Firearm Injuries Are on the Rise, the Results of a Pediatric Trauma Center.

INTRODUCTION: Firearm injury is the leading cause of death in children. The recent rise has coincided with the COVID-19 pandemic. The purpose of this study was to evaluate the trends of pediatric firearm injury over a 6-y period, to include the COVID-19 pandemic, at our pediatric trauma center. METHODS: A retrospective review of the trauma registry at a free-standing children's hospital from January 2018 to December 2023 was performed. The variables evaluated included year of injury, age of injury, race, gender, admission requirements, need for blood products, need for operation, mortality, insurance type, and reason for injury. RESULTS: There were 397 firearm injury presentations identified over the 6-y period. The median age of injury was 13 y with an interquartile range of 6-15 y. Most were male (72.3%) and of Black race (74.6%). A majority of children who sustained a firearm injury had Medicaid (77.8%). During the years of 2018 and 2019, we evaluated 40 and 39 patients, respectively. Over the next 2 y, there was a dramatic increase in pediatric firearm injuries with an increase of 65% (N = 66) in 2020 and 102.5% (N = 81) in 2021. Although there was less of an increase above baseline in 2022, there was still an elevation of 82.5% (N = 73). By the end of 2023, there had been a 145% rise (N = 98) in pediatric firearm injuries above the baseline year of 2018. The mortality rate was 7.6% (N = 30), which is 2.5 times higher than the all-cause trauma mortality of 3.1% at our facility. CONCLUSIONS: The number of firearm injuries dramatically increased during the COVID-19 pandemic and these increases have been sustained. Most of the victims have been male, of Black race, and publicly insured. While the state population of Alabama is 26.4% Black race, Black children account for 74.6% of all firearm-injured pediatric patients in our trauma registry. The reason for this disparity is not well-understood. Through ongoing research, we hope to gain insight into the reasons behind pediatric firearm injury and the best ways to mitigate them through both the medical and public health arenas.

Reducing the burden: managing lymphoedema and its complications.

Lymphoedema effects approximately 200 000 people in UK. It is a chronic condition without a cure but there is much that can be done to ease and manage these complications. This article looks at the eight most common complications, providing advise on how to manage them, derived from the literature and the author's own experience. It also presents advise on how nurses can promote self-management of these complications, promoting patients' self-care.

Venous eczema: more than just a rash.

Venous eczema-also known as varicose, gravitational or stasis eczema-is a common form of eczema. In fact, 37-44% of patients with leg ulcers can present with a venous eczema. It is highly unpleasant, and can disrupt an individual's personal and social life. In this article, Drew Payne provides a community nurse's perspective on what venous eczema is, how to manage it in patients, and how to prevent further reoccurences.

When the dressing does not fit: choosing the right dressing for the right patient.

There is a lot of literature about selecting a primary dressing for a wound. However, not much is made available on the selection of a secondary dressing, which is just as important, as it allows the primary dressing to remain in place. This article looks at selecting a secondary dressing that is appropriate for a patient, considering the patient's mobility or immobility, where the wound is located, how exudate can cause dressings to become detached, controlling a wound's odour, selecting a secondary dressing that will not damage a patient's skin and how nurses can keep themselves up-to-date with dressings.

Use a wrap instead: using compression wraps in lymphoedema and venous disease.

Lymphoedema is more than 'swollen legs'; it is an unpleasant condition that affects approximately 260 000 people in the UK. This article briefly looks at what the lymphatic system is and what lymphoedema is. It then looks at compression wraps and argues for wider use with patients, as they can promote self-care in patients.

Intravenous diuretic administration in the home environment.

Chronic heart failure is a condition associated with ageing, affecting 1-2% of the adult population, raising to 70% of the adult population over 70 years of age. Diuretics are often the first-line treatment for patients with symptomatic heart failure, not just oedema. Traditionally, intravenous (IV) diuretic therapy has been administered only in hospitals. In 2012, the British Heart Foundation ran a pilot study investigating the effectiveness of IV diuretic administration within the home. Since then, there has been an increase in these services. This article examines the advantages and disadvantages of this service, whether community nurses are best placed to deliver this, and what the benefits to the patient might be.

Catheters at home: managing urinary catheters in the home environment.

In England, there are some 90000 people with catheters in the community, and community nurses often have to manage catheter-related problems. This article looks at these common catheter problems found in the community, for example, blockage, infections and positioning problems. These problems were identified by a literature review and from the author's experience, from many years working in the community. It has been found that education, knowledge, empowerment and communication are vital factors affecting patients' ability to manager their catheters themselves. The article begins with a discussion about how patients can be involved in and manage many aspects of care for their own catheters. It goes on to talk about the common catheter-associated problems and how these can be avoided or addressed. It is hoped that better management of catheter-associated complications in the community settings can prevent unnecessary visits to the emergency department, which will save time and costs for the health service, as well as avoid the negative impact of these on patient lives.

The challenge of infection control in patients' homes.

Infection control is the responsibility of all nurses, but, traditionally, it has been seen as a priority only in hospitals. Infection control does not stop when a patient is discharged home, but should be practiced wherever clinical care takes place. Community nurses face a unique challenge as they work in patients' homes, and they must manage infection control in that unique environment. This article looks at practical ways to maintain infection control in patients' homes. It covers hand hygiene and personal protective equipment (PPE), including the five moments of hand hygiene, appropriate hand hygiene, the use of all PPE and when gloves are required and when they are not. It also discusses managing clinical equipment, both that taken into the home and that left with a patient, including decontamination, safe storage of sharps and waste management. It touches upon what can be done in a patient's home to reduce the risk of contamination, as well as infectious disease management, including specimens and wound infection management. Lastly, it talks about cross-infection and why staff health is also important.

