Epidemiology and outcomes of geriatric trauma patients consulting at the center hospitalier universitaire de Kigali emergency department

Background Life expectancy in low- and middle-income countries (LMIC) continues to rise, resulting in a growing geriatric population. In Rwanda, a sub-Saharan LMIC, traumatic injuries are a common cause of mortality and morbidity. However, little is known about the frequency and type of traumatic injuries among geriatric populations in Rwanda. Objective We explored the epidemiology and outcomes of trauma for geriatric patients presenting to the emergency department (ED) of the center Hospitalier Universitaire de Kigali (CHUK) in Rwanda. Methods This prospective cross-sectional study was conducted from July 2019 to January 2020 at the ED of CHUK. Trauma patients aged 65 and above and alive at the time of evaluation were eligible for inclusion. Demographic characteristics were collected along with triage category, mechanism of injury, transfer status, transport method to CHUK, time spent at the ED, complications, and mortality predictors. Results For the 100 patients enrolled, the most common injury mechanism was falls (63%), followed by road traffic accidents (28%). The majority of patients spent less than 48 h in the ED (63%). The mortality rate was 14%, with most deaths resulting from injury-related complications. Triage category, Kampala Trauma Score, and Glasgow Coma Scale were significant predictors of mortality, with p-values of 0.002, <0.001, and <0.001, respectively. Conclusions The epidemiology of geriatric trauma found in this study can inform public health and clinical guidelines. Interventions targeting falls and road traffic accidents would target the most common geriatric trauma mechanisms, and clinical protocols that take into account predictors of mortality could improve outcomes and increase life expectancy for this population.

Application of dynamic case scenario simulation combined with video playback method in the teaching of trauma emergency for nursing students in practice / 中华医学教育探索杂志

Objective:To explore the application effect of dynamic case scenario simulation combined with video playback in the teaching of trauma emergency for nursing interns.Methods:A total of 80 nursing interns who had internship in the Department of Emergency, The First Affiliated Hospital of Guangzhou Medical University from December 2017 to November 2018 were recruited in the study, and they were randomly divided into experimental group and control group (40 nurses per group). The dynamic case scenario simulation combined with video playback method was applied in the experimental group, and the traditional teaching method was used in the control group. Both groups had the same teaching hours (8 class hours) and trauma practice outline. Trauma theoretical knowledge and operational skills of the two groups were assessed, and the scores of nursing students in the two groups, teaching satisfaction and teaching evaluation in the experimental group were analyzed. SPSS 19.0 was used for t test. Results:The trauma theoretical knowledge assessment results and clinical operation skills assessment scores of control group were (73.40±7.11) points and (78.69±8.71) points, respectively, and those of experimental group were (78.09±6.84) points and (85.34±6.43) points respectively, with a statistical difference between the two groups ( P<0.05). The overall satisfaction of nursing students in the experimental group was higher than that in the control group [(98.34±2.19) vs. (94.94±2.58), P<0.01]. Most of nursing students (97.5%, 39/40) in the experimental group hoped to apply dynamic case scenario simulation combined with video playback method in the future. Conclusion:The dynamic case scenario simulation combined video playback method could enhance the trauma emergency ability of the nursing interns and improve the teaching satisfaction and teaching effect.

A broad-spectrum beta-lactam-sparing stewardship program in a middle-income country public hospital: antibiotic use and expenditure outcomes and antimicrobial susceptibility profiles

ABSTRACT Background: Antimicrobial stewardship programs are an efficient way to reduce inappropriate use of antimicrobials and costs; however, supporting data are scarce in middle-income countries. The aim of this study was to evaluate antibiotic use, bacterial susceptibility profiles, and the economic impact following implementation of a broad-spectrum beta-lactam-sparing antimicrobial stewardship program. Methods: An interrupted time-series analysis was performed to evaluate antibiotic use and expenditure over a 24-month period (12 months before the antimicrobial stewardship program and in the 12 months after implementation of the antimicrobial stewardship program). Antibiotics were classified into one of two groups: beta-lactam antibiotics and beta-lactam-sparing antibiotics. We also compared the antimicrobial susceptibility profiles of key pathogens in each period. Results: Beta-lactam antibiotics use decreased by 43.04 days of therapy/1000 patient-days (p = 0.04) immediately following antimicrobial stewardship program implementation, whereas beta-lacta-sparing antibiotics use increased during the intervention period (slope change 6.17 days of therapy/1000 patient-days, p < 0.001). Expenditure decreased by $2089.99 (p < 0.001) immediately after intervention and was maintained at this level over the intervention period ($−38.45; p = 0.24). We also observed that a greater proportion of pathogens were susceptible to cephalosporins and aminoglycosides after the antimicrobial stewardship program. Conclusions: The antimicrobial stewardship program significantly reduced the use of broad-spectrum beta-lactam-antibiotics associated with a decrease in expenditure and maintenance of the susceptibility profile in Gram-negative bacteria.

Construction and application of information platform for pre-hospital and in-hospital synergic treatment in trauma emergency center / 中华创伤杂志

In order to provide timely and effective treatment and reduce the rate of death and disability for trauma patients,the National Health Construction Commission issued a document to promote the construction of trauma centers and achieve centralized hospitalization for trauma patients.Pre-hospital first aid is the most important part of the modem emergency medical system,and it is especially important for the successful treatment of trauma patients.In order to achieve close coordination,efficient docking,emergency clinic advancement in the front yard,and improve the success rate of trauma patients,Nanchang Emergency Center proposed an integrated treatment mode for pre-hospital first aid and trauma emergency center,and developed a pre-hospital collaborative treatment information platform.The authors explore the application of the information platform in the integrated treatment mode of pre-hospital first aid and trauma emergency center and realize information sharing in the front yard of trauma patients,prehospital teleconsultation and seamless docking in the front yard,so as to provide a foundation for fast,efficient and full-coverage medical treatment system for trauma.

Construction and application of information platform for pre-hospital and in-hospital synergic treatment in trauma emergency center / 中华创伤杂志

In order to provide timely and effective treatment and reduce the rate of death and disability for trauma patients, the National Health Construction Commission issued a document to promote the construction of trauma centers and achieve centralized hospitalization for trauma patients. Pre-hospital first aid is the most important part of the modern emergency medical system, and it is especially important for the successful treatment of trauma patients. In order to achieve close coordination, efficient docking, emergency clinic advancement in the front yard, and improve the success rate of trauma patients, Nanchang Emergency Center proposed an integrated treatment mode for pre-hospital first aid and trauma emergency center, and developed a pre-hospital collaborative treatment information platform. The authors explore the application of the information platform in the integrated treatment mode of pre-hospital first aid and trauma emergency center and realize information sharing in the front yard of trauma patients, pre-hospital teleconsultation and seamless docking in the front yard, so as to provide a foundation for fast, efficient and full-coverage medical treatment system for trauma.