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В статье рассматриваются особенности порядка расследования несчастных случаев на производстве и возбуждения дел об административных правонарушениях в сфере охраны труда по материалам расследования несчастных случаев. Целью исследования является выявление пробелов в урегулировании порядка расследования и административного производства по делам в области охраны труда и формулирование выводов о совершенствовании законодательства. Для достижения цели решаются следующие задачи: определение специфики материальных норм, обеспеченных административной ответственностью в области охраны труда; исследование проблематики административного принуждения и административной ответственности по материалам расследования несчастных случаев на производстве; сравнение порядка расследования несчастных случаев на производстве и контрольно-надзорной деятельности. Методологической основой статьи являются формально-юридический метод, формально-логические и диалектические методы. Выводы: с одной стороны, требуется уделить больше внимания решению пробелов в порядке расследования несчастных случаев, в том числе установлению причин случая как возможному основанию для определения объективной стороны административного правонарушения, а с другой — создать основу для более объективного судебного решения по административным делам, дифференцировав составы по степени риска и определив механизм установления вины юридического лица., The present article concerns features of workplace accidents’ procedure, including initiation of administrative proceedings in the field of labor protection adapted from accidents investigation. Goal of the research is to identify gaps in the regulation of investigation procedure and administrative proceedings concerning labor protection cases and to draw conclusions of their improvement. In order to achieve the above indicated goal, the following matters shall be considered herein: the determination of the substantive rules peculiarities provided by administrative liability in the field of labor protection, the problematics research of administrative enforcement and administrative liability adapted from workplace accidents’ investigation, the comparison of investigation procedure of workplace accidents and control and supervision procedure. The methodological background of the present article is the legalistic, formal-logic, and dialectical approaches. Conclusions: in one respect, some specific attention should be drawn to the issues of the gaps in the investigation procedure of workplace accidents, including accident reasons as a possible ground for objective element of administrative offense determination, and in other respect, to create a basis for a more objective judicial decision on administrative cases, by differentiating constituent elements according to the degree of risk and guilt ascertainment of a legal entity., СОВРЕМЕННОЕ ПРАВО, Выпуск 4 2023, Pages 93-98

OBJECTIVE: The aim of this study was to determine the risk factors associated with the increase of the injury severity of powered two wheelers (PTW) riders when involved in a road accident in Portugal. METHODS: A retrospective analysis of 37769 PTW accidents that occurred in Portugal between 2010 and 2015 was performed. Injury severity was classified into 3 levels: minor injury, severe injury and fatal injury. An ordered logistic regression was applied to identify the potential risk factors that can affect PTW accidents severity. RESULTS: The following factors increase the chances of more severe injuries: motorcycle in PTW category, rest days, 20 h to 5h59, clean and dry roads, Braga and Viana do Castelo regions, rural areas, bended roads, national roads, male rider, no helmet worn, blood alcohol content between 0.5 g/L and 0.8 g/L, truck involvement and other vehicle driver injured. CONCLUSIONS: Special attention should be given to PTW accidents as they represent a large safety problem in Portugal. Understanding the risk factors that influence PTW accident severity is essential to develop safety countermeasures to improve road safety. Prevention plans should be promoted to improve the PTW riders safety. More control of the speed and of the alcohol blood content should be done by the authorities. PTW occupants should be alerted as well to use protective clothing and helmet. These results are important for the consideration of further measures to reduce the injury severity of PTW accidents in Portugal.

