Characteristics associated with delays in decision to transfer injured patients

Introduction The regionalized nature of trauma care necessitates interfacility transfer which is vulnerable to delays given its complexity. Little is known about the interval of time a patient spends at the sending hospital prior to when the transfer is initiated—the “decision to transfer” time. This primary objective of the study was to explore the impact of patient, environmental, and institutional characteristics on decision to transfer time. Methods This was a retrospective cohort study of injured adult patients who underwent emergent interfacility transfer by a provincial critical care transport organization over a 31-month period. Quantile regression was used to evaluate the impact of patient, environmental, and institutional characteristics on the time to decision to transfer. Results A total of 1128 patients were included. The median decision to transfer time was 2.42 h and the median total transport time was 3.12 h. The following variables were associated with an increase in time to decision to transfer at the 90th percentile of time: age >75 (+2.47 h), age 66–75 (+3.70 h), age 56–65 (+1.20 h), transfer between 00:00 and 07:59 (+2.08 h), and transfer in the summer (+2.25 h). The following variables were associated with a decrease in time to decision to transfer at the 90th percentile of time: Glasgow Coma Scale 3–8 (−2.21 h), respiratory rate >30 (−2.01 h), sending site being a community hospital with <100 beds (−4.11 h), or the sending site being a nursing station (−5.66 h). Conclusion Time to decision to transfer was a sizable proportion of the patients interfacility transfer. Older patients were associated with a delay in decision to transfer as were patients transferred overnight and in the summer. These findings may be used to support the implementation of geriatric trauma triage guidelines and promote ongoing education and quality improvement initiatives to decrease delay.

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Failure to Rescue in Geriatric Trauma: The Impact of Any Complication Increases with Age and Injury Severity in Elderly Trauma Patients

The American Surgeon ◽

10.1177/00031348211054072 ◽

2021 ◽

pp. 000313482110540

Author(s):

David P. Stonko ◽

Eric W. Etchill ◽

Katherine A. Giuliano ◽

Sandra R. DiBrito ◽

Daniel Eisenson ◽

...

Keyword(s):

Geriatric Patients ◽

Injury Severity ◽

Data Bank ◽

Geriatric Trauma ◽

Trauma Patients ◽

Failure To Rescue ◽

Elderly Trauma Patients ◽

Injured Patients ◽

The Impact ◽

Overall Mortality

Introduction The interaction of increasing age, Injury Severity Score (ISS), and complications is not well described in geriatric trauma patients. We hypothesized that failure to rescue rate from any complication worsens with age and injury severity. Methods The National Trauma Data Bank (NTDB) was queried for injured patients aged 65 years or older from January 1, 2013 through December 31, 2016. Demographics and injury characteristics were used to compare groups. Mortality rates were calculated across subgroups of age and ISS, and captured with heatmaps. Multivariable logistic regression was performed to identify independent predictors of mortality. Results 614,496 geriatric trauma patients were included; 151,880 (24.7%) experienced a complication. Those with complications tended to be older, female, non-white, have non-blunt mechanism, higher ISS, and hypotension on arrival. Overall mortality was highest (19%) in the oldest (≥86 years old) and most severely injured (ISS ≥ 25) patients, with constant age increasing across each ISS group was associated with a 157% increase in overall mortality ( P < .001, 95% CI: 148-167%). Holding ISS stable, increasing age group was associated with a 48% increase in overall mortality ( P < .001, 95% CI: 44-52%). After controlling for standard demographic variables at presentation, the existence of any complication was an independent predictor of overall mortality in geriatric patients (OR: 2.3; 95% CI: 2.2-2.4). Conclusions Any complication was an independent risk factor for mortality, and scaled with increasing age and ISS in geriatric patients. Differences in failure to rescue between populations may reflect critical differences in physiologic vulnerability that could represent targets for interventions.

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Simultaneous Casualty Admissions—Do they Affect Treatment in the Receiving Trauma Center?

World Journal of Surgery ◽

10.1007/s00268-021-06074-8 ◽

2021 ◽

Author(s):

Michel Paul Johan Teuben ◽

Carsten Mand ◽

Laura Moosdorf ◽

Kai Sprengel ◽

Alba Shehu ◽

...

