Treatment Of Trauma Research Articles

An evaluation of survive and thrive: a 10-week group psychoeducational course for adult interpersonal trauma survivors in Scotland

ABSTRACT Emerging evidence supports a phased approach to trauma treatment, including manualised group-based interventions, to facilitate symptom reduction resulting from complex trauma sequelae. This study investigates the efficacy of Survive and Thrive, a 10-week group psychoeducational course for adult survivors of interpersonal trauma. Between August 2019 and February 2022, participants were enrolled on the course. The Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM) and Difficulties in Emotion Regulation Scale—Short Form (DERS-SF) were administered pre-intervention and immediately post-intervention. In addition, thematic analysis was applied to qualitative feedback. Results revealed significant reductions in CORE-OM and DERS-SF scores post-intervention, with minimal variability in scores attributed to group delivery (either face-to-face or online). The thematic analysis demonstrated that normalising trauma symptoms and providing coping skills positively impacted participants’ experiences. At the same time, the breadth and nature of the content were observed to be an occasional barrier to engagement. In summary, this study proposes that group-based psychoeducational interventions are generally effective for those with mild-to-moderate symptoms of complex trauma. However, further evidence is needed to offer more nuanced recommendations for identifying individuals who may benefit the most from these interventions.

Клинический случай этапной хирургии последствий открытой травмы глаза

Purpose. To present a clinical case of staged surgical treatment of a patient with a battle-open eye injury. Material and methods. Patient M., born in 1976, with a condition after an open eye injury of the V degree, type B, zone II (1, 2, 3, 4, 5), with prolapse of the inner membranes, post-traumatic aniridia, post-traumatic aphakia, total hemophthalmos. From the anamnesis it is known that the patient during the shelling received several «blows» in the left side of the face. Primary surgical treatment of facial soft tissue wounds, left paraorbital area, lacerations of the upper eyelid laceration was performed. Prescribed with recommendations of conservative treatment of the left eye. The patient performed a phased surgical treatment of open eye trauma. Results. Surgical treatment was performed routinely, there were no intra- and postoperative complications. The recommended vitreoretinal and optico-reconstructive interventions ensure maximum functional, anatomical and cosmetic recovery of the operated eye. Conclusions. In stage surgical treatment of the consequences of open eye trauma, the duration of each surgical intervention is reduced. This minimizes intraoperative trauma to intraocular structures, which subsequently allows to assess the scope of optical reconstructive interventions and the need for surgical compensation of intraocular pressure. Similarly, delayed implantation of the actually required intraocular lens and iris-lens diaphragm ensures maximum refractive result and cosmetic effect. Keywords: fighting uncovered eye injury, stage-by-stage surgical treatment, optoreconstructive vitreoretinal surgery

Identification of temporal shifts of oral bacteria in bone regeneration following mandibular bone defect injury and therapeutic surgery in a porcine model.

Considered the second largest and most diverse microbiome after the gut, the human oral ecosystem is complex with diverse and niche-specific microorganisms. Although evidence is growing for the importance of oral microbiome in supporting a healthy immune system and preventing local and systemic infections, the influence of craniomaxillofacial (CMF) trauma and routine reconstructive surgical treatments on community structure and function of oral resident microbes remains unknown. CMF injuries affect a large number of people, needing extensive rehabilitation with lasting morbidity and loss of human productivity. Treatment efficacy can be complicated by the overgrowth of opportunistic commensals or multidrug-resistant pathogens in the oral ecosystem due to weakened host immune function and reduced colonization resistance in a dysbiotic oral microbiome. To understand the dynamics of microbiota's community structure during CMF injury and subsequent treatments, we induced supra-alveolar mandibular defect in Hanford miniature swine (n=3) and compared therapeutic approaches of immediate mandibullar reconstructive (IMR) versus delayed mandibullar reconstructive (DMR) surgeries. Using bacterial 16S ribosomal RNA gene marker sequencing, the composition and abundance of the bacterial community of the uninjured maxilla (control) and the injured left mandibula (lingual and buccal) treated by DMR were surveyed up to 70-day post-wounding. For the injured right mandibula receiving IMR treatment, the microbial composition and abundance were surveyed up to 14-day post-wounding. Moreover, we measured sera level of biochemical markers (e.g., osteocalcin) associated with bone regeneration and healing. Computed tomography was used to measure and compare mandibular bone characteristics such as trabecular thickness between sites receiving DMR and IMR therapeutic approaches until day 140, the end of study period. Independent of IMR versus DMR therapy, we observed similar dysbiosis and shifts of the mucosal bacteria residents after CMF injury and/or following treatment. There was an enrichment of Fusobacterium, Porphyromonadaceae, and Bacteroidales accompanied by a decline in Pasteurellaceae, Moraxella, and Neisseria relative abundance in days allotted for healing. We also observed a decline in species richness and abundance driven by reduction in temporal instability and inter-animal heterogeneity on days 0 and 56, with day 0 corresponding to injury in DMR group and day 56 corresponding to delayed treatment for DMR or injury and immediate treatment for the IMR group. Analysis of bone healing features showed comparable bone-healing profiles for IMR vs. DMR therapeutic approach.