Epidemiologic studies related to the demographics and trends of ocular injury in the pediatric cohort in the last decade are limited. This study describes epidemiologic trends in consumer product–related pediatric ocular injuries from 2010 to 2019. This is a retrospective observational study utilizing data from the National Electronic Injury Surveillance System (NEISS). Inclusion criteria include pediatric patients ages 1–20 presenting to NEISS emergency departments with an ocular injury from January 1, 2010, to December 31, 2019. Outcome measures include prevalence of ocular injury related to consumer products stratified by age group, sex, and injury setting. There were an estimated 636,582 consumer product (CP)–related incidents of ocular injury in children ages 1–20 years with an average age of 9.7 years (SD = 5.92) between 2010 and 2019; 416,378 (65.4%) patients were males with a male-to-female ratio of 1.9:1. The annual incidence of CP-related ocular injury in males decreased from 2010 to 2019 while that in females remained unchanged. The greatest number of injuries occurred in the 1–5-year age group (31%) followed 6–10 group (25%), 16–20 (22%), and 11–15 (21%). Ocular contusion was the most common diagnosis. The most common setting of injury was home (63%). The majority (96%) of patients were treated and released from the ED suggesting a minor injury. Of the 1% of patients admitted to the hospital with ocular injuries, one-fourth were due to an open globe injury. Most ocular injuries occurred in the summer months, and presentation to the ED was more frequent on the weekend than a weekday. Over one-fourth (28%) of injuries were sports-related followed by detergents/chemicals (16%), toys (11%), home workshop equipment (8%), kitchenware (5.0%), and home furniture in (4.4%). The frequency and rate of pediatric ocular injuries in the USA decreased during the last decade. Sports and non-powder guns caused the greatest number of eye injuries in the older pediatric cohorts (11–15- and 16–20-year age groups), while detergents/chemicals accounted for nearly 1/3 of all injuries in younger children (1–5 years). Prophylactic measures targeted to specific age groups will be important in reducing eye injuries further.

Traditionally, breast cancer patients with centrally located mass always receive mastectomy or the combination of central excision and primary closure. With the development of modern oncoplastic breast-conserving techniques, these patients can conserve their breast, and achieve satisfactory cosmetic outcome as well as clear margin. A variety of techniques are available to deal with centrally located breast cancers (CLBCs). Among these techniques, Grisotti flap technique is special, because it is easy to handle, and only causes minor injury by using a local rotational dermoglandular flap to fill the defection of central part. However, in our clinical practice, we find a lot of women in south China have special properties. Such as short distance from inframammary liner to the nipple, long distance from midclavicular to the nipple, and large breast diameter. Simply apply the Grisotti flap technique to those patients is not very suitable that drive us to modify this technique to suit our patients. We adopt the idea that use pedicled skin flap with skin island to replace the central defection to modify Grisotti flap technique. And applied this technique to two patients. We find modified Grisotti flap technique for Paget’s disease or CLBC had good cosmetic results as well as safety in suitable patients. In the future, we can use superior pedicle with skin island for ptotic breasts, and lateral pedicle is suitable for patients without large and ptotic breasts.

Transportation is an important part of human life, which has the benefit of facilitating the movement of people and the transportation of goods. This study aims to determine and analyze the locations where accidents often occur along the Cakung - Cilincing road, North Jakarta and determine what factors cause accidents along this road. The research on the analysis of accident-prone areas used the observation method with the quantity data provided by the North Jakarta Police Traffic Unit through IRSMS data, and the survey method was carried out on roads with the recording of passing vehicles, followed by calculations according to MKJI 1997. The results of the study were the location coordinates of the locations that had the highest value Accident-prone, namely segment 3 at the coordinate point -6.140891 to -6.13712 with an AEK value of 80 which causes 6 deaths, 0 serious injuries, 1 minor injury, 5 objects losses, and Rp.13,200,000 material loss. The number of accidents at the coordinate point was 5 incidents. The value of material losses from accidents on Jalan Cakung Cilincing reached Rp. 92,900,000 for the last 4 years from 2016 - 2019. And research on road segment performance obtained LOS A with DS 0.06 in the morning, 0.06 in the afternoon, and 0, 07 in the afternoon.

