Seasonality in trauma admissions - Are daylight and weather variables better predictors than general cyclic effects?

Trauma is a leading global cause of death, and predicting the burden of trauma admissions is vital for good planning of trauma care. Seasonality in trauma admissions has been found in several studies. Seasonal fluctuations in daylight hours, temperature and weather affect social and cultural practices but also individual neuroendocrine rhythms that may ultimately modify behaviour and potentially predispose to trauma. The aim of the present study was to explore to what extent the observed seasonality in daily trauma admissions could be explained by changes in daylight and weather variables throughout the year.publishedVersio

Parathyroid hormone is a plausible mediator for the metabolic syndrome in the morbidly obese: a cross-sectional study

<p>Abstract</p> <p>Background</p> <p>The biological mechanisms in the association between the metabolic syndrome (MS) and various biomarkers, such as 25-hydroxyvitamin D (vit D) and magnesium, are not fully understood. Several of the proposed predictors of MS are also possible predictors of parathyroid hormone (PTH). We aimed to explore whether PTH is a possible mediator between MS and various possible explanatory variables in morbidly obese patients.</p> <p>Methods</p> <p>Fasting serum levels of PTH, vit D and magnesium were assessed in a cross-sectional study of 1,017 consecutive morbidly obese patients (68% women). Dependencies between MS and a total of seven possible explanatory variables as suggested in the literature, including PTH, vit D and magnesium, were specified in a path diagram, including both direct and indirect effects. Possible gender differences were also included. Effects were estimated using Bayesian path analysis, a multivariable regression technique, and expressed using standardized regression coefficients.</p> <p>Results</p> <p>Sixty-eight percent of the patients had MS. In addition to type 2 diabetes and age, both PTH and serum phosphate had significant direct effects on MS; 0.36 (95% Credibility Interval (CrI) [0.15, 0.57]) and 0.28 (95% CrI [0.10,0.47]), respectively. However, due to significant gender differences, an increase in either PTH or phosphate corresponded to an increased OR for MS in women only. All proposed predictors of MS had significant direct effects on PTH, with vit D and phosphate the strongest; -0.27 (95% CrI [-0.33,-0.21]) and -0.26 (95% CrI [-0.32,-0.20]), respectively. Though neither vit D nor magnesium had significant direct effects on MS, for women they both affected MS indirectly, due to the strong direct effect of PTH on MS. For phosphate, the indirect effect on MS, mediated through serum calcium and PTH, had opposite sign than the direct effect, resulting in the total effect on MS being somewhat attenuated compared to the direct effect only.</p> <p>Conclusion</p> <p>Our results indicate that for women PTH is a plausible mediator in the association between MS and a range of explanatory variables, including vit D, magnesium and phosphate.</p

Workplace Incivility and Turnover Intention in Organizations: A Meta-Analytic Review

Incivility has been identified as a prevalent and crucial issue in workplaces and one that may be associated with detrimental effects on employees and organizational outcomes, such as turnover intention. Many studies have been published regarding the effects of incivility, but there is a lack of integrative reviews and meta-analyses. The aim of the present study is to conduct an early meta-analysis of the relationship between employees’ perceptions of workplace incivility and their turnover intentions. Six databases, including ISI Web of Science, PsychInfo, Scopus, Emerald, Hospitality & Tourism Complete, and Soc Index, were searched to identify empirical articles for this meta-analytical paper. The results of statistical meta-analyses and meta-regression suggest that there is a positive relationship between perceived incivility and turnover intentions in employees and that relationship is consistent across different sources of workplace incivility. However, we did observe a possible interaction effect of “supervisor” and “coworker incivility”. The results also suggest that the relationship between workplace incivility and turnover intention is stronger in the academic sector than in other industries and stronger in the United States than in other countries.publishedVersio

Does Medical Staffing Influence Perceived Safety? An International Survey on Medical Crew Models in Helicopter Emergency Medical Services

