Articles: trauma.
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Case Reports
Disenfranchised grief following a non-fatal road traffic incident: a case study exploring a mother's experience.
This case study explores a scenario that was observed by a final year nursing student on placement in a paediatric emergency department, in a busy London teaching hospital. A mother appeared distressed following the news that her son who had survived a road traffic incident with minimal impact to his cognitive and physical abilities, was stable enough to be transferred to the children's medical ward. Whilst this appeared to be positive for supporting figures in her life and the emergency practitioners involved, observation and discussion with the mother revealed that her distress was related to her experience of losses that were undetected by those around her. ⋯ There are consequences of disenfranchised grief, such as a lack of social support leading to a higher risk of adverse psychological outcomes. Nurses in the emergency department can help resolve negative outcomes for patients and families experiencing disenfranchised grief. The key steps are to have knowledge of disenfranchised grief to be able to detect it, and then to validate it as a form of grief.
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This study determined inter- and intra-observer reliability for measurement of the angles of Böhler and Gissane, for the decision between surgical or conservative management and for the three mostly used classification systems for calcaneal fractures with the use of 2D-CT imaging versus 2D- and 3D-CT imaging. A consecutive series of 38 fractures in 36 patients, treated at a level II trauma centre between 2005 and 2008, were evaluated in two rounds by five observers. We measured the inter- and intraobserver reliability for the Sanders', Zwipp and Essex-Lopresti classification systems using the kappa values as described by Cohen. ⋯ The intraobserver reliability was fair for measurement of the angle of Gissane and it was moderate for the Sanders', Zwipp and Essex-Lopresti classification systems and for the measurement of the angle of Böhler. The addition of three-dimensional CT imaging did not increase inter- and intraobserver reliability for the classification of calcaneal fractures. Authors commented they experienced no additional benefit from 3D-CT imaging for the assessment of calcaneal fractures.
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Prehospital spine immobilization has long been applied to victims of trauma in the United States and up to 5 million patients per year are immobilized mostly with a cervical collar and a backboard. ⋯ The implementation of a SMR training program significantly decreases the use of backboards and allows alternative methods of maintaining spine precautions.
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Alaska's 1049-mile Iditarod Trail Sled Dog Race is the world's longest sled dog race and the flagship event in the sport of sled dog racing. Race conditions are typically harsh. Physicians are not officially enlisted to care for human competitors. Instead, medical needs are met through an informal system of volunteers, local health care providers, and a fleet of bush planes. The goals of this study were to identify the types of human injury and illness experienced and the methods by which these conditions are treated. ⋯ Most injuries and illnesses sustained by mushers in the Iditarod are minor and self-treatable. Life-threatening conditions are rare, and the need for an organized medical care system seems low.