MedicalResearch.com Interview with:
Dr. Monika K. Goyal, MD
Associate Division Chief, Emergency Medicine
Children’s National Hospital
Department of Pediatrics, School of Medicine and Health Sciences
The George Washington University
Washington, District of Columbia
MedicalResearch.com: What is the background for this study?
Response: There has been growing attention to the disproportionate use of police force in communities of color. Therefore, we sought to investigate whether Black and Hispanic teenagers have higher rates of death due to police shootings when compared to white youth.
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MedicalResearch.com Interview with:
Natasha Nayak Kolomeyer, MD
Glaucoma Service, Wills Eye Hospital
Co-authors:
Eric J. Shiuey, MS
Sidney Kimmel Medical College, Thomas Jefferson University
Anton M. Kolomeyer, MD, PhD
Scheie Eye Institute, Department of Ophthalmology, University of Pennsylvania
Philadelphia, Pennsylvania
MedicalResearch.com: What is the background for this study? Response: I still remember the 6-year-old boy that was brought in to our emergency room on July 4th with a ruptured globe (severe eye trauma) due to fireworks; he permanently lost vision in that eye despite surgery. This is not a rare occurrence especially around certain holidays.
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MedicalResearch.com Interview with:
Michael A. Vella, M.D., M.B.A.
Assistant Professor of Surgery
Division of Acute Care Surgery and Trauma
University of Rochester School of Medicine and Dentistry
MedicalResearch.com: What is the background for this study? Response: There is a lot of (appropriate) focus on the mortality statistics related to gun violence, but sometimes we forget about the large number of survivors of gunshot wounds. We wanted to specifically look at the long term physical and mental health outcomes in this patient population.
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MedicalResearch.com Interview with:
Justin C. McCarty, DO, MPH
General Surgery Resident, PGY-4
Department of Surgery | St. Elizabeth’s Medical Center
MedicalResearch.com: What is the background for this study? What are the main findings?Response: The main finding of the paper is that the assumption of the training that teaching how to apply one type of tourniquet translates to knowledge and understanding of how to apply any other tourniquet is questionable.
I love the Stop the Bleed campaign and what it stands for but I believe that it is important that as it moves forward that there is continuous questioning of the educational curriculum and how it is delivered. Currently, I question whether the best interim method of teaching and empowering laypeople is to focus more on pressure and packing of wounds; a skill that is always fully translatable, doesn’t require anything other than a willing set of hands, and is incredibly effective, rather than tourniquets.
A second question I have is whether existing tourniquets and the associated training are approaching the issue from the right angle since to me the device should be designed to not require training and continuous practice, but rather should be intuitive and simple to use, features lacking from all existing devices. (more…)
MedicalResearch.com Interview with:
Dr. Garth Essig, MD
Otolaryngologist
The Ohio State University Wexner Medical Center.MedicalResearch.com: What is the background for this study? What are the main findings?Response: Dog bites are a significant yet modifiable public health concern, but the true magnitude is difficult to estimate with such wide ranges in reporting, severity of injury and varieties of breeds that bite. We reviewed bites from reports in the literature and from two regionally distinct medical centers.
We concluded that bite frequency and severity could be attributed to certain breeds in this sample, if the breed is known. Our study also acknowledged the significant risk of biting with the mixed breed population, which creates a dilemma with identification.
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MedicalResearch.com Interview with:
Dr. Mark R. Hemmila MD
Associate Professor of Surgery
Division of Acute Care Surgery
University of MichiganMedicalResearch.com: What is the background for this study? What are the main findings?Response: Traumatic injury has a tendency to be thought of as a disease that preferentially impacts younger people. We wanted to explore the prevalence and impact of traumatic injury within the population of patients for whom Medicare is the third party payer.(more…)
MedicalResearch.com Interview with:
Jeffrey Howard, PhD
Assistant Professor
Department of Kinesiology, Health and Nutrition
University of Texas at San Antonio
San Antonio, TX 78249
MedicalResearch.com: What is the background for this study? Response:There is a saying that “the only winner in war is medicine”, which is the first sentence in the article. The point of that quote is that many medical advances over the last 500 years or more have been learned or propagated as a result of war.
