J Trauma
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Injury patterns and interpretation of injuries in homicidal deaths are important components of medicolegal autopsies. The objective of this article is to describe the incidence of female homicides and their related injury patterns with reference to autopsy practices in South Africa. ⋯ South Africa has a high female homicide rate that exceeds reported rates with the cause of homicide varying by social group. Assessment of injury description suggests weaknesses in the documentation of injuries at autopsy. This weakens the forensic investigation and undermines the strength of evidence presented in court. Further measures are needed to strengthen forensic pathology services in South Africa.
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Our goal was to define risk factors for ventilator-associated pneumonia (VAP) relapse and examine the implications, if any, for initial therapy in trauma patients. ⋯ There is a high rate of VAP relapse associated with primary infection by NFGNB, suggesting initial treatment failure. Trauma patients with primary VAP involving these organisms may benefit from increased surveillance for relapse.
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Multicenter Study Comparative Study
Differences in prescription of narcotic pain medication after operative treatment of hip and ankle fractures in the United States and The Netherlands.
Interactions between American and Dutch surgeons suggested differences in prescription habits for pain medication after fracture treatment. ⋯ American patients are prescribed significantly more inpatient and outpatient narcotic pain medication than Dutch patients after operative treatment of hip and ankle fractures.
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Increased production of red blood cells (RBCs) should be reflected by increased reticulocyte counts (RC). With the introduction of modern fully automated measurements of RC, the recovery of hemoglobin (Hb) after blood loss might be assessed earlier. We investigated the temporal relation of Hb and RC in trauma patients. ⋯ Hb and RC are clearly related in trauma patients. Measuring RC may be helpful in predicting the rise of Hb after acute blood loss.
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Comparative Study
Commitment to COT verification improves patient outcomes and financial performance.
After an unsuccessful American College of Surgery Committee on Trauma visit, our level I trauma center initiated an improvement program that included (1) hiring new personnel (trauma director and surgeons, nurse coordinator, orthopedic trauma surgeon, and registry staff), (2) correcting deficiencies in trauma quality assurance and process improvement programs, and (3) development of an outreach program. Subsequently, our trauma center had two successful verifications. We examined the longitudinal effects of these efforts on volume, patient outcomes and finances. ⋯ A major hospital commitment to Committee on Trauma verification had several salient outcomes; increased admissions, interfacility transfers, and acuity. Despite more seriously injured patients, there has been a major, sustained reduction in mortality and a trend toward decreased intensive care unit length of stay. This resulted in a substantial increase in contribution to margin (CTM), net profit, and revenues. With a high level of commitment and favorable payer mix, trauma center verification improves outcomes for both patients and the hospital.