Kooperativer Bibliotheksverbund

Berlin Brandenburg

and
and

Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
Filter
  • Gruen, Russell L.  (16)
  • Abridged
Type of Medium
Language
Year
  • 1
    Language: English
    In: JAMA, 07 January 2004, Vol.291(1), pp.94-8
    Description: Although leaders and other commentators have called for the medical profession's greater engagement in improving systems of care and population health, neither medical education nor the practice environment has fostered such engagement. Missing have been a clear definition of physicians' public roles, reasonable limits to what can be expected, and familiarity with tasks that are compatible with busy medical practices. We address these issues by proposing a definition and a conceptual model of public roles that require evidence of disease causation and are guided by the feasibility and efficacy of physician involvement. We then frame a public agenda for individual physicians and physician organizations that focuses on advocacy and community participation. By doing so, we aim to stimulate dialogue about the appropriateness of such roles and promote physician engagement with pressing health issues in the public arena.
    Keywords: Bioethics and Professional Ethics ; Health Care and Public Health ; Delivery of Health Care ; Ethics, Medical ; Goals ; Physician'S Role ; Social Responsibility
    ISSN: 00987484
    E-ISSN: 1538-3598
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 2
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1099-1108
    Description: Most surgeons have adopted damage control surgery for severely injured patients, in which the initial operation is abbreviated after control of bleeding and contamination to allow ongoing resuscitation in the intensive-care unit. Developments in early resuscitation that emphasise rapid control of bleeding, restrictive volume replacement, and prevention or early management of coagulopathy are making definitive surgery during the first operation possible for many patients. Improved topical haemostatic agents and interventional radiology are becoming increasingly useful adjuncts to surgical control of bleeding. Better understanding of trauma-induced coagulopathy is paving the way for the replacement of blind, unguided protocols for blood component therapy with systemic treatments targeting specific deficiencies in coagulation. Similarly, treatments targeting dysregulated inflammatory responses to severe injury are under investigation. As point-of-care diagnostics become more suited to emergency environments, timely targeted intervention for haemorrhage control will result in better patient outcomes and reduced demand for blood products. Our Series paper describes how our understanding of the roles of the microcirculation, inflammation, and coagulation has shaped new and emerging treatment strategies.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 3
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1033-1034
    Description: By 2030, road traffic injuries are predicted to be the world's fifth leading cause of death and the third leading cause of disability.1 The Lancet's accompanying Series on trauma surgery updates present knowledge of three broad aspects of acute trauma care: haemorrhagic shock (responsible for most preventable...
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 4
    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
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 5
    Language: English
    In: The Lancet, 22 September 2012, Vol.380(9847), pp.1109-1119
    Description: Musculoskeletal injuries are the most common reason for operative procedures in severely injured patients and are major determinants of functional outcomes. In this paper, we summarise advances and future directions for management of multiply injured patients with major musculoskeletal trauma. Improved understanding of fracture healing has created new possibilities for management of particularly challenging problems, such as delayed union and non union of fractures and large bone defects. Optimum timing of major orthopaedic interventions is guided by increased knowledge about the immune response after injury. Individual treatment should be guided by trading off the benefits of early definitive skeletal stabilisation, and the potentially life-threatening risks of systemic complications such as fat embolism, acute lung injury, and multiple organ failure. New methods for measurement of fracture healing and function and quality of life outcomes pave the way for landmark trials that will guide the future management of musculoskeletal injuries.
    Keywords: Medicine
    ISSN: 0140-6736
    E-ISSN: 1474-547X
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 6
    Language: English
    In: BMJ : British Medical Journal, 19 November 2012, Vol.345
    Description: Tranexamic acid was discovered in the 1950s and has been used during surgery to minimise blood loss. A systematic review evaluated 126 randomised controlled trials in elective surgery and three in emergency surgery (total of 10 488 patients) that had been conducted between 1972 and 2011. This showed that tranexamic acid reduced blood transfusions by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65),4 an effect that persisted when only trials with adequate allocation concealment were considered (0.68, 0.62 to 0.74). In these higher quality trials the effect on mortality was uncertain (0.67, 0.33 to 1.34), as was the effect on myocardial infarction, stroke, and venous thromboembolism.
