Transfer Guidelines Research Articles

Abstract WP322: Transfer Guidelines for IV Alteplase (tPA) Patients Improves Outcomes

Background: Comprehensive Stroke Center (CSC) identified tPA transfers were missing documentation of treatments and vital signs from transferring facilities (TFs) and during transfer by Emergency Medical Services (EMS). A patient who became hypertensive and had hemorrhagic transformation (HT) arrived without documentation. Purpose: Implement transfer guidelines to ensure documentation is received and blood pressures (BP) are monitored and treated during transfer to avoid HT. Method: Guidelines developed included required documentation from TFs to be sent with patients; parameters for BP monitoring and treatment during EMS transfer; and receiving nurse checklist to verify receipt of documented care prior to arrival. Guidelines were communicated to TFs, EMS, and CSC nurses. Results: Review of 293 tPA records, excluding endovascular interventions, were compared pre-guidelines 2016 (Pre-G) and post-guidelines January 2017-June 2018 (Post-G). Transfer volumes Pre-G were 37 of 129 and Post-G 54 of 164. Rate of hemorrhage on brain imaging within 36 hours after tPA was higher on transfers for both review periods 19%(7/37) and 15%(8/54) compared to non-transfers 8%(7/92) and 8%(9/110). Of the Pre-G HTs that were symptomatic, transfers had a higher rate 71%(5/7) than non-transfers 29%(2/7) and decreased to a rate of 50%(4/8) Post-G. Blood pressures were controlled on 60% of 2016 cases versus 75% in 2017. There were zero transfer symptomatic HTs in 2018. Pre-G and Post-G transfers with symptomatic HT had dispositions of Hospice 60%(3/5) and 25%(1/4), Rehab 40%(2/5) and 25%(1/4), Home 0%(0/5) and 50%(2/4), respectively. Pre-G and Post-G modified Rankin Score (mRS) at discharge for symptomatic HT transfers were mRS 4-5 = 100%(5/5) and 50%(2/4) and mRS 2-3 = 0%(0/5) and 50%(2/4), respectively. mRS at 90 days hospice or expired was Pre-G 60%(3/5) and Post-G 25%(1/4). Conclusion: Prior to implementing transfer guidelines for tPA patients, this population had higher rates of HT, symptomatic HT, and mRS at discharge. Transfer guidelines improved acquisition of documentation for continuum of care and BP management with decreased rates of symptomatic HT and improved outcomes.

Evidence for population differentiation among Jeffrey and Ponderosa pines in survival, growth and phenology

Ecological restoration projects that include reforestation require that land managers select appropriate source of seeds for long-term persistence. In California, the standard approach for making this choice is based on seed zone and elevational band, both geographically-based measures. However, given the pace of contemporary climate change, populations previously adapted to local conditions may become increasingly mismatched to the changes in climate. If there is a lag in adaptation, current seed zones which assume local is best, would be less useful for reforestation guidelines. Here we use a historic provenance test to evaluate genetic differences among provenances of two species of pine, Pinus ponderosa and P. jeffreyi, and assess performance following seedling transfer across an elevational gradient. Growth in Ponderosa pine shows evidence of a lag in adaptation: trees transferred from lower elevations had consistently increased growth when compared to those trees from higher elevations. In contrast, Jeffrey pine showed no evidence of a lag in adaptation for height. However, survival of Jeffrey pine provenances showed a significant quadratic relationship with transfer distance, consistent with local adaptation. In particular, Jeffrey pine trees from cooler, higher elevation sites had increased survival at high elevation. Jeffrey pine trees from higher elevation also exhibited earlier bud burst than trees from lower elevation grown in the same site, consistent with counter-gradient adaptation in phenology. Together, our results show that genetic variation within species is important for tree survival, growth and phenology in different climates. However, species-specific responses to elevational transfer indicates generalizing seed transfer guidelines across conifer species may be challenging and additional information is necessary to inform managed relocation in a changing climate.

