Reports Of Serious Injury Research Articles

Twenty years of the tiger feeding pole: review and recommendations

The tiger feeding pole was developed at Glasgow Zoo, UK, more than 20 years ago as a feeding‐enrichment device. Since then the adoption of the feeding pole by other zoos for Tigers Panthera tigris and other cats has been slow and sporadic until recent years when many zoos in the UK have begun to use this device. In this paper we review the basis for and the development of the feeding pole as a feeding‐enrichment tool, including its stimulation of simulated hunting behaviours, and benefits to health and welfare. A survey of 19 zoos (mostly based in the UK) found that 79% use or have used feeding poles usually about once per week at heights of 3–6 m. We know of no confirmed reports of serious injuries or deaths of cats using feeding poles. A comparison of the skeletons of tigers found that feeding‐pole‐using tigers had a mean arthrosis score that is four times less than that of tigers that did not use them, providing a positive indicator of the health benefit of the use of this enrichment device. Based on previous experience we provide a refined set of recommendations for the safe use of feeding poles for cats, but recognize that providing physical and mental challenges to animals in zoos carries some minor risks that animals are well able to cope with. We discuss the possible next steps in feeding enrichment, which may include a holistic approach that considers the need to manage predators alongside prey to allow for mutual visual and olfactory enrichments.

Dabigatran: ‘One-dose-fits-all’ approach raises risks

Dabigatran: ‘One-dose-fits-all’ approach raises risks

Orthodontic treatment for distalising upper first molars in children and adolescents

When orthodontic treatment is provided with fixed appliances, it is sometimes necessary to move the upper molar teeth backwards (distalise) to create space or help to overcome anchorage requirements. This can be achieved with the use of extraoral or intraoral appliances. The most common appliance is extraoral headgear, which requires considerable patient co-operation. Further, reports of serious injuries have been published. Intraoral appliances have been developed to overcome such shortcomings. The comparative effects of extraoral and intraoral appliances have not been fully evaluated. To assess the effects of orthodontic treatment for distalising upper first molars in children and adolescents. We searched the following electronic databases: the Cochrane Oral Health Group's Trials Register (to 10 December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 11), MEDLINE via OVID (1946 to 10 December 2012) and EMBASE via OVID (1980 to 10 December 2012). No restrictions were placed on the language or date of publication when searching the electronic databases. Randomised clinical trials involving the use of removable or fixed orthodontic appliances intended to distalise upper first molars in children and adolescents. We used the standard methodological procedures expected by The Cochrane Collaboration. We performed data extraction and assessment of the risk of bias independently and in duplicate. We contacted authors to clarify the inclusion criteria of the studies. Ten studies, reporting data from 354 participants, were included in this review, the majority of which were carried out in a university dental hospital setting. The studies were published between 2005 and 2011 and were conducted in Europe and in Brazil. The age range of participants was from nine to 15 years, with an even distribution of males and females in seven of the studies, and a slight predominance of female patients in three of the studies. The quality of the studies was generally poor; seven studies were at an overall high risk of bias, three studies were at an unclear risk of bias, and we judged no study to be at low risk of bias.We carried out random-effects meta-analyses as appropriate for the primary clinical outcomes of movement of upper first molars (mm), and loss of anterior anchorage, where there were sufficient data reported in the primary studies. Four studies, involving 159 participants, compared a distalising appliance to an untreated control. Meta-analyses were not undertaken for all primary outcomes due to incomplete reporting of all summary statistics, expected outcomes, and differences between the types of appliances. The degree and direction of molar movement and loss of anterior anchorage varied with the type of appliance. Four studies, involving 150 participants, compared a distalising appliance versus headgear. The mean molar movement for intraoral distalising appliances was -2.20 mm and -1.04 mm for headgear. There was a statistically significant difference in mean distal molar movement (mean difference (MD) -1.45 mm; 95% confidence interval (CI) -2.74 to -0.15) favouring intraoral appliances compared to headgear (four studies, high or unclear risk of bias, 150 participants analysed). However, a statistically significant difference in mean mesial upper incisor movement (MD 1.82 mm; 95% CI 1.39 to 2.24) and overjet (fixed-effect: MD 1.64 mm; 95% CI 1.26 to 2.02; two studies, unclear risk of bias, 70 participants analysed) favoured headgear, i.e. there was less loss of anterior anchorage with headgear. We reported direct comparisons of intraoral appliances narratively due to the variation in interventions (three studies, high or unclear risk of bias, 93 participants randomised). All appliances were reported to provide some degree of distal movement, and loss of anterior anchorage varied with the type of appliance.No included studies reported on the incidence of adverse effects (harm, injury), number of attendances or rate of non-compliance. It is suggested that intraoral appliances are more effective than headgear in distalising upper first molars. However, this effect is counteracted by loss of anterior anchorage, which was not found to occur with headgear when compared with intraoral distalising appliance in a small number of studies. The number of trials assessing the effects of orthodontic treatment for distilisation is low, and the current evidence is of low or very low quality.

