Search Results for: Riabilitazione dopo un trauma traumatico

Stroke, Ahead of Print. There is a large burden of stroke in the United States, and extensive systems of care have been established to address it. The resources devoted to stroke centers are analogous to those of trauma centers, both sharing many strict requirements for certification, clinical preparedness, quality improvement, data management, and reporting. However, trauma programs partly defray these costs through a trauma activation billing code, a billable fee that is charged for activation of the trauma team under strict criteria. There are potential benefits to establishing an analogous national stroke code activation fee. Although a billable stroke code activation fee may increase financial burden on patients, this may be counterbalanced by the significant potential for individual and societal benefits. Providing additional financial support for stroke systems of care may improve acute stroke treatment, reduce stroke burden and poststroke disability, and reduce inequality by broadening the reach of stroke systems of care to disadvantaged communities. Further evaluation of the costs and benefits of implementing a stroke code activation fee based on that currently used by trauma centers is needed.

Objective
To describe, through the phenomenological lens, the experiences of mothers following preterm birth and admitted at a tertiary hospital.

Methods

Design
Descriptive phenomenological study.

Setting
Neonatal intensive care unit (NICU) of a tertiary hospital in Ghana.

Population
Mothers who delivered prematurely and were admitted.

Main outcome measures
Experiences of mothers who delivered prematurely and had their neonates admitted to the NICU.

Results
Four themes and three subthemes were realised: (1) maternal anxiety about unknown outcomes of the newborn condition, (2) the positive impact of family-centred care, (3) maternal roles for preterm care and (4) poor support for maternal involvement in care.

Conclusions
Mothers of preterm newborns sustained varying degrees of emotional trauma and faced challenges that deprived them of active involvement in their newborn care. Despite these, family-centred care was impactful and gave a window of opportunity for mothers to provide maternal roles. We highly recommend tailored emotional and psychological supports for mothers who have delivered prematurely, as it is crucial to ensuring both maternal and neonatal survival.

Objective
This study planned to analyse the association between ondansetron use within 24 hours before intensive care unit (ICU) admission to within 48 hours after ICU admission and the risk of sepsis in ICU patients.

Design
A cohort study.

Setting and participants
Data of 65 366 participants in Medical Information Mart for Intensive Care IV from ICU in the Beth Israel Deaconess Medical Center.

Primary and secondary outcome measures
Sepsis was the primary outcome, which indicated patients with documented or suspected infection and acute change in total Sequential Organ Failure Assessment (SOFA) score ≥2 points. In-hospital mortality was the secondary outcome.

Results
There were 6737 patients with early ondansetron use. In total, 1646 patients suffered sepsis. According to the data from multivariate cox regression model, compared with participants without early ondansetron use, the risk of sepsis was reduced in participants with early ondansetron use relative to those without HR (HR=0.84, 95% CI: 0.76 to 0.93). The risk of in-hospital mortality was reduced in those with early ondansetron use (HR=0.63, 95% CI: 0.55 to 0.72). Subgroup analysis revealed that the association between early ondansetron use and decreased risk of sepsis was significant in participants aged

Objective
To map what is currently known about knowledge translation (KT) in Anglo-American paramedicine. The review focuses on reported barriers and facilitators to the implementation of new knowledge, and the use of models, theories and frameworks to guide implementation practice.

Design
Scoping review reported as per both the Joanna Briggs Institute and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guidelines.

Data sources
CINAHL (EBSCO Host) and Medline (OVID interface) were searched from January 2000 to May 2023. Reference lists of all included papers were reviewed, and several key professional journals were hand-searched.

Eligibility criteria for selecting studies
Primary sources that focused on KT models, theories or frameworks, or barriers and facilitators to KT implementation, involving paramedics or Emergency Medical Technicians (Paramedic in America) working in an out-of-hospital, Anglo-American Emergency Medical Service (EMS) system were eligible for inclusion.

Data extraction and synthesis
One reviewer used a data extraction template developed for this review and 10% of the papers were checked by the second author. Findings were summarised in tables and synthesised both quantitatively and qualitatively.