AIP-based Professional Intervention Program for Adversity for trauma and stress reduction in groups: a pilot study in Ethiopia.

Drawing from the principles of EMDR (Eye Movement Desensitization and Reprocessing) therapy and the AIP model, the Professional Intervention Program for Adversity (PIPA) was developed with the objective of amalgamating low-intensity group exercises into a unified framework, as a comprehensive intervention for group therapy. The PIPA Program integrates various aspects of EMDR therapy-such as stabilization, resourcing, desensitization, reprocessing, and forming beliefs about the self and future-into a cohesive program. The program's structure includes self-regulation exercises, the Pillars of Life, the Flash Technique, and the Quadrants exercise. The PIPA Program was administered to more than 220 individuals with a high probability of traumatization by the two-year civil war in Ethiopia (2020-2022). The results of this study show a statistically significant improvement in PTSD symptoms on PCL-5 scores (from M = 38.58 to M = 20.59) after completing the entire PIPA Program and statistically significant lower SUDS scores within the program segments of the Flash Technique and the Quadrants exercises. Future studies should explore the long-term effects of the PIPA Program and its broader application across different therapeutic contexts. The findings suggest that the PIPA Program is a promising group-based intervention for trauma treatment that is safe and effective, especially in non-clinical settings and for culturally diverse populations.

Development and validation of an intervention for childhood trauma and exposure to violence in Vhembe District, South Africa

Most strategies are implemented; however, South Africa needs to evaluate and develop trauma interventions. The study aims to develop, test and validate childhood trauma exposure intervention in the Vhembe district, Limpopo province. Donabedian's structure-process-outcome model will guide the study. The study will employ multiphase mixed methods with five phases. Phase 1 will be a thorough systematic evaluation of literature on childhood trauma and exposure to violence interventions to describe existing interventions. Phase 2, stage 1: Will explore the experiences of children exposed to trauma and violence regarding their experiences of the treatment they received, using semi-structured qualitative interviews. Non-probability purposeful sampling techniques will be used to select participants. The Thoyondou Victim Empowerment's database will select participants. The researchers will conduct semi-structured and unstructured interviews with youngsters exposed to violence and trauma. Stage 2 will be a qualitative study of trauma centre managers and personnel sampled from the contact record. IPA will analyze data. Phase 3 will conceptualize Phase 1 and the empirical phase into Donabedian's SPO framework for Phase 4. Phase 4 develops the intervention using Phase 3′s conceptual framework and tests and validates it.

O64: Aortic Trauma in the UK (UK): Vascular Interventions and Surgery in Trauma Audit (VISTA)

Abstract Background In the UK, the incidence, treatment strategies and clinical outcomes for aortic injury are unknown. Stent graft sizing can be challenging in the acute trauma setting which may increase the risk of stent graft complications. VISTA aimed to describe the UK burden and treatment of aortic trauma. Methods Subgroup analysis of a six-month multicentre, prospective audit of vascular injuries at 27 UK Major Trauma Centres by the National Trauma Research & Innovation Collaborative and Vascular & Endovascular Research Network. Results In total, 58 aortic injuries (43 thoracic, 15 abdominal) with 24 interventions (n=23 TEVAR) were analysed. The median age of TEVAR patients was 46 (IQR: 27 - 59) years and 92% were male. The median time to intervention was 288 (IQR: 208 - 722) minutes and 75% of cases were performed for grade 3 and 4 aortic injuries with one simultaneous carotid-subclavian bypass. A consultant vascular surgeon was documented as present in 75% of cases and the post-procedure mortality rate was 8%. Conclusion TEVARs performed for vascular trauma setting are currently excluded from the National Vascular Registry. UK centre performance, device surveillance and long-term outcomes for this patient cohort requires national monitoring to assure patient safety and drive care quality improvements.