Keyword(s):

Injury Severity ◽

Damage Control ◽

Ct Scanning ◽

Mortality Rates ◽

Trauma Centers ◽

Simultaneous Treatment ◽

Diagnostic Pathway ◽

Injured Patients ◽

The Impact ◽

Mean Time

Abstract Background Simultaneous trauma admissions expose medical professionals to increased workload. The impact of simultaneous trauma admissions on hospital allocation, therapy, and outcome is currently unclear. We hypothesized that multiple admission-scenarios impact the diagnostic pathway and outcome. Methods The TraumaRegister DGU® was utilized. Patients admitted between 2002–2015 with an ISS ≥ 9, treated with ATLS®- algorithms were included. Group ´IND´ included individual admissions, two individuals that were admitted within 60 min of each other were selected for group ´MULT´. Patients admitted within 10 min were considered as simultaneous (´SIM´) admissions. We compared patient and trauma characteristics, treatment, and outcomes between both groups. Results 132,382 admissions were included, and 4,462/3.4% MULTiple admissions were found. The SIM-group contained 1,686/1.3% patients. The overall median injury severity score was 17 and a mean age of 48 years was found. MULT patients were more frequently admitted to level-one trauma centers (68%) than individual trauma admissions were (58%, p < 0.001). Mean time to CT-scanning (24 vs. 26/28 min) was longer in MULT / SIM patients compared to individual admissions. No differences in utilization of damage control principles were seen. Moreover, mortality rates did not differ between the groups (13.1% in regular admissions and 11.4%/10,6% in MULT/SIM patients). Conclusion This study demonstrates that simultaneous treatment of injured patients is rare. Individuals treated in parallel with other patients were more often admitted to level-one trauma centers compared with individual patients. Although diagnostics take longer, treatment principles and mortality are equal in individual admissions and simultaneously admitted patients. More studies are required to optimize health care under these conditions.

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The impact of regionalized trauma care on the distribution of severely injured patients in the Netherlands

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01615-1 ◽

2021 ◽

Author(s):

Suzan Dijkink ◽

Erik W. van Zwet ◽

Pieta Krijnen ◽

Luke P. H. Leenen ◽

Frank W. Bloemers ◽

...

Keyword(s):

The Netherlands ◽

Trauma Care ◽

Trauma System ◽

Future Research ◽

Severely Injured ◽

Trauma Centers ◽

Severely Injured Patients ◽

The Right ◽

Injured Patients ◽

The Impact

Abstract Background Twenty years ago, an inclusive trauma system was implemented in the Netherlands. The goal of this study was to evaluate the impact of structured trauma care on the concentration of severely injured patients over time. Methods All severely injured patients (Injury Severity Score [ISS] ≥ 16) documented in the Dutch Trauma Registry (DTR) in the calendar period 2008–2018 were included for analysis. We compared severely injured patients, with and without severe neurotrauma, directly brought to trauma centers (TC) and non-trauma centers (NTC). The proportion of patients being directly transported to a trauma center was determined, as was the total Abbreviated Injury Score (AIS), and ISS. Results The documented number of severely injured patients increased from 2350 in 2008 to 4694 in 2018. During this period, on average, 70% of these patients were directly admitted to a TC (range 63–74%). Patients without severe neurotrauma had a lower chance of being brought to a TC compared to those with severe neurotrauma. Patients directly presented to a TC were more severely injured, reflected by a higher total AIS and ISS, than those directly transported to a NTC. Conclusion Since the introduction of a well-organized trauma system in the Netherlands, trauma care has become progressively centralized, with more severely injured patients being directly presented to a TC. However, still 30% of these patients is initially brought to a NTC. Future research should focus on improving pre-hospital triage to facilitate swift transfer of the right patient to the right hospital.

