Using Team Innovation and Networking to Respond to Rapid Changes in the Academy.

When COVID-19 shuttered schools across the nation, it propelled higher education institutions into uncharted territories. Institutions had to make rapid decisions in a short period of time with limited information or direction. In these uncertain and challenging times, pharmacy academics in the United States and around the world reached out to one another to discuss, share, and learn. What began with a few members of the Student Services Personnel Special Interest Group (SIG) grew to many members who banded together as a team through open discussions to innovative problem-solving. Working together through open discussions created a setting that promoted diverse ideas, multiple perspectives, and a depth of knowledge to address some of the most challenging issues faced by pharmacy education. When partnering together, institutions had a much greater resource of knowledge and support that could be leveraged to broadly benefit the Academy.

Plastic baton round injuries.

OBJECTIVES: To review the injuries resulting from a new plastic baton round. METHODS: Review of case notes of patients presenting with injuries caused by plastic baton rounds over a four month period in Northern Ireland. RESULTS: Twenty nine patients were identified, 28 with 30 injuries were included in the study. Eighty nine per cent were male; the average age was 24.3 years. Seven patients required admission. There were no fatalities. Five injuries were to the upper limbs and 16 to the lower limbs. Three patients sustained pulmonary contusions. There were no head injuries. CONCLUSIONS: Although the numbers in this study are small it should be noted that no patient suffered a face, neck, or head injury. This is in contrast with previous studies in which up to 41.4% of attendances were for face, neck, or head injuries. In this study there were seven injuries to the trunk. Of the 14 deaths attributable to plastic baton rounds in Northern Ireland, all have been the result of head or chest trauma. The use of plastic baton rounds has decreased and, while a reduction in head injuries is noted, potentially serious chest injuries are still occurring. It is vital that guidelines on firing are adhered to. A large proportion of people who have been struck by plastic baton rounds do not attend an accident and emergency department and therefore doctors must be aware of patients with potentially serious injuries presenting late.

Proposed risk stratification in upper gastrointestinal haemorrhage: is hospitalisation essential?

AIMS: Patients with upper gastrointestinal haemorrhage (UGIH) are usually admitted to hospital regardless of the severity of the bleed. The aim of this study was to identify patients who could be safely managed without hospitalisation and immediate inpatient endoscopy. METHODS: Based on a literature review, a protocol was devised using clinical and laboratory data regarded as being of prognostic value. A retrospective observational study of consecutive patients who attended the emergency department (ED) with UGIH was conducted during one calendar month. RESULTS: Fifty four patients were identified of whom 44 (81%) were admitted. Twelve suffered an adverse event. One of the 10 patients (10%) initially discharged from the ED was later admitted. Strict implementation of the protocol would have resulted in safe discharge of a further 15 patients, (34% of those admitted), and a saving of an estimated 37 bed days per month. CONCLUSIONS: Patients at low risk from UGIH may be identified in the ED. If validated, this protocol may improve patient management and resource utilisation.

Transfer of telemedical support to Cornwall from a national telemedicine network during a solar eclipse.

During late 1998 and early 1999, planning officers in Cornwall predicted a huge increase in summer visitors to the county to observe the August solar eclipse. There was the possibility that a mass gathering in Cornwall could overload existing arrangements for handling accident and emergency patients. We therefore set up a telemedicine system to support the county's minor injury units (MIUs) from hospitals throughout the UK. Six main hospital accident and emergency departments outside Cornwall with existing links to their own MIUs were twinned with 10 of the 11 MIUs in Cornwall before the expected date of the gathering. The network was live for nine days, starting four days before the eclipse, and 2045 patients were seen in the 10 MIUs. There were 93 telemedicine calls from the 10 MIUs, involving 91 patients. Overall, 4.6% of the patients required a telemedicine consultation. Fifty-seven calls were made during working hours. Thirty-four patients were referred for further management, of whom 18 were referred on the same day. The transfer of telemedical support to a national network was successful.

Plastic bullet injuries in Northern Ireland: experiences during a week of civil disturbance.

