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Exsanguination remains the leading cause of preventable death among victims of trauma. For adult and pediatric trauma patients in the prehospital phase of care, methods to control hemorrhage and hemostatic resuscitation are described in this joint consensus opinion by the American College of Surgeons Committee on Trauma, the American College of Emergency Physicians, and the National Association of EMS Physicians. [ABSTRACT FROM AUTHOR]

The number of U.S. prisoners with minor children has increased dramatically in recent decades. Although the quality of inmate-child communication is positively associated with individual and familial outcomes, innovative programming for incarcerated parents is limited. This mixed methods study explored the initial delivery to incarcerated fathers of a letter-writing intervention developed for and previously used with incarcerated mothers. Pre- to post-intervention measures of parental stress, communication, and relationships with caregivers were tested with the Wilcoxon Signed Rank test. Focus groups were conducted post-intervention to explore perceptions of parental challenges and the intervention. Participants experienced significant improvements in communication and caregiver relations, but not in parental stress. Themes from qualitative analysis highlighted important barriers to communication, positive attributes of the intervention—including structured prompts, outside facilitators and peer support—and improved emotional responses and parental identity among participants. The discussion explores ways to build on this successful delivery to incarcerated fathers. [ABSTRACT FROM AUTHOR]

➤ The consequences of undermanaged perioperative hyperglycemia are notable and can have a serious impact on adverse postoperative outcomes, especially surgical site infections and periprosthetic joint infections (PJIs). ➤ Preoperative screening of hemoglobin A1c with a goal threshold of <7.45% is ideal. ➤ There are a variety of risk factors that contribute to hyperglycemia that should be considered in the perioperative period, including glucocorticoid use, nutritional factors, patient-specific factors, anesthesia, and surgery. ➤ There are expected trends in the rise, peak, and fall of postoperative blood glucose levels, and identifying and treating hyperglycemia as swiftly as possible are the fundamental aims of treatment and improved glucose control. Performing frequent postoperative blood glucose monitoring (in the post-anesthesia care unit, on the day of surgery at 1700 and 2100 hours, and in the morning of postoperative day 1) should be considered to allow for the early detection of alterations in glucose metabolism. In addition, instituting a postoperative dietary restriction of carbohydrates should be considered. ➤ The use of insulin as a hypoglycemic agent in orthopaedic patients is relatively safe and is an effective means of controlling fluctuating blood glucose levels. Insulin therapy should be administered to treat hyperglycemia at ≥140 mg/dL when fasting and ≥180 mg/dL postprandially. Insulin therapy should be ceased at blood glucose levels of <110 mg/dL; however, monitoring for glycemic dysregulation should be continued. In all cases of complex diabetes, consultation with diabetes specialty services should be considered. ➤ The emerging use of technology, including continuous subcutaneous insulin pump therapy and continuous glucose monitoring, is an exciting area of further research and development as such technology can more immediately detect and correct aberrations in blood glucose levels. [ABSTRACT FROM AUTHOR]

The American College of Surgeons Committee on Trauma (ACS-COT), the American College of Emergency Physicians (ACEP), the National Association of State EMS Officials (NASEMSO), the National Association of EMS Physicians (NAEMSP) and the National Association of EMTs (NAEMT) have previously offered varied guidance on the use of ketamine in trauma patients. The following consensus statement represents the collective positions of the ACS-COT, ACEP, NASEMSO, NAEMSP and NAEMT. This updated uniform guidance is intended for use by emergency medical services (EMS) personnel, EMS medical directors, emergency physicians, trauma surgeons, nurses and pharmacists in their treatment of the trauma patient in both the prehospital and hospital setting. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic is a worldwide historical event that will continue to affect nearly every aspect of ordinary life, including affecting our economic, political, and healthcare eco-systems. An effective pandemic response demands a coordinated and integrated response across community healthcare stakeholders, including Public Health and Emergency Management Officials. EMS systems are in a unique position and perform an essential role on the frontlines of COVID-19, including facilitating coordination of response efforts to COVID-19 within their communities while supporting public health mitigation efforts to slow the spread of the SARS-CoV-2. EMS physicians serve their communities at a unique intersection as clinical leaders, population health experts, and advocates. This paper examines and recommends crucial roles for EMS physician leaders as communities work together in pandemic response. [ABSTRACT FROM AUTHOR]

The Geriatric Social Work Competency Scale II is the leading measure of students' competency with older adults. Although the 40-item instrument has demonstrated strong internal consistency and congruent validity, the hypothesized four-factor structure has not been tested. We used confirmatory factor analysis with a sample of social work students (N=667) to test the fit of the hypothesized model and explore respecification. The original model demonstrated strong internal consistency and a roughly acceptable fit. However, high interfactor correlations and items with significant cross-loadings led to the development of a 36-item version. The reduced version made small but consistent improvements in model fit and discrimination among factors while retaining strong internal consistency. Implications for future research and scale usage are discussed. [ABSTRACT FROM AUTHOR]