Minimally invasive surgical treatment of combat trauma of the chest cavity (first results)

Annotation. The article is devoted to the study and comparison of the first results of the treatment of the wounded with combat damage to the chest cavity, which were obtained during the hostilities of 2022-2023. The aim of the study – to improve the results of treatment of the wounded with damage to the organs of the thoracic cavity, by implementing modern diagnostic and surgical methods using minimally invasive technologies and tissue viability imaging systems. All wounded (20 patients) underwent VATS surgical interventions with pleurectomy, lung decortication and resections of areas of damaged lung parenchyma. The wounded of the first group (10 patients) additionally underwent visualization control of the viability of tissues by using ICG technology with the contrast “Verday” 0.1 mg/kg of body weight and subsequent lung resection within the determined limits of viability. In the second group (10 patients), if lung resection was necessary, the selection of the resection margin was based on the surgeon's subjective assessment. In the postoperative period, the following were evaluated: the duration of artificial lung ventilation after surgical procedures, the duration of dependence on oxygen support, the presence of repeated VATS or thoracotomy operations, the presence of acute respiratory distress syndrome in adults (ARDS), pneumonia, pneumothorax, pleural empyema. Statistical analysis of clinical data on postoperative complications was carried out using the statistical analysis package EZR v. 1.35 (Saitama Medical Center, Jichi Medical University, Saitama, Japan). The Mann-Whitney test was used to analyze the differences between groups of quantitative and rank characteristics. According to indicators evaluated after operations, no significant difference between groups of patients was obtained was, however, there was a trend toward better outcomes in the patient group where ICG contrast was used to assess tissue viability and assess the extent of lung resection. The absence of a significant difference between the indicators of the two groups is due to the small sample of patients included in the study. Therefore, it is necessary to continue to investigate the use of indocyanine green (ICG) contrast technology during VATS interventions with a larger sample of patients.

Lifespan integration therapy: Patients’ discourse about outcomes and integration feeling

ObjectivesLifespan Integration (LI) therapy is a relatively recent mind-body psychotherapy, primarily developed to help survivors in the treatment of trauma. The therapy resets integration, a high-level process promoting mental health, well-being, and flexible adaptation to the environment. This study aims to explore the perception of LI outcomes and “integration feeling” through LI patients’ perspectives. MethodTwelve patients were recruited via LI-certified therapists and took part in an interview (50 % men; mean age 45.1 years; with therapies lasting 1–5 years). Each interview was conducted using a guide, and discourse was analyzed using a general inductive approach (interjudge fidelity = 0.750). ResultsThe analysis revealed six salient themes: relation to oneself (including well-being, self-acceptance, self-consciousness, self-knowledge, self-care, self-image, and self-sufficiency), skills (emotional regulation, self-determination, and parenting skills), relation to others (involving relational openness, authenticity, independence, acceptance of others, and social connections readjustment), relation to reality (change in perspective and acceptance of reality), integration feeling (unification, appeasement, strength, reconnection and focusing), process (effectiveness perception, sensations, disorganization, non-linear evolution, commitment to therapy, trust with therapist, and difficulty of observing changes), and symptomatic improvement (depression, anxiety, substance use, and other symptoms). ConclusionThis study highlights the processes that improve LI therapy efficacy according to patients. More generally, it sheds some light on the integration process and its consequences underlying the unity of identity and consciousness.

