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Pressure Methods For Primary Hemorrhage Control: A Randomized Crossover Trial., Nathan Phillip Charlton, Robert Solberg, Justin Rizer, Nici Singletary, William A. Woods 2018 University of Virginia and American Red Cross Scientific Advisory Council

Pressure Methods For Primary Hemorrhage Control: A Randomized Crossover Trial., Nathan Phillip Charlton, Robert Solberg, Justin Rizer, Nici Singletary, William A. Woods

International Journal of First Aid Education

Background: The importance of hemorrhage control in traumatic injury has been highlighted by the 2015 Stop the Bleed federal campaign in the United States and subsequent development of modular bleeding control courses offered by organizations such as the American Red Cross (https://www.dhs.gov/stopthebleed). However, the scientific evidence regarding the best methods and mechanisms of applying direct manual pressure to stop hemorrhage is lacking to inform first aid education skill development.

Hypothesis: The purpose of this tri-phase study is to evaluate the pressure generated when adding increasing layers of gauze dressings and to compare the force generated using ...


Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, R6, Trauma Team, Rehab Medicine, Neurosurgery, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks 2018 Maine Medical Center

Strategies To Increase Early Discharges To Decrease Hospital Length Of Stay And Avoidable Patient Days For Neuro-Spine Patients, Corey Fravert, R6, Trauma Team, Rehab Medicine, Neurosurgery, Joy Moody, Mark Parker, Suneela Nayak, Stephen Tyzik, Ruth Hanselman, Amy Sparks

Operational Excellence

STRATEGIES TO INCREASE MORNING DISCHARGES IN AN ACADEMIC TERTIARY HOSPITAL

Delays in patient discharge result in numerous negative impacts on the health care system. Amongst those are a reduced patient flow and satisfaction, long wait times, and physician/ staff frustration.

An inpatient neurotrauma unit initiated a performance improvement project that utilized a multidisciplinary approach to identify barriers to discharge and coordinate a discharge plan focused on neurospine patients.

A root cause analysis was conducted to collect reasons that these patients were not discharged by 11:00am. As a result of the findings, 4 performance improvement plans were created. Subsequent data ...


Linking Hostile/Helpless Maternal Representations In Pregnancy And Later Child Protection Involvement: A Pilot Study, Madeleine Terry 2018 The Graduate Center, City University of New York

Linking Hostile/Helpless Maternal Representations In Pregnancy And Later Child Protection Involvement: A Pilot Study, Madeleine Terry

All Dissertations, Theses, and Capstone Projects

The present pilot study examined whether there are reliable indices in the narratives of pregnant women that can be used to identify child abuse and neglect potential before the birth of the child. The Hostile/Helpless (HH) Classification system (Lyons-Ruth et al., 1995-2005), which detects mental states associated with trauma, disturbances in early attachment, and severe pathology, was adapted for use with the Pregnancy Interview (PI), a semi-structured clinical interview (Slade, 2003) that assesses a woman's emotional experience of pregnancy, and quality of her developing relationship with her baby. The study sample was drawn from a replication study of ...


A Retrospective Analysis Of Fall Patients And The Potential Contribution Of Opioids, Stephanie Adjei, Jake Muha, Jana Sanders, Annette Chard, Lisa Hollister, Deborah McMahan MD 2018 Parkview Health

A Retrospective Analysis Of Fall Patients And The Potential Contribution Of Opioids, Stephanie Adjei, Jake Muha, Jana Sanders, Annette Chard, Lisa Hollister, Deborah Mcmahan Md

