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  • 1
    Language: English
    In: Bulletin of the World Health Organization, April 2004, Vol.82(4), pp.241
    Keywords: International Cooperation ; Interprofessional Relations ; Practice Guidelines As Topic ; Emergency Medical Services -- Standards ; Traumatology -- Standards ; Wounds and Injuries -- Therapy
    ISSN: 0042-9686
    E-ISSN: 15640604
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  • 2
    Language: English
    In: Bulletin of the World Health Organization, 01 August 2016, Vol.94(8), pp.585-598C
    Description: To understand the degree to which the trauma care guidelines released by the World Health Organization (WHO) between 2004 and 2009 have been used, and to identify priorities for the future implementation and dissemination of such guidelines. We conducted a systematic review, across 19 databases, in which the titles of the three sets of guidelines - Guidelines for essential trauma care, Prehospital trauma care systems and Guidelines for trauma quality improvement programmes - were used as the search terms. Results were validated via citation analysis and expert consultation. Two authors independently reviewed each record of the guidelines' implementation. We identified 578 records that provided evidence of dissemination of WHO trauma care guidelines and 101 information sources that together described 140 implementation events. Implementation evidence could be found for 51 countries - 14 (40%) of the 35 low-income countries, 15 (32%) of the 47 lower-middle income, 15 (28%) of the 53 upper-middle-income and 7 (12%) of the 59 high-income. Of the 140 implementations, 63 (45%) could be categorized as needs assessments, 38 (27%) as endorsements by stakeholders, 20 (14%) as incorporations into policy and 19 (14%) as educational interventions. Although WHO's trauma care guidelines have been widely implemented, no evidence was identified of their implementation in 143 countries. More serial needs assessments for the ongoing monitoring of capacity for trauma care in health systems and more incorporation of the guidelines into both the formal education of health-care providers and health policy are needed.
    Keywords: Clinical Protocols ; Guidelines As Topic ; World Health Organization ; Wounds and Injuries -- Therapy
    ISSN: 00429686
    E-ISSN: 1564-0604
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  • 3
    Language: English
    In: World Journal of Surgery, 2012, Vol.36(5), pp.959-963
    Description: Byline: Charles Mock (1), Manjul Joshipura (2), Carlos Arreola-Risa (3), Robert Quansah (4) Abstract: Background Reducing the global burden of injury requires both injury prevention and improved trauma care. We sought to provide an estimate of the number of lives that could be saved by improvements in trauma care, especially in low income and middle income countries. Methods Prior data showed differences in case fatality rates for seriously injured persons (Injury Severity Score aY=9) in three separate locations: Seattle, WA (high income case fatality 35%) Monterrey, Mexico (middle income case fatality 55%) and Kumasi, Ghana (low income case fatality 63%). For the present study, total numbers of injury deaths in all countries in different economic strata were obtained from the Global Burden of Disease study. The number of lives that could potentially be saved from improvements in trauma care globally was calculated as the difference in current number of deaths from trauma in low income and middle income countries minus the number of deaths that would have occurred if case fatality rates in these locations were decreased to the case fatality rate in high income countries. Results Between 1,730,000 and 1,965,000 lives could be saved in low income and middle income countries if case fatality rates among seriously injured persons could be reduced to those in high income countries. This amounts to 34--38% of all injury deaths. Conclusions A significant number of lives could be saved by improvements in trauma care globally. This is another piece of evidence in support of investment in and greater attention to strengthening trauma care services globally. Author Affiliation: (1) Harborview Injury Prevention and Research Center, Harborview Medical Center, University of Washington, 325 Ninth Avenue, P.O. Box 359960, Seattle, WA, 98104, USA (2) Department of Violence and Injury Prevention and Disability, World Health Organization, Geneva, Switzerland (3) School of Medicine, Tecnologico de Monterrey, Monterrey, Mexico (4) Department of Surgery, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Article History: Registration Date: 24/01/2012 Online Date: 15/03/2012
    Keywords: Public Health ; Universities And Colleges;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 4
    Language: English
    In: World journal of surgery, 20 September 2018
    Description: The burden of musculoskeletal conditions is growing worldwide. In low- and middle-income countries (LMIC), the burden cannot be fully estimated, due to paucity of credible data. Further, no attempt has been made so far to estimate surgical burden of musculoskeletal conditions. This is a difficult task and accurate estimation of what would constitute surgical burden out of the total musculoskeletal burden in LMIC is not possible, due to number of constraints. This review looks at current understanding of the musculoskeletal conditions, that can be measured in LMIC and the limitations based on previous studies and past global burden of diseases estimates. An attempt has been made to identify major conditions where a range of surgical burden can be predicted. We conclude that there is huge scope for improvement in the current surveillance mechanism of surgical procedures undertaken for musculoskeletal conditions in LMIC so that the surgical burden can be more accurately predicted. Unless this burden can be highlighted, the attention to these conditions in LMIC will be limited.