Road freight transport and heavy vehicles play a significant role in transporting commodities and merchandise goods in Australia. According to the predictions, heavy vehicle traffic in Australia will increase by 50 per cent by 2030. The heavy vehicle traffic growth increases safety concerns since the probability of vehicle crashes increases by five per cent when the heavy vehicle percentage is higher than 30 per cent of the total traffic volume. Despite comprising a small proportion of total registered vehicles (roughly 3%), heavy vehicles are involved in 18% of total road fatalities. Therefore, the reduction in the number of crashes involving heavy vehicles is of high priority. The objective of this research is to identify the influencing factors on injury severity in heavy vehicle crashes using the multinomial logit model. A dataset, including 9175 heavy vehicle crashes in the Victoria State, Australia, over the period of 2006–2018 is used in this paper. The severity of truck crashes includes fatal/serious injury, minor injury, and property damage only, and various characteristics were examined as the potential risks factor, including the driver, crash, road, environment, and vehicle characteristics. Our results show that factors such as occupant variables (e.g. driver age and gender), collision characteristics (e.g. collisions with fixed objects and truck overturns), temporal characteristics (e.g. early morning, midnight), spatial characteristics (e.g. urban or rural areas), environmental factors (e.g. lights condition) increase the probability of fatal/serious injuries in heavy vehicle crashes. The result from the study can be applied to reduce the severity of heavy vehicle crashes.

Atividades profissionais podem causar lesão ao trabalhador e sua ocorrência varia de acordo com a probabilidade e gravidade. Diante da necessidade de estabelecer um modelo que possa auxiliar o gestor de risco a priorizar ações em atividades rotineiras de trabalho, este estudo por meio de aplicação de contexto legal e normativo, legislações previdenciárias, normas regulamentadoras e de pesquisas, propõe a aplicação de uma matriz de risco para avaliação dos fatores e ou fontes de risco ocupacional. A matriz inclui análise de probabilidade (improvável, provável e altamente provável), gravidade (sem lesão, lesão leve, lesão grave ou doença ocupacional e fatal ou incapacidade permanente) e do número de trabalhadores, e tem como resultado quatro tipos de graduação: Risco Crítico, Alto, Moderado e Baixo. Atividades de risco crítico têm prioridade nas ações de eliminação de risco, seguida pelo risco alto, moderado e baixo. Atividades de risco crítico, além da rotina de trabalho, devem também incluir uma análise de risco, quando essa não for exigida por alguma normativa. Atividades de risco crítico e alto devem fazer parte de inspeções periódicas.

This study compared effects of exercise-based interventions with usual care on functional decline, physical performance, and health-related quality of life (12-item Short-Form health survey) at 3 and 6 months after minor injuries, in older adults discharged from emergency departments. Participants were randomized either to the intervention or control groups. The interventions consisted of 12-week exercise programs available in their communities. Groups were compared on cumulative incidences of functional decline, physical performances, and 12-item Short-Form health survey scores at all time points. Functional decline incidences were: intervention, 4.8% versus control, 15.4% (p = .11) at 3 months, and 5.3% versus 17.0% (p = .06) at 6 months. While the control group remained stable, the intervention group improved in Five Times Sit-To-Stand Test (3.0 ± 4.5 s, p

ObjectiveTo demonstrate how the mechanism and agent of injury can influence the anatomical location of a scald.DesignProspective multicentre cross-sectional study.Setting20 hospital sites across England and Wales including emergency departments, minor injury units and regional burns units.PatientsChildren aged 5 years and younger who attended hospital with a scald.Main outcome measuresPrimary outcome: a descriptive analysis of the mechanism, agent and anatomical location of accidental scalds. Secondary outcome: a comparison of these factors between children with and without child protection (CP) referral.ResultsOf 1041 cases of accidental scalds, the most common narrative leading to this injury was a cup or mug of hot beverage being pulled down and scalding the head or trunk (132/1041; 32.9% of cases). Accidental scalds in baths/showers were rare (1.4% of cases). Accidental immersion injuries were mainly distributed on hands and feet (76.7%). There were differences in the presentation between children with accidental scalds and the 103 who were referred for CP assessment; children with scalds caused by hot water in baths/showers were more likely to get referred for CP assessment (pConclusionsAn understanding of the distributions of scalds and its relationship to different mechanisms of injury and causative agents will help clinicians assess scalds in young children, particularly those new to the emergency department who may be unfamiliar with expected scald patterns or with the importance of using appropriate terminology when describing scalds.

