Patient-reported outcomes of postdischarge functional status can provide insight into patient recovery experiences not typically reflected in trauma registries. Injuries may be characterized by a ...long-term loss of independence. We sought to examine factors predictive of patient-reported, postdischarge loss of independence in trauma patients.
Trauma patients admitted to 1 of 3 level I trauma centers were contacted by phone between 6 to 12 months after hospital discharge to complete the Revised Trauma Quality of Life survey. Loss of independence was defined as a new need for assistance with at least one activity of daily living or transition to living in an institutional setting. Patients with severe traumatic brain injury or spinal cord injury were excluded. Multivariable logistic regression analyses were performed to identify predictors of loss of independence.
801 patients were included. The median age was 65 (interquartile range: 46–76) years, 46.1% were female, and the median Injury Severity Score was 9 (interquartile range: 9–13). Two hundred seventy-one patients (33.8%) experienced a loss of independence, most commonly requiring assistance walking up stairs. The main predictors of loss of independence were persistent daily pain (odds ratio: 3.83, 95% confidence interval: 2.90–5.04, P < .001), length of hospital stay (odds ratio: 1.04, 95% confidence interval: 1.01–1.09, P = .021) and income below the national median (odds ratio: 1.46, 95% confidence interval: 1.12–1.91, P = .006). Perceived social support (odds ratio: 0.75, 95% confidence interval: 0.66–0.85, P < .001) was protective against loss of independence.
Injury is associated with a relatively high rate of long-term loss of independence. Ensuring adequate social support systems for patients postdischarge may help them regain functional independence after injury.
The COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and ...mental health outcomes after trauma.
Patients in a prospective study were included. The cohort injured during the pandemic was compared to a cohort injured before the pandemic. We performed regression analyses to evaluate the association between the COVID-19 pandemic and physical and mental health outcomes.
1,398 patients were included. In adjusted analysis, patients injured during the pandemic scored significantly worse on the SF-12 physical composite score (OR 2.21; 95% CI 0.69-3.72; P = 0.004) and were more likely to screen positive for depression (OR 1.46; 1.02-2.09; P = 0.03) and anxiety (OR 1.56; 1.08-2.26; P = 0.02). There was no significant difference in functional outcomes.
Patients injured during the COVID-19 pandemic had worse mental health outcomes but not physical health outcomes.
Collectively, studies from medical and surgical intensive care units (ICU) suggest that long-term outcomes are poor for patients who have spent significant time in an ICU. We sought to identify ...determinants of post-intensive care physical and mental health outcomes 6–12 months after injury.
Adult trauma patients ISS ≥9 admitted to one of three Level-1 trauma centers were interviewed 6–12 months post-injury to evaluate patient-reported outcomes. Patients requiring ICU admission ≥ 3 days (“ICU patients”) were compared with those who did not require ICU admission (“non-ICU patients”). Multivariable regression models were built to identify factors associated with poor outcomes among ICU survivors.
2407 patients were followed 598 (25%) ICU and 1809 (75%) non-ICU patients. Among ICU patients, 506 (85%) reported physical or mental health symptoms. Of them, 265 (52%) had physical symptoms only, 15 (3%) had mental symptoms only, and 226 (45%) had both physical and mental symptoms. In adjusted analyses, compared to non-ICU patients, ICU patients were more likely to have new limitations for ADLs (OR = 1.57; 95% CI = 1.21, 2.03), and worse SF-12 mental (mean Δ = −1.43; 95% CI = −2.79, −0.09) and physical scores (mean Δ = −2.61; 95% CI = −3.93, −1.28). Age, female sex, Black race, lower education level, polytrauma, ventilator use, history of psychiatric illness, and delirium during ICU stay were associated with poor outcomes in the ICU-admitted group.
Physical impairment and mental health symptoms following ICU stay are highly prevalent among injury survivors. Modifiable ICU-specific factors such as early liberation from ventilator support and prevention of delirium are potential targets for intervention.
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•Delirium during an intensive care unit (ICU) stay is linked with long-term physical impairment in injury survivors who spent three or more days in the ICU.•The use of ventilators in the ICU is another factor associated with long-term physical impairment and mental health symptoms in these patients.•Delirium and ventilator use are potentially modifiable, suggesting opportunities for improving patient outcomes.•This knowledge can inform the development of intervention programs specifically targeting delirium and ventilator use to mitigate long-term impairments.