Results
The search yielded 1268 primary sources, of which 48 were included in the review. Thirty-two papers examining KT interventions and 16 papers examining the barriers and facilitators to KT were found. Only one randomised controlled trial was found, and only one paper made explicit use of any KT framework. Overall, eight themes describing barriers and facilitators to KT arose from the qualitative literature, with clinicians’ perception of the evidence being the dominant theme. All 32 papers describing KT interventions included some form of educational intervention.

Conclusions
Overall, there is little depth and breadth in the literature, with many papers focusing on trauma and airway management. There are large gaps in the evidence surrounding the use of KT theories and frameworks in Anglo-American EMS. Further research is needed to identify appropriate KT models and frameworks that are contextualised to EMS to ensure that paramedic-led research finds its way to the clinicians needing to use it.

Objective
This study aimed to assess the risk, incidence and predictors of venous thromboembolism (VTE) among patients admitted to the emergency department of tertiary hospitals in Addis Ababa city, Ethiopia.

Design
A multicentre hospital-based prospective follow-up study was conducted.

Setting
The study was conducted in three tertiary care hospitals in Addis Ababa city, Ethiopia: Tikur Anbesa Specialized Hospital, Addis Ababa Burn Emergency and Trauma Hospital and St. Paulos Hospital Millennium Medical College.

Participants
A total of 422 patients admitted to the adult emergency wards of the selected hospitals during the study period were included.

Main outcome measures
The study assessed the level of VTE risk, incidence and independent risk factors for VTE.

Results
Nearly half (51.7%) of the study participants were male, with a mean age of 49.36 (±17.12) years. Around one-third of patients (130, 30.8%) were unable to perform physical activity, and about two-thirds had comorbid illnesses. The most common admission diagnosis was trauma (23.7%), followed by infectious disease (19.2%). More than two-thirds (70.64%) of patients were at high risk of developing VTE according to the Padua Risk Prediction Score. Eighteen patients (4.3%) were diagnosed with VTE during their emergency stay. Multivariate Cox regression analysis revealed that patients who were physically active prior to admission (adjusted hazard ratio (AHR)=0.67, 95% CI 0.082 to 1.579, p=0.014) and those receiving pharmacological prophylaxis (AHR=0.167, 95% CI 0.037 to 0.768, p=0.021) were found to have a protective effect against the risk of developing VTE. Conversely, patients with acute infection (AHR=8.169, 95% CI 1.045 to 63.854, p=0.045) and active cancer (AHR=5.133, 95% CI 1.241 to 21.093, p=0.023) had a higher risk of VTE incidence.

Conclusion
The study found that the risk and incidence of VTE were high among patients in the emergency department. Absence of pharmacological prophylaxis, physical inactivity prior to admission, active cancer and acute infection were identified as independent predictors of VTE incidence during emergency ward stays.

Introduction
Patients undergoing surgical procedures are often prone to developing acute stress disorder (ASD) postoperatively. Presently, oxytocin nasal spray has shown significant potential in the treatment of stress-related neuropsychiatric diseases. However, there are few reports on the use of oxytocin nasal spray in postoperative ASD, a condition that can potentially develop into a high-risk factor for post-traumatic stress disorder. This study aims to investigate the effect of pretreatment with oxytocin nasal spray on postoperative ASD in patients with accidental trauma and fracture to provide new clinical insights for the prevention of postoperative ASD.

Methods and analysis
This study is a single-centre, double-blind, randomised controlled clinical trial. The trial aims to recruit 328 patients with accidental traumatic fractures who underwent surgical treatment. Participants will be randomly categorised into two groups: a control group (0.9% normal saline nasal spray, 1 mL) and an oxytocin group (oxytocin nasal spray, 1 mL/40 IU) at a ratio of 1:1 using the random number table method. The primary outcome is the incidence of ASD on postoperative days 1–3. Secondary outcomes include patient resilience, anxiety, depression and pain scores on postoperative days 1–3. The exploratory results include the concentrations of stress response indicators such as malondialdehyde, cortisol and superoxide dismutase in the saliva before the first intervention and on days 1–3 after surgery.

