PREVENTION OF SCUBA DIVING MISHAPS USING A PREDIVE CHECKLIST: A CLUSTER RANDOMIZED TRIAL

Scuba diving mishaps, caused by equipment problems or human errors, increase the risk of morbidity and mortality while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers. A multi-location cluster randomized trial with parallel groups and allocation concealment was conducted between June 1 and August 17, 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator, and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates/ 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol, and marginal structural model analyses were conducted. Two nested studies were also conducted - first, among the control group participants, to evaluate the relationship of routine use of written self-checklist on the incidence of mishaps. And second, among the intervention group participants, to assess the factors affecting the adherence to the intervention pre-dive checklist. Total 1043 divers (intervention=617; control=426) made 2041 dives, on 70 location-days (intervention=40; control=30) at four locations. Compared to the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26%, and all mishaps by 32%. On average, there was one fewer mishap in every 26 intervention dives. Routine use of a self-checklist was associated with 69% fewer major mishaps and 50% fewer all mishaps in the control group. 30% participants were non-adherent to the intervention checklist. Factors associated with greater adherence were routine use of self-checklist and older age. Factors that were associated with lower adherence were non-white race and diving in North Carolina. In this trial, pre-dive checklist use prevented the incidence of mishaps which could prevent injuries and fatalities. Use of pre-dive checklists should not entail any risk and their use should be promoted. Trial Registration: ClinicalTrials.gov ID NCT01960738Doctor of Philosoph

The effect of using a pre-dive checklist on the incidence of diving mishaps in recreational scuba diving: a cluster-randomized trial

BACKGROUND: Scuba diving mishaps, caused by equipment problems or human errors, increase the occurrence of injuries and fatalities while diving. Pre-dive checklists may mitigate mishaps. This study evaluated the effect of using a pre-dive checklist on the incidence of diving mishaps in recreational divers. METHODS: A multi-location cluster-randomized trial with parallel groups and allocation concealment was conducted between 1 June and 17 August 2012. The participants had to be at least 18 years of age, permitted to dive by the dive operator and planning to dive on the day of participation. They were recruited at the pier and dive boats at four locations. The intervention group received a pre-dive checklist and post-dive log. The control group received a post-dive log only. The outcomes, self-reported major and minor mishaps, were prompted by a post-dive questionnaire. Mishap rates per 100 dives were compared using Poisson regression with generalized estimating equations. Intent-to-treat, per-protocol and marginal structural model analyses were conducted. RESULTS: A total of 1043 divers (intervention = 617; control = 426) made 2041 dives, on 70 location-days (intervention = 40; control = 30) at four locations. Compared with the control group, the incidence of major mishaps decreased in the intervention group by 36%, minor mishaps by 26% and all mishaps by 32%. On average, there was one fewer mishap in every 25 intervention dives. CONCLUSIONS: In this trial, pre-dive checklist use prevented mishaps which could lead to injuries and fatalities. Pre-dive checklists can increase diving safety and their use should be promoted. Trial Registration: ClinicalTrials.gov ID NCT01960738

Mishaps and unsafe conditions in recreational scuba diving and pre-dive checklist use: a prospective cohort study

Abstract Background Recreational scuba diving involves the use of complex instruments and specialized skills in an unforgiving environment. Errors in dive preparation in such an environment may lead to unsafe conditions, mishaps, injuries and fatalities. Diving mishaps can be major and minor based on their potential to cause injury and the severity of the resulting injury. The objective of this study is to assess the incidence of diving mishaps and unsafe conditions, and their associations with the participants’ routine use of their own checklists. Methods Between June and August 2012, 426 divers participated in the control group of a randomized trial to evaluate the effectiveness of an intervention pre-dive checklist. The current nested analysis prospectively follows the control participants, who did not receive the intervention checklist. Poisson regression models with generalized estimating equations were used to estimate rate ratios comparing written checklist use with memorized and no checklist use. Results The overall incidence of major mishaps and minor mishaps was 11.2 and 18.2 per 100 dives, respectively. Only 8% participants reported written checklist use, 71% reported using memorized checklists, and 21% did not use any checklist. The rate ratio for written checklist use as compared to using a memorized or no checklist was 0.47 (95%CI: 0.27, 0.83) for all mishaps (major and minor combined), and 0.31 (95% CI: 0.10, 0.93) for major mishaps. The rate of mishaps among memorized checklist users was similar to no checklist users. Conclusion This study reinforces the utility of written checklists to prevent mishaps and, potentially, injuries and fatalities

Intended and unintended consequences: Changes in opioid prescribing practices following two policies in North Carolina, 2012–2018 – A controlled interrupted time series analysis

Poster presented at the 38th International Conference on Pharmacoepidemiology & Therapeutic Risk Management. Objective: To understand the extent to which unintended prescribing consequences followed implementation of two statewide opioid prescribing policies among privately insured, opioid-naïve individuals in North Carolina between 2012 and 2018

Reporting Crime Victimizations to the Police and the Incidence of Future Victimizations: A Longitudinal Study.