Evaluating the Design Standard of UiTM Massive Open Online Courses

Massive Open Online Course (MOOC) was one of the initiatives of the Malaysia Ministry of Education to ensure the standard of our national education system was at par with the global education trends. This initiative was documented in Malaysian Education Blueprint 2015 -2025 (Higher Education, Shift No.9: Globalised Online Learning). Universiti Teknologi MARA (UiTM) was among the public universities in Malaysia that were seriously involved in MOOC development. Starting with one MOOC in 2014, four MOOCs in 2015, 16 MOOCs in 2016, UiTM embarked into developing 450 new MOOCs in 2017. To ensure UiTM MOOC had achieved the required standard and quality of Malaysian MOOC, an internal guideline for UiTM MOOC Development (i-Learn Centre, 2016) was constructed. The construction of the guideline was based on the standard provided by the Guidelines of Development and Delivery of Malaysian MOOC (KPT, 2017). Some additional elements required by the administrator of UiTM MOOC were also added. The study was interested to determine whether the MOOCs developed by UiTM lecturers complied with the standard of UiTM MOOC and ultimately the Malaysian MOOC. It was also interested to determine the readiness of UiTM MOOC for credit transfer. To do that, a UiTM MOOC Evaluation Checklist was introduced. The checklist consisted of 45 questions which were constructed based on the guideline on UiTM MOOC Development (i-Learn Centre, 2016) and the Guidelines for Credit Transfer for MOOC (MQA, 2016). The study evaluated two active UiTM MOOCs in terms of adherence to the standard of UiTM MOOC. The findings of the study highlighted areas to be improved and provided suggestions to increase readiness for MOOC credit transfer.

Spatial decision‐support tools to guide restoration and seed‐sourcing in the Desert Southwest

AbstractAltered disturbance regimes and shifting climates have increased the need for large‐scale restoration treatments across the western United States. Seed‐sourcing remains a considerable challenge for revegetation efforts, particularly on public lands where policy favors the use of native, locally sourced plant material to avoid maladaptation. An important area of emphasis for public agencies has been the development of spatial tools to guide selection of genetically appropriate seed. When genetic information is not available, current seed transfer guidelines stipulate use of climate‐based or provisional seed transfer zones, which serve as a proxy for local adaptation by representing climate gradients to which plants are commonly adapted. Despite this guidance, little emphasis has been placed on identifying best practices for deriving provisional seed zones or on incorporating predictions from future climate. We describe a flexible, multivariate procedure for deriving such zones that incorporates a broad range of climatic characteristics while accounting for covariation among climate variables. With this approach, we derive provisional seed zones for four regions in the Desert Southwest (the Mojave Desert, Sonoran Desert, Colorado Plateau, and Southern Great Basin). To facilitate future‐resilient restoration designs, we project each zone into its relative position in the future climate based on near‐term, RCP4.5 and RCP8.5 emissions scenarios. Although provisional seed zones are useful in a variety of contexts, there are also situations in which site‐specific guidance is preferable. To meet this need, we implement Climate Distance Mapper, an interactive decision‐support tool designed to help practitioners match seed sources with restoration sites through an accessible online interface. The application allows users to rank the suitability of seed sources anywhere on the landscape based on multivariate climate distances. Users can perform calculations for either the current or future climates. Additionally, tools are available to guide sample effort in regional‐scale seed collections or to partition the landscape into climate clusters representing suitable planting sites for different seed sources. Our tools and analytic procedures represent a flexible and reproducible framework for advancing native plant development programs in the Desert Southwest and beyond.

Clinical epidemiology and outcomes of community acquired infection and sepsis among hospitalized patients in a resource limited setting in Northeast Thailand: A prospective observational study (Ubon-sepsis).

