scholarly journals Pediatric Prehospital Airway Management by U.S. Forces in Iraq and Afghanistan

2020 ◽  
Vol 185 (9-10) ◽  
pp. e1435-e1439
Author(s):  
Elizabeth A Koslow ◽  
Matthew A Borgman ◽  
Michael D April ◽  
Steven G Schauer
Keyword(s):  
Hospital Discharge ◽  
Head Injuries ◽  
Pediatric Trauma ◽  
Secondary Analysis ◽  
Medical Personnel ◽  
Developed Countries ◽  
Injury Score ◽  
Serious Injury ◽  
Prehospital Airway Management ◽  
Head Neck

Abstract Introduction Airway obstruction is a treatable cause of potentially preventable death on the battlefield. Emergency cricothyrotomies are rarely performed in developed countries, but are a common prehospital procedure in recent conflicts in Iraq and Afghanistan. We describe prehospital airway interventions performed on pediatric casualties with a focus on cricothyrotomy during these recent conflicts. Materials and Methods This is a secondary analysis of previously published dataset from the Department of Defense Trauma Registry for pediatric encounters from January 2007 to January 2017. Within our dataset we searched for all instances of airway interventions in the prehospital setting. Results During this time, there were 3,439 pediatric casualties in the registry with a total of 18 prehospital cricothyrotomies and 211 prehospital intubations. For cricothyrotomies, the median age was 10 years, most (72.2%) were male, median composite injury score was 25, most were injured by explosive (44.4%), more commonly located in Afghanistan (77.8%), and approximately half survived to hospital discharge (44.4%). The head was most frequently injured (44.4%). Of those undergoing endotracheal intubation, the median age was 10 years, most (75.8%) were male, median injury score was 17, most were injured by explosives (53.5%), most were in Afghanistan (85.7%), and most survived to hospital discharge (66.8%). The head/neck most frequently had a serious injury (56.8%). Conclusions In this dataset, 6.8% of children underwent prehospital intubation and 0.5% underwent prehospital cricothyrotomy. Airway interventions were frequently associated with head injuries. This highlights the importance of training and equipping prehospital medical personnel for pediatric trauma care in accordance with military clinical practice guidelines.

scholarly journals An Analysis of Outcomes and Interventions for Female Pediatric Casualties in Iraq and Afghanistan

2021 ◽  
Author(s):  
Hannah L Gale ◽  
Natalie J Koons ◽  
Matthew A Borgman ◽  
Michael D April ◽  
Steven G Schauer
Keyword(s):  
Hospital Discharge ◽  
Department Of Defense ◽  
Pediatric Patients ◽  
Secondary Analysis ◽  
Medical Personnel ◽  
Military Hospitals ◽  
Traumatic Injuries ◽  
Severity Of Injury ◽  
Initial Dataset ◽  
Reason For Admission

ABSTRACT Background Traumatic injuries were the most common reason for admission of pediatric patients to military hospitals during the recent wars in Iraq and Afghanistan. We compare survival and interventions between female and male pediatric casualties. Materials and Methods This is a secondary analysis of a previously described dataset from the Department of Defense Trauma Registry. We requested pediatric encounters from January 2007 to January 2016 within Iraq and Afghanistan. We separated casualties by sex to compare injury and mortality patterns. Results Our initial dataset included 3439 pediatric encounters—784 (22.8%) females and 2655 (77.2%) males. Females were less likely to sustain injuries by explosive (38.0% versus 44.5%) but more likely to sustain injuries via alternative mechanisms of injury (28.9% versus 21.5%). Both sexes had similar ISS (females median 10 [5-17], males 10 [4-17]). Fewer females underwent tourniquet application (4.2% versus 7.2%; all findings were significant). In unadjusted and adjusted regression analyses, females under age 8 had lower odds of survival to hospital discharge (OR 0.67, 95% CI 0.51-0.89) compared to males. Conclusions Among pediatric patients treated by U.S. medical personnel in Iraq and Afghanistan, females had a lower survival to hospital discharge despite similar severity of injury. Further studies are necessary to elucidate causes for this finding.