BACKGROUND: Plastic bullets were introduced to Northern Ireland for riot-control purposes in 1973. Their use has been controversial, with a number of fatalities. In the week beginning July 7, 1996, some 8,000 plastic bullets were fired during widespread rioting. METHODS: Details of injuries attributed to plastic bullets were obtained retrospectively from patient notes for the period July 8 to 14, 1996, in six hospitals. A total of 172 injuries in 155 patients were recorded. RESULTS: Nineteen percent of injuries were to the face/head/neck, 20% were to the chest or abdomen, and 61% were to the limbs. Abbreviated Injury Scale scores ranged from I to 3. Forty-two patients were admitted for hospitalization, three to intensive care units. No fatalities occurred. CONCLUSION: Plastic bullet impact to the abdomen or above may cause life-threatening injuries. Below this site, major trauma is unlikely.

Where do we go after the three standard cervical spine views in the conscious trauma patient? A survey.

The objective of this study was to assess, by questionnaire survey, national practice in respect of radiological assessment of the cervical spine in the conscious adult patient with suspected neck injury. The physicians in charge of accident and emergency departments with more than 25000 new patients per year were sent a questionnaire. One hundred and ninety-one replies were received from 243 physicians (79%). Sixty-five per cent of departments have written protocols for imaging the cervical spine. Seven per cent of departments use fewer than the three standard views for clearing the cervical spine. If adequate views do not visualize the cervicothoracic junction, 89% use swimmer's views and 12% use supine oblique views, prior to computerized tomography scanning. It is concluded that the majority of departments use three standard views in the first instance. Swimmer's views are the most common additional X-rays taken if the C7-T1 junction is not visualized, even though supine oblique views give better information about spinal alignment. Imaging of the cervical spine following trauma is difficult and guidelines should be drawn up to address these problems.

Violence and verbal abuse against staff in accident and emergency departments: a survey of consultants in the UK and the Republic of Ireland.

OBJECTIVES: To determine the incidence of verbal abuse and physical violence in accident and emergency (A&E) departments and to discover the extent of provision of security measures and instructions for staff on how to deal with these problems. DESIGN: A postal questionnaire. SETTING: A&E departments in the UK and the Republic of Ireland. SUBJECTS: Two hundred and seventy three consultants named in charge of 310 departments. MAIN OUTCOME MEASURES: Frequency of physical violence and verbal abuse, injuries sustained, perceived precipitating factors, security measures instituted, and legal action taken. RESULTS: Two hundred and thirty three replies were received. Alcohol, waiting times, recreational drug usage, and patients' expectations were perceived as the chief causes. Patients were the chief perpetrators with nurses being the commonest victims. Staff sustained 10 fractures, 42 lacerations, and 505 soft tissue injuries. There were 298 arrests and 101 court appearances that resulted in 76 convictions. Panic buttons and video cameras were the most common security measures. CONCLUSIONS: Staff within A&E departments are regularly abused, both verbally and physically. Inner city departments appear to be most affected. Documentation is poor. Perpetrators are seldom convicted. There do appear to be actions which hospitals could undertake that might help to ameliorate these problems.

Short stay observation patients: general wards are inappropriate.

OBJECTIVE: To assess the efficiency of a short stay observation ward attached to the accident and emergency (A&E) department of a main teaching hospital. METHODS: The study was done on 107 patients admitted to the A&E observation ward and 107 similar patients admitted to general wards after closure of the observation ward. Patients of 13 years and over who required short term admission to hospital for observation or investigation were included. RESULTS: Patients admitted to the A&E observation ward were seen sooner by a senior doctor, had fewer investigations, and had a shorter stay in hospital than similar patients admitted to the general wards. CONCLUSIONS: The A&E observation ward was more efficient than the general acute wards at dealing with short stay patients.

The accident and emergency department as a single portal of entry for the reassessment of all trauma patients transferred to specialist units.

127 patients who were transferred to a regional referral centre for specialist treatment within 48 h of serious injury were reassessed on arrival in the receiving accident and emergency department by a trauma team. 80 transferred patients (63%) required intervention in the accident and emergency department to complete assessment or resuscitation. In view of the well recognised difficulties in managing patients with multiple trauma and the possibility that initially occult injuries may become clinically significant during transport, transferred trauma patients should be reassessed in the accident and emergency department of the receiving hospital by a trauma team consisting of senior medical staff experienced in all aspects of trauma care.

An evaluation of telemedical support for a minor treatment centre.

