Worker,workplace, and community/environmental risk factors for workplace violence in emergency departments

Workplace violence committed by patients and visitors has high propensity to occur against emergency department employees. This article reports the association of worker, workplace, and community/environmental factors with violence risks. A cross-sectional research design was used with 280 employees from six emergency departments in the Midwest United States. Respondents completed the Survey of Violence Experienced by Staff and a 10-item demographic questionnaire. Data were analyzed using frequencies, percentages, Chi-square tests, and adjusted relative risks with 95% confidence intervals. Over 80% of respondents experienced at least one type of workplace violence with their current employer and approximately 40% experienced all three types. Risks for workplace violence were significantly higher for registered nurses and hospital-based emergency departments. Workplace violence can impact all employees in the emergency department regardless of worker, workplace, and community/environmental factors.     

Changing Medical School IT to Support Medical Education Transformation

Problem: Many medical schools are modifying curricula to reflect the rapidly evolving health care environment, but schools struggle to provide the educational informatics technology (IT) support to make the necessary changes. Often a medical school's IT support for the education mission derives from isolated work units employing separate technologies that are not interoperable. Intervention: We launched a redesigned, tightly integrated, and novel IT infrastructure to support a completely revamped curriculum at the Vanderbilt School of Medicine. This system uses coordinated and interoperable technologies to support new instructional methods, capture students' effort, and manage feedback, allowing the monitoring of students' progress toward specific competency goals across settings and programs. Context: The new undergraduate medical education program at Vanderbilt, entitled Curriculum 2.0, is a competency-based curriculum in which the ultimate goal is medical student advancement based on performance outcomes and personal goals rather than a time-based sequence of courses. IT support was essential in the creation of Curriculum 2.0. In addition to typical learning and curriculum management functions, IT was needed to capture data in the learning workflow for analysis, as well as for informing individual and programmatic success. We aligned people, processes, and technology to provide the IT infrastructure for the organizational transformation. Outcomes: Educational IT personnel were successfully realigned to create the new IT system. The IT infrastructure enabled monitoring of student performance within each competency domain across settings and time via personal student electronic portfolios. Students use aggregated performance data, derived in real time from the portfolio, for mentor-guided performance assessment, and for creation of individual learning goals and plans. Poorly performing students were identified earlier through online communication systems that alert the appropriate instructor or coach of low quiz grades or missed learning goals. Graphical and narrative displays of a student's competency performance across courses and clinical experiences informed high-stake decisions made about student progress by the promotions committee. Similarly, graphical display of aggregate student outcomes provided education leaders with information needed to adjust and improve the curriculum. Lessons Learned: With the alignment of people, processes, and technology, educational IT can facilitate transformational steps in the training of medical students.     

Pudendal nerve entrapment in a bareback rodeo cowboy: A case study

The case of a 31 year-old bareback rodeo cowboy who suffered from pelvic floor pain and spasm is presented. The clinical care pathway for this case was not simple and in fact, misdiagnosed for months prior to seeking the care of an osteopathic manual therapist. The pelvic floor muscle spasm was presumably caused by pudendal nerve entrapment even though there were no diagnostic tests such as EMG to confirm it. The entrapment was thought to be from the abdominal viscera (mesentery and sigmoid colon) being adhered to peritoneal tissue in the small pelvis. Treatment consisted of four consecutive days of osteopathic manual therapy treatment due to special patient availability and circumstances. The treatment focused on a release of the root of the mesentery and ischial intraosseous lesions, the release of the sigmoid colon from posterior abdominal wall and iliopsoas muscle, myofascial release of the thoraco-lumbar fascia, and myofascial release of pelvic floor musculature including balancing of three diaphragms, and harmonizing the primary respiratory mechanism within the cranial-sacral system. The etiology is thought to occur due to the sport's natural ptosis forces on the viscera. The patient returned to bareback riding without any issue and on follow-up five years later, did not report any symptoms.     