With that as the backdrop, the purpose of our study was to provide a more comprehensive assessment of the trauma system than previous work. We accomplished this by compiling the most complete data to-date on the conflicts, using data from both Afghanistan and Iraq, and analyzing multiple interventions/policy changes simultaneously rather than in isolation. Previous work had focused primarily on single interventions and within more narrow timeframes. We wanted to expand the scope to include multiple interventions and encompass the entirety of the conflicts through the end of 2017. (more…)
MedicalResearch.com Interview with:
Adil Haider, MD, MPH, FACS
Kessler Director for the Center for Surgery and Public Health
Brigham and Women’s Hospital, Harvard Medical School, and
Harvard T.H. Chan School of Public Health
Deputy Editor of JAMA Surgery
MedicalResearch.com: What is the background for this study? Response: Firearm-related mortality is a public health issue. However, in the US, due in part to lack of funding, there is not enough research to inform the debate about firearms.
The question our group sought to answer was to understand if the presence of a semi-automatic weapon increased the number of victims killed or hurt during an active shooter incident. We chose to focus on these incidents given the availability of an FBI database detailing these active shooter incidents based on a strict definition and the similarities between such incidents that make a comparison valid.
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MedicalResearch.com Interview with:Dr. Julie Leonard MD MPH
Nationwide Children’s Hospital
Columbus, OH
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We looked at children with unintentional injuries who were hospitalized to see if there was an increase in their mental health needs. We saw an average 63% increase in mental health diagnoses and a 155% increase in medications prescribed to treat a mental illness.
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MedicalResearch.com Interview with: Dr. Wataru Takayama
Tokyo Medical and Dental University
Department of Emergency and Disaster Medicine
Tokyo, Japan
MedicalResearch.com: What is the background for this study?Response: ABO blood type is a potential risk of various diseases and various conditions. Furthermore, ABO blood type has a profound influence on hemostasis. Hemorrhage is the leading cause of death in patients with trauma, we assessed the association between the difference in blood types and the outcomes of death.
MedicalResearch.com: What are the main findings?Response: Blood type O was the independent risk factor for all-cause in-hospital mortality and death due to exsanguination, TBI, and other causes after adjusting for potential confounders. This is the first study to report the association between ABO blood types and mortality in patients with severe trauma.
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MedicalResearch.com Interview with:
Simon Chapman AO PhD FASSA Hon FFPH (UK)
Emeritus Professor in the School Public Health
University of Sydney
MedicalResearch.com: What is the background for this study? Response: Since major gun law reforms in 1996, Australian has seen zero mass shootings (five or more deaths, not including the perpetrator).The law reforms outlawed semi-automatic rifles, those often favored by mass killers.
In the 18 years prior to the reforms, Australia experienced 13 mass shootings. The National Rifle Association and others have suggested that the 22 year absence of mass shootings may simply reflect that these events are rare and statistically unlikely to occur regardless of any policy.
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MedicalResearch.com Interview with:
Dr. Molly Jarman PhD
Postdoctoral Research Fellow at
Brigham and Womens HospitalMedicalResearch.com: What is the background for this study?Response: Injuries are a leading cause of death and disability in the US, and there are well documented disparities in injury incidence and outcomes. Certain populations (i.e. rural, low income, people of color) experience more injury than others, and are more likely to die following and injury.
Past studies focused on individual health and socioeconomic characteristics as the primary driving force behind these disparities, along with variation in the time required to transport an injured patient to the hospital. We wondered if geographic features of an injury incident location contributed to variation in injury mortality that was not explained by differences in individual patient characteristics.
In other words, we know that who you are contributes to injury mortality, and we wanted to know if it also matters where you are when an injury occurs.
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MedicalResearch.com Interview with:
Dr Chris Gale
Clinical Senior Lecturer in Neonatal Medicine
Imperial College London and
Consultant Neonatologist at Chelsea and Westminster Hospital
NHS Foundation Trust
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: As part of a drive to make England a safer place to give birth, the Department of Health in England has set a target of reducing the number of babies that incur brain injury during or soon after birth by 20% by 2020 and to halve them by 2030.
Before now United Kingdom health services did not have a standard definition of brain injury in babies and there has been no systematic collection of data for this purpose. With colleagues and in collaboration with the Department of Health, we have devised a practical way to measure the incidence rate of brain injury in babies using routinely recorded data held in the National Neonatal Research Database.
