavam relacionados com: a) Fatores de Incômodo e Fadiga no Trabalho (referentes à organização do trabalho e aos aspectos psicossociais do trabalho) sendo que, após análise fatorial, o único dos fatores resultantes que teve significância estatística foi o que agrupava as variáveis Falta de reconhecimento no trabalho e Postura desconfortável no trabalho (ORaj=3,54; p=0,004); b) Posturas assumidas durante a realização das atividades - Não sentir conforto no corpo/pescoço/ombros enquanto trabalha (ORaj=2,78; p=0,004); c) Tempo de profissão acima de 15 anos(ORaj=3,04; p=0,022). Identificou-se, por meio de relato de sintomas e da análise ergonômica do trabalho, que os fatores de riscos ocupacionais associados ao desenvolvimento de LER/DORT em cabeleireiras, confirmam os riscos já descritos na literatura referentes a outras atividades, ou seja, aqueles relacionados aos fatores biomecânicos, organizacionais e psicossociais do trabalho.An activity poorly studied in Occupational Health in Brazil is the work of professionals in Beauty Parlours. This occupation is historically linked to the female gender and in the past years has been through huge changes in its operational process. In this study it was decided to analyze the job of airdressers since these professionals are under different health hazards due to risk factors related to their activity. The objectives of the study were to assess the prevalence of WRMD among hairdressers through reported symptoms, to characterize the most injured anatomic regions, and to identify and analyze the risk factors for WRMD present in the activities of these professionals. A cross-sectional study was employed together with the theories of the method for evaluation of the work situation and its consequence on health developed by the French Ergonomics, in order to discuss certain associations between working conditions and reported morbidity. Between April 2002 and February 2004 a total of 220 hairdressers who worked in Beauty Parlors in the districts of Pinheiros and Jardim Paulista were studied. A prevalence of WRMD of 70,5% was found. The body region most reported with symptoms of WRMD was shoulder (48,6%), followed by neck (47,3%) and spinal column (38,6%). It was noted that the risk factors for WRMD in hairdressers were related to: a) Annoying Factors and Fatigue at Work (connected to the work organization and the psychosocial aspects of the work) that after factorial analysis the only remaining factor statistically significant was the one that contains the variables lack of recognition at work and uncomfortable position at work (ORaj=3,54; p=0,004); b) Postures during attainment of activities - not feeling comfortable in the body/neck/shoulder while working (ORaj=2,78; p=0,004); c) Time at this occupation above 15 years (ORaj=3,04; p=0,022). Through reported symptoms and ergonomic analysis it was identified that the occupational risk factors associated with the development of WRMD in hairdressers corroborate the risks already described in the literature for other occupations, that is, those related to biomechanical, organizational and psychosocial factors.
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Carpenter, Tyler, and Kate Beatty. "Demographic Fall Predictors in a Rural Level One Trauma Center." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/6865.
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Falls are the number one mechanism of injury for The Trauma Center and Johnson City Medical Center (JCMC TC). JCMC TC is one of two level one trauma centers in the region and one of only six in the state. The main method for trauma prevention is outcome specific education and awareness. Injury prevention education is a critically needed area in the field of trauma and emergency care. Falls are the number one cause of injury in populations age >65. Socioeconomic status, age, gender, and race are all mitigating factors in the likelihood of greater length of stays, death in hospital, and death within one year of discharge for those who fall in a home setting. According to the CDC, people over the age of 75 are four to five times more likely than people under 75 to be admitted to a long-term care facility for more than a year. What is the relationship between patient characteristics and fall related outcomes in a level one trauma center? We looked at associations between patient demographics and associated outcomes for those admitted to the trauma center secondary to a ground level fall (GLF) in the home. Dataset: De-identified National Trauma Databank information was compiled by the JCMC Registrar for the past 8 years for the metrics: Injury Severity Score (ISS), length of stay, 48hr readmission, and disposition (home, nursing home, skilled nursing facility (SNF)).Demographic information, along with mechanism of fall, was collected for each patient. Patient age, gender, and date of injury was all used for statistical analysis and trend recognition. Statistical Analysis: Bivariate analyses included independent samples t-tests and Oneway ANOVA to find differences between groups. Results: T-test results show women are significantly more likely than men to be admit for a ground level fall (p<.001) and those with a higher ISS are more likely to have an extended stay in an inpatient setting (p<.001). One-Way ANOVA analysis of collected data shows an annual increase from 2006-2013 of trauma admissions for ground level falls (p<.01). Eight year analysis showed a two-fold increase in these admissions. Over 30% of patients admitted with a GLF are discharged to a SNF leading to higher societal costs due to Medicare reimbursement rates. Diagnosis related groups codes (DRG) dictate Medicare reimbursement rate of $14,091 per patient with an average facility cost of $14,196 per patient with no readmissions (Unplanned readmission within 180 days occurred at a rate of 8.3%). Conclusion: Fall education programs are necessary and needed in rural level one trauma centers to educate citizens on causes and methods of preventing falls in their homes. A decrease in these falls would lead to an increase in productive years of life and a reduction in strain on the hospital system.
