Incidence of Gunshot Wounds: Before and After Implementation of a Shall Issue Conceal Carry Law

Introduction. This study examined the incidence of gunshot wounds before and after enacting a conceal carry (CC) law in a predominately rural state. Methods. A retrospective review was conducted of all patients who were admitted with a gunshot injury to a Level I trauma center. Patient data collected included demographics, injury details, hospital course, and discharge destination. Results. Among the 238 patients included, 44.6% (n = 107) were admitted during the pre-CC period and 55.4% (n = 131) in the post-CC period. No demographic differences were noted between the two periods except for an increase in uninsured patients from 43.0% vs 61.1% (p = 0.020). Compared to pre-CC patients, post-CC patients experienced a trend toward increased abdominal injury (11.2% vs 20.6%, p = 0.051) and increased vascular injuries (11.2% vs 22.1%, p = 0.026) while lower extremity injuries decreased significantly (38.3% vs 26.0%, p = 0.041). Positive focused assessment with sonography in trauma (FAST) exams (2.2% vs 16.8, p < 0.001), intensive care unit admission (26.2% vs 42.0%, p = 0.011) and need for ventilator support (11.2% vs 22.1%, p = 0.026) all increased during the post-CC period. In-hospital mortality more than doubled (8.4% vs 18.3%, p = 0.028) across the pre- and post-CC time periods. Conclusion. Implementation of a CC law was not associated with a decrease in the overall number of penetrating injuries or a decrease in mortality

Transportation Time In A Rural State Following Splenic Injury: Does Time Matter

Background: Failure rates remain high following attempted non-operative treatment of spleen injuries despite progress made in identifying risk factors. Over the past thirty years, transportation times were excluded from predictive models although rapid transportation was advocated to improve patient outcomes. For patients living in a rural environment, this time may prove critical. The purpose of this study was to assess the effect of transport time on survival rates and hospital length of stay for patients selected to receive non-operative versus operative treatment. Methods: A 10-year retrospective review was conducted of patients ages 13 years and older who presented to an American College of Surgeons-verified Level 1 trauma center between January 1, 2003 to December 31, 2012. Non-operative management (NOM) was defined as observation with or without the adjunctive use of angiography (AE) or splenic artery embolization (SAE) performed less than 2 hours from admission. Failed non-operative management (FNOM) was defined as AE or SAE performed greater than two hours from admission, or a planned operation greater than two hours from admission (POR) for any reason. Cox proportional hazard regression and logistic regression analysis were conducted to identify factors associated with hospital length of stay (H-LOS) and mortality. Covariates included: age, gender, injury severity score (ISS), injury type (blunt versus penetrating), treatment group (POR, NOM, or FNOM), time from admission to procedure, and transportation time from the time EMS received the 911 phone call to emergency department admission.   Results: Among the 364 patients included in the final analysis, 11.0% (n=40) died before hospital discharge. The median transport time was 64 minutes (average=92.6 ± 81 minutes, range=6 to 480 minutes). The majority (92.9%, n=338) of patients underwent NOM, with 7.1% (n=26) receiving POR. Among those 338 NOM patients, 92.3% (n=312) remained NOM after 2 hours, and others had FNOM after 2 hours (7.7%, n=26). Those who received POR or NOM were associated with 45.5% and 47.4% of the transportation time being less than 60 minutes, respectively. After two hours, average ISS score by treatment group (POR, NOM, or FNOM) of 23.83, 21.96, and 28.07, respectively. Cox proportional hazard regression analysis reported that ISS score was the only significant predictor for H-LOS. Logistic regression revealed that ISS score and age were associated with mortality. Transport time was not statistically associated with H-LOS or mortality. Conclusion: While not predictive of H-LOS or mortality, transportation time demonstrated that in rural environments longer transportation times allow physiologic symptoms to manifest prior to admission. Our results demonstrated that the majority (96%) of our FNOMs occurred less than six hours following admission and 100% less than 48 hours. We recommend intensive observation during hospital days one, with less robust surveillance through hospital day two. Discharge can be considered on hospital day three based on other injuries

Environmental and Public Health in the Kimberley: Developments, Directions and Data