Ethics and dissemination
The trial was approved by the clinical research ethics committee of the General Hospital of the Western Theater Command (identifier: 2024EC3-ky014). The findings of this trial will be disseminated in a peer-reviewed journal and in national or international paediatric research to guide future practice.

Trial registration number
ChiCTR2400082612.

An attribute shared by poetry and medicine is their capacity for accommodating, and even embracing, sheer strangeness. Poetry, because of its frequent juxtapositions and metaphors, is often said to create an uncanny otherworldliness, as experienced in reading poets like Elizabeth Bishop and Wallace Stevens. Similarly, medicine, by constructing its own alternate reality of our familiar physical body via x-ray vision and acronymic medicalese, can also make us feel at once recognizable, and yet not, to ourselves. In “Test Results Are Inconclusive,” this parallel knowing-yet-not-knowing is enacted at the oddly satisfying, yet impossible intersection of these two fields of inquiry. First, the poem plays with the idea of validating knowledge, requiring us to “triple authenticate” ourselves with “cornea scan/fingerprint and second device,” strangely juxtaposing the human with the technological. The poem then questions repeatedly if any of the mysterious “results” we seek are true. Like poetry, medicine’s attempts to define us and our “private organs and generational/trauma” are as wobbly as the unexpected line break and equally unreliable, as when “ultrasound techs are not permitted/to inhale deeply, whistle, or show facial grimaces/as they move their wand in a widening oval,” which does and does not make sense. Ultimately, through its references to “viral/neon spirographs” and “beauty and abstract art in the digital/breast tomosynthesis,” we understand that our imagination, whether expressed in poetry or through medicine, is wondrous—if we truly understand anything at all.

Objectives
To evaluate the association between heart rate on admission and mortality in elderly patients with hip fractures.

Design
A retrospective cohort study.

Setting
At a trauma centre in northwestern China.

Participants
Elderly patients with hip fractures.

Results
This cohort study included 2006 patients who met the study criteria. The mean heart rate at admission was 81.77±15.63 beats per minute. During follow-up, 189 patients died for all-cause reasons in 1 year. Age, coronary heart disease, cancer, dementia and time to operation were introduced in multivariate regression analysis. Multivariate logistic regression showed that heart rate was associated with mortality in geriatric patients with hip fracture (OR=1.01, 95% CI 1.00 to 1.02, p=0.0242). However, the linear association was unstable, and we found a nonlinear one. In the nonlinear association, the inflection point was 84 beats per minute. If below this threshold, each 1 beat per minute increase in heart rate was associated with a 4% increase in the risk of death (OR=1.04, 95% CI 1.01 to 1.06, p=0.0017). If greater than this threshold, the risk of death peaked and was not associated with the heart rate (OR=1.00, 95% CI 0.98 to 1.01, p=0.6691).

Conclusion
In conclusion, the heart rate was nonlinearly associated with 1-year mortality in geriatric patients with hip fractures. The low heart rate on admission was associated with low 1-year mortality. When the heart rate was over 84 beats per minute, the risk of death peaked, and there was no association with heart rate anymore.

Trial registration number
This study was registered on the website of the Chinese Clinical Trial Registry (ChiCTR: ChiCTR2200057323).

Treating patients with trauma-related distress might turn out to be the preferred application for this drug.

Objective
This study aimed to assess gender-based violence and associated factors during the time of armed conflict among female high school students in Kobo administration town, North Wollo, Ethiopia.

Study design
An institutional-based, quantitative and cross-sectional study was conducted.

Setting
This research was carried out in Kobo town, North Wollo, Ethiopia high schools.

Study participants
This study was conducted among 422 female high school students in Kobo administration town at time of armed conflict from May 20 to 5 June 2022.

Outcome measures
Gender-based violence (GBV) was assessed using a self-administered questionnaire. Data were entered in Epidemiological data (EPI-Data) V.3.1 and exported to SPSS V.25 for analysis. A binary logistic regression model was used to identify significant factors associated with GBV.