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Karsten, Laurie. "Trauma and Transformation: a center for trafficked women in India." University of Cincinnati / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1337101748.
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Perri, Emanuela. "The Trauma Towers: Dimensions of Trauma in 9/11 Literature." Master's thesis, Alma Mater Studiorum - Università di Bologna, 2015. http://amslaurea.unibo.it/8147/.
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The topic of this dissertation is the aspects of trauma and reaction to the traumatic experience that can be found in 9/11 literature. The research engages in a comparative analysis of five books that can be categorised as 9/11 literature, which means that the events of 9/11 are central in the novels and are a recurrent theme. The books have been written by authors of different nationalities: "Extremely Loud & Incredibily Close" by J. S. Foer, "Falling Man" by D. DeLillo, "Windows on the World" by F. Beigbeder, "Saturday" by I. McEwan and "The Reluctant Fundamentalist" by M. Hamid. The characters have either experienced the attacks personally or their lives have been largely influenced by the event. In either case, the protagonist has been traumatised by the tragedy. Therefore, in this study two different fields are fused together – the field of comparative literature and that of trauma studies.
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Fagelson, Marc A. "Tinnitus and Trauma." Digital Commons @ East Tennessee State University, 2016. https://dc.etsu.edu/etsu-works/1959.
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Fagelson, Marc A. "Tinnitus and Trauma." Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/1659.
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Moore, Tal. "Post-traumatic cultural differences in trauma-centered identity and self-consistency." Thesis, University of East Anglia, 2012. https://ueaeprints.uea.ac.uk/48119/.
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Posttraumatic stress disorder (PTSD) is an anxiety disorder that can occur in response to traumatic experiences. Research has shown that the trauma memory may become central to a survivor’s life story and result in a trauma-centred identity. Posttraumatic changes to identity vary across cultures. Trauma-centred identity has been found to be positively associated with PTSD symptoms in individualistic cultures, but not in collectivistic cultures. Cultural differences have also been observed in levels of self-consistency. Individualistic cultures value high levels of consistency, whereas collectivistic cultures promote identity flexibility and adaptation to different social contexts. Several PTSD models describe the involvement of selfconsistency in posttraumatic coping, but research to date has yet to examine cultural variations in self-consistency and their relation to trauma-centred identity and PTSD. The present study investigated the relationships between self-consistency, traumacentred identity and posttraumatic symptoms across cultures. Trauma survivors from individualistic (n= 60 British) and collectivistic (n= 37 Soviets) cultures completed the Centrality of Events Scale, a self-consistency measure, and provided self-defining memories and self-cognitions. Trauma-centred identity was positively associated with posttraumatic symptoms in both cultural groups. Self-consistency was negatively associated with traumacentred identity in the two groups, and with posttraumatic symptoms in the Soviet culture. Mediation analyses indicated that levels of self-consistency mediated the impact of traumacenteredness on the development of PTSD. It can be concluded that, following trauma, selfconsistency appears to be protective for British and Soviets. The clinical implications of the present finding, particularly the benefits of self-consistency in the treatment of clients from British and Soviet cultures, are discussed.
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Ronayne, Emma. "Trauma-centred identity and autobiographical memory in posttraumatic stress disorder (PTSD)." Thesis, University of East Anglia, 2013. https://ueaeprints.uea.ac.uk/49477/.
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Posttraumatic stress disorder is a prevalent and disabling disorder that can occur following experience of trauma. Contemporary clinical models of PTSD assert that memories for trauma are poorly elaborated and inadequately integrated into autobiographical memory (AM). Recent work of cognitive psychologists suggests, however, that trauma memories remain highly accessible and form a cognitive reference point for the organisation of autobiographical knowledge, leading to the development of trauma-centred identity. The current study sought to explore further the relationships between PTSD symptoms, the phenomenological properties of AM for trauma, and trauma-centred identity. A community sample of 82 participants (male, n = 24; mean age = 36.10 years, SD = 10.82) was recruited. A within-subjects, correlational design was employed. Participants completed online questionnaires relating to PTSD symptoms, the phenomenological properties of a trauma memory and negative memory, and centrality of event to identity. Participants also provided written narratives of both a trauma and negative event. Differences between traumatic and negative memories, and relationships between trauma memory features and both PTSD and centrality were assessed using computerised textual analysis and self-report measures. Results indicated that trauma memories were significantly less coherent, less detailed, and contained fewer spatial references but more cognitive process terms than negative memories. PTSD symptoms correlated significantly with fragmentation of trauma memories and with use of the present tense in trauma narratives. A sense of reliving when remembering trauma and use of present tense were both significantly associated with centrality of event. Results were thus primarily consistent with contemporary clinical theories of PTSD with certain 3 elements of the centrality position also demonstrated. Findings were discussed in relation to the study’s methodological limitations, including difficulties encountered through LIWC’s lack of consideration of context when counting lexical items. Theoretical implications regarding the measurement of constructs such as fragmentation were outlined. Findings supported current treatment guidelines.