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Digital Addiction: Systematic Review of Computer Game Addiction Impact on Adolescent Physical Health

Electronics ◽

10.3390/electronics10090996 ◽

2021 ◽

Vol 10 (9) ◽

pp. 996

Author(s):

Norshakirah Aziz ◽

Md Jan Nordin ◽

Said Jadid Abdulkadir ◽

Muhammad Muhaimin M. Salih

Keyword(s):

Physical Health ◽

Computer Games ◽

Relevant Literature ◽

Primary Objective ◽

Extensive Literature ◽

Literature Study ◽

Computer Gaming ◽

Digital Addiction ◽

The Impact ◽

Malaysian Adolescents

The advancement of technology has enabled powerful microprocessors to render high-quality graphics for computer gaming. Despite being intended for leisure purposes, several components of the games alongside the gamer’s environmental factors have resulted in digital addiction (DA) towards computer games such as massively multiplayer online games (MMOG). Excessive gaming among adolescents has various negative impacts on an individual. However, only a few researchers have addressed the impact of DA on physical health. Thus, the primary objective of this research is to study the impact of DA on physical health among Malaysian adolescents. This study focuses on Malaysian adolescents of ages 12–18 years old who are addicted to computer games, specifically the MMOG. The methodology used for the study involves focus group discussions (FGD) and extensive literature study. The FGD sessions have involved both medical experts and game experts. The outcome of FGD discussion is recorded and justified with the existing relevant literature from high-impact journals, theses, conferences, books, and reports. This paper provides evidence of five physical health impacts of DA associated with adolescents. The factors of DA, the addiction components existing in MMOG computer games, and the DA health risk assessment are presented in the results section. Based on the study, it is concluded that DA among Malaysian adolescents can cause various impacts on physical health such as obesity, back pain, and neck pain, orthopaedic/joint muscle, eyesight problem, hearing problem, as well as physical inactivity.

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Shifting Landscapes: The Impact of Centralized and Decentralized Nursing Station Models on the Efficiency of Care

HERD Health Environments Research & Design Journal ◽

10.1177/1937586717698812 ◽

2017 ◽

Vol 10 (5) ◽

pp. 80-94 ◽

Cited By ~ 11

Author(s):

Lindsey Fay ◽

Allison Carll-White ◽

Aric Schadler ◽

Kathy B. Isaacs ◽

Kevin Real

Keyword(s):

Team Approach ◽

Culture Of Care ◽

Hospital Design ◽

Unit Design ◽

Quantitative Results ◽

Nursing Station ◽

Efficient Care ◽

The Impact ◽

Integrated Team ◽

Data Collection Approach

Objective: The focus of this research was to analyze the impact of decentralized and centralized hospital design layouts on the delivery of efficient care and the resultant level of caregiver satisfaction. Background: An interdisciplinary team conducted a multiphased pre- and postoccupancy evaluation of a cardiovascular service line in an academic hospital that moved from a centralized to decentralized model. This study examined the impact of walkability, room usage, allocation of time, and visibility to better understand efficiency in the care environment. Method: A mixed-methods data collection approach was utilized, which included pedometer measurements of staff walking distances, room usage data, time studies in patient rooms and nurses’ stations, visibility counts, and staff questionnaires yielding qualitative and quantitative results. Results: Overall, the data comparing the centralized and decentralized models yielded mixed results. This study’s centralized design was rated significantly higher in its ability to support teamwork and efficient patient care with decreased staff walking distances. The decentralized unit design was found to positively influence proximity to patients in a larger design footprint and contribute to increased visits to and time spent in patient rooms. Conclusion: Among the factors contributing to caregiver efficiency and satisfaction are nursing station design, an integrated team approach, and the overall physical layout of the space on walkability, allocation of caregiver time, and visibility. However, unit design alone does not solely impact efficiency, suggesting that designers must consider the broader implications of a culture of care and processes.

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The impact of frailty on failure-to-rescue in geriatric trauma patients

Journal of Trauma and Acute Care Surgery ◽

10.1097/ta.0000000000001250 ◽

2016 ◽

Vol 81 (6) ◽

pp. 1150-1155 ◽

Cited By ~ 38

Author(s):

Bellal Joseph ◽

Herb Phelan ◽

Ahmed Hassan ◽

Tahereh Orouji Jokar ◽

Terence O’Keeffe ◽

...

