Radiographic arthrosis after elbow trauma : interobserver reliability

Purpose : This study measured observer variation in radiographic rating of elbow arthrosis.

Methods : Thirty-seven independent orthopedic surgeons graded the extent of elbow arthrosis in 20 consecutive sets of plain radiographs, according to the Broberg and Morrey rating system (grade 0, normal joint; grade 1, slight joint-space narrowing with minimum osteophyte formation; grade 2, moderate joint-space narrowing with moderate osteophyte formation; and grade 3, severe degenerative change with gross destruction of the joint). The kappa multirater measure (κ) was used to estimate reliability between observers, with 0 indicating no agreement above chance, and 1 indicating perfect agreement.

Results : There was fair agreement in arthrosis ratings between surgeons. Surgeons with more than 10 years of experience had greater agreement than did surgeons with less experience, and surgeons who treated more than 10 elbow fractures per year had better agreement than did those treating fewer fractures. In post hoc analyses, 2 simplified binary rating systems (eg, “none or mild” vs “moderate or severe” arthrosis) resulted in moderate agreement among observers.

Conclusions : The 4 grades of the Broberg and Morrey classification system have only fair interobserver reliability that is influenced by subspecialty and experience. Binary rating systems might be more reliable.

Spaces of trauma : young people, homelessness and violence

Little contemporary research has examined young people’s experiences ofviolence and homelessness in detail within the Australian context. This articledraws upon qualitative research with 33 homeless youth in Melbourne andseeks to enhance understanding of the impact of violence on young people.It argues that everyday experiences of violence play a central role in shapinghomeless young people’s lived experiences, traumatising young people andviolating any sense of connection and home. It suggests that violence is notonly a causal factor for homelessness, but also exacerbates and prolongs homelessness.

The pornography of trauma : faking identity in misery memoirs

Examining hoax memoirs by James Frey (2003), Dave Pelzer (1995) and Kathy O’Beirne (2006), this paper illustrates how anxieties about the inability of representation to provide a direct access to truth are mitigated via an emotional connection with the text. While the degree of faking varies, each scandal reveals concerns about authenticity and the need to find—or feel—something that can be accepted as unquestionably ‘true’. The mimicking performed by a fake unsettles the boundaries between fact and fiction to reveal a public investment in an undisturbed effect of the real, a willingness to accept a blurring of ‘truth’ in the interests of the sensational experience of literature.

Trauma-related symptoms in Sri Lankan adult survivors after the tsunami: pretraumatic and peritraumatic factors

Limited research has addressed factors associated with psychological distress following disasters among non-Western populations. The 2004 tsunami affected 1.7 million people across South Asia and Africa, with considerable variations in trauma-related outcomes. Pretraumatic and peritraumatic conditions associated with trauma-related symptoms in 305 Sri Lankan adult survivors (28% male, aged 18-83 years; mean = 39.9 years; standard deviation = 15.3), clinically assessed 1 month posttsunami, were evaluated retrospectively. Outcome measures were total scores on 11 trauma-related symptoms. Multivariate linear regression analyses tested for associations between pretraumatic and peritraumatic conditions and symptom scores, with peritraumatic conditions adjusted for pretraumatic variables. Pretraumatic conditions of female gender, employment, prior health and social issues, and substance use and peritraumatic conditions of loss of family, witnessing the tsunami, or suffering an injury were associated with trauma-related symptoms. The findings facilitate understanding cultural contexts that define risk factors associated with trauma-related symptoms in Sri Lankans, which are critical for developing culturally appropriate interventions.

Stylised configurations of trauma: faking identity in Holocaust memoirs

Exploring a series of fraudulent Holocaust memoirs-Herman Rosenblat's Angel at the Fence, Misha Defonseca's Misha: A Mémoire of the Holocaust, Binjamin Wilkomirski's Fragments and Helen Demidenko's The Hand That Signed the Paper-, this paper argues that fakes are not some 'bogus Other' (Ruthven 3) of 'genuine' literature but in fact parodic works that reflect on the tenuous nature of both the past and the notion of self. Indeed, the revelation of a fraudulent memoir exposes the investments of a public culture in notions of the real-firstly, in terms of an authentic identity and secondly, in relation to a genuine literary experience. The Holocaust frauds perpetuated by Rosenblat, Defonseca, Demidenko and Wilkomirski, in exploiting an historical phenomena regarded as sacrosanct, highlight and utilise the commodification of trauma in both public and literary arenas, manipulating discourses of victimhood and authenticity in order to interrogate the boundaries of the real and the unreal and, indeed, to reveal the faultlines in literary culture per se. Less interested in literary classifications, however, than in notions of history and identity, this paper contends that the scandals surrounding fakes are fundamental to understanding anxieties about the connection between word and world, and the strange expectation that literature is able to provide access to something 'true'.

The performance of trauma in moving image art

With reference to recent neurological research into Post-Traumatic Stress Disorder (PTSD) using new imaging technologies and models of implicit and explicit memory systems developed from this research, The Performance of Trauma in Moving ...

The impact of past direct-personal traumatic events on 12-month outcome in first episode psychotic mania: trauma and early psychotic mania

Past traumatic events have been associated with poorer clinical outcomes in people with bipolar disorder. However, the impact of these events in the early stages of the illness remains unclear. The aim of this study was to investigate whether prior traumatic events were related to poorer outcomes 12 months following a first episode of psychotic mania.

The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

Different clinical courses of children exposed to a single incident of psychological trauma: a 30-month prospective follow-up study

We investigated the distinct longitudinal trajectories of posttraumatic stress symptoms in a sample of 167 children, who witnessed death of two mothers of their schoolmates.

A randomised controlled trial of the effectiveness of soft silicone multi-layered foam dressings in the prevention of sacral and heel pressure ulcers in trauma and critically ill patients: The border trial

The prevention of hospital acquired pressure ulcers in critically ill patients remains a significant clinical challenge. The aim of this trial was to investigate the effectiveness of multi-layered soft silicone foam dressings in preventing intensive care unit (ICU) pressure ulcers when applied in the emergency department to 440 trauma and critically ill patients. Intervention group patients (n = 219) had Mepilex^® Border Sacrum and Mepilex^® Heel dressings applied in the emergency department and maintained throughout their ICU stay. Results revealed that there were significantly fewer patients with pressure ulcers in the intervention group compared to the control group (5 versus 20, P = 0·001). This represented a 10% difference in incidence between the groups (3·1% versus 13·1%) and a number needed to treat of ten patients to prevent one pressure ulcer. Overall there were fewer sacral (2 versus 8, P = 0·05) and heel pressure ulcers (5 versus 19, P = 0·002) and pressure injuries overall (7 versus 27, P = 0·002) in interventions than in controls. The time to injury survival analysis indicated that intervention group patients had a hazard ratio of 0·19 (P = 0·002) compared to control group patients. We conclude that multi-layered soft silicone foam dressings are effective in preventing pressure ulcers in critically ill patients when applied in the emergency department prior to ICU transfer.