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Chyfetz, Michael. "Geriatric hip fractures: do they necessitate admission to a Level 1 trauma center?" Thesis, McGill University, 2013. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=114604.
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BACKGROUND: Hip fractures result in significant mortality, morbidity, and costs. Falls are the main mechanism of injury in the geriatric population with hip fractures associated with an annual cost of $9 billion dollars in the United States. Within the next decade, it is estimated that approximately 25% of the Canadian population will be 65 years and older. The cost of trauma center care is high, raising questions about the value of treating isolated hip fractures at Level 1 (tertiary) trauma centers. OBJECTIVES: To conduct a cost-effectiveness analysis of isolated geriatric hip fractures treated in Level 1 trauma centers compared with Level II and III centers. METHODS: A retrospective cohort study was comprised of patients over 65 years of age treated for isolated hip fractures in the Province of Quebec, Canada between January 1, 1998 and December 31, 2002. Data for the study was obtained from the Quebec Trauma Registry (QTR) and 3 patient cohorts were created according to treatment at 3 Level I, 29 Level II, and 21 Level III trauma centers. The primary outcome was total treatment cost defined as hospital costs for patient care from time of arrival at the hospital to discharge. All statistical analyses were carried out with SPSS version 19.0 (SPSS Inc., Chicago, Illinois). RESULTS: We identified 11,009 cases which met our inclusion criteria. The majority of patients were female (77%). Average age was 82 (Range: 65-105; SD: 7.5). The vast majority (96.9%) of admissions were as a result of falls. There were no significant differences with respect to mean age of patients, complication rate, and mortality amongst patient admitted to Level 1, 2 and 3 Trauma Centers. Average length of stay for all patients was 15.4 days (Confidence Interval 95%: 2-55). Our study finds a 20% and 60% savings of approximately $5 and $16 million dollars when patients are admitted to Level 2 and 3 Trauma Centers when compared to Level 1 Centers. CONCLUSIONS: Level 1 trauma centers do not improve the long term functional and rehabilitation outcomes of geriatric isolated hip fracture patient when compared to Level 2 and 3 centers. Our results suggest that treatment of Isolated Hip Fractures at Level 1 Trauma Centers is not cost-effective. A separate geriatric triage criteria for isolated hip fractures could lead to improved resource utilization, cost effectiveness and acute care outcomes.KEY WORDS: Elderly, Isolated hip fractures, Cost of trauma care, Trauma center performance, Level I.CONTEXTE: Fractures de la hanche suite à une importante mortalité, la morbidité et les coûts. Les chutes sont le principal mécanisme de blessure chez les personnes âgées avec des fractures de la hanche liées à un coût annuel de 9 milliards de dollars aux États-Unis. Dans la prochaine décennie, on estime qu'environ 25% de la population canadienne sera âgée de 65 ans et plus. Le coût des soins de traumatologie est élevé, ce qui soulève des questions sur la valeur du traitement des fractures de la hanche isolées au niveau 1 (tertiaire) des centres de traumatologie. OBJECTIFS: Pour effectuer une analyse coûts-efficacité analyse des fractures de la hanche isolés gériatriques traités dans les centres de traumatologie de niveau 1 par rapport aux niveaux II et III. Centres Méthodes: Une étude de cohorte rétrospective a été composé de patients de plus de 65 ans traités pour des fractures de la hanche isolées dans la province de Québec, au Canada entre Janvier 1, 1998 et Décembre 31, 2002. Les données de l'étude a été obtenue à partir du Registre des traumatismes du Québec (QTR) et 3 cohortes de patients ont été créés selon le traitement au niveau 3 I, 29 II niveau, et 21 centres de traumatologie de niveau III. Le critère principal était coût total du traitement définis comme les coûts hospitaliers pour les soins aux patients de l'heure d'arrivée à l'hôpital de se décharger. Toutes les analyses statistiques ont été réalisées avec SPSS version 19,0 (SPSS Inc, Chicago, Illinois). Résultats: Nous avons identifié 11.009 cas qui répondaient à nos critères d'inclusion. La majorité des patients étaient des femmes (77%). L'âge moyen était de 82 (intervalle: 65-105; SD: 7,5). La grande majorité (96,9%) des admissions étaient à la suite de chutes. Il n'y avait pas de différences significatives en ce qui concerne moyenne d'âge des patients, le taux de complications et de la mortalité parmi les patients admis au niveau 1, 2 et 3 centres de traumatologie. Durée moyenne de séjour pour tous les patients était de 15,4 jours (intervalle de confiance à 95%: 2-55). Notre étude a montré une réduction de 20% et 60% des économies de l'ordre de $ 5 et $ 16 millions de dollars lorsque les patients sont admis au niveau 2 et 3 centres de traumatologie par rapport au niveau 1 centres. CONCLUSIONS: Les centres de traumatologie de niveau 1 ne pas améliorer les résultats fonctionnels à long terme et de réadaptation gériatrique du patient de fracture de la hanche isolé par rapport aux niveaux 2 et 3 centres. Nos résultats suggèrent que le traitement des fractures de la hanche isolés dans les Centres de traumatologie de niveau 1 n'est pas rentable. Un des critères de triage séparées pour les fractures de la hanche gériatriques isolés pourrait conduire à une meilleure utilisation des ressources, la rentabilité et les résultats des soins aigus.MOTS CLÉS: Personnes âgées, isolées fractures de la hanche, coûts des soins de traumatologie, le rendement centre de traumatologie de niveau I.
