Scand J Trauma Resus
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Scand J Trauma Resus · Nov 2016
Randomized Controlled Trial Multicenter StudyHeel pressure ulcer, prevention and predictors during the care delivery chain - when and where to take action? A descriptive and explorative study.
Hazardous healthcare settings, for example acute care, need to focus more on preventing adverse events and preventive actions across the care delivery chain (i.e pre-hospital and emergency care, and further at the hospital ward) should be more studied. Pressure ulcer prevalence is still at unreasonably high levels, causing increased healthcare costs and suffering for patients. Recent biomedical research reveals that the first signs of cell damage could arise within minutes. However, few studies have investigated optimal pressure ulcer prevention in the initial stage of the care process, e.g. in the ambulance care or at the emergency department. The aim of the study was to describe heel pressure ulcer prevalence and nursing actions in relation to pressure ulcer prevention during the care delivery chain, for older patients with neurological symptoms or reduced general condition. Another aim was to investigate early predictors for the development of heel pressure ulcer during the care delivery chain. ⋯ In the ambulance and at the emergency department, skin inspection seems to be appropriate for preventing pressure ulcer. However, carrying out risk assessment with a validated instrument is of significant importance at the ward level. This would also be an appropriate level of resource use. Context-specific actions for pressure ulcer prevention should be incorporated into the care of the patient from the very beginning of the care delivery chain.
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Scand J Trauma Resus · Nov 2016
Team talk and team activity in simulated medical emergencies: a discourse analytical approach.
Communication errors can reduce patient safety, especially in emergency situations that require rapid responses by experts in a number of medical specialties. Talking to each other is crucial for utilizing the collective expertise of the team. Here we explored the functions of "team talk" (talking between team members) with an emphasis on the talk-work relationship in interdisciplinary emergency teams. ⋯ Discourse analysis reveals naturally occurring communication strategies that trigger actions relevant for safe practice and thus provides supplemental insights into what comprises "good" team communication in medical emergencies.
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Scand J Trauma Resus · Nov 2016
Multicenter Study Observational StudyTraumatic brain injury patient volume and mortality in neurosurgical intensive care units: a Finnish nationwide study.
Differences in outcomes after traumatic brain injury (TBI) between neurosurgical centers exist, although the reasons for this are not clear. Thus, our aim was to assess the association between the annual volume of TBI patients and mortality in neurosurgical intensive care units (NICUs). ⋯ We did not find any association between annual TBI patient volume and 6-month mortality in NICUs. These findings should be interpreted taking into account that we only included NICUs, which by international standards all treated high volumes of TBI patients, and that we were not able to study the effect of NICU volume on neurological outcome.
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Scand J Trauma Resus · Nov 2016
Multicenter StudyHemodynamic, management, and outcomes of patients admitted to emergency department with heart failure.
Heart failure is one of the leading reasons for hospitalization in developed countries. Our goal was to describe the hemodynamic vital signs (heart rate and systolic blood pressure) of patients presenting to the emergency department (ED) with heart failure and to describe the frequency of adverse events for patients presenting with various heart rate and systolic blood pressure values. ⋯ We found a relatively high frequency of serious adverse events among patients who present to the ED with heart failure, particularly among the patients having low systolic blood pressure and high heart rate.
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Scand J Trauma Resus · Nov 2016
Comparative StudyWhich score should be used for posttraumatic multiple organ failure? - Comparison of the MODS, Denver- and SOFA- Scores.
Multiple organ dysfunction and multiple organ failure (MOF) is still a major complication and challenge in the treatment of severely injured patients. The incidence varies decisively in current studies, which complicates the comparability regarding risk factors, treatment recommendations and patients' outcome. Therefore, we analysed how the currently used scoring systems, the MODS, Denver- and SOFA Score, influence the definition and compared the scores' predictive ability. ⋯ All three scores have a comparable ability to predict the outcome in trauma patients including patients with severe traumatic brain injury (TBI). Either score could be favored depending weather a higher sensitivity or specificity is targeted. The SOFA score showed the most balanced relation of sensitivity and specificity. The incidence of posttraumatic MOF relies decisively on the score applied. Therefore harmonizing the competing scores and definitions is desirable.