Effectiveness of regionalization of trauma care services: a systematic review

Objectives Improving trauma systems in various forms has always been an important aspect of health policy. While several papers have reported the implementation of a structured trauma system of care, research evidence on the effectiveness of such regionalization for improvement in trauma outcome is limited. Study design Systematic review. Method Medline, EMbase, EconLit and Health Management Information Consortium were searched, using sensitive search terms, for interventional studies that reported a trauma regionalization system as their intervention, and compared important outcomes such as mortality and preventable deaths. At least two authors assessed eligibility for inclusion and risk of bias, and extracted data from the included studies. As meta-analysis was not possible for all studies, two controlled before–after studies were included in the meta-analysis, and a narrative analysis was conducted for the other studies. Results After title and abstract sifting, 66 papers were retrieved. After reading the full texts, a total of 24 studies from the USA, UK, Canada, Australia, and the Netherlands were included in this review. In spite of variation in study specifications, most were before–after studies with a high risk of bias. Although a reduction in mortality was shown in most studies, only two studies were eligible for meta-analysis, and the results showed a significant reduction in mortality after implementation of an organized trauma system (odds ratio 0.840, 95% confidence interval 0.756–0.924; P = 0.00). Conclusion Correlation was found between a regionalized network of trauma care and a reduction in trauma-related mortality, based on studies that did not exclude the effects of other concurrent changes on observed reductions. It is recommended that more studies with robust research designs should be conducted in a more diverse range of countries to assess the effectiveness of regionalization. Despite this limitation, the present findings support the regionalization of trauma care services

Views of patients undergo hematopoietic stem cell transplantation on their basic needs

Background: Today, hematopoietic stem cells transplantation (HSCT) has been accepted as a therapeutic approach and is widely applied in many patients with disorders of hematopoietic systems or patients with malignancies. Concomitant use of this therapeutic approach with long term chemotherapeutic procedures and hospitalization requires special care. This study was conducted to examine basic needs of patients after HSCT. Methods: In this study, 171 hospitalized patients were selected after transplantation, using convenience sampling method. They completed a questionnaire formulated on the basis of Yura and Walsh Theory of Basic Needs. Results: Most of the needs reported in the areas of vital functions, functional health status, and reaction to functional health status were chills (76.8), insomnia (68.5), and dissatisfaction with changes of lifestyle/habits (53.6), respectively. Furthermore, 94.1 of the patients were aware of their disease. Conclusion: This study identified a broad spectrum of the needs in HSCT patients. Given the importance of determining needs to reach a thorough nursing care, paying attention to the provided list can facilitate the achievement of the goals of the care program for these patients