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Search Results: 1 - 10 of 1837 matches for " Karim Brohi "
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The Utstein template for uniform reporting of data following major trauma: A valuable tool for establishing a pan-European dataset
Karim Brohi
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine , 2008, DOI: 10.1186/1757-7241-16-8
Abstract: Trauma registries are therefore key elements of any public health approach to managing severe injury. The past two decades have seen several European countries recognise the importance of this and successfully develop their own national registries. Each country continues to face its own difficulties with regard to completeness, data quality and funding for informatics management. Nevertheless, a recent publication by Ringdal et al [1] have recognised the enticing potential of a pan-European registry. The value of these datasets increases almost exponentially with the amount of data collected. Beyond simple size implications, a pan-European dataset will allow comparison of different methods of delivering trauma care, Europe-wide programmes for clinical research and large-scale funding and policy development. Reminiscent of the spirit of the European Union the authors have not attempted to foist a single tool on all members, but rather attempted to agree a core dataset common to all which can be built on to respond to the specific needs of individual states.The Utstein Group have attempted to reduce the core dataset from 92 parameters to only 35. There are rational arguments for doing so, and a smaller dataset is more likely to be collected in its entirety. Some datapoints are redundant, and coupled so closely to others that their utility is minimal. Some datapoints provide no information on outcomes, system characteristics or process of care. Some are superseded by newer measures or tools. Both the reasoning behind the reduction in parameters, and the methodology by which the Utstein participants have proceeded are robust, and the resultant dataset is interesting for its conciseness in what it contains – and in what has been left out.But is this reductionist approach the right one for our times? Can this 35-point dataset tell us not only that outcomes are different in different systems but why? Will they allow rational trial design? Will they ensure that funding is t
The acute management of trauma hemorrhage: a systematic review of randomized controlled trials
Nicola Curry, Sally Hopewell, Carolyn Dorée, Chris Hyde, Karim Brohi, Simon Stanworth
Critical Care , 2011, DOI: 10.1186/cc10096
Abstract: Comprehensive searches were performed of MEDLINE, EMBASE, CENTRAL (The Cochrane Library Issue 7, 2010), Current Controlled Trials, ClinicalTrials.gov, the World Health Organization International Clinical Trials Registry Platform (ICTRP) and the National Health Service Blood and Transplant Systematic Review Initiative (NHSBT SRI) RCT Handsearch Database.A total of 35 RCTs were identified which evaluated a wide range of clinical interventions in trauma hemorrhage. Many of the included studies were of low methodological quality and participant numbers were small. Bleeding outcomes were reported in 32 studies; 7 reported significantly reduced transfusion use following a variety of clinical interventions, but this was not accompanied by improved survival. Minimal information was found on traumatic coagulopathy across the identified RCTs. Overall survival was improved in only three RCTs: two small studies and a large study evaluating the use of tranexamic acid.Despite 35 RCTs there has been little improvement in outcomes over the last few decades. No clear correlation has been demonstrated between transfusion requirements and mortality. The global trauma community should consider a coordinated and strategic approach to conduct well designed studies with pragmatic endpoints.Trauma is one of the world's leading causes of death and disability. Around 40% of deaths are due to bleeding or its consequences, establishing hemorrhage as the most common cause of preventable death in this clinical group [1-3]. The relationship between trauma hemorrhage and poor outcomes has been well recognized for over 30 years [4], and applies globally [5,6], in both civilian and military settings [7]. However, outcomes from severe hemorrhage remain poor, with mortality rates approaching 50% for patients who require massive blood transfusion or who develop a significant coagulopathy [8,9]. Management of trauma hemorrhage depends on a multifactorial approach of timely surgical intervention, fluid r
A pictorial review of traumatic pericardial injuries
Ashok Adams,Nicos Fotiadis,Jann Yee Chin,Wayne Sapsford,Karim Brohi
Insights into Imaging , 2012, DOI: 10.1007/s13244-012-0177-9
Abstract: The imaging findings of pericardial trauma with various imaging modalities (ultrasound, plain radiography and computed tomography) are presented in order to aid interpretation during the acute trauma setting.
Health Outcome after Major Trauma: What Are We Measuring?