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Kruger, Andries Michiel. "Review of Damage Control Laparotomy (DCL) outcomes in a Major Urban Trauma Center." Master's thesis, Faculty of Health Sciences, 2020. http://hdl.handle.net/11427/32281.
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Introduction Damage control laparotomy (DCL) in an urban trauma centre is associated with high mortality. Aim The purpose of this prospective study was to review the outcomes of DCL in a level one urban trauma centre, looking particularly at primary closure rate and other factors influencing outcomes. Methods All patients undergoing DCL for penetrating trauma from May 2015 to July 2017 were retrieved from the prospectively recorded eTHR data base. Data retrieved were basic demographics, mechanism of injury, perioperative vitals and biochemical parameters. Injury severity was described by the Revised Trauma Score (RTS), Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS) and Trauma and Injury Severity Score (TRISS). Indications for DCL were determined as well as length of ICU stay, days of ventilation, number of procedures and primary abdominal closure rates. Complications and mortality were recorded. Results During the study period, 51 patients underwent DCL. Three patients sustained stab wounds and 47 patients suffered from gunshots. Only 1 female was included in the study with the other 50 being male. The mean age was 28 years and 4 months (range 15 to 48 years). Indications for laparotomy were haemodynamic instability (n = 27) and peritonism in stable patients (n = 22). The means for the different severity scores were RTS 7.36, ISS 17.5, TRISS 93.76 and PATI 28. Means were calculated for different physiological markers of trauma (lowest pH 7.12, highest lactate 7.11, lowest core temp 34.9˚C and lowest systolic BP 63.8 mmHg). The organs most commonly injured, in decreasing frequency, were small bowel (n = 33), large bowel (n = 25), abdominal vasculature (n = 22), liver (n = 18), stomach (n = 14), kidney (n = 10), diaphragm (n = 10), spleen (n = 9) and pancreas (n = 8). DCL procedures performed were abdominal packing (n = 36), bowel ligation (n = 30), vascular shunting (n = 5) and shunting of the ureter (n = 1). The median number of laparotomies done per patient was 3, with a primary fascial closure rate of 69%. The mortality rate was 29%. Conclusion DCL in our setting is associated with a 29% mortality rate. Severe acidosis, massive blood transfusion in first 24hours and median PATI score more than 47 are independent factors associated with increased mortality.
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Myers, Robert A. "Engineering Healthcare Delivery: A Systems Engineering Approach to Improving Trauma Center Nursing Efficacy." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1482419145222356.
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Chughtai, Talat S. "Absence of an elective on-site neurological service : impact on outcomes in severely injured head trauma patients in a tertiary referral trauma center." Thesis, McGill University, 2006. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=97932.
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A retrospective study was conducted to compare two groups of patients treated at the Montreal General Hospital (MGH) for traumatic brain injuries (TBI). The time to neurosurgery, vital status and length of stay in the ICU was evaluated in 299 patients treated before (1997-1998), and 307 patients after (2000-2001) an elective neurosurgery service was eliminated from the NIGH. The outcomes were not significantly different between the two groups. There were trends towards a shorter time to neurosurgery in the group treated in 2000-2001 (4.5 hours) compared to the group treated in 1997-1998 (5.5 hours; p=0.32). Mortality and length of stay in the ICU did not significantly differ between the two groups. This study suggests the provision of adequate neurotrauma care with respect to acute outcomes in the absence of an on-site neurosurgery service, at our institution.
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Bergan, Britta L. "Demographic Characteristics and Trauma Symptomology in Juvenile Justice Residents at Echo Glen Children's Center." Antioch University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1459871411.
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Fagelson, Marc A. "Tinnitus and Trauma." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/1956.
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Trauma-provoked tinnitus challenges patients and clinicians. Effects of trauma may exacerbate tinnitus, and patients with both tinnitus and posttraumatic stress disorder rate distress levels as higher than patients who experience only one or the other. This presentation will highlight links between tinnitus and trauma histories relevant to clinical audiologists.
