Lateral neck radiographs are commonly used in the investigation and management of patients presenting with suspected fish bone impaction. The effectiveness of these is questioned, as many fish do not have radio-opaque bones.

This study evaluated the utility of lateral neck radiographs in the management of patients presenting with fish bones retained in the upper aerodigestive tract, with the creation of a treatment algorithm to guide further management.

An audit of practice was undertaken at the University Hospital of Southampton, identifying all patients admitted with potential fish bone impaction in the upper aerodigestive tract. Following analysis, a treatment algorithm was constructed for use by junior doctors.

In total, 34 per cent of patients with a normal radiograph were subsequently found to have a fish bone present under local or general anaesthetic assessment. The sensitivity of radiographs in the detection of fish bones was found to be 51.6 per cent.

Lateral neck radiographs have limited value in the management of suspected fish bone impaction, and should only be used following detailed clinical examination of the upper aerodigestive tract.

In recent years mental health officials have reported a rise in the number of forensic patients present within their state psychiatric hospitals and the adverse impacts that these trends had on their hospitals. To date there have been no large-scale national studies conducted to determine if these trends are specific only to a few states or representative of a more global trend. The purpose of this study was to investigate these reported trends and their national prevalence.

The forensic directors of each state behavioral health agency (including the District of Columbia) were sent an Excel spreadsheet that had two components: a questionnaire and data tables with information collected between 1996 and 2014 from the State Profiling System maintained by the National Association of State Mental Health Program Directors Research Institute. They were asked to verify and update these data and respond to the questionnaire.

Responses showed a 76% increase nationally in the number of forensic patients in state psychiatric hospitals between 1999 and 2014. The largest increase was for individuals who were court-committed after being found incompetent to stand trial and in need of inpatient restoration services.

The data reviewed here indicate that increases in forensic referrals to state psychiatric hospitals, while not uniform across all states, are nonetheless substantial.

More research is needed to determine whether this multi-state trend is merely a coincidence of differing local factors occurring in many states, or a product of larger systemic factors affecting mental health agencies and the courts.

In recent years, several high-profile attacks on hospitals providing medical aid in conflict settings have raised international concern. The International Humanitarian Law prohibits the deliberate targeting of health care settings. Violation of this law is considered a war crime and impacts both those delivering and receiving medical aid.

While it has been demonstrated that both aid workers and health care settings are increasingly being targeted, little is known about the trends and characteristics of security incidents involving aid workers in health care compared to non-health care settings.

Data from the publicly available Aid Worker Security Database (AWSD) containing security incidents involving humanitarian aid workers world-wide were used in this study. The security incidents occurring from January 1, 1997 through December 31, 2016 were classified by two independent reviewers as having occurred in health care and non-health care settings, and those in health care settings were further classified into five categories (hospital, health clinic, mobile clinic, ambulance, and vaccination visit) for the analysis. A stratified descriptive analysis, χ2 Goodness of Fit test, and Cochran-Armitage test for trend were used to examine and compare security incidents occurring in health care and non-health care settings.

Among the 2,139 security incidents involving 4,112 aid workers listed in the AWSD during the study period, 74 and 2,065 incidents were in health care settings and non-health care settings, respectively. There was a nine-fold increase from five to 45 incidents in health care settings (χ2 = 56.27; P < .001), and a five-fold increase from 159 to 852 incidents in non-health care settings (χ2 = 591.55; P < .001), from Period 1 (1997-2001) to Period 4 (2012-2016). Of the 74 incidents in health care settings, 23 (31.1%) occurred in ambulances, 15 (20.3%) in hospitals, 13 (17.6%) in health clinics, 13 (17.6%) during vaccination visits, and six (8.1%) in mobile clinics. Bombings were the most common means of attack in hospitals (N = 9; 60.0%), followed by gun attacks (N = 3; 20.0%). In health care settings, 184 (95.3%) were national staff and nine (4.7%) were international staff.