Caregiver Reports of Serious Injuries in Children Who Remain at Home After a Child Protective Services Investigation

The study objectives were to examine serious injuries requiring medical attention among children who remain at home after a child welfare/child protective services (CPS) maltreatment investigation in the US and to determine whether child/caregiver characteristics and ongoing CPS involvement are related to injuries requiring medical attention. Using the National Survey of Child and Adolescent Well-being, we analyzed data on the subsample of children who remained at home (N = 3,440). A multivariate logistic regression model included child characteristics, chronic illness and disability in the child, level of CPS involvement, subsequent foster care placement, caregiver characteristics, and caregiver/family psychological variables. Injuries requiring medical attention were identified in 10.6% of the in-home population over a 15-month period, with no differences in rates by age. Children with a chronic medical condition (OR = 2.07; 95% CI, 1.20-3.58) and children with depressed caregivers (OR = 2.28; 95% CI, 1.45-3.58) were more likely to have an injury that required medical care. Older caregivers (>54 years) were less likely (OR = 0.15; 95% CI, 0.03-0.69) to have a child with an injury requiring care. Injuries were not related to further involvement with CPS after the initial maltreatment investigation. Children with chronic medical conditions who remained in their biological homes or whose caregivers were depressed were likely to experience an injury requiring medical attention. Older caregivers were less likely to report a child injury. Extending existing health policies for foster children to children who remain at home following referral to CPS may encourage more comprehensive injury prevention for this population.

Fatal cranial shot by blank cartridge gun: Two suicide cases

Blank firing pistols are generally considered to be harmless and these guns are not accepted as being firearms in most countries. Due to lack of legal regulations these guns are easily purchased by anyone aged over 18 years. Reports of serious injuries and even fatalities due to these guns are increasing in the literature. These guns when modified or even unmodified can cause serious and potentially fatal injuries. Without doing any changes to the barrel, using blank or tear gas cartridges, firing at contact range can cause penetration of gas into the body including bone originated from gunpowder. We report two suicide cases shooting themselves at temporal region with a blank cartridge gun at contact range. There was no foreign body on radiological examination and there was no trajectory of a bullet inside the brain. In both cases the wound was at the right temporal region and there was defect at temporal bone. There was circular soot around this bone defect. The injury of the brain tissue was localized at the level of the defect but there was widespread subarachnoidal bleeding. We discussed the potential danger of these guns and stressed the need of legal regulations concerning these guns.

Quarter Watch: 2008 Quarter 1 : QUARTER WATCH PROJECT TEAM

EXECUTIVE SUMMARY A record number of deaths and serious injuries associated with drug therapy were reported to the US Food and Drug Administration (FDA) in the first quarter of 2008. Serious injuries associated with drug therapy reached a total of 20,745 new cases; there were a total of 4,824 reported deaths, a 2.6-fold increase from the previous quarter. In addition, varenicline (Chantix, Champix), an aid to smoking cessation, accounted for more reported serious injuries than any other prescription drug for a second quarter, with a total of 1,001 new cases and including 50 additional deaths. Varenicline was the subject of a previ ous Quarter Watch Special Report and a separate FDA Public Health Alert about psychiatric adverse events. Ranked second in reported serious injuries was heparin, a drug that helps prevent injury from blood clots. Heparin was the subject of a major product recall after a potentially lethal contaminant was identified and traced to suppliers in China. In the first quarter of 2008, the FDA received reports of 779 cases of serious injury in which heparin was the principal suspect drug. These findings come from a program being developed by the Institute for Safe Medication Practices (ISMP) for improvement of patient safety through increasing understanding of how and why drugrelated injuries and medication errors occur. The results are from analyses of new adverse drug event reports submitted to the FDA. The agency releases computer excerpts of these reports for research use after personal-identifying information has been removed. However, the results of this monitoring program should be interpreted with caution because of the known limitations of these data and the nature of the overall system through which adverse events are monitored in the United States. Because reporting is voluntary, only a small fraction of adverse drug events that occur are ever reported to the FDA or to drug manufacturers who then investigate and forward reports to the agency. Although the sum totals of reported adverse event reports usually provide an accurate overall adverse event profile for a drug, the individual reports themselves do not prove that the drug caused the event described. Trends in Reported Cases Serious injuries and deaths associated with drug therapy were reported for a record total of 20,745 persons in the first quarter of 2008. The total was 38% higher than the average for the previous 4 quarters and the highest for any quarter. Reported deaths totaled 4,824 cases, a 2.6-fold increase over the previous quarter and the highest number of deaths in a calendar quarter since 2004. Fatal cases also accounted for a larger share of all serious cases, 23% of those in the first quarter of 2008 compared with an historical average of 16%. Identifiable medication errors accounted for 7.1% (1,464) of all cases of serious injury. The largest numbers of cases were divided evenly between errors of administration (wrong drug, wrong dose, or wrong route of administration) and overdoses (both accidental and intentional). Most drugs in medical use produced only a small number of reports of serious injury or death. One-half the 773 identifiable drugs tracked in the most recent quarter had 6 or fewer serious adverse events reported. Only 50 drugs accounted for 100 or more reported serious injuries. Hospital Pharmacy Volume 44, Number 1, pp 47–56 2009 Wolters Kluwer Health, Inc.