Karen Hoffman, Elaine Cole, E. Diane Playford, Eva Grill, Helene L. Soberg, Karim Brohi
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0103082
Abstract: Importance Trauma is a global disease and is among the leading causes of disability in the world. The importance of outcome beyond trauma survival has been recognised over the last decade. Despite this there is no internationally agreed approach for assessment of health outcome and rehabilitation of trauma patients. Objective To systematically examine to what extent outcomes measures evaluate health outcomes in patients with major trauma. Data Sources MEDLINE, EMBASE, and CINAHL (from 2006–2012) were searched for studies evaluating health outcome after traumatic injuries. Study selection and data extraction Studies of adult patients with injuries involving at least two body areas or organ systems were included. Information on study design, outcome measures used, sample size and outcomes were extracted. The World Health Organisation International Classification of Function, Disability and Health (ICF) were used to evaluate to what extent outcome measures captured health impacts. Results 34 studies from 755 studies were included in the review. 38 outcome measures were identified. 21 outcome measures were used only once and only five were used in three or more studies. Only 6% of all possible health impacts were captured. Concepts related to activity and participation were the most represented but still only captured 12% of all possible concepts in this domain. Measures performed very poorly in capturing concepts related to body function (5%), functional activities (11%) and environmental factors (2%). Conclusion Outcome measures used in major trauma capture only a small proportion of health impacts. There is no inclusive classification for measuring disability or health outcome following trauma. The ICF may provide a useful framework for the development of a comprehensive health outcome measure for trauma care.
Early release of high mobility group box nuclear protein 1 after severe trauma in humans: role of injury severity and tissue hypoperfusion
Mitchell J Cohen, Karim Brohi, Carolyn S Calfee, Pamela Rahn, Brian B Chesebro, Sarah C Christiaans, Michel Carles, Marybeth Howard, Jean-Fran?ois Pittet
Critical Care , 2009, DOI: 10.1186/cc8152
Abstract: One hundred sixty eight patients were studied as part of a prospective cohort study of severe trauma patients admitted to a single Level 1 Trauma center. Blood was drawn within 10 minutes of arrival to the emergency room before the administration of any fluid resuscitation. HMGB1, tumor necrosis factor (TNF)-α, interleukin (IL)-6, von Willebrand Factor (vWF), angiopoietin-2 (Ang-2), Prothrombin time (PT), prothrombin fragments 1+2 (PF1+2), soluble thrombomodulin (sTM), protein C (PC), plasminogen activator inhibitor-1 (PAI-1), tissue plasminogen activator (tPA) and D-Dimers were measured using standard techniques. Base deficit was used as a measure of tissue hypoperfusion. Measurements were compared to outcome measures obtained from the electronic medical record and trauma registry.Plasma levels of HMGB1 were increased within 30 minutes after severe trauma in humans and correlated with the severity of injury, tissue hypoperfusion, early posttraumatic coagulopathy and hyperfibrinolysis as well with a systemic inflammatory response and activation of complement. Non-survivors had significantly higher plasma levels of HMGB1 than survivors. Finally, patients who later developed organ injury, (acute lung injury and acute renal failure) had also significantly higher plasma levels of HMGB1 early after trauma.The results of this study demonstrate for the first time that HMGB1 is released into the bloodstream early after severe trauma in humans. The release of HMGB1 requires severe injury and tissue hypoperfusion, and is associated with posttraumatic coagulation abnormalities, activation of complement and severe systemic inflammatory response.Trauma remains the leading cause of mortality for patients between 1 and 40 years of age and eclipses cancer, heart disease and HIV/AIDS [1]. Although there remain a large proportion of trauma victims who die early from overwhelming injury, trauma patients who survive their initial injury do not die from their injury per se, but from an
Technology as A Global Pillar and Its Main Features in Greek-Rome Age
M. Nawaz Brohi
Asian Journal of Information Technology , 2012,
Abstract: The purpose of this study is to discuss technology as a global pillar that is used to support the world. Today s world is based on technology, technological developments, discoveries, technological theories and technological advancements which are used by human being to solve their daily life problems. This study also deals with the main features in different ages of Greek-Rome and the long-term changes in the relationship between science and technology. The study is based on Joseph Pitt s definition of technology Building on What We Have Learned: The Relationship between Science and Technology. The Symbiotic Relationship of Science and Technology in the 21st Century. The basic concept of the study is based on Techne, Technology and Tragedy.