Security threats are a growing occupational health hazard for aid workers, especially those working in health care settings. There is a need for high-quality data from the field to better monitor the rapidly changing security situation and improve counter-strategies so aid workers can serve those in need without having to sacrifice their lives.

Music therapy has been shown to be effective for reducing anxiety and pain in people with a serious illness. Few studies have investigated the feasibility of integrating music therapy into general inpatient care of the seriously ill, including the care of diverse, multiethnic patients. This leaves a deficit in knowledge for intervention planning. This study investigated the feasibility and effectiveness of introducing music therapy for patients on 4 inpatient units in a large urban medical center. Capacitated and incapacitated patients on palliative care, transplantation, medical intensive care, and general medicine units received a single bedside session led by a music therapist.

A mixed-methods, pre-post design was used to assess clinical indicators and the acceptability and feasibility of the intervention. Multiple regression modeling was used to evaluate the effect of music therapy on anxiety, pain, pulse, and respiratory rate. Process evaluation data and qualitative analysis of observational data recorded by the music therapists were used to assess the feasibility of providing music therapy on the units and patients’ interest, receptivity, and satisfaction.

Music therapy was delivered to 150 patients over a 6-month period. Controlling for gender, age, and session length, regression modeling showed that patients reported reduced anxiety post-session. Music therapy was found to be an accessible and adaptable intervention, with patients expressing high interest, receptivity, and satisfaction.

This study found it feasible and effective to introduce bedside music therapy for seriously ill patients in a large urban medical center. Lessons learned and recommendations for future investigation are discussed.

A significant proportion of adults who are admitted to psychiatric hospitals are homeless, yet little is known about their outcomes after a psychiatric hospitalisation discharge. The aim of this study was to assess the impact of being homeless at the time of psychiatric hospitalisation discharge on psychiatric hospital readmission, mental health-related emergency department (ED) visits and physician-based outpatient care.

This was a population-based cohort study using health administrative databases. All patients discharged from a psychiatric hospitalisation in Ontario, Canada, between 1 April 2011 and 31 March 2014 (N = 91 028) were included and categorised as homeless or non-homeless at the time of discharge. Psychiatric hospitalisation readmission rates, mental health-related ED visits and physician-based outpatient care were measured within 30 days following hospital discharge.

There were 2052 (2.3%) adults identified as homeless at discharge. Homeless individuals at discharge were significantly more likely to have a readmission within 30 days following discharge (17.1 v. 9.8%; aHR = 1.43 (95% CI 1.26–1.63)) and to have an ED visit (27.2 v. 11.6%; aHR = 1.87 (95% CI 1.68–2.0)). Homeless individuals were also over 50% less likely to have a psychiatrist visit (aHR = 0.46 (95% CI 0.40–0.53)).

Homeless adults are at higher risk of readmission and ED visits following discharge. They are also much less likely to receive post-discharge physician care. Efforts to improve access to services for this vulnerable population are required to reduce acute care service use and improve care continuity.

There is renewed interest in the inverse association between psychiatric hospital and prison places, with reciprocal time trends shown in more than one country. We hypothesised that the numbers of admissions to psychiatric hospitals and committals to prisons in Ireland would also correlate inversely over time (i.e. dynamic measures of admission and committal rather than static, cross-sectional numbers of places).

Publicly available activity statistics for psychiatric hospitals and prisons in Ireland were collated from 1986 to 2010.

There was a reciprocal association between psychiatric admissions and prison committals (Pearson r=−0.788, p<0.001), an increase of 91 prison committals for every 100 psychiatric hospital admissions foregone.

Penrose’s hypothesis applies to admissions to psychiatric hospitals and prisons in Ireland over time (dynamic measures), just as it does to the numbers of places in psychiatric hospitals and prisons in Ireland and elsewhere (static, cross-sectional measures). Although no causal connection can be definitively established yet, mentally disordered prisoners are usually known to community mental health services. Psychiatric services for prisons and the community should be linked to ensure that the needs of those currently accessing care through prisons can also be met in the community.

