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McCauley CJ, Purcell LN, Schiro SE, Nakayama DK, McLean SE. Injury Patterns, Imaging Usage, and Disparities Associated With Car Restraint Use in Children. Am Surg 2023; 89:5858-5864. [PMID: 37220878 DOI: 10.1177/00031348231175455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Motor vehicle collision (MVC) is a leading cause of accidental death in children. Despite effective forms of child safety restraint (eg, car seat and booster seat), studies demonstrate poor compliance with guidelines. The goal of this study was to delineate injury patterns, imaging usage, and potential demographic disparities associated with child restraint use following MVC. METHODS A retrospective review of the North Carolina Trauma Registry was performed to determine demographic factors and outcomes associated with improper restraint of children (0-8 years) involved in MVC from 2013 to 2018. Bivariate analysis was performed by the appropriateness of restraint. Multivariable Poisson regression identified demographic factors for the relative risk of inappropriate restraint. RESULTS Inappropriately restrained patients were older (5.1 years v. 3.6 yrs, P < .001) and weighed more (44.1 lbs v. 35.3 lbs, P < .001). A higher proportion of African American (56.9% v. 39.3%, P < .001) and Medicaid (52.2% v. 39.0%, P < .001) patients were inappropriately restrained. Multivariable Poisson regression showed that African American patients (RR 1.43), Asian patients (RR 1.51), and Medicaid payor status (RR 1.25) were associated with a higher risk of inappropriate restraint. Inappropriately restrained patients had a longer length of stay, but injury severity score and mortality were no different. DISCUSSION African American children, Asian children, and Medicaid insurance payor status patients had an increased risk of inappropriate restraint use in MVC. This study describes unequal restraint patterns in children, which suggests opportunity for targeted patient education and necessitates research to further delineate the underlying etiology of these differences.
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Affiliation(s)
| | - Laura N Purcell
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sharon E Schiro
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Don K Nakayama
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA
| | - Sean E McLean
- Division of Pediatric Surgery, University of North Carolina, Chapel Hill, NC, USA
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Murnane KS, Augustine JM, Marshall LL. Student pharmacists' attitudes, perceptions, and knowledge regarding opioid use, misuse, and overdose: Four years of data. CURRENTS IN PHARMACY TEACHING & LEARNING 2022; 14:1222-1228. [PMID: 36283793 DOI: 10.1016/j.cptl.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The American Association of Colleges of Pharmacy has urged pharmacy faculty to commit to actions to reduce the public health threat from opioid use and misuse. Optimizing student pharmacist training necessitates understanding changes in their attitudes and perceptions over time. This study assessed student attitudes, perceptions, and understanding of addiction, opioid use and misuse, and opioid overdose over four sequential years, from 2016 to 2019. METHODS The participants were third-professional year doctor of pharmacy students enrolled in a required course. Participants voluntarily completed a 27-statement survey to determine student attitudes, perceptions, and understanding. RESULTS A total of 452 participants completed the survey (response rate = 76.5%). Of the 27 survey items, five survey statements showed year on year positive increases in specific student attitudes towards addiction, hopefulness for its treatment, and confidence to use and train opioid overdose reversal agents. These yearly changes did not appear to be related to any changes in the academic aptitude of the students. The 22 remaining statements showed positive and stable attitudes towards self-perceived understanding of opioid use and misuse, hopefulness for its treatment, and the role of pharmacists. CONCLUSION To our knowledge, this is the first large multiyear assessment of student pharmacists' attitudes, perceptions, and understanding of opioid use, misuse, and overdose. The data indicate favorable and improving attitudes. Knowledge of student attitudes, perceptions, and understanding regarding opioid use, misuse, and overdose will aid in the development of effective training programs for students in our, and other colleges of pharmacy.