Lactation Consultation by an International Board Certified Lactation Consultant Improves Breastfeeding Rates for Mothers With Gestational Diabetes Mellitus

2021 ◽  
pp. 089033442110186
Author(s):  
Laurie Beth Griffin ◽  
Jia Jennifer Ding ◽  
Phinnara Has ◽  
Nina Ayala ◽  
Martha B. Kole-White
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Gestational Diabetes ◽  
Hospital Discharge ◽  
Exclusive Breastfeeding ◽  
Secondary Analysis ◽  
Feeding Preference ◽  
Lactation Consultant ◽  
Breastfeeding Rates

Background In patients with gestational diabetes, breastfeeding decreases the lifetime risk of Type 2 diabetes by half. Lactation consultation has been shown to increase breastfeeding rates in the general population but has not been assessed in a gestational diabetes population. Research Aims To determine if (1) a postpartum International Board Certified Lactation Consultant (IBCLC) consultation during delivery hospitalization improved inclusive (any) or exclusive breastfeeding rates at hospital discharge and 3 months postpartum in participants with GDM; and if (2) obstetrical providers’ acknowledgement of maternal feeding preference affected the rates of IBCLC consultation for patients. Methods This was a retrospective, comparative, secondary analysis of a prospective cohort ( N = 517) study of women gestational diabetes. Participants who received a IBCLC consultation ( n = 386; 74.5%) were compared to those who did not ( n = 131; 25.5%). Baseline demographics, antepartum characteristics, neonatal information, mode of infant feeding at hospital discharge and 3 months postpartum, and IBCLC consultation during postpartum hospitalization were measured. Results After adjusting for baseline differences, participants who received an IBCLC consultation were more likely to report any breastfeeding at postpartum discharge (aOR 4.87; 95% CI [2.67, 8.86]) and at 3 months postpartum (aOR 5.39; 95% CI [2.61, 11.16]) compared to participants who did not. However, there was no difference in exclusive breastfeeding rates between those who did and did not receive IBCLC consultation. Conclusion Inpatient IBCLC consultation during the immediate postpartum period was associated with improved rates of any breastfeeding in participants with GDM.

scholarly journals Factors Related to Breastfeeding Discontinuation Between Hospital Discharge and 2 Weeks Postpartum

2011 ◽  
Vol 20 (1) ◽  
pp. 36-44 ◽  
Author(s):  
Elizabeth Brand ◽  
Catherine Kothari ◽  
Mary Ann Stark
Keyword(s):  
Longitudinal Study ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Perceived Support ◽  
Breastfeeding Initiation ◽  
New Mothers ◽  
Early Discontinuation ◽  
Problem Solving Skills ◽  
Study Support ◽  
Duration Of Breastfeeding

Although breastfeeding is known to be beneficial to both mother and infant, many women encounter barriers to breastfeeding, even after successful breastfeeding initiation, which may put them at greater risk for early cessation of breastfeeding. The objectives of this study were to conduct a secondary analysis of data from a longitudinal study of postpartum depression to (a) examine factors related to very early discontinuation of breastfeeding (at 2 weeks postpartum) following hospital discharge and (b) identify women’s reasons for very early cessation of breastfeeding. The results of this study support findings from previous research. Having a perceived support system, whether it is personal or professional, may have an effect on both the initiation and duration of breastfeeding. Educating expectant and new mothers, especially women who encounter multiple barriers and are at risk for very early cessation of breastfeeding, of the benefits of breastfeeding and supporting them in developing efficient techniques and problem-solving skills can help increase the duration of breastfeeding.

scholarly journals Spatial Approach to Diseases of Affluence Epidemiology and Regional Economic Development

2016 ◽  
Vol 16 (2) ◽  
pp. 203-218
Author(s):  
Alicja Olejnik ◽  
Agata Żółtaszek
Keyword(s):  
Economic Development ◽  
Technological Development ◽  
Medical Personnel ◽  
Developed Countries ◽  
Mortality Rates ◽  
Economic Resources ◽  
The Other ◽  
Financial Resources ◽  
Highly Qualified ◽  
Spatial Approach