During the 2014-2015 Ebola outbreak in West Africa, the lack of infection prevention and control (IPC) measures in health care facilities amplified human-to-human transmission and contributed to the magnitude of this humanitarian disaster.

In the summer of 2014, the Geneva University Hospitals (HUG; Geneva, Switzerland) conducted an IPC assessment and developed a project based on the local needs and their expertise with the support of the Swiss Agency for Development and Cooperation and the Humanitarian Aid Unit (SDC/HA; Bern, Switzerland). The project consisted of building local capacity in the production of alcohol-based hand-rub solution (ABHRS) based on the World Health Organization (WHO; Geneva, Switzerland) formula in non-Ebola health facilities at the peak of the outbreak in Liberia (Fall 2014) and during recovery in Guinea (September 2015) to promote safer care. Twenty-one pharmacists in Liberia and 22 in Guinea were trained and one years’ worth of laboratory equipment, chemical products, containers for personal use, and bioethanol were delivered to 10 hospitals per country with more than 8,000 100 ml bottles of solution produced at the end of the project.

Hand hygiene using hand-rub solution is a critical component of safer care, especially in health care settings lacking runnable water. Throughout the Ebola outbreak, it was a timely moment to promote hand-rub solution and to reinforce IPC measures in non-Ebola health facilities. During the project implementation, a substantial challenge was the unavailability of bioethanol in Liberia and Guinea. In the long run, sustainability of the production can become an issue as it depends heavily on the local government’s financial and political commitment, the capacity to create an on-going demand for hand-rub solution in health facilities, the local purchase and replacement of the materials and chemical products, as well as the availability of continuous local partners’ support.

The project demonstrated that it was feasible to build local capacity in ABHRS production during an emergency and in limited-resource settings when materials and training are provided. Future programs in similar contexts should identify and address the factors of sustainability during the implementation phase and provide regular, long-term technical support.

Jacquerioz BauschFA, HellerO, BengalyL, Matthey-KhouityB, BonnabryP, TouréY, KervillainGJ, BahEI, ChappuisF, HagonO. Building Local Capacity in Hand-Rub Solution Production during the 2014-2016 Ebola Outbreak Disaster: The Case of Liberia and Guinea.. Prehosp Disaster Med. 2018;33(6):660–667.

The objective of the study was to research the basic seismic response capability (BSRC) of hospitals in Lima Metropolitana. A large number of wounded could be registered in case of an earthquake; therefore, operational hospitals are necessary to cure the injured. The study focused on the operational performance of the hospitals, autonomies of essential resources such as power, water, medical gases, and medicine, in addition to the availability of emergency communication system and ambulances.

Data by a probabilistic seismic risk analysis have been used to assess the operational level of the hospitals. Subsequently, availability of an essential resource has been combined with the immediately operational hospitals to evaluate the BSRC of the health facilities.

Forty-one of Lima’s hospitals have been analyzed for a seismic event with 72-100 years of a return period. Three hospitals (7.3%) were capable to work in a self-sufficient manner for 72 hours, another three (7.3%) for 24 hours, and one (2.4%) for 12 hours.

Results showed a low performance of the hospitals in case of an earthquake. The issue is due to the high seismic vulnerability of the existing structures. Given the importance of Lima city in Peru, structural and nonstructural retrofitting plans should be implemented to improve the preparedness of the health system in case of an emergency. (Disaster Med Public Health Preparedness. 2019;13:138–143)

To complement our environmental scan of academic emergency medicine departments, we conducted a similar environmental scan of the academic pediatric emergency medicine programs offered by the Canadian medical schools.

We developed an 88-question form, which was distributed to pediatric academic leaders at each medical school. The responses were validated via email to ensure that the questions were answered completely and consistently.

