Ten-year evolution of a massive transfusion protocol in a level 1 trauma centre : have outcomes improved?

Background: We aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to life‐threatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre. Methods: A retrospective study of prospectively collected data was performed over a 14‐year period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a pre‐MTP group (2002–2006), an MTP‐I group (2006–2010) and an MTP‐II group (2010–2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused. Results: A total of 168 patients were included: 54 pre‐MTP patients were compared to 47 MTP‐I and 67 MTP‐II patients. In the MTP‐II group, fewer units of PRBC and platelets were administered within the first 24 h: 17 versus 14 (P = 0.01) and 12 versus 8 (P < 0.001), respectively. Less infections were noted in the MTP‐I group: 51.9% versus 31.9% (P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay. Conclusion: Introduction of an MTP‐II in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of real‐life medical care in a level 1 civilian trauma centre

Assembly of Annual Statistical Report and Basic Fact Sheets - 2012

La base de datos CARE reúne los datos desagregados de los accidentes de tránsito y las víctimas de toda Europa , al combinar las bases de datos nacionales sobre accidentes que son mantenidos por todos los estados miembros de la UE . El acceso a la base de datos CARE se limita , sin embargo , por lo que es importante que una amplia gama de publicaciones sobre la base de estos datos sea accesible al público en general . Este proceso se inició en el proyecto SafetyNet que se llevó a cabo entre 2004 y 2008 , y el concepto de la Hoja de Datos Básicos ( BFS ) Hojas de datos básicos y el Informe Anual ( ASR ) se ha desarrollado. En 2008, doce hojas informativas se están preparando anualmente por investigadores de cinco institutos y un informe estadístico . Una de las tareas de Dacota Paquete de Trabajo 3 ha sido la de continuar desarrollando esta área de trabajo . Se han actualizado Estos doce de la BFS y el nuevo contenido se ha añadido . Se han desarrollado de seis nuevos BFS , y se enumeran las de BFS dieciocho a continuación junto con el socio responsable de la preparación de la versión 2012 . Las Hojas Informativas presentan una visión general destacando los principales hechos de un tema específico. Siempre que sea posible , las medidas de riesgo se calculan relacionando el número de víctimas mortales de CARE a los datos de exposición disponibles de otras fuentes. La mayoría de las Hojas Informativas examinaron las tendencias en el período 2001-2010 , con análisis más detallados de los datos de 2010 . Estos socios también trabajaron para elaborar el Informe Estadístico Anual de 2008 , dirigido por KFV . Más recientes datos de accidentes de tráfico de la base de datos CARE, para que más países se incorporaron . El Informe Estadístico Anual consta de un gran número de tablas y figuras con los datos recuperados de la base de datos CARE, sin mayor análisis o comentario . Incluye un glosario con las definiciones de las variables y los valores utilizados en el Informe Estadístico Anual . El Informe Estadístico Anual de 2012 proporciona las características básicas de los accidentes de tráfico en los 26 estados miembros de la Unión Europea y Suiza para el período 2001-2010 , y los datos más detallados para el último año disponible. Se compone de 56 tablas y 26 figuras con la combinación más interesante de los datos de accidentes de tráfico de CARE sobre los principales temas de seguridad vial , dando la descripción general de la situación de la seguridad vial en la UE y el desarrollo de las muertes en los países a través del tiempo . Efectuará un seguimiento de las tendencias utilizando series de tiempo de datos fatales de la década y también analiza los datos sobre muertes y de accidentes fatales para los diferentes atributos relacionados con accidentes como el tiempo , el tipo de zona , la red de carreteras y el modo de transporte.The CARE database brings together the disaggregate details of road accidents and casualties across Europe, by combining the national accident databases that are maintained by all EU member states. Access to the CARE database is restricted, however, so it is important that a comprehensive range of publications based on these data be accessible to the general public. This process was begun in the SafetyNet project that was carried out between 2004 and 2008, and the concept of the Basic Fact Sheet (BFS) Basic Fact Sheets and Annual Statistical Report (ASR) was developed. By 2008, twelve Fact Sheets were being prepared annually by researchers at five institutes and one Statistical Report. One of the tasks of DaCoTA Work Package 3 has been to continue to develop this area of work. These twelve BFS’s have been updated and new content has been added. Six new BFS’s have been developed, and the eighteen BFS’s are listed below together with the partner responsible for the preparation of the 2012 version. The Fact Sheets present an overview highlighting the main facts for a specific topic. Wherever possible, measures of risk are calculated by relating the number of fatalities from CARE to exposure data available from other sources. Most Fact Sheets examined trends over the period 2001-2010, with more detailed analyses of data from 2010. These partners also worked to develop the Annual Statistical Report of 2008, led by KfV. More recent road accident data from the CARE database, for more countries, were incorporated. The Annual Statistical Report consists of a large number of Tables and Figures with data retrieved from the CARE database, without further analysis or comment. It includes a Glossary with the definitions of the variables and values used in the Annual Statistical Report. The Annual Statistical Report of 2012 provides the basic characteristics of road accidents in 26 member states of the European Union and Switzerland for the period 2001-2010, and more detailed data for the last available year. It consists of 56 Tables and 26 Figures with the most interesting combination of CARE road accident data on major road safety topics, giving the overall description of the road safety situation in the EU and the development of fatalities in the countries over time. It monitors trends using time series of fatal data from the decade and also analyses data on fatalities and fatal accidents for different accident-related attributes like time, area type, road network and mode of transport