Keyword(s):

Geriatric Trauma ◽

Trauma Patients ◽

Failure To Rescue ◽

The Impact

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Abstract P301: Evaluating the Impact of a Pharmacist-Managed Hypertension Collaborative Care Model in Vascular Neurology Patients in an Inpatient Acute Care Setting

Stroke ◽

10.1161/str.52.suppl_1.p301 ◽

2021 ◽

Vol 52 (Suppl_1) ◽

Author(s):

Ann Smith ◽

Kathleen Bledsoe ◽

Thomas Madden ◽

Jamie Artale ◽

Ted Sindlinger

Keyword(s):

Blood Pressure ◽

Acute Care ◽

Care Setting ◽

Management Practice ◽

Primary Objective ◽

Adverse Outcomes ◽

Acute Care Setting ◽

Percentage Reduction ◽

Improvement Project ◽

The Impact

Introduction: The utility of pharmacist-managed collaborative practice agreements (CPA) in the management of hypertension is well established in the outpatient setting. There has been little evaluation of the use of CPAs in the inpatient acute care setting, and none described specifically in the vascular neurology population. Treatment of hypertension is a critical intervention for the secondary prevention of acute ischemic stroke. This quality improvement project evaluated the implementation of a CPA for the inpatient acute care management of hypertension in vascular neurology patients at University of Virginia Health. Methods: A CPA was developed between the neurosciences clinical pharmacist group and the inpatient vascular neurology service, legally vetted, and implemented in June 2019. All vascular neurology patient charts in which an electronic CPA referral was placed from June 2019 through June 2020 were reviewed. Patients were excluded if they were discharged within 24 hours of the referral being placed. The primary objective was to describe and evaluate the implementation of a pharmacist-driven hypertension management practice in the inpatient acute care setting. All patient demographic and clinical data were analyzed using descriptive statistics. Secondary safety outcomes included documented hypotensive events (SBP <90) and acute kidney injury (AKI, increase in SCr by 0.3 mg/dl within 48 hours). Results: During the study period, 26 referrals were placed, and 19 patients were included for review. On average, patients were on 2 anti-hypertensive medications prior to admission. From the time of referral to discharge (mean 6 days), systolic blood pressure (SBP) was reduced on average by 36 mmHg (mean percentage reduction 20%) and diastolic blood pressure (DBP) by 12 mmHg (mean percentage reduction 7%). Ten patients (53%) met the goal of SBP < 140 at discharge. There were 5 hypotensive events and 4 instances of AKI, all of which were mild and recovered prior to discharge. Conclusion: A pharmacist-managed hypertension CPA was successfully implemented in vascular neurology patients in the inpatient acute care setting. The practice demonstrated improved blood pressure control and minimal adverse outcomes.

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Sensitivity of the neutron multiplication factor to water ingress into a spent fuel cask

Kerntechnik ◽

10.1515/kern-2020-850107 ◽

2020 ◽

Vol 85 (1) ◽

pp. 38-53

Author(s):

M. J. Leotlela ◽

I. Petr ◽

A. Mathye

Keyword(s):

Gradual Increase ◽

Primary Objective ◽

Fuel Pellet ◽

Main Body ◽

Spent Fuel ◽

Reactivity Effect ◽

Water Ingress ◽

Accident Scenarios ◽

The Impact ◽

Gain Access

Abstract An essential component of safety analyses is the investigation of accident scenarios. In this paper water ingress scenarios of spent fuel containers, as they may occur during transport or storage, are examined. In the main body of this paper, a number of paths are studied through which water can gain access to the spent fuel cask and eventually reach the fuel pellet, potentially resulting in an increase in reactivity as a result of over-moderation. The primary objective of this project was to perform an assessment of what, in the unlikely event of a Fukushima- type accident, the impact would be on the reactivity of the cask by analyzing a gradual increase in water level in the spent fuel casks. In addition, the way the keff of the system responds to such an increase is discussed. The paper also provides the results of an assessment of the reactivity effect of water ingress via various pathways/channels.

