J Trauma
-
"Implementation research" promotes the systematic conversion of evidence-based principles into routine practice to improve the quality of care. We hypothesized a system-based initiative to reduce nosocomial infection would lower the incidence of ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and bloodstream infection (BSI). ⋯ Over 28 months, a systems approach to reducing nosocomial infection rates after trauma decreased nosocomial infections: UTI (76.3%), BSI (74.1%), and VAP (24.9%). Our experience suggests that infection reduction requires (1) an evidence-based plan; (2) MD and staff education/commitment; (3) electronic documentation; and (4) auditors to monitor and ensure compliance.
-
Although efforts have been made to address disparities in access to trauma care in the past decade, there is little evidence to show if utilization has changed. We use patient-level data to describe the changes in utilization of trauma centers (TCs) in an 8-year period in California. ⋯ Admissions to TCs for all categories of injury severity are increasing. There remains, however, a large disparity in TC care depending on geographical distance and availability of a TC within county.
-
To assess clinical and functional outcomes as well as the relative stability of various configurations of tension band wiring approaches for treating olecranon fractures, a retrospective cohort study was conducted. ⋯ Placement of the ends of Kirschner wires in the proximal ulnar canal should be avoided whenever possible. Because placement of the ends of Kirschner wires through the anterior ulnar cortex may produce serious complications as reported in medical literature, placement of the ends of Kirschner wires in the distal ulnar canal may be the most effective approach.
-
Artifacts produced by metallic fragments and orthopedic hardware limit the usefulness of conventional computed tomography in many military trauma patients. Contemporary literature suggests that multidetector computed tomographic angiography (MDCTA) by resolving these limitations may provide a useful noninvasive alternative to invasive arteriography. The objective of this study is to review the utility of MDCTA in the evaluation of recent combat casualties with vascular injuries. ⋯ MDCTA yielded high resolution images that were very useful for the delayed evaluation of combat casualties. The presence of metallic fragments or orthopedic hardware did not significantly interfere with MDCTA. It is a reliable and promising alternative to traditional arteriography for evaluating clinically occult vascular trauma.