Trauma Surgeons’ Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation

2021 ◽  
pp. 000313482110651
Author(s):  
Allan Peetz ◽  
Marie Kuzemchak ◽  
Catherine Hammack ◽  
Oscar D Guillamondegui ◽  
Bradley M, Dennis ◽  
...  
Keyword(s):  
Moral Agency ◽  
Organ Preservation ◽  
Resource Constraints ◽  
Clinical Information ◽  
Organ Donor ◽  
Structured Interviews ◽  
Standard Of Practice ◽  
Trauma Surgeons ◽  
Injured Patients ◽  
Pattern Variability

Background Trauma surgeons face a challenge when deciding whether to resuscitate lethally injured patients whose organ donor status is unknown. Data suggests practice pattern variability in this setting, but little is known about why. Materials and Methods We conducted semi-structured interviews with trauma surgeons practicing in Level 1 or 2 trauma centers in Tennessee. Interviews focused on ethical dilemmas and resource constraints. Analysis was performed using inductive thematic analysis. Results Response rate was 73% (11/15). Four key themes emerged. All described resuscitating patients to buy time to collect more definitive clinical information and to identify family. Some acknowledged this served the secondary purpose of organ preservation. 11/11 participants felt a primacy of obligation to the patient in front of them even after it became apparent, they could not personally benefit. For 9/11 (82%), the moral obligation to consider organ preservation was secondary/balancing; 2/11 (18%) felt it was irrelevant/immoral. Resource allocation was commonly considered. All participants expressed some limitation to resources they would allocate. All participants conveyed clear moral agency in determining resuscitation extent when the goal was to save the patient’s life, however this was less clear when resuscitating for organ preservation. Across themes, perceptions of a “standard practice” existed but the described practices were not consistent across interviewees. Discussion Widely ranging perceptions regarding ethical and resource considerations underlie practices resuscitating toward organ preservation. Common themes suggest a lack of consensus. Despite expressed beliefs, there is no identifiable standard of practice amongst trauma surgeons resuscitating in this setting.

scholarly journals The evolution of trauma care in the Netherlands over 20 years

2019 ◽  
Vol 46 (2) ◽  
pp. 329-335 ◽  
Author(s):  
Falco Hietbrink ◽  
Roderick M. Houwert ◽  
Karlijn J. P. van Wessem ◽  
Rogier K. J. Simmermacher ◽  
Geertje A. M. Govaert ◽  
...  
Keyword(s):  
The Netherlands ◽  
Trauma Care ◽  
Trauma System ◽  
Trauma Surgeon ◽  
Severely Injured ◽  
Severely Injured Patients ◽  
The Past ◽  
Level 1 ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract Introduction In 1999 an inclusive trauma system was initiated in the Netherlands and a nationwide trauma registry, including all admitted trauma patients to every hospital, was started. The Dutch trauma system is run by trauma surgeons who treat both the truncal (visceral) and extremity injuries (fractures). Materials and Methods In this comprehensive review based on previous published studies, data over the past 20 years from the central region of the Netherlands (Utrecht) was evaluated. Results It is demonstrated that the initiation of the trauma systems and the governance by the trauma surgeons led to a region-wide mortality reduction of 50% and a mortality reduction for the most severely injured of 75% in the level 1 trauma centre. Furthermore, major improvements were found in terms of efficiency, demonstrating the quality of the current system and its constructs such as the type of surgeon. Due to the major reduction in mortality over the past few years, the emphasis of trauma care evaluation shifts towards functional outcome of severely injured patients. For the upcoming years, centralisation of severely injured patients should also aim at the balance between skills in primary resuscitation and surgical stabilization versus longitudinal surgical involvement. Conclusion Further centralisation to a limited number of level 1 trauma centres in the Netherlands is necessary to consolidate experience and knowledge for the trauma surgeon. The future trauma surgeon, as specialist for injured patients, should be able to provide the vast majority of trauma care in this system. For the remaining part, intramural, regional and national collaboration is essential

scholarly journals Lived Experiences of Iranian Nurses Caring for Brain Death Organ Donor Patients: Caring as “Halo of Ambiguity and Doubt”

