Illinois violent injury reporting, 2005.

Explains the legal mandate, reporting requirements, and other details of the Illinois Dept. of Public Health's statistical registry (started in March 1998) of victims of violent injuries in Illinois.

Elements of surgery, for the use of students.

Added t.p.

Treatment of chemical warfare casualties /

Includes index.

Thoracic surgery.

Includes bibliographies.

In the wake of trauma

Mode of access: Internet.

Community-based programs to promote care seat restraints in children 0-16 years - A systematic review

Study Objective: Community-based models for injury prevention have become an accepted part of the overall injury control strategy. This systematic review of the scientific literature examines the evidence for their effectiveness in reducing injury due to inadequate car seat restraint use in children 0-16 years of age. Methods: A comprehensive search of the literature was performed using the following study selection criteria: community-based intervention study: target population was children aged 0-16 years of age; outcome measure was either injury rates due to motor vehicle crashes or observed changes in child restraint use; and use of community control or historical control in the study design. Quality assessment and data abstraction was guided by a standardized procedure and performed independently by two authors. Data synthesis was in tabular and text form with meta-analysis not being possible due to the discrepancy in methods and measures between the studies. Results: This review found eight studies, that met all the inclusion criteria. In the studies that measured injury outcomes, significant reductions in risk of motor vehicle occupant injury (33-55%) were reported in the study communities. For those studies reporting observed car seat restraint use the community-based programs were successful in increasing toddler restraint use in 1-5 year aged children by up to 11%; child booster seat use in 4-8 year aged children by up to 13%; rear restraint use in children aged 0-15 years by 8%; a 50% increase in restraint use in pre-school aged children in a high-risk community; and a 44% increase in children aged 5-11 years. Conclusion: While this review highlights that there is some evidence to support the effectiveness of community-based programs to promote car restraint use and/or motor vehicle occupant injury, limitations in the evaluation methodologies of the studies requires the results to be interpreted with caution. There is clearly a need for further high quality program evaluation research to develop an evidence base. (C) 2004 Elsevier Ltd. All rights reserved.

Utilização de plantas medicinais no tratamento de feridas : perfil do stryphnodendron barbatiman

Introdução – O recurso à utilização de plantas com fins terapêuticos, é uma das mais antigas formas de prática medicinal da humanidade, sobretudo por parte da população de países menos desenvolvidos, que ainda hoje, segundo a Organização Mundial de Saúde, recorre, em muitas situações, à utilização das plantas medicinais como a única forma de acesso aos cuidados básicos de saúde. Porém, e apesar do advento da medicina moderna, que se correndo do avanço da biotecnologia, por meio da qual as plantas, consideradas medicinais, podem ter seu potencial terapêutico aprovado pela ciência para fins medicamentosos, uma parte significativa da comercialização de plantas medicinais continua a não ser feita em farmácias ou lojas de produtos naturais, mas sim comercializadas em feiras livres, pelos chamados raizeiros. Partindo deste enquadramento, os objetivos centrais desta investigação foram: identificar quais as espécies de plantas medicinais mais indicadas por comerciantes, raizeiros, no tratamento de feridas e que são comercializadas nas mais importantes feiras livres da cidade de Maceió, e caracterizar a fonte de conhecimento desses raizeiros, em relação às mesmas. Métodos – Realizou-se um estudo que seguiu os pressupostos de uma pesquisa de natureza qualitativa, de matriz transversal, com recurso a uma amostra não probabilística, acidental e por conveniência constituída por 26 raizeiros, na sua maioria pertencentes ao do grupo etário dos 37-52 anos (46,14%), que desenvolvem a atividade comercial de plantas medicinais como sua única e/ou principal atividade produtiva (76,90%), e em que 50% são do sexo feminino. Como instrumento de recolha de dados recorreu-se à entrevista, a partir de convites efectuados pela autora do estudo na sequência da realização de visitas às principais feiras livres da cidade de Maceió-AL. Resultados – Os dados recolhidos pela totalidade das entrevistas permitiram constatar que o barbatimão (Stryphnodendron barbatiman) é a planta mais frequentemente indicada para o tratamento em feridas, logo seguida da Aroeira (MyracrodruonurundeuvaLâmina), e da Sambacaitá (Hyptis pectinata). As menos recomendadas são a Garra do Diabo (Harpagophytum procubens); a Jatobá (Hymenae acourbaril L.) e a Babosa (Aloe arborescens). A maioria dos raizeiros afirmaram também que recomendavam a “casca” e a “entre casca” como a forma farmacêutica mais eficaz. Em relação à aprendizagem/ conhecimento sobre a utilização medicinal do barbatimão (Stryphnodendron barbatiman): 69,3% dos raizeiros entrevistados afirmaram ter aprendido com familiares; 19,2 com amigos e 11,5% através de conversas com outros comerciantes do mesmo ramo de negócio. Cem por cento dos entrevistados afirmaram que o Stryphnodendron barbatiman, independetemente de ser a planta mais recomendada pelos raizeiros, é a planta mais procurada pela população e, que segundo a mesma, é a que apresenta um melhor resultado. Apenas 50% dos entrevistados refere que o barbatimão é armazenado seco e ensacado, e quanto questionados sobre a validade do mesmo, 69,3% dos raizeiros afirmaram que esse prazo é indeterminado. Quanto à duração da “terapia” pelo barbatimão, 100% dos raizeiros entrevistados, afirmaram que deve permanecer durante o tempo que o paciente ou o profissional de saúde que estiver acompanhando o caso, julgar necessário. Conclusões – Os resultados deste estudo vêm confirmar que o recurso à utilização de plantas com fins terapêuticos no tratamento de feridas, por parte da população brasileira, continua sendo muito usual, sendo o barbatimão (Stryphnodendron barbatimam) o mais indicado e conhecido pela cultura popular. Nesse sentido é relevante que, por um lado, o profissional de enfermagem, procure entender a utilização dessa planta medicinal, popularmente utilizada, com afirmativa de êxito, no tratamento de feridas, e por outro, entendemos ser necessária a realização de estudos multidisciplinares que permitam a ampliação e a profundidade dos conhecimentos das plantas medicinais, como agem, quais são os seus efeitos tóxicos e colaterais, e quais as suas verdadeiras indicações terapêuticas. Palavras-chave: Plantas Medicinais, Ferimentos e lesões, Tratamento, Enfermagem, Raizeiros.