MAHE Student Research

Background: The leading cause of death due to unintentional injuries amidst individuals 65 years and older is falls, and there is increasing evidence of an association between opioid use and falls in older adults. Objective: The aim of this study was to observe the rate at which patients admitted to trauma centers had opioids listed on their current medications list or present in their urine drug screen. Methods & Design: This study conducted a retrospective, descriptive, correlational study of 2,873 patients aged 15 years and older who were admitted to Allen County trauma centers as a result of a fall between 01/01/2017 and 04/30/2018. Data regarding if the patient had an opioid or benzodiazepine medication on their current medications list and if they were discharged with an opioid were gathered via chart review. The age groups were divided into two groups to observe differences between younger and older adults. Associations were evaluated via univariate and multivariate logistic regression tests. Odds ratios (ORs) were utilized to demonstrate the results with 90% confidence intervals (90% CI). Additional sub-analyses for length of stay (LOS), patient status at time of discharge, and injury severity score (ISS) were also performed. Results: Of all the patients who were admitted to a trauma center for a fall, 30.0% had an existing opioid prescription in their medical records. Of those that had a documented opioid prescription in their current medications list, 87.2% were in the older adult age group. Overall, older adults with an opioid prescription comprised 31.2% of the total fall population (Odds Ratio [OR]=0.71; 90% CI 0.59-0.86). Conclusion: This study demonstrates that the proportion of patients on opioid medications prior to their fall may have been underestimated, compared to the previous literature.


Beta-Testing Of An Interactive Multimedia Computer Program Of Exposure Therapy For Ptsd, Marie C. Barrett 2018 Western Michigan University

Beta-Testing Of An Interactive Multimedia Computer Program Of Exposure Therapy For Ptsd, Marie C. Barrett

Dissertations

Posttraumatic Stress Disorder (PTSD) results in significant impairment for the individual and substantial costs to society. Research indicates that cognitive behavioral psychotherapy (CBT) is the most effective treatment for PTSD and that among CBT treatments, exposure therapy is the treatment technique with the strongest evidence to recommend it for PTSD treatment. Computerized programs that deliver evidenced-based treatments offer a potential solution to barriers that prevent individuals from accessing and completing treatment. The present study evaluates the clinical and practical functionality of a computer-based program designed for the treatment of PTSD. Results indicate that completion of the program is associated with ...


Opioid Administration And Prescribing In Older Adults In U.S. Emergency Departments (2005-2015)., Erin M Marra, Maryann Mazer-Amirshahi, Peter Mullins, Jesse M Pines 2018 George Washington University

Opioid Administration And Prescribing In Older Adults In U.S. Emergency Departments (2005-2015)., Erin M Marra, Maryann Mazer-Amirshahi, Peter Mullins, Jesse M Pines

Emergency Medicine Faculty Publications

Introduction: We assess trends in opioid administration and prescribing from 2005-2015 in older adults in United States (U.S.) emergency departments (ED).

Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) survey from 2005 to 2015. ED visits for painful conditions were selected and stratified by age (18-64, 65-74, 75-84, ≥ 85 years). We analyzed trends in opioid administration in the ED and prescribing at discharge to encounters ≥ 65 and assessed predictors of use using survey-weighted chi-square tests and logistic regression. Trends in the use of five commonly prescribed opioids were also explored.

Results: Opioid administration in ...


When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber 2018 Valparaiso University

When Disaster Strikes: A Training Intervention To Improve Nurses' Confidence And Preparedness For The Surge, Nichole M. Weber

Evidence-Based Practice Project Reports

There has been an exponential rise in mass casualty incidents (MCI) internationally. These human induced and naturally occurring events have affected over 4.6 billion people, and are not discriminatory to region or community (World Health Organization, 2011). Governing bodies require training and education, but nurses continue to report suboptimal competence and self-reported readiness, and a need for standardized, evidence-based training remains. The purpose if this evidence-based practice project is to authenticate current research supporting implementation of competency-based education, to improve nurses’ self- perceived preparedness and confidence in their ability to respond to MCI. The project results can be utilized ...


Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio 2018 University of San Diego

Rapid Assessment Of Adults With Traumatic Brain Injuries, Pedro Colio

Doctor of Nursing Practice Final Manuscripts

The aim of this evidence-based project was to improve the medical screening process, enhance medical decision-making, and standardized the utilization of an adult traumatic brain injury neuroimaging guideline among advanced practice providers in a rural emergency department. Neuroimaging, specifically computed tomography (CT) scans, help to identify life-threatening intracranial injuries when clinically appropriate. The literature supports the utilization of neuroimaging guidelines, clinical exam, and provider expertise when identifying the need for a head CT scan. Although head CT scans are clinically useful, they increase healthcare costs and pose potential cancer risks from radiation exposure. Eight advanced practice providers (i.e., nurse ...


Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin 2018 Liberty University

Spinal Cord Trauma: An Overview Of Normal Structure And Function, Primary And Secondary Mechanisms Of Injury, And Emerging Treatment Modalities, Daniel Morin

Senior Honors Theses

The structures of the spinal cord and vertebral column are designed to provide flexibility, while still providing ample protection for the spinal cord deep within. While it does offer remarkable protection against most routine trauma, the spinal cord is still vulnerable to high-force etiologies of trauma and may become damaged as a result. These events are referred to as primary injury. Following the initial injury, the body’s own physiological responses cause a cascade of deleterious effects, known as secondary injury. Secondary injury is a major therapeutic target in mitigating the effects of spinal cord injury (SCI), and much research ...


Expressive Arts Group Therapy With Children And Adolescents Who Have Experienced Trauma, Shade Alfred 2018 Lesley University

Expressive Arts Group Therapy With Children And Adolescents Who Have Experienced Trauma, Shade Alfred

Expressive Therapies Capstone Theses

Experiencing traumatic situations is an inevitable part of life that many have struggled to understand and have difficulty working through its effects. This results in persons seeking therapy to better cope and heal from the impact of the traumatic experience. Children and adolescents who are considered vulnerable require more assistance to help them when they have encountered a traumatic experience. Research has highlighted that Expressive Arts Therapies is a favorable treatment option used with traumatized children and adolescents. Hence, this paper reflects research that has been conducted on group expressive arts therapy with children and adolescents who have experienced trauma ...


A Global Health Research Checklist For Clinicians., Rasha D Sawaya, Kristen A Breslin, Eiman Abdulrahman, Jennifer I Chapman, Dafina M Good, Lili Moran, Paul C Mullan, Oluwakemi Badaki-Makun 2018 George Washington University

A Global Health Research Checklist For Clinicians., Rasha D Sawaya, Kristen A Breslin, Eiman Abdulrahman, Jennifer I Chapman, Dafina M Good, Lili Moran, Paul C Mullan, Oluwakemi Badaki-Makun

Pediatrics Faculty Publications

Global health research has become a priority in most international medical projects. However, it is a difficult endeavor, especially for a busy clinician. Navigating the ethics, methods, and local partnerships is essential yet daunting.To date, there are no guidelines published to help clinicians initiate and complete successful global health research projects. This Global Health Research Checklist was developed to be used by clinicians or other health professionals for developing, implementing, and completing a successful research project in an international and often low-resource setting. It consists of five sections: Objective, Methodology, Institutional Review Board and Ethics, Culture and partnerships, and ...


Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, DNP, MS, ANP-BC 2018 George Washington University

Identification Of Risk Factors Associated With Falls In The Long Term Care Setting, Jacqueline L. Patel, Dnp, Ms, Anp-Bc

Doctor of Nursing Practice Projects

Background: Falls threaten the safety of older adults in long term care (LTC).

Objectives: To assess environmental, clinical and pharmacological causes of falls as well as compare Fall Risk Assessment Score, Brief Interview of Mental Status (BIMS) score, Activities of Daily Living (ADL) scores, age and gender of residents with one fall, recurrent falls, and no falls.

Methods: Using a descriptive-comparative design, we included a convenience sample of 290 adults ≥50 years old at our LTC facility. Fall and recurrent fall groups were matched to those with no falls. We assessed environmental, clinical and pharmacological variables, Fall Risk Assessment Scores ...


Jack Peirs, Third Ypres, And Control, Jonathan Tracey 2018 Gettysburg College

Jack Peirs, Third Ypres, And Control, Jonathan Tracey

Student Publications

During the First World War, British officers, primarily upper class, struggled to adapt to trauma within the boundaries of social expectations. Viewing the combat experience and letters of Jack Peirs during the battle of Passchendaele offers insight into how officers experienced the war, explained it to their families, and coped with trauma.


