1,720,973 research outputs found
Analysis of Severe Trauma Patients Management : Triage and Care Process
No full textLa traumatologie est un problème de santé publique au troisième rang des années de vie perdues ajustées sur l’incapacité en France. L’investissement sanitaire et le volume de recherche qu’elle génère sont en deçà de ce que représente son impact sociétal. L’objet de ce travail de recherche était de plonger au cœur du parcours du patient traumatisé sévère pour en cibler trois problématiques clefs et tenter de répondre aux interrogations qu’elles génèrent.Les données utilisées provenaient essentiellement d’un observatoire de traumatologie lourde hospitalier (Traumabase®), régional et national, qui collige un ensemble de variables épidémiologiques, cliniques, paracliniques, et thérapeutiques des patients traumatisés sévères admis en centre de traumatologie.Le premier projet a ciblé l’orientation initiale (triage) des patients traumatisés sévères suite à un accident de la circulation au sein de la région Île de France et son effet sur la mortalité. Les patients initialement mal triés, transférés secondairement dans les centres de traumatologie régionaux, ne présentaient pas un pronostic plus sombre que les patients qui étaient transportés directement. Le système de soin dans son ensemble permettait de leur assurer un devenir équivalent. Une analyse en population réalisée par un chainage probabiliste des données avec les fiches d’accident de l’observatoire national de la sécurité routière a permis d’approcher le taux de sous triage conduisant au décès dans la région (0,15%) et d’objectiver que 60% des décès survenaient avant toute admission hospitalière.Le second projet visait l’optimisation de la jonction entre l’équipe médicalisée préhospitalière et l’équipe intrahospitalière. Il s’est attelé à développer un outil de prédiction de la sévérité des patients hémorragiques pour permettre l’anticipation de l’admission des patients les plus graves. Cet outil, le Red Flag, avait pour cahier des charges d’être simple et pragmatique, et de ne pas nécessiter de dispositif externe pour l’utiliser. Il a identifié cinq caractéristiques (shock index>1, pression artérielle moyenne 1, mean blood pressure <70mmHg, capillary hemoglobin <13g/dL, unstable pelvis and intubation). If two or more variables were present, the tool identified patient with acute hemorrhage and the corresponding pathway should be activated. This tool requires prospective validation and assessment of its impact on care provision and patient outcome.The third research project focused on a therapeutic component of trauma induced coagulopathy. The study attempted to quantify the effect of fibrinogen concentrate administration at the early phase of traumatic hemorrhagic shock (first 6 hours) on 24 hours all-cause mortality using a causal inference approach (propensity score and double robust estimator). The research did not demonstrate any impact on mortality (observed risk difference: -0.031, 95% confidence interval [-0.084; 0.021]); a lack of power might be responsible for this result
Analyse de la prise en charge des patients traumatisés sévères dans le contexte français : processus de triage et processus de soin
No full textIn France, the third most frequent cause of disability adjusted life years lost is trauma, an observation that makes trauma a public health challenge. However, investment in trauma care and specific research fails to meet this challenge and to acknowledge the associated societal and economic impact.The purpose of this research was to explore the core of the pathway of a major trauma patient and bring to light key issues and question and to find answers. The data used in this research were mainly extracted from a regional and national trauma registry, the Traumabase®. The registry collects epidemiological, clinical, paraclinical and therapeutic variables for patients with severe trauma admitted to participating trauma centres. The first project focused on the effects of triage on patients with severe trauma following a road traffic accident in the Ile de France region. Patients who were initially under triaged and then transferred to regional trauma centres did not have a worse prognosis than patients who were transported directly. The emergency medical system as a whole ensured that they would have an equivalent outcome. A population analysis carried out by a probabilistic data chainage using the accident records of the National Road Safety Observatory made it possible to approach the undertriage rate leading to death in the region (0.15%) and to reveal that 60% of deaths occurred before any hospital admission. The second project developed a pragmatic pre-alert tool based on simple, clinical prehospital criteria to predict acute hemorrhage in trauma patients. This tool is meant to increase the performance of the receiving hospital trauma team of these critically sick patients and activate a specific hemorrhage pathway. The study identified five variables (shock index>1, mean blood pressure 1, pression artérielle moyenne <70mmHg, hémoglobine capillaire < 13g/dL, bassin instable et intubation), dont la présence de deux ou plus d’entre-elles permettait d’activer l’alerte pour l’hôpital receveur. Cet outil devra être évalué en prospectif pour confirmer ses performances et évaluer son impact sur l’organisation et le devenir des patients.Le troisième projet de recherche ciblait plus spécifiquement une des thérapeutiques de la coagulopathie aigue du traumatisé sévère en choc hémorragique. Il a tenté de quantifier l’impact de l’administration de concentré de fibrinogène à la phase précoce du choc hémorragique traumatique (6 premières heures) sur la mortalité toutes causes confondues des 24 premières heures par une approche d’inférence causale (score de propension et méthode d’estimation double robuste). Il n’a pas été retrouvé d’effet significatif sur la mortalité, un manque de puissance pouvant être responsable de ce résultat (différence de risque observée : -0,031, Intervalle de confiance 95% [-0,084 ; 0,021]).Ainsi l’ensemble de ces 3 projets de recherche ont permis de répondre à des problématiques ciblées du parcours du patient traumatisé sévère, générant par la même de nouvelles perspectives d’analyse pour mieux circonscrire les réponses de terrain
