Trauma Commons^™

Bomb Blast Injuries: An Exploration Of Patient Characteristics And Outcome Using Pakistan National Emergency Departments Surveillance (Pak-Neds) Data., Irum Qamar Khan, Nadeem Ullah Khan, Rubaba Naeem, Salima Kerai, Kate Allen, Nukhba Zia, Sana Shahbaz, Shiraz Qayoom Afridi, Emaduddin Siddiqui, Uzma Rahim Khan, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

BACKGROUND:

Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries.

METHODS:

Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital's emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated.

RESULTS: …

Critical Time Intervention For People Leaving Shelters In The Netherlands: Assessing Fidelity And Exploring Facilitators And Barriers, Renee De Vet, Danielle A. M. Lako, Marielle D. Beijersbergen, Linda Van Den Dries, Sarah Conover, Albert M. Van Hemert, Daniel Herman, Judith R. L. M. Wolf

Publications and Research

International dissemination of evidence-based interventions calls for rigorous evaluation. As part of an evaluation of critical time intervention (CTI) for homeless people and abused women leaving Dutch shelters, this study assessed fidelity in two service delivery systems and explored factors influencing model adherence. Data collection entailed chart review (n = 70) and two focus groups with CTI workers (n = 11). The intervention obtained an overall score of three out of five (fairly implemented) for compliance fidelity and chart quality combined. Fidelity did not differ significantly between service systems, supporting its suitability for a range of populations. The eight themes …

Differences In Risk-Adjusted Outcome Of Road Traffic Injuries In Urban Tertiary Care Centers Of Pakistan, Amber Mehmood, Junaid Abdul Razzak, Mohammed Umer Mir, Rashid Jooma

Department of Emergency Medicine

Objective: To assess the differences in road injury survival in three tertiary care hospitals in an urban setting.
Methods: The study was conducted in and comprised all road traffic injury victims presenting to the three state-run tertiary care centres in Karachi from September 2006 to October 2009. Patients' age, gender, mode, and delay in arrival, severity of injury were noted. Data was stratified by hospital of presentation. A logistic regression model was developed and probability of survival was assessed after adjusting for various risk factors, including patient characteristics and injury severity.
Results: There were 93,657victims in the study, but complete …

Soldiers Returning From Deployment: A Qualitative Study Regarding Exposure, Coping, And Reintegration, Lisa A. Brenner, Lisa M. Betthauser, Nazanin Bahraini, Jaimie L. Lusk, Heidi Terrio, Ann I. Scher, Karen A. Schwab

Graduate School of Professional Psychology: Student Scholarship

Purpose/Objective: The purpose of this study was to qualitatively explore exposure to deployment-related physical and/or emotional trauma and associated symptoms among Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) soldiers. Interviews also focused on in-theater- and reintegration-related experiences. Research Method/Design: OEF/OIF soldiers (N = 103) participated in semistructured interviews, and a qualitative descriptive methodology was used to analyze the data. Results: Themes were identified regarding (a) common experiences related to emotional and physical traumas and associated symptoms and strategies for coping and making meaning of experiences and (b) how combat and reintegration experiences affected soldiers’ senses of self, relationships with others, …

Epidermal Growth Factor Mediated Healing In Stem Cell-Derived Vocal Fold Mucosa, Liliana Palencia, Amritava Das, Sean P. Palecek, Susan L. Thibeault, Ciara Leydon

Communication Disorders Faculty Publications

Background: The goal of vocal fold wound healing is the reconstitution of functional tissue, including a structurally and functionally intact epithelium. Mechanisms underlying reepithelialization in vocal folds are not known, although it is suspected that healing involves the interplay between several growth factors. We used a three-dimensional human embryonic stem cell-derived model of vocal fold mucosa to examine the effects of one growth factor, exogenous epidermal growth factor (EGF), on wound healing. Materials and methods: A scratch wound was created in the in vitro model. Rate of wound healing, epidermal growth factor receptor (EGFR) activation, and cell proliferation after injury …

Advanced Practice Nurses Knowledge And Use Of Fall Prevention Guidelines, Katherine Hays

Doctor of Nursing Practice Scholarly Projects

Falls are a significant public health issue resulting in a significant economic and social burden on society. Specific strategies are available that can reduce the risk of falling for older adults age 65 and older; however, providers have failed to integrate these guidelines into clinical practice (Rubenstein, Solomon & Roth, 2004; Chou, Tinetti, King, Irwin, & Fortinsky, 2006; Jones, Ghosh, Horn, Smith, & Vogt, 2011). The CDC has published the STEADI toolkit, a healthcare resource for integrating fall prevention guidelines into clinical practice; but little information is available on the knowledge and use of the STEADI toolkit by Advance Practice …

Using Screening And Assessment Evidence Of Trauma In Child Welfare Cases, Frank E. Vandervort

Articles

If you are a child welfare lawyer representing children, parents, or the child welfare agency, understanding how traumatic experiences may impact your clients will help you frame your advocacy. Understanding children and their parents’ histories of exposure to potentially traumatic life events and how those events have impacted the client’s functioning—in school, in interactions with other people, and as parents—can be critical to framing your approach in the case. Evidence of the client’s trauma history and any compromised functioning that may have resulted from that trauma is critical to integrate into your advocacy.

