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  • Gruen, Russell  (120)
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  • 1
    In: Evidence & Policy: A Journal of Research, August 2014, Vol.10(3), pp.337-359
    Keywords: Systematic Review
    ISSN: 1744-2648
    Source: IngentaConnect
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  • 2
    Language: English
    In: The Lancet, 2011, Vol.377(9771), pp.1052-1054
    Description: Unlike coagulopathy that is secondary to haemodilution, hypothermia, or acidosis, acute traumatic coagulopathy is a hyperacute process in which systemic fibrinolysis releases D-dimers that are detectable within 30 min of injury.5 While the mechanisms are poorly understood, shock and tissue injury seem to be important initiators.6 Not all severely injured patients develop acute coagulopathy, but those who do are much more likely to die and to die early.7 The earlier that tranexamic acid is administered, the more likely it might be to prevent full activation of fibrinolysis. Helicopter and road transport direct to major trauma centres has reduced overall injury mortality, but has extended the time before patients reach hospital.10 Prehospital administration of blood products, especially plasma, is uncommon in civilian settings, resulting in little directed management of coagulopathy.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 3
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1088-1098
    Description: Severe traumatic brain injury remains a major health-care problem worldwide. Although major progress has been made in understanding of the pathophysiology of this injury, this has not yet led to substantial improvements in outcome. In this report, we address present knowledge and its limitations, research innovations, and clinical implications. Improved outcomes for patients with severe traumatic brain injury could result from progress in pharmacological and other treatments, neural repair and regeneration, optimisation of surgical indications and techniques, and combination and individually targeted treatments. Expanded classification of traumatic brain injury and innovations in research design will underpin these advances. We are optimistic that further gains in outcome for patients with severe traumatic brain injury will be achieved in the next decade.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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  • 4
    Language: English
    In: Intensive Care Medicine, 2016, Vol.42(1), pp.3-15
    Description: INTRODUCTIONThe Glasgow Coma Scale (GCS) provides a structured method for assessment of the level of consciousness. Its derived sum score is applied in research and adopted in intensive care unit scoring systems. Controversy exists on the reliability of the GCS. The aim of this systematic review was to summarize evidence on the reliability of the GCS. METHODSA literature search was undertaken in MEDLINE, EMBASE and CINAHL. Observational studies that assessed the reliability of the GCS, expressed by a statistical measure, were included. Methodological quality was evaluated with the consensus-based standards for the selection of health measurement instruments checklist and its influence on results considered. Reliability estimates were synthesized narratively. RESULTSWe identified 52 relevant studies that showed significant heterogeneity in the type of reliability estimates used, patients studied, setting and characteristics of observers. Methodological quality was good (n = 7), fair (n = 18) or poor (n = 27). In good quality studies, kappa values were ≥0.6 in 85%, and all intraclass correlation coefficients indicated excellent reliability. Poor quality studies showed lower reliability estimates. Reliability for the GCS components was higher than for the sum score. Factors that may influence reliability include education and training, the level of consciousness and type of stimuli used. CONCLUSIONSOnly 13% of studies were of good quality and inconsistency in reported reliability estimates was found. Although the reliability was adequate in good quality studies, further improvement is desirable. From a methodological perspective, the quality of reliability studies needs to be improved. From a clinical perspective, a renewed focus on training/education and standardization of assessment is required.
    Keywords: Glasgow Coma Scale ; Glasgow Coma Score ; Grading scales ; Reliability ; Reproducibility of results ; Systematic review
    ISSN: 0342-4642
    E-ISSN: 1432-1238
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  • 5
    Language: English
    In: Journal of Clinical Epidemiology, May 2013, Vol.66(5), pp.496-502.e2
    Description: We present a multistep process for identifying priority research areas in rehabilitation and long-term care of traumatic brain-injured (TBI) patients. In particular, we aimed to (1) identify which stakeholders should be involved; (2) identify what methods are appropriate; (3) examine different criteria for the generation of research priority areas; and (4) test the feasibility of linkage and exchange among researchers, decision makers, and other potential users of the research. Potential research questions were identified and developed using an initial scoping meeting and preliminary literature search, followed by a facilitated mapping workshop and an online survey. Identified research questions were then prioritized against specific criteria (clinical importance, novelty, and controversy). Existing evidence was then mapped to the high-priority questions using usual processes for search, screening, and selection. A broad range of stakeholders were then brought together at a forum to identify priority research themes for future research investment. Using clinical and research leaders, smaller targeted planning workshops prioritized specific research projects for each of the identified themes. Twenty-six specific questions about TBI rehabilitation were generated, 14 of which were high priority. No one method identified all high-priority questions. Methods that relied solely on the views of clinicians and researchers identified fewer high-priority questions compared with methods that used broader stakeholder engagement. Evidence maps of these high-priority questions yielded a number of evidence gaps. Priority questions and evidence maps were then used to inform a research forum, which identified 12 priority themes for future research. Our research demonstrates the value of a multistep and multimethod process involving many different types of stakeholders for prioritizing research to improve the rehabilitation outcomes of people who have suffered TBI. Enhancing stakeholder representation can be augmented using a combination of methods and a process of linkage and exchange. This process can inform decisions about prioritization of research areas.