This team presentation will describe how the links between environmental health and public health have been strengthened in the Kimberley region. Environmental health looks at disease risk reduction in the environment. Public health has a ‘system-wide’ focus and, here in the Kimberley, has supported an unobstructed bridge between clinical service providers and environmental health expertise. Nirrumbuk has worked with many partners to initiate environmental health referrals as a way to build this bridge. This has also created closer ties with the Department of Housing. This presentation will also tell the ‘data story’ that has underpinned these initiatives. This includes the determination of Kimberley Environmental Attributable Fractions (KEAFs) originally sourced from values published by the World Health Organisation (WHO). Inspired by local priorities, this academic work has been extended further to cost hospitalisations of Aboriginal people due to the environment. The recently released WA Sustainable Health Review acknowledged this important applied research

Human rights and the clean development mechanism

The 2010 UN climate conference in Cancún emphasized that "Parties should, in all climate change related actions, fully respect human rights". However, so far there is no further guidance. This article discusses the relevant legal human rights norms and two case studies from the Kyoto Protocol's Clean Development Mechanism (CDM). The first case (Bajo Aguán, Honduras) shows that the current absence of any international safeguards can lead to registration of highly problematic projects. The second case (Olkaria, Kenya) suggests that safeguards, introduced here as a side effect of World Bank involvement, can have a positive impact, but that it is necessary to have them based on human rights. It therefore seems recommendable that the UN climate regime develop mandatory human rights safeguards. In addition or alternatively, individual buyer countries or groups of countries, such as the European Union, could introduce their own additional requirements for CDM projects

Providing a secure base for LGBTQ young people in foster care: the role of foster carers

The experiences and needs of lesbian, gay, bisexual, trans and queer / questioning (LGBTQ) young people in care have been overlooked in England, both in policy and research. This article reports on findings from the first study of LGBTQ young people in care in England, and focuses on the nature of foster carers’ experiences and perspectives on caring for LGBTQ young people. Qualitative interviews regarding the fostering role in caring for LGBTQ young people were conducted with a sample of foster carers (n=26) and analysed thematically. Foster carers described the importance of offering LGBTQ young people not only the nurturing relationships that all children in care need, but also availability, sensitivity and acceptance to help young people manage stigma and other challenges associated with minority sexual orientation and gender identity. The Secure Base caregiving model provided a framework for analysing the different dimensions of these relationships. Understanding caregiving roles and relationships for LGBTQ young people in care has important implications for recruiting, training, matching and supporting foster carers to care for LGBTQ young people effectively

Computed Tomography in Trauma Patients Accepted in Transfer:: Missed Injuries and Rationale for Repeat Imaging. Can we do Better?

Introduction. Computed tomography scans often are repeated ontrauma patient transfers, leading to increased radiation exposure,resource utilization, and costs. This study examined the incidenceof repeated computed tomography scans (RCT) in trauma patienttransfers before and after software upgrades, physician education,and encouragement to reduce RCT.Methods.xThe number of RCTs at an American College of SurgeonsCommittee on Trauma verified level 1 trauma center was measured.The trauma team was educated and encouraged to use the computedtomography scans received with transfer trauma patients as perstudy protocol. All available images were reviewed and reasons for aRCT when ordered were recorded and categorized. Impact of systemimprovements and education on subsequent RCT were evaluated.Results. A RCT was done on 47.2% (n = 76) of patients throughoutthe study period. Unacceptable image quality and possible misseddiagnoses were the most commonly reported reasons for a RCT. Preventablereasons for a RCT (attending refusal to read outside films,incompatible software, and physician preference) decreased from25.8 to 14.3% over the study periods.Conclusions. The volume of unnecessary RCT can be reduced primarilythrough software updates and physician education, therebydecreasing radiation exposure, patient cost, and inefficiencies in hospitalresource usage. Kans J Med 2019;12(1):7-10

A Systematic Review of Self-Reported Ethical Practices in Publications of Cluster Randomised Trials Conducted in Aboriginal and Torres Strait Islander Settings