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Virago, Enid. "Death Notification Skills, Secondary Stress, and Compassion Fatigue In a Level One Urban Trauma Center." VCU Scholars Compass, 2010. http://scholarscompass.vcu.edu/etd/2152.
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Abstract This quasi-experimental design study compared two small samples of Emergency medicine residents after one group had an educational intervention on death notification skills and the other did not. Comparisons were made on residents’ confidence in their communication, interpersonal skills and level of compassion fatigue/satisfaction and EM Residents’ level of Secondary Traumatic Stress after an event of patient death and subsequent notification of Secondary Patients. Residents were interviewed to gather recommendations for designing death notification curriculum. Over an eight month period, forty emergency medicine residents at two sites, control and intervention, completed surveys designed to provide quantitative data on self-confidence and stress related to recent patient deaths. Residents who participated in a death notification event completed the Secondary Traumatic Stress Scale. Interviews were conducted to gather information on the impact of the notification and recommend changes in curriculum at the experimental site. The data infer that an educational intervention on death notification skills increased residents’ confidence in their ability to give compassionate death notification to families as compared with the control group. Residents in the intervention and control group had no significant differences in their potential for compassion satisfaction. Residents who had the educational intervention showed less Secondary Traumatic Stress symptoms than their non-intervention counterparts. The intervention group showed less risk for burnout (although it would only be significant at p < 0.10). The overall conclusion is that there is some evidence for a positive effect of the intervention. However, due to the small sample size the conclusion is tentative and more research is needed to evaluate the training.
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Lison-Pick, Mandy. "Accepting a reduced self after acute trauma." Thesis, Curtin University, 2011. http://hdl.handle.net/20.500.11937/201.
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Disability associated with loss of limb function following major/minor trauma is a life-changing phenomenon of global significance which poses a heavy burden on healthcare systems, communities and individuals. While there is a voluminous and growing body of knowledge on disabilities and chronic illness, little attention has been given to the short and long-term experiences of those living with loss of limb function and disability following acute major and minor trauma. The aim of this thesis is to develop a substantive theory that describes the phenomenon of living with disabilities resulting from a loss of limb function from acute minor or major trauma.Data were obtained from face-to-face interviews with 15 consenting participants aged between 18-45 years who had lost limb function from acute major/minor trauma all of whom were attending the Pain Management Centre of a major teaching hospital in Western Australia. Four clinical practitioners (who were classed as experts in their field) were also interviewed to clarify the practices the participants discussed so an all round picture could be given and analysed. Data analysis was conducted using the constant comparative technique of the Grounded Theory Method. The results indicate that the basic social problem was Loss of Self and developed from either a sudden or gradual loss of limb function as a result of acute trauma. This trauma had a biopsychosocial impact as the participant’s hospitalisations, surgical procedures, extended rehabilitation programs and resultant disability reduced the self.The basic social process experienced was recognised as Accepting a Reduced Self appearing in three stages: Floundering, Treading Water and Wading to Shore. However these stages were strongly influenced by various modifying conditions such as their persistent pain, the availability of a support crew, the type of trauma experienced and the length of time since injury. It was concluded that disabilities related to loss of limb function can occur following acute major or minor trauma. The impairment the participants experienced affected all aspects of their lives and that of their partners, family and friends as most of them continued to struggle with their disability, either biologically, psychologically or socially. The findings of this thesis point to the importance of more research into designing care and offering ongoing support services to provide long term care for this vulnerable, disabled population.
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Fagelson, Marc A. "Trauma, Tinnitus, Suicide, Counseling and the Audiologist." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/etsu-works/1665.
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Fagelson, Marc A. "Tinnitus and Trauma: Challenges for Patients and Providers." Digital Commons @ East Tennessee State University, 2014. https://dc.etsu.edu/etsu-works/1954.
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Campbell, Ellen Catherine. "TRAUMATIZED WIVES AND THE TRANSATLANTIC NOVEL: UNVEILING THE CULTURAL NARRATIVE OF NINETEENTH-CENTURY MARITAL SUFFERING." OpenSIUC, 2018. https://opensiuc.lib.siu.edu/dissertations/1536.
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My dissertation charts the transatlantic nineteenth-century novel's subtle revisions to the traditional marriage plot, in terms of both narrative and form, identifying a gradual shift in the way marriage was fictionalized. I argue that incremental revisions to the marriage plot reconstruct positive representations of female marital experience into negative depictions that transform marriage into a form of institutionalization that leads to psychological and bodily trauma. I reveal the development of a collective trauma narrative that underscores the nineteenth-century woman's experience living inside society's oppressive marital culture. The novel serves as the body of cultural work that both represents and shapes women's marital experiences inside a society that legally forced them to surrender their identity, person, and property to their husband, as well as socially holding them to a much higher standard of propriety and obedience. In specific chapters, I create transatlantic pairings that trace the novel's troubled efforts to free itself and its heroines from the constraints of the marriage plot which reflect women's inability to do so in real life.