Infection and sepsis are leading causes of death worldwide but the epidemiology and outcomes are not well understood in resource-limited settings. We conducted a four-year prospective observational study from March 2013 to February 2017 to examine the clinical epidemiology and outcomes of adults admitted with community-acquired infection in a resource-limited tertiary-care hospital in Ubon Ratchathani province, Northeast Thailand. Hospitalized patients with infection and accompanying systemic manifestations of infection within 24 hours of admission were enrolled. Subjects were classified as having sepsis if they had a modified sequential organ failure assessment (SOFA) score ≥2 at enrollment. This study was registered with ClinicalTrials.gov, number NCT02217592. A total of 4,989 patients were analyzed. Of the cohort, 2,659 (53%) were male and the median age was 57 years (range 18–101). Of these, 1,173 (24%) patients presented primarily to the study hospital, 3,524 (71%) were transferred from 25 district hospitals or 8 smaller hospitals in the province, and 292 (6%) were transferred from one of 30 hospitals in other provinces. Three thousand seven hundred and sixteen (74%) patients were classified as having sepsis. Patients with sepsis had an older age distribution and a greater prevalence of comorbidities compared to patients without sepsis. Twenty eight-day mortality was 21% (765/3,716) in sepsis and 4% (54/1,273) in non-sepsis patients (p<0.001). After adjusting for gender, age, and comorbidities, sepsis on admission (adjusted hazard ratio [HR] 3.30; 95% confidence interval [CI] 2.48–4.41, p<0.001), blood culture positive for pathogenic organisms (adjusted HR 2.21; 95% CI 1.89–2.58, p<0.001) and transfer from other hospitals (adjusted HR 2.18; 95% CI 1.69–2.81, p<0.001) were independently associated with mortality. In conclusion, mortality of community-acquired sepsis in Northeast Thailand is considerable and transferred patients with infection are at increased risk of death. To reduce mortality of sepsis in this and other resource-limited setting, facilitating rapid detection of sepsis in all levels of healthcare facilities, establishing guidelines for transfer of sepsis patients, and initiating sepsis care prior to and during transfer may be beneficial.

Biological material collection to advance translational research and treatment of children with CNS tumours: position paper from the SIOPE Brain Tumour Group

Paediatric CNS tumours are the most common cause of childhood cancer-related morbidity and mortality, and improvements in their diagnosis and treatment are needed. New genetic and epigenetic information about paediatric CNS tumours is transforming the field dramatically. For most paediatric CNS tumour entities, subgroups with distinct biological characteristics have been identified, and these characteristics are increasingly used to facilitate accurate diagnoses and therapeutic recommendations. Future treatments will be further tailored to specific molecular subtypes of disease, specific tumour predisposition syndromes, and other biological criteria. Successful biomaterial collection is a key requirement for the application of contemporary methodologies for the validation of candidate prognostic factors, the discovery of new biomarkers, the establishment of appropriate preclinical research models for targeted agents, a quicker clinical implementation of precision medicine, and for other therapeutic uses (eg, for immunotherapies). However, deficits in organisational structures and interdisciplinary cooperation are impeding the collection of high-quality biomaterial from CNS tumours in most centres. Practical, legal, and ethical guidelines for consent, storage, material transfer, biobanking, data sharing, and funding should be established by research consortia and local institutions to allow optimal collection of primary and subsequent tumour tissue, body fluids, and normal tissue. Procedures for the collection and storage of biomaterials and related data should be implemented according to the individual and organisational structures of the local institutions.

The Price of Always Saying Yes: A Cost Analysis of Secondary Overtriage to an Urban Level I Trauma Center

Level I trauma centers serve as a community resource, with most centers using an inclusive transfer policy that may result in overtriage. The financial burden this imparts on an urban trauma system has not been well examined. We sought to examine the incidence of secondary overtriage (SOT) at an urban Level I trauma center. This was a retrospective study from an urban Level I trauma center examining patients admitted as trauma transfers (TT) from 2010 to 2014. SOT was defined as patients not meeting the "Orange Book" transfer criteria and who had a length of stay of <48 hours. Average ED and transport charges were calculated for total transfer charges. A total of 2397 TT were treated. The number of TT increased over the study interval. The mean age of TT was 59.7 years (SD ± 26.4 years); patients were predominantly male (59.2%), white (83.2%), with at least one comorbidity (71.5%). Blunt trauma accounted for 96.8 per cent of admissions with a median Injury Severity Score of nine (IQR: 5-16). Predominant injuries were isolated closed head trauma (61.4%), skin/soft tissue injury (18.9%), and spinal injury (17.6%). SOT was 48.2 per cent and increased yearly (P < 0.001). The median trauma center charge for SOT was ($27,072; IQR: $20,089-34,087), whereas ED charges were ($40,440; IQR: $26,150-65,125), resulting in a total cost of $67,512/patient. A liberal TT policy results in a high SOT rate adding significant unnecessary costs to the health-care system. Efforts to establish transfer guidelines may allow for significant cost savings without compromising care.