A low-cost telemedicine link was established from an accident and emergency department in Belfast to support nurse practitioners running a minor treatment centre (MTC) in London. During the 12 months before the introduction of the telemedicine link, 6729 patients were seen in the MTC. Of these, 155 (2.3%) were referred to the nearest accident and emergency department and 802 (11.9%) were referred to their general practitioner (GP). During the first 12 months of the use of the telemedicine link, 9972 patients were seen in the MTC. Of these, 147 (1.5%) were referred to the accident and emergency department and 383 (3.8%) were referred to their GP. During the evaluation period, 51 patients were seen using the telemedicine link, representing 0.5% of all MTC attenders during that period. The total number of teleconsultations was less than expected. The reasons for this difference include random variation, but could also include confidence resulting from the presence of the link and a training effect. The telemedicine link for trauma and minor injuries was an extremely cost-effective way of providing medical expertise to cover the clinical risk of the 0.5-1.5% of the case load that required expert medical opinion. The direct costs of on-site medical staff would have been 50,000 pounds per annum, excluding overhead charges. The annual cost of the videolink, including overheads, was 7250 pounds, amounting to a saving of some 42,000 pounds per annum.

A randomized clinical trial of two different durations of oral cryotherapy for prevention of 5-fluorouracil-related stomatitis.

BACKGROUND: The authors previously reported that 30 minutes of oral cryotherapy inhibits 5-fluorouracil (5-FU)-induced stomatitis. The current trial was designed to determine whether a longer duration of cryotherapy would provide additional protection. METHODS: This trial involved patients who were receiving their first course of a 5-FU plus leucovorin chemotherapy regimen, for which stomatitis is a major dose-limiting toxicity. These patients were randomized to receive either 30 or 60 minutes of oral cryotherapy given at around the same time as the 5-FU therapy. RESULTS: A total of 178 evaluable patients were studied. Both cryotherapy groups had similar degrees of mucositis. CONCLUSION: The authors continue to recommend the use of 30 minutes of oral cryotherapy for patients receiving bolus intensive courses of 5-FU-based chemotherapy.

Clinical predictors of forearm fracture in children.

This study was undertaken to try to define the best clinical predictors of forearm fractures in children aged 3 to 15 years. Over an 8-month period, 136 children attending the Accident and Emergency Department of the Mater Infirmorum Hospital were enrolled in the study and 67 fractures were diagnosed. Gross deformity, point tenderness and decrease in supination and pronation movements of the forearm were the best predictors of bony injury. Gross deformity was obviously the most predictive with a sensitivity of 95%. The risk ratios for moderate to severe point tenderness and decrease in rotatory movements were 3.4 and 3.2 respectively.

Spontaneous rupture of the triceps in the presence of a patella cubiti.

Spontaneous rupture of the triceps tendon is a rare injury, 24 cases having been previously reported in the Literature. Patella cubiti is the rare anomaly of a sesamoid bone in the triceps tendon. We report a combination of the two conditions.

Psychological consequences of the Enniskillen bombing.

Eleven people were killed and 60 injured in the Enniskillen bombing of November 1987. Survivors were psychologically appraised six months and one year later. At six months 50% had developed post-traumatic stress disorder (PTSD). This group comprised more females than males. However, all victims had high scores on the GHQ. We found no correlation between psychological injury (as measured by the GHQ) and physical injury (as measured by the ISS), calling into question previous assertions.

Staples versus sutures in the closure of scalp wounds: a prospective, double-blind, randomized trial.

Over a 6-month period, patients attending the Accident and Emergency Department of the Mater Infirmorum Hospital with scalp wounds were randomly allocated to one of two groups for closure of their wounds with either nylon sutures or metal staples. Each group contained 100 patients. Patients were reviewed at 5 days (95 per cent) after the removal of sutures or staples and again at 3 weeks (61 per cent). The two groups were similar for age, sex, aetiology and wound characteristics. There was no difference in morbidity or rate of wound infection but stapling was significantly faster and less painful. The use of staples carries no risk of accidental needle-stick injury and should therefore be safer than suturing for the user.

Injuries caused by plastic bullets compared with those caused by rubber bullets.

The injuries sustained by 99 people struck by plastic bullets, were compared with those sustained by 90 people struck by rubber bullets. Plastic bullets struck the head and chest less often than rubber bullets and caused fewer serious injuries to the face and chest, but tended to cause more serious skull and brain injuries.