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DeBorde, Alisa M. "Seeing Trauma: The Known and the Hidden in Nineteenth-Century Literature." Scholar Commons, 2018. http://scholarcommons.usf.edu/etd/7141.
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Trauma as an official diagnosis first entered the DSM in 1980 and literary theorists began employing the term to discuss literature not too long after. Since the 1990s, theorists have largely focused on twentieth-century trauma literature with Holocaust and Modernist texts garnering much of the critical interest. Yet, Victorian life was also marked by trauma-causing events. From railway catastrophes, to industrial accidents, to premature deaths, and infectious diseases, Victorians reckoned with wounds to the mind through their lived experience. Trauma scholars who do work with nineteenth-century texts, with few exceptions, consider trauma in terms of its modern theories. While the work of Cathy Caruth, Shoshanna Felman, Ann Whitehead, E. Anne Kaplan, Dominick LaCapra, and Judith Herman has stimulated important discussions about trauma literature, their development of the concept of trauma rarely reaches further back than Freud. Victorian configurations of the mind and its response to psychical wounding have much to offer to the current discussion of literary trauma. This dissertation presents a study of Victorian literary texts through current theories of trauma juxtaposed with nineteenth-century formulations of the concept. The analysis offers three main points: one, to identify instances of trauma in nineteenth century texts that would otherwise go unnoticed; two, to situate texts within the cultural and historic milieu of their publication and to consider how literary conventions and forms indicative of the nineteenth-century serve to represent the effects and symptoms of trauma, and three, as a result of seeing trauma in the texts, to challenge common readings of Victorian literary characters, images, and forms.
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Bendall, William Bryson. "Retrospective Analysis of Injuries Sustained In Vehicle Front‐ and Back‐Overs in a Level I Pediatric Trauma Center." Thesis, The University of Arizona, 2017. http://hdl.handle.net/10150/623628.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Motor vehicle accidents involving pedestrians are some of the most common and lethal forms of injury for children in the United States. Among younger children, a common mechanism of action for severe trauma is when a vehicle runs over the child in a forward or backward motion at low speed resulting in a blunt crush injury. This typically occurs in non‐traffic settings including driveways, sidewalks, and roadways. Such incidents have been referred to in many different ways in the literature but for the purposes of this paper will be referred to as low speed vehicle run‐overs. This is a retrospective chart review carried out at Phoenix Children’s Hospital in affiliation with the University of Arizona College of Medicine‐Phoenix that categorizes and examines the injuries sustained by patients involved in low speed vehicle runovers occurring between December 2007 and August 2013. Fifty‐five pediatric patients were included with a median age of 24 months and 6 of these patients were fatally injured. Internal injuries were common overall and significantly more common in children ≤24months. Over half of the cohort sustained fractures, with a 24% incidence of skull fractures. All fatalities were the result of traumatic brain injury. Twenty percent of victims required operative intervention. It was concluded that the severity of these types of incidents varies from minimal to life threatening and best care requires close and thorough evaluation by the trauma and emergency department teams.
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Travis, Isabelle. "The poetry of pain : trauma, madness and suffering in post-World War II American poetry." Thesis, University of Reading, 2011. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.553108.
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Chang, Vicki, and Stephanie Campbell. "An Evaluation of Student Pharmacist Admission Medication Histories at a Level 1 Trauma, Academic Medical Center: A Descriptive Study." The University of Arizona, 2017. http://hdl.handle.net/10150/624163.
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Class of 2017 AbstractObjectives: The purpose of this study is to demonstrate the effect of using advanced pharmacy practice experience (APPE) students in the collection of admission medication history at an academic teaching hospital prior to pharmacist review. Methods: The study is a retrospective, descriptive study. Using electronic medical records, the study looked at patients admitted to specific floors during a two-month period. The primary outcome was number of discrepancies found by the APPE students. The secondary outcome was the type of discrepancy found (omission, duplication, wrong dose, wrong frequency, wrong dosage form, and medications the subject no longer takes). Results: Over eight weeks, the APPE students identified 2,666 discrepancies, which equates to approximately 4.71 ± 4.76 discrepancies per patient. The majority of these discrepancies were identified as omissions of therapy (39.1%), followed by medications the patients were no longer taking (29.8%), and wrong dosing frequencies (18.1%). Conclusions: APPE students assisted the medication reconciliation process by identifying numerous medication discrepancies which may have prevented patient harm. APPE students are an underutilized resource and prove to be an asset to the healthcare team.
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Marcolongo, Ellen. "The Relationships Between Sleep Disturbances, Depression, Inflammatory Markers, and Sexual Trauma in Female Veterans." Scholar Commons, 2014. https://scholarcommons.usf.edu/etd/5266.