Pediatric Readiness in Critical Access Hospital Emergency Departments.

Critical Access Hospitals (CAHs), often the first point of access for emergency care, see few children and are challenged to remain proficient in caring for pediatric patients. Our analysis provides guidance to facilitate increasing CAHs staffs' ability to provide effective pediatric emergency care. The National Pediatric Readiness Project (NPRP) assessment of 4,146 emergency departments (EDs) was linked with the CAHs list from Centers for Medicare and Medicaid Services. Pediatric readiness was assessed using the weighted pediatric readiness score (WPRS). A WPRS of 100 indicates that the ED meets essential guidelines for pediatric readiness. Using descriptive statistics, we also compared low (fewer than 5 children a day) and medium patient volume (5-14 children a day) EDs in 6 core areas of readiness. Eighty-six percent (1,140) of CAHs were linked to the NPRP. In the study, 80% were low and 20% medium volume. The median WPRS was 59.0 for low and 67.3 for medium volume. While some differences were found by patient volume, overall 63% of CAHs had a pediatric emergency care coordinator, 34% had a pediatric patient care review process, 62% had interfacility transfer guidelines, and 45% weighed children only in kilograms. CAHs participating in a facility recognition program had significantly higher median WPRS scores (84.3) compared to those not participating (59.5). CAHs have challenges in being ready to care for children in the areas of pediatric emergency care coordinators, policies, procedures, and patient safety. Minimal cost interventions are available to increase the readiness of CAHs to care for children.

Invited commentary

Invited commentary

Bloom’s Taxonomy with Respect to Cognition in a Diverse Socio-Economic Classroom

The paper will look at the role of the socio economic influence in the transfer of knowledge and whether it can be used as a negative-positive stimulator in the meta- cognitive process. Through the diverse level of economic disparity that encompasses them we will look at the factors that go into a making a classroom a level playing environment for the diffusion of knowledge. The paper will look at how experience can play a role in the creation of meta cognitive knowledge and the role of teachers as role models by sharing with students and amongst themselves as a pivotal feature in the establishment of positive meta cognitive experiences. The proposed structure would envisage creation of knowledge from ‘bottom- up’ through people via the teacher- student relationship with the entire focus on human- tacit knowledge creation and codification. The scope of the paper is to : 1. Identify potential issues in making a classroom a level playing field for a diverse group of socio-economic students 2. Apply Bloom’s ‘revised’ Taxonomic table with respect to recall, understanding & applying of cognitive processes in the knowledge domain and the human infrastructure and tools required to implement this as a continuous process. The paper will look at evaluating the problem through the framework provided by Bloom’s Taxonomy and analyze its relation through diverse socio economic influences in the classroom. The proposed solution will be based on the analysis of the taxonomic model as well as based on the results from our interviews. The conclusions will provide a significant roadmap in the generation of knowledge through the classroom while attempting to minimize the impact of the socio-economic divides. In addition through the taxonomy we hope to provide knowledge transfer guidelines that will help in the sustainability of the knowledge cycle in the classroom.

