Talking about firearm injury prevention with patients: a survey of medical residents.

BackgroundFirearm injury and death are significant public health problems in the U.S. and physicians are uniquely situated to help prevent them. However, there is little formal training in medical education on identifying risk for firearm injury and discussing safe firearm practices with patients. This study assesses prior education, barriers to counseling, and needs for improved training on firearm safety counseling in medical education to inform the development of future education on clinical strategies for firearm injury prevention.MethodA 2018 survey administered to 218 residents and fellows at a large, academic medical center asked about medical training on firearm injury prevention, frequency of asking patients about firearm access, and perceived barriers.ResultsThe most common barriers cited were not knowing what to do with patients' answers about access to firearms (72.1%), not having enough time (66.2%), not feeling comfortable identifying patients at-risk for firearm injury (49.2%), and not knowing how to ask patients about firearm access (48.6%). Prior education on firearm injury prevention was more strongly associated with asking than was personal exposure to firearms: 51.5% of respondents who had prior medical education reported asking compared with who had not received such education (31.8%, p=0.004). More than 90% of respondents were interested in further education about interventions, what questions to ask, and legal mechanisms to separate dangerous people from their firearms.ConclusionsEducation on assessing risk for firearm-related harm and, when indicated, counseling on safe firearm practices may increase the likelihood clinicians practice this behavior, though additional barriers exist

Alcohol Misuse and Gun Violence: An Evidence-Based Approach for State Policy

This report summarizes the connection between alcohol and firearm use, reviews existing state laws, and makes a core set of recommendations for addressing the problem at the state level:Limiting access to firearms by persons with a record of alcohol misuseLimiting access to guns when and where alcohol is consumedIf these policy recommendations are to be effective, it is also important to address the environment where alcohol is sold and consumed. We therefore consider additional policies known to be effective in reducing excessive alcohol consumption and its related harms. In the last section, the report reviews key legal considerations that can help policymakers successfully implement the policies recommended in the report

Spontaneous Anterior Lens Capsular Dehiscence Causing Lens Particle Glaucoma

To report acute onset lens particle glaucoma associated with a spontaneous anterior capsular dehiscence. A 66-year-old man presented with spontaneous anterior lens capsule dehiscence with an acute onset of right eye pain that was associated with white particles in the anterior chamber angle and intraocular pressure (IOP) of 55 mmHg. No trauma or other inflammatory antecedents were reported. A hypermature cataract was observed at slit lamp exam. After medical treatment without IOP control, we performed extracapsular cataract extraction and anterior vitrectomy. Anterior chamber aspirate confirmed the presence of macrophages. The postoperative IOP at one month was 16 mmHg OD without medication. Spontaneous dehiscence of the anterior lens capsule in a patient with a hypermature cataract may release lens cortical material, resulting in lens particle glaucoma. Prompt surgical removal of the lens material usually controls the high IOP, and the need for additional glaucoma surgery is not common

The Youth Criminal Justice Act: New Directions and Implementation Issues

This article explains some of the Youth Criminal Justice Act's key provisions and policy directions. It also identifies implementation issues that can significantly influence how the youth justice system operates under the YCJA. Major objectives of the act include reducing the use of the youth court and reducing the use of incarceration. The YCJA emphasizes restraint, accountability, proportionality, and greater structuring of the discretion of decision makers. It contains provisions to encourage the use of extrajudicial measures, including a presumption that non-violent first offenders should be dealt with through extrajudicial measures. Conferences are recognized as a potentially useful means of improving decision making. Pre-trial detention is prohibited for child welfare purposes and presumed to be unnecessary if the youth could not be sentenced to custody. The sentencing principles set out a new approach to sentencing. Sentences must be proportionate to the seriousness of the offence and, within the limits of proportionality, must promote rehabilitation. The sentencing provisions also place specific restrictions on the use of custody. Implementation issues include appropriate use of available funding, the risk of net-widening, the adequacy of provincial policies and guidelines for police and prosecutors, conditions of release, and the interpretation of provisions related to proportionality, rehabilitation, and restrictions on custody. </jats:p