Objective: The competence, composition, and number of crewmembers have generally been considered to influence the degree of patient care and safety in helicopter emergency medical services (HEMS), but evidence to support the advantages of one crew concept over another is ambiguous; additionally, the benefit of physicians as crewmembers is still highly debated. Methods: To compare perceived safety in different medical crew models, we surveyed international HEMS medical directors regarding the types of crew compositions their system currently used and their supportive rationales and to evaluate patient and flight safety within their services. Results: Perceived patient and flight safety is higher when HEMS is staffed with a dual medical crew in the cabin. Tradition and scientific evidence are the most common reasons for the choice of medical crew. Most respondents would rather retain their current crew configuration, but some would prefer to add a physician or supplement the physician with an assistant in the cabin. Conclusion: Our survey shows a wide variety of medical staffing models in HEMS and indicates that these differences are mainly related to medical competencies and the availability of an assistant in the medical cabin. The responses suggest that differences in medical staffing influence perceived flight and patient safety.publishedVersio

Klynger

Ikke alle datasett har forklaringsvariabler og utfall. Allikevel kan det finnes sammenhenger i dataene som er nyttige å avdekke. På 2010-tallet arbeidet Intervensjonssenteret på Rikshospitalet med å utvikle en dataalgoritme som automatisk kunne finne tumorer i et radiologisk bilde. Resultatet av dataalgoritmen var en todimensjonal geometrisk form: omrisset av en tumor. Om algoritmen fungerte eller ikke, ble fastslått ved å sammenligne omrisset fra den automatiske metoden med omriss laget manuelt av fire erfarne radiologer. En geometrisk form er matematikk, men den er ikke et tall, og å sammenligne omriss av tumorer krevde en annen kvantitativ tilnærming enn tradisjonelle statistiske metoder.publishedVersio

Evaluation of the reported data linkage process and associated quality issues for linked routinely collected healthcare data in multimorbidity research: a systematic methodology review

Objective The objective of this systematic review was to examine how the record linkage process is reported in multimorbidity research. Methods A systematic search was conducted in Medline, Web of Science and Embase using predefined search terms, and inclusion and exclusion criteria. Published studies from 2010 to 2020 using linked routinely collected data for multimorbidity research were included. Information was extracted on how the linkage process was reported, which conditions were studied together, which data sources were used, as well as challenges encountered during the linkage process or with the linked dataset. Results Twenty studies were included. Fourteen studies received the linked dataset from a trusted third party. Eight studies reported variables used for the data linkage, while only two studies reported conducting prelinkage checks. The quality of the linkage was only reported by three studies, where two reported linkage rate and one raw linkage figures. Only one study checked for bias by comparing patient characteristics of linked and non-linked records. Conclusions The linkage process was poorly reported in multimorbidity research, even though this might introduce bias and potentially lead to inaccurate inferences drawn from the results. There is therefore a need for increased awareness of linkage bias and transparency of the linkage processes, which could be achieved through better adherence to reporting guidelines. PROSPERO registration number CRD42021243188

Factors associated with ongoing criminal engagement while in opioid maintenance treatment

Introduction: This study examines factors associated with criminal engagement among patients in opioid maintenance treatment (OMT). Methods: Questionnaire data recorded annually among 5 654 patients in the Norwegian OMT programme between 2005 and 2010 from seven regional treatment centres were available for analyses. Each patient answered approximately 4 times (mean: 4.11, SD: 1.46) generating a total of 18 538 questionnaires. The outcome variable of the study, engagement in criminal activity, was defined as whether a patient had been arrested, put in custody, been charged and/or convicted of a crime within the last 12 months prior to the completion of the questionnaire. Three types of covariates were included: demographical, psychosocial and drug use-related. Missing data were imputed using Multivariate Imputation by Chained Equations and regression parameters were estimated by Generalized Estimation Equations to account for correlated measurements. Results: Having a full-time job (aOR: 0.47, CI: 0.34-0.64) or being a student/having a part-time job (aOR: 0.72, CI: 0.59-0.88) was negatively associated with ongoing criminal involvement, as did having a stable living situation (aOR: 0.70, CI: 0.57-0.87). On the other hand, being male (aOR: 1.83, CI: 1.59-2.10), younger (aOR: 0.96, CI: 0.95-0.97) and using illicit drugs regularly (aOR: 3.00, CI: 2.56-3.52) was positively associated with ongoing criminal activity while in OMT. Conclusions: Stable accommodation and participation in meaningful daily activity was found to be protective in terms of ongoing criminal engagement. Focus on these modifiable, psychosocial factors should therefore be an important and integral aspect of opioid maintenance treatment.acceptedVersio