2015 ◽  
Vol 8 (7) ◽  
pp. 281 ◽  
Author(s):  
Zahra Keshtkaran ◽  
Farkhondeh Sharif ◽  
Elham Navab ◽  
Sakineh Gholamzadeh
Keyword(s):  
Brain Death ◽  
Thematic Analysis ◽  
Lived Experiences ◽  
Organ Donor ◽  
Organ Donors ◽  
Structured Interviews ◽  
Supportive Services ◽  
Care Giving ◽  
The Given ◽  
The Brain

<p><strong>BACKGROUND: </strong>Brain death is a concept in which its criteria have been expressed as documentations in Harvard Committee of Brain Death. The various perceptions of caregiver nurses for brain death patients may have effect on the chance of converting potential donors into actual organ donors.</p><p>Objective: The present study has been conducted in order to perceive the experiences of nurses in care-giving to the brain death of organ donor patients.</p><p><strong>METHODS:</strong> This qualitative study was carried out by means of Heidegger’s hermeneutic phenomenology. Eight nurses who have been working in ICU were interviewed. The semi-structured interviews were recorded bya tape-recorder and the given texts were transcribed and the analyses were done by Van-Mannen methodology and (thematic) analysis.</p><p><strong>RESULTS: </strong>One of the foremost themes extracted from this study included ‘Halo of ambiguity and doubt’ that comprised of two sub-themes of ‘having unreasonable hope’ and ‘Conservative acceptance of brain death’. The unreasonable hope included lack of trust (uncertainty) in diagnosis and verification of brain death, passing through denial wall, and avoidance from explicit and direct disclosure of brain death in patients’ family. In this investigation, the nurses were involved in a type of ambiguity and doubt in care-giving to the potentially brain death of organ donor patients, which were also evident in their interaction with patients’ family and for this reason, they did not definitely announce the brain death and so far they hoped for treatment of the given patient. Such confusion and hesitance both caused annoyance of nurses and strengthening the denial of patients’ family to be exposed to death.</p><p><strong>CONCLUSION:</strong> The results of this study reveal the fundamental perceived care-giving of brain death in organ donor patients and led to developing some strategies to improve care-giving and achievement in donation of the given organ and necessity for presentation of educational and supportive services for nurses might become more evident than ever.</p>

scholarly journals Maximising health literacy and client recall of clinical information: An exploratory study of clients and speech-language pathologists

2010 ◽  
Vol 57 (1) ◽  
Author(s):  
Friderike Schmidt Von Wûhlisch ◽  
Michelle Pascoe
Keyword(s):  
Health Literacy ◽  
Exploratory Study ◽  
Cleft Lip ◽  
Treatment Effectiveness ◽  
Clinical Information ◽  
High Tech ◽  
Structured Interviews ◽  
Speech Language Pathologists ◽  
Need To Evaluate ◽  
Language Pathology

Limited research has been carried out in the field of speech-language pathology with regard to ways of maximising health literacy and client recall. However, speech-language pathologists (SLPs) frequently provide vast amounts of information that clients need to understand, apply and review in order to manage their (or their child’s) health. This exploratory study aimed to contribute information about ways in which SLPs can overcome low health literacy and poor client recall so that treatment effectiveness is improved. A case-study design was used with specific focus on four clients receiving treatment for dysphagia, voice disorders (including laryngectomies) and cleft lip and/or palate management in Cape Town. Strategies which may be able to maximise health literacy and client recall of clinical information were trialled and evaluated by clients and their SLPs, using semi-structured interviews. The researchers proposed a combination of high-tech strategies which assisted in all the cases. No single solution or universal tool was found that would be appropriate for all. There is a need to evaluate the long-term effectiveness of the combined strategies across a wider population, at different stages of rehabilitation and in diverse contexts. Implications and suggestions for future related research are presented.