    Keywords: Change Page
    ISSN: BMJ
    E-ISSN: 1756-1833
    E-ISSN: 17561833
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 7
    In: Journal of Trauma and Acute Care Surgery, 2014, Vol.76(4), pp.1122-1130
    Description: BACKGROUND: There is considerable interest in whether routine whole-body computed tomography (WBCT) imaging produces different patient outcomes in blunt trauma patients when compared with selective imaging. This article aimed to systematically review the literature for all outcomes measured in comparing WBCT with selective imaging in trauma patients and to evaluate the comprehensiveness of relevant dimensions for this comparison. METHODS: We performed a systematic review of studies comparing WBCT and selective imaging approaches during the initial assessment of multitrauma patients. Peer-reviewed studies including cohort studies, randomized controlled trials, meta-analyses, and systematic reviews were identified through large database searches and filtered through methodologic inclusion criteria. Data on study characteristics, hypotheses and conclusions made, outcomes assessed, and references to potential benefits and harms were extracted. RESULTS: Eight retrospective cohort studies and two systematic reviews were identified. Six primary studies evaluated mortality as an outcome, and four studies found a significant difference in results favoring WBCT imaging over selective imaging. All five articles assessing various time intervals in hospital following imaging after injury found significantly reduced times with WBCT. Radiation exposure was found to be increased after WBCT imaging compared with selective imaging in the only study in which it was evaluated. The two systematic reviews analyzed the same three articles with regard to mortality but concluded differently about overall benefits. CONCLUSION: WBCT imaging seems to be associated with reduced times to events in hospital following traumatic injury and seems to be associated with decreased mortality. Whether this is a true effect mediated through an as yet unsubstantiated change in management or the result of hospital- or individual-level confounders is unclear. When evaluating these outcomes, it seems that the authors of both primary studies and systematic reviews have often been selective in their choice of short-term outcomes, painting an incomplete picture of the issue. LEVEL OF EVIDENCE: Systematic review, level III.
    Keywords: Disease Management ; Tomography, X-Ray Computed ; Multiple Trauma -- Diagnostic Imaging ; Whole Body Imaging -- Methods;
    ISSN: 2163-0755
    E-ISSN: 21630763
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 8
    Language: English
    In: JAMA, 22 November 2006, Vol.296(20), pp.2467-75
    Description: Whether physicians have a professional responsibility to address health-related issues beyond providing care to individual patients has been vigorously debated. Yet little is known about practicing physicians' attitudes about or the extent to which they participate in public roles, which we defined as community participation, political involvement, and collective advocacy. To determine the importance physicians assign to public roles, their participation in related activities, and sociodemographic and practice factors related to physicians' rated levels of importance and activity. Mail survey conducted between November 2003 and June 2004 of 1662 US physicians engaged in direct patient care selected from primary care specialties (family practice, internal medicine, pediatrics) and 3 non-primary care specialties (anesthesiology, general surgery, cardiology). Rated importance of community participation, political involvement, collective advocacy, and relevant self-reported activities encompassing the previous 3 years; rated importance of physician action on different issues. Community participation, political involvement, and collective advocacy were rated as important by more than 90% of respondents, and a majority rated community participation and collective advocacy as very important. Nutrition, immunization, substance abuse, and road safety issues were rated as very important by more physicians than were access-to-care issues, unemployment, or illiteracy. Two thirds of respondents had participated in at least 1 of the 3 types of activities in the previous 3 years. Factors independently related to high overall rating of importance (civic-mindedness) included age, female sex, underrepresented race/ethnicity, and graduation from a non-US or non-Canadian medical school. Civic mindedness, medical specialty, practice type, underrepresented race/ethnicity, preceptors of physicians in training, rural practice, and graduation from a non-US or non-Canadian medical school were independently related to civic activity. Public roles are definable entities that have widespread support among physicians. Civic-mindedness is associated primarily with sociodemographic factors, but civic action is associated with specialty and practice-based factors.