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Quality of Life of Family Caregivers of Patients With Cancer in Korçe, Albania

Journal of Palliative Care ◽

10.1177/0825859718812432 ◽

2018 ◽

Vol 34 (2) ◽

pp. 118-125 ◽

Cited By ~ 1

Author(s):

Jonathon Judkins ◽

Irena Laska ◽

Judith Paice ◽

Priya Kumthekar

Keyword(s):

Quality Of Life ◽

Well Being ◽

Risk Groups ◽

The United States ◽

Primary Objective ◽

Care Clinic ◽

Demographic Groups ◽

Spiritual Well Being ◽

The Impact

Purpose: The primary objective of this study was to quantify cancer family caregiver (FCG) quality of life (QOL) in a Southern Albanian population and to determine whether differences exist between 4 domains of QOL (physical, psychological, social, and spiritual). This study also sought to compare QOL in our cohort to QOL in historical studies that used the same survey instrument, and to examine correlations between demographic characteristics and QOL to identify any high-risk groups. Methods: A sample of 40 FCGs was recruited at the Mary Potter Palliative Care Clinic in Korçe, Albania. Each participant completed the City of Hope Quality of Life (Family Version), a validated 37-question instrument that measures caregiver well-being in 4 domains: physical, psychological, social, and spiritual well-being. Results: There were no significant differences between the composite scores of the 4 QOL domains in our study. However, there were differences when comparing self-reported QOL between domains (“Rate your overall physical/psychological/social/spiritual well-being”). The QOL measured in our study was significantly lower than in 3 studies from the United States that used the same questionnaire. There were no significant correlations between demographic groups and QOL. Conclusions: This study examines the impact that the paucity of palliative services has on the QOL of Albanian cancer FCGs. Although there were no domains of QOL or demographic groups identified in our study that were faring significantly worse than others, the poor overall QOL provides further evidence to support the continued development of palliative services for both patients and family members in Albania.

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Evaluating the impact of type 2 diabetes mellitus on CYP450 metabolic activities: protocol for a case–control pharmacokinetic study

BMJ Open ◽

10.1136/bmjopen-2017-020922 ◽

2018 ◽

Vol 8 (2) ◽

pp. e020922 ◽

Cited By ~ 2

Author(s):

Sophie Gravel ◽

Jean-Louis Chiasson ◽

Suzanne Dallaire ◽

Jacques Turgeon ◽

Veronique Michaud

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Adult Population ◽

Study Groups ◽

Primary Objective ◽

Research Centre ◽

Probe Drug ◽

The Impact

IntroductionDiabetes affects more than 9% of the adult population worldwide. Patients with type 2 diabetes mellitus (T2DM) show variable responses to some drugs which may be due, in part, to variability in the functional activity of drug-metabolising enzymes including cytochromes P450 (CYP450s). CYP450 is a superfamily of enzymes responsible for xenobiotic metabolism. Knowledge must be gained on the impact of T2DM and related inflammatory processes on drug metabolism and its consequences on drug response. The aim of this study is to characterise the activity of CYP1A2, CYP2B6, CYP2C9, CYP2C19, CYP2D6, CYP2E1 and CYP3A4/5 in T2DM versus non-T2DM subjects following the administration of a cocktail of probe drug substrates.Methods and analysisThis single-centre clinical study proposes the first detailed characterisation of T2DM impacts on major CYP450 drug-metabolising enzyme activities. We intend to recruit 42 patients with controlled T2DM (A1C≤7%), 42 patients with uncontrolled T2DM (A1C>7%) and 42 non-diabetic control subjects. The primary objective is to determine and compare major CYP450 activities in patients with T2DM versus non-diabetic subjects by dosing in plasma and urine probe drug substrates and metabolites following the oral administration of a drug cocktail: caffeine (CYP1A2), bupropion (CYP2B6), tolbutamide (CYP2C9), omeprazole (CYP2C19), dextromethorphan (CYP2D6), chlorzoxazone (CYP2E1) and midazolam (CYP3A4/5). Secondary objectives will evaluate the influence of variables such as glycaemia, insulinaemia, genetic polymorphisms and inflammation. The value of an endogenous biomarker of CYP3A activity is also evaluated. The first patient was recruited in May 2015 and patients will be enrolled up to completion of study groups.Ethics and disseminationApproval was obtained from the ethic review board of the CHUM research centre (Montreal, Canada).Trial registration numberNCT02291666.

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