Infectious disease,injection practices,and risky sexual behavior among anabolic steroid users

Anabolic-androgenic steroids (AAS) and other performance-enhancing drugs (PEDs) are commonly misused to increase muscle size and strength, as well as improve physical appearance. Many AAS and certain PEDs are administered via injection and therefore pose a risk for transmission of infectious diseases such as human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and skin and soft tissue infections (SSTIs). Further, AAS users may be more likely to take part in high-risk sexual behaviors than non-AAS users. This review explores the prevalence of infectious diseases as well as risky injection practices and sexual behaviors of AAS users in the current literature. A comprehensive MEDLINE search (1984–17 April 2015) for English language reports was performed on AAS users. Ten studies analyzed the prevalence of HIV infection, 6 studies analyzed HBV infection, and 6 studies analyzed HCV infection; 20 studies analyzed injection practices and 7 studies analyzed high-risk sexual behaviors of AAS users. HIV, HBV, HCV, and SSTIs have been associated with AAS users. In particular, HIV infection seems much higher among homosexual male AAS users. AAS users also take part in high-risk injection practices but to a much lower extent than intravenous drug users. AAS users are also more likely to engage in high-risk sexual behaviors than the general population. Clinicians and health-policy leaders may utilize these findings to implement strategies to decrease the spread of infectious diseases.     

Practice Paper of the Academy of Nutrition and Dietetics Abstract: Promoting Ecological Sustainability within the Food System

Registered dietitians (RDs) and dietetic technicians, registered (DTRs) can implement environmentally responsible practices in their workplace and personal lives. RDs and DTRs who conserve natural resources while minimizing environmental degradation will help maintain sustainability of the food system, which requires knowledge of the external costs of operational and personal decisions. These external costs include energy to produce, transport, and process food; water for food production, preparation, and sanitation; removal of air pollutants; and waste management. As client and public educators, RDs and DTRs are uniquely positioned to meet the growing needs of those seeking guidance on food choices as they relate to ecological sustainability. In an effort to promote ecologically sustainable diets, it is important to consider natural resources as they relate to food production, transformation, distribution, access, and consumption. It is essential that the dietetics community takes a more active leadership role in support of ecological sustainability and social responsibility. RDs and DTRs can influence policy at the institutional, community, local, state, and national levels by presenting results of operational practices and science-based natural resource information. RDs and DTRs are encouraged to become educated and active in implementing sustainable practices and shaping policy in an effort to promote healthier individuals, communities, and the nation as a whole.     

Prenatal maternal infections and children’s socioemotional development: findings from the UK Millennium Cohort Study

Previous research suggests that prenatal maternal infections may be associated with increased odds of children having a neurodevelopmental disorder. However, little evidence exists on associations with broader child outcomes, especially subclinical symptoms. Participants were the N = 14,021 members of the population-representative UK Millennium Cohort Study. We examined associations between prenatal maternal infections, both maternal-reported and hospital-recorded, and children’s socioemotional development, using the Strengths and Difficulties Questionnaire (SDQ) at age three. Maternal-reported prenatal infections were associated with increased emotional symptoms, after adjusting for several potential confounds and covariates. Hospital-recorded prenatal infections were not associated with children’s socioemotional outcomes, after adjusting for potential confounding and covarying factors. Findings suggest that prenatal maternal infections, particularly those which the mothers remember months later, may be associated with increased emotional problems in early childhood. This emphasises the need for screening for and preventing infections during pregnancy. Further, the occurrence of prenatal infection indicates the potential need for early intervention for children’s emotional difficulties.

     

Veal Calves Produce Less Antibodies against C. Perfringens Alpha Toxin Compared to Beef Calves

Enterotoxaemia is a disease with a high associated mortality rate, affecting beef and veal calves worldwide, caused by C. perfringens alpha toxin and perfringolysin. A longitudinal study was conducted to determine the dynamics of antibodies against these toxins in 528 calves on 4 beef and 15 veal farms. The second study aimed to determine the effect of solid feed intake on the production of antibodies against alpha toxin and perfringolysin. The control group only received milk replacer, whereas in the test group solid feed was provided. Maternal antibodies for alpha toxin were present in 45% of the veal calves and 66% of the beef calves. In beef calves a fluent transition from maternal to active immunity was observed for alpha toxin, whereas almost no veal calves developed active immunity. Perfringolysin antibodies significantly declined both in veal and beef calves. In the second study all calves were seropositive for alpha toxin throughout the experiment and solid feed intake did not alter the dynamics of alpha and perfringolysin antibodies. In conclusion, the present study showed that veal calves on a traditional milk replacer diet had significantly lower alpha toxin antibodies compared to beef calves in the risk period for enterotoxaemia, whereas no differences were noticed for perfringolysin.