Results
The magnitude of GBV among female high school students at Kobo town during armed conflict was 45%, with 95% CI 40.2% to 49.8%. Students with poor current academic performance (Adjusted Odds Ratio (AOR)=3.001; 95% CI 1.335 to 6.750), students with a family member who participated in conflict (AOR=1.809; 95% CI 1.135 to 2.882), students with a family member who was subjected to conflict (AOR=1.954; 95% CI 1.164 to 3.281), students who drank alcohol (AOR=8.158; 95% CI 4.325 to 15.386) and students who did not freely disclosing reproductive health issues (AOR=3.267; 95% CI 1.509 to 7.075) were more likely to suffer GBV.

Conclusions
The magnitude of GBV during the armed conflict was high. Variables such as poor academic performance, family members who participated in the war, family members subjected to the war, students who drank alcohol and not freely discussing reproductive health issues were statistically associated with GBV. It is recommended to put in place programmes that address factors such as academic challenges, alcohol use, family trauma and the need for open discussions on reproductive health to help to reduce GBV.

Introduction
Traumatic injuries are a significant public health concern globally, resulting in substantial mortality, hospitalisation and healthcare burden. Despite the establishment of specialised trauma centres, there remains considerable variability in trauma-care practices and outcomes, particularly in the initial phase of trauma resuscitation in the trauma bay. This stage is prone to preventable errors leading to adverse events (AEs) that can impact patient outcomes. Prior studies have identified common causes of these errors, including delayed diagnostics, disorganisation of staff, equipment issues and communication breakdowns, which collectively contribute to AEs. This study addresses gaps in understanding the root causes of these errors by evaluating the most frequent AEs in trauma care through real-time video reviews of resuscitations in the trauma bay. Insights from this evaluation will inform targeted interventions to improve procedural adherence, communication and overall team performance, ultimately reducing preventable errors and improving patient safety.

Methods and analysis
A prospective observational study will be conducted at St. Michael’s Hospital, a level-1 trauma centre, to evaluate resuscitations in the trauma bay. All consecutive trauma team activations over 12 months will be included, with data collected using audio-visual recordings and physiological monitoring. A synchronised data capture and analysis platform will comprehensively assess AEs, errors and human and environmental factors during trauma resuscitations. The study aims to detect recurring error patterns, evaluate practice variations and correlate trauma team performance with in-hospital outcomes. Statistical analyses will include descriptive statistics, logistic regression models and multivariable analyses to identify associations and predictors of AEs and patient outcomes.

Ethics and dissemination
Institutional research ethics approval was obtained (SMH REB # 21-009). A modified consent model will be employed for participants. Staff, physicians and learners will be provided with information regarding the study and will have the option to opt-out or withdraw consent. Similarly, trauma patients and their next of kin will be informed about the study, with provisions for opting out or withdrawing consent within 48 hours of recording. Measures will be implemented to ensure data confidentiality, anonymity and respect for participants’ autonomy and privacy. The study results will be shared through peer-reviewed journal publications and conference presentations, and key institutional stakeholders will be informed about developing strategies to improve patient safety in trauma care.

This genetic association study examined the associations between sexual trauma, polygenic liability to mental health outcomes, and clinical diagnoses of schizophrenia, bipolar disorder, and major depressive disorder in a clinical biobank setting.

A man in his early 50s presented to autoimmune dermatology clinic for 3 years of periarticular nodules on his fingers that were painful with manipulation or minor trauma and symmetric polyarthralgia. What is your diagnosis?

Introduction
Traumatic brain injury (TBI) is one of the leading causes of death and disability worldwide. Treatments for TBI patients are limited and none has been shown to provide prolonged and long-term neuroprotective or neurorestorative effects. A growing body of evidence suggests a link between TBI-induced neuro-inflammation and neurodegenerative post-traumatic disorders. Consequently, new therapies triggering immunomodulation and promoting neurological recovery are the subject of major research efforts. We hypothesise that repeated intravenous treatment with mesenchymal stromal cells derived from Wharton’s Jelly of the umbilical cord-derived mesenchymal stromal cells ((WJ-UC-MSC) may be associated with a significant decrease of post-TBI neuroinflammation and improvement of neurological status.