This pilot study compared the recidivism risks of older, high-risk juvenile probationers exposed or unexposed to an experimental case-management intervention to further the development of a supportive community intervention. The experimental intervention targeted unmet basic needs before and after the exposed group aged out of the juvenile justice system to prevent transition to adult crime. A prospective-cohort design compared the recidivism risks of the intervention group (n = 29) with a randomly selected comparison group (n = 114) stratified by gender, race, and risks/needs. We followed both groups for 3 years after members turned 18. The results of this pilot study showed no effects on recidivism risks, but statistically significant effects on the timing to recidivism for the group exposed to an innovative intervention. The study also revealed that the intervention was able to recruit and maintain the probationers and members of their family for the duration of the intervention. [ABSTRACT FROM AUTHOR]

Since 1989, drug courts have provided an alternative to incarceration for arrestees who have a substance use disorder. Previous research has suggested that participants who graduate from the program are less likely to recidivate than those who are terminated from the program. The majority of research on drug courts is quantitative; therefore, the benefits of qualitative methods are not fully seen in the literature. This qualitative study developed an in-depth understanding of participants’ (n = 42) views on the strengths and limitations of a Midwestern drug court. Two themes emerged from the data. First, participants felt that the drug court promoted camaraderie, which enhanced their motivation for change and supported them in graduating from the program. Second, participants felt that the drug court did not adequately treat their mental illnesses, which for some resulted in relapse and was perceived as a barrier to graduating from the program. Recommendations for drug court practice are discussed. [ABSTRACT FROM AUTHOR]

Veterans treatment courts (VTCs) are designed to offer a rehabilitative approach to criminal justice, focusing on treatment for mental health and substance use disorders. This qualitative study develops an in-depth understanding of a Midwestern VTC by asking participants (n = 15) their views on the most helpful aspects of the program and how the program could be more helpful. Three themes emerged from the data. 1) Military veterans felt that they were treated in a compassionate and caring manner, while also being held accountable for their behaviors. 2) Military veterans felt that they were not labeled by their mental health diagnoses, but that their identities as people and military veterans were more fully recognized. 3) Military veterans were dissatisfied with some of the services they received from the local VA. These findings are discussed in the context of problem-solving courts and military veterans’ experiences of services. [ABSTRACT FROM PUBLISHER]

The Buss–Perry Aggression Questionnaire (BP-AQ) is a 29-item, four-factor instrument that measures physical aggression, verbal aggression, anger, and hostility. A large number of competing versions of the original BP-AQ have been proffered in the literature, but testing with aggressive offenders is limited. The present study used confirmatory factor analysis to compare the fit of seven models with a sample of 246 men and women who pled guilty to misdemeanor aggressive offenses. The study found two similar parsimonious 12-item versions of the four-factor BP-AQ that outperformed the other models and fit the data well while retaining acceptable reliability. Taken together, superior psychometric properties, acceptable reliability, and reduced item-burden are properties that clearly support the usage of either of these 12-item versions. The relative merits of these shorter versions of the BP-AQ are examined and implications for their use in applied contexts and further research are considered. [ABSTRACT FROM AUTHOR]

Background. Patient and provider safety is paramount in all aspects of emergency medical services (EMS) systems. The leaders, administrators, and policymakers of these systems must have an understanding of situations that present potential for harm to patients or providers. Objective. This study analyzed reports to a statewide EMS safety event reporting system with the purpose of categorizing the types of incidents reported and identifying opportunities to prevent future safety events. Methods. This statewide EMS safety incident reporting system is a Web-based system to which any individual can anonymously report any event or situation perceived to impact safety. We reviewed all reports between the system's inception in 2003 through August 2010. A stipulation of the system is that any entry containing information that identifies an EMS provider, agency, or patient will be deleted and thus not included in the analysis. Each event report included the description of the event, the relationship of the reporter, and the year in which the event occurred. Each entry was placed into a category that best represents the situation described. Results. A total of 415 reports were received during the study period, and 186 reports were excluded-163 (39%%) excluded by the state because of identifiable information and 23 (6%%) excluded by the authors because of nonsensical description. Within the remaining 229 reports, there were 237 distinct safety events. These events were classified as actions/behavior (32%%), vehicle/transportation (16%%), staffing or ambulance availability (13%%), communications (8%%), medical equipment (9%%), multiple patients/agencies/units and level-of-care issues (7%%), medical procedure (6%%), medication (5%%), accident scene management/scene safety (3%%), and protocol issues (1%%). EMS providers directly involved in the event represented the largest reporting group (33%%). We also provide examples of statewide system and policy changes that were made in direct response to these reports. Conclusion. This EMS safety incident reporting system identified situations that occurred in many categories of EMS care. These potential dangers represent opportunity to assess, and ultimately change, policy and procedures to reduce potential safety events and medical errors and improve overall safety. A substantial number of cases were excluded to maintain the promise of anonymity within the system. [ABSTRACT FROM AUTHOR]