Introduction. Chickenpox is a common pediatric disease, while herpes zoster (HZ) is rare among children, especially among infants. HZ in infancy may appear after intrauterine or postnatal infection with varicella-zoster virus (VZV). We report on a case of HZ in an immunocompetent infant who had a history of chickenpox in early infancy. Case outline. A seven-month-old male infant was presented with skin changes in the left T1 and T2 dermatomes. Skin changes appeared eight days after the infant had a mild left-arm traction injury. The patient?s medical history revealed that he had a mild form of chickenpox at the age of three and a half months. After the clinical diagnosis of HZ was made, he was treated with oral acyclovir 20 mg/kg every six hours for five days and had complete recovery without any sequelae. Conclusion. Risk factors for pediatric HZ are immunosuppression and chickenpox during the first year of life. Local trauma is a reported risk for VZV reactivation among adults. To our best knowledge, our case is the first reported pediatric case in which the injury of the left arm precedes HZ appearance. Routine vaccination against chickenpox may be an important preventive measure because herd immunity will protect infants and immunocompromised children from getting chickenpox and thus HZ.

Zusammenfassung Hintergrund Die stationäre Aufnahme von Patienten mit Prellungen wird in Kliniken der Akutversorgung regelhaft praktiziert. Dabei stehen die pathophysiologischen Unfallfolgen oft im Hintergrund. Ziel dieser retrospektiven monozentrischen Untersuchung war die Untersuchung der Ätiologie sowie der kostenverursachenden Faktoren und Refinanzierung bei Aufnahmen durch Prellungen. Methodik Es erfolgte die Abfrage der Patienten entsprechend den Entlassdiagnosen aus dem krankenhausinternen Informationssystem (KIS). Eingeschlossen wurden 117 Patienten in einem Zeitraum von 2 Jahren. Es erfolgten hier die Klassifizierung nach Unfallmechanismus sowie die Einteilung in Altersgruppen. Des Weiteren erfolgte die Kostenkalkulation anhand von abteilungs- und klinikspezifischen Tagessätzen. Ergebnisse Bezüglich der Ätiologie war der häusliche Sturz die häufigste Ursache (48,7 %), gefolgt von dem Hochrasanztrauma (22,8 %). Innerhalb der Gruppe des häuslichen Sturzes lag das Durchschnittsalter im Mittel bei 77,8 Jahre. Diese Gruppe zeigte die längste Verweildauer (VWD) mit 5,2 Tagen. Im Rahmen der kalkulierten Kosten zeigte die Gruppe nach häuslichem Sturz die höchsten Kosten mit 2596,24 € bei einem mittleren DRG-Erlös von 1464,51 €. Diskussion Die Auswertung der klinikinternen Daten bestätigte die subjektive Wahrnehmung, dass ein Großteil der nach Prellung aufgenommenen Patienten aus der Altersgruppe >65 Jahre stammt. Die Aufnahme erfolgt hier vor dem Hintergrund der in dieser Altersgruppe zunehmenden Komorbiditäten sowie zur Abwendung von Folgeerkrankungen und Folgen der Immobilisierung. Ebenfalls konnte gezeigt werden, dass die Versorgungskosten gesundheitsökomisch relevant sind und die Behandlung in diesen Fällen nicht kostendeckend ist.

The coronavirus 2019 (COVID-19) global pandemic has had a significant impact on trauma and orthopaedic (T&O) departments worldwide. To manage the peak of the epidemic, orthopaedic staff were redeployed to frontline medical care; these roles included managing minor injury units, forming a “proning” team, and assisting in the intensive care unit (ICU). In addition, outpatient clinics were restructured to facilitate virtual consultations, elective procedures were cancelled, and inpatient hospital admissions minimized to reduce nosocomial COVID-19 infections. Urgent operations for fractures, infection and tumours went ahead but required strict planning to ensure patient safety. Orthopaedic training has also been significantly impacted during this period. This article discusses the impact of COVID-19 on T&O in the UK and highlights key lessons learned that may help to proactively prepare for the next global pandemic. Cite this article: Bone Joint Open 2020;1-7:420–423.