Law enforcement depends on cooperation from the public and crime victims to protect citizens and maintain public safety; however, many crimes are not reported to police because of fear of repercussions or because the crime is considered trivial. It is unclear how police reporting affects the incidence of future victimization.To evaluate the association between reporting victimization to police and incident future victimization.We conducted a retrospective cohort study using National Crime Victimization Survey 2008-2012 data. Participants were 12+ years old household members who may or may not be victimized, were followed biannually for 3 years, and who completed at least one follow-up survey after their first reported victimization between 2008 and 2012. Crude and adjusted generalized linear mixed regression for survey data with Poisson link were used to compare rates of future victimization.Out of 18,657 eligible participants, 41% participants reported to their initial victimization to police and had a future victimization rate of 42.8/100 person-years (PY) (95% CI: 40.7, 44.8). The future victimization rate of those who did not report to the police (59%) was 55.0/100 PY (95% CI: 53.0, 57.0). The adjusted rate ratio comparing police reporting to not reporting was 0.78 (95%CI: 0.72, 0.84) for all future victimizations, 0.80 (95% CI: 0.72, 0.90) for interpersonal violence, 0.73 (95% CI: 0.68, 0.78) for thefts, and 0.95 (95% CI: 0.84, 1.07) for burglaries.Reporting victimization to police is associated with fewer future victimization, underscoring the importance of police reporting in crime prevention. This association may be attributed to police action and victim services provisions resulting from reporting

Management of Pain in the United States—A Brief History and Implications for the Opioid Epidemic

Pain management in the United States reflects attitudes to those in pain. Increased numbers of disabled veterans in the 1940s to 1960s led to an increased focus on pain and its treatment. The view of the person in pain has moved back and forth between a physiological construct to an individual with pain where perception may be related to social, emotional, and cultural factors. Conceptually, pain has both a medical basis and a political context, moving between, for example, objective evidence of disability due to pain and subjective concerns of malingering. In the 20th century, pain management became predominately pharmacologic. Perceptions of undertreatment led to increased use of opioids, at first for those with cancer-related pain and then later for noncancer pain without the multidimensional care that was intended. The increased use was related to exaggerated claims in the medical literature and by the pharmaceutical industry, of a lack of addiction in the setting of noncancer pain for these medications—a claim that was subsequently found to be false and deliberatively deceptive; an epidemic of opioid prescribing began in the 1990s. An alarming rise in deaths due to opioids has led to several efforts to decrease use, both in patients with noncancer conditions and in those with cancer and survivors of cancer

The healthy diver: A cross-sectional survey to evaluate the health status of recreational scuba diver members of Divers Alert Network (DAN)

<div><p>Background</p><p>Scuba diver fitness is paramount to confront environmental stressors of diving. However, the diving population is aging and the increasing prevalence of diseases may be a concern for diver fitness.</p><p>Purpose</p><p>The purpose of this study is to assess the demographics, lifestyle factors, disease prevalence, and healthcare access and utilization of Divers Alert Network (DAN) members and compare them with those from the general population.</p><p>Methods</p><p>DAN membership health survey (DMHS) was administered online in 2011 to DAN members in the United States (US). Health status of DMHS respondents was compared with the general US population data from the Center for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System using two-sided student’s <i>t</i>-tests and Mantel-Haenszel chi-square tests. Univariate and multivariate logistic regression analyses were conducted to identify factors associated with healthcare utilization among the DMHS participants.</p><p>Results</p><p>Compared to the general US population, the DMHS population had lower prevalence of asthma, heart attack, angina, stroke, diabetes, hypertension, hypercholesterolemia, and disabilities (p<0.01); more heavy alcohol drinkers, and fewer smokers (p<0.01); and greater access and utilization (routine checkup) of healthcare (p<0.01). Healthcare utilization in males was lower than among females. Increasing age and increase in the number of chronic illnesses were associated with increased healthcare utilization.</p><p>Conclusions</p><p>DAN members are healthier than the general US population. DAN members also have better access to healthcare and utilize healthcare for preventive purposes more often than the general population. DAN members appear to have a better fitness level than their non-diving peers.</p></div

Participant selection and exposure distribution in the NCVS, 2008–2012, US.

<p>Participant selection and exposure distribution in the NCVS, 2008–2012, US.</p

Adjusted^a police reporting vs non-reporting rate ratios by initial victim-offender relationship and victim’s race/ethnicity: NCVS 2008–2012, US.

<p>Adjusted<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0160072#t003fn001" target="_blank">^a</a> police reporting vs non-reporting rate ratios by initial victim-offender relationship and victim’s race/ethnicity: NCVS 2008–2012, US.</p

Association of Police Reporting With the Incidence of Future Victimizations in the NCVS 2008–2012, US.

<p>Association of Police Reporting With the Incidence of Future Victimizations in the NCVS 2008–2012, US.</p