Harvard Medical School Global Mental Health: Trauma and Recovery Course: What is the Global Impact? Three Year’s Results

Purpose: This paper describes and documents an innovative blended learning Global Mental Health: Trauma and Recovery certificate training course. This course combines a two-week face-to-face training in Orvieto, Italy with a five-month follow-up online virtual training as a learning experience for global health care practitioners. Continuing medical education (CME) accreditation is offered upon completion. This course utilized an innovative blended learning model with a community of practice approach, a combination of lectures and discussions, and online in-depth group case study discussions. Methodology: Data was collected by self-reported anonymous evaluation by participants of three continuous years of the CME Global Mental Health: Trauma and Recovery certificate training course sponsored by Harvard Medical School. One hundred fifty-five participants (n= 39 in 2011; n = 57 in 2012; n=59 in 2013) underwent a pre- and post-course evaluation to determine sustained confidence in performing medical and psychiatric care to traumatized patients and communities, as well as to determine their learning of the Global Mental Health Action Plan (GMHAP). Results: Over the course of three independent years, a total of 155 participants were evaluated. There was evidence for significant improvement in their confidence levels in all clinical areas (diagnosis; treatment of trauma; use of psychotropic medication) when comparing baseline to completion of the six-month course. All ten dimensions of the GMHAP and nine medical and psychiatric aspects of treatment revealed significant improvement in confidence levels. Regression analysis also indicated similar results after the adjustment of demographic covariates. Physicians and participants with mental health and social work background had significantly higher confidence. Participants who were MD’s or psychiatrists had higher confidence in most of the categories of confidence except for self-care, understanding culture, collaboration, and policy and financing. The model showed no difference in learning based upon gender and level of development of country of origin. Conclusion: The evaluation of this blended learning CME program provides evidence of significant enhancement of clinical practice and planning skills in health care practitioners working with highly traumatized patients and communities worldwide. This successful training over the past 18 years has gone far to achieve the health and mental health capacity building as requested by the Ministers of Health from post-conflict societies in the historic Rome meeting in 2004.

Long-Term Psychological and Physiological Effects of Male Sexual Trauma.

Male sexual trauma presents multiple clinical challenges. Although the topic has received increased attention in the last couple decades, male sexual trauma continues to be underreported and underrecognized. This study aimed to investigate the long-term effects of sexual trauma for men who were victimized within an institutional environment by a person in a position of power. This study included data from 47 adult men who were victims of sexual abuse or misconduct by an assigned physician at a higher education academic institution between 1966 and 2003. A primary finding was elevated rates of intimacy and sexual problems and erectile dysfunction, which started shortly after the abuse and persisted over time. We found that there was an association between intimacy and sexual problems and difficulty maintaining employment, drug addiction, erectile dysfunction, and loss of meaningful and romantic relationships. Levels of potential psychopathology were prominently linked to loss of sexual interest or pleasure, intimacy concerns, and loss of intimate and other personal relationships. Men who experienced sexual abuse as adults within an institutional environment developed long-standing patterns of interpersonal and professional problems. This study emphasizes the need for nuanced screening, evaluation, and treatment for male sexual trauma.

An examination of internal family systems interventions for trauma with implications for ethical psychedelic-assisted treatment

AbstractThough several treatments effectively address the pervasive impact of trauma, they do not achieve complete symptom resolution for all clients, inspiring the search for alternatives. Internal Family Systems (IFS) therapy has grown popular, especially in informal psychedelic-assisted treatments (PAT). Compared to stereotypes of empirically validated, exposure-based treatments, IFS has novel facets with widespread appeal. The model encourages improved quality of interactions among multiple, naturally arising “parts” or subpersonalities potentially generated by traumatic experience. The body of IFS literature is extensive, enthusiastic, and thought-provoking. Outcome data for applying the model to Post-Traumatic Stress Disorder are limited. Attempts to operationalize and falsify the theory's assumptions and proposed mechanisms will likely prove challenging. Nevertheless, the model's popularity underscores a problem with perceptions of the empirically-supported treatments. Contemplating ethical ways to present the IFS approach given the state of relevant research, we note strategies that would apply to recommendations for PAT of any type. These strategies include detailed psychoeducation about empirically-supported treatments, candid description of the experimental nature of alternatives, frequent assessments of improvement, and detailed monitoring of potential iatrogenic effects. Drawing on facets of IFS to improve perceptions of the empirically validated treatments might provide an efficient way to appeal to more clients, decrease drop out, and increase gains as we await results of empirical investigations of IFS-influenced PAT. These steps can allow clients to choose an approach consistent with their own impressions of a credible intervention, potentially leading to better outcomes.