Opioid overprescription in trauma contributes to the opioid epidemic through diversion of unused pills. Through our study, we sought to do the following: (1) understand the variation in opioid ...prescription after injury and its relationship to patient and/or clinical variables, and (2) study the relationship between opioid prescribing and long-term pain and analgesic use.
Trauma patients with an injury severity score ≥9 admitted to 3 level 1 trauma centers were screened for chronic pain and analgesic use 6 to 12 months postinjury. First, multivariable linear regression models were constructed with “oral morphine equivalents” and “number of opioid pills prescribed” at discharge as dependent variables. The coefficients of determination were calculated to determine how much of the variation in opioid prescription was explained by patient and clinical variables. Second, a multivariable logistic regression analysis was created to study the association between opioid prescription at discharge and chronic pain/analgesic use at 6 to 12 months. Analyses were adjusted for patient demographics, socioeconomics, comorbidities, injury parameters, and hospital course.
Of the 2,702 patients included (mean standard deviation age: 61.0 21.5; 55% males), 74% were prescribed opioids at discharge (mean number of pills standard deviation: 24.0 26.5; mean oral morphine equivalent standard deviation: 204.8 348.1). The adjusted coefficients of determination for oral morphine equivalents and number of pills was 0.12 and 0.21, respectively, suggesting that the measured patient and clinical factors explain <21% of the variation in opioid prescribing in trauma. Patients prescribed opioids were more likely to have chronic pain (odds ratio 95% confidence interval: 1.34 1.05–1.71) and use analgesics daily (odds ratio 95% confidence interval: 1.86 1.25–2.77) 6 to 12 months postinjury.
The variation in opioid prescription after traumatic injury is more affected by system and provider level rather than clinical or patient-related factors, and opioid prescribing correlates independently with long-term chronic pain and continued analgesic use postinjury. Efforts to decrease opioid use should prioritize standardizing prescription practices after traumatic injury.
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Objective:
Determine the proportion and characteristics of traumatic injury survivors who perceive a negative impact of the COVID-19 pandemic on their recovery and to define post-injury outcomes for ...this cohort.
Background:
The COVID-19 pandemic has precipitated physical, psychological, and social stressors that may create a uniquely difficult recovery and reintegration environment for injured patients.
Methods:
Adult (≥18 years) survivors of moderate-to-severe injury completed a survey 6 to 14 months post-injury during the COVID-19 pandemic. This survey queried individuals about the perceived impact of the COVID-19 pandemic on injury recovery and assessed post-injury functional and mental health outcomes. Regression models were built to identify factors associated with a perceived negative impact of the pandemic on injury recovery, and to define the relationship between these perceptions and long-term outcomes.
Results:
Of 597 eligible trauma survivors who were contacted, 403 (67.5%) completed the survey. Twenty-nine percent reported that the COVID-19 pandemic negatively impacted their recovery and 24% reported difficulty accessing needed healthcare. Younger age, lower perceived-socioeconomic status, extremity injury, and prior psychiatric illness were independently associated with negative perceived impact of the COVID-19 pandemic on injury recovery. In adjusted analyses, patients who reported a negative impact of the pandemic on their recovery were more likely to have new functional limitations, daily pain, lower physical and mental component scores of the Short-Form-12 and to screen positive for PTSD and depression.
Conclusions:
The COVID-19 pandemic is negatively impacting the recovery of trauma survivors. It is essential that we recognize the impact of the pandemic on injured patients while focusing on directed efforts to improve the long-term outcomes of this already at-risk population.
The prevalence of antibodies to Toxoplasma gondii was determined in sera from 105 domestic cats from Durango City, Mexico. Using a modified agglutination test, antibodies to this parasite were found ...in 21% of the 105 cats, with titers of 1:25 in 3 cats, 1:50 in 4 cats, 1:200 in 5 cats, 1:400 in 2 cats, 1:800 in 2 cats, 1:1,600 in 4 cats, and 1:3,200 or higher in 2 cats. Cats older than 1 yr had a significantly higher frequency of infection than that found in cats younger than 0.5 yr (41 vs. 13.2%, respectively; odds ratio = 4.55; 95% CI = 1.24– 17.18; P = 0.01). Overall, the seroprevalence of T. gondii antibodies in cats in Durango, Mexico, is much lower compared with those reported in other countries.
Access to postacute care services in rehabilitation or skilled nursing facilities is essential to return trauma patients to their preinjury functional level but is often hindered by systemic ...barriers. We sought to study the association between the type of insurance, socioeconomic status (SES) measures, and postacute care utilization after injury.