Analyse de la prise en charge des patients traumatisés sévères dans le contexte français : processus de triage et processus de soin
No full textIn France, the third most frequent cause of disability adjusted life years lost is trauma, an observation that makes trauma a public health challenge. However, investment in trauma care and specific research fails to meet this challenge and to acknowledge the associated societal and economic impact.The purpose of this research was to explore the core of the pathway of a major trauma patient and bring to light key issues and question and to find answers. The data used in this research were mainly extracted from a regional and national trauma registry, the Traumabase®. The registry collects epidemiological, clinical, paraclinical and therapeutic variables for patients with severe trauma admitted to participating trauma centres. The first project focused on the effects of triage on patients with severe trauma following a road traffic accident in the Ile de France region. Patients who were initially under triaged and then transferred to regional trauma centres did not have a worse prognosis than patients who were transported directly. The emergency medical system as a whole ensured that they would have an equivalent outcome. A population analysis carried out by a probabilistic data chainage using the accident records of the National Road Safety Observatory made it possible to approach the undertriage rate leading to death in the region (0.15%) and to reveal that 60% of deaths occurred before any hospital admission. The second project developed a pragmatic pre-alert tool based on simple, clinical prehospital criteria to predict acute hemorrhage in trauma patients. This tool is meant to increase the performance of the receiving hospital trauma team of these critically sick patients and activate a specific hemorrhage pathway. The study identified five variables (shock index>1, mean blood pressure 1, pression artérielle moyenne <70mmHg, hémoglobine capillaire < 13g/dL, bassin instable et intubation), dont la présence de deux ou plus d’entre-elles permettait d’activer l’alerte pour l’hôpital receveur. Cet outil devra être évalué en prospectif pour confirmer ses performances et évaluer son impact sur l’organisation et le devenir des patients.Le troisième projet de recherche ciblait plus spécifiquement une des thérapeutiques de la coagulopathie aigue du traumatisé sévère en choc hémorragique. Il a tenté de quantifier l’impact de l’administration de concentré de fibrinogène à la phase précoce du choc hémorragique traumatique (6 premières heures) sur la mortalité toutes causes confondues des 24 premières heures par une approche d’inférence causale (score de propension et méthode d’estimation double robuste). Il n’a pas été retrouvé d’effet significatif sur la mortalité, un manque de puissance pouvant être responsable de ce résultat (différence de risque observée : -0,031, Intervalle de confiance 95% [-0,084 ; 0,021]).Ainsi l’ensemble de ces 3 projets de recherche ont permis de répondre à des problématiques ciblées du parcours du patient traumatisé sévère, générant par la même de nouvelles perspectives d’analyse pour mieux circonscrire les réponses de terrain
Going Beyond Counting First Authors in Author Co-citation Analysis
Get PDFThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Get PDF“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Get PDFWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Dispelling the Myths Behind First-author Citation Counts
Get PDFWe conducted a full-scale evaluative citation analysis study of scholars in the XML research field to explore just how different from each other author rankings resulting from different citation counting methods actually are, and to demonstrate the capability of emerging data and tools on the Web in supporting more realistic citation counting methods. Our results contest some common arguments for the continued
use of first-author citation counts in the evaluation of scholars, such as high correlations between author rankings by first-author citation counts and other citation
counting methods, and high costs of using more realistic citation counting methods that are not well-supported by the ISI databases. It is argued that increasingly available digital full text research papers make it possible for citation analysis studies to go beyond what the ISI databases have directly supported and to employ more
sophisticated methods
koamabayili/VECTRON-author-checklist: VECTRON author checklist
No full textWe have done our best to complete the author checklist relating to the use of animals in the hut study. Note that the objective for the hut study was to evaluate the IRS treatment applications for residual efficacy against Anopheles mosquitoes, including the local An. coluzzii mosquito population. Cows were only used to attract mosquitoes into the huts and no tests were carried out directly on the cows. The author checklist is intended for use with studies where experiments are carried out on animals, which is why we have had such difficulty in completing this for the hut study, as many of the questions do not relate to how the cows were used
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