Navegando por Palavras-chave "Traumatology"
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- ItemAcesso aberto (Open Access)Adesão a protocolo de atendimento do trauma pediátrico em um centro de trauma brasileiro(Universidade Federal de São Paulo (UNIFESP), 2020-06-25) Botelho Filho, Fabio Mendes [UNIFESP]; Abib, Simone de Campos Vieira [UNIFESP]; Universidade Federal de São PauloObjectives: this study aims to quantify the adherence of trauma assessment protocols among different types of frontline trauma providers. As a secondary objective, it was also evaluated if adherence is associated with improved clinical outcomes for children. Methods: A descriptive study of pediatric trauma care in Hospital João XXIII was conducted between October 2017 and March 2018. Trauma primary survey assessments were observed and adherence to each step of a standardized primary assessment protocol was recorded. Adherence to the assessment protocol was compared considering different types of providers, the time of presentation, and severity of injury. The relationship between protocol adherence and clinical outcomes including mortality, length of hospital stay, admission to pediatric intensive care unit, use of blood components, need of mechanical ventilation, and number of imaging exams performed were also assessed. Results: Emergency Department evaluations of 64 patients of 274 pediatric admissions were observed over a period of 6 months. The mean patient age was 7.3 years. 40.6% of patients presented due to fall injuries and a majority sustained injury categorized as severe (59.4%). 50% of the primary assessments were performed by general surgeons, 34.4% by residents in general surgery and 15.6% by pediatricians. There was an average adherence rate of 34.1% to the trauma primary assessment protocol. Adherence among each specific step included airway: 17.2%; Breathing: 59.4%; Circulation: 95.3%; Disability: 28.8%; Exposure: 18.8%. No differences between specialties or time of presentation (day vs night) were observed as an influencer in physical assessment. Therefore, adherence was lower in severe patients than non-severe patients. Patients with a more thorough primary assessment, independent of severity, underwent fewer CT scans (ROC curve area: 0.661; p:0.027). Finally, no other associations between adherence and outcomes were observed. Conclusions: Our study demonstrates that trauma assessment protocol adherence among trauma providers is low for both surgeons and nonsurgeons. Thorough initial assessment reduced the use of CT scans, suggesting that standardized pediatric trauma assessments may be a way to reduce unnecessary radiologic imaging among children. It suggests that a standardized assessment should be encouraged, because it could decrease number of unnecessary radiologic exams in a child patient.
- ItemAcesso aberto (Open Access)Collaborative multicenter trials in Latin America: challenges and opportunities in orthopedic and trauma surgery(Associacao Paulista Medicina, 2013-01-01) Moraes, Vinicius Ynoe de [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Faloppa, Flavio [UNIFESP]; Bhandari, Mohit; Universidade Federal de São Paulo (UNIFESP); McMaster UnivCONTEXT and OBJECTIVE: Orthopedic research agendas should be considered from a worldwide perspective. Efforts should be planned as the means for obtaining evidence that is valid for health promotion with global outreach.DESIGN and SETTING: Exploratory study conducted at Universidade Federal de São Paulo (Unifesp), São Paulo, Brazil, and McMaster University, Hamilton, Canada.METHODS: We identified and analyzed collaborative and multicenter research in Latin America, taking into account American and Canadian efforts as the reference points. We explored aspects of the data available from official sources and used data from traffic accidents as a model for discussing collaborative research in these countries.RESULTS: the evaluation showed that the proportion of collaborative and multicenter studies in our setting is small. A brief analysis showed that the death rate due to traffic accidents is very high. Thus, it seems clear to us that initiatives involving collaborative studies are important for defining and better understanding the patterns of injuries resulting from orthopedic trauma and the forms of treatment. Orthopedic research may be an important tool for bringing together orthopedic surgeons, researchers and medical societies for joint action.CONCLUSIONS: We have indicated some practical guidelines for initiatives in collaborative research and have proposed some solutions with a summarized plan of action for conducting evidence-based research involving orthopedic trauma.
- ItemAcesso aberto (Open Access)Effectiveness of intra-articular lidocaine injection for reduction of anterior shoulder dislocation: randomized clinical trial(Associação Paulista de Medicina - APM, 2012-01-01) Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Wajnsztejn, André [UNIFESP]; Archetti Netto, Nicola [UNIFESP]; Matsumoto, Marcelo Hide [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)CONTEXT AND OBJECTIVE: Shoulder dislocation is the most common dislocation among the large joints. The aim here was to compare the effectiveness of reduction of acute anterior shoulder dislocation with or without articular anesthesia. DESIGN AND SETTING: Prospective randomized trial conducted in Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP) (EPM-UNIFESP). METHODS: From March 2008 to December 2009, 42 patients with shoulder dislocation were recruited. Reductions using traction-countertraction for acute anterior shoulder dislocation with and without lidocaine articular anesthesia were compared. As the primary outcome, pain was assessed through application of a visual analogue scale before reduction, and one and five minutes after the reduction maneuver was performed. Complications were also assessed. RESULTS: Forty-two patients were included: 20 in the group without analgesia (control group) and 22 in the group that received intra-articular lidocaine injection. The group that received intra-articular lidocaine had a statistically greater decrease in pain over time than shown by the control group, both in the first minute (respectively: mean 2.1 (0 to 5.0), standard deviation, SD 1.3, versus mean 4.9 (2.0 to 7.0, SD 1.5; P < 0.001) and the fifth minute (respectively: mean 1.0; 0 to 3.0; SD = 1.0 versus mean 4.0; 1.0 to 6.0; SD = 1.4; P < 0.001). There was one failure in the control group. There were no other complications in either group. CONCLUSION: Reduction of anterior shoulder dislocation using intra-articular lidocaine injection is effective, since it is safe and diminishes the pain. CLINICAL TRIAL REGISTRATION: ISRCTN27127703.
- ItemAcesso aberto (Open Access)Ensaios Clínicos Randomizados na ortopedia e traumatologia: avaliação sistemática da evidência nacional(Sociedade Brasileira de Ortopedia e Traumatologia, 2010-01-01) Moraes, Vinícius Ynoe de [UNIFESP]; Moreira, Cesar Domingues [UNIFESP]; Tamaoki, Marcel Jun Sugawara [UNIFESP]; Faloppa, Flávio [UNIFESP]; Belloti, Joao Carlos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: To assess whether there was an improvement in the quality and quantity of randomized controlled trials (RCTs) in nationally published journals through an application of standardized and validated scores. METHODS: We selected, electronically, for the period of 2000-2009, all RCTs published at the two indexed, orthopaedics-focused Brazilian journals: Acta Ortopédica Brasileira(AOB) and Revista Brasileira de Ortopedia (RBO). These RCTs were identified and scored by two independent researchers according to the JADAD scale and Cochrane Bone, Joint and Muscle Trauma Group score. The selected studies were grouped: 1) by publication period (2000-2004 and 2004-2009); 2) journal of publication (AOB and RBO). RESULTS: Twenty-two papers were selected, 10 from AOB and 12 from RBO. No statistically significant differences were found between the proportion (nRCT/nTotal of published papers) of RCTs published in the two journals (p=0.458), as well as for the JADAD score (p=0.722) and Cochrane score (p=0.630). CONCLUSION: The quality and quantity of randomized clinical trials in the period was similar in the journals analyzed. There is a trend of improvement of quality, yet there was no increase in the number of randomized clinical trials in both periods.