Commercialization, Altruism, Clinical Practice: Seeking Explanation for Similarities and Differences in Californian and Canadian Gestational Surrogacy Outcomes

Surrogacy is growing worldwide. Although recently some countries have sought to ban it, between 2010 and 2014 the number of babies born to gestational surrogates having invitro fertilization treatment in California doubled, and in Canada it grew by 35%. This work seeks to fill identified knowledge gaps about the similarities and differences in the practices and outcomes of gestational surrogacy, which in California operates on a commercial basis, whereas in Canada it is illegal to pay a surrogate. The paper focusses on the period from 2010 to 2014, for which comparable American and Canadian national assisted reproduction technology information exist. A retrospective data analysis was performed using information on gestational surrogate multiple births obtained from the Centers for Disease Control and Prevention National Assisted Reproductive Technology Surveillance System (NASS) and Canada's Assisted Reproduction Registry-Better Outcomes Registry and Network (CARTR-BORN). Multiple birth rates and transfers of multiple embryos were compared using relative risk analysis. Adherence to voluntary American Society for Reproductive Medicine-Society for Assisted Reproductive Technology and Canadian Fertility and Andrology Society embryo transfer guidelines was modelled. Among gestational surrogates, when donor ova embryos obtained from women aged less than 35years were used, embryo transfer guideline adherence was 42% in California and 48% in Canada. Regardless of where on the commercial/noncommercial boundary North American surrogates reside, they are more likely to receive more donor ova embryos per invitro fertilization transfer than other invitro fertilization patients. An altruistic desire to assist childless couples and individuals create families along with clinic practices seem to play major roles in treatment decisions privileging the transfer two or more embryos.

Provisional methods to guide species‐specific seed transfer in ecological restoration

AbstractTransferring plant material during ecological restoration has inherent risk. The use of seed transfer guidelines minimizes the possibility of introducing maladapted genotypes. We delineated biogeographic regions relevant to the distribution of Cercocarpus montanus for the purpose of creating provisional seed transfer zones for ecological restoration. We also modeled seed transfer guidelines using quantitative estimates of environmental tolerance and thresholds. Analyses identified broadscale environmental patterns relevant for seed transfer success. First, a species distribution model was used to identify the distribution of C. montanus. Next, we used non‐metric multidimensional scaling to investigate the structure of environmental data, and hierarchical cluster analysis to delineate biogeographic regions (i.e., environmental discontinuities) using species distribution data. Finally, we calculated measures of environmental tolerance and thresholds for C. montanus to model the probability of seed transfer success with multiple logistic regression. Biogeographic regionalization of C. montanus resulted in four major clusters, which agreed with ordination methods. Logistic regression was implemented using estimates of environmental tolerance and threshold data to model seed transfer success. We compared our species‐specific seed transfer zones and guidelines with other provisional seed transfer zone methods and found that our species‐specific methods performed better at explaining phenotypic variation of C. montanus in four out of six cases. Seed transfer zones are useful for restoration planning; however, zonal models fail to reflect much of the environmental heterogeneity present across the range of C. montanus. Continuous models for seed transfer success using environmental tolerance and thresholds enhance the development and use of seed transfer guidelines because they reflect landscape heterogeneity at a fine scale, and the results are relative to restoration sites of interest. Herein, we describe a methodology to construct provisional seed transfer zones and continuous seed transfer guidelines using species‐specific distribution models and multivariate analyses.

Trauma case review: A quality and safety feature of the Victorian State Trauma System.

