J Trauma
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A variety of policy groups recommend that screening and brief intervention (SBI) programs for alcohol-use disorders be widely implemented in health care settings. This article reports the extent to which trauma surgeons support SBI programs and the feasibility of implementing these programs in trauma centers. ⋯ Most trauma surgeons supported alcohol screening and interventions. Preliminary data showed that one half-time research assistant at each facility could successfully screen most injured patients and implement brief interventions. An alcohol screening and brief intervention program seems feasible in any trauma center committed to implementation.
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Multicenter Study
Damage control orthopedics in patients with multiple injuries is effective, time saving, and safe.
Although early fracture fixation is expedient in patients with multiple injuries, early total care (ETC) may be associated with posttraumatic systemic complications. This study was conducted to prospectively evaluate the concept of damage control by immediate external fracture fixation (damage control orthopedics [DCO]) and consecutive conversion osteosynthesis with regard to time savings, effectiveness, and safety. ⋯ DCO appears to provide a major reduction of operation time and blood loss in the primary treatment period in severely injured patients compared with h-ETC. In addition, we found that DCO is not associated with an increased rate of procedure-related complications. So far, DCO with early and one-stage conversion seems to be a safe strategy of primary fracture treatment in patients with multiple injuries.
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Randomized Controlled Trial Multicenter Study Comparative Study
Prone positioning improves oxygenation in post-traumatic lung injury--a prospective randomized trial.
In a prospective randomized trial the effect of prone positioning on the duration of mechanical ventilation was evaluated in multiple trauma patients and was compared with patients ventilated in supine position. ⋯ Intermittent prone positioning was not able to reduce the duration of mechanical ventilation in this limited number of patients. However the oxygenation improved significantly over the first four days of treatment, and the prevalence of ARDS and pneumonia were reduced.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials.
Uncontrolled bleeding is a leading cause of death in trauma. Two randomized, placebo-controlled, double-blind trials (one in blunt trauma and one in penetrating trauma) were conducted simultaneously to evaluate the efficacy and safety of recombinant factor VIIa (rFVIIa) as adjunctive therapy for control of bleeding in patients with severe blunt or penetrating trauma. ⋯ Recombinant FVIIa resulted in a significant reduction in RBC transfusion in severe blunt trauma. Similar trends were observed in penetrating trauma. The safety of rFVIIa was established in these trauma populations within the investigated dose range.
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Multicenter Study Comparative Study
Trauma base knowledge and the effect of the trauma evaluation and management program among senior medical students in seven countries.
We compared base trauma knowledge and the impact of the Trauma Evaluation and Management (TEAM) program among senior medical students in seven countries. ⋯ Base trauma knowledge in these students, though variable, was generally very low and improved with TEAM. Our data suggest a need for greater undergraduate emphasis in trauma education.