Gewelddadige ervaringen zijn niet alleen indrukwekkend op het moment dat mensen ze meemaken. Ervaring en onderzoek laten zien dat geweld nog lang nadat een incident of een serie incidenten plaatsvond zijn sporen nalaat op plegers, slachtoffers en getuigen. Eerder besteedden wij in dit blad aandacht aan trauma bij mensen die met eerproblematiek in hun familie te maken hebben.1 In die bijdrage behandelden we een aantal misverstanden: de gedachte dat een posttraumatische stressstoornis (PTSS) synoniem is voor alle vormen van trauma, dat de diagnose PTSS een verklaring biedt voor alles wat in het leven van de betroffene tegenzit, en tot slot dat Eye Movement Desensitization and Reprocessing (EMDR) de enige remedie is voor de behandeling van trauma.
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Purpose: Resuscitation quality and pace depend on effective team coordination, which can be facilitated by adequate leadership. Our primary aim was to assess the influence of trauma team leader experience on resuscitation pace. Second, we investigated the influence of injury severity on resuscitation pace. Methods: The trauma team leaders were identified (Staff trauma surgeon vs Fellow trauma surgeon) and classified from video analysis during a 1-week period. Resuscitations were assessed for time to the treatment plan, total resuscitation time, and procedure time. Furthermore, patient and resuscitation characteristics were assessed and compared: age, gender, Injury Severity Score, Glasgow Coma Scale < 9, and the number (and duration) of surgical procedures during initial resuscitation. Correlations between total resuscitation time, Injury Severity Score, and time to treatment plan were calculated. Results: After adjustment for the time needed for procedures, the time to treatment plan and total resuscitation time was significantly shorter in resuscitations led by a Staff trauma surgeon compared to a Fellow trauma surgeon (median 648 s (IQR 472-813) vs 852 s (IQR 694-1256); p 0.01 resp. median 1280 s (IQR 979-1494) vs 1535 s (IQR 1247-1864), p 0.04). Surgical procedures were only performed during resuscitations led by Staff trauma surgeons (4 thorax drains, 1 endotracheal intubation, 1 closed fracture reduction). Moreover, a significant negative correlation (r: - 0.698, p < 0.01) between Injury Severity Score and resuscitation time was found. Conclusion: Experienced trauma team leaders may positively influence the pace of the resuscitation. Moreover, we found that the resuscitation pace increases when the patient is more severely injured.
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Background: Non-technical errors, such as insufficient communication or leadership, are a major cause of medical failures during trauma resuscitation. Research on staffing variation among trauma teams on teamwork is still in their infancy. In this study, the extent of variation in trauma team staffing was assessed. Our hypothesis was that there would be a high variation in trauma team staffing. Methods: Trauma team composition of consecutive resuscitations of injured patients were evaluated using videos. All trauma team members that where part of a trauma team during a trauma resuscitation were identified and classified during a one-week period. Other outcomes were number of unique team members, number of new team members following the previous resuscitation and new team members following the previous resuscitation in the same shift (Day, Evening, Night). Results: All thirty-two analyzed resuscitations had a unique trauma team composition and 101 unique members were involved. A mean of 5.71 (SD 2.57) new members in teams of consecutive trauma resuscitations was found, which was two-third of the trauma team. Mean team members present during trauma resuscitation was 8.38 (SD 1.43). Most variation in staffing was among nurses (32 unique members), radiology technicians (22 unique members) and anesthetists (19 unique members). The least variation was among trauma surgeons (3 unique members) and ER physicians (3 unique members). Conclusion: We found an extremely high variation in trauma team staffing during thirty-two consecutive resuscitations at our level one trauma center which is incorporated in an academic teaching hospital. Further research is required to explore and prevent potential negative effects of staffing variation in trauma teams on teamwork, processes and patient related outcomes.
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Forensisch sociale professionals komen regelmatig in aanraking met cliënten bij wie zich een of meerdere ingrijpende ervaringen in hun leven hebben voorgedaan. Het begeleiden van deze cliënten kan uitdagend zijn omdat het verband tussen ingrijpende ervaringen uit het verleden en klachten in het heden regelmatig gemist wordt. Trauma wordt beschreven als een directe risicofactor voor gewelddadig gedrag en indirecte risicofactor door middel van mediërende variabelen zoals impulsiviteit, negatieve emotionaliteit of hypervigilantie en achterdocht. Trauma kan ook gezien worden als responsiviteitsfactor omdat traumagerelateerde symptomen de behandeling en het toezicht bemoeilijken. Deze symptomen kunnen er voor zorgen dat cliënten hun programma niet kunnen volgen, niet op afspraken kunnen verschijnen of niet optimaal kunnen profiteren van de therapie. In dit hoofdstuk wordt het verband tussen ingrijpende ervaringen uit het verleden en klachten in het heden nader beschreven en concrete adviezen geformuleerd hoe hier in de praktijk zo goed mogelijk mee om te gaan.
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Research shows that victimization rates in forensic mental health care are high for both female and male patients. However, gender differences have been found in types and patterns of victimization (more sexual abuse and more complex trauma for women), cognitive appraisal, and response to traumatic events. Gender-responsive treatments focusing on trauma have been designed to adhere to these gender differences; however, despite promising research results, these interventions are yet to be introduced in many settings. This study examined how trauma is addressed in current clinical practice in Dutch forensic mental health care, whether professionals are knowledgeable of gender differences in trauma, and how gender-responsive factors such as self-esteem, self-efficacy, social relations, and coping skills are considered in treatment for female patients. We used a mixed-method design consisting of an online survey and 33 semi-structured interviews with professionals and patients. The results suggested that Dutch forensic mental health care could address trauma more structurally, and professionals could be more aware of gender differences and gender-responsive factors. Early start of trauma treatment was deemed important but was not current practice according to patients. Based on this study, guidelines were developed for gender-responsive, trauma-informed work in forensic mental health care.