Reappraising the concept of massive transfusion in trauma
Simon J Stanworth, Timothy P Morris, Christine Gaarder, J Carel Goslings, Marc Maegele, Mitchell J Cohen, Thomas C K?nig, Ross A Davenport, Jean-Francois Pittet, P?r I Johansson, Shubha Allard, Tony Johnson, Karim Brohi
Critical Care , 2010, DOI: 10.1186/cc9394
Abstract: Datasets on trauma admissions over a 1 or 2-year period were obtained from the trauma registries of five large trauma research networks. A fractional polynomial was used to model the transfusion-associated probability of death. A logistic regression model for the prediction of massive transfusion, defined as 10 or more units of red cell transfusions, was developed.In total, 5,693 patient records were available for analysis. Mortality increased as transfusion requirements increased, but the model indicated no threshold effect. Mortality was 9% in patients who received none to five PRBC units, 22% in patients receiving six to nine PRBC units, and 42% in patients receiving 10 or more units. A logistic model for prediction of massive transfusion was developed and validated at multiple sites but achieved only moderate performance. The area under the receiver operating characteristic curve was 0.81, with specificity of only 50% at a sensitivity of 90% for the prediction of 10 or more PRBC units. Performance varied widely at different trauma centers, with specificity varying from 48% to 91%.No threshold for definition exists at which a massive transfusion specifically results in worse outcomes. Even with a large sample size across multiple trauma datasets, it was not possible to develop a transportable and clinically useful prediction model based on available admission parameters. Massive transfusion as a concept in trauma has limited utility, and emphasis should be placed on identifying patients with massive hemorrhage and acute traumatic coagulopathy.Hemorrhage is responsible for more than 40% of all trauma deaths and therefore represents an important target for improving outcomes after severe injury. The concept of massive transfusion has existed for more than half a century and was developed to highlight the dilutional complications occurring when administering large volumes of packed red blood cells (PRBCs) or other fluids, which could be addressed by the use of massi
Conceptual Analysis and Fieldwork in Macroeconometric Methodology: Modeling Unemployment, Inflation and Production  [PDF]
Karim Errouaki
Technology and Investment (TI) , 2014, DOI: 10.4236/ti.2014.53015
Abstract:

The recent failure of commonly accepted, inductive, econometric models to provide insights into real, macroeconomic phenomenon during economic crises has provoked a debate concerning contemporary econometric methodology. Based on the foundations laid by Haavelmo, and Hollis and Nell, an assessment of Edward J. Nell’s (1998) “unifying methodological framework” (UMF) is offered. Nell’s UMF places socioeconomic institutions and interdependencies, and technological realities as basis of analysis. Using “conceptual analysis” and “fieldwork” Nell presents an alternative to generally accepted, mainstream, econometric methodology. The purpose of this paper is to look at some examples of the way, and this can help develop useful theory and improve macroeconometric model building. Applying Nell’s UMF to unemployment, inflation, and production reveals a methodological advance that promises more realistic insights into macroeconomic phenomena than is offered by contemporary, mainstream, econometric models.

Mobile Ipv6 Protocol and Mobility
S.M. Faheem,M. Nawaz Brohi
Asian Journal of Information Technology , 2012,
Abstract: IPv6 is a protocol which allows nodes to remain reachable while moving around in the Ipv6 Internet. Mobile IPv6 (MIPv6) enables a node to roam around in home and foreign networks while maintaining the active sessions. The network layer hides the change of addresses, while the node is on move, from the upper layers. This study introduces the basic structure of IPv6 header, the concept behind the mobility of a node, the difference in IPv4 and IPv6 headers with respect to mobility. The study also discusses the mechanism of mobility in IPv6, shows how the registration process takes place within the home and foreign networks. Like any other development this protocol too is not a perfect one, and has pros and cons both which are discussed in the end of this study.
Cyber Crime and Internet Growth in Pakistan
Fahd Abdul Momein,M. Nawaz Brohi
Asian Journal of Information Technology , 2012, DOI: 10.3923/ajit.2010.1.4
Abstract: Crime is a social phenomenon that has existed throughout human history. As people and technology evolved and developed new technology, there is no doubt that criminals continue to exploit or take advantage of this technological progress. We are now in the era of an information revolution, which provides modern science, high technology and accordingly, it is axiomatic that new types of crimes have come to the forefront. The criminal of yesterday is exactly like the criminal of today and therefore, the crime of yesterday is certainly not like the crime of today.
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