Co-infection with genital gonorrhoea and genital chlamydia in female sex workers in Yunnan, China

2006 ◽  
Vol 17 (5) ◽  
pp. 329-332 ◽  
Author(s):  
Xiang-Sheng Chen ◽  
Yue-Ping Yin ◽  
Guo-Jun Liang ◽  
Xiang-Dong Gong ◽  
Hua-Sheng Li ◽  
...  
Keyword(s):  
Sex Workers ◽  
Female Sex Workers ◽  
Vaginal Discharge ◽  
Transmitted Disease ◽  
Clinical Information ◽  
Gonococcal Infection ◽  
Structured Interviews ◽  
Sexually Transmitted ◽  
Female Sex ◽  
Control Programmes

An observational study on prevalence of co-infection with gonorrhoea and chlamydia was conducted among female sex workers (FSWs) in Kunming, China. A total of 505 FSWs participated in the study. All eligible participants gave informed consent. Demographic, behavioural and clinical information of the participants was gathered by direct structured interviews. Tampon swabs were collected to test for Chlamydia trachomatis and Nesseria gonorrhoeae. One-hundred and twenty-four (24.6%) FSWs were co-infected with these two pathogens. Of the 191 FSWs with gonorrhea, 124 (64.9%, 95% confidence interval [CI] = 57.9–71.3%) were co-infected with chlamydia which was significantly higher than the proportion (41.9%, 95% CI = 36.4–47.6%) co-infected with gonorrhoea among 296 FSWs with chlamydia ( P < 0.001). Only 47 of 191 (24.6%) FSWs with gonococcal infection and 28 of 124 (22.6%) with co-infection with gonorrhoea and chlamydia reported vaginal discharge. The results of the study justify the recommendation in the national sexually transmitted disease (STD) guidelines that patients infected with gonorrhoea also be treated routinely with an anti-chlamydial regimen. However, a periodic mass treatment may be considered in some circumstances in STD control programmes to rapidly reduce the infections in this population.

scholarly journals Experiences of GP trainees in undertaking telephone consultations: a mixed-methods study

BJGP Open ◽  
2020 ◽  
Vol 4 (1) ◽  
pp. bjgpopen20X101008 ◽  
Author(s):  
Umar Chaudhry ◽  
Judith Ibison ◽  
Tess Harris ◽  
Imran Rafi ◽  
Miles Johnston ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Clinical Information ◽  
Mixed Methods Study ◽  
Strong Positive Correlation ◽  
Structured Interviews ◽  
Cross Sectional ◽  
Electronic Survey ◽  
Positive Experiences ◽  
Positive Correlations ◽  
Observation Tools

BackgroundPrimary care telephone consultations are increasingly used for patient triage, reviews, and providing clinical information. They are also a key postgraduate training component yet little is known about GP trainees’ preparation for, or experiences and perceptions of, them.AimTo understand the experiences, perceptions, and training of GP trainees in conducting telephone consultations.Design & settingA mixed-methods study was undertaken of North Central and East London (NCEL) GP trainees.MethodA cross-sectional electronic survey of trainees was performed with subsequent semi-structured interviews. Survey data were analysed using descriptive statistics, and qualitative data using thematic analysis.ResultsThe survey response was 16% (n = 100/618), and 10 participated in semi-structured interviews. Trainees felt least confident with complicated telephone consulting, and there was a strong positive correlation between the percentage reporting having received training and their confidence (R2 = 0.71, P<0.0001). Positive experiences included managing workload and convenience. Negative experiences included complex encounters, communication barriers, and absence of examination. Trainees reported that training for telephone consultations needed strengthening, and that recently introduced audio-clinical observation tools (COTs) were useful. Positive correlations were found between the length of out-of-hours (OOH) but not in-hours training and the level of supervision or feedback received for telephone consultations.ConclusionThis project sheds light on GP trainees’ current experiences of telephone consultations and the need to enhance future training. The findings will inform a wider debate among stakeholders and postgraduate learners regarding training for telephone consultations, and potentially for other remote technologies.