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The purpose of this secondary data analysis was to assess for the relationships among sleep disturbances, depressive symptoms, inflammatory markers, and sexual trauma in female veterans. This may contribute to an understanding of the physical and mental health effects of sexual trauma in female veterans. Correlational analyses were conducted to evaluate the strength of these relationships. A reported history of sexual trauma was significantly correlated with longer sleep latencies, poorer sleep efficiency, shorter sleep durations, more daytime dysfunction, and poorer overall sleep quality in female veterans. A reported history of sexual trauma was also significantly correlated with depressive symptoms including anhedonia and a negative affect in female veterans. No significant correlations were noted between inflammatory markers and a reported history of sexual trauma in female veterans. Female veterans with a reported history of sexual trauma had more trouble falling and staying asleep, had more trouble functioning during daytime hours, and had total poorer sleep quality. These veterans also appeared depressed and they found normally pleasurable activities unenjoyable. Disturbed sleep and depressive symptoms may be risk factors in the development of chronic health diseases. By assessing and treating the sleep disturbances and depressive symptoms experienced by sexually traumatized female veterans, nurses may help to prevent the development of costly and deadly chronic diseases
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Lund, Menke Sunniva, and Susanne Mannelqvist. "Patienters upplevelser och erfarenheter av traumaomhändertagande : en litteraturstudie." Thesis, Sophiahemmet Högskola, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:shh:diva-4053.
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Trauma är vanligt förekommande internationellt och drabbar främst unga under livets fyra första årtionden. Dödligheten relaterat till trauma förväntas att fortsätta öka till 2030 i Sverige. Trauma orsakar såväl ett fysiskt som ett psykiskt lidande för patienter, samt skapar stora samhällskostnader. Kunskap om patienters upplevelser och erfarenheter angående traumaomhändertagandet initialt är begränsat. Det är av vikt att sjuksköterskan har kunskap om patienters upplevelser och erfarenheter så att sjuksköterskan kan göra patienten delaktig i vården och tillgodose patientens behov och samtidigt tillhandahålla och bedriva en patientsäker vård i mötet med traumapatienten. Syftet var att beskriva patienters upplevelser och erfarenheter av traumaomhändertagande. Metoden till studien var en allmän litteraturstudie. PubMed och CINAHL var databaserna som användes. Manuell sökning och kedjesökning utfördes också. Kvalitetsgranskningen resulterade i 15 artiklar som inkluderades för att därefter bearbetas med hjälp av en integrerad analys. Resultatet mynnade ut i två huvudkategorier; patienternas positiva upplevelser och erfarenheter och patientens negativa upplevelser och erfarenheter. Till vardera huvudkategorier identifierades fem respektive sex underkategorier. Under huvudkategorin patienternas positiva upplevelser och erfarenheter identifierades underkategorierna; en välfungerande vårdkedja, tillfredsställande undersökning och behandling, professionellt bemötande, gynnsam informationsöverföring och kommunikation, och gynnsamma emotionella aspekter. Under den andra huvudkategorin patienternas negativa upplevelser och erfarenheter identifierades; brister i vårdkedjan, otillfredsställande undersökning och behandling, fysiologiska konsekvenser, brister i personalens kompetens, hinder för informationsöverföring och kommunikation, och psykologiska påfrestningar. Slutsatsen av litteraturstudien är att upplevelserna och erfarenheterna av traumaomhändertagande är mångfacetterat och individuellt, vilket ställer höga krav på personalens kommunikationsförmåga samt krav på att individanpassa hälso- och sjukvården, då vården av traumapatienter är komplex.Trauma is common internationally and mainly affects young people during the first four decades of life. Mortality related to trauma is expected to continue to increase until 2030 in Sweden. Trauma causes both physical and psychological suffering for patients and creates large societal costs. Knowledge of the patient's experiences regarding initial trauma care is limited. It is important that the nurse has knowledge of the patient's experiences so that the nurse can involve the patient in the care and ensure that the patient's needs are met, and at the same time provide care that is safe in the meeting with the trauma patient. The aim was to describe patients' experiences of trauma care. The method of the study was a general literature study. PubMed and CINAHL were the databases used. Manual search and snowballing were also performed. The result after quality review of articles contributed to 15 included articles that were analyzed according to an integrated analysis. The analysis resulted in two main categories: the patients' positive experiences and the patients' negative experiences. Five respectively six subcategories were identified for each main category. Under the main category of patients' positive experiences, the subcategories were: a well-functioning care, satisfaction with examination and treatment, professional treatment, adequate knowledge and skills of the staff, good information transfer and communication, and that emotional aspects were considered as favorable. Under the second main category, the patients' negative experiences were identified; the lack of care, dissatisfaction with examination and treatment, the physiological consequences, lack of competence, obstacles to information transfer and communication, and psychological stress. The conclusion of the literature study was that the experiences of trauma care are multifaceted and individual, which put high demands on health care staff in communication skills and the ability to adapt care individually, since the care of trauma patients is complex.
