Impact of emergency medical helicopter transport directly to a university hospital trauma center on mortality of severe blunt trauma patients until discharge
Source: Critical Care
The benefits of transporting severely injured patients by helicopter remains controversial. This study aimed to analyze the impact on mortality of helicopter compared to ground transport directly from the scene to a University hospital trauma center.
The French Intensive Care Research for Severe Trauma cohort study enrolled 2703 patients with severe blunt trauma requiring admission to University hospital intensive care units within 72 hours. Pre-hospital and hospital clinical data including the mode of transport, helicopter (HMICU) vs ground (GMICU), both with medical teams, were recorded. The analysis was restricted to patients admitted directly from the scene to a University hospital trauma center. The main endpoint was mortality until ICU discharge.
Of the 1958 patients analyzed, 74% were transported by GMICU, 26% by HMICU. Median ISS was 26 (IQR 19-34) for HMICU patients and 25 (IQR 18-34) for GMICU patients. Compared to GMICU, HMICU patients had a higher median time frame before hospital admission and were more intensively treated in the pre-hospital phase. Crude mortality until hospital discharge was the same regardless of pre-hospital mode of transport. After adjustment for initial status, the risk of death was significantly lower (OR: 0.68, 95% CI 0.47-0.98, p=0.035) for HMICU compared with GMICU. This result did not change after further adjustment for ISS and overall surgical procedures.
This study suggests a beneficial impact of helicopter transport on mortality in severe blunt trauma. Whether this association could be due to better management in the pre-hospital phase needs to be more thoroughly assessed.
WWC Review of the Report “The Effects of Student Coaching in College: An Evaluation of a Randomized Experiment in Student Mentoring”
Source: U.S. Department of Education
What is this study about?
The study examined whether InsideTrack, a personalized student coaching service for college students, increased rates of staying in and graduating from college. It determined InsideTrack’s effectiveness by comparing the outcomes of students who were randomly selected through one of 17 lotteries to receive InsideTrack with the outcomes of students who were not selected.
What did the study find?
For students in the seven lotteries that were well-executed, the study found that students assigned to receive InsideTrack were significantly more likely than students in the comparison group to remain enrolled at their institutions six, 12, and 18 months after random assignment. For three lotteries with longer-term follow-up data, there was no significant difference between the groups in enrollment 24 months after random assignment or college completion within four years.
For the full set of 17 lotteries, which includes both those that were well-executed and those in which random assignment was compromised, the results were similar six, 12, and 18 months after random assignment. For the 12 lotteries with longer-term follow-up data, the difference in enrollment between the groups 24 months after random assignment was significantly different.
New GAO Reports
Source: Government Accountability Office
1. Warfighter Support: DOD Should Improve Development of Camouflage Uniforms and Enhance Collaboration Among the Services. GAO-12-707, September 28.
Highlights – http://www.gao.gov/assets/650/648950.pdf
2. VA and DOD Health Care: Department-Level Actions Needed to Assess Collaboration Performance, Address Barriers, and Identify Opportunities. GAO-12-992, September 28.
Highlights – http://www.gao.gov/assets/650/648960.pdf
3. Government Contracting: Federal Efforts to Assist Small Minority Owned Businesses. GAO-12-873. September 28.
Highlights – http://www.gao.gov/assets/650/648986.pdf
4. Trade Adjustment Assistance: Changes to the Workers Program Benefited Participants, but Little Is Known about Outcomes. GAO-12-953, September 28
Highlights – http://www.gao.gov/assets/650/648979.pdf
5. Trade Adjustment Assistance: Labor Awarded Community College Grants in Accordance with Requirements, but Needs to Improve Its Process. GAO-12-954, September 28.
Highlights – http://www.gao.gov/assets/650/649003.pdf
6. Department of Homeland Security: Efforts to Assess Realignment of Its Field Office Structure. GAO-12-185R, September 28.
Source: Migration Policy Institute
With overseas employment a more permanent feature of the development strategies of a number of Asian states, predeparture orientation programs have emerged as an important tool for the protection of migrant workers. This brief examines the strengths, limitations, and areas for improvement of this intervention, based on findings from field research conducted in Indonesia, Nepal, and the Philippines.
