Evaluation of the Implementation of the NFFF Stress First Aid Intervention in Career Fire Departments: A Cluster Randomized Controlled Trial.

Firefighting is inherently dangerous, though recently concerns have shifted from traditional fireground injuries (burns and asphyxiation) to a focus on mental and behavioral health. Although firefighters are remarkably resilient, research suggests many suffer negative psychological consequences from repeated exposures to trauma. While the Stress First Aid (SFA) model has gained increased attention and adoption among fire departments as a model for behavioral health training, it has not been formally evaluated. This cluster randomized controlled trial used a crossover design comparing the immediate SFA group to delayed SFA control to test the impact of the SFA on firefighters' mental and behavioral health changes after 10-12 months (n = 400; Mage = 37.6, 4.8% women). A convenience sample of 79 firefighters (Mage = 41.4; 8.7% women) provided evaluations on one or more of the training modules. Participants reported satisfaction with all training components (Peer team training 97.6%, Online SFA 94.9%, Curbside Manner 88.4%, After Action Review 89.4%) and reported success in changing personnel's perception of their department's ability to respond to behavioral health issues (SFA M = 3.93, Control 3.50; t = 2.52, p = 0.042). Future work should focus on additional resources and training to augment existing efforts to help departments continue their efforts.

A difficult airway in a patient with nephrogenic sclerosing fibrosis.

Nephrogenic sclerosing fibrosis (dermopathy) is a relatively rare complication of long-term renal dialysis. The syndrome includes marked thickening of the skin and diffuse fibrosis of fascia, muscle, heart, and lungs, leading to contractures of the joints and limbs and cardiopulmonary compromise. We present the case of a 29-year-old woman who required emergent intubation because of respiratory compromise, and who had had normal airway examinations and intubations before the onset of nephrogenic sclerosing fibrosis symptoms.

Amniotic fluid embolism.

Amniotic fluid embolism is one of the most catastrophic complications of pregnancy. First described in 1941, the condition is exceedingly rare and the exact pathophysiology is still unknown. The etiology was thought to be embolic in nature, but more recent evidence suggests an immunologic basis. Common presenting symptoms include dyspnea, nonreassuring fetal status, hypotension, seizures, and disseminated intravascular coagulation. Early recognition of amniotic fluid embolism is critical to a successful outcome. However, despite intensive resuscitation, outcomes are frequently poor for both infant and mother. Recently, aggressive and successful management of amniotic fluid embolism with recombinant factor VIIa and a ventricular assist device, inhaled nitric oxide, cardiopulmonary bypass and intraaortic balloon pump with extracorporeal membrane oxygenation have been reported and should be considered in select cases.

Genital Autoinoculation with Vaccinia: A Look at Two Cases.

Introduction: Smallpox, or vaccinia, has been eradicated worldwide as a disease; however, it may be weaponized and is thus a required immunization when military members deploy to certain parts of the world. Materials and Methods: We report two unusual cases of genital autoinoculation following smallpox vaccination. Results: Both patients' lesions resolved without sequelae within 20 d. Conclusions: We advocate for thorough education on this potential vaccination adverse event. These cases highlight the importance of a broad differential diagnosis when dealing with vulvar lesions, particularly in our military population.

An analogue study of the effects of Psychological Debriefing on eyewitness memory.

Sixty-one participants from the community participated in a randomised controlled trial of group debriefing to assess the effect of this intervention upon memory for a stressful event. Participants were randomly allocated to one of three groups: debriefing; debriefing with an experimenter confederate present (who supplied three pieces of misinformation to the group regarding the stressful event); and a no-treatment control. All groups were shown a very stressful video and were again reviewed after 1 month. Members of the debriefing group where a confederate provided misinformation were more likely to recall this misinformation as fact than members of the other two groups. The debriefing group was also more accurate in their recall of peripheral content than the confederate group. Across all groups, participants were found to be more accurate at central rather than peripheral recall yet more confident for incorrect memories of the video than correct memories.

Laparoscopic pomeroy tubal ligation: a comparison with tubal cauterization in a teaching hospital.

OBJECTIVE: To compare laparoscopic Pomeroy tubal ligation to standard bipolar tubal cauterization for the outcome measures of failure rate, complication rate and procedure duration, with an analysis of the effect of resident experience on procedure duration. STUDY DESIGN: Retrospective study of patients presenting for interval sterilization between August 1998 and June 2000. RESULTS: The characteristics of the laparoscopic Pomeroy (n = 99) and bipolar cautery (n = 62) patients were comparable. The mean procedure duration was 40.8 +/- 14.6 minutes for laparoscopic Pomeroy and 39.6 +/- 18.8 minutes for bipolar cautery (p < 0.68). Multiple regression analysis revealed that procedure duration was a function of both months in residency (R2 = .098, p < 0.007) and number of laparoscopic Pomeroy procedures performed (R2 = .082, p < 0.01). One complication occurred with each procedure (p < 0.576). Two sterilization failures occurred after bipolar cautery and 1 after laparoscopic Pomeroy (p < 0.33). The laparoscopic Pomeroy failure occurred in the shortest tubal segment obtained, 0.7 cm, versus the average segment length, 2.07 +/- .79 cm. CONCLUSION: Laparoscopic Pomeroy did not differ from bipolar cautery for the outcome measures studied. Both time in residency and procedure-specific experience affect the duration of laparoscopic Pomeroy. A tubal segment length of 1 cm should be removed to limit sterilization failures.

