Vicarious Trauma: Exploring the Experiences of Qualitative Researchers Who Study Traumatized Populations

Objective: A substantial body of research exists regarding vicarious trauma (VT) exposure among helping professionals across disciplines and settings. There is limited research, however, on exposure to VT in qualitative researchers studying traumatized populations. The objective of this study was to explore the experiences of qualitative researchers who study traumatized populations and to identify potential protective strategies for reducing the risk of VT. Methods: The study utilized a qualitative methodological design. Focus groups and in-depth interviews were conducted using a semi-structured script. Thematic analysis was conducted to identify both risk factors and protective factors associated with VT. A sample of 58 research participants were recruited using a multimodal recruitment strategy. Results: Using thematic analysis, the following key themes emerged: exposure to primary trauma, the impact of stigma, organizational context, individual context, and research context. The opportunity for posttraumatic growth was also identified. Conclusion: Qualitative researchers of traumatized populations need to recognize the potential for VT and implement appropriate protection strategies from the risk of VT. The development of policies and guidelines that recognize the importance of both self-care and plan for researcher safety and well-being is a potential strategy for building researcher resilience and preventing VT.

The Role of Nonophthalmologists in the Primary Evaluation of Head Injury Patients with Ocular Injuries

Purpose—Visual complaints are common in trauma cases. However, not every institution provides immediate ophthalmic consultations 24 h per day. Some patients may receive an ophthalmic consultation but without positive findings. We tried to evaluate risk factors for ocular emergencies in trauma patients. Then, the ophthalmologists could be selectively consulted. Methods—From January 2019 to December 2019, head injuries patients concurrent with suspected ocular injuries were retrospectively reviewed. All of the patients received comprehensive ophthalmic examinations by ophthalmologists. Patients with and without ocular injuries were compared. Specific ophthalmic evaluations that could be primarily performed by primary trauma surgeons were also analyzed in detail. Results—One hundred forty cases were studied. Eighty-nine (63.6%) patients had ocular lesions on computed tomography (CT) scans or needed ophthalmic medical/surgical intervention. Near 70% (69.7%, 62/89) of patients with ocular injuries were diagnosed by CT scans. There was a significantly higher proportion of penetrating injuries in patients with ocular injuries than in patients without ocular injuries (22.5% vs. 3.9%, p = 0.004). Among the patients with blunt injuries (N = 118), 69 (58.5%) patients had ocular injuries. These patients had significantly higher proportions of periorbital swelling (89.9% vs. 67.3%, p = 0.002) and diplopia (26.1% vs. 8.2%, p = 0.014) than patients without ocular injuries. Conclusions—In patients with head injuries, concomitant ocular injuries with indications for referral should always be considered. CT serves as a rapid and essential diagnostic tool for the evaluation of concomitant ocular injuries. Ophthalmologists could be selectively consulted for patients with penetrating injuries or specific ocular presentations, thus reducing the burden of ophthalmologists.

Impact of trauma workshop on knowledge, attitude and practice conducted on undergraduate MBBS students

In India the organized trauma care services are restricted only to tertiary care centres and golden hour trauma care is often delayed. We decided to create awareness among the MBBS students by teaching basic trauma management skills since they are the first responders to a trauma victim brought to any hospital setup. This would help improve primary trauma care. Aim: To assess the improvement in knowledge, attitude and practice after primary trauma care workshop in MBBS students Methods and Material: A one day primary trauma care workshop was conducted in our institute for two consecutive years during the annual academic undergraduate conference 2018 and 2019 respectively. The MBBS students enrolled were given a questionnaire to solve before and after the workshop. They received a lecture on triage and hands-on practice on Primary survey, log roll & cervical spine stabilization, Airway management, Intravenous fluids & shock management and Basic life support. Statistical analysis: The pre and post workshop questionnaires were statistically analyzed by paired t-test using software version SPSS 20.0 and a P value of < 0.05 was considered statistically significant. Results: Pre workshop 9.9% and 10.5% of the students had above average total score in 2018 and 2019 respectively which increased to 67.6% and 78.5% post workshop. The mean Knowledge, Attitude and Practice scores also improved individually. Conclusion: We should include such workshops in the undergraduate curriculum, it would improve primary trauma care and will reduce trauma related morbidity and mortality

The Algorithm for Territorial Distribution of Public Emergency Rooms in Megapolis (by the Example of Moscow)

Background. The lack of a system for evaluating the feasibility of new trauma and orthopedic departments in outpatient clinics under construction creating is one of the main reasons for the imbalance in their territorial location. Therefore, one of the most urgent modern tasks in the megalopolis healthcare organization — is to develop a system for effective regulation of the trauma and orthopedic outpatient departments network construction. The purpose of the study is to improve the effectiveness of outpatient trauma and orthopedic care for megalopolis residents. Materials and Methods. In the research process, theoretical (formalization, synthesis, deduction) and empirical (observation, comparison, modeling, measurement) methods were used. A total of 67 emergency trauma outpatient departments in Moscow were sampled and data on their attendance for April 2019 were collected. Results. Creation of a mathematical model of the network of outpatient primary trauma care and a basic algorithm for estimating the average time from the moment a patient received injuries to the time of primary care in one of the emergency outpatient trauma units of the medical organizations of the capital, which can be used by the executive bodies of the healthcare organization cities in solving administrative and economic problems. Conclusion. The developed specialized mathematical algorithm for assessing the existing effectiveness of the already existing emergency outpatient trauma units network and the distribution of new units allows you to create an “ideal” model for the location of these deparments in a megapolis. In the future, this model can be developed taking into account the development of the transport network, the financing of emergency rooms, etc.