scholarly journals Providing telecare for older adults: understanding the care navigators’ experience

2018 ◽  
Vol 19 (1) ◽  
pp. 31-41 ◽  
Author(s):  
Madeline Naick
Keyword(s):  
Older Adults ◽  
Knowledge Exchange ◽  
Structure Interview ◽  
Small Sample ◽  
Structured Interviews ◽  
Content Type ◽  
Experience Of Care ◽  
Framework Approach ◽  
Standard Of Practice ◽  
Hospital Teams

Purpose The provision of telecare for older adults in England is increasingly being facilitated by care navigators in the non-statutory sector. The purpose of this paper is to explore the experiences of care navigators when assessing older adults for telecare and to understand what contextual and organisational factors impact on their practice. Design/methodology/approach A purposeful sample of care navigators and telecare installers was selected. Care navigators were recruited from five non-statutory organisations. In order to provide an insight into telecare provision by this sector, telecare installers were also recruited. Semi-structured interviews were conducted with 11 participants covering: role, training, assessment, reviews, installation, suitability, impact, aims, outcomes, and organisational structure. Interview data were analysed using the framework approach. Findings Five main themes emerged from the analysis: responsiveness, autonomy, knowledge exchange, evolving practice, and sustaining performance. Research limitations/implications This study included a small sample, and was only based in one local authority, focusing on the experience of care navigators in only one sector. Practical implications The findings suggest that strategic placement of care navigators could support the demand for telecare assessment to facilitate discharges from hospital. This study highlights the perception of home assessment as a gold standard of practice for care navigators. In order to develop a more sustainable model for care navigators’ capacity to work within hospital teams and provide home assessments needs further consideration. Originality/value This study is one of the first to explore the role of the care navigator and their involvement in the provision of telecare for older adults.

Implementing an Emergency Department Information System

2014 ◽  
Vol 6 (1) ◽  
pp. 17-30
Author(s):  
Paraskevas Vezyridis ◽  
Stephen Timmons
Keyword(s):  
Emergency Department ◽  
Information System ◽  
Information And Communication Technologies ◽  
Clinical Information System ◽  
Clinical Information ◽  
Actor Network Theory ◽  
Linear Process ◽  
University Hospitals ◽  
Structured Interviews ◽  
Healthcare Settings

Information and communication technologies (ICT) are increasingly used in healthcare settings. Despite their technical robustness, their implementation has not always been straightforward. This is a case study of the implementation of a clinical information system for patient registration and tracking in the busy emergency department (ED) of a large English NHS University Hospitals Trust. By adopting an Actor-Network Theory (ANT) approach, the authors explore the complex intertwining of people and machines in the local setting as they negotiate the success of the project. Based on the analysis of 30 semi-structured interviews with clinical and administrative staff and, of relevant policy and project documentation, the authors demonstrate how the technologically-mediated transformation of healthcare practices is not a fixed and linear process, but the interplay of various fluctuating, performative and co-constitutive technical and social factors.

scholarly journals Mellkasi sérültek drenázsadatainak vizsgálata

2019 ◽  
Vol 160 (5) ◽  
pp. 172-178
Author(s):  
Ákos Csonka ◽  
Dávid Dózsai ◽  
Tamás Ecseri ◽  
István Gárgyán ◽  
István Csonka ◽  
...  
Keyword(s):  
Average Duration ◽  
Middle Section ◽  
Lower Section ◽  
Chest Drainage ◽  
X Ray ◽  
Chest Injuries ◽  
Method Clinical Data ◽  
Significant Difference ◽  
Trauma Surgeons ◽  
Injured Patients

