Interdisciplinary Education for Mandated Reporters of Child Abuse

Domestic Violence is an important public health issue, with state mandated continuing medical education for physicians inConnecticut. We plan to develop an interdisciplinary educational program for Department of Children and Family (DCF) workers, physicians, veterinarians, animal control officers (ACO) and others. Evidence demonstrates an association between domestic violence and animal abuse1. Connecticut passed a law that took effect October 2011, mandating cross reporting of suspected child abuse and animal abuse or neglect between the Department of Children and Families and the Department of Agriculture, who oversee animal control officers. The law mandates developing education for DCF employees to “identify cruelty to or neglect of animals and their relationship to child welfare cases.” ACO need to be trained to identify and report child abuse and neglect. We propose to develop an educational program in one community:Stamford,CT. This program would include DCF workers, ACO, as well as physicians, veterinarians, prosecutors, social workers and law enforcement officers. There are limited studies that document the outcome of such legislation, and none that we are aware of from theUnited States. We hope to collect data from theStamfordarea and compare to other locations in the state to determine if the intervention has had an impact on reporting. Recommendations for future investigations would be dependent on the initial findings. Learning Objectives: At the end of this session, participants will: Identify three signs of child abuse Identify three signs of cruelty to or neglect of domestic animals Outline the link between domestic violence and animal abuse Recognize an individual’s obligations for reporting suspected cases under the law 1Long, Dennis: Interpersonal Violence and Animals: Mandated Cross-Sector Reporting. Journal of Sociology and Social Welfare, 2007

Treatment of Unstable Elbow Injuries with a Hinged Elbow Fixator: Subjective and Objective Results

Introduction: Injuries around the elbow pose a challenging problem for orthopaedic surgeons. The complex bony architecture of the joint should be restored and the thin soft tissue envelope needs to be handled with meticulous care. Elbow instability is a complication seen after dislocations and fractures of the elbow and remains a treatment challenge. The purpose of this study was to provide subjective and objective results following the surgical treatment of unstable elbow dislocations with an external hinged fixation technique. Methods: Forty-six consecutive patients with complex trauma of the elbow with instability after ligament reconstruction were enrolled between January 2017 and December 2019. The parameters used to quantify the subjective and objective functional results were the Mayo Elbow Score (MES, objective) and Oxford Elbow Score (OES, subjective), and clinical stability of the elbow joint. We also performed a radiological follow-up of the fractures. Results: The mean MES and OES scores were good at the 12-month follow-up. We had 38 patients with stable joints and 8 patients with minor instability. Using the stress test, we saw a significant difference in the affected joint under varus stress (6.7 ± 1.8 mm) compared to the healthy joint (5.8 ± 1.2 mm) laterally. Furthermore, medially the gap was significantly larger (5.8 ± 0.8 mm, treated elbow) than the contralateral gap under valgus stress (4.3 ± 0.8 mm) (p <0.001). Twenty-one complications occurred in 46 patients (46%): Seven patients had a clinical change of elbow axis: Three valgus (6%), four varus (9%); Superficial wound infection occurred in one case (2%) and ulnar nerve dysfunction in two (4%). The most common medium-term complication was post-traumatic osteoarthritis in eight cases (17%). Heterotopic ossification occurred in five patients (11%) and elbow stiffness in five cases (11%). Conclusion: The use of the hinged elbow external fixator in the treatment of complex elbow trauma is a valid therapeutic adjunct to ligamentous reconstruction showing encouraging results with acceptable complications

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2