Aims:We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate injury pattern with clinical course and outcome.Materials and Methods:Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications.Results:There were 41 patients, 25 (61%) male, with a median age of 26 years. Median injury severity score (ISS) was 25 (range 6–66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from injury to surgery. Median time to surgery for the immediate group (n = 12) was 1.05 h, early group (n = 22) was 2.7 h, and delayed group (n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality (P < 0.01) and morbidity compared with patients with the “classic” bowel injury pattern associated with a typical seatbelt sign.Conclusion:Our data suggest that there is a cohort of patients with seatbelt injury who have solid organ injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.
Background Following combat-related, extensive soft tissue injury from gunshot wounds or blasts, prolonged duration from injury to full wound closure is associated with infection, increased morbidity and mortality, failure to mobilize, poor functional outcome and increased cost. The purpose of this study was to evaluate a novel treatment enabling early primary closure of combat wounds. Methods This was a retrospective study of 10 soldiers and civilians with extensive combat-related soft tissue limb injuries (5 gunshot wounds, 5 blasts) treated using the TopClosure® Tension Relief System (TRS) with simultaneous administration of regulated oxygen-enriched and irrigation negative pressure-assisted wound therapy (ROINPT) via the Vcare α® device. Results Nine patients were treated during the acute phase of injury and one was treated following removal of a flap due to deep infection 20 years after injury and flap reconstruction. Two patients had upper limb injury and the rest lower limb injury. With the aid of the TRS and/or ROINPT, immediate primary closure during reconstruction was achieved in 6 patients and delayed primary closure in three. Only one patient required a skin graft to close a small area of the wound after most of the wound had been closed by delayed primary closure. Wound closure was achieved within 0–37 days (median: 12.5 days, interquartile range: 2.75–19.75) from injury. Conclusions The TRS is a novel device for effective, early skin stretching and secure wound closure through the application of stress relaxation and mechanical creep, achieving primary closure of large defects using a simplified surgical technique and reducing the need for closure using skin grafts and flaps and the use of tissue expanders. Delivering supplemental oxygen to the wound by ROINPT reverses the reduced oxygen levels inherent in conventional negative pressure-assisted wound therapy, mitigating anaerobic contamination and reducing infection. Irrigation may accelerate the evacuation of infectious material from the wound and provide a novel method for antibiotic administration. The combination of TRS and ROINPT devices allow for early primary closure with improved functionality of combat-related limb injuries.
The experience of the care of patients across a hostile border has been unprecedented. Hospital protocols required adjustment to deliver quality clinical and social care to patients suffering from both the acute and chronic effects of civil war.
Introduction: The standardization of global health education and assessment remains a significant issue among global health educators. This paper explores the role of multiple choice questions (MCQs) in global health education: whether MCQs are appropriate in written assessment of what may be perceived to be a broad curriculum packed with fewer facts than biomedical science curricula; what form the MCQs might take; what we want to test; how to select the most appropriate question format; the challenge of quality item-writing; and, which aspects of the curriculum MCQs may be used to assess.Materials and Methods: The Medical School for International Health (MSIH) global health curriculum was blue-printed by content experts and course teachers. A 30-question, 1-h examination was produced after exhaustive item writing and revision by teachers of the course. Reliability, difficulty index and discrimination were calculated and examination results were analyzed using SPSS software.Results: Twenty-nine students sat the 1-h examination. All students passed (scores above 67% - in accordance with University criteria). Twenty-three (77%) questions were found to be easy, 4 (14%) of moderate difficulty, and 3 (9%) difficult (using examinations department difficulty index calculations). Eight questions (27%) were considered discriminatory and 20 (67%) were non-discriminatory according to examinations department calculations and criteria. The reliability score was 0.27.Discussion: Our experience shows that there may be a role for single-best-option (SBO) MCQ assessment in global health education. MCQs may be written that cover the majority of the curriculum. Aspects of the curriculum may be better addressed by non-SBO format MCQs. MCQ assessment might usefully complement other forms of assessment that assess skills, attitude and behavior. Preparation of effective MCQs is an exhaustive process, but high quality MCQs in global health may serve as an important driver of learning.
Background: Adolescent injuries and fatalities constitute a world health concern and present a major public health burden. Of all childhood injuries in Israel 61.8% occur during road traffic crashes. The risk of being injured or killed in a road traffic crash is especially high among individuals deemed to have a low socio-economic status, but, there also exist crucial risk factors for road traffic crashes that are intrinsic social determinants of health, including behavior, lifestyle, education and employment. These associations are explored in this study.Aim: To examine the contribution of socioeconomic inequalities to the incidence of road traffic crashes among adolescents living in the Galilee and the Golan.Methods: A large retrospective study of trauma records (N = 3293) of 15–20-year-old patients who were injured in road traffic crashes and admitted to Ziv Medical Center between 2004 and 2015 was performed. These patients were subcategorized according to their home address. Using census data and other databases associations between socioeconomic inequalities, intrinsic social determinants and the prevalence of road crashes were investigated.Results: Road traffic crashes in the Galilee and the Golan are more frequent among residents of low socioeconomic areas. Fifty-five percent of drivers are from the areas of lowest socioeconomic level (levels 2 to 4) and are responsible for 60% of the road traffic injuries admitted to Ziv Medical Center (p < 0.001). In contrast, 42% of drivers are from areas of medium socioeconomic level (levels 5 and 6) but are responsible for only 35% of road traffic injuries (p < 0.001). Young women in the Galilee and the Golan are less likely to be involved in road traffic crashes−35.8% compared to 64.2% in young men.Conclusions: This research has shown that youth, male gender, socioeconomic status, education level and the quality of road infrastructure are important factors in the incidence of road traffic crashes in the Galilee and the Golan. This should be taken into consideration by policy makers in order to develop appropriate interventions in road safety targeted at multiple levels.
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