BMJ open
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Breathlessness 'crises' in people with chronic respiratory conditions are a common precipitant for emergency department (ED) presentations, many of which might be avoided through improved self-management and support. This study sought insights from people with experience of ED 'near misses' where they considered going to the ED but successfully self-managed instead. ⋯ In addition to teaching non-pharmacological and pharmacological management of breathlessness, interventions should aim to develop patients' generic self-management skills. Interventions to improve self-efficacy should ensure this is substantiated by transfer of skills and support, including knowledge about when ED presentation is necessary. Complementary initiatives are needed to improve coordinated, person-centred care. Future research should seek ways to break the cyclical relationship between affective and sensory-perceptual dimensions of breathlessness.
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This systematic review protocol aims to provide the methods used to evaluate the effectiveness and safety of acupuncture therapy for treating vascular dementia. ⋯ CRD42017071820.
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Outcomes of atrial fibrillation (AF) in patients with severe mental disorders are largely unknown. We compared rates of stroke, fatal thromboembolic events and bleeding in patients with AF with and without mental disorders. ⋯ Patients with AF with schizophrenia or severe depression experienced increased rates of stroke and major bleeding compared with matched comparisons. This increase was largely explained by differences in the prevalence of risk factors for stroke and bleeding, comorbidity and initiation of OAT during follow-up. Patients with AF with schizophrenia further experienced higher mortality following thromboembolic events than matched comparisons without mental disorders.
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This systematic review out of Berkeley investigated data on death, injury and disability resulting from crowd control projectiles:
- Rubber and plastic bullets
- Beanbag rounds
- Shot pellets
- Baton rounds
The researchers looked at published data from a 27 year period in the US, UK/N Ireland, Israel, Palestine, Switzerland, Turkey, Kashmir and Nepal.
The study was part of a larger effort from Physicians for Human Rights and the International Network of Civil Liberties Organizations.
What did they find?
Analysing 26 articles (mainly cohort studies) including 1,984 injured people, they identified 53 (3%) deaths and 300 (15%) permanently disabled. Half of total deaths and 83% of disabilities were due to head or neck strikes.
More than half (56%) of the deaths were from penetrative injuries, and 27% from chest or abdominal trauma.
The majority of permanent disability was vision loss, or abdominal injuries resulting in splenectomy or colostomy.
71% of survived injuries were severe, mostly to skin or extremities.
"Given their inherent inaccuracy, potential for misuse and associated health consequences of severe injury, disability and death, KIPs do not appear to be appropriate weapons for use in crowd-control settings."
Take-home
Although colloquially called 'non-lethal weapons', it would be more accurate to label kinetic impact projectiles (KIPs) as less-lethal weapons given the high risk of severe injury, permanent disability or even death.
"We identified only two basic contexts in which CCWs should be used in crowd-control settings:
- Arrest of individuals engaged in unlawful behaviour, such as throwing rocks and;
- Crowd dispersal in riot situations that threaten public safety."
Compounding issue...
Several articles highlighted the effect on morbidity of delays in accessing medical care due to police action and civil unrest.
summary"There is an urgent need to establish international guidelines on the use of CCWs to prevent unnecessary injury, disability and death, particularly in the use of operational models that avoid the use of weapons."
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This study aimed to evaluate whether use of a discharge criteria tool for nursing assessment of patients in Post Anaesthesia Care Unit (PACU) would enhance nurses' recognition and response to patients at-risk of deterioration and improve patient outcomes. ⋯ This study found that using a structured discharge criteria tool, the PACT, enhanced nurses' recognition and response to patients who experienced clinical deterioration, reduced length of stay for patients who experienced an adverse event in PACU and was cost-effective.