    Keywords: Chiropractic Medicine ; Income ; Low Income Groups ; Surgery;
    ISSN: 03642313
    E-ISSN: 1432-2323
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  • 5
    Language: English
    In: Injury, June 2013, Vol.44(6), pp.713-721
    Description: The burden of injury is greatest in developing countries. Trauma systems have reduced mortality in developed countries and trauma registries are known to be integral to monitoring and improving trauma care. There are relatively few trauma registries in developing countries and no reviews describing the experience of each registry. The aim of this study was to examine the collective published experience of trauma registries in developing countries. A structured review of the literature was performed. Relevant abstracts were identified by searching databases for all articles regarding a trauma registry in a developing country. A tool was used to abstract trauma registry details, including processes of data collection and analysis. There were 84 articles, 76 of which were sourced from 47 registries. The remaining eight articles were perspectives. Most were from Iran, followed by China, Jamaica, South Africa and Uganda. Only two registries used the Injury Severity Score (ISS) to define inclusion criteria. Most registries collected data on variables from all five variable groups (demographics, injury event, process of care, injury severity and outcome). Several registries collected data for less than a total of 20 variables. Only three registries measured disability using a score. The most commonly used scores of injury severity were the ISS, followed by Revised Trauma Score (RTS), Trauma and Injury Severity Score (TRISS) and the Kampala Trauma Score (KTS). Amongst the small number of trauma registries in developing countries, there is a large variation in processes. The implementation of trauma systems with trauma registries is feasible in under-resourced environments where they are desperately needed.
    Keywords: Trauma Registry ; Trauma Database ; Trauma Databank ; Developing Countries, Low Income Countries, Middle Income Countries
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 6
    Language: English
    In: Injury, July 2012, Vol.43(7), pp.1148-1153
    Description: The burden of injury is very high in developing countries. Trauma systems reduce mortality; the trauma registry is a key driver of improvements in trauma care. Developing countries have begun to develop trauma systems but the level of local trauma registry activity is unclear. The aim of this study was to determine a global estimate of trauma registry activity. A structured review of the literature was performed. All abstracts referring to a trauma registry over a two-year period were included. For the trauma registry described in each abstract, the source country was recorded. An additional search of web pages posted over a one year period was conducted. Those linked to an active trauma registry website were included and the country of the trauma registry was recorded. A selection of trauma registries from countries of different levels of development were identified and compared. 571 abstracts were included in the review. Most articles utilised “general” trauma registries (436(76%)) and were based at a single hospital (279(49%)). Other registries were limited to military or paediatric populations (36(6%) and 35(6%) articles respectively). Most articles sourced registries from the US (288(50%)), followed by Australia (45(8%)), Germany (32(6%)), Canada (27(5%)), UK (13(2%)), China (13(2%)) and Israel (12(2%)). The Americas produced most trauma registry articles and South East Asia the least. The majority of trauma registry articles originated from very highly developed countries 467(82%). Least developed countries had the fewest (5(1%)). The additional search yielded 37 web pages linked to 27 different trauma registry websites. Most of these were based in the US (16(59%)). The basic features of trauma registries, such as inclusion criteria, number and type of variables and injury severity scoring, varied widely depending on the country's level of development. This review, using a combination of the number of trauma registry articles and web pages to locate active trauma registries, demonstrated the disparity in trauma registry activity between the most and least developed countries. The absence of trauma care information systems remains a challenge to trauma system development globally.
    Keywords: Trauma Registry ; Trauma Database ; Trauma Databank ; Developing Countries ; Low Income Countries ; Middle Income Countries
    ISSN: 0020-1383
    E-ISSN: 1879-0267
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  • 7
    Language: English
    In: Bulletin of the World Health Organization, July 2006, Vol.84(7), pp.507
    Keywords: Disabled Persons ; Emergency Medical Services -- Organization & Administration ; Wounds and Injuries -- Mortality
    ISSN: 0042-9686
    E-ISSN: 15640604
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  • 8
    Language: English
    In: World Journal of Surgery, 2012, Vol.36(8), pp.1978-1992
    Description: Byline: Henry Thomas Stelfox (1), Manjul Joshipura (2), Witaya Chadbunchachai (3), Ranjith N. Ellawala (4), Gerard O'Reilly (5), Thai Son Nguyen (6), Russell L. Gruen (7) Abstract: Background Quality Improvement (QI) programs have been shown to be a valuable tool to strengthen care of severely injured patients, but little is known about them in low and middle income countries (LMIC). We sought to explore opportunities to improve trauma QI activities in LMIC, focusing on the Asia--Pacific region. Methods We performed a mixed methods research study using both inductive thematic analysis of a meeting convened at the Royal Australasian College of Surgeons, Melbourne, Australia, November 21--22, 2010 and a pre-meeting survey to explore experiences with trauma QI activities in LMIC. Purposive sampling was employed to invite participants with demonstrated leadership in trauma care to provide diverse representation of organizations and countries within Asia--Pacific. Results A total of 22 experts participated in the meeting and reported that trauma