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Affiliation(s)
- Kevin S Murnane
- Department of Pharmacology, Toxicology & Neuroscience, Department of Psychiatry, Director of Basic Sciences Research, Louisiana Addiction Research Center, Louisiana State University Health Sciences Center - Shreveport, 1501 Kings Highway, Shreveport, LA 71103, United States.
| | - Jill M Augustine
- Department of Pharmaceutical Sciences, Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
| | - Leisa L Marshall
- Department of Pharmacy Practice, Mercer University College of Pharmacy, 3001 Mercer University Drive, Atlanta, GA 30341, United States.
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Macy ML, Carter P, Kendi S, Pollock B, Miguel LS, Goldstick J, Resnicow K. “Tiny Cargo, Big Deal! Abróchame Bien, Cuídame Bien” an emergency department-based intervention to promote child passenger safety: Protocol for an adaptive randomized trial among caregivers of 6-month through 10-year-old children. Contemp Clin Trials 2022; 120:106863. [DOI: 10.1016/j.cct.2022.106863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 07/17/2022] [Accepted: 07/27/2022] [Indexed: 11/03/2022]
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Cutler GJ, Zagel AL, Spaulding AB, Linabery AM, Kharbanda AB. Emergency Department Visits for Pediatric Firearm Injuries by Trauma Center Type. Pediatr Emerg Care 2021; 37:e686-e691. [PMID: 31135685 DOI: 10.1097/pec.0000000000001846] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study aimed to characterize pediatric visits to emergency departments (EDs) for firearm injuries and examine differences by trauma center type. METHODS Analyses included all patients younger than 19 years from the National Trauma Data Bank, years 2009 to 2014. Trauma centers were categorized as adult, mixed adult and pediatric, or pediatric based on certification level. Baseline characteristics were compared between subgroups using χ2 tests. Multivariable logistic regression was used to examine risk of death. RESULTS Of 466,403 pediatric ED visits, 21,416 (4.6%) resulted from a firearm injury. Most firearm injuries were treated at an adult (64.9%) or mixed trauma center (29.1%) and involved patients that were male (87.1%), in the 15- to 18-year age group (83.2%), and black or African American (61.3%). Most visits were for injuries resulting from assault (78.1%), followed by unintentional (12.6%) and self-inflicted (4.7%) injuries, undetermined intent (3.7%), and legal intervention (0.8%). Patients visiting EDs for firearm injuries had more than 7 times the odds of dying compared with patients with other injuries (odds ratio, 7.30; 95% confidence interval, 6.82-7.72), and firearm injuries were responsible for more than a quarter (26.1%) of the total pediatric deaths in the National Trauma Data Bank (n = 2866). Assault-related injuries resulted in the most deaths (n = 2010; 70.1%), but the case fatality rate was highest for self-inflicted (n = 453; 44.6%). CONCLUSION We identified more than 20,000 firearm-related ED visits by pediatric patients from 2009 to 2014, averaging nearly 10 visits per day. Findings from this study can inform strategic planning in hospitals focused on preventing firearm injuries in children and adolescents.
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Affiliation(s)
| | | | | | | | - Anupam B Kharbanda
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, MN
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Carmona J, Maxwell JC, Park JY, Wu LT. Prevalence and Health Characteristics of Prescription Opioid Use, Misuse, and Use Disorders Among U.S. Adolescents. J Adolesc Health 2020; 66:536-544. [PMID: 31964613 PMCID: PMC7359040 DOI: 10.1016/j.jadohealth.2019.11.306] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/15/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE The prevalence of past-year prescription opioid use (POU), nonmedical POU (NMPOU), and POU disorder (POUD) and their correlates were examined in a national sample of American adolescents (N = 41,579). METHODS This study used data from the public-use files of the 2015, 2016, and 2017 National Surveys on Drug Use and Health, which captured substance use and mental health problems among noninstitutionalized individuals. Prevalence and specific types of prescription opioids and other substances used and misused in the past year were examined among adolescents. Logistic regression analyses were conducted to determine correlates (demographics, other substances used, past-year major depressive episode, school enrollment, two-parent household, number of lifetime medical conditions, and survey year) of POU, NMPOU, and POUD. RESULTS Multiple substance use was common within the past year. The most frequently used prescription opioids were hydrocodone, codeine, oxycodone, and other opioids among adolescents. Cannabis use disorder and alcohol use disorder were comparatively prevalent among opioid misusers. Several correlates (demographics, other substances used, lifetime medical conditions, major depressive episode, and survey year) of POU, NMPOU, and POUD were found. CONCLUSIONS In this national sample, multiple substance use was common among adolescents with past-year POU and NMPOU. Clinical screening for opioid use problems, assessment, and treatment expansion for POUD can focus on persons with substance use, mental health, and/or behavioral problems. Longitudinal studies are needed to better elucidate temporal associations between POU and NMPOU/POUD among adolescents, and more prevention and treatment research on rural residents and minority groups is needed.
