Clinician Attitudes, Screening Practices, and Interventions to Reduce Firearm-Related Injury.

Firearm injury is a leading cause of injury-related morbidity and mortality in the United States. We sought to systematically identify and summarize existing literature on clinical firearm injury prevention screening and interventions. We conducted a systematic search of PubMed, Web of Science, Cumulative Index of Nursing and Allied Health Literature (CINAHL), PsycInfo, and ClinicalTrials.gov for English-language original research (published 1992-2014) on clinical screening methods, patient-level firearm interventions, or patient/provider attitudes on the same. Unrelated studies were excluded through title, abstract, and full-text review, and the remaining articles underwent data abstraction and quality scoring. Of a total of 3,260 unique titles identified, 72 were included in the final review. Fifty-three articles examined clinician attitudes/practice patterns; prior training, experience, and expectations correlated with clinicians' regularity of firearm screening. Twelve articles assessed patient interventions, of which 6 were randomized controlled trials. Seven articles described patient attitudes; all were of low methodological quality. According to these articles, providers rarely screen or counsel their patients-even high-risk patients-about firearm safety. Health-care-based interventions may increase rates of safe storage of firearms for pediatric patients, suicidal patients, and other high-risk groups. Some studies show that training clinicians can increase rates of effective firearm safety screening and counseling. Patients and families are, for the most part, accepting of such screening and counseling. However, the current literature is, by and large, not high quality. Rigorous, large-scale, adequately funded studies are needed.

Communicable Diseases and Outbreak Control.

Infectious disease during an emergency condition can raise the death rate 60 times in comparison to other causes including trauma. An epidemic, or outbreak, can occur when several aspects of the agent (pathogen), population (hosts), and the environment create an ideal situation for spread. Overcrowding, poor regional design and hygiene due to poverty, dirty drinking water, rapid climate changes, and natural disasters, can lead to conditions that allow easier transmission of disease. Once it has been established that an emergency condition exists, there must be a prompt and thorough response for communicable disease control. A camp should be created, and the disease managed rapidly. The overall goals are rapid assessment, prevention, surveillance, outbreak control, and disease management.

Prenatal diagnosis of renal developmental anomalies associated with an empty renal fossa.

Fetal kidneys are evaluated on routine obstetric ultrasounds; therefore, fetal renal developmental anomalies are frequently encountered with prenatal screening. Absence of the fetal kidney from its expected location generates a differential diagnosis that originates from the knowledge of the developmental origins of the kidneys. Many of the renal developmental anomalies demonstrate overlapping features in both symptoms and imaging appearance. We illustrate the pertinent findings of selected fetal renal anomalies in the setting of a unilateral empty renal fossa and suggest an algorithm for differentiating between the diagnoses. Discussed anomalies include horseshoe kidney, pelvic kidney, crossed fused renal ectopia, and renal agenesis.