Fourteen of the 17 Canadian medical schools have some type of pediatric emergency medicine academic program. None of the pediatric emergency medicine units have full departmental status, while nine are divisions, two are sections, and three have no status. Canadian academic pediatric emergency medicine is practised at 13 major teaching hospitals and one specialized pediatric emergency department. There are 394 pediatric emergency medicine faculty members, including 13 full professors and 64 associate professors. Eight sites regularly take pediatric undergraduate clinical clerks, and all 14 provide resident education. Fellowship training is offered at 10 sites, with five offering advanced pediatric emergency medicine fellowship training. Half of the sites have at least one physician with a Master’s degree in education, totalling 18 faculty members across Canada. There are 31 clinical researchers with salary support at nine universities. Eleven sites have published peer-reviewed papers (n=423) in the past five years, ranging from two to 102 per site. Annual academic budgets range from $10,000 to $2,607,515.

This comprehensive review of academic activities in pediatric emergency medicine across Canada identifies the variability across the country, including the recognition of sites above and below the national average, which may prompt change at individual sites. Sharing these academic practices may inspire sites to provide more support to teachers, educators, and researchers.

The use of specialised psychiatric services for depression and anxiety has increased steadily among young people in Sweden during recent years. It is not known to what extent this service use is due to an increase in psychiatric morbidity, or whether other adversities explain these trends. The aim of this study is to examine if there is increased use of psychiatric services among young adults in Sweden between 2000 and 2010, and if so, to what extent this increase is associated with differences in depression, anxiety and negative life events.

This is a repeated cross-sectional study of 20–30-year old men and women in Stockholm County in 2000 and 2010 (n = 2590 and n = 1120). Log-binomial regression analyses were conducted to compare the prevalence of service use, depression and panic disorder between the two cohorts. Self-reported life events were entered individually and as a summary index, and entered as potential mediators. Different effects of life events on service use were examined through interaction analysis. We report prevalence proportion ratios (PPR) with 95% confidence intervals.

Specialised psychiatric service use, but also depression and panic disorder was more common in the younger cohort (current service use 2.4 and 5.0%). The younger cohort did not report more life events overall or among those with depression or anxiety. Neither depression, panic disorder nor life events could explain the increased use of psychiatric services in the younger cohort (Fully adjusted model PPR = 1.70, 1.20–2.40 95% CI). There was no significant interaction between cohort and life events in predicting psychiatric service use.

This study provides initial support for an increase in service use among young adults compared with 10 years earlier. The increased service use cannot be explained with increasing worse life situations.

No study on hospital staff preparedness for managing blast injuries has been conducted in Libya. The internal conflict in Libya since 2011 and the difficulties faced by the hospitals has highlighted the need for such studies.

Physicians working in Tripoli (capital city Libya) hospitals are inadequately prepared for the management of blast injuries.

A survey was conducted in all 13 hospitals in Tripoli between June 2014 and May 2015 by using interviews based on a questionnaire consisting of 29 questions covering physicians’ education related to blast injury, hospital management of mass casualties, and aspects of hospital preparedness for such incidents.

Of 3,799 physicians working in Tripoli hospitals, 607 physicians were interviewed (16.0%). All but one of the physicians reported that there was no disaster response plan, none of them had read such a plan, 496 (81.7%) reported that hospitals were not prepared, and 471 (77.6%) that hospitals were not equipped for blast injuries. Though 414 (68.2%) reported that radiological equipment was available, 597 (98.3%) revealed that hospitals do not adopt training for blast injury. Only 39 (6.4%) had received professional training, though 183 (30.1%) were seeing blast injury patients at least once a week in their daily practice. Nevertheless, 185 (30.5%) had previous knowledge and experience in blast injuries management and 338 (55.70%) were aware of the major physical findings, but only 75 (12.4%) were following specific guidelines. According to approximately one-third of the physicians (192; 31%), staff and patient safety were not priorities for the hospital administration. Almost all (606; 99.9%) revealed that personal protective equipment for chemical and nuclear accidents was not available.

Preparedness for blast injuries in Tripoli hospitals is seriously deficient. Planning optimized blast and disaster management in Libya is essential.

Oun AM , Hadida EM , Stewart C . Assessment of the Knowledge of Blast Injuries Management among Physicians Working in Tripoli Hospitals (Libya). Prehosp Disaster Med. 2017;32(3):311–316.