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Price, David. "Evaluation of a Difficult Urinary Catheter Team in an Academic Medical Center." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5118.
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The placement of an indwelling urinary catheter (IUC) is a commonly performed clinical procedure which may become challenging for the clinician and painful for the patient. In response to urologic complications attributed to repeated failed IUC insertion attempts by nurses, a difficult urinary catheter (DUC) team program was launched in October 2012. The purpose of the doctoral project was to conduct a quality improvement evaluation of the effectiveness of the DUC team program using retrospective data from May 1, 2013 through May 31, 2017. Benner's novice to expert model was chosen as the theoretical framework to guide the additional training, critical thinking, problem-solving, and skill acquisition necessary for team member inclusion. The practice-focused question for the project answered whether DUC team nurses, through advanced training and demonstrated procedural competence, have been effective with DUC insertions. Sources of evidence included primary and secondary articles in peer-reviewed journals, as well as clinical evidence collected from internal sources. During the project time-line, 463 DUC team consultations were recorded with an insertion success rate of 89.6%. Based on the DUC team concept, additional didactic content and simulation training may be developed for other cognitive and skill-based clinical procedures. The implications for positive social change include improved patient safety and comfort, as well as cost savings for the organization and overall healthcare system.
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McClellan, Caroline A. "PROGRAM EVALUATION OF A TRAUMA INFORMED YOGA THERAPY PROGRAM FOR INDIVIDUALS WITH POST TRAUMATIC STRESS DISORDER IN A COMMUNITY MENTAL HEALTH CENTER." Wright State University Professional Psychology Program / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=wsupsych1596034704426718.
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Domon-Archambault, Vincent. "Élaboration et étude préliminaire d'efficacité d'un guide d'interventions axées sur la mentalisation pour les jeunes hébergés en centre jeunesse." Thèse, Université de Sherbrooke, 2014. http://hdl.handle.net/11143/5433.
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Cette étude propose d’utiliser la notion de mentalisation, soit la capacité qu’a un individu de percevoir et d’interpréter ses comportements et ceux d’autrui en fonction d’états mentaux (Allen & Fonagy, 2006), pour comprendre les difficultés que présentent les enfants hébergés en centre jeunesse et guider les interventions des éducateurs œuvrant auprès d’eux. De récents travaux documentent les liens existant entre les lacunes au sein de la capacité de mentalisation du parent et les traumas perpétrés dans la relation d’attachement avec son enfant (Allen, 2013; Slade, 2005; Slade, Grienenberger, Bernbach, Levy, & Locker, 2005). Ces traumas engendrent un développement altéré de la capacité de mentalisation chez l’enfant, lequel se lie à une autorégulation socioaffective déficitaire, marquée par l’agir et l’agressivité. Ces travaux suggèrent également qu’une intervention stimulant la reprise du développement de la capacité de mentalisation peut se traduire par une amélioration corollaire des mécanismes d’autorégulation, lesquels seraient alors opérés par la pensée plutôt que par l’agir (Gergely, 2003). En s’appuyant sur ces notions, un manuel d’interventions axées sur la notion de mentalisation destiné aux intervenants des centres jeunesse a été élaboré (Domon-Archambault & Terradas, 2012). Ce guide a été utilisé pour mener la formation des intervenants d’un centre jeunesse œuvrant auprès d’une clientèle d’enfants âgés de 6 à 12 ans. Le processus de théorisation et d’élaboration du manuel est décrit dans un premier article. Puis, l’évaluation préliminaire de l’efficacité de la formation s’appuyant sur ce manuel est abordée dans un deuxième article. Cette évaluation compare des mesures de la mentalisation prises chez les intervenants avant et après la formation. L’évaluation comprend également la comparaison des mesures, prises avant et après la formation, des difficultés émotionnelles et comportementales manifestées par les enfants vivant dans les milieux d’hébergement des centres jeunesse dans lesquelles ces intervenants travaillent. Bien que les résultats ne démontrent pas d’effet statistiquement significatif de la formation sur la capacité de mentalisation des éducateurs ciblés par celle-ci, les analyses statistiques effectuées attestent d’une réduction significative des symptômes dépressifs, des problèmes sociaux, de la somatisation, des troubles attentionnels de même que des troubles intériorisés totaux, suite à la formation, chez les enfants auprès desquels les éducateurs interviennent. Ces résultats confirment la possibilité d’adapter la compréhension et les interventions axées sur la mentalisation, étudiées par plusieurs auteurs chez une population adulte, aux enfants hébergés en centre jeunesse. Malgré les limites inhérentes à la nature exploratoire de l’étude, la réponse positive des intervenants suite à la formation de même que les impacts de celle-ci sur les difficultés comportementales et émotionnelles des enfants laissent croire qu’un tel projet serait pertinent à implanter et à évaluer de façon plus poussée en centre jeunesse.