Abstract Diseases of affluence (of the 21st c.) by definition should have higher prevalence and/or mortality rates in richer and more developed countries than in poorer, underdeveloped states (where diseases of poverty are more common). Therefore, it has been indicated that it is civilizational progress that makes us sick. On the other hand, substantial financial resources, highly qualified medical personnel, and the cutting-edge technology of richer states, should allow for effective preventions, diagnostics, and treatment of diseases of poverty and of affluence. Therefore, a dilemma arises: is progress making us sick or curing us? To evaluate the influence of country socioeconomic and technological development on population health, a spatial analysis of the epidemiology of diseases of affluence and distribution of economic resources for European NUTS 2 has been performed. The main aim of this paper is to assess, how regional diversity in the prevalence of diseases of affluence is related to the regional development of regions.

scholarly journals Cross-cultural differences in the epidemiology of unexplained fatigue syndromes in primary care

2003 ◽  
Vol 182 (3) ◽  
pp. 205-209 ◽  
Author(s):  
Petros Skapinakis ◽  
Glyn Lewis ◽  
Venetsanos Mavreas
Keyword(s):  
Primary Care ◽  
Secondary Analysis ◽  
Composite International Diagnostic Interview ◽  
Developed Countries ◽  
Diagnostic Interview ◽  
World Health ◽  
Less Developed Countries ◽  
Cross Cultural Differences ◽  
International Data ◽  
Health Organization

BackgroundUnexplained fatigue has been extensively studied but most of the samples used were from Western countries.AimsTo present international data on the prevalence of unexplained fatigue and fatigue as a presenting complaint in primary care.MethodSecondary analysis of the World Health Organization study of psychological problems in general health care. A total of 5438 primary care attenders from 14 countries were assessed with the Composite International Diagnostic Interview.ResultsThe prevalence of unexplained fatigue of 1-month duration differed across centres, with a range between 2.26 (95% CI 1.17–4.33) and 15.05 (95% CI 10.85–20.49). Subjects from more-developed countries were more likely to report unexplained fatigue but less likely to present with fatigue to physicians compared with subjects from less developed countries.ConclusionsIn less-developed countries fatigue might be an indicator of unmet psychiatric need, but in more-developed countries it is probably a symbol of psychosocial distress.

scholarly journals Homelessness and integrated care: an application of integrated care knowledge to understanding services for wicked issues

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Michael Clark ◽  
Michelle Cornes ◽  
Martin Whiteford ◽  
Robert Aldridge ◽  
Elizabeth Biswell ◽  
...  
Keyword(s):  
Integrated Care ◽  
Hospital Discharge ◽  
Secondary Analysis ◽  
Policy Issue ◽  
Content Type ◽  
Complex Needs ◽  
Integration Of Services ◽  
Key Issues ◽  
Discharge From Hospital ◽  
High Degree

PurposePeople experiencing homelessness often have complex needs requiring a range of support. These may include health problems (physical illness, mental health and/or substance misuse) as well as social, financial and housing needs. Addressing these issues requires a high degree of coordination amongst services. It is, thus, an example of a wicked policy issue. The purpose of this paper is to examine the challenge of integrating care in this context using evidence from an evaluation of English hospital discharge services for people experiencing homelessness.Design/methodology/approachThe paper undertakes secondary analysis of qualitative data from a mixed methods evaluation of hospital discharge schemes and uses an established framework for understanding integrated care, the Rainbow Model of Integrated Care (RMIC), to help examine the complexities of integration in this area.FindingsSupporting people experiencing homelessness to have a good discharge from hospital was confirmed as a wicked policy issue. The RMIC provided a strong framework for exploring the concept of integration, demonstrating how intertwined the elements of the framework are and, hence, that solutions need to be holistically organised across the RMIC. Limitations to integration were also highlighted, such as shortages of suitable accommodation and the impacts of policies in aligned areas of the welfare state.Research limitations/implicationsThe data for this secondary analysis were not specifically focussed on integration which meant the themes in the RMIC could not be explored directly nor in as much depth. However, important issues raised in the data directly related to integration of support, and the RMIC emerged as a helpful organising framework for understanding integration in this wicked policy context.Practical implicationsIntegration is happening in services directly concerned with the discharge from hospital of people experiencing homelessness. Key challenges to this integration are reported in terms of the RMIC, which would be a helpful framework for planning better integrated care for this area of practice.Social implicationsAddressing homelessness not only requires careful planning of integration of services at specific pathway points, such as hospital discharge, but also integration across wider systems. A complex set of challenges are discussed to help with planning the better integration desired, and the RMIC was seen as a helpful framework for thinking about key issues and their interactions.Originality/valueThis paper examines an application of integrated care knowledge to a key complex, or wicked policy issue.

