Nghiên cứu chấn thương ở các nước có thu nhập thấp và trung bình là rất cấp thiết để củng cố chuỗi sống sót Dịch bởi AI Springer Science and Business Media LLC - Tập 19 - Trang 1-5 - 2011
Torben Wisborg, Thapelo R Montshiwa, Charles Mock
Chấn thương là nguyên nhân chính - và ngày càng gia tăng - gây ra cái chết, đặc biệt là ở các nước có thu nhập thấp và trung bình. Ở tất cả các quốc gia, các vùng nông thôn bị ảnh hưởng nặng nề, và sự phân bố bác sĩ bị thiên lệch về phía các thành phố. Để giảm thiểu các cái chết có thể phòng ngừa do chấn thương, tất cả các mắt xích trong chuỗi sống sót sau chấn thương cần được củng cố. Việc ưu tiên tại mỗi quốc gia nên do các nhà nghiên cứu địa phương thực hiện, nhưng có rất ít nghiên cứu về chấn thương được công bố từ các nước có thu nhập thấp và trung bình. Các nhà nghiên cứu ở những quốc gia này cần được hỗ trợ và hợp tác với đồng nghiệp ở các nước công nghiệp hóa. Quan hệ đối tác này sẽ mang lại lợi ích cho cả hai bên.
#chấn thương #chuỗi sống sót #nghiên cứu #hỗ trợ quốc tế #thu nhập thấp và trung bình
Self-rated worry is associated with hospital admission in out-of-hours telephone triage – a prospective cohort studySpringer Science and Business Media LLC - - 2020
Hejdi Gamst‐Jensen, Erika Frischknecht Christensen, Freddy Lippert, Fredrik Folke, Ingrid Egerod, Linda Huibers, Mikkel Brabrand, Janne Schurmann Tolstrup, Lau Caspar Thygesen
Abstract
Objective
Telephone triage manages patient flow in acute care, but a lack of visual cues and vague descriptions of symptoms challenges clinical decision making. We aim to investigate the association between the caller’s subjective perception of illness severity expressed as “degree-of-worry” (DOW) and hospital admissions within 48 h.
Design and setting
A prospective cohort study was performed from January 24th to February 9th, 2017 at the Medical Helpline 1813 (MH1813) in Copenhagen, Denmark. The MH1813 is a primary care out-of-hours service.
Participants
Of 38,787 calls received at the MH1813, 11,338 met the inclusion criteria (caller being patient or close friend/relative and agreement to participate). Participants rated their DOW on a 5-point scale (1 = minimum worry, 5 = maximum worry) before talking to a call handler.
Main outcome measure
Information on hospitalization within 48 h after the call, was obtained from the Danish National Patient Register. The association was assessed using logistic regression in three models: 1) crude, 2) age-and-gender adjusted and 3) age, gender, co-morbidity, reason for calling and caller status adjusted.
Results
A total of 581 participants (5.1%) were admitted to the hospital, of whom 170 (11.3%) presented with a maximum DOW, with a crude odds ratio (OR) for hospitalization of 6.1 (95% confidence interval (CI) 3.9 to 9.6) compared to minimum DOW. Estimates showed dose-response relationship between DOW and hospitalization. In the fully adjusted model, the ORs decreased to 3.1 (95%CI 2.0 to 5.0) for DOW = 5, 3.2 (2.0 to 5.0) for DOW = 4, 1.6 (1.0 to 2.6) for DOW = 3 and 0.8 (0.5 to 1.4) for DOW = 2 compared to minimum DOW.
Conclusion
Patients’ self-assessment of illness severity as DOW was associated with subsequent hospital admission. Further, it may be beneficial in supporting clinical decision making in telephone triage. Finally, it might be useful as a measure to facilitate patient participation in the triage process.
A national survey on temporary and delayed abdominal closure in Norwegian hospitalsSpringer Science and Business Media LLC - Tập 19 - Trang 1-4 - 2011
Sigrid Groven, Pål A Næss, Erik Trondsen, Christine Gaarder
Temporary abdominal closure (TAC) is included in most published damage control (DC) and abdominal compartment (ACS) protocols. TAC is associated with a range of complications and the optimal method remains to be defined. The aim of the present study was to describe the experience regarding TAC after trauma and ACS in all acute care hospitals in a sparsely populated country with long transportation distances. A questionnaire was sent to all 50 Norwegian hospitals with acute care general surgical services. The response rate was 88%. A very limited number of hospitals had treated more than one trauma patient with TAC (5%) or one patient with ACS (14%) on average per year. Most hospitals preferred vacuum assisted techniques, but few reported having formal protocols for TAC or ACS. Although most hospitals would refer patients with TAC to a trauma centre, more than 50% reported that they would perform a secondary reconstruction procedure themselves. This study shows that most Norwegian hospitals have limited experience with TAC and ACS. However, the long distances between hospitals mandate all acute care hospitals to implement formal treatment protocols including monitoring of IAP, diagnosing and decompression of ACS, and the use of TAC. Assuming experience leads to better care, the subsequent treatment of these patients might benefit from centralization to one or a few regional centers.
2-year survival of patients undergoing mild hypothermia treatment after ventricular fibrillation cardiac arrest is significantly improved compared to historical controlsSpringer Science and Business Media LLC - Tập 18 - Trang 1-4 - 2010
Christian Storm, Jens Nee, Anne Krueger, Joerg C Schefold, Dietrich Hasper
Therapeutic hypothermia has been proven to be effective in improving neurological outcome in patients after cardiac arrest due to ventricular fibrillation (VF). Data concerning the effect of hypothermia treatment on long-term survival however is limited. Clinical and outcome data of 107 consecutive patients undergoing therapeutic hypothermia after cardiac arrest due to VF were compared with 98 historical controls. Neurological outcome was assessed at ICU discharge according to the Pittsburgh cerebral performance category (CPC). A Kaplan-Meier analysis of follow-up data concerning mortality after 24 months as well as a Cox-regression to adjust for confounders were calculated. Neurological outcome significantly improved after mild hypothermia treatment (hypothermia group CPC 1-2 59.8%, control group CPC 1-2 24.5%; p < 0.01). In Kaplan-Meier survival analysis hypothermia treatment was also associated with significantly improved 2-year probability for survival (hypothermia 55% vs. control 34%; p = 0.029). Cox-regression analysis revealed hypothermia treatment (p = 0.031) and age (p = 0.013) as independent predictors of 24-month survival. Our study demonstrates that the early survival benefit seen with therapeutic hypothermia persists after two years. This strongly supports adherence to current recommendations regarding postresuscitation care for all patients after cardiac arrest due to VF and maybe other rhythms as well.
