Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systematic Review of [randomized] Controlled Trials

Firearm access and adolescent suicide risk: toward a clearer understanding of effect size

BACKGROUND

Strong and consistent associations between access to firearms and suicide have been found in ecologic and individual-level observational studies. For adolescents, a seminal case-control study estimated that living in a home with (vs without) a firearm was associated with a fourfold increase in the risk of death by suicide.

METHODS

We use data from a nationally representative study of 10 123 US adolescents aged 13-18 years to (1) measure how much adolescents who live in a home with a firearm differ from those who do not in ways related to their risk of suicide, and (2) incorporate these differences into an updated effect estimate of the risk of adolescent suicide attributable to living in a home with firearms.

RESULTS

Almost one-third (30.7%) of adolescents reported living in a home with firearms. Relative to those who did not, adolescents reporting living in a home with a firearm were slightly more likely to be male, older and reside in the South and rural areas, but few differences were identified for mental health characteristics. The effect size found by Brent and colleagues appeared robust to sources of possible residual confounding: updated relative risks remained above 4.0 across most sensitivity analyses and at least 3.1 in even the most conservative estimates.

CONCLUSIONS

Although unmeasured confounding and other biases may nonetheless remain, our updated estimates reinforce the suggestion that adolescents' risk of suicide was increased threefold to fourfold if they had lived in homes with a firearm compared with if they had not.

Enhancing the training of trauma resuscitation flash teams: A mixed methods study

AIMS

To determine whether simulated multidisciplinary team training influences teamwork practices and experiences when resuscitating critically injured patients and to generate evidence for training trauma resuscitation flash teams.

BACKGROUND

Trauma teams perform in stressful situations. They are 'flash' teams, mobilised quickly and comprise of different specialties and disciplines. Simulation is promoted as a training strategy. Significant gaps remain in evaluating the impact of this training on clinical practice. Further research is warranted to determine the most effective way to train trauma resuscitation flash team.

DESIGN

Final integration phase of a mixed methods embedded experimental study.

METHODS

Primary quantitative results (time to critical operations, facilitators and barriers to teamwork) were merged with supplementary qualitative results (team members' experiences and perspectives) to explain the influences of simulated multidisciplinary trauma team training on teamwork and patient outcomes.

RESULTS

Four main themes were developed: communication needs to be specific to the emergency context; collaborative decision-making influences resuscitation situations; standardisation promotes efficient trauma care; proficient leadership empowers multidisciplinary teamwork.

CONCLUSION

Frontline clinicians identified real-world experiences that enable or impede team performance in trauma resuscitations. Our findings ascertain why multidisciplinary team training enhances team performance and what content should be incorporated in training programmes.