Abstract 12069: Long-Term Trends in the Incidence and Outcome of Refractory and Non-Refractory Ventricular Fibrillation Cardiac Arrest

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Ziad Nehme ◽  
Emily Andrew ◽  
Jocasta Ball ◽  
Karen L Smith
Keyword(s):  
Cardiac Arrest ◽  
Ventricular Fibrillation ◽  
Hospital Discharge ◽  
Temporal Trends ◽  
Developed Countries ◽  
Population Based ◽  
Logistic Regression Models ◽  
Shockable Rhythm ◽  
Adjusted Logistic Regression ◽  
Population Based Registry

Introduction: Although many developed countries are reporting temporal improvements in out-of-hospital cardiac arrest (OHCA) outcomes from initial shockable rhythms, trends in the incidence and outcome of refractory ventricular fibrillation are not well understood. Methods: Between 2010 and 2019, we performed a retrospective observational study of OHCA from a population-based registry in Victoria, Australia. We included all adult, non-traumatic OHCA with an initial shockable rhythm. Temporal trends in incidence and survival to hospital discharge were compared across non-refractory and refractory OHCA, defined as cases receiving 3 or more consecutive shocks for a persistent shockable rhythm. Risk-adjusted logistic regression models were used to describe the year-on-year change in the likelihood of refractory OHCA and survival to hospital discharge. Results: Of the 7,267 initial shockable OHCA with an attempted resuscitation, 4168 (57.4%) and 3,099 (42.6%) were non-refractory and refractory OHCA, respectively. The proportion of cases with refractory OHCA declined over the study period from 48.4% in 2010 to 40.2% in 2019 (p trend <0.001). Unadjusted survival to hospital discharge was higher in non-refractory OHCA (46.3% vs. 25.8%, p<0.001), although both populations experienced increases in survival over time (p trend <0.05 for both). After adjustment for arrest confounders, the likelihood of refractory VF decreased by 4.4% every year (adjusted odds ratio [AOR]: 0.96, 95% CI: 0.94, 0.97; p<0.001). Factors reducing the likelihood of refractory OHCA were female sex, bystander CPR, arrest witnessed by emergency medical services, and public location. In the survival model, refractory OHCA was independently associated with a reduction in survival to hospital discharge (AOR 0.50, 95% CI: 0.45, 0.56; p<0.001). Temporal improvements in survival were observed year-on-year (AOR 1.03, 95% CI: 1.02, 1.05; p<0.001) and this did not differ between non-refractory and refractory OHCA (group interaction, p = 0.51). Conclusions: The incidence of refractory OHCA is declining in our region and survival outcomes are improving. Further research identifying factors contributing to the decline in refractory OHCA may help to improve outcomes further.

PP39 What is the risk of major trauma following a fall down stairs? – A systematic review

2021 ◽  
Vol 38 (9) ◽  
pp. A16.2-A16
Author(s):  
Christopher Holt ◽  
Samuel Keating ◽  
Michael Tonkins ◽  
Daniel Bradbury ◽  
Gordon Fuller
Keyword(s):  
Systematic Review ◽  
Major Trauma ◽  
Alcohol Intoxication ◽  
Grey Literature ◽  
Developed Countries ◽  
Risk Of Bias ◽  
Qualitative Synthesis ◽  
Increased Risk ◽  
Study Heterogeneity ◽  
Serious Injury