    Keywords: Prioritization ; Traumatic Brain Injury ; Research Funding ; Evidence Mapping ; Research Gaps ; Rehabilitation ; Medicine
    ISSN: 0895-4356
    E-ISSN: 1878-5921
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  • 6
    Language: English
    In: The Lancet, April 27, 2015, Vol.385, p.S25
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0140-6736(15)60820-0 Byline: Phil Hider, Leona Wilson, John Rose, Thomas G Weiser, Russell Gruen, Stephen W Bickler Abstract: Surgery is a crucial component of health systems, yet its actual contribution has been difficult to define. We aimed to link use of national hospital service with national epidemiological surveillance data to describe the use of surgical procedures in the management of a broad spectrum of conditions. Author Affiliation: (a) Department of Population Health, University of Otago, Christchurch, New Zealand (b) Perioperative Mortality Review Committee, Health Quality and Safety Commission, Wellington, New Zealand (c) Department of Anesthesia, Hutt Valley District Health Board, Lower Hutt, New Zealand (d) Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA (e) Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA (f) Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA (g) The Alfred Hospital and Monash University, Melbourne, VIC, Australia
    Keywords: Mortality – New Zealand ; Prevalence Studies (Epidemiology) – Health Aspects
    ISSN: 0140-6736
    Source: Cengage Learning, Inc.
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  • 7
    Language: English
    In: The Lancet, April 27, 2015, Vol.385, p.S25
    Description: To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/S0140-6736(15)60820-0 Byline: Phil Hider, Leona Wilson, John Rose, Thomas G Weiser, Russell Gruen, Stephen W Bickler Abstract: Surgery is a crucial component of health systems, yet its actual contribution has been difficult to define. We aimed to link use of national hospital service with national epidemiological surveillance data to describe the use of surgical procedures in the management of a broad spectrum of conditions. Author Affiliation: (a) Department of Population Health, University of Otago, Christchurch, New Zealand (b) Perioperative Mortality Review Committee, Health Quality and Safety Commission, Wellington, New Zealand (c) Department of Anesthesia, Hutt Valley District Health Board, Lower Hutt, New Zealand (d) Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA, USA (e) Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA (f) Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA (g) The Alfred Hospital and Monash University, Melbourne, VIC, Australia
    Keywords: Mortality -- New Zealand ; Prevalence Studies (Epidemiology) -- Health Aspects
    ISSN: 0140-6736
    Source: Cengage Learning, Inc.
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  • 8
    Language: English
    In: Journal of Clinical Epidemiology, May 2013, Vol.66(5), pp.503-510.e4
    Description: To identify high-priority research questions for osteoarthritis systematic reviews with consideration of health equity and the social determinants of health (SDH). We consulted with experts and conducted a literature search to identify a priority-setting method that could be adapted to address the health equity and SDH. We selected the Global Evidence Mapping priority-setting method, and through consultations and consensus, we adapted the method to meet our objectives. This involves developing an evidence map of the existing systematic reviews on osteoarthritis; conducting one face-to-face workshop with patients and another one with clinicians, researchers, and patients; and conducting an online survey of patients to rank the top 10 research questions. We piloted the adapted method with the Cochrane Musculoskeletal Review Group to set research priorities for osteoarthritis. Our focus was on systematic reviews: we identified 34 high-priority research questions for osteoarthritis systematic reviews. Prevention and self-management interventions, mainly diet and exercise, are top priorities for osteoarthritis systematic reviews. Evaluation against our predefined objectives showed that this method did prioritize SDH (50% of the research questions considered SDH). There were marked gaps: no high-priority topics were identified for access to care until patients had advanced disease–lifestyle changes once the disease was diagnosed. This method was felt feasible if conducted annually. We confirmed the utility of an adapted priority-setting method that is feasible and considers SDH. Further testing of this method is needed to assess whether considerations of health equity are prioritized and involve disadvantaged groups of the population.