Pain Control in Breast Surgery: Survey of Current Practice and Recommendations for Optimizing Management—American Society of Breast Surgeons Opioid/Pain Control Workgroup

Introduction: The opioid epidemic in the United States is a public health crisis. Breast surgeons are obligated to provide good pain control for their patients after surgery but also must minimize administration of narcotics to prevent a surgical episode of care from becoming a patient's gateway into opioid dependence. Methods: A survey to ascertain pain management practice patterns after breast surgery was performed. A review of currently available literature that was specific to breast surgery was performed to create recommendations regarding pain management strategies. Results: A total of 609 surgeons completed the survey and demonstrated significant variations in pain management practices, specifically within regards to utilization of regional anesthesia (e.g., nerve blocks), and quantity of prescribed narcotics. There is excellent data to guide the use of local and regional anesthesia. There are, however, fewer studies to guide narcotic recommendations; thus, these recommendations were guided by prevailing practice patterns. Conclusions: Pain management practices after breast surgery have significant variation and represent an opportunity to improve patient safety and quality of care. Multimodality approaches in conjunction with standardized quantities of narcotics are recommended

Understanding Parkinson’s Disease (PD) in Ayurvedic Prospective

Parkinson’s disease (PD) known as Kampavata in Ayurveda, is a degenerative neurological disorder of central nervous system, mainly affecting the motor system. It is the major cause of disability in the aging society, which usually affects after the age of 50 years. This disease is increasing in its frequency with the world population showing an incidence of 1-2 per 1000 population and has equal sex distribution. Symptoms like Kampa (Tremor), Stambha (Rigidity), Chestasanga (Bradykinesia and Akinesia), Vakvikriti (disturbance in speech) etc were described in different contexts of Charaka Samhita, Susruta Samhita and Basavarajeeyam. There is no cure for Parkinson’s disease, but medications, surgery and multidisciplinary management can provide relief and improve the quality of life of the individual. In the treatment aspect, the drug L-Dopa has shown better results similarly Ayurvedic drugs having the similar compounds are useful in this disorder. Based on the symptoms manifested, the disease can be correlated to Kampavata mentioned in Ayurveda classics. Despite of so many advances in the field of medicine, treatment of PD remains highly symptomatic. This instills the need for Ayurvedic management of Kampavata. The present article is intended to focus on the Nidana, Lakshanas, Samprapthi and the management principles of Parkinson’s disease (Kampavata)

Is it all about perception? A sustainability viewpoint on psychological capital and life well-being of management graduates

Purpose: Well-being and employability are considered important indicators of a sustainable career that must be incorporated into the system at the beginning of a job. Hence, it is essential to explore the role of positive personal resources to improve young managers' well-being. The unending ambivalence in the academic environment and the job market is detrimental to management graduates' well-being. The study aims to look into the possible intervening methods to enhance the well-being of management students during difficult times. Design/methodology/approach: A cross-sectional study was conducted among 212 management students from Kerala, India. Multi-stage random sampling was used to collect data. Structural equation modelling using IBM-AMOS was done to gain insights into the proposed relationships. Findings: The results indicated that psychological capital had a significant impact on the well-being of management students. Both perceived employability and psychological capital are positively related to life well-being. And, perceived employability mediated the relationship between psychological capital and life well-being. Research limitations/implications: The theoretical contribution comes from the application of the broaden-and-build theory and resource caravans from the conservation of resource theory as a theoretical framework to understand the positive impact of developing psychological capital among university students. The practical contribution comes from identifying a need for universities to make their campus climate more supportive of the non-academic needs of students by supporting them to become more self-reliant and enhance their positive psychological resources. Developing psychological resources of perceived employability and psychological capital is quintessential to enhance life well-being and career sustainability of early careers talent. Originality/value: This study is one of the first attempts to discern how psychological capital leads to an accumulation of psychological resources and life well-being in university students and graduates offering opportunities for career sustainability.</p