Methods and analysis
The TRAUMACELL trial is a prospective, national multicentre, phase III, superiority, double-arm comparative randomised (1:1) double-blinded clinical trial. Among patients aged between 18–50, with a severe TBI defined by a Glasgow score less than 12 (within the first 48 hours) with brain traumatic lesion on CT Scan and needing intracranial pressure monitoring, with no other significant organ trauma (abbreviated injury scale

Objectives
To develop and validate a simplified Bleeding Audit Triage Trauma (sBATT) score for use by lay persons, or in areas and environments where physiological monitoring equipment may be unavailable or inappropriate.

Design
The sBATT was derived from the original BATT, which included prehospital systolic blood pressure (SBP), heart rate, respiratory rate, Glasgow Coma Scale (GCS), age and trauma mechanism. Variables suitable for lay interpretation without monitoring equipment were included (age, level of consciousness, absence of radial pulse, tachycardia and trapped status). The sBATT was validated using data from the UK Trauma Audit Research Network (TARN) registry.

Setting
Data sourced from prehospital observations from multiple trauma systems in the UK.

Participants
70 027 motor vehicle collision (MVC) patients from the TARN registry (2012–2019). Participants included were those involved in MVCs, with exclusion criteria being incomplete data or non-trauma-related admissions.

Interventions
Not applicable.

Primary and secondary outcome measures
Death within 24 hours of MVC. Secondary: need for trauma intervention.

Results
In a cohort of 70 027 MVC patients, 1976 (3%) died within 24 hours. The sBATT showed an area under receiver operating characteristic curve of 0.90 (95% CI: 0.90 to 0.91) for predicting 24-hour mortality, surpassing other trauma scores such as the Shock Index and Assessment of Blood Consumption score. Sensitivity was 96% and specificity 72%, with a negative likelihood ratio below 0.1, indicating strong rule-out capability. Sensitivity analyses confirmed consistent performance across varying SBP and GCS thresholds. The sBATT was equally effective across sexes with no significant predictive discrepancies.

Conclusions
The sBATT is a novel, simplified tool that performs well at predicting early death in the TARN dataset. It demonstrates high predictive accuracy for 24-hour mortality and need for trauma intervention. Further research should validate sBATT in diverse populations and real-world scenarios to confirm its utility and applicability.

Objectives
To adapt and apply a model for evaluating the functional benefits and cost efficiency of specialist inpatient rehabilitation to the Australian context, comparing functional outcomes and savings in the cost of ongoing care after acquired brain injury.

Design
An observational cohort analysis of prospectively collected clinical data from admission to discharge, with follow-up to 3 years.

Setting
A newly established state-wide inpatient postacute rehabilitation unit in Victoria, Australia for patients with moderate to severe acquired brain injury.

Participants
This study included consecutive patients admitted to the programme during its first 2 years’ operation (January 2016 to December 2017). Inclusion criteria consisted of complete outcome measures recorded on admission and discharge, total n=196, mean age 44.6 years (range 17–78), males:females 72:28%, aetiology:trauma n=124 (63%), stroke n=42 (21%), diffuse n=18 (9%) and other-mixed n=12 (7%).

Interventions
Specialist inpatient multidisciplinary rehabilitation.

Outcome measures
Dependency and care costs: Northwick Park Dependency Scale/Care Needs Assessment (NPCNA); Functional independence: UK Functional Assessment Measure. Cost efficiency: (a) Time is taken to offset rehabilitation costs by savings in NPCNA-estimated costs of ongoing care and (b) net projected lifetime savings.

Results
Median length of stay 75 (IQR: 33.5–169.5) days, mean episode costs were $A147 044 (95% CI $A126 436, $A167 652). There was a significant reduction in dependency between admission and discharge on all measures (Holm-Bonferroni corrected p