Exercise in the End-Stage Renal Disease Population

Many of the known benefits of exercise in the general population are of particular relevance to the ESRD population. In addition, the poor physical functioning that is experienced by patients who are on dialysis is potentially addressable through exercise interventions. The study of exercise in the ESRD population dates back almost 30 yr, and numerous interventions, including aerobic training, resistance exercise training, and combined training programs, have reported beneficial effects. Recently, interventions during hemodialysis sessions have become more popular and have been shown to be safe. The risks of exercise in this population have not been rigorously studied, but there have been no reports of serious injury as a result of participation in an exercise training program. It is time that we incorporate exercise into the routine care of patients who are on dialysis, but identification of an optimal training regimen or regimens, according to patient characteristics or needs, is still needed to facilitate implementation of exercise programs.

“Heading” and Neck Injuries in Soccer: A Review of Biomechanics and Potential Long-Term Effects

Although soccer has a lower injury rate than does American football, injuries to the head and neck do occur. Indeed, soccer is classified as a contact sport. The potential for cervical injuries from the maneuver known as "heading" are of particular concern. This review provides a synopsis of soccer-related head and neck injuries, an overview of the biomechanics of trauma, and a rational approach to evaluating patients. This review was conducted to assess and evaluate existing literature on the biomechanics of the act of heading in soccer and the potential for acute and long-term injury to the head and neck. The resulting work is based on literature searches of the PubMed and Medline databases, textbook reviews, and bibliographies of articles and textbooks obtained during the search. Findings from several studies were summarized and critiqued. Biomechanics, anatomy, pathophysiology, and their relation to the act of heading in soccer were also synthesized into the discussion. Relevant studies of athletes in other sports where activity can affect the neck and head in a manner similar to heading were also considered. The act of heading in soccer involves the athlete's entire body, and studies have used electromyography to define the activity of neck musculature during heading. The majority of head and neck injuries in soccer occur secondary to impacts other than those that occur during heading, however, rare case reports of serious injury exist. Degenerative bony changes in the cervical spine of soccer players have been noted in a few studies, but the connection with heading is not well established. Data from research in other sports, particularly American football and rugby, suggest a predisposition to degenerative disease of the neck secondary to axial loading mechanisms; the exact relevance of these studies to heading and soccer is unclear. The complex biomechanics of heading in soccer are not completely defined, especially with regard to long-term effects on the neck and cervical spine. Existing studies of long-term effects suggest a predisposition to degenerative changes of the cervical spine, though they are somewhat limited, even when coupled with data regarding athletes in other sports. Further research in this area is needed with studies that assess biomechanical forces under simulated play conditions and control for impacts and stresses to the neck and spine that occur from non-heading activity.

The impact of violence on emergency department staff

AbstractThe impact of violence on the carers has yet to be clearly defined and explored. Research has shown that there is significant under‐reporting of violence against emergency department personnel.There exist published reports of serious injury or death to staff due to violence occurring in the emergency department. Physical violence occurs in about 50% of violent incidents. The occurrence of threats, assault not resulting in injury, and the psychological impact of such violence need further examination. The part workplace violence has to play in occupational stress and ‘burnout’ are all issues yet to be comprehensively studied and reported.One study has shown a significant reduction in assault and injury in staff trained in aggression control techniques. Further evaluation of aggression control training and psychological debriefing are needed to determine the effect of such measures on the incidence of violence and its sequelae on care givers.Only when there is further research to determine the physical, emotional and financial impact on the carer can the cost of violent events be defined and give financial justification to employers for investing in measures aimed at reducing the impact of these events on the carer.

The medicalization of the exotic: Latah as a colonialism‐bound “syndrome”

Latah is typified as an involuntary culture‐bound syndrome that is almost exclusively confined to Malayo‐Indonesian cultures, involving exaggerated responses to startle. Severe cases typically respond with verbal insults, obscenities, mimicking the words and actions of others, and “automatic obedience,” with reports of serious injury or death to bystanders. All known legal and historical accounts of Malayo‐lndonesian latah are reviewed. There is neither a single firsthand account of a latah subject inflicting serious injury nor a recorded legal case describing the perpetration of a violent act. Neither participants nor onlookers appear to be distressed by paroxysms, nor do they seek patient status, supporting ethnographic accounts suggesting that latah is a deviant social role. Claims that latah is a local variant of a universal startle disorder that is shaped by cultural conditioning are criticized. It is concluded that latah is a uniquely Malayo‐lndonesian idiom.