Finding ways for a product to succeed in a beleaguered marketplace takes a mix of pragmatism and creative genius. And the winners of the 2012 Nielsen Breakthrough Innovation Award did just that. In contrast to innovation awards focused on one-year wonders, the Nielsen Breakthrough Innovation Award honors new products that succeed on multiple dimensions over multiple years.
Nielsen analyzed more than 11,000 new products in the U.S. between 2008 and 2010 to find the 2012 winners. Of the products evaluated, only 34 products met award criteria. These products totaled less than 0.5% of all new product introductions during the period.
The study revealed that there are no easy formulas on the road to successful innovation, and many common pitfalls. Of the product launches that didn’t meet award criteria, one trap many companies fell into was losing sight of consumer needs. Often– to save time and money, attract a certain demographic group, or respond to competitors in the market– new product teams added features that consumers don’t value, or shifted product focus away from what made the original concept a fresh, viable solution.
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Source: U.S. Department of Health and Human Services, Office of Inspector General
WHY WE DID THIS STUDY
OIG is authorized to exclude certain individuals and entities (providers) from participating in federally funded health care programs, such as Medicaid managed care. These programs are generally prohibited from paying for any items or services furnished, ordered, or prescribed by an excluded provider or paying anyone who contracts with an excluded provider. In Medicaid managed care, States contract with managed care entities (MCE) to provide healthcare services to enrolled beneficiaries. The managed care entities create and manage networks of providers who deliver healthcare services to the enrolled beneficiaries. Since the providers in the Medicaid managed care networks are not under direct oversight by the States, we wanted to determine if the provider networks are vulnerable to excluded providers.
HOW WE DID THIS STUDY
This is the second of two evaluations related to excluded providers in Medicaid managed care. In the prior study, entitled Excluded Providers in Medicaid Managed Care Entities (OEI‑07‑09‑00630), we compared the provider networks of 12 selected MCEs to the List of Excluded Individuals and Entities (LEIE) to identify excluded providers. In the current study, we selected a stratified random sample of 500 hospitals, nursing facilities, home health agencies, and pharmacies from the population of providers enrolled in the 12 MCEs. From each of the 500 sampled providers, we collected rosters of employees in 2011, and responses to a survey on the safeguards they used to ensure that excluded individuals are not employed. We compared the employee rosters to the LEIE to identify excluded individuals.
WHAT WE FOUND
Of the 248,869 individuals listed on the employee rosters requested from sampled providers, we identified 16 individuals who were excluded among the employees of 14 sampled providers. Incorrect names and failure of contractors to follow procedures contributed to the employment of the excluded individuals. Most providers reported using a variety of safeguards to ensure they do not employ excluded individuals, but identified costs and resource burdens as challenges in executing those safeguards. Seven percent of providers in the 12 selected MCEs do not check the exclusions status of their employees; most of these providers lacked knowledge regarding exclusions.
This report does not contain recommendations.
Influenza Vaccination Coverage Among Health-Care Personnel — 2011–12 Influenza Season, United States
Source: Morbidity and Mortality Weekly Report (CDC)
Influenza vaccination of health-care personnel (HCP) is recommended by the Advisory Committee on Immunization Practices (ACIP) (1). Vaccination of HCP can reduce morbidity and mortality from influenza and its potentially serious consequences among HCP, their family members, and their patients (1–3). To provide timely estimates of influenza vaccination coverage and related data among HCP for the 2011–12 influenza season, CDC conducted an Internet panel survey with 2,348 HCP during April 2–20, 2012. This report summarizes the results of that survey, which found that, overall, 66.9% of HCP reported having had an influenza vaccination for the 2011–12 season. By occupation, vaccination coverage was 85.6% among physicians, 77.9% among nurses, and 62.8% among all other HCP participating in the survey. Vaccination coverage was 76.9% among HCP working in hospitals, 67.7% among those in physician offices, and 52.4% among those in long-term care facilities (LTCFs). Among HCP working in hospitals that required influenza vaccination, coverage was 95.2%; among HCP in hospitals not requiring vaccination, coverage was 68.2%. Widespread implementation of comprehensive HCP influenza vaccination strategies is needed, particularly among those who are not physicians or nurses and who work in LTCFs, to increase HCP vaccination coverage and minimize the risk for medical-care–acquired influenza illnesses.