PurposeThis study aims to examine the influence of a sports-related accident and its severity on sponsorship effects, including brand recognition, attitude toward the sponsoring brand and purchase intention.Design/methodology/approachThe fear appeal theory and sensation-seeking are applied as a theoretical framework. The research is carried out via an experiment using auto racing video footage and print material that manipulates the severity of accidents at three levels – no accident, an accident with a minor injury and an accident resulting in a fatality.FindingsThe analyses demonstrate that the severity of the accident elicits varying sponsorship effects. Sponsorship effects are maximized in a minor injury condition, while smaller sponsorship effects are garnered in the absence of an accident or during fatal injury conditions, as expected via the fear appeal theory. These results suggest that sports fans are excited by auto racing crashes, but are averse to witnessing a fatal accident.Research limitations/implicationsThe participants of the experiment were all students. Consequently, the participants did not represent all sports fans. Only auto racing was examined as experiment stimuli. Different demographic characteristics (e.g. age, race, nationality) and sports could differently influence the relationships among the research variables.Practical implicationsPotential sponsors do not need to take a negative view of the dangers of sports accidents. Rather, it is recommended that such companies actively plan their sponsorship activities with the appropriate strategy.Originality/valueThe relationship between the severity of a sports-related accident and sponsorship effects has received little attention regarding its potential impact on brand recognition, attitude toward the sponsoring brand and purchase intention. The current study is the first known empirical research using the fear appeal theory in sports sponsorship. It investigates the severity of a sports-related accident and determines how that severity influences sponsorship effects in auto racing. This study provides a better understanding of the effects of an accident and its severity on sponsorship effects.

Background Despite the risk of developing posttraumatic stress disorder (PTSD) and associated comorbidities after physical injury, few emergency departments (EDs) in the United States screen for the presence of psychological symptoms and conditions. Barriers to systematic screening could be overcome by using a tool that is both comprehensive and brief. This study aimed to determine 1) the feasibility of screening for posttraumatic sequelae among adults with minor injury in the ED and 2) the relationship between ED screening and later psychological symptoms and poor quality of life (QOL) at 6 weeks postinjury. Methods In the EDs of two Level I trauma centers, we enrolled injured patients (n = 149) who reported serious injury and/or life threat in the past 24 hours. Subjects completed the Posttraumatic Adjustment Scale (PAS) to screen for PTSD and depression in the ED, and 6 weeks later they completed assessments for symptoms of PTSD, depression, and trauma-specific QOL (T-QoL). Results Our retained sample at 6 weeks was 84 adults (51.2% male; mean ± SD age = 33 ± 11.88 years); 38% screened positive for PTSD, and 76% screened positive for depression in the ED. Controlling for age, hospital admission, and ED pain score, regression analyses revealed that a positive ED screen for both PTSD and depression was significantly associated with 6 weeks PTSD (p = 0.027, 95% confidence interval [CI] = 0.92 to 15.14) and depressive symptoms (p = 0.001, 95% CI = 2.20 to 7.74), respectively. Further, a positive ED screen for depression (p = 0.043, 95% CI = -16.66 to -0.27) and PTSD (p = 0.015, 95% CI = -20.35 to -2.24) was significantly associated with lower T-QoL. Conclusions These results suggest that it is feasible to identify patients at risk for postinjury sequelae in the ED; screening for mental health risk may identify patients in need of early intervention and further monitoring.

Background/Aims Urgent care centres provide a broad range of services in comparison to minor injury units. In order to establish new urgent care centres, the Sustainability and Transformation Partnership in Cornwall aimed to identify the optimal number and location for these centres, which could then help to reduce the volume of patients attending emergency departments. Methods A computer model that calculated average and maximum travel times, along with number of attendances, for over 4000 potential urgent care centre geographic configurations, was developed. The model predicted that establishing five urgent care centres would significantly minimise travel times for patients across the county. The model also predicted the locations for these centres that would minimise average travel times. Results The results from the model were used to directly inform a decision made by the Sustainability and Transformation Partnership. Conclusion The first urgent care centres in Cornwall, at Treliske, Bodmin Community Hospital and West Cornwall Hospital, were established in 2018. The urgent care centre in West Cornwall is now accepting patients; the two other sites are still under construction.