Association Of Insurance Status With Health Outcomes Following Traumatic Injury: Statewide Multicenter Analysis, Vatsal Chikani, Maureen Brophy, Anne Vossbrink, Khaleel Hussaini, Christopher Salvino, Jeffrey Skubic, Rogelio Martinez

School of Medicine Publications

Introduction: Recognizing disparities in definitive care for traumatic injuries created by insurance status may help reduce the higher risk of trauma-related mortality in this population. Our objective was to understand the relationship between patients' insurance status and trauma outcomes.

Methods: We collected data on all patients involved in traumatic injury from eight Level I and 15 Level IV trauma centers, and four non-designated hospitals through Arizona State Trauma Registry between January 1, 2008 and December 31, 2011. Of 109,497 records queried, we excluded 29,062 (26.5%) due to missing data on primary payer, sex, race, zip code of residence, injury severity …

Utilization Of An Electronic Best Practice Advisory Decreases Brain Computed Tomography In An Academic Emergency Department Setting, Donald Szlosek

Thinking Matters Symposium Archive

More than 1.3 million people seek emergency care following a mild traumatic brain injury (MTBI) each year. While most MTBI patients are safely discharged, a small proportion experience serious intracranial processes. The wide availability of computed tomography (CT) has generated a dramatic increase in the number of CTs performed to identify those patients with clinically important traumatic brain injury (ciTBI), generating expense and radiation exposure risks for patients. To address unwarranted variation in practice, we implemented an electronic best practice advisory (eBPA) based upon a validated clinical prediction rule that appears when emergency department (ED) clinicians order CT following MTBI.

Tell Me A Story: The Relationship Between Identity And Life Stories Following Brain Injury, Sara Henson

Theses, Dissertations and Capstones

Following brain injury, people can demonstrate cognitive-linguistic deficits as well as a shift in their identities. Clinicians use assessment and treatment methods that focus on cognitive-linguistic deficits with this population; however, they rarely (if ever) consider identity as a viable and necessary target for intervention efforts. For individuals with brain injury, life narratives can be used to assess and treat the cognitive-linguistic skills and discourse at a macro-systemic level, build relationships through the use of a client-centered approach, develop a strong sense of self-identity that aids in goal setting, establish life purpose that motivates greater participation and effort in rehabilitation, …

Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazm, Syed Shahid Ali, Rashid Jooma, Zeeshan Akhtar

Section of Neurosurgery

Increase in road Traffic Accidents is a global phenomenon and Pakistan is no exception. In Karachi, this problem becomes severe due to rapid growth of population. This menace is ruining the lives of thousands of people and making Karachi a worrisome place to live. Recent road geometrical transitions in the city with insufficient accessories have been reducing the problem of traffic congestion to a limited extent. On the contrary, this has erupted as a problem of Road Traffic Accidents which is reaching out of proportions. Recently, induction of a unique feature named, Signal Free Corridor in Karachi has cost many …

Exploration Of Factors Associated With Patient Adherence In Upper Extremity Rehabilitation: A Mixed-Methods Embedded Design, Enrique V. Smith-Forbes

Theses and Dissertations--Rehabilitation Sciences

Adherence is considered a prerequisite for the success of exercise programs for musculoskeletal disorders. The negative effects of non-adherence to exercise recommendations impact the cost of care, and also treatment effectiveness, treatment duration, the therapeutic relationship, waiting times, the efficiency of personnel and use of equipment. Adherence to therapeutic exercise intervention is a multifaceted problem.

The World Health Organization (WHO) established the multidimensional adherence model (MAM). The MAM describes five interactive dimensions (socioeconomic, healthcare team and system, condition-related, therapy-related, and patient-related factors) that have an effect on patient adherence.

The first purpose of this dissertation was to explore the MAM …

Outcomes Associated With Blood Component Transfusion In Adult Trauma Patients, Allison R. Jones

Theses and Dissertations--Nursing

The purpose of this dissertation was to evaluate outcomes associated with blood component (BC) transfusion in adult trauma patients. Specific aims were to: 1) explore the relationship between traumatic injury, hemorrhage, and BC transfusion, focusing on consequences of the component storage lesion through presentation of a conceptual model; 2) systematically review research literature comparing outcomes of massively transfused major trauma patients based on ratios of BCs received; 3) evaluating the relationship between type of blood transfusion trauma patients received (whole blood versus BCs) and mortality likelihood after controlling for demographic and clinical variables; 4) evaluating the relationship between volume and …

Adhd Versus Ptsd In Preschool-Aged Children: Implications For Misdiagnosis, Klaudette D. Stewart

PCOM Psychology Dissertations

Attention Deficit Hyperactivity Disorder (ADHD) has been one of the most diagnosed disorders in children since it was included in the Diagnostic and Statistical Manual of Mental Disorders−III (DSM−III) in 1980. The number of children who have been diagnosed since that time has grown significantly, raising concerns about the overwhelming number of young children being diagnosed and prescribed medication. According to the literature, young children are diagnosed at a higher rate by pediatric primary care physicians (PCPs) than clinical child psychologists (CCPs) because they are taken to a PCP’s office by a parent, rather than referred from a school environment, …

