The predictive power of geographic health care utilization for unintentional fatal fall rates.

BACKGROUND: Falls are the leading cause of fatal and nonfatal injuries among adults over 65 years old. The increase in fall mortality rates is likely multifactorial. With a lack of key drivers identified to explain rising rates of death from falls, accurate predictive modelling can be challenging, hindering evidence-based health resource and policy efforts. The objective of this work is to examine the predictive power of geographic utilization and longitudinal trends in mortality from unintentional falls amongst different demographic and geographic strata. METHODS: This is a nationwide, retrospective cohort study using the United States Centers for Disease Control (CDC) Web-based Injury Statistics Query and Reporting System (WISQARS) database. The exposure was death from an unintentional fall as determined by the CDC. Outcomes included aggregate and trend crude and age-adjusted death rates. Health care utilization, reimbursement, and cost metrics were also compared. RESULTS: Over 2001 to 2018, 465,486 total deaths due to unintentional falls were recorded with crude and age-adjusted rates of 8.42 and 7.76 per 100,000 population respectively. Comparing age-adjusted rates, males had a significantly higher age-adjusted death rate (9.89 vs. 6.17; p <  0.00001), but both male and female annual age-adjusted mortality rates are expected to rise (Male: + 0.25 rate/year, R2= 0.98; Female: + 0.22 rate/year, R2= 0.99). There were significant increases in death rates commensurate with increasing age, with the adults aged 85 years or older having the highest aggregate (201.1 per 100,000) and trending death rates (+ 8.75 deaths per 100,000/year, R2= 0.99). Machine learning algorithms using health care utilization data were accurate in predicting geographic age-adjusted death rates. CONCLUSIONS: Machine learning models have high accuracy in predicting geographic age-adjusted mortality rates from health care utilization data. In the United States from 2001 through 2018, adults aged 85+ years carried the highest death rate from unintentional falls and this rate is forecasted to accelerate.

Orbitocerebral Impalement: Case Discussion and Management Algorithm.

Orbitocerebral impalement by inanimate objects is a relatively uncommon event. If orbitocerebral impalement is suspected, management entails prompt referral to a trauma facility with neurosurgical, neuroanesthesiological, craniomaxillofacial, and ophthalmological expertise. The aim of this report is to describe the unique mechanism and perioperative considerations of a remarkable, deep orbitocerebral impalement from a walker brake lever through the orbital roof after a fall from standing. We discuss clinical vignette, evaluation, anesthetic approach, and considerations and review the literature on the epidemiology, pathophysiology, surgical and anesthetic management, and prognosis of this traumatic mechanism. We also offer a management algorithm that aims to streamline management.

Emerging Therapies for Sensorineural Hearing Loss.

OBJECTIVE: To critically review and evaluate the proposed mechanisms and documented results of the therapeutics currently in active clinical drug trials for the treatment of sensorineural hearing loss. DATA SOURCES: US National Institutes of Health (NIH) Clinical Trials registry, MEDLINE/PubMed. STUDY SELECTION & DATA EXTRACTION: A review of the NIH Clinical Trials registry identified candidate hearing loss therapies, and supporting publications were acquired from MEDLINE/PubMed. Proof-of-concept, therapeutic mechanisms, and clinical outcomes were critically appraised. DATA SYNTHESIS: Twenty-two active clinical drug trials registered in the United States were identified, and six potentially therapeutic molecules were reviewed. Of the six molecules reviewed, four comprised mechanisms pertaining to mitigating oxidative stress pathways that presumably lead to inner ear cell death. One remaining therapy sought to manipulate the cell death cascade, and the last remaining therapy was a novel cell replacement therapy approach to introduce a transcription factor that promotes hair cell regeneration. CONCLUSION: A common theme in recent clinical trials registered in the United States appears to be the targeting of cell death pathways and influence of oxidant stressors on cochlear sensory neuroepithelium. In addition, a virus-delivered cell replacement therapy would be the first of its kind should it prove safe and efficacious. Significant challenges for bringing these bench-to-bedside therapies to market remain. It is never assured that results in non-human animal models translate to effective therapies in the setting of human biology. Moreover, as additional processes are described in association with hearing loss, such as an immune response and loss of synaptic contacts, additional pathways for targeting become available.

A crash course in medical writing for health profession students.

The production of publications is a key component of one's career advancement in medicine. The goal of this piece is to discuss five tips to help health profession students get started in medical writing. First, students should take full advantage of the time-saving resources at the local academic biomedical library. Second, outlining a manuscript is one of the essential first steps for producing a successful, high-quality publication. Third, planning the manuscript and writing efficiently is critical since many young authors are either in medical school or residency and do not have ample time to devote to the writing process. Fourth, communicating complex concepts, thoughts, ideas, and observations in a simple way is important and helps limit redundancies, awkward passages, and improves reader comprehension. Lastly, a student can maximize their chances at publication if they are persistent in how they approach manuscript submission. The chances for successful publication of a project can be increased if young authors consider the tips supplied here.