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Identifying targets for potential interventions to reduce rural trauma deaths: a population-based analysis.

https://arctichealth.org/en/permalink/ahliterature146641
Source
J Trauma. 2010 Sep;69(3):633-9
Publication Type
Article
Date
Sep-2010
Author
David Gomez
Myriam Berube
Wei Xiong
Najma Ahmed
Barbara Haas
Nadine Schuurman
Avery B Nathens
Author Affiliation
Division of Trauma and the Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada. gomezjaramid@smh.toronto.on.ca
Source
J Trauma. 2010 Sep;69(3):633-9
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Accidents, Traffic - mortality
Adolescent
Adult
Age Factors
Catchment Area (Health) - statistics & numerical data
Chi-Square Distribution
Child
Child, Preschool
Confidence Intervals
Emergency Service, Hospital - standards - statistics & numerical data
Female
Health Services Accessibility - statistics & numerical data
Hospitals, Rural - standards - statistics & numerical data
Humans
Infant
Male
Middle Aged
Ontario - epidemiology
Poisson Distribution
Retrospective Studies
Risk
Rural Population - statistics & numerical data
Sex Factors
Trauma Centers - standards - statistics & numerical data
Wounds and Injuries - mortality
Young Adult
Abstract
Rural environments have consistently been characterized by high injury mortality rates. Although injury prevention efforts might be directed to reduce the frequency or severity of injury in rural environments, it is plausible that interventions directed to improve injury care in the rural settings might also play a significant role in reducing mortality. To test this hypothesis, we set out to examine the relationship between rurality and the setting in which patient death was most likely to occur.
This is a population-based retrospective cohort study evaluating all trauma deaths occurring in the province of Ontario, Canada, over the interval 2002 to 2003. Patient cohorts were defined by their potential to access trauma center care using two different approaches, rurality and timely access to trauma center care.
There were 3,486 deaths over the study interval, yielding an overall injury mortality rate of 14.6 per 100,000 person-years. Overall, more than half of deaths occurred before reaching an emergency department (ED). Prehospital deaths were twice as likely in the most rural locations and in those with limited access to timely trauma center care. However, among patients surviving long enough to reach hospital, there was a threefold increase in the risk of ED death among those injured in a region with limited access to trauma center care.
We demonstrate that a significant proportion of deaths occur in rural EDs. This study provides new insights into rural trauma deaths and suggests the potential value of targeted interventions at the policy and provider level to improve the delivery of preliminary trauma care in rural environments.
PubMed ID
20016384 View in PubMed
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Potential gaps in congestive heart failure management in a rural hospital.

https://arctichealth.org/en/permalink/ahliterature173480
Source
Can J Rural Med. 2005;10(3):155-61
Publication Type
Article
Date
2005
Author
Margaret D Sanborn
Douglas G Manuel
Ewa Ciechanska
Douglas S Lee
Author Affiliation
South Bruce Grey Health Care Centre, Chesley, Ont. msanborn@sbghc.on.ca
Source
Can J Rural Med. 2005;10(3):155-61
Date
2005
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Female
Health Care Surveys
Health Services Accessibility - standards - statistics & numerical data
Heart Failure - drug therapy - epidemiology - therapy
Hospitals, Community - standards - statistics & numerical data
Hospitals, Rural - standards - statistics & numerical data
Humans
Middle Aged
Ontario - epidemiology
Patient Care Planning - standards - statistics & numerical data
Retrospective Studies
Rural Health
Rural Health Services - standards - statistics & numerical data
Rural Population - statistics & numerical data
Abstract
Congestive heart failure (CHF) is increasingly recognized as an important cause of morbidity and mortality. Previous studies in urban settings have shown that patients frequently are not receiving recommended therapy. There is a paucity of studies that have evaluated CHF management in a rural setting. We therefore reviewed hospital and outpatient care in this setting as an initial step toward improving CHF care.
A retrospective chart review was used to examine the care of all 34 patients hospitalized for CHF from 2000-2001 in a small rural hospital, to assess the need for improved CHF management.
The median age of the patients was 78 yr, and a number of them had many co-morbid cardiovascular risks. Similar to other studies, only 23% of patients were prescribed recommended doses of angiotensin-converting enzyme (ACE) inhibitors. Use of beta-blockers was far below expected rates. Although there was follow-up care for nearly all patients (97%), few patients had echocardiography performed (38%) or had their medications altered in the outpatient setting.
There is a need for improved management of CHF in the rural setting. Approaches to improving CHF care should use the continuity of care advantage provided by primary care physicians to optimize outpatient medical treatment regimens and improve access to diagnostic services such as echocardiography.
PubMed ID
16079031 View in PubMed
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Surgical site infection rates at the Pontiac Health Care Centre, a rural community hospital.

https://arctichealth.org/en/permalink/ahliterature170889
Source
Can J Rural Med. 2006;11(1):41-8
Publication Type
Article
Date
2006
Author
Runi Chattopadhyay
Sevag Zaroukian
Earle Potvin
Author Affiliation
Department of Surgery, Pontiac Health Care Centre, Shawville, Quebec, Canada. runi.chatto.padhyay@ucsfmedctr.org
Source
Can J Rural Med. 2006;11(1):41-8
Date
2006
Language
English
Publication Type
Article
Keywords
Cross Infection - epidemiology - microbiology
Female
Follow-Up Studies
Health Care Surveys
Hospitals, Community - standards - statistics & numerical data
Hospitals, Rural - standards - statistics & numerical data
Humans
Infection Control - standards - trends
Male
Multicenter Studies as Topic
Prevalence
Quebec - epidemiology
Reference Values
Retrospective Studies
Risk assessment
Severity of Illness Index
Surgical Wound Infection - diagnosis - epidemiology
Abstract
The prevalence of surgical site infections (SSIs) at the Pontiac Health Care Centre, a rural hospital, was compared with rates obtained by large multicentre studies. Postoperative nosocomial infection (NI) rates were also calculated.
A review of all surgical interventions involving an incision, excluding ophthalmological procedures, performed between October 2001 and March 2003 (n = 831) was undertaken. Various clinical parameters were recorded. Infection rates were calculated. Data were analyzed using either the chi2 or Student's t test.
The overall SSI rate was 5.54%: 3.50% in clean cases (C), 6.77% in clean-contaminated cases (CC), and 14.58% in contaminated or dirty cases (D). The postoperative NI rate was 6.62% (C, 3.68%; CC, 9.90%; D, 16.67%). The mean duration of surgery was significantly higher among patients with SSIs and with NIs than those without infections for CC (133 +/- 95 v. 78 +/- 60 min, p
PubMed ID
16454971 View in PubMed
Less detail