    Keywords: Priority Setting ; Health Equity ; Osteoarthritis ; Social Determinants of Health ; Systematic Reviews ; Methods ; Methodology ; Research Priorities ; Medicine
    ISSN: 0895-4356
    E-ISSN: 1878-5921
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  • 9
    Article
    Article
    Language: English
    In: BMJ Simulation and Technology Enhanced Learning, 03/2017, Vol.3(Suppl 1), pp.S41-S42
    Description: Procedures such as rapid vascular access in relatively simple limb models, resuscitations on more complex whole-body simulators, surgical procedures on live animal models and scenario-based management of mass casualty incidents using human volunteers are widely employed, and it is now hard to imagine the training of a trauma surgeon without them. Furthermore, as trauma specialists are increasingly involved as leaders of integrated trauma systems that aim to ensure the timely provision of life-saving and limb-saving care, other types of modelling and simulation are needed to ensure optimal triage and transport protocols for the severely injured, so that each gets the needed treatment in the shortest time. Figure 3; Virtual Singapore-3D digital platform enabling users from different sectors to develop sophisticated tools and applications for test-bedding concepts and services, planning and decision-making and research on technologies to solve emerging and complex challenges for Singapore.
    Keywords: Thailand ; Bangkok Thailand ; Singapore ; Darzi, Ara Warkes (Lord Darzi) ; Innovations ; Surgeons ; Patient Safety ; Trauma ; Health Care ; Low Income Groups ; Hospitals ; Quality ; Domain Group ; Linden Lab ; Simnovate Supplement;
    ISSN: BMJ Simulation and Technology Enhanced Learning
    E-ISSN: 2056-6697
    Source: CrossRef
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  • 10
    Language: English
    In: The Lancet, 27 April 2015, Vol.385, pp.S25-S25
    Description: BACKGROUND: Surgery is a crucial component of health systems, yet its actual contribution has been difficult to define. We aimed to link use of national hospital service with national epidemiological surveillance data to describe the use of surgical procedures in the management of a broad spectrum of conditions.METHODS: We compiled Australian Modification-International Classification of Diseases-10 codes from the New Zealand National Minimum Dataset, 2008-11. Using primary cause of admission, we aggregated admissions to 91 hospitals into 119 disease states and 22 disease subcategories of the WHO Global Health Estimate (GHE). We queried each admission for any surgical procedure in a binary manner to determine the frequency of admitted patients whose care required surgery. Surgical procedures were defined as requiring general or neuroaxial anaesthesia. We then divided the volume of surgical cases by counts of disease prevalence from the GBD 2010 to determine surgical incidence. This study was approved by the University of Otago Human Ethics Committee (Health; Reference Number HD14/42). Raw data was only handled by coauthors with direct affiliation with the New Zealand Ministry of Health.FINDINGS: Between 2008 and 2011, there were 1 108 653 hospital admissions with 275 570 associated surgical procedures per year. Surgical procedures were associated with admissions for all 22 GHE disease subcategories and 116 of 119 GHE disease states (excluding intestinal nematode infections, iodine deficiency, and vitamin A deficiency). The subcategories with the largest surgical case volumes were unintentional injuries (48 073), musculoskeletal diseases (38 030), and digestive diseases (27 640), and the subcategories with the smallest surgical case volumes were nutritional deficiencies (13), neonatal conditions (204), and infectious and parasitic diseases (982). Surgical incidence ranged widely by individual disease states with the highest in other neurological conditions, abortion, appendicitis, obstructed labour, and maternal sepsis.INTERPRETATION: This study confirms previous research that surgical care is required across the entire spectrum of GHE disease subcategories, showing the crucial role of operative intervention in health systems. Surgical incidence might be useful as an index to estimate the need for surgical procedures in other populations.FUNDING: None.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
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