QI activities varied between countries and organizations: morbidity and mortality conferences (56 %), monitoring complications (31 %), preventable death studies (25 %), audit filters (19 %), and statistical methods for analyzing morbidity and mortality (6 %). Participants identified QI gaps to include paucity of reliable/valid injury data, lack of integrated trauma QI activities, absence of standards of care, lack of training in QI methods, and varying cultures of quality and safety. The group highlighted barriers to QI: limited engagement of leaders, organizational diversity, limited resources, heavy clinical workload, and medico-legal concerns. Participants proposed establishing the Asia--Pacific Trauma Quality Improvement Network (APTQIN) as a tool to facilitate training and dissemination of QI methods, injury data management, development of pilot QI projects, and advocacy for quality trauma care. Conclusions Our study provides the first description of trauma QI practices, gaps in existing practices, and barriers to QI in LMIC of the Asia--Pacific region. In this study we identified opportunities for addressing these challenges, and that work will be supported by APTQIN. Author Affiliation: (1) Department of Critical Care Medicine, Medicine and Community Health Sciences, Institute for Public Health, University of Calgary, Teaching Research & Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada (2) Academy of Traumatology, Ahmedabad, India (3) Khon Kaen Hospital, Khon Kaen, Thailand (4) College of Surgeons, Colombo, Sri Lanka (5) Emergency and Trauma Centre, The Alfred Hospital, Monash University, Melbourne, Australia (6) Duc Giang Hospital, Hanoi, Vietnam (7) The National Trauma Research Institute, The Alfred Hospital, Monash University, Melbourne, Australia Article History: Registration Date: 23/03/2012 Online Date: 13/04/2012
    Keywords: Information Management -- Analysis ; Information Management -- Methods ; Information Management -- Health Aspects ; Universities And Colleges -- Analysis ; Universities And Colleges -- Methods ; Universities And Colleges -- Health Aspects ; Safety Regulations -- Analysis ; Safety Regulations -- Methods ; Safety Regulations -- Health Aspects ; Medical Societies -- Analysis ; Medical Societies -- Methods ; Medical Societies -- Health Aspects ; Public Health -- Analysis ; Public Health -- Methods ; Public Health -- Health Aspects ; Quality Control -- Analysis ; Quality Control -- Methods ; Quality Control -- Health Aspects;
    ISSN: 0364-2313
    E-ISSN: 1432-2323
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  • 9
    Language: English
    In: Bulletin of the World Health Organization, May 2009, Vol.87(5), pp.382-9
    Description: Part of the solution to the growing problem of child injury is to strengthen the care that injured children receive. This paper will point out the potential health gains to be made by doing this and will then review recent advances in the care of injured children in individual institutions and countries. It will discuss how these individual efforts have been aided by increased international attention to trauma care. Although there are no major, well-funded global programmes to improve trauma care, recent guidance documents developed by WHO and a broad network of collaborators have stimulated increased global attention to improving planning and resources for trauma care. This has in turn led to increased attention to strengthening trauma care capabilities in countries, including needs assessments and implementation of WHO recommendations in national policy. Most of these global efforts, however, have not yet specifically addressed children. Given the special needs of the injured child and the high burden of injury-related death and disability among children, clearly greater emphasis on childhood trauma care is needed. Trauma care needs assessments being conducted in a growing number of countries need to focus more on capabilities for care of injured children. Trauma care policy development needs to better encompass childhood trauma care. More broadly, the growing network of individuals and groups collaborating to strengthen trauma care globally needs to engage a broader range of stakeholders who will focus on and champion the improvement of care for injured children.
    Keywords: Disabled Children -- Rehabilitation ; Wounds and Injuries -- Therapy
    ISSN: 00429686
    E-ISSN: 1564-0604
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  • 10
    Language: English
    In: Bulletin of the World Health Organization, August 2005, Vol.83(8), pp.626-31
    Description: Emergency medical care is not a luxury for rich countries or rich individuals in poor countries. This paper makes the point that emergency care can make an important contribution to reducing avoidable death and disability in low- and middle-income countries. But emergency care needs to be planned well and supported at all levels--at the national, provincial and community levels--and take into account the entire spectrum of care, from the occurrence of an acute medical event in the community to the provision of appropriate care at the hospital. The mix of personnel, materials, and health-system infrastructure can be tailored to optimize the provision of emergency care in settings with different levels of resource availability. The misconception that emergency care cannot be cost effective in low-income settings is demonstrably inaccurate. Emergencies occur everywhere, and each day they consume resources regardless of whether there are systems capable of achieving good outcomes. With better planning, the ongoing costs of emergency care can result in better outcomes and better cost-effectiveness. Every country and community can and should provide emergency care regardless of their place in the ratings of developmental indices. We make the case for universal access to emergency care and lay out a research agenda to fill the gaps in knowledge in emergency care.
    Keywords: Developing Countries ; Information Systems ; Emergency Medical Services -- Organization & Administration
    ISSN: 0042-9686
    E-ISSN: 15640604
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