Trajectory subtypes after injury and patient-centered outcomes

BACKGROUND: The recent focus on patient-centered outcomes highlights the need to better describe recovery trajectories after injury. The purpose of this study was to characterize recovery trajectory subtypes that exist after non-neurologic injury. MATERIALS AND METHODS: A prospective, observational cohort of 500 adults with an Injury Severity Score > 10 but without traumatic brain or spinal cord injury from 2009 to 2011 was formed. The Short Form-36 was administered at admission and repeated at 1, 2, 4, and 12 mo after injury. Group-based trajectory modeling was used to determine the number and shape of physical composite score (PCS) and mental composite score (MCS) trajectories. RESULTS: Three PCS trajectories and five MCS trajectories were identified. For PCS, trajectory 1 (10.4%) has low baseline scores, followed by no improvement over time. Trajectory 2 (65.6%) declines 1 mo after injury then improves over time. Trajectory 3 (24.1%) has a sharp decline followed by rapid recovery. For MCS, trajectory 1 (9.4%) is low at baseline and remains low. Trajectory 2 (14.4%) has a large decrease after injury and does not recover over the next 12 mo. Trajectory 3 (22.7%) has an initial decrease in MCS early, followed by continuous recovery. Trajectory 4 (19.1%) has a steady decline over the study period. Trajectory 5 (34.3%) stays consistently high at all time points. CONCLUSIONS: Recovery after injury is complex and results in multiple recovery trajectories. This has implications for patient-centered clinical trial design and in development of patient-specific interventions to improve outcomes

A snapshot of compliance with the sepsis six care bundle in two acute hospitals in the West Midlands, UK

The sepsis six care bundle has been adopted by hospitals in England and Wales for the management of patients with sepsis, with the aim of increasing survival when all elements of the bundle are achieved. To assess compliance with the Sepsis Six Care Bundle in two acute NHS hospitals in the West Midlands. Adults admitted to hospital over a 24-hour period were screened for sepsis. Sepsis was identified using the Systemic Inflammatory Response (SIRS) criteria and the quick sequential organ failure assessment (qSOFA) score. Adherence to the Sepsis Six Care Bundle was assessed. 249 patients were screened and 24 patients were identified as having sepsis (9.6%). One patient received all six elements of the bundle. Compliance was highest for giving intravenous fluids (58.3%) and antibiotics (58.3%), and lowest for measuring urine output (16.7%). Further research is needed to establish the reasons for low compliance. Frankling C, Patel J, Sharif B, Melody T, Yeung J, Gao F, et al. A Snapshot of Compliance with the Sepsis Six Care Bundle in Two Acute Hospitals in the West Midlands, UK. Indian J Crit Care Med 2019;23(7):310-315

Building a Framework for Language and Cultural Revitalisation: Lessons Learnt from the Bidayuh Indigenous Community in Sarawak, Malaysia

This poster explores community-based language planning (CBLP) for Bidayuh language and cultural revitalization in Malaysia. Specifically, it takes a closer look at how the Bidayuh community is working to reclaim and sustain their language and culture so that a framework of CBLP can be built

Poster 101 Pediatric Mononeuritis Multiplex Secondary to a Nonsystemic Vasculitis: A Case Report

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147008/1/pmr2s203a.pd

TEM study of homoepitaxial diamond layers scheduled for high power devices: FIB method of sample preparation

Homoepitaxial diamond structure observation by transmission electron microscopy (TEM) is still a very hard job due to the difficulty in preparing electron transparent samples for the further observation. The present contribution details the experimental operations with their respective conditions step by step. Finally high resolution TEM (HREM) observations of a CVD grown epilayer on a unnintentionally doped HPHT (001) oriented substrate are present to show the high quality of the sample preparation method.4 page

Shock volume: Patient-specific cumulative hypoperfusion predicts organ dysfunction in a prospective cohort of multiply injured patients

BACKGROUND: Multiply injured patients are at risk of developing hemorrhagic shock and organ dysfunction. We determined how cumulative hypoperfusion predicted organ dysfunction by integrating serial Shock Index measurements. METHODS: In this study, we calculated shock volume (SHVL) which is a patient-specific index that quantifies cumulative hypoperfusion by integrating abnormally elevated Shock Index (heart rate/systolic blood pressure ≥ 0.9) values acutely after injury. Shock volume was calculated at three hours (3 hr), six hours (6 hr), and twenty-four hours (24 hr) after injury. Organ dysfunction was quantified using Marshall Organ Dysfunction Scores averaged from days 2 through 5 after injury (aMODSD2–D5). Logistic regression was used to determine correspondence of 3hrSHVL, 6hrSHVL, and 24hrSHVL to organ dysfunction. We compared correspondence of SHVL to organ dysfunction with traditional indices of shock including the initial base deficit (BD) and the lowest pH measurement made in the first 24 hr after injury (minimum pH). RESULTS: SHVL at all three time intervals demonstrated higher correspondence to organ dysfunction (R2 = 0.48 to 0.52) compared to initial BD (R2 = 0.32) and minimum pH (R2 = 0.32). Additionally, we compared predictive capabilities of SHVL, initial BD and minimum pH to identify patients at risk of developing high-magnitude organ dysfunction by constructing receiver operator characteristic curves. SHVL at six hours and 24 hours had higher area under the curve compared to initial BD and minimum pH. CONCLUSION: SHVL is a non-invasive metric that can predict anticipated organ dysfunction and identify patients at risk for high-magnitude organ dysfunction after injury. LEVEL OF EVIDENCE: Prognostic study, level III