The research estimated that 3,418 babies suffered conditions linked to brain injury at or soon after birth in 2015, which equates to an incidence rate of 5.14 per 1,000 live births. For preterm births (babies born at or less than 37 weeks) the rate was 25.88 per 1,000 live births in 2015, almost six times greater than the rate for full-term births, which was 3.47 per 1,000 live births.
Overall, the research found that the most common type of condition that contributed brain injuries was damage caused by lack of oxygen to the brain, called hypoxic ischaemic encephalopathy; this is seen mainly in term babies. For preterm babies, the largest contributor to brain injuries is from bleeding into and around the ventricles of the brain, a condition called periventricular haemorrhage.
It is also the first time that brain injuries in babies have been measured using data gathered routinely during day to day clinical care on NHS neonatal units. The use of routine data required no additional work for clinical staff and provides a valuable way to measure the effectiveness of interventions to reduce brain injury.
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MedicalResearch.com Interview with:
Dr. Vivian Mcalister, M.B., CCFP(C), FRCSC, FRCS(I), FACS
Professor - Department of Surgery
London Health Sciences Centre
University Hospital
London, Ontario, Canada
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: This study was performed by medical and nursing officers who were all deployed to the war zone. We were deeply concerned about the type of injuries we were seeing. They were more awful than any we had seen before. We were familiar with reviews of antipersonnel landmine injuries that were reported by Red Cross surgeons in the 1990s. The injuries that we were dealing with were from antipersonnel IEDs more than landmines. We decided to do a formal prospective study for two reasons: first was to carefully describe the pattern of injury so we could develop new medical strategies, if possible, to help victims. The second reason was to catalogue these injuries so we could impartially and scientifically report what we were witnessing.
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MedicalResearch.com Interview with:
Dr. Joanna Shepherd
Centre for Trauma Sciences
Blizard Institute
Queen Mary, University of London
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Recent advances in resuscitation and treatment of life-threatening critical injuries means that patients with previously unsurvivable injuries are now surviving to reach hospital. However, many of these patients develop Multiple Organ Dysfunction Syndrome (MODS), which is a failure of several organs including the lung, heart, kidney, and liver.
We studied immune cell genes in the blood of critically injured patients within the first few minutes to hours after injury, a period called the ‘hyperacute window’. We found a small and specific response to critical injury during this window that then evolved into a widespread immune reaction by 24 hours. The development of MODS was linked to changes in the hyperacute window, with central roles for innate immune cells (including natural killer cells and neutrophils) and biological pathways associated with cell death and survival. By 24 hours after injury, there was widespread immune activation present in all critically injured patients, but the MODS signal had either reversed or disappeared.
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MedicalResearch.com Interview with:Kris Jatana, MD FAAP
Pediatric Otolaryngologist
Nationwide Children’s Hospital
MedicalResearch.com: What is the background for this study? What are the main findings?Response: This study looked at a 21-year period – 1990 through 2010 – and focused on children younger than 18 years of age treated in U.S. hospital emergency departments for cotton tip applicator-related ear injuries. About 263,000 children were injured during the study period, which comes out to approximately 1000 injuries seen in emergency departments every month or 34 per day.
The majority of injuries occurred when cotton tip applicators were used to clean a child’s ear canal (73%), and most of those injuries occurred when a child was using a cotton tip applicator on their own (77%), or their parent was using the device (16%) to clean the ear canal. About two out of every three patients were younger than 8 years of age, and patients aged 0-3 years accounted for 40% of all injuries.
Surprisingly, the highest rate of injury was in children 0-3 years old. The most common injuries were foreign body sensation (30%), perforated ear drum (25%) and soft tissue injury (23%).
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MedicalResearch.com Interview with:
Joshua Brown, M.D., M.S., research fellow
Division of Trauma and General Surgery
University of Pittsburgh School of Medicine
MedicalResearch.com: What is the background for this study?
Response: A trauma center is a hospital equipped to immediately provide specialized care to patients suffering from major traumatic injuries, such as falls, car crashes, burns or shootings. In the U.S., the American College of Surgeons sets criteria and conducts reviews for trauma center validation, and the individual states ultimately grant trauma center designation. In Pennsylvania, trauma centers are granted “Level” designations based on their capabilities, ranging from Level-I (highest) to Level-IV (lowest).