The aim of the present study was to describe the trauma case review process and its role in a regionalised trauma system. Victoria has a population of 5.9 million people, accounting for 26% of Australia's population. Victoria has been serviced by an inclusive, organised trauma system since 2000 comprising 138 health services with trauma designations and three major trauma services. Pre- and interhospital guidelines prescribe the timely transport of patients to the appropriate level of trauma service. A review of the role and contribution of 10 years of operation of the trauma case review group (CRG) was undertaken to describe the aims, processes and governance surrounding the implementation of an individual case review for specified major trauma patients. Specified patients were those identified by the Victorian State Trauma Registry as being managed outside of established Victorian State Trauma System prehospital and interhospital guidelines. A state-wide trauma case review process was implemented across the trauma system using data-informed detection flags and screening criteria. Using data from the Victorian State Trauma Registry, detection flags were correlated with patients at risk of a poorer outcome, thereby ensuring that all patients managed outside of the requirements of established trauma triage and transfer guidelines were subject to review. The CRG provides an individual review process as a technique for assessing and monitoring major trauma patient care and compliance with trauma system triage and transfer guidelines. The process has been effective as a quality and safety strategy by improving clinician knowledge of major trauma triage and transfer guidelines and facilitating improved compliance, particularly with interhospital transfers. Strong compliance has been achieved from health services with the requirement to internally review and respond to CRG concerns regarding 'high-risk' trauma cases. Anecdotal feedback from health services regarding participation in the CRG process has been positive. The trauma case review process is an embedded feature of the Victorian State Trauma System that aims to improve compliance with major trauma guidelines by reviewing major trauma cases that have been managed outside of established triage and transfer guidelines. All trauma-designated Victorian health services, Ambulance Victoria and Victorian adult and paediatric patient retrieval services might receive trauma cases for review. The process is also an integral component of trauma system clinical governance, which enables the identification of system-level issues for escalation to the State Trauma Committee and the Victorian Department of Health and Human Services.

Geographic patterns of genetic variation in nuclear and chloroplast genomes of two related oaks (Quercus aliena and Q. serrata) in Japan: implications for seed and seedling transfer

In this study, we assessed geographic patterns of genetic variations in nuclear and chloroplast genomes of two related native oaks in Japan, Quercus aliena and Q. serrata, in order to facilitate development of genetic guidelines for transfer of planting stocks for each species. A total of 12 populations of Q. aliena and 44 populations of Q. serrata were analyzed in this study. Genotyping of nuclear microsatellites in Q. aliena was done with only nine populations (n = 212) due to limited numbers of individuals in two populations, while all 12 populations (n = 89) were used in sequencing chloroplast DNA (cpDNA). In Q. serrata, 43 populations (n = 1032) were genotyped by nuclear microsatellite markers, while cpDNA of 44 populations (n = 350) was sequenced. As anticipated, geographic patterns detected in the variations of Q. aliena’s nuclear genome and its chloroplast haplotype distribution clearly distinguished northern and southern groups of populations. However, those of Q. serrata were inconsistent. The geographic distribution of its chloroplast haplotypes tends to show the predicted differentiation between northern and southern lineages, but geographic signals in the genetic structure of its nuclear microsatellites are weak. Therefore, treating northern and southern regions of Japan as genetically distinct transferrable zones for planting stocks is highly warranted for Q. aliena. For Q. serrata, the strong NE-SW geographic structure of cpDNA should be considered.

Phylogeographic pattern suggests a general northeastward dispersal in the distribution of Machilus pauhoi in South China.

Machilus pauhoi Kanehira is an important timber species in China. A provenance trial was recently set up to evaluate the growth performance of trees from different localities, with the aim of designing seed transfer guidelines. Here, we tested twelve nuclear microsatellite markers derived from other species of the Lauraceae family and investigated population genetic structure in M. pauhoi. Both the number of observed alleles per locus (Na) and the polymorphic information content (PIC) significantly decreased against the latitude, but showed an insignificant decrease against the longitude. Heterozygosity (Ho) and gene diversity (h) exhibited a weak correlation with geographic location. Private alleles were present in multiple populations, and a moderate level of population genetic differentiation was detected (Gst = 0.1691). The joint pattern of genetic diversity (Na, PIC, Ho, and h) suggests that general northeastward dispersal led to the current distribution of M. pauhoi. Significant but weak effects of isolation-by-distance (IBD) occurred, implicating the mountain ranges as the major barrier to gene flow. Both STRUCTURE and hierarchical clustering analyses showed three distinct groups of populations related to the physical connectivity among mountain ranges. A priority in designing genetic conservation should be given to the populations at the southwest side of the species’ distribution. This conservation strategy can also be combined with the pattern of adaptive genetic variation from the provenance trial for comprehensive genetic resource management of native M. pauhoi.

Applying landscape genomic tools to forest management and restoration of Hawaiian koa (Acacia koa) in a changing environment.