STACKification: automating assessments in tertiary mathematics

In this paper, we report on four university lecturers’ first-time experiences with computer-aided assessments. They were required to automate a significant proportion of the pre-existing weekly coursework for modules in first- or second-year undergraduate mathematics using STACK. We consider lecturers’ perspectives on the role of computer-aided assessments in course design for undergraduate mathematics; the knowledge of technical aspects required to implement STACKbased assessments; and the perceived merits of automated assessment for different aspects of mathematical study. We conclude with a series of reflections upon our departmental practice and the process of enculturating mathematicians into the realm of automated assessment

Prevalence and Treatment of Depression and Posttraumatic Stress Disorder among Trauma Patients with Non-neurological Injuries

Background Psychological impairment among injury survivors is well documented. Little is known about the prevalence of treatment of psychological impairment, however. We aimed to determine the proportion of injury survivors treated for depression and post-traumatic stress disorder (PTSD) in the year after injury as well as to determine potential barriers to treatment. Methods Adults (18 and over) admitted to a Level I trauma center with an injury severity score (ISS) greater than 10, but without traumatic brain injury or spinal cord injury were eligible for study inclusion. The Center for Epidemiological Studies-Depression (CES-D) and PTSD CheckList – Civilian Versions (PCL-C) surveys were administered during the initial hospitalization and repeated at 1, 2, 4, and 12 months after injury. Patients were asked if they received treatment specifically for depression or PTSD at each follow-up. Factors associated with treatment were determined using multivariable logistic regression analysis. Results 500 injury survivors were enrolled in this prospective observational study. Of those, 68.4% of patients screened positive for depression at some point in the year after their injury (53.3% 1 month, 49.9% 2 month, 49.0% 4 month, and 50.2% 12 month). Only 22.2% of depressed patients reported receiving treatment for depression. 44.4% of patients screened positive for PTSD (26.6% 1 month, 27.8% 2 month, 29.8% 4 month, and 30.0% 12 month), but only 9.8% received treatment for PTSD. After adjusting for other factors, compared to commercial insurance status, self-pay insurance status was negatively associated with treatment for PTSD or depression (OR 0.44, 95% CI 0.21-0.95). Conclusion Depression and PTSD are common in non-neurotrauma patients in the year following injury. Greater collaboration between those caring for injury survivors and behavioral health experts may help improve psychological outcomes after injury

Resiliency and quality of life trajectories after injury

Injury can greatly impact patients' long-term quality of life. Resilience refers to an individual's ability to positively adapt after facing stress or trauma. The objective of this study was to examine the relationship between preinjury resiliency scores and quality of life after injury. METHODS: Two hundred twenty-five adults admitted with an Injury Severity Score greater than 10 but without neurologic injury were included. The 36-item Short Form was administered at the time of admission and repeated at 1 month, 2 months, 4 months, and 12 months after injury. The Connor-Davidson Resilience Scale was completed at admission and scores were categorized into high resiliency or not high resiliency. Group-based trajectory modeling was used to identify distinct recovery trajectories for physical component scores (PCS) and mental component scores (MCS) of the 36-item Short Form. Multinomial logistic regression was used to determine whether baseline resiliency scores were predictive of PCS and MCS recovery trajectories. RESULTS: Age, race, sex, mechanism of injury, Charlson Comorbidity Index, Injury Severity Score, presence of hypotension on admission, and insurance status were not associated with high resiliency. Compared with those who made less than US $10,000 per year, those who made more than US$50,000 per year had higher odds of being in the high resilience group (odds ratio, 10.92; 95% confidence interval, 2.58-46.32). Three PCS and 5 MCS trajectories were identified. There was no relationship between resilience and PCS trajectory. However, patients with high resiliency scores were 85% less likely to belong to trajectory 1, the trajectory that had the lowest mental health scores over the course of the study. Follow-up for the study was 93.8% for month 1, 82.7% for month 2, 69.4% for month 4, and 63.6% for month 12. CONCLUSION: Patient resiliency predicts quality of life after injury in regards to mental health with over 25% of patients suffering poor mental health outcome trajectories. Efforts to teach resiliency skills to injured patients could improve long-term mental health for injured patients. Trauma centers are well positioned to carry out such interventions. LEVEL OF EVIDENCE: Prognostic/epidemiologic study, level III

Study protocol for the Anesthesiology Control Tower—Feedback Alerts to Supplement Treatments (ACTFAST-3) trial: A pilot randomized controlled trial in intraoperative telemedicine [version 1; referees: 2 approved]

Background: Each year, over 300 million people undergo surgical procedures worldwide. Despite efforts to improve outcomes, postoperative morbidity and mortality are common. Many patients experience complications as a result of either medical error or failure to adhere to established clinical practice guidelines. This protocol describes a clinical trial comparing a telemedicine-based decision support system, the Anesthesiology Control Tower (ACT), with enhanced standard intraoperative care. Methods: This study is a pragmatic, comparative effectiveness trial that will randomize approximately 12,000 adult surgical patients on an operating room (OR) level to a control or to an intervention group. All OR clinicians will have access to decision support software within the OR as a part of enhanced standard intraoperative care. The ACT will monitor patients in both groups and will provide additional support to the clinicians assigned to intervention ORs. Primary outcomes include blood glucose management and temperature management. Secondary outcomes will include surrogate, clinical, and economic outcomes, such as incidence of intraoperative hypotension, postoperative respiratory compromise, acute kidney injury, delirium, and volatile anesthetic utilization. Ethics and dissemination: The ACTFAST-3 study has been approved by the Human Resource Protection Office (HRPO) at Washington University in St. Louis and is registered at clinicaltrials.gov (NCT02830126). Recruitment for this protocol began in April 2017 and will end in December 2018. Dissemination of the findings of this study will occur via presentations at academic conferences, journal publications, and educational materials