Perinephric Hematoma Size can be a Strong Prognostic Factor of Need of Surgical Intervention in High Grade Renal Trauma

Background: For the majority of renal injuries, non-operative management is the standard of care with nephrectomy reserved for those with severe trauma. The aim of our study is to assess the characteristics of perinephric hematoma and other prognostic factors of surgical intervention for high grade renal trauma independent of AAST OIS. Materials and Methods: A total of 119 patients with high grade renal trauma from January 2005 to September 2021 were identified for analysis. Hospital records and diagnostic imaging were reviewed to identify the need for surgical intervention, including total and partial nephrectomy. Factors examined include patient age, gender, ISS (Injury severity score), AAST-OIS, laceration location, length and number, perinephric hematoma characteristics, intravascular contrast extravasation and devitalised segment status. Descriptive statistics and binary logistic regression were performed as appropriate. Results: Mean patient age was 31, 39 and mean ISS was 22, 80. A total of 24 surgical intervention were required (20%) including partial and total nephrectomy. On univariate analysis, hypotension on admission, hematoma diameter, degree of devitalised fragment superior of 25% and AAST OIS grade were associated with the need of surgical intervention. On multivariate analysis, only hypotension on admission (p: 0,029), hematoma diameter greater than 3,5 cm (p:0,021) and AAST-OIS grade (p: 0,010) remained independently associated with surgical intervention. Conclusions: Perinephric hematoma size remains among prognostic factors for surgical intervention that allow better stratification of renal lesions and its study allows a better management of high-grade renal trauma.

Management of dental trauma: re-attachment workflows. Guidelines and case studies

Dental trauma presents in a number of different ways and the outcome of treatment of trauma is equally varied, and can be dependent on the mode of management at the acute presentation. Pulpal vitality, retention of the periodontal ligament, discolouration factors, apical maturity, mobility and recession are just some of the follow-up complications that can be influenced not only by the nature of the injury, but also the method of immediate management. This report of two cases of broken incisors highlights the use of adhesive techniques and a knowledge of hue, chroma and opacity to re-attach tooth fragments in an aesthetic zone trauma. The cases also highlight the variance of outcome based on the nature of the trauma and the injury sustained. CPD/Clinical Relevance: To highlight the relevance of trauma management, the techniques available and the variation in outcome with treatment.

Sandtray and Sandplay in the Treatment of Trauma with Children and Adolescents: A Systemic Review

Sandtray and Sandplay in the Treatment of Trauma with Children and Adolescents: A Systemic Review

EMDR in Three Adults With Severe Intellectual Disability and Posttraumatic Stress Disorder: A Multiple-Baseline Evaluation

Research on trauma treatment in people with severe intellectual disability (SID; IQ 20–35) is scarce, and controlled studies are lacking. This study examined the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy using the storytelling method in three adults with SID and posttraumatic stress disorder (PTSD). A multiple-baseline design was used to examine the effects of EMDR storytelling method on PTSD classification, PTSD symptoms, challenging behaviors, and dysfunctional behaviors in three adults with SID and PTSD. EMDR resulted in a significant decrease in PTSD symptoms, challenging behaviors, and most dysfunctional behaviors. None of the participants had a PTSD classification anymore after EMDR. Findings suggest EMDR to be effective in the treatment of PTSD in adults with SID. Follow-up research with a larger sample size is required.

Frailty predicts non-home discharge in anterior lumbar interbody fusion patients.

Anterior lumbar interbody fusion (ALIF) is a well-established surgical approach in the treatment of degenerative pathology, trauma, infection, and neoplasia of the spine. This study sought to assess the usefulness of frailty as a predictor of non-home discharge (NHD) for patients who undergo the procedure. Patient cases were extracted from the American College of Surgeons's National Surgical Quality Improvement Program database from 2012 to 2020. Univariable and receiver operating characteristic curve analyses were used to compare the 5-item Modified Frailty Index (mFI-5) to the Revised Risk Analysis Index (RAI-rev) in relation to NHD. Simple linear regression demonstrated that increasing frailty was associated with an increased likelihood of NHD among 25,317 patients (mFI-5 odds ratio: 2.13, 3.23, 8.4; RAI-rev odds ratio: 3.22, 9.6, 23.6 [P<0.001 for all]). In each instance, a Cochran-Armitage trend test was significant (P<0.001), indicating a linear association of increasing odds. The RAI-rev resulted in a C-statistic of 0.722, compared to 0.628 for the mFI-5, and was shown to have superior discriminative ability with a DeLong Test (P<0.001). Frailty, as measured by mFI-5 and RAI-rev, was associated with an increased likelihood of NHD in patients who underwent ALIF. This finding supports recent literature on the promising utility of these indices, especially the RAI-rev, in preoperative decision-making across multiple facets of neurosurgery.