Flipped education may help in the education of junior general surgery residents in their trauma rotation; a mixed-method study

Introduction: This study aims to assess the effectiveness of flipped learning in trauma rotation of first-year general surgery residents. This method entails the use of books, podcasts, and movies prior to the discussion of the topics in the classroom/conferences.Method: All (n=15) junior general surgery residents in Shiraz medical school. In the quantitative phase of the study, 3 test scores were compared. All tests were composed of 20 multiple choice clinical scenarios. A pretest was done on the registration date. After that, the media (videos and podcasts) and books were given to the residents. One month later, the residents had a case-based discussion on the primary trauma survey. An early post-test was done immediately after the case-based discussion, and a late post-test one month following commencement of the program. Also, a semi-structured phone interview was done with residents by an external audit. Results: The was a significant correlation between pretest (Mean=10.733,SD=2.25) and early post-test scores (Mean=12.8 ,SD=1.82) among residents (P=0.004) . Moreover, residents had a higher delayed post-test score (M=13.267, SD=1.53) in comparison to the pre-test (P=0.002). Surprisingly there was no significant difference between early and late post-test (P=0.404). The resident was also satisfied with the overall usefulness of the program for junior residents (overall score 4/5). We did not find any correlation between gender with the test scores. In the qualitative phase of the study, we noticed that our participants tend to use podcasts more than other materials. They believed that the videos and books help more to foster theoretical knowledge. The case-based discussion makes them more confident in dealing with the patients in their daily encountersConclusion: Finding in this study reveals that flipped learning can be a useful, highly beneficial platform and promotive for junior general surgery programs.

Increasing the use of continuing professional development courses to strengthen trauma care in Ghana

Injury is a major cause of death and disability in Ghana. Strengthening care of the injured is essential to reduce this burden. Trauma continuing professional development (CPD) courses are an important component of strengthening trauma care. In many countries, including Ghana, their use needs to be more uniformly promoted. We propose lowcost strategies to increase the utilization of trauma CPD in Ghana, especially in district hospitals and higher need areas. These strategies include developing plans by regional health directorates and teaching hospitals for the regions for which they are responsible. Lists could be kept and monitored of which hospitals have doctors with which type of training. Those hospitals that need to have at least one doctor trained could be flagged for notice of upcoming courses in the area and especially encouraged to have the needed doctors attend. The targets should include at least one surgeon or one emergency physician at all regional or large district hospitals who have taken the Advanced Trauma Life Support (ATLS) (or locally-developed alternative) in the past 4 years, and each district hospital should have at least one doctor who has taken the Primary Trauma Care (PTC) or Trauma Evaluation and Management (TEAM) (or locally-developed alternatives) in the past 4 years. Parallel measures would increase enrollment in the courses during training, such as promoting TEAM for all medical students and ATLS for all surgery residents. It is important to develop and utilize more “home grown” alternatives to increase the long-term sustainability of these efforts, Keywords: trauma, injury, education, training, continuing professional developmentFunding: None

CAUSES OF ADVERSE SURGERY EFFECTS IN TREATMENT OF PATIENTS WITH ESOPHAGUS STENOTIC DISEASES

Esophageal stenosis requires a responsible approach to the choice of rational treatment tactics. Intraoperatively, bleeding, interponate necrosis, complications associated with the wrong choice of the path of the interponate imposition to the neck, damage to the nutrient vessel (the arcade rupture), pleural leaves during the formation of the thoracic tunnel, n. vagus and its branches, pneumothorax, hemothorax, uncontrolled mediastinal bleeding, the need for drainage of the pleural cavity due to injury to the latter, iatrogenic splenectomy, membranous tracheal tear. Post−surgery complications are developed at different times after esophagoplasty. Most often, early postoperative complications occur because of the wound: bleeding and failure of the sutures of the anastomosis line. Complications resulted from the respiratory system are as follows: tracheobronchitis, pleurisy, "congestive", nosocomial pneumonia and atelectasis, pleural empyema. In the remote post−surgery period, the patients may experience: stenosis of the esophageal (or pharyngeal) anastomosis, adhesions, fistulas, reflux, peptic ulcers of the esophagus, pain, inflections and excess loops, complications associated with mechanical trauma of implant, scar−altered cancer esophagus, polyposis of the colon, various disorders associated with primary trauma, nonspecific complications. Damage to the recurrent nerve in patients causes constant hoarseness and difficult swallowing. Occasionally there are cardiac arrhythmias in the form of atrial fibrillation, "sympathetic" pleurisy, reflux, post−vagotomy symptom and dumping syndrome, delayed gastric emptying due to insufficient dilated pyloromyotomy in the patients with a combination of stenosis of the esophageal lumen and esophageal lumen hernia. Key words: esophageal stenosis, esophageal anastomosis, postoperative complications.