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Affiliation(s)
- Jasmin Carmona
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina.
| | - Jane Carlisle Maxwell
- Addiction Research Institute, Steve Hicks School of Social Work, University of Texas at Austin
| | - Ji-Yeun Park
- Moores Cancer Center, University of California San Diego, San Diego, CA 92093, USA
| | - Li-Tzy Wu
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina; Division of General Internal Medicine, Department of Medicine, Duke University Medical Center, Durham, North Carolina; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Center for Child and Family Policy, Sanford School of Public Policy, Duke University, Durham, North Carolina.
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Wong AH, Tiyyagura GK, Dodington JM, Hawkins B, Hersey D, Auerbach MA. Facilitating Tough Conversations: Using an Innovative Simulation-Primed Qualitative Inquiry in Pediatric Research. Acad Pediatr 2017; 17:807-813. [PMID: 28652069 DOI: 10.1016/j.acap.2017.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 04/17/2017] [Accepted: 06/03/2017] [Indexed: 12/13/2022]
Abstract
Deep exploration of a complex health care issue in pediatrics might be hindered by the sensitive or infrequent nature of a particular topic in pediatrics. Health care simulation builds on constructivist theories to guide individuals through an experiential cycle of action, self-reflection, and open discussion, but has traditionally been applied to the educational domain in health sciences. Leveraging the emotional activation of a simulated experience, investigators can prime participants to engage in open dialogue for the purposes of qualitative research. The framework of simulation-primed qualitative inquiry consists of 3 main iterative steps. First, researchers determine applicability by consideration of the need for an exploratory approach and potential to enrich data through simulation priming of participants. Next, careful attention is needed to design the simulation, with consideration of medium, technology, theoretical frameworks, and quality to create simulated reality relevant to the research question. Finally, data collection planning consists of a qualitative approach and method selection, with particular attention paid to psychological safety of subjects participating in the simulation. A literature review revealed 37 articles that used this newly described method across a variety of clinical and educational research topics and used a spectrum of simulation modalities and qualitative methods. Although some potential limitations and pitfalls might exist with regard to resources, fidelity, and psychological safety under the auspices of educational research, simulation-primed qualitative inquiry can be a powerful technique to explore difficult topics when subjects might experience vulnerability or hesitation.
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Affiliation(s)
- Ambrose H Wong
- Department of Emergency Medicine, Yale University, New Haven, Conn.
| | - Gunjan K Tiyyagura
- Department of Emergency Medicine, Yale University, New Haven, Conn; Department of Pediatrics, Yale University, New Haven, Conn
| | - James M Dodington
- Department of Emergency Medicine, Yale University, New Haven, Conn; Department of Pediatrics, Yale University, New Haven, Conn
| | - Bonnie Hawkins
- Yale School of Medicine, Yale University, New Haven, Conn
| | - Denise Hersey
- Cushing/Whitney Medical Library, Yale University, New Haven, Conn
| | - Marc A Auerbach
- Department of Emergency Medicine, Yale University, New Haven, Conn; Department of Pediatrics, Yale University, New Haven, Conn
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