The Dynamics Of Concussion: Mapping Pathophysiology, Persistence, And Recovery With Causal-Loop Diagramming, Erin S. Kenzie, Elle L. Parks, Erin D. Bigler, David W, Wright, Miranda M. Lim, James C. Chesnutt, Gregory W.J. Hawryluk, Wayne Gordon, Wayne Wakeland 2018 Portland State University

The Dynamics Of Concussion: Mapping Pathophysiology, Persistence, And Recovery With Causal-Loop Diagramming, Erin S. Kenzie, Elle L. Parks, Erin D. Bigler, David W, Wright, Miranda M. Lim, James C. Chesnutt, Gregory W.J. Hawryluk, Wayne Gordon, Wayne Wakeland

Systems Science Faculty Publications and Presentations

Concussion, also known as mild traumatic brain injury (mTBI),1 is a significant public health issue responsible for a variety of cognitive, emotional, and somatic symptoms and deficits (3). It is unclear why some individuals appear to recover relatively quickly while others suffer prolonged symptoms and impairments (4–7). Robust clinical means of diagnosis, prognosis, and treatment are also lacking (8–11). Research is hindered by an inadequate classification system for traumatic brain injury (TBI) (12), “poor” study quality (13, 14), disagreement about appropriate inclusion and exclusion criteria for concussion (8, 15), and an incomplete understanding of underlying pathophysiology (16 ...


The Role Of Reactive Astrocitose In The Chronological Evolution Of Traumatic Brain Injury, Roxana M. Duncea-Borca, Vladimir Belis, Mihnea Costescu, Relu G. Calota, Reka Kutasi, Cosmin A. Moldovan 2018 Forensic Medicine of Teleorman County, Department of Forensic Medicine

The Role Of Reactive Astrocitose In The Chronological Evolution Of Traumatic Brain Injury, Roxana M. Duncea-Borca, Vladimir Belis, Mihnea Costescu, Relu G. Calota, Reka Kutasi, Cosmin A. Moldovan

Journal of Mind and Medical Sciences

Introduction and objectives. This study aims to investigate whether the cerebral modifications of posttraumatic reactive astrocitose can be considered an objective criterion for determining the age of traumatic cranio-cerebral lesions.

Materials and methods. The present study consists of a series of 23 medico-legal cases that underwent autopsy inTeleormanCounty(Romania) Department of Forensic Medicine during 2007–2016, with full immune-histochemical microscopic examination using GFAP staining. The study consists of two groups, a series of 13 cases with cranio-cerebral trauma with different posttraumatic survival periods and 9 cases as a control group.

Results and discussions. We discovered GFAP+ reactive astrocytes even when ...


Emergency Surgery On Mentally Impaired Patients: Standard In Consenting, Mihai Paduraru, Ahmed Saad, Krystian Pawelec 2018 Milton Keynes University Hospital NHS Foundation Trust, Emergency Surgery Department, Milton Keynes, UK

Emergency Surgery On Mentally Impaired Patients: Standard In Consenting, Mihai Paduraru, Ahmed Saad, Krystian Pawelec

Journal of Mind and Medical Sciences

Emergency surgery is often performed on the elderly and susceptible patients with significant comorbidities; as a consequence, the risk of death or severe complications are high. Consent for surgery is a fundamental part of medical practice, in line with legal obligations and ethical principles. Obtaining consent for emergency services (for surgical patients with chronic or acute mental incapacity, due to surgical pathology) is particularly challenging, and meeting the standards requires an up-to-date understanding of legislation, professional body guidelines, and ethical or cultural aspects. The guidance related to consent requires physicians and other medical staff to work with patients according to ...