Knowledge of neonatal car seat location in a predominantly disadvantaged prenatal population.

In order to assess knowledge of correct car seat location in prenatal patients of predominant lower socioeconomic status, an anonymous survey was performed at 2 inner city obstetric clinics. The survey participants (n = 688) were asked to select from among 3 drawings the correct location of a neonatal car seat. The choices showed an infant facing backward in the rear seat, forward in the rear seat, and backward in the front seat. The correct location of the car seat was selected by 61% of the participating subjects. Knowledge of correct location was related to age (p = 0.047), race (p = 0.002), and parity (p = 0.001) on univariate analysis. Education, survey site, and attendance at prenatal classes did not significantly correlate with car seat knowledge. Multiple regression analysis revealed that Caucasian race compared to African-American race predicted correct knowledge of car seat location with an Odds Ratio of 2.11 (CI 1.38-3.24). Multiparous women were more likely to know where to install a car seat relative to nulliparous women with an Odds Ratio of 1.63 (CI 1.12-2.38). Age was not significantly correlated with car seat knowledge on multivariate analysis. Knowledge of neonatal car seat location was suboptimal in our predominantly disadvantaged population, particularly in nulliparous, African-American women. Further prenatal education is needed during pregnancy or before hospital discharge to address this knowledge deficit.

[The role of psychological debriefing in the treatment of victims of trauma]. / A função do debriefing psicológico no tratamento de vítimas de trauma.

The application of psychological debriefing has become an expected and widespread intervention following exposure to trauma. This article assesses the wisdom of such an approach and reports upon expert consensus regarding its use. Meta-analytic and narrative reviews are summarised and areas of agreement and disagreement are outlined. In sum, it was concluded that the majority of people do not become traumatised from stressful events; that generic psychological debriefing, when applied to individuals, appears to have little impact on functioning; that a specific form of debriefing called Critical Incident Stress Debriefing holds the possibility of noxious effects for some participants and that those most deleteriously affected by debriefing appear to be those most distressed by the initial trauma; that there is no randomised controlled trial evidence to support the validity of group debriefing approaches; and that early intervention using Cognitive Behavioural techniques for those with clinically significant presentations appears the most promising approach. A generic set of guidelines for intervention following trauma is provided.

The incidence of urinary tract injury during hysterectomy: a prospective analysis based on universal cystoscopy.

OBJECTIVE: To evaluate the incidence of urinary tract injury due to hysterectomy for benign disease. STUDY DESIGN: Patients were enrolled prospectively from 3 sites. All patients undergoing abdominal, vaginal, or laparoscopic hysterectomy for benign disease underwent diagnostic cystourethroscopy. RESULTS: Four hundred seventy-one patients participated. Ninety-six percent (24/25) of urinary tract injuries were detected intraoperatively. There were 8 cases of ureteral injury (1.7%) and 17 cases of bladder injury (3.6%). Ureteral injury was associated with concurrent prolapse surgery (7.3% vs 1.2%; P = .025). Bladder injury was associated with concurrent anti-incontinence procedures (12.5% vs 3.1%; P = .049). Abdominal hysterectomy was associated with a higher incidence of ureteral injury (2.2% vs 1.2%) but this was not significant. Only 12.5% of ureteral injuries and 35.3% of bladder injuries were detected before cystoscopy. CONCLUSION: The incidence of urinary tract injury during hysterectomy is 4.8%. Surgery for prolapse or incontinence increases the risk. Routine use of cystoscopy during hysterectomy should be considered.

A função do debriefing psicológico no tratamento de vítimas de trauma / The role of psychological debriefing in the treatment of victims of trauma

A aplicaçäo do chamado debriefing psicológico (DP) tornou-se uma intervençäo disseminada e esperada após a exposiçäo ao trauma. Este artigo avalia a validade desse enfoque e relata o consenso entre os especialistas em relaçäo ao seu uso. Revisöes sistemáticas e narrativas säo resumidas e as áreas de acordo e desacordo säo delineadas. Em resumo, conclui-se que a maioria das pessoas näo fica traumatizada devido a eventos estressantes; que o DP parece ter pequeno impacto; que uma forma de DP chamada de "debriefing sobre o incidente crítico (DICE)" pode exercer efeitos nocivos em certos indivíduos e que aqueles com efeitos mais negativos devido ao DP parecem ser os que mais sofreram com o trauma inicial. Näo há ensaios clínicos randomizados que sustentem a validade do DP em grupo. A intervençäo precoce Cognitivo-Comportamental parece ser o enfoque mais promissor em pacientes com apresentaçöes clínicas bem definidas. É oferecido um conjunto genérico de diretrizes para a intervençäo pós-trauma