1,721,065 research outputs found
Surveillance in the service of safety
Get PDFThe World Report on Road Traffic Injury Prevention of 2004 recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify highrisk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. This presentation shares the results of an urban RTI surveillance program that has been running for the past 8 years since 2007 in the emergency departments of five major hospitals in Karachi, Pakistan. We describe the process of establishing the road injury surveillance system incorporating a multi-institution research group including physicians and transportation engineers. Data was collected from 5 city-wide hospitals with details of the injury, severity scoring and information of the circumstances of the crash. Site visits supplemented this data and the results were disseminated to municipal authorities along with low cost engineering solutions to rectify hazards in the road network. In the 8 years between 2007 and 2014, 262,269 road injury victims were registered by the surveillance system. Though 76% of the injuries were categorized as “minor”, 20% led to hospital admission and in 3% deaths occurred. The information on location of crashes and site visits led to an extensive catalogue of road network hazards and their rectification led to demonstrated reductions in crash frequency. Data was also used for safety advocacy in groups found to be vulnerable in the surveillance, such as motorcyclists, road sweepers and school going pedestrians. We demonstrate that a functional RTI surveillance program can be established and effectively managed in a developing country. The data collected and analyzed from the victim’s perspective can be a potent tool for effecting safety education and hazard rectification
878 Surveillance in the service of safety
No full textBackground: It has been recommended that the newly motorizing countries establish road injury surveillance to define the burden, identify high risk groups, plan intervention and monitor their impact. Despite its stated importance in the literature, very few examples of sustained surveillance systems are reported from low income countries. We present the results of an urban road injury surveillance program that has been running for the past 8 years in the emergency departments of five major hospitals in Karachi, Pakistan.Methods: We describe the process of establishing the road injury surveillance system incorporating a multi-institution research group including physicians and transportation engineers. Data was collected from 5 hospitals with details of the injury, severity scoring and information of the circumstances of the crash. Crash site visits supplemented this data and the results were disseminated to municipal authorities along with low cost engineering solutions to rectify hazards in the road network. The impact of these interventions were monitored in the surveillance. Results: In the 8 years between 2007 and 2014, 262,269 road injury victims were registered. Though 76% of the injuries were categorised as “minor”, 20% led to hospital admission and in 3% deaths occurred. The information on location of crashes and site visits led to an extensive catalogue of road network hazards and their rectification led to demonstrated reductions in crash frequency. Data was also used for safety advocacy in groups found to be vulnerable in the surveillance, such as motorcyclists, road sweepers and school going pedestrians.Conclusions: We demonstrate that a functional road injury surveillance program can be established and effectively managed in a developing country. The data collected and analysed from the victim’s perspective can be a potent tool for effecting safety education and hazard rectification
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
Trigeminocardiac reflex during skull base surgery: mechanism and management.
No full textAbstract BACKGROUND:
We study the occurrence and management of the trigeminocardiac reflex (TCR) during neurosurgical procedures for lesions of the skull base. METHOD:
Two hundred patients underwent neurosurgical procedures for various skull base lesions and were evaluated retrospectively for the occurrence of the TCR during surgery. This phenomenon was defined as the onset of bradycardia lower than 60 beats/minute and hypotension with a drop in mean arterial blood pressure of 20% or more due to intra-operative manipulation or traction on the trigeminal nerve. FINDINGS:
Sixteen patients (8%) had a TCR intra-operatively (7 vestibular schwannomas, 5 sphenoid wing meningiomas, 3 petroclival meningiomas, 1 intracavernous epidermoid cyst). In all 16 patients with a TCR the postoperative courses presented no complications that could be directly related to this intra-operative phenomenon. CONCLUSIONS:
Due to the intracranial course of the trigeminal nerve several surgical procedures at the anterior, middle and posterior skull base may elicit the trigeminocardiac reflex. Continuous monitoring of hemodynamic parameters allows the surgeon to interrupt surgical manoeuvres immediately upon the occurrence of the TCR. This technique is sufficient for the heart rate and the arterial blood pressure to return to normal levels without the necessity of additional anticholinergic medicatio
Cost-effective practice of neurology: an idea whose time has come
Get PDFPakistanis spent 39.4. The government contribution to this was no more than 31.4% ($ 12.4 per capita). The public allocations to health thus represent a paltry 4.7% of total government expenditure and are just shy of 1% of our GDP
666 Human cost of “motorcycle mass transit”: Report of 9,000 fatalities from urban road injury surveillance in a developing country
No full textBackground: Many of the burgeoning megacities in developing countries have witnessed poorly planned urban sprawls. The absence of a coherent mass public transport system encourages the acquisition of inexpensive motorcycles for commuting and this has distorted the traffic mix. In Karachi the proportion of motorcycles on the road has risen from 34% of registered vehicles to 55% over the past decade. We have sought to assess the impact of this on road use fatalities by analysis of data captured by ongoing road traffic injury surveillance based in 5 city hospitals.Methods: The recorded road-use deaths were those dying within 30 days of being admitted to hospital and included cases brought dead to the EDs or the mortuaries of the hospitals. The case information included gender, age, number of vehicles involved in the crash, road-user type (motorcycle rider or pillion rider), helmet use and injury scoring.Results: During 8 years, 2007–2014, motorcycle occupants accounted for 3901 of the 9192 fatalities and over the study period these increased from 36% to 53% of the recorded road deaths (p \u3c 0.001). 69% of them were aged 35 years or less. Though most motorcycle collisions resulting in death involved heavy commercial vehicles, 185 fatalities resulted from motorcycle to motorcycle collisions. Of the 3253 pedestrian fatalities recorded, a motorcycle had struck 19% of them. Of the 2179 instances where a cause could be ascribed to the motorcycle fatality, over speeding was reported in over 50% and the top 6 roads for motorcyclist fatalities were signal-free corridors.Conclusions: An escalating socio-economic tragedy is being played out in the urban centres of many developing countries by the juxtaposition of poor public transport and availability of inexpensive motorcycles. Our study suggests that while the implementation of mass transit schemes are awaited, strategies that segregate traffic and reduce speeds should be prioritised along with strict enforcement of helmet laws
Quadriparesis after a shunting procedure in a case of cervical spinal neurinoma associated with hydrocephalus: Case report
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