Abstract: Introduction: Chest injuries cause a significant number of pneumothorax (PTX) and hemothorax (HTX). The most commonly used treatment is chest-tube drainage. The position of the tube is a prime necessity to achieve adequate drainage. Aim: To analyze the duration of chest drainage at the occurrence of PTX and HTX. To find what the underlying cause of drainage insufficiency is and whether there is any relation between the surgical qualification needed to the procedure. Method: Clinical data of 110 injured patients from 2011 to 2015 were collected and retrospectively analyzed. In the case of tube breaking or drainage insufficiency it was investigated if repositioning, usage of new tubes or insertion of additional tubes resolved the drainage insufficiency. Authors investigated the location of the tube on x-ray and CT, and the connection between the drainage insufficiency and the surgical qualifications needed to the procedure. Results: The average duration of chest drainage was 6.5 days. The duration of drainage was shorter by 1.9 days regarding the tube inserted in the middle section of the chest compared to the upper one and shorter by 1.2 days regarding the tube inserted in the lower section of the chest compared to the upper one. In the case of HTX, the duration of drainage was shorter by 2.8 days regarding the lower and by 3.6 days regarding the middle section compared to the upper position. Drainage insufficiency occurred in 30% of all cases. The duration of chest drainage was shorter after application of new tubes (9.5 days) than after reposition (10.2 days), but there was no significant difference. Conclusion: Chest injury is a wide entity, thus one standard protocol cannot be developed on the management of these injuries. Authors concluded that drainage duration decreases significantly if the position of the tube is in the middle or lower section of the chest. The high occurrence of drainage insufficiency was caused by inadequate tube positioning and tube breaking. The practical qualification of trauma surgeons did not play a significant role regarding the prevalence of drainage insufficiency rather if the tube positioning was appropriate. Orv Hetil. 2019; 160(5): 172–178.

The Presence of In-House Attending Trauma Surgeons Does Not Improve Management or Outcome of Critically Injured Patients

2003 ◽  
Vol 55 (1) ◽  
pp. 20-25 ◽  
Author(s):  
Thomas S. Helling ◽  
Paul W. Nelson ◽  
John W. Shook ◽  
Kathy Lainhart ◽  
Denise Kintigh
Keyword(s):  
Trauma Surgeons ◽  
Injured Patients

scholarly journals Combating Antimicrobial Resistance in Singapore: A Qualitative Study Exploring the Policy Context, Challenges, Facilitators, and Proposed Strategies

Antibiotics ◽  
2019 ◽  
Vol 8 (4) ◽  
pp. 201 ◽  
Author(s):  
Shweta Rajkumar Singh ◽  
Alvin Qijia Chua ◽  
Sok Teng Tan ◽  
Clarence C. Tam ◽  
Li Yang Hsu ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Resource Constraints ◽  
Public Awareness ◽  
Public Hospitals ◽  
Global Public Health ◽  
Structured Interviews ◽  
Control Programs ◽  
Policy Context ◽  
National Environment ◽  
Interpretative Approach

Antimicrobial resistance (AMR) is a global public health threat that warrants urgent attention. However, the multifaceted nature of AMR often complicates the development and implementation of comprehensive policies. In this study, we describe the policy context and explore experts’ perspectives on the challenges, facilitators, and strategies for combating AMR in Singapore. We conducted semi-structured interviews with 21 participants. Interviews were transcribed verbatim and were analyzed thematically, adopting an interpretative approach. Participants reported that the Ministry of Health (MOH) has effectively funded AMR control programs and research in all public hospitals. In addition, a preexisting One Health platform, among MOH, Agri-Food & Veterinary Authority (restructured to form the Singapore Food Agency and the Animal & Veterinary Service under NParks in April 2019), National Environment Agency, and Singapore’s National Water Agency, was perceived to have facilitated the coordination and formulation of Singapore’s AMR strategies. Nonetheless, participants highlighted that the success of AMR strategies is compounded by various challenges such as surveillance in private clinics, resource constraints at community-level health facilities, sub-optimal public awareness, patchy regulation on antimicrobial use in animals, and environmental contamination. This study shows that the process of planning and executing AMR policies is complicated even in a well-resourced country such as Singapore. It has also highlighted the increasing need to address the social, political, cultural, and behavioral aspects influencing AMR. Ultimately, it will be difficult to design policy interventions that cater for the needs of individuals, families, and the community, unless we understand how all these aspects interact and shape the AMR response.

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