Increased proportion of alcohol-related trauma in a South London major trauma centre during lockdown: A cohort study

PurposeAlcohol has been associated with 10%–35% trauma admissions and 40% trauma-related deaths globally. In response to the COVID-19 pandemic, the United Kingdom entered a state of “lockdown” on March 23, 2020. Restrictions were most significantly eased on June 1, 2020, when shops and schools re-opened. The purpose of this study was to quantify the effect of lockdown on alcohol-related trauma admissions.MethodsAll adult patients admitted as “trauma calls” to a London major trauma centre during April 2018 and April 2019 (pre-lockdown, n = 316), and 1st April–31st May 2020 (lockdown, n = 191) had electronic patient records analysed retrospectively. Patients’ blood alcohol level and records of intoxication were used to identify alcohol-related trauma. Trauma admissions from pre-lockdown and lockdown cohorts were compared using multiple regression analyses.ResultsAlcohol-related trauma was present in a significantly higher proportion of adult trauma calls during lockdown (lockdown 60/191 (31.4%), vs. pre-lockdown 62/316 (19.6%); (odds ratio (OR): 0.83, 95% CI: 0.38–1.28, p < 0.001). Lockdown was also associated with increased weekend admissions of trauma (lockdown 125/191 weekend (65.5%) vs. pre-lockdown 179/316 (56.7%); OR: 0.40, 95% CI: 0.79 to −0.02, p = 0.041). No significant difference existed in the age, gender, or mechanism between pre-lockdown and lockdown cohorts (p > 0.05).ConclusionsThe United Kingdom lockdown was independently associated with an increased proportion of alcohol-related trauma. Trauma admissions were increased during the weekend when staffing levels are reduced. With the possibility of further global “waves” of COVID-19, the long-term repercussions of dangerous alcohol-related behaviour to public health must be addressed.     

Assisting Problem Gamblers in the Gaming Venue: A Counsellor Perspective

Governments now recognise gambling as a social and public health issue that invites a collaborative approach to responsible gambling and help-seeking involving the gambling industry, gambling help agencies and the wider community. In this paper, we report on findings from interviews with 23 counsellors working in Queensland Gambling Help agencies in Australia based on their own and their clients’ experiences of the processes and practices involved in help seeking in gaming venues. An aim of this study was to establish how venues interact with local gambling help agencies to provide assistance to patrons with gambling problems and the way that venue staff respond. It identified gaps in relevant staff skills and responsible gambling training, particularly the barriers to providing appropriate assistance to problem gamblers, and best practice examples. The barriers to seeking assistance included: patrons feeling shame; issues of confidentiality; and lack of awareness of help available at gaming venues.     

What Behaviours and Cognitions Support Responsible Consumption of Gambling? Results from an Expert Survey

This study analysed expert views on (1) the adequacy of the current promotion of responsible gambling, (2) the practicality and worth of developing an evidence-based set of responsible gambling consumption behaviours and cognitions and (3) the relative importance of behaviours and cognitions promoted as supporting responsible consumption of gambling. Experts (N = 107) rated the importance of 61 behaviours and cognitions, distilled from a systematic literature review and content analysis of 30 websites, and grouped into seven categories. Behaviours and cognitions considered most important for problem gamblers related to ensuring gambling is affordable, limiting persistence at gambling, and using help and support. Those for at-risk gamblers related to understanding gambling, ensuring gambling expenditure is affordable, and keeping gambling in balance. For non-problem gamblers, important behaviours and cognitions related to understanding gambling, keeping gambling in balance, and positive motivations for gambling. Current promotion of responsible gambling was considered inadequate. Efforts to develop, validate and promote evidence-based responsible gambling consumption behaviours and cognitions can build on those identified in this research.     

Steroid-induced avascular necrosis of the hip in neurosurgical patients: epidemiological study

BACKGROUND: Avascular necrosis (AVN) of the femoral head is perceived to be a rare complication of short-term steroid therapy for neurosurgical conditions but its precise risk is unknown. METHODS: Retrospective review of hospital records between 1994 and 2001. RESULTS: The risk of developing AVN of the femoral head is 0.3% with an incidence of one per one thousand patients per year. CONCLUSIONS: It would be advisable to minimize both the dosage and the duration of steroid treatment where possible.     

A retrospective drug utilization evaluation of vancomycin usage in paediatric patients

Objective: To evaluate the appropriateness of use of vancomycin in paediatric patients at KK Women's and Children's Hospital, the major paediatric hospital in Singapore to identify potential problems in prescribing practices that may necessitate intervention to optimize vancomycin usage. Methods: A retrospective drug utilization evaluation was performed for paediatric patients who received intravenous vancomycin from 1 June 1998 to 31 June 1999. The outcome measures were consistency of vancomycin indication with recommended guidelines, dosing regimens, microbiological data, monitoring of serum drug levels, renal function, clinical outcomes and adverse drug reactions (ADRs). Results: A total of 96 cases was available for evaluation. Sixty‐two (64·6%) courses of vancomycin were consistent with guidelines for indication of therapy. Eighty‐six (89·6%) of the dosing regimen were consistent. All infusion times that were recorded (56·3%) were consistent with criteria. Of the patients treated with vancomycin for more than 1 day, peak and/or trough serum vancomycin levels were ordered for 70 cases. Of the 56 cases with paired levels ordered, 46 cases had at least one level that fell outside the therapeutic range. Nineteen (19·8%) cases of ADRs were documented. Fifty‐eight (60·4%) cases received concurrent nephrotoxic drugs. However, a substantial portion of vancomycin courses were apparently not prescribed for appropriate indications, and there was poor recording of vancomycin administration information and sampling time. Conclusion: The majority of dosing regimens of vancomycin was consistent with guideline criteria. The most evident problem was the sub‐optimal use of the monitoring of vancomycin serum levels. The information derived from this study may be used as a for further study and for the development of strategies for optimize vancomycin usage.