Adult trauma patients with an Injury Severity Score (ISS) ≥9 admitted to one of three Level I trauma centers were contacted 6-12 mo after injury to gather long-term functional and patient-centered outcome measures. In addition to SES inquiry specifically focused on education and income levels, patients were asked to subjectively categorize their perceived SES (p-SES) as high, mid-high, mid-low, or low. Insurance and income data were retrieved from trauma registries. Multivariable regression models were built to determine the association between type of insurance, SES, and discharge disposition after adjusting for patient and injury characteristics and hospitalization events.
A total of 1373 patients were included, of which 44% were discharged to postacute care facilities. The median age (IQR) was 65 (46, 76) years, 56% of patients were male, 11% were on Medicaid, 68% had attained education higher than high school, 27% had low income, and 29% reported a low/mid-low p-SES. Medicaid patients were less likely to be discharged to postacute care compared to privately insured (OR 95% CI: 0.41 0.29-0.58) and Medicare patients (OR 95% CI: 0.29 0.16-0.50). The latter relationship was true across p-SES categories. P-SES, income and educational level were not associated with discharge destination.
Insurance status, specifically having Medicaid, can pose a barrier to access to postacute care services in the trauma patient population across patients of all SES. Initiatives and policies that aim at reducing these access disparities are warranted.
The effect of environmental humidity on the self-lubricating properties of a thin film of boric acid (H3BO3) was evaluated. H3BO4 films were successfully formed on the surface of AISI 316L steel. The ...study was conducted on AISI 316L steel because of its use in biomedical applications. First, the samples were exposed to boriding to generate a continuous surface layer of iron borides. The samples were then exposed to a short annealing process (SAP) at 1023 K for 5 min and cooled to room temperature while controlling the relative humidity (RH). Five different RH conditions were tested. The purpose of SAP was to promote the formation of a surface film of boric acid from the boron atoms present in the iron boride layers. The presence of the boric acid at the surface of the borided layer was confirmed by Raman spectroscopy and X-ray diffraction (XRD). The self-lubricating capability of the films was demonstrated using the pin-on-disk technique. The influence of RH was reflected by the friction coefficient (FC), as the samples cooled with 20% of RH exhibited FC values of 0.16, whereas the samples cooled at 60% RH showed FC values of 0.02.
The COVID-19 pandemic has led to decreased access to care and social isolation, which have the potential for negative psychophysical effects. We examine the impact of the pandemic on physical and ...mental health outcomes after trauma.
Patients in a prospective study were included. The cohort injured during the pandemic was compared to a cohort injured before the pandemic. We performed regression analyses to evaluate the association between the COVID-19 pandemic and physical and mental health outcomes.
1,398 patients were included. In adjusted analysis, patients injured during the pandemic scored significantly worse on the SF-12 physical composite score (OR 2.21; 95% CI 0.69–3.72; P = 0.004) and were more likely to screen positive for depression (OR 1.46; 1.02–2.09; P = 0.03) and anxiety (OR 1.56; 1.08–2.26; P = 0.02). There was no significant difference in functional outcomes.
Patients injured during the COVID-19 pandemic had worse mental health outcomes but not physical health outcomes.
•Those injured during the pandemic have higher rates of depression and anxiety.•There is no difference in rates of PTSD for patients injured pre and post-pandemic.•Physical health outcomes after trauma are similar pre- and post-pandemic.
The mechanical vibrations surrounding the environment can be converted in electrical energy by piezoelectric energy harvesters (PEH). The increase on the availability of Wireless Sensor Networks ...(WSN) increases the need for power supply that replaces ordinary batteries. In this paper, an electromechanical modelling and a deposition of multilayer zinc oxide (ZnO) films for an PEH are presented. The aim of the study is to obtain the thickness of the multilayer ZnO films in different conditions, in order to improve the energy harvesting capacity for a PEH device. The ZnO synthesis was performed by the sol-gel method with dehydrated zinc acetate as a precursor, making deposits of 5, 10 and 15 layers. The depositions were made at room temperature by spin coating at 1440 revolutions per minute for 16 s. An UV-Vis test showed that ZnO were present, with a percentage of peak reflectance at 370 nm and a XRD test showed a preferential crystalline orientation at (002). Also, a Finite Element Modelling (FEM) simulation of the substrate behaviour was performed, functioning as a cantilever beam. When adding a seismic mass and oscillating in the resonance frequency of 103.31 Hz and with 15 layers of ZnO deposited, 2.67 volts were obtained.
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