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Background: Although the timely involvement of trauma surgeons is widely accepted as standard care in a trauma center, there is an ongoing debate regarding the value of an on-site attending trauma surgeon compared to an on-call trauma surgeon. The aim of this study was to evaluate the effect of introducing an on-site trauma surgeons and the effect of their presence on the adherence to Advanced Trauma Life Support (ATLS) related tasks and resuscitation pace in the trauma bay. Methods: The resuscitations of severely injured (ISS > 15) trauma patients 1 month before and 1 month after the introduction of an on-site trauma surgeon were assessed using video analysis. The primary outcome was total resuscitation time. Second, time from trauma bay admission until tasks were performed, and ATLS adherence were assessed. Results: Fifty-eight videos of resuscitations have been analyzed. After the introduction of an on-site trauma surgeon, the mean total resuscitation time was 259 seconds shorter (p = 0.03) and seven ATLS related tasks (breathing assessment, first and second IV access, EKG monitoring and abdominal, pelvic, and long bone examination; were performed significantly earlier during trauma resuscitation (p ≤ 0.05). Further, we found a significant enhancement to the adherence of six ATLS related tasks (Airway assessment, application of a rigid collar, IV access; EKG monitoring, log roll, and pronouncing results of arterial blood gas analysis; p-value ≤0.05). Conclusion: Having a trauma surgeon on-site during trauma resuscitations of severely injured patients resulted in improved processes in the trauma bay. This demonstrates the need of direct involvement of trauma surgeons in institutions treating severely injured patients.
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Background: A crucial but often overlooked impact of early life exposure to trauma is its farreaching effect on a person’s relationship with their body. Several domains of body experience may be negatively influenced or damaged as a result of early childhood trauma. Objective: The aim of this study was to investigate disturbances in three domains of body experience: body attitude, body satisfaction, and body awareness. Furthermore, associations between domains of body experience and severity of trauma symptoms as well as frequency of dissociation were evaluated. Method: Body attitude was measured with the Dresden Body Image Questionnaire, body satisfaction with the Body Cathexis Scale, and body awareness with the Somatic Awareness Questionnaire in 50 female patients with complex trauma and compared with scores in a non-clinical female sample (n = 216). Patients in the clinical sample also filled out the Davidson Trauma Scale and the Dissociation Experience Scale. Results: In all measured domains, body experience was severely affected in patients with early childhood trauma. Compared with scores in the non-clinical group, effect sizes in Cohen’s d were 2.7 for body attitude, 1.7 for body satisfaction, and 0.8 for body awareness. Associations between domains of body experience and severity of trauma symptoms were low, as were the associations with frequency of dissociative symptoms. Conclusions: Early childhood trauma in women is associated with impairments in selfreported body experience that warrant careful assessment in the treatment of women with psychiatric disorders.
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Introduction: A trauma resuscitation is dynamic and complex process in which failures could lead to serious adverse events. In several trauma centers, evaluation of trauma resuscitation is part of a hospital's quality assessment program. While video analysis is commonly used, some hospitals use live observations, mainly due to ethical and medicolegal concerns. The aim of this study was to compare the validity and reliability of video analysis and live observations to evaluate trauma resuscitations. Methods: In this prospective observational study, validity was assessed by comparing the observed adherence to 28 advanced trauma life support (ATLS) guideline related tasks by video analysis to life observations. Interobserver reliability was assessed by calculating the intra class coefficient of observed ATLS related tasks by live observations and video analysis. Results: Eleven simulated and thirteen real-life resuscitations were assessed. Overall, the percentage of observed ATLS related tasks performed during simulated resuscitations was 10.4% (P < 0.001) higher when the same resuscitations were analysed using video compared to live observations. During real-life resuscitations, 8.7% (p < 0.001) more ATLS related tasks were observed using video review compared to live observations. In absolute terms, a mean of 2.9 (during simulated resuscitations) respectively 2.5 (during actual resuscitations) ATLS-related tasks per resuscitation were not identified using live observers, that were observed through video analysis. The interobserver variability for observed ATLS related tasks was significantly higher using video analysis compared to live observations for both simulated (video analysis: ICC 0.97; 95% CI 0.97-0.98 vs. live observation: ICC 0.69; 95% CI 0.57-0.78) and real-life witnessed resuscitations (video analyse 0.99; 95% CI 0.99-1.00 vs live observers 0.86; 95% CI 0.83-0.89). Conclusion: Video analysis of trauma resuscitations may be more valid and reliable compared to evaluation by live observers. These outcomes may guide the debate to justify video review instead of live observations.
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Je cliënt heeft gedragsproblemen en moeite met slapen. Ervaringen uit het verleden zijn daarvan misschien de oorzaak. Hoe herken je of er van trauma sprake is? En hoe ga je dieper in op de gevolgen van trauma, zonder de cliënt juist verder te beschadigen? Zorg+Welzijn sprak over het herkennen van trauma met Simona Karbouniaris, onderzoeker aan de Hogeschool Utrecht. Ze is werkzaam als sociaal wetenschapper bij Kenniscentrum Sociale Innovatie. De afgelopen jaren begeleidde Karbouniaris diverse intervisiegroepen voor ggz professionals bij het inzetten en benutten van persoonlijke traumatische ervaringen. Samen met hoogleraar Jim van Os schreef ze het boek ‘Kopzorgen. Trauma begrijpen in 33 vragen’.
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