Exploring the relationship between self-perceived academic performance and entrepreneurial intention: the moderating roles of serious leisure, perceived stress, and gender

Purpose: drawing on a framework of conservation of resources theory, the purpose of this paper is to explore the relationship between self-perceived academic performance and individual entrepreneurial intention, and consider the potential moderating role of (a) participation in serious leisure, (b) perceived stress, and/or (c) gender.Design/methodology/approach: 405 UK-based undergraduates completed the questionnaire, with a representative gender split of 57% women and 43% men.Findings: The positive relationship between self-perceived academic performance and individual entrepreneurial intention was moderated by serious leisure (stronger when participation in serious leisure increased) and by perceived stress (stronger when levels of perceived stress were lower). However, contrary to our expectations, gender had no statistically significant moderating role.Originality: the theoretical contribution comes from advancing conservation of resources theory, specifically the interaction of personal resources, resource caravans, and resource passageways.Practical implications: the practical contribution comes from informing policy for universities and national governments to increase individual entrepreneurial intention in undergraduates

Clidar Mountain Boundary Layer Case Studies

A CCD Camera Lidar system called the CLidar system images a vertically pointing laser from the side with a spatially separated CCD camera and wide angle optics. The system has been used to investigate case studies of aerosols in mountain boundary layers in in the times following sunset. The aerosols detected by the system demonstrate the wide variation of near ground aerosol structure and capabilities of the CLidar system

Ten‐year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Background: We aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to life-threatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre. Methods: A retrospective study of prospectively collected data was performed over a 14-year period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a pre-MTP group (2002–2006), an MTP-I group (2006–2010) and an MTP-II group (2010–2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused. Results: A total of 168 patients were included: 54 pre-MTP patients were compared to 47 MTP-I and 67 MTP-II patients. In the MTP-II group, fewer units of PRBC and platelets were administered within the first 24 h: 17 versus 14 (P = 0.01) and 12 versus 8 (P < 0.001), respectively. Less infections were noted in the MTP-I group: 51.9% versus 31.9% (P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay. Conclusion: Introduction of an MTP-II in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of real-life medical care in a level 1 civilian trauma centre

Ten-year evolution of a massive transfusion protocol in a level 1 trauma centre: have outcomes improved?

Background: We aimed to evaluate the evolution and implementation of the massive transfusion protocol (MTP) in an urban level 1 trauma centre. Most data on this topic comes from trauma centres with high exposure to life-threatening haemorrhage. This study examines the effect of the introduction of an MTP in an Australian level 1 trauma centre. Methods: A retrospective study of prospectively collected data was performed over a 14-year period. Three groups of trauma patients, who received more than 10 units of packed red blood cells (PRBC), were compared: a pre-MTP group (2002–2006), an MTP-I group (2006–2010) and an MTP-II group (2010–2016) when the protocol was updated. Key outcomes were mortality, complications and number of blood products transfused. Results: A total of 168 patients were included: 54 pre-MTP patients were compared to 47 MTP-I and 67 MTP-II patients. In the MTP-II group, fewer units of PRBC and platelets were administered within the first 24 h: 17 versus 14 (P = 0.01) and 12 versus 8 (P < 0.001), respectively. Less infections were noted in the MTP-I group: 51.9% versus 31.9% (P = 0.04). No significant differences were found regarding mortality, ventilator days, intensive care unit and total hospital lengths of stay. Conclusion: Introduction of an MTP-II in our level 1 civilian trauma centre significantly reduced the amount of PRBC and platelets used during damage control resuscitation. Introduction of the MTP did not directly impact survival or the incidence of complications. Nevertheless, this study reflects the complexity of real-life medical care in a level 1 civilian trauma centre