Philosophy at Cambridge, Newsletter of the Faculty of Philosophy

Philosophy at Cambridge. Newsletter of the Philosophy Faculty. Articles by: Simon Blackburn, 'From the Chairman' ; Philip Pettit, 'Hobbes, Berlin and Freedom' ; Matthew Kramer, 'What is Legal Philosophy?' ; 'A Conversation with Tim Crane' Interviewed by Simon Blackburn ; Alexis Papazoglou, 'The Philosophy of Wine- Review' ; Lubomira Radoilska, 'Autonomy and Mental Health Conference' ; Winston Fletcher, 'The Meaning of Harpic'

Outcomes and costs of penetrating trauma injury in England and Wales

The official published version of the article can be found at the link below.Background: Penetrating trauma injury is generally associated with higher short-term mortality than blunt trauma, and results in substantial societal costs given the young age of those typically injured. Little information exists on the patient and treatment characteristics for penetrating trauma in England and Wales, and the acute outcomes and costs of care have not been documented and analysed in detail.Methods: Using the Trauma Audit Research Network (TARN) database, we examined patient records for persons aged 18+ years hospitalised for penetrating trauma injury between January 2000 and December 2005. Patients were stratified by injury severity score (ISS).Results: 1365 patients were identified; 16% with ISS 1-8, 50% ISS 9-15, 15% ISS 16-24, 16% ISS 25-34, and 4% with ISS 35-75. The median age was 30 years and 91% of patients were men. Over 90% of the injuries occurred in alleged assaults. Stabbings were the most common cause of injury (73%), followed by shootings (19%). Forty-seven percent were admitted to critical care for a median length of stay of 2 days; median total hospital length of stay was 7 days. Sixty-nine percent of patients underwent at least one surgical procedure. Eight percent of the patients died before discharge, with a mean time to death of 1.6 days (S.D. 4.0). Mortality ranged from 0% among patients with ISS 1-8 to 55% in patients with ISS > 34. The mean hospital cost per patient was 7983 pound, ranging from 6035 pound in patients with ISS 9-15 to El 6,438 among patients with ISS > 34. Costs varied significantly by ISS, hospital mortality, cause and body region of injury.Conclusion: The acute treatment costs of penetrating trauma injury in England and Wales vary by patient, injury and treatment characteristics. Measures designed toreduce the incidence and severity of penetrating trauma may result in significant hospital cost savings. (C) 2008 Elsevier Ltd. All rights reserved.This study was funded by Novo Nordisk A/S

Outcomes and costs of blunt trauma in England and Wales

Background Trauma represents an important public health concern in the United Kingdom, yet the acute costs of blunt trauma injury have not been documented and analysed in detail. Knowledge of the overall costs of trauma care, and the drivers of these costs, is a prerequisite for a cost-conscious approach to improvement in standards of trauma care, including evaluation of the cost-effectiveness of new healthcare technologies. Methods Using the Trauma Audit Research Network database, we examined patient records for persons aged 18 years and older hospitalised for blunt trauma between January 2000 and December 2005. Patients were stratified by the Injury Severity Score (ISS). Results A total of 35,564 patients were identified; 60% with an ISS of 0 to 9, 17% with an ISS of 10 to 16, 12% with an ISS of 17 to 25, and 11% with an ISS of 26 to 75. The median age was 46 years and 63% of patients were men. Falls were the most common cause of injury (50%), followed by road traffic collisions (33%). Twenty-nine percent of patients were admitted to critical care for a median length of stay of 4 days. The median total hospital length of stay was 9 days, and 69% of patients underwent at least one surgical procedure. Seven percent of the patients died before discharge, with the highest proportion of deaths among those in the ISS 26–75 group (32%). The mean hospital cost per person was £9,530 (± 11,872). Costs varied significantly by Glasgow Coma Score, ISS, age, cause of injury, type of injury, hospital mortality, grade and specialty of doctor seen in the accident and emergency department, and year of admission. Conclusion The acute treatment costs of blunt trauma in England and Wales vary significantly by injury severity and survival, and public health initiatives that aim to reduce both the incidence and severity of blunt trauma are likely to produce significant savings in acute trauma care. The largest component of acute hospital cost is determined by the length of stay, and measures designed to reduce length of admissions are likely to be the most effective in reducing the costs of blunt trauma care