Aerosol-generating procedures in home care.

COVID-19 has changed the landscape of healthcare in the UK since the first confirmed case in January 2020. Most of the resources have been directed towards reducing transmission in the hospital and clinical environment, but little is known about what community nurses can do to reduce the risk when they nurse people in their own homes? This article looks at what COVID-19 is, how it is spread and how health professionals are at an increased risk from aerosol-generating procedures (AGPs). There is also a discussion on the benefit of mask usage. It defines what AGPs are, which clinical procedures are AGPs, including ones performed in the community setting, and which identified clinical practices that have been mistaken for AGPs. There is also a discussion on the suitability of performing cardiopulmonary resuscitation (CPR). It also describes how to reduce the risk by the use of full personal protective equipment (PPE) and other strategies when AGPs are performed in a patient's home. It ends with general advice about managing the risk of COVID-19 transmission with patients in their homes.

Skin integrity in older adults: pressure-prone, inaccessible areas of the body.

Good skin integrity is vital to good health because the skin acts as a barrier to microbes and toxins, as well as physical stressors such as sunlight and radiation. It is well known that the skin loses integrity with the ageing process, and this makes older adults susceptible to pressure injury. Additionally, older skin takes longer to heal where there are injuries or breaks. This article looks at what skin integrity is by briefly outlining the physiology of the skin. It discusses how skin integrity can be impaired, what can be done to maintain skin integrity and skin health, and why skin integrity is important for pressure ulcer prevention. Some of the factors that can make skin care difficult are discussed, in addition to the role of community nurses in helping patients engage in skin care. The article outlines how community nurses can identify when there is skin integrity risk or damage and support patients and carers or relatives, in maintaining skin integrity.

Managing incontinence in people with dementia.

It is estimated that there are 850 000 people with dementia in the UK, and 53% of them have incontinence. Dementia adds an extra challenge to managing a patient's continence. This article discusses that challenge, looking at the nature and causes of incontinence, the effects that ageing has on continence and the associated complications. It then examines the nature of dementia and some of its causes and goes on to show how the symptoms of dementia can impact on a person's continence. The article highlights the important of conducting a thorough assessment of a person with dementia who experiences incontinence, including medical history, medications and symptom profile. Using a bladder diary, the importance of involving relatives and carers, physical examination and 'red-flag' symptoms to be aware of are also discussed. Lastly, this article talks about creating a strategy to manage a patient's incontinence, including prompted toileting, medication, using incontinence pads, catheterisation, care planning and supporting relatives and carers.

One trust's rationale for choosing a lubrication gel for use in catheterisation.

Current NHS policy is to reduce the number of catheter-associated urinary tract infections (CAUTIs). To achieve this, guidance suggests reducing the use of catheterisation as much as possible. For those patients requiring catheterisation, Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH) ensured that a medicinal anaesthetic, antiseptic lubricant containing chlorhexidine and lidocaine was used for all catheterisations. Between 2011 and 2018 the Trust reduced CAUTIs by around 50%. This article discusses catheterisation, national policy in reducing CAUTIs, and how NNUH achieved this reduction.

Administering intravenous therapy in patients' homes.

Intravenous therapy in patients' homes is a relatively new procedure in the community nursing practice. This article looks at the practicalities of administering home IV therapy from the following aspects: hand hygiene; how to adjust IV therapy practices to the home environment; care of the IV access site including appropriate dressings; identifying and reacting to problems; maintaining a safe environment when performing IV therapy in a patient's home; anaphylaxis and how to identify and manage it; and the need for training to perform home IV therapy.

Medications at home.

This article looks at practical ways to support patients with oral medication compliance in their own homes. It addresses the importance of assessing why the patient needs support, the importance of a medication review and strategies and tools to aid patient compliance, alongside instances where a nurse can aid patient's relatives and carers can provide medication instead of a nurse.

Medications at home.

This article looks at practical ways to support patients with oral medication compliance in their own homes. It addresses the importance of assessing why the patient needs support, the importance of a medication review and strategies and tools to aid patient compliance, alongside instances where a nurse can aid patient's relatives and carers can provide medication instead of a nurse.

Strategies to support prevention, identification and management of pressure ulcers in the community.

Pressure ulcers are classified as serious incidents, cause pain and distress, and are a source of infection. Unlike patients in hospital, those in the community spend only a small amount of time with healthcare practitioners, so strategies are required to ensure they remain protected against pressure damage when community nurses are not with them. A risk assessment should be carried out to outline a patient's risks and used to develop a strategy for that person. Patients have different risks so prevention strategies need to be tailored individually. Strategies, which cover issues such as pressure-relieving equipment, mattress type, mobility aids and nutrition, should be monitored to ensure they continue to meet patients' needs, as their health, carers and other matters may change. Patients and their carers may need education on ulcers, including on myths, as it is essential they are involved.

Selecting appropriate absorbent products to treat urinary incontinence.

Urinary incontinence can have a significant negative effect on a person's life, especially if left unmanaged and untreated. Continence assessment, often carried out by community nurses, is an important element in the management of a person's urinary incontinence, and so is the selection of appropriate absorbent incontinence pads. This article reviews: the causes and effects of urinary incontinence; how to derive the most appropriate information from a continence assessment; strategies for selecting incontinence pads for a person, on the basis of the results of the continence assessment; and some of the problems and risks associated with the use of incontinence pads.