Les lésions de l'intestin grêle et du côlon dans les traumatismes fermés de l'abdomen [Lesions of the small intestine and colon in blunt injuries of the abdomen].

Between 1976 and 1991, we observed lesions of the small bowel or colon in 39 patients having sustained blunt abdominal trauma. 70% of the patients presented with concomitant injuries. Except for 3 cases, all the patients presented with abdominal pain on admission. All the patients were operated on. The delay between admission and operation varied between a few minutes and 48 hours. Indication was hemoperitoneum, peritonitis or progressive abdominal pain. Overall morbidity is high, often related to associated disease. 4 patients died (mortality 10%), including 2 patients with isolated intestinal trauma who were operated on after 20 and 36 hours. Due to the lack of specific laboratory or X-ray test, we suggest a high index of suspicion for bowel lesions in blunt abdominal trauma, especially in unconscious patients. Close observation is mandatory. Indication for laparotomy must not be delayed if any doubt exists regarding the integrity of hollow viscus.

Diagnosis of intra-abdominal injuries can be challenging in multitrauma patients with associated injuries. Our experience and review of the literature

ntroduction. Trauma is the most common cause of death and disability among patients during the first four decades of life. Abdominal trauma is reported to be the 3rd most common injured region. Clinical examination may be unreliable in the evaluation of these patients especially in the presence of associated injuries. Therefore the use of diagnostic tools is essential in the management of the injured patient with abdominal trauma and additional injuries. Patients and Methods. During 1 year period from December 2010 to November 2011 we recorded the patients that presented to the emergency department of our hospital and were found to suffer from intra-abdominal injuries. These patients were divided in two groups depending on whether they had additional comorbid injuries or not. Several parameters were recorded and compared between the two groups, such as mechanism of injury, general status and hemodynamic stability of the patient on presentation, physical examination, use of imaging modalities and concomitant findings, need for surgical intervention and mortality rates. Furthermore the discrepancy between physical findings and final diagnosis after the use of diagnostic adjuncts is reported. Results. We recorded 31 patients with abdominal trauma. 13 (42%) patients were found to suffer from abdominal trauma and associated injuries (Group I), whereas 18 (58%) presented with abdominal trauma alone (Group II). The patients of the first group presented hemodynamic instability in 38% of cases while the patients of the second in 22% of cases. Reduced consciousness was present in 38% in group I versus 17% in group II. Signs of abdominal injury during clinical examination were present in only 15% in group I versus 72% in group II that represented a remarkable difference between the two groups. Conservative treatment was possible in 15% of patients with additional injuries and in 22% of patients with abdominal injury alone. In group I there were two deaths whereas in group II all patients survived. Conclusion. In patients with abdominal trauma, associated injuries seem to add to the severity of injury and indicate a worse prognosis. Clinical examination is unreliable and misleading in the majority of these patients and the use of diagnostic tools cannot be overemphasized.

