World journal of surgery
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World journal of surgery · Aug 2008
Multicenter StudyAcute management of hemodynamically unstable pelvic trauma patients: time for a change? Multicenter review of recent practice.
Hemorrhage-related mortality (HRM) associated with pelvic fractures continues to challenge trauma care. This study describes the management and outcome of hemodynamically unstable patients with a pelvic fracture, with emphasis on primary intervention for hemorrhage control and HRM. ⋯ HRM associated with major pelvic trauma is unacceptably high especially in the laparotomy group. Hence, nontherapeutic laparotomy must be avoided, concentrating instead on arresting pelvic hemorrhage. Standards of care must be implemented and abided by.
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World journal of surgery · Aug 2008
What World Health Assembly Resolution 60.22 means to those who care for the injured.
On May 23, 2007, the World Health Assembly (WHA) adopted WHA Resolution 60.22, "Health Systems: Emergency Care Systems," which called on the World Health Organization (WHO) and governments to adopt a variety of measures to strengthen trauma and emergency care services worldwide. This resolution constituted some of the highest level attention ever devoted to trauma care worldwide. This article reviews the background of this resolution and discusses how it can be of use to surgeons, emergency physicians, and others who care for the injured, especially in low- and middle-income countries.
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World journal of surgery · Aug 2008
Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI).
Recent studies have investigated disruptions to surgical process via observation. We developed the Disruptions in Surgery Index (DiSI) to assess operating room professionals' self-perceptions of disruptions that affect surgical processes. ⋯ Although operating room professionals acknowledged disruptions and their impact, they attributed disruptions related to individual performance and attitudes more to their colleagues than to themselves. The cross-professional discrepancy in perceived disruptions (surgeons perceiving fewer than the other two groups) suggests that attempts to improve the surgical environment should always start with thorough assessment of the views of all its users. DiSI is useful in that it differentiates between the frequency and the severity of disruptions. Further research should explore correlations of DiSI-assessed perceptions and other observable measures.
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The quality of trauma care in New Zealand is good, but not optimal; it is characterized by skilled and dedicated staff relying on personal knowledge and institutional guidelines to deliver care. Quality assessment, standardization, and coordination of care continue to be hampered by the absence of a national trauma registry within the framework of a national trauma system. There is some hope that a planned regional pilot of the national trauma database will lead to more robust trauma system development, although this will only be achievable with solid governmental support.