Multidisciplinary trauma team care in Kandahar, Afghanistan: Current injury patterns and care practices

Background Team care improves processes and outcomes of care, especially for patients with complex medical conditions that require coordination of care. This study aimed to compare the processes and outcomes of care provided to older patients with diabetes by primary care teams comprised of only primary care physicians (PCPs) versus team care that included nurse practitioners (NPs) or physician assistants (PAs). Methods We studied 3,524 primary care practices identified via social network analysis and 306,741 patients ≥66 years old diagnosed with diabetes in or before 2015 in Medicare data. Guideline-recommended diabetes care included eye examination, hemoglobin A1c test, and nephropathy monitoring. High-risk medications were based on recommendations from the American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Preventable hospitalizations were defined as hospitalizations for a potentially preventable condition. Results Compared with patients in the PCP only teams, patients in the team care practices with NPs or PAs received more guideline-recommended diabetes care (annual eye exam: adjusted odds ratio (aOR): 1.04 (95% CI: 1.00–1.08), 1.08 (95% CI: 1.03–1.13), and 1.10 (95% CI: 1.05–1.15), and HbA1C test: aOR: 1.11 (95% CI: 1.04–1.18), 1.11 (95% CI: 1.02–1.20), and 1.15 (95% CI: 1.06–1.25) for PCP/NP, PCP/NP/PA, and PCP/PA teams). Patients in the PCP/NP and the PCP/PA teams had a slightly higher likelihood of being prescribed high-risk medications (aOR: 1.03 (95% CI: 1.00–1.07), and 1.06 (95% CI: 1.02–1.11), respectively). The likelihood of preventable hospitalizations was similar among patients cared for by various types of practices. Conclusion The team care practices with NPs or PAs were associated with better adherence to clinical practice guideline recommendations for diabetes compared to PCP only practices. Both practices had similar outcomes. Further efforts are needed to explore new and cost-effective team-based care delivery models that improve process, outcomes, and continuity of care, as well as patient care experiences.

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Changes in pediatric major trauma epidemiology, injury patterns, and outcome during COVID-19–associated lockdown

Trauma ◽

10.1177/14604086211045359 ◽

2021 ◽

pp. 146040862110453

Author(s):

Naama Pines ◽

Miklosh Bala ◽

Itai Gross ◽

Lea Ohana-Sarna-Cahan ◽

Ruth Shpigel ◽

...

Keyword(s):

Injury Severity ◽

Pediatric Trauma ◽

Admission Rate ◽

Policy Decision ◽

Trauma Team ◽

Injury Patterns ◽

Hospital Policy ◽

Policy Makers ◽

Trauma Team Activation ◽

Awareness Programs

Introduction The COVID-19 pandemic and its associated preventive measures such as national and regional lockdowns have dramatically changed the epidemiology of pediatric admissions to the emergency department. Nevertheless, there are scant data on the epidemiology and injury patterns of major pediatric trauma injuries during these lockdown periods. Methods A single-center retrospective study of data obtained from a tertiary level 1 trauma hospital trauma registry. The data included demographics, injury mechanisms, injury severity and type, treatment, and resource utilization in children aged 0–18 years who required trauma team activation upon arrival. The analysis compares the data from the 5-week lockdown period from March to May 2020 in Jerusalem, Israel, to its parallel periods in 2018–2019. Results A total of 187 trauma visits that required trauma team activation (TTA) were analyzed: 48 visits during the lockdown period vs. 139 in 2018–2019, corresponding to a 40% drop in TTA. There was a significant decrease of 34% in MVA-related injuries ( p = 0.0001) but a significant increase of 14% in burns ( p = 0.01) and a 16% increase in bicycle-related injuries ( p = 0.001). No changes in ISS, injury patterns, admission rate, PICU utilization, or need for interventions were observed. Conclusion There was a significant decrease in the number of overall pediatric trauma visits during the 2020 lockdown, mainly in MVA-associated trauma, but an increase in burns and bicycle injuries. These findings can thus inform policy makers as to the need to formulate prevention awareness programs alerting the public to indoor hazards and the dangers of activities outside the home. Furthermore, it can inform hospital policy decision-making in future lockdowns. The fact that PICU admissions and the need for operating rooms stayed unchanged suggests that it is vital to maintain trauma team capabilities even during lockdowns.

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Injury Patterns in Near-Hanging Patients: How Much Workup is Really Needed?