Introducing fairness in Norwegian air ambulance base location planning

Background A primary task of the Norwegian helicopter emergency medical services (HEMS) is to provide advanced medical care to the critical ill and injured outside of hospitals. Where HEMS bases are located, directly influences who in the population can be reached within a given response time threshold and who cannot. When studying the locations of bases, the focus is often on efficiency, that is, maximizing the total number of people that can be reached within a given set time. This approach is known to benefit people living in densely populated areas, such as cities, over people living in remote areas. The most efficient solution is thus typically not necessarily a fair one. This study aims to incorporate fairness in finding optimal air ambulance base locations. Methods We solve multiple advanced mathematical optimization models to determine optimal helicopter base locations, with different optimization criteria related to the level of aversion to inequality, including the utilitarian, Bernoulli-Nash and iso-elastic social welfare functions. This is the first study to use the latter social welfare function for HEMS. Results Focusing on efficiency, a utilitarian objective function focuses on covering the larger cities in Norway, leaving parts of Norway largely uncovered. Including fairness by rather using an iso-elastic social welfare function in the optimization avoids leaving whole areas uncovered and in particular increases service levels in the north of Norway. Conclusions Including fairness in determining optimal HEMS base locations has great impact on population coverage, in particular when the number of base locations is not enough to give full coverage of the country. As results differ depending on the mathematical objective, the work shows the importance of not only looking for optimal solutions, but also raising the essential question of ‘optimal with respect to what’.publishedVersio

The success of pre-hospital tracheal intubation by different pre-hospital providers: a systematic literature review and meta-analysis

Background: Pre-hospital basic airway interventions can be ineffective at providing adequate oxygenation and ventilation in some severely ill or injured patients, and advanced airway interventions are then required. Controversy exists regarding the level of provider required to perform successful pre-hospital intubation. A previous meta-analysis reported pre-hospital intubation success rates of 0.849 for non-physicians versus 0.991 for physicians. The evidence base on the topic has expanded significantly in the last 10 years. This study systematically reviewed recent literature and presents comprehensive data on intubation success rates. Methods: A systematic search of MEDLINE and EMBASE was performed using PRISMA methodology to identify articles on pre-hospital tracheal intubation published between 2006 and 2016. Overall success rates were estimated using random effects meta-analysis. The relationship between intubation success rate and provider type was assessed in weighted linear regression analysis. Results: Of the 1838 identified studies, 38 met the study inclusion criteria. Intubation was performed by non-physicians in half of the studies and by physicians in the other half. The crude median (range) reported overall success rate was 0.969 (0.616–1.000). In random effects meta-analysis, the estimated overall intubation success rate was 0.953 (0.938–0.965). The crude median (range) reported intubation success rates for non-physicians were 0.917 (0.616–1.000) and, for physicians, were 0.988 (0.781–1.000) (p = 0.003). Discussion: The reported overall success rate of pre-hospital intubation has improved, yet there is still a significant difference between non-physician and physician providers. The finding that less-experienced personnel perform less well is not unexpected, but since there is considerable evidence that poorly performed intubation carries a significant risk of morbidity and mortality careful consideration should be given to the training and experience required to deliver this intervention safely.publishedVersio