BackgroundSpecific mechanisms of injury are stated in pre-hospital triage tools to identify suspected cases of major trauma. Falls down stairs are common presentations in UK emergency departments, yet are frequently overlooked as a causative mechanism of major trauma. No prior systematic review has examined this association.MethodsSeven internationally recognised literature databases and seven grey literature databases were screened utilising a common search strategy from inception until 31 December 2019. Abstracts were screened for relevance by a single reviewer. Full texts were screened and subsequently extracted by 3 separate reviewers against strict inclusion/exclusion criteria. A risk of bias assessment based on GRADE recommendations was performed. In the absence of study heterogeneity, a narrative synthesis was planned. The reporting of this systematic review followed PRISMA 2009 statement guidelines.Results5240 articles were identified from database searching, 89 articles had their full texts assessed for eligibility and 6 articles were included for qualitative synthesis. All studies were retrospective in nature and originated from more economically developed countries. 7431 patients who fell down stairs were analysed, of which, 707 (9.5%) met major trauma definitions. Falls down stairs resulted in a significantly increased risk of serious injury compared to other fall mechanisms (OR: 1.621, 95% CI: 1.381 – 1.902, p<0.0005). Analysis of confounding factors demonstrated age (OR: 2.59, 95% CI: 1.57 – 4.28, p<0.001) and alcohol intoxication (OR: 2.6, 95% CI: 1.4 – 4.7, p=0.001) to be significantly associated with major trauma. Risk of bias was moderate to high across all 6 studies.ConclusionThis systematic review highlighted the paucity of literature surrounding the incidence of major trauma following falls down stairs.A retrospective cohort study is currently being undertaken to analyse the risk of major trauma following falls down stairs. On completion, the results will be incorporated with the results of this systematic review.

Post-discharge decolonization of patients harboring methicillin-resistant Staphylococcus aureus (MRSA) USA300 strains: secondary analysis of the CLEAR Trial

2021 ◽  
pp. 1-4
Author(s):  
Gabrielle M. Gussin ◽  
Lauren Heim ◽  
Thomas Tjoa ◽  
James A. McKinnell ◽  
Loren G. Miller ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Secondary Analysis ◽  
Post Discharge ◽  
Methicillin Resistant ◽  
Usa300 Strain ◽  
Strain Type ◽  
Trial Participants

Abstract The CLEAR Trial recently found that decolonization reduced infections and hospitalizations in MRSA carriers in the year following hospital discharge. In this secondary analysis, we explored whether decolonization had a similar benefit in the subgroup of trial participants who harbored USA300, using two different definitions for the USA300 strain-type.

Unsupervised Children in Vehicles: A Risk for Pediatric Trauma

PEDIATRICS ◽  
1991 ◽  
Vol 87 (1) ◽  
pp. 70-73
Author(s):  
Phyllis Agran ◽  
Diane Winn ◽  
Dawn Castillo
Keyword(s):  
Monitoring System ◽  
Health Professionals ◽  
Preventive Measures ◽  
Motor Vehicle ◽  
Head Injuries ◽  
Pediatric Trauma ◽  
The Public ◽  
Police Statistics ◽  
Official Police

In this study, a series of instances of children injured by a motor vehicle set in motion by an unsupervised child are reviewed. During a 24-month period, nine such children were identified through a multihospital and coroner's office monitoring system in a single urban county. Injuries ranged from multiple abrasions and contusions to serious leg and head injuries. Three children died. The typical circumstance involved a child releasing the brake or placing the vehicle in gear in a private driveway which resulted in the vehicle striking or rolling over the victim. In four of the nine cases, the child who set the vehicle in motion fell or jumped from the vehicle and then became the injured victim. The extent of these unusual motor vehicle-related injuries is unknown because they are unlikely to be reported in official police statistics. According to the study findings, there is a need to educate the public and health professionals about the risks associated with leaving a child unattended in a motor vehicle and the hazardous environment of the private driveway. Preventive measures would include not leaving a child unattended in a vehicle, locking unattended vehicles to prevent access, and redesigning of private driveways.

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