Adaptive signal control technology (ASCT) is an intelligent transportation systems (ITS) technology that optimizes signal timings in real time to improve corridor flow. While a few past studies have examined the impact of ASCT on crash frequency, little is known about its effect on injury severity outcomes. Similarly, the impact of different types of ASCTs deployed across different states is also uncertain. This paper therefore, used ordered probit models with random parameters to estimate the injury severity outcomes resulting from ASCT deployment across Pennsylvania and Virginia. Two disparate systems deployed across the two different states were analyzed to assess whether they had similar impacts on injury severity, although signal timings are optimized using different algorithms by both systems. The estimation results revealed that both ASCT systems were associated with reductions in injury severity levels. Marginal effects showed that Type A ASCT systems reduced the propensity of severe plus moderate and minor injury crashes by 11.70% and 10.36% while type B ASCT reduced the propensity of severe plus moderate and minor injury crashes by 4.39% and 6.92%. Similarly, the ASCTs deployed across the two states were also observed to reduce injury severities. The combined best fit model also revealed a similar trend towards reductions in severe plus moderate and minor injury crashes by 5.24% and 9.91%. This model performed well on validation data with a low forecast error of 0.301 and was also observed to be spatially transferable. These results encourage the consideration of ASCT deployments at intersections with high crash severities and have practical implications for aiding agencies in making future deployment decisions about ASCT.

Motorcycles constitute 61% of the total registered vehicles in Pakistan and there has been a 371% growth in motorcycles in the country from year 2005-2015. Motorcycle is an essential and popular mode of transportation in Pakistan, therefore, the present study estimated a random parameters logit model to investigate the factors influencing the motorcycle injury severity using motorcycle crash data of Rawalpindi city collected by the Provincial Emergency Response Service. No injury, minor injury, severe injury and fatal injury are used as four categories of motorcyclist injury severity levels to calibrate the model. Mainly the effects of speed limits, crash-specific factors, rider attributes, roadway characteristics, weather and socio-demographics factors are considered for motorcycle-injury severity analysis. It was revealed that probability of fatal/severe injury increases for crashes: involving middle-aged riders (25–50 years) and riders with no education, occurring on roads with posted speed limit of 70 kms per hour or higher, crashes involving a motorcycle and a heavy vehicle, involving collision of a motorcycle with a fixed object and occurring during dry weather conditions. Also, the probability of minor injury increases for crashes: occurring on divided streets and road segments with a posted speed limit of less than 50 kms per hour, involving Chinese brand motorcycles, involving registered motorcycles, and where at least one motorcycle and auto rickshaw is involved. The research findings suggest that besides measures to control/ reduce the risky motorcyclists behavior there is a need to lower speed limits on roads with a higher motorcycle proportion, separate motorcycles from heavy vehicles and removal of fixed objects from the roadside. Besides data limitations, results are expected to generate more discussion and interest in motorcycle safety in the country and can be used by the enforcement agencies to improve/ enhance the current state of motorcycle safety in the country.

Trauma centers frequently accept patients from other institutions who are being sent due to the need for a higher level of care. We hypothesized that patients with minor traumatic injuries who are transferred from outside institutions would impart a negative financial impact on the receiving trauma center.We performed a retrospective review of all trauma patients admitted to our urban level I trauma center from October 1, 2011, through September 30, 2013. Patients were categorized as minor trauma if they did not require operation within 24 h of arrival, did not require ICU admission, did not die, and had a hospital length of stay24 h. Transferred patients and nontransfers (those received directly from the field) were compared with respect to injury severity, insurance status, and hospital net margin. Student's t-test and z-test for proportions were performed for data analysis.A total of 6951 trauma patients were identified (transfer n = 2228, nontransfer n = 4724). Minor injury transfers (n = 440) were compared to nontransfers (n = 689). Hospital net margin of transferred patients and nontransferred patients were $2227 and $2569, respectively (P = 0.22). Percentages of uninsured/underinsured for transfers and nontransfers were 27.3% and 36.1%, respectively (P = 0.002).During our study period, 19.7% of transfers and 14.6% of nontransfers can be categorized as having minor trauma. Minor trauma transfer patients are associated with a positive hospital net margin for the trauma center that is similar to that of the nontransfer group. The data also demonstrate a lower percentage of uninsured/underinsured in the transferred group.