Philosophy at Cambridge, Newsletter of the Faculty of Philosophy, Issue 12

Newsletter of the Philosophy Faculty. Articles by: Richard Holton, 'From the Chair'; New directions in the philosophy of mind; Fred Lewsey, 'Trust me, I'm a Banker'; Arif Ahmed, 'Religious Belief'; Will MacAskill, 'Effective Altruism'; Matthew van der Merwe, 'The 14 students giving away £3 million'; Shyane Siriwardena, 'Richard Baron on giving back to philosophy'

Philosophy at Cambridge

Newsletter of the Philosophy Faculty. Articles by: Tim Crane, 'From the Chair' ; Huw Price, "Erroneously supposed to do no harm"; Arthur Gibson, 'The Wittgenstein-Skinner Archive; Emily Thomas, 'Elizabeth Anscombe'

The CRASH3 study: prehospital TXA for every injured patient?

The CRASH3 results are out, but do we know what to do? The study enrolled 9202 head injured patients within 3 hours of injury with a Glasgow Coma Scale (GCS) of 12 or less, or any intracranial bleeding on CT scan and randomised them to Tranexamic Acid (TXA) or placebo. The relative risk (RR) of all-cause mortality (RR 0.96, 95% CI 0.89-1.04) and head injury death (RR 0.94, 95% CI 086-1.02) among those receiving TXA were not significant. However there were significant differences in subgroups who were less severely injured (RR 0.89 95%CI 0.80-1.00 if those with GCS=3 or bilateral fixed pupils were excluded, and RR 0.78, 95% CI 0.64 to 0.95, in the GCS 9 to 15 subgroup) or treated earlier (p=0.005 for time effect)[1].The results need to be considered in the context of earlier CRASH2[2] results, which showed a reduction in all-cause mortality (RR 0.91, 0.85 to 0.97) and death due to bleeding (RR 0.85, 0.76-0.96) if trauma patients who were bleeding or at risk of bleeding were given TXA. In both CRASH2 and CRASH3 the TXA was given in the emergency department.</div

Therapeutic Challenges Of Multi-Being

This paper emerges from an attempt to shift the locus of understanding human action from the individual to relationship. In doing so we come to see persons as multi-beings, that is, as constituted within multiple relationships from which they emerge with multiple, incoherent, and often conflicting potentials. Therapy, in this context, becomes a collaborative relationship with the aim of transforming the client\u27s broader relational network. In this view, schooling in a singular practice of therapy artificially limits the therapist\u27s potential, and thus the possible outcomes of the client–therapist relationship. Invited, then, is a reflective eclecticism, in which the myriad potentials of both the therapist and client are considered in tandem. This view is illustrated by contrasting three relational conditions in which clients find themselves, each of which invites a different form of self-expression from the therapist

Proof of influence evaluation of the Nigeria evidence‐based health system initiative (NEHSI)

The goal of this Proof of Influence evaluation is to harvest the outcomes of the project; it provides background and context for the project, objectives, and theory of change. The Nigeria Evidence‐based Health System Initiative (NEHSI) undertook activities to increase the generation and use of evidence for decision-making in Bauchi and Cross River states, in order to strengthen the health care system towards delivering effective, efficient and equitable primary health care (PHC). This evaluation reviews outcomes, relevance, and NEHSI’s contribution with NEHSI stakeholders. The pattern of outcomes at the community and individual levels was distinctly different from that at the institutional level

‘Major trauma’: now two separate diseases?

Across the developed world, demographic change is having a profound impact on emergency care, with recognition that older people have different needs, and may need different services. The article by Hawley et al in this edition, and the recent publication of a report on major trauma in older people from the Trauma Audit and Research Network (TARN), suggest that we may also need to think differently about our major trauma systems. In England and Wales, recent improvements in data collection from trauma units (hospitals that are not major trauma centres) means that in 2016 the ‘typical’ case of major trauma is no longer a young male admitted after a road traffic accident, but is an older male admitted after a fall of less than 2 metres