We examined records of nearly 840,000 seriously injured patients seen at 287 trauma centers between 2000 and 2012. The centers averaged 247 severely injured patients per year, and 90 percent of the cases involved blunt injury. We compared the expected death rate for each center if everything involving each trauma patient’s care had gone perfectly to the center’s actual death rate.
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MedicalResearch.com Interview with:Hannah Carliner, ScD MPH
Post Doctoral Fellow in Substance Abuse Epidemiology
Mailman School of Public Health
Columbia University
MedicalResearch.com: What is the background for this study? What are the main findings?Dr. Carliner: We know from previous research that traumatic experiences in childhood can have far-reaching effects on the mental and physical health of adults, including increasing the risk for substance use disorders. There is a particularly strong body of evidence about this concerning exposure to child abuse and various other forms of family dysfunction and violence.
However, no previous studies have examined a wider range of traumatic childhood experiences and their link to experimentation with different kinds of drugs in adolescence. While some studies have interviewed adults about initiation of drug use at this age, those results are not as reliable as interviewing teens directly.
Using a nationally-representative sample of almost 10,000 non-institutionalized U.S. adolescents, we therefore determined that childhood trauma was associated with lifetime drug use in teens-- not only with clinically-significant disordered drug use, but even with just trying drugs one time.
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MedicalResearch.com Interview with:
Dr. Joanne Klevens, MD, PhD, MPH
Division of Violence Prevention
US Centers for Disease Control and Prevention
Atlanta, Georgia
Medical Research: What is the background for this study? What are the main findings?
Dr. Klevens: Pediatric abusive head trauma is a leading cause of fatal child maltreatment among young children and current prevention efforts have not been proven to be consistently effective. In this study, compared to seven states with no paid family leave policies, California’s policy showed significant decreases of hospital admissions for abusive head trauma in young children. This impact was observed despite low uptake of policy benefits by Californians, particularly among populations at highest risk of abusive head trauma.
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MedicalResearch.com Interview with:
Dr. Rachael Callcut M.D., M.S.P.H
Assistant Professor of Surgery
Division of General Surgery
UCSFMedical Research: What is the background for this study? What are the main findings?
Dr. Callcut: San Francisco General Hospital (SFGH) responded on July 6, 2013 to one of the larger multiple casualty events in the history of our institution. Asiana Airlines flight 214 crashed on approach to San Francisco International Airport with 307 people on board. 192 patients were injured and SFGH received the highest total of number of patients of area hospitals. The majority of data that is available on disaster response focuses on initial scene triage or initial hospital resources required to respond to these types of major events. Our paper focuses on some additional considerations for optimizing disaster response not typically included in literature on these events including nursing resources, blood bank needs, and radiology studies. As an example, over 370 hours of nursing overtime were needed just in the first 18 hours following the disaster to care for patients. This type of information in traditionally not been included in disaster planning, but clearly was a critical element of providing optimum care to our patients.
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MedicalResearch.com Interview with:
Huiyun Xiang, M.D., M.P.H.
Center for Pediatric Trauma Research
The Research Institute at Nationwide Children’s Hospital
Columbus, OH
Medical Research: What is the background for this study? What are the main findings?
Response: In the United States trauma system, the most severe injuries ideally should receive definitive treatment at level I or level II trauma centers, while less severe injuries should receive treatment at level III or nontrauma centers. “Undertriage” occurs when a severe injury receives definitive treatment at a lower level trauma center instead of a level I or level II trauma center. But no study had used nationally representative data to evaluate mortality outcomes of undertriage at nontrauma centers.
Our study found detrimental consequences associated with undertriage at nontrauma centers. There was a significant reduction in the odds of emergency department (ED) death – by approximately half – in severely injured trauma patients who were properly triaged to a level I or level II trauma center versus those who were undertriaged to a nontrauma center. We also found that patients with moderate injuries may not have a reduction in the odds of ED death when triaged to a level I or level II trauma center instead of a nontrauma center. That suggests a possible threshold of injury severity when triaging trauma patients.
(more…)
MedicalResearch.com Interview with:
Peter M. Rhee, MD, MPH
Chief, Division of Trauma, Critical Care, Burn and Emergency Surgery
Professor of Surgery, Medical Director,...
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