Acupuncture and rehabilitation of the painful shoulder: study protocol of an ongoing multicentre randomised controlled clinical trial [ISRCTN28687220]

BACKGROUND Although the painful shoulder is one of the most common dysfunctions of the locomotor apparatus, and is frequently treated both at primary healthcare centres and by specialists, little evidence has been reported to support or refute the effectiveness of the treatments most commonly applied. According to the bibliography reviewed, physiotherapy, which is the most common action taken to alleviate this problem, has not yet been proven to be effective, because of the small size of sample groups and the lack of methodological rigor in the papers published on the subject. No reviews have been made to assess the effectiveness of acupuncture in treating this complaint, but in recent years controlled randomised studies have been made and these demonstrate an increasing use of acupuncture to treat pathologies of the soft tissues of the shoulder. In this study, we seek to evaluate the effectiveness of physiotherapy applied jointly with acupuncture, compared with physiotherapy applied with a TENS-placebo, in the treatment of painful shoulder caused by subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). METHODS/DESIGN Randomised controlled multicentre study with blind evaluation by an independent observer and blind, independent analysis. A study will be made of 465 patients referred to the rehabilitation services at participating healthcare centres, belonging to the regional public health systems of Andalusia and Murcia, these patients presenting symptoms of painful shoulder and a diagnosis of subacromial syndrome (rotator cuff tendinitis and subacromial bursitis). The patients will be randomised into two groups: 1) experimental (acupuncture + physiotherapy); 2) control (TENS-placebo + physiotherapy); the administration of rescue medication will also be allowed. The treatment period will have a duration of three weeks. The main result variable will be the change produced on Constant's Shoulder Function Assessment (SFA) Scale; as secondary variables, we will record the changes in diurnal pain intensity on a visual analogue scale (VAS), nocturnal pain intensity on the VAS, doses of non-steroid anti-inflammatory drugs (NSAIDs) taken during the study period, credibility scale for the treatment, degree of improvement perceived by the patient and degree of improvement perceived by the evaluator. A follow up examination will be made at 3, 6 and 12 months after the study period has ended. Two types of population will be considered for analysis: per protocol and per intention to treat. DISCUSSION The discussion will take into account the limitations of the study, together with considerations such as the choice of a simple, safe method to treat this shoulder complaint, the choice of the control group, and the blinding of the patients, evaluators and those responsible for carrying out the final analysis.

Cardiac injuries in blunt chest trauma

Blunt chest traumas are a clinical challenge, both for diagnosis and treatment. The use ofCardiovascular Magnetic Resonance can play a major role in this setting. We present two cases: a12-year-old boy and 45-year-old man. Late gadolinium enhancement imaging enabled visualizationof myocardial damage resulting from the trauma.

Do orthopaedic shoes improve local dynamic stability of gait? An observational study in patients with chronic foot and ankle injuries.

BACKGROUND: Complex foot and ankle fractures, such as calcaneum fractures or Lisfranc dislocations, are often associated with a poor outcome, especially in terms of gait capacity. Indeed, degenerative changes often lead to chronic pain and chronic functional limitations. Prescription footwear represents an important therapeutic tool during the rehabilitation process. Local Dynamic Stability (LDS) is the ability of locomotor system to maintain continuous walking by accommodating small perturbations that occur naturally during walking. Because it reflects the degree of control over the gait, LDS has been advocated as a relevant indicator for evaluating different conditions and pathologies. The aim of this study was to analyze changes in LDS induced by orthopaedic shoes in patients with persistent foot and ankle injuries. We hypothesised that footwear adaptation might help patients to improve gait control, which could lead to higher LDS: METHODS: Twenty-five middle-aged inpatients (5 females, 20 males) participated in the study. They were treated for chronic post-traumatic disabilities following ankle and/or foot fractures in a Swiss rehabilitation clinic. During their stay, included inpatients received orthopaedic shoes with custom-made orthoses (insoles). They performed two 30s walking trials with standard shoes and two 30s trials with orthopaedic shoes. A triaxial motion sensor recorded 3D accelerations at the lower back level. LDS was assessed by computing divergence exponents in the acceleration signals (maximal Lyapunov exponents). Pain was evaluated with Visual Analogue Scale (VAS). LDS and pain differences between the trials with standard shoes and the trials with orthopaedic shoes were assessed. RESULTS: Orthopaedic shoes significantly improved LDS in the three axes (medio-lateral: 10% relative change, paired t-test p < 0.001; vertical: 9%, p = 0.03; antero-posterior: 7%, p = 0.04). A significant decrease in pain level (VAS score -29%) was observed. CONCLUSIONS: Footwear adaptation led to pain relief and to improved foot & ankle proprioception. It is likely that that enhancement allows patients to better control foot placement. As a result, higher dynamic stability has been observed. LDS seems therefore a valuable index that could be used in early evaluation of footwear outcome in clinical settings.