    Keywords: Community Participation ; Consumer Advocacy ; Physician'S Role ; Politics ; Public Health
    ISSN: 00987484
    E-ISSN: 1538-3598
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 9
    In: Annals of Surgery, 2012, Vol.256(1), pp.163-169
    Description: OBJECTIVE:: To compare quality improvement (QI) programs of trauma centers in 4 high-income countries. BACKGROUND:: Injury is a leading cause of morbidity and mortality in countries around the world, but patient outcomes vary among countries with similar systems of trauma care. METHODS:: We surveyed medical directors and program managers from 330 trauma centers verified by professional trauma organizations in the United States (n = 263), Canada (n = 46), and Australasia (Australia, n = 18; New Zealand, n = 3) regarding their QI programs. Quality indicators were requested from all centers that measured quality of care. Follow-up interviews were performed with 75 centers purposively sampled across 6 baseline criteria. RESULTS:: A total of 251 centers (76% response rate) responded to the survey, with a similar distribution across countries. Trauma centers in the United States were more likely than those in Canada and Australasia to report measuring quality indicators (100% vs 94% vs 93%, P = 0.008), using report cards (53% vs 33% vs 31%, P = 0.033) and benchmarking (81% vs 61% vs 69%, P = 0.019). Centers in all 3 regions primarily used hospital process and outcome measures designed to establish whether care was safe (98% vs 97% vs 75%, P = 0.008), effective (97% vs 97% vs 92% P = 0.399), timely (88% vs 100% vs 92%, P = 0.055), and efficient (95% vs 100% vs 83%, P = 0.082). QI programs were largely local in nature, used different criteria to identify patients under QI purview, and employed diverse quality indicators and improvement strategies. Few centers evaluated the effectiveness of their QI program. CONCLUSIONS:: This study provides the first international comparison of trauma center QI programs and demonstrates broad implementation in verified trauma centers in the United States, Canada, and Australasia. Significant variation exists in how trauma centers perform QI activities. Opportunities exist for improving and standardizing QI processes.
    Keywords: Quality Improvement ; Trauma Centers -- Standards;
    ISSN: 0003-4932
    E-ISSN: 15281140
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
  • 10
    In: Journal of Trauma and Acute Care Surgery, 2013, Vol.75(4), pp.642-656
    Description: BACKGROUND: Patients with blunt head injury are at high risk of venous thromboembolism. However, pharmacologic thromboprophylaxis (PTP) may cause progression of intracranial hemorrhage, and clinicians must often weigh up the risks and benefits. This review aimed to determine whether adding PTP to mechanical prophylaxis confers net benefit or harm and the optimal timing, dose, and agent for PTP in patients with blunt head injury. METHODS: We searched MEDLINE, EMBASE, The Cochrane Library Central Register of Controlled Trials (CENTRAL), and www.clinicaltrials.gov on April 24, 2013, to identify controlled studies and ongoing trials that assessed the efficacy or safety of thromboprophylaxis interventions in the early management of head-injured patients. Studies were classified based on types of interventions and comparisons, and the quality of included studies was assessed using Cochrane risk-of-bias tool and the Newcastle-Ottawa Quality Assessment Scale. We intended to undertake a meta-analysis if studies were sufficiently similar. RESULTS: Sixteen studies met the inclusion criteria, including four randomized controlled trials. At least two randomized controlled trials were at high risk of bias owing to inadequate randomization and concealment of allocation, and observational studies were potentially confounded by substantial differences between comparison groups. Heterogeneity of included studies precluded meta-analysis. Results were mixed, with some studies supporting and others refuting addition of PTP to mechanical interventions. Little evidence was available about dose or choice of agent. The safety and efficacy of early PTP in patients without early progression of hemorrhage is unclear. CONCLUSION: There is currently insufficient evidence to guide thromboprophylaxis in patients with blunt head injury. Standardized definitions and outcome measurements would facilitate comparison of outcomes across future studies. Studies in mixed populations should report head-injured specific subgroup data. Future randomized controlled trials should investigate the efficacy and safety of early pharmacologic prophylaxis in addition to mechanical intervention. LEVEL OF EVIDENCE: Systematic review, level IV.
    Keywords: Anticoagulants–Adverse Effects ; Head Injuries, Closed–Therapeutic Use ; Humans–Complications ; Treatment Outcome–Drug Therapy ; Venous Thromboembolism–Etiology ; Venous Thromboembolism–Prevention & Control ; Abridged ; Anticoagulants;
    ISSN: 2163-0755
    E-ISSN: 21630763
    Library Location Call Number Volume/Issue/Year Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. Further information can be found on the KOBV privacy pages