Ankle sprains continue to be among the most common musculoskeletal injuries, most of which never require surgical treatment. Surgical treatment has traditionally been successful for those patients whose symptoms do not improve with nonoperative care. However, recurrent instability, although rare, can occur early or late after a stabilization procedure, as the result of an acute traumatic event or chronic repetitive minor injury. A complete workup of patients with recurrent ankle instability should be completed before revision surgery and should include evaluation for generalized joint hypermobility as well as anatomic variations, such as hindfoot varus, first ray plantarflexion, and midfoot cavus.

Musculoskeletal injuries are often presented in primary care, and general practice nurses should be aware of the best practice guidelines on accurate patient assessment, say Jonathan Thomas and Ann Paynter, which is as important as knowing when to refer The aim of this article is to discuss the assessment and management of patients that present to primary care with minor musculoskeletal injuries. Accurate patient assessment is essential and this article will explore important aspects to consider within the assessment as well as when to refer the patient.

BackgroundMinor injuries are very common in the pediatric population and often occur in the home environment. Despite its prevalence, little is known about outcomes in children following minor injury at home. Understanding the impact of these injuries on children and their families is important for treatment, prevention, and policy. The objectives of our study were (1) To describe the distribution of short-term outcomes following pediatric minor injuries sustained at home and (2) To explore the relationship of injury type and patient and household demographics with these outcomes.MethodsChildren (n = 102) aged 0–7 years with a minor injury sustained at home were recruited in an urban pediatric emergency department as part of the Child Housing Assessment for a Safer Environment (CHASE) observational study. Each patient had a home visit following the emergency department visit, where five parent-reported outcomes were assessed. Relationships were explored with logistic regression.ResultsThe most common type of injury was soft tissue (57.8 %). 13.2 % of children experienced ≥ 7 days of pain, 21.6 % experienced ≥ 7 days of abnormal activity, 8.9 % missed ≥ 5 days of school, 17.8 % of families experienced ≥ 7 days of disruption, and 9.1 % of parents missed ≥ 5 days of work. Families reported a total of 120 missed school days and 120 missed work days. Children who sustained a burn had higher odds of experiencing pain (OR 6.97), abnormal activity (OR 8.01), and missing school (OR 8.71). The parents of children who sustained a burn had higher odds of missing work (OR 14.97).ConclusionsFamilies of children suffering a minor injury at home reported prolonged pain and changes in activity as well as significant school and work loss. In this cohort, burns were more likely than other minor injuries to have these negative short-term outcomes reported and represent an important target for interventions. The impact of these injuries on missed school and disruption of parental work warrants further consideration.

Introduction: As coronavirus disease 2019 (COVID-19) became a public health emergency of international concern, countries across the globe began to instate strict social distancing restrictions or “lockdowns”. During these times emergency departments in the United Kingdom (UK) recorded a significant drop in patients attending when compared to the same months of previous years. Attendances related to musculoskeletal (MSK) trauma also saw a significant drop in numbers Objective: The purpose of this retrospective audit was to investigate patterns of injuries attending during the pandemic and more specifically during times of lockdown. Method: Retrospective audit data was collected from an electronic medical record system (MediTech V6) during the time period of the first lockdown in the UK. Data was collected for patients attending the emergency department at the Queens Hospital Burton site of the University Hospitals of Derby and Burton National Health Service (NHS) Trust. Presenting complaints were recorded for the entire emergency department, and diagnosis on discharge and activity status was recorded for minor injuries only. This data was then compared to the same date from 2019. Results: Overall attendances in the emergency department decreased by 45.42% during the first lockdown when compared to the same time period in 2019. MSK problems also saw a significant drop as back pain decreased by 58.88%, neck pain fell by 78.52% and limb problems decreased by 59.74%. When comparing data from the minor injury department, limb problems decreased by 20.45%. The number of soft tissue injuries decreased by 24.05% and fractures decreased by 7.96%. Conclusion: Attendances in the emergency department were greatly reduced during the COVID-19 pandemic, especially during the first lockdown. The rates of fractures and soft tissue injuries within the minors’ area of the emergency department were also reduced but not at the same rate as the overall attendance. A large number of fractures and soft tissue injuries still presented to the emergency department despite reduced national activity. These attendances may be as a result of the increased rate of Do It Yourself (DIY)-related injuries and altered patient/social behaviour due to lockdown, social distancing, and seasons/weather. Further research would be required to investigate the changing patterns of behaviour especially as we enter a second wave of cases.