Using Support Vector Machines On Photoplethysmographic Signals To Discriminate Between Hypovolemia And Euvolemia, Natasa Reljin, Gary Zimmer, Yelena Malyuta, Kirk Shelley, Yitzhak Mendelson, David J. Blehar, Chad E. Darling, Ki H. Chon 2018 University of Connecticut - Storrs

Using Support Vector Machines On Photoplethysmographic Signals To Discriminate Between Hypovolemia And Euvolemia, Natasa Reljin, Gary Zimmer, Yelena Malyuta, Kirk Shelley, Yitzhak Mendelson, David J. Blehar, Chad E. Darling, Ki H. Chon

Open Access Articles

Identifying trauma patients at risk of imminent hemorrhagic shock is a challenging task in intraoperative and battlefield settings given the variability of traditional vital signs, such as heart rate and blood pressure, and their inability to detect blood loss at an early stage. To this end, we acquired N = 58 photoplethysmographic (PPG) recordings from both trauma patients with suspected hemorrhage admitted to the hospital, and healthy volunteers subjected to blood withdrawal of 0.9 L. We propose four features to characterize each recording: goodness of fit (r2), the slope of the trend line, percentage change, and the absolute change between ...


Identifying Gaps And Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit., Fareen Zaver, Nicole Battaglioli, William Denq, Anne Messman, Arlene Chung, Michelle Lin, Emberlynn L Liu 2018 George Washington University

Identifying Gaps And Launching Resident Wellness Initiatives: The 2017 Resident Wellness Consensus Summit., Fareen Zaver, Nicole Battaglioli, William Denq, Anne Messman, Arlene Chung, Michelle Lin, Emberlynn L Liu

Emergency Medicine Faculty Publications

Introduction: Burnout, depression, and suicidality among residents of all specialties have become a critical focus for the medical education community, especially among learners in graduate medical education. In 2017 the Accreditation Council for Graduate Medical Education (ACGME) updated the Common Program Requirements to focus more on resident wellbeing. To address this issue, one working group from the 2017 Resident Wellness Consensus Summit (RWCS) focused on wellness program innovations and initiatives in emergency medicine (EM) residency programs.

Methods: Over a seven-month period leading up to the RWCS event, the Programmatic Initiatives workgroup convened virtually in the Wellness Think Tank, an online ...


Acute Vitreoretinal Trauma And Inflammation After Traumatic Brain Injury In Mice, Lucy P. Evans, Elizabeth A. Newell, MaryAnn Mahajan, Stephen H. Tsang, Polly J. Ferguson, Jolonda Mahoney, Christopher D. Hue, Edward W. Vogel, Barclay Morrison, Ottavio Arancio, Russell Nichols, Alexander G. Bassuk, Vinit B. Mahajan 2018 University of Iowa

Acute Vitreoretinal Trauma And Inflammation After Traumatic Brain Injury In Mice, Lucy P. Evans, Elizabeth A. Newell, Maryann Mahajan, Stephen H. Tsang, Polly J. Ferguson, Jolonda Mahoney, Christopher D. Hue, Edward W. Vogel, Barclay Morrison, Ottavio Arancio, Russell Nichols, Alexander G. Bassuk, Vinit B. Mahajan

Stead Family Department of Pediatrics Publications

Objective: Limited attention has been given to ocular injuries associated with traumatic brain injury (TBI). The retina is an extension of the central nervous system and evaluation of ocular damage may offer a less-invasive approach to gauge TBI severity and response to treatment. We aim to characterize acute changes in the mouse eye after exposure to two different models of TBI to assess the utility of eye damage as a surrogate to brain injury.

Methods: A model of blast TBI (bTBI) using a shock tube was compared to a lateral fluid percussion injury model (LFPI) using fluid pressure applied directly ...


The Principles And Practice Of Open Fracture Care, 2018, Amna Diwan, Kyle R. Eberlin, Raymond Malcolm Smith 2018 University of Massachusetts Medical School

The Principles And Practice Of Open Fracture Care, 2018, Amna Diwan, Kyle R. Eberlin, Raymond Malcolm Smith

Open Access Articles

The principles of open fracture management are to manage the overall injury and specifically prevent primary contamination becoming frank infection. The surgical management of these complex injuries includes debridement and lavage of the open wound with combined bony and soft tissue reconstruction. Good results depend on early high quality definitive surgery usually with early stable internal fixation and associated soft tissue repair. While all elements of the surgical principles are very important and depend on each other for overall success the most critical element appears to be achieving very early healthy soft tissue cover. As the injuries become more complex ...


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