Tuning in addictology, the story of a shared musical experience

Music can be used as a therapeutic tool with people suffering from complex addictions and traumas. By playing together, the patient and care team create a transitional space conducive to emotional attunement and trust. This shared experience facilitates connection and engagement in the therapeutic relationship, which conveys a sense of security. Music is a powerful tool in the treatment of addiction and trauma. It helps to repair damaged bonds and develop empathy, cooperation and creativity within the care team.

Tratamiento conservador no invasivo del traumatismo esplénico

Background: Non-invasive conservative treatment of splenic trauma reduces the rate of unnecessary surgical interventions and depends on the type of healthcare center involved. Objective: The aim of this study is to describe the outcomes of non-invasive conservative treatment in patients with blunt abdominal trauma and splenic injury and their correlation with the preoperative variables. Material and methods: We conducted a retrospective and observational study of patients admitted with blunt abdominal trauma and splenic injury between 2012 and 2022. The variables analyzed were kinematics of trauma, lesion severity on computed tomography images, amount of hemoperitoneum, type of unit of hospitalization and results of non-invasive conservative treatment. Results: Among 102 patients, the most common kinematics of trauma was motorcycle-to-car collisions (47.1%); the success rate of non-invasive conservative treatment was 66.6%, and was associated with lesion severity on computed tomography images (p &lt; 0.001), amount of hemoperitoneum (p &lt; 0.001), presence of other injuries (p &lt; 0.001), severe trauma brain injury (p &lt; 0.009), and type of unit of hospitalization (p &lt; 0.002). Conclusion: Despite the absence of recommended human and technological resources, the results of non-invasive conservative treatment in this series were comparable to those obtained in high complexity centers.

Culturally responsive evaluation with Latinx communities through culturally specific assessment: Building the Latinx immigration trauma assessment

AbstractThis article emphasizes that assessments misaligned with the populations of study have the potential for measurement disjuncture, invalidation of data meaning, and, ultimately, the invalidation of evaluation findings. The authors conducted a study to identify and describe the development of a culturally specific assessment (CSA) model and how it was used in the development of a Latinx Immigration Trauma assessment framework to reflect the unique experiences of Latinx immigrants. The authors outline the use of the Disjuncture‐response Dialectic as the theoretical grounding and utilize a Critical comparative case study design. The resultant multidimensional Latinx Immigration Trauma Assessment framework consists of the dimensions of nervios, desaliento, desesperanza, duelo, y pena. The development process may encourage evaluators to seek deeper understanding of their methodological choices when examining the efficacy of trauma interventions for Latinx immigrants.

Microparticle deposition induced asymmetric adhesive hydrogel for suture-less gastric trauma treatment

Stomach trauma repair remains a paramount concern in the biomedical field. Despite numerous studies into the creation of gastric hydrogel patches, many exhibit inadequate wet-state adhesion or problematic double-sided adhesion that can inadvertently adhere to surrounding tissues. Consequently, asymmetric adhesive hydrogels are one of the directions for the development of suture-less sealing wound patches for the stomach trauma. However, existing asymmetric patches often entail intricate fabrication processes, challenging their scalability for industrial production. In this study, we propose a novel and universal preparation method for fabricating asymmetric adhesive hydrogel patches for favorable suture-less sealing gastric repair based on the existing high adhesive strength hydrogel patch research. This is followed by a thorough examination of its adhesion qualities using various adhesion tests. MTS assay and AO staining method are used to confirm the cytocompatibility. The bursting test is used to simulate in vitro stomach trauma. Subsequently,a rat gastric trauma repair model is performed to mimic its application in actual surgery, and its excellent repair effect is confirmed by immunohistochemical staining and immunofluorescence staining, which verifies the potential of asymmetric adhesive hydrogel patches prepared by microparticle deposition induced method in biomedical field.