Identifying and quantifying the importance of environmental variables in structuring population genetic variation can help inform management decisions for conservation, restoration, or reforestation purposes, in both current and future environmental conditions. Landscape genomics offers a powerful approach for understanding the environmental factors that currently associate with genetic variation, and given those associations, where populations may be most vulnerable under future environmental change. Here, we applied genotyping by sequencing to generate over 11,000 single nucleotide polymorphisms from 311 trees and then used nonlinear, multivariate environmental association methods to examine spatial genetic structure and its association with environmental variation in an ecologically and economically important tree species endemic to Hawaii, Acacia koa. Admixture and principal components analyses showed that trees from different islands are genetically distinct in general, with the exception of some genotypes that match other islands, likely as the result of recent translocations. Gradient forest and generalized dissimilarity models both revealed a strong association between genetic structure and mean annual rainfall. Utilizing a model for projected future climate on the island of Hawaii, we show that predicted changes in rainfall patterns may result in genetic offset, such that trees no longer may be genetically matched to their environment. These findings indicate that knowledge of current and future rainfall gradients can provide valuable information for the conservation of existing populations and also help refine seed transfer guidelines for reforestation or replanting of koa throughout the state.

Consistency of total body surface area assessment in severe burns: Implications for practice.

Paediatric burn injury is common and often serious. Injuries occur across New South Wales (NSW), with specialised treatment provided in a centralised burns unit. Early management prior to transfer is essential but variation is seen. To determine if differences exist between referring hospital estimates of the total body surface area (TBSA) of burns, and estimates for the same burns by the Burns Unit. To consider if differences in estimations influence initial and ongoing management, and decisions regarding transfer/retrieval. A retrospective record review of all patients referred to NSW Newborn and Paediatric Emergency Transport Service (NETS) with burn injury between January 2009 and January 2011. Both NETS and NSW Burns Unit records were analysed. A total of 123 patients were referred to NETS with burn injury. Approximately half (55/123 = 45%) were referred with a TBSA >10% and transferred to the NSW Burns Unit, where just over half (33/55 = 60%) were assessed as >10%. This means 40% of cases received an initial overestimation of TBSA by referring hospitals. NETS medical teams transferred 34 patients to the Burns Unit, eight (24%) of which on retrospective review did not meet the NSW Burn Transfer Guidelines criteria for a medical team transfer. Our review demonstrated significant differences between the TBSA assessment of referring hospitals and the NSW Burns Unit. These inconsistencies may have resulted in children receiving treatment and transport not indicated based on accurate TBSA assessment. Potentially unnecessary transfers have implications for the displacement of children and families but also impact overall health costs and resource availability.

Effect of Policy Change on the Use of Long-Distance Transport and Follow-Up Care for Patients With Traumatic Finger Amputations

In January 2006, the American College of Emergency Physicians released updated guidelines for air transfer. Digit amputation and near-amputation were no longer an indication for this costly service. We analyzed the effect of this update on the use of air transport and associated care outcomes for finger amputation patients and examined factors involved in providing follow-up care for these patients. A retrospective chart review identified all patients treated for traumatic finger amputation between 1995 and 2012 at a major hand trauma referral center. Analysis of available outcome measures was conducted using multiple logistic and linear regression models. Analysis of factors affecting frequency of return visits was performed via negative binomial regression. We identified 724 patients with isolated traumatic finger amputations. A total of 267 patients (37%) were transferred from an outside hospital. Patients injured after 2006 were less likely to be transferred via air, with a decrease from 29.5% pre-2006 to 14.9% post-2006. There was no difference in likelihood of replantation success, length of hospital stay, or number of return visits pre- versus post-2006. Patients transferred via helicopter after 2006 were more likely to be younger than 20 years of age and injured in a winter month. Following successful replantation, work-relatedness was associated with a higher number of return visits, whereas increasing age and transfer from farther than 100 miles away were associated with fewer. After the American College of Emergency Physicians policy update, decreased use of emergency air transport to a hand trauma referral center for patients with traumatic finger amputations did not adversely affect care delivery and outcomes. These changes may be successfully implemented on a center-by-center basis to reduce costs without detriment to patient care; however, coordination of follow-up care for long-distance transport patients may require special focus when designing policy around referral centers. Therapeutic IV.