Cluster randomised trials (CRTs) present unique ethical complexities for research ethics committees, participants, researchers and evidence users. In this design, whole social units (‘clusters’) such as hospitals, schools or entire communities are randomised to interventions. In addition, units of randomisation, intervention and outcome measurement differ within the one study. As a consequence, clearly determining research participants and establishing whose consent is required not only for randomisation and interventions but also data collection are correspondingly difficult. This systematic review describes self-reported ethical practices in research conducted in Australia in which social units comprising Aboriginal and Torres Strait Islander people, their communities or services upon which they rely were randomised as whole clusters to trial interventions. To undertake this systematic review, we developed a study protocol and registered it prospectively on a public database (PROSPERO1 protocol CRD42018106463). Applying this protocol meant we could methodically identify all CRTs conducted in Aboriginal and Torres Strait Islander settings in Australia by finding their peer-reviewed study protocols or articles with main results reporting primary outcomes.https://researchonline.nd.edu.au/nulungu_research/1006/thumbnail.jp

Acceptability and effectiveness of opportunistic referral of smokers to telephone cessation advice from a nurse: a randomised trial in Australian general practice

<p>Abstract</p> <p>Background</p> <p>GPs often lack time to provide intensive cessation advice for patients who smoke. This study aimed to determine the effectiveness of opportunistic referral of smokers by their GP for telephone cessation counselling by a trained nurse.</p> <p>Methods</p> <p>Adult smokers (n = 318) attending 30 GPs in South Western Sydney, Australia were randomly allocated to usual care or referral to a telephone-based program comprising assessment and stage-based behavioural advice, written information and follow-up delivered by a nurse. Self-reported point prevalence abstinence at six and 12 months was compared between groups. Characteristics of patients who accepted and completed the intervention were investigated.</p> <p>Results</p> <p>Of 169 smokers randomised to the intervention, 76 (45%) consented to referral. Compared with smokers in 'pre-contemplation', those further along the stage-of-change continuum were significantly more likely to consent (p = 0.003). Those further along the continuum also were significantly more likely to complete all four calls of the intervention (OR 2.6, 95% CI: 0.8–8.1 and OR 8.6, 95% CI: 1.7–44.4 for 'contemplation' and 'preparation' respectively). At six months, there was no significant difference between groups in point prevalence abstinence (intention to treat) (9% versus 8%, p = 0.7). There was no evidence of differential intervention effectiveness by baseline stage-of-change (p = 0.6) or patient sex (p = 0.5). At 12 months, point prevalence abstinence in the intervention and control groups was 8% and 6% respectively (p = 0.6).</p> <p>Conclusion</p> <p>Acceptance of opportunistic referral for nurse delivered telephone cessation advice was low. This trial did not demonstrate improved quit rates following the intervention. Future research efforts might better focus support for those patients who are motivated to quit.</p> <p>Australian Clinical Trials Registry number</p> <p>ACTRN012607000091404</p

Evaluation of Protective Equipment Used Among Motorbike Riders

Introduction. This study compared outcomes between patientsinjured at a motorbike track, which requires riders to follow safetyequipment guidelines, and those involved in recreational riding wheresafety equipment usage is voluntary. Methods. A retrospective review was conducted of all patients presentingwith motorbike-related injuries at an American College ofSurgeons verified level-I trauma center between January 1, 2009 andDecember 31, 2013. Data collected included demographics, injurydetails, safety equipment use, hospitalization details, and dischargedisposition. Comparisons were made regarding protective equipmentusage. Results. Among the 115 patients admitted, more than half (54.8%, n =63) were injured on a motorbike track, and 45.2% (n = 52) were injuredin a recreational setting. The majority of patients were male (93.9%),Caucasian (97.4%), and between the ages of 18 to 54 (64.4%). Helmetusage was higher among track riders (95.2%, n = 60) than recreationalriders (46.2%, n = 24, p &lt; 0.0001). Comparisons of injury severity andoutcomes between those who wore protective equipment and thosewho did not were not significant. Conclusions. Even though track riders wore protective equipmentmore than recreational riders, there was no difference between thegroups regarding injury severity or hospital outcomes. These resultssuggested that motocross riders should not rely on protective equipmentas the only measure of injury prevention.Kans J Med 2018;11(2):44-47