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- Berg, Johanna, et al.
(författare)
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Perceived usefulness of trauma audit filters in urban India: a mixed-methods multicentre Delphi study comparing filters from the WHO and low and middle-income countries
- 2022
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Ingår i: Bmj Open. - : BMJ. - 2044-6055. ; 12:6
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Tidskriftsartikel (refereegranskat)abstract
- Objective To compare experts' perceived usefulness of audit filters from Ghana, Cameroon, WHO and those locally developed; generate context-appropriate audit filters for trauma care in selected hospitals in urban India; and explore characteristics of audit filters that correlate to perceived usefulness. Design A mixed-methods approach using a multicentre online Delphi technique. Setting Two large tertiary hospitals in urban India. Methods Filters were rated on a scale from 1 to 10 in terms of perceived usefulness, with the option to add new filters and comments. The filters were categorised into three groups depending on their origin: low and middle-income countries (LMIC), WHO and New (locally developed), and their scores compared. Significance was determined using Kruskal-Wallis test followed by Wilcoxon rank-sum test. We performed a content analysis of the comments. Results 26 predefined and 15 new filter suggestions were evaluated. The filters had high usefulness scores (mean overall score 9.01 of 10), with the LMIC filters having significantly higher scores compared with those from WHO and those newly added. Three themes were identified in the content analysis relating to medical relevance, feasibility and specificity. Conclusions Audit filters from other LMICs were deemed highly useful in the urban India context. This may indicate that the transferability of defined trauma audit filters between similar contexts is high and that these can provide a starting point when implemented as part of trauma quality improvement programmes in low-resource settings.
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- Warnberg, MG, et al.
(författare)
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A pilot multicentre cluster randomised trial to compare the effect of trauma life support training programmes on patient and provider outcomes
- 2022
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Ingår i: BMJ open. - : BMJ. - 2044-6055. ; 12:4, s. e057504-
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Tidskriftsartikel (refereegranskat)abstract
- Trauma accounts for nearly 10% of the global burden of disease. Several trauma life support programmes aim to improve trauma outcomes. There is no evidence from controlled trials to show the effect of these programmes on patient outcomes. We describe the protocol of a pilot study that aims to assess the feasibility of conducting a cluster randomised controlled trial comparing advanced trauma life support (ATLS) and primary trauma care (PTC) with standard care.Methods and analysisWe will pilot a pragmatic three-armed parallel, cluster randomised controlled trial in India, where neither of these programmes are routinely taught. We will recruit tertiary hospitals and include trauma patients and residents managing these patients. Two hospitals will be randomised to ATLS, two to PTC and two to standard care. The primary outcome will be all-cause mortality at 30 days from the time of arrival to the emergency department. Our secondary outcomes will include patient, provider and process measures. All outcomes except time-to-event outcomes will be measured both as final values as well as change from baseline. We will compare outcomes in three combinations of trial arms: ATLS versus PTC, ATLS versus standard care and PTC versus standard care using absolute and relative differences along with associated CIs. We will conduct subgroup analyses across the clinical subgroups men, women, blunt multisystem trauma, penetrating trauma, shock, severe traumatic brain injury and elderly. In parallel to the pilot study, we will conduct community consultations to inform the planning of the full-scale trial.Ethics and disseminationWe will apply for ethics approvals to the local institutional review board in each hospital. The protocol will be published to Clinical Trials Registry—India and ClinicalTrials.gov. The results will be published and the anonymised data and code for analysis will be released publicly.
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- Brönnimann, D., et al.
(författare)
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The lay of land: Strontium isotope variability in the dietary catchment of the Late Iron Age proto-urban settlement of Basel-Gasfabrik, Switzerland
- 2018
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Ingår i: Journal of Archaeological Science: Reports. - : Elsevier BV. - 2352-409X. ; 17, s. 279-292
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Tidskriftsartikel (refereegranskat)abstract
- Basel-Gasfabrik (Switzerland) comprises an extensive La Tène (chiefly Lt D, 150–80 BCE) settlement and two associated cemeteries at which strontium (87Sr/86Sr) isotope analysis of human and animal teeth investigated regional and supra-regional contacts. The interpretation of the analytic data, however, requires information on the isotopic baseline values around the site. Using 102 modern vegetation and 9 water samples from 51 localities, this study characterizes the isotopic ratios of the biologically available strontium of geological units and watercourses around Basel and compares these to 28 human infant, 6 pig, and 5 dog teeth from the site. Furthermore, pedological criteria evaluate the suitability of landforms for crop and pasturelands. The 87Sr/86Sr ratios of the environmental samples from geological units in up to 50 km distance varied between 0.70776 and 0.71794. Human infant teeth exhibited much more homogeneous 87Sr/86Sr ratios (0.70847–0.70950), which coincided largely with those of potential arable soils around Basel and indicate targeted exploitation of landscapes for agriculture. The more variable values of the faunal teeth suggest more widely ranging habitats or imports from the site's hinterlands. Two local isotope ranges were defined based on archaeological enamel samples and modern vegetation data from a confined radius around Basel. The study documents the complexity of distinguishing local and non-local individuals in a geologically heterogeneous region as well as the potential of isotope analyses to explore prehistoric land-use patterns.
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