Association between physician's case volume in prehospital advanced trauma care and 30-day mortality: a registry-based analysis of 4,032 patients

BACKGROUND: Seriously injured patients may benefit from prehospital interventions provided by a critical care physician. The relationship between case volume and outcome has been established in trauma teams in hospitals, as well as in prehospital advanced airway management. In this study, we aimed to assess if a volume-outcome relationship exists in prehospital advanced trauma care.METHODS: We performed a retrospective cohort study using the national helicopter emergency medical services database, including trauma patients escorted from scene to hospital by a helicopter emergency medical services physician during January 1, 2013, to August 31, 2019. In addition, similar cases during 2012 were used to determine case volumes. We performed a multivariate logistic regression analysis, with 30-day mortality as the outcome. Age, sex, Glasgow Coma Scale, shock index, mechanism of injury, time interval from alarm to the patient and duration of transport, level of receiving hospital, and physician's trauma case volume were used as covariates. On-scene times, interventions performed, and status at hospital arrival were assessed in patients who were grouped according to physician's case volume.RESULTS: In total, 4,032 escorted trauma patients were included in the study. The median age was 40.2 (22.9-59.3) years, and 3,032 (75.2%) were male. Within 30 days, 498 (13.2%) of these patients had died. In the highest case volume group, advanced interventions were performed more often, and patients were less often hypotensive at handover. Data for multivariate analysis were available for 3,167 (78.5%) of the patients. Higher case volume was independently associated with lower mortality (odds ratio, 0.59; 95% confidence interval, 0.38-0.89).CONCLUSION: When a prehospital physician's case volume is higher in high-risk prehospital trauma, this seems to be associated with more active practice patterns and significantly lower 30-day mortality. The quality of prehospital critical care could be increased by ensuring sufficient case volume for the providers of such care. (J Trauma Acute Care Surg. 2023;94: 425-432. Copyright (c) 2022 The Author(s). Published by Wolters Kluwer Health, Inc.) LEVEL OF EVIDENCE: Prognostic and Epidemiologic; Level III.Peer reviewe

Bibliometric studies on single journals: a review

This paper covers a total of 82 bibliometric studies on single journals (62 studies cover unique titles) published between 1998 and 2008 grouped into the following fields; Arts, Humanities and Social Sciences (12 items); Medical and Health Sciences (19 items); Sciences and Technology (30 items) and Library and Information Sciences (21 items). Under each field the studies are described in accordance to their geographical location in the following order, United Kingdom, United States and Americana, Europe, Asia (India, Africa and Malaysia). For each study, elements described are (a) the journal’s publication characteristics and indexation information; (b) the objectives; (c) the sampling and bibliometric measures used; and (d) the results observed. A list of journal titles studied is appended. The results show that (a)bibliometric studies cover journals in various fields; (b) there are several revisits of some journals which are considered important; (c) Asian and African contributions is high (41.4 of total studies; 43.5 covering unique titles), United States (30.4 of total; 31.0 on unique titles), Europe (18.2 of total and 14.5 on unique titles) and the United Kingdom (10 of total and 11 on unique titles); (d) a high number of bibliometrists are Indians and as such coverage of Indian journals is high (28 of total studies; 30.6 of unique titles); and (e) the quality of the journals and their importance either nationally or internationally are inferred from their indexation status

Reduced brain mammillary body volumes and memory deficits in adolescents who have undergone the Fontan procedure.

BackgroundAdolescents with single ventricle heart disease (SVHD) who have undergone the Fontan procedure show cognitive/memory deficits. Mammillary bodies are key brain sites that regulate memory; however, their integrity in SVHD is unclear. We evaluated mammillary body (MB) volumes and their associations with cognitive/memory scores in SVHD and controls.MethodsBrain MRI data were collected from 63 adolescents (25 SVHD; 38 controls) using a 3.0-Tesla MRI scanner. Cognition and memory were assessed using Montreal Cognitive Assessment (MoCA) and Wide Range Assessment of Memory and Learning 2. MB volumes were calculated and compared between groups (ANCOVA, covariates: age, sex, and total brain volume [TBV]). Partial correlations and linear regression were performed to examine associations between volumes and cognitive scores (covariates: age, sex, and TBV).ResultsSVHD group showed significantly lower MoCA and WRAML2 scores over controls. MB volumes were significantly reduced in SVHD over controls. After controlling for age, sex, and TBV, MB volumes correlated with MoCA and delayed memory recall scores in SVHD and controls.ConclusionAdolescents with SVHD show reduced MB volumes associated with cognitive/memory deficits. Potential mechanisms of volume losses may include developmental and/or hypoxic/ischemic-induced processes. Providers should screen for cognitive deficits and explore possible interventions to improve memory

Analytical methods for vasopressin: A review

Thesis (M.A.)—Boston Universit