Epithelial Cells Are Active Participants In Vocal Fold Wound Healing: An In Vivo Animal Model Of Injury, Ciara Leydon, Mitsuyoshi Imaizumi, Rebecca S. Bartlett, Sarah F. Wang, Susan L. Thibeault

Communication Disorders Faculty Publications

Vocal fold epithelial cells likely play an important, yet currently poorly defined, role in healing following injury, irritation and inflammation. In the present study, we sought to identify a possible role for growth factors, epidermal growth factor (EGF) and transforming growth factor-beta 1 (TGFβ1), in epithelial regeneration during wound healing as a necessary first step for uncovering potential signaling mechanisms of vocal fold wound repair and remodeling. Using a rat model, we created unilateral vocal fold injuries and examined the timeline for epithelial healing and regeneration during early and late stages of wound healing using immunohistochemistry (IHC). We observed time-dependent …

Development Of A Fatal Noncompressible Truncal Hemorrhage Model With Combined Hepatic And Portal Venous Injury In Normothermic Normovolemic Swine, Ujwal R. Yanala, Jason M. Johanning, Iraklis I. Pipinos, Gustavo F. Larsen, William H. Velander, Mark A. Carlson

William H. Velander Publications

Noncompressible truncal hemorrhage and brain injury currently account for most early mortality of warfighters on the battlefield. There is no effective treatment for noncompressible truncal hemorrhage, other than rapid evacuation to a surgical facility. The availability of an effective field treatment for noncompressible truncal hemorrhage could increase the number of warfighters salvaged from this frequently-lethal scenario. Our intent was to develop a porcine model of noncompressible truncal hemorrhage with a ,50% one-hour mortality so that we could develop new treatments for this difficult problem. Normovolemic normothermic domestic swine (barrows, 3 months old, 34–36 kg) underwent one of three injury types …

Research Brief: "Preferences For Gender-Targeted Health Information: A Study Of Male Veterans Who Have Experienced Military Sexual Trauma", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about male veterans' preferences for health information provided to them after experiencing military sexual trauma and the effect of that information on use of mental health services. In policy and practice, veterans who have experienced military sexual trauma should seek military sexual trauma care from the VA, health practitioners should learn more about military sexual assault to better help servicemembers, and gender-targeted literature should be distributed to servicemembers who have experienced military sexual trauma; the VHA should include gender-specific resources for male veterans who experienced military sexual trauma. Suggestions for future research include the addition of a …

Self-Reported Head Injury And Risk Of Late-Life Impairment And Ad Pathology In An Ad Center Cohort, Erin L. Abner, Peter T. Nelson, Frederick A. Schmitt, Steven R. Browning, David W. Fardo, Lijie Wan, Gregory A. Jicha, Gregory E. Cooper, Charles D. Smith, Allison M. Caban-Holt, Linda J. Van Eldik, Richard J. Kryscio

Sanders-Brown Center on Aging Faculty Publications

Aims: To evaluate the relationship between self-reported head injury and cognitive impairment, dementia, mortality, and Alzheimer's disease (AD)-type pathological changes. Methods: Clinical and neuropathological data from participants enrolled in a longitudinal study of aging and cognition (n = 649) were analyzed to assess the chronic effects of self-reported head injury. Results: The effect of self-reported head injury on the clinical state depended on the age at assessment: for a 1-year increase in age, the OR for the transition to clinical mild cognitive impairment (MCI) at the next visit for participants with a history of head injury was 1.21 and 1.34 …

Research Brief: "Women At War: Understanding How Women Veterans Cope With Combat And Military Sexual Trauma", Institute For Veterans And Military Families At Syracuse University

Institute for Veterans and Military Families

This brief is about stressors during military service that OEF/OIF female veterans experienced and how they coped with the stress. In policy and practice, female veterans should tell healthcare providers of their healthcare needs, and should form support groups with other veteran women; family members should support returning female service members; the VA should adapt its services to address the needs of female veterans, policymakers should allocate funding toward creating non-VA mental health and substance abuse counseling, and the VA should offer gender-specific mental health programs. Suggestions for future research include analyzing differences between age groups and length of time …

Strategies For Prevention Of Road Traffic Injuries (Rtis) In Pakistan: Situational Analysis., Adeel Ahmed Khan, Zafar Fatmi

Community Health Sciences

Road traffic injuries (RTIs) are one of the leading causes of death among productive age group. Using systems approach framework (SAF), current preventive strategies for RTI control were reviewed in Pakistan. A review of the literature was done using four international search engines. Only ten studies on preventive strategies for RTI stemming from Pakistan were found. The first Road Traffic Injuries Research Network (RTIRN) surveillance system for road traffic injuries was established in urban city (Karachi) in Pakistan has shown promise for injury control and should be scaled up to other cities. Enforcement of traffic laws on seat-belt and helmet …