The American Surgeon ◽

10.1177/000313481908500534 ◽

2019 ◽

Vol 85 (5) ◽

pp. 549-555 ◽

Cited By ~ 1

Author(s):

David M. Berke ◽

Stephen D. Helmer ◽

Jared Reyes ◽

James M. Haan

Keyword(s):

Brain Injuries ◽

Surgical Intervention ◽

Thyroid Cartilage ◽

Signs And Symptoms ◽

Trauma Team ◽

Vascular Injuries ◽

Associated Injuries ◽

Injury Patterns ◽

Low Incidence ◽

Trauma Activation

Survivors of near-hangings suffer anoxic brain injuries, but it remains uncertain whether the incidence of associated injuries warrants extensive workup or trauma activation. An 11-year retrospective review was conducted on adult patients with a hanging mechanism who underwent trauma workup and management. The majority of patients (n = 98) were white (88.8%) males (75.5%) with an average age of 30 ± 12.3 years. Two-hundred fifty-four CTand magnetic resonance scans were performed and eight injuries were uncovered: three thyroid cartilage/hyoid fractures; three vertebral injuries; and two cervical vascular injuries. Anoxic brain injury was diagnosed clinically in 35 patients (35.7%) and was present in all 19 patients (19.4%) who died. Only one patient had intra-abdominal injury requiring surgical intervention. Injuries were more likely in patients with abnormal Glasgow Coma Scale (GCS) versus normal GCS (55% vs 10.5%, respectively). Patients who present after near-hanging have a low incidence of associated injuries. Workup can be restricted to patients with abnormal GCS scores and for specific signs and symptoms or high-risk energy mechanisms. The trauma team can be activated for signs of trauma.

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PRÁTICAS DE CUIDADO DA EQUIPE DA ESTRATÉGIA SAÚDE DA FAMÍLIA / FAMILY HEALTH STRATEGY TEAM CARE PRACTICES

Brazilian Journal of Development ◽

10.34117/bjdv6n11-095 ◽

2020 ◽

Vol 6 (11) ◽

pp. 85452-85459

Author(s):

John Vinícius Oliveira da Silva ◽

Victor Fernando Matos de Almeida ◽

Francisco Alves Lima Junior ◽

Karla Vanessa Morais Lima ◽

Adriano Figueredo Neves ◽

...

Keyword(s):

Family Health ◽

Team Care ◽

Health Strategy ◽

Family Health Strategy ◽

Care Practices

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Knowing nursing team care practices in relation to newborns in end-of-life situations

Escola Anna Nery ◽

10.1590/2177-9465-ean-2016-0369 ◽

2017 ◽

Vol 21 (4) ◽

Cited By ~ 3

Author(s):

Isabella Navarro Silva ◽

Natália Rejane Salim ◽

Regina Szylit ◽

Patricia Stella Silva Sampaio ◽

Carolliny Rossi de Faria Ichikawa ◽

...

Keyword(s):

End Of Life ◽

Nursing Staff ◽

Neonatal Intensive Care ◽

Human Life ◽

Neonatal Intensive Care Units ◽

End Of Life Decisions ◽

Team Care ◽

Care Practices ◽

Care Relationships ◽

Nursing Professionals

Abstract Objective: Understand the care practices experiences of nursing staff in relation to providing end-of-life care to newborns and their families in neonatal intensive care units (NICU). Method: Descriptive study with a qualitative approach, involving eight nursing professionals from an NICU. Results: Through the data analysis, it was possible to identify three central themes: the "obscurity of death in neonatal ICUs": coping with death at the onset of a human life; palliative care and end-of-life decisions: the challenges faced by nursing staff in neonatal ICUs; and types of nursing care in the daily activities of neonatal ICUs. Conclusion: It is essential to understand the experiences and needs of nursing staff, so that proposals can be formulated for seeking improvements in the care relationships that take place in this context.

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Traumatic Brain Injury: A Trauma Surgeon's Perspective

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld22.3.82 ◽

2012 ◽

Vol 22 (3) ◽

pp. 82-89

Author(s):

Oscar D. Guillamondegui

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Multidisciplinary Approach ◽

Trauma Team ◽

The United States ◽

Long Term Outcomes ◽

Term Care ◽

Injured Brain ◽

The Moment

Traumatic brain injury (TBI) is a serious epidemic in the United States. It affects patients of all ages, race, and socioeconomic status (SES). The current care of these patients typically manifests after sequelae have been identified after discharge from the hospital, long after the inciting event. The purpose of this article is to introduce the concept of identification and management of the TBI patient from the moment of injury through long-term care as a multidisciplinary approach. By promoting an awareness of the issues that develop around the acutely injured brain and linking them to long-term outcomes, the trauma team can initiate care early to alter the effect on the patient, family, and community. Hopefully, by describing the care afforded at a trauma center and by a multidisciplinary team, we can bring a better understanding to the armamentarium of methods utilized to treat the difficult population of TBI patients.

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