Comunicación para la ciencia, una ruta hacia la visibilidad en la Universidad Autónoma de Bucaramanga (UNAB)

Saber cómo llegar y para quién se escribe sin perder el nivel de complejidad, sacándolo del metalenguaje científico y haciéndolo comprensible, es una ardua tarea que aprovecha las plataformas tecnológicas y diferentes estrategias de comunicación para lograr el acceso al conocimiento, de esta forma y siendo coherentes con la responsabilidad social que tienen las Instituciones de Educación Superior de llevar la educación a todas partes, y en congruencia con su función sustantiva y sus ejes misionales: docencia, investigación y extensión; con miras a cumplir el objetivo, las instituciones gestionan procesos editoriales con el fin de consolidar y potenciar una propuesta de visibilidad Institucional, más que de rentabilidad. &#x0D; Una radiografía generalizada para la mayoría de las editoriales universitarias que han centrado sus esfuerzos en apoyar la producción intelectual han desembocado lamentablemente en “bodegas repletas de libros que se acumulan, …que fueron utilizados en pequeñas cantidades para alguna actividad de prensa y como exigua retribución al autor o los autores” (1) situación que pone de manifiesto la necesidad de tomar la ruta de la comunicación para ciencia, en donde el proceso editorial sirve de mediador entre la universidad y la sociedad civil, el ideal, para que realmente sea útil y cumpla una función social, en la vía de lograr la democratización del conocimiento y por ende la apropiación social del mismo.&#x0D; Partiendo de la premisa de que la comunicación es transversal a la gestión Institucional, es un ejercicio dialógico constante entre quienes participan y dinamizan los diferentes procesos y actividades cotidianas de una Universidad. Es por ello que la apuesta de la Universidad Autónoma de Bucaramanga (UNAB) desde este año, va encaminada a fortalecer la visibilidad Institucional mediante el proyecto estratégico “Comunicación para la Ciencia”, el cual se integra y alinea con otros proyectos y lineamientos universitarios. El eje central de esta propuesta se basa en el aumento del factor de visibilidad de la UNAB en diversas instancias de orden Nacional e Internacional, a partir de un portafolio de publicaciones que incluyen revistas seriadas, libros de investigación, libros de difusión, cartillas, boletines informativos y trabajos de grado, entre otros, en congruencia con lineamientos de calidad, pertinencia, valor agregado y transferencia del conocimiento, basados en los 4 pilares de la comunicación para la ciencia: la difusión, la divulgación, la legalización y la distribución.&#x0D; Partiendo de la complejidad inmersa tanto en la gestión del conocimiento, insumo fundamental de la propuesta de comunicación para la ciencia, y en la gestión editorial desde los 4 pilares, la Universidad reconoce las ventajas que representan servicios tercerizados de tecnología y gestión digital del conocimiento, infraestructura tecnológica de punta requerida y canales de acceso adecuados para el público objetivo de la propuesta de comunicación. Es por ello que desde cada uno de los pilares se establecieron directrices y operadores internos y externos para el proceso.

Western Vascular Society guidelines for transfer of patients with ruptured abdominal aortic aneurysm

When a patient with ruptured abdominal aortic aneurysm (rAAA) presents at a facility ill-equipped to provide care, transfer may provide the best chance for survival. Large distances and long travel times provide challenging barriers to prompt and appropriate care in the western United States. The Western Vascular Society (WVS) adopted a set of guidelines in considering transfer of a patient withan rAAA using published literature, membership survey and input, and existing recommendations. This article reports the guidelines and describes the process and rationale behind their development. Fifteen guidelines for transfer and care of rAAAs were endorsed by the WVS. When local care cannot be provided, transfer guidelines may standardize care for rAAAs and may be applicable across may practice settings.