Background Various types of follicular trauma occur during follicular unit excision (FUE). However, the effects of different types of follicular injury on graft survival have not been reported. Objective This study was performed to evaluate the differences in hair follicle survival by the type of follicular injury, including paring, fracture, and bulb injury. Methods Seven healthy patients who underwent hair transplant surgery by FUE were enrolled in the study. For each patient, 10 single-hair follicular unit grafts per injury group (paring, fracture, bulb injury, or intact) were differentiated. Using sharp implanters, 10 grafts of each of the 4 injury types were transplanted into mice, and the mice were sacrificed 5 months after transplantation. The skin was excised at each of the 4 locations, and newly formed follicular units were counted and photographed under a microscope. Results Of 70 hair follicles in each group, the number of successfully engrafted follicles was 50 (71.43%) in the intact group, 36 (51.43%) in the paring injury group, 9 (12.86%) in the fracture injury group, and 31 (44.29%) in the bulb injury group. Conclusion Grafts with minor injury had a lower survival rate than intact grafts. Fractured follicles showed the lowest survival rate.

Introduction Ambulatory Majors was set up in the Countess of Chester Hospitals Emergency Department to take the workstream of ‘non minor injury’ patients, who are not suitable for the Urgent Treatment Centre and do not need a bed to wait on. Ambulatory Majors has the largest throughput of patients, but has minimal senior doctor supervision. Patients have long waits to be seen with their consultation time disproportionately shorter. Patients are having cannulation or blood tests which are not required which increases patient length of stay. Their length of stay is the biggest factor causing congestion which leads to the impression of chaos to both patients and staff. Methods The aim of this project was to decrease the length of time from patients’ arrival to being seen and patients’ arrival to depart. A force field analysis, Driver diagram and a literature search are used to help identify possible solutions to the problem. Buy in was gained from key stakeholders. Intervention A team-based approach to seeing patients in Ambulatory Majors was adapted which included two doctors and a nurse seeing each patient. Whilst one doctor saw the patient, the other doctor recorded the notes in real time and the nurse preformed any investigations necessary. Results The average arrival to seen improved from an average of 139.63 minutes to 112.5 minutes during the first month and average arrival to departure time from an average of 194 minutes to 162.5 minutes. Results over the year saw an initial decrease for the month of March when the intervention was introduced but this was not sustained throughout the year. Conclusion This project explored ways of reducing time to be seen and the length of overall stay in ambulatory majors. Strategies using alternative team working and environmental change were used. Despite some promising initial results, benefits were not sustained which were multifactorial.

Acute compartment syndrome (ACS) of the foot is one of the most severe injuries of the foot and typically results from a fracture, crush or vascular injury. ACS, isolated to a single foot compartment, is a rare complication following a simple twisting injury of the ankle. In this article, the authors present the case report of a 25-year-old man who developed ACS, isolated to the lateral compartment of the foot, secondary to rupture of the lateral ligament complex and subsequent haematoma formation. An emergency fasciotomy was performed and the patient had complete resolution of his symptoms. ACS is usually associated with significant trauma, however, there are reported cases in the literature associated with a minor injury. In this case report, the authors describe how ACS developed following a simple ankle sprain playing sports in the absence of a high-energy insult or fracture.

The admission of patients with minor injuries, such as contusions is a regular practice in acute care hospitals. The pathophysiological changes resulting from the accident are seldom the primary reason for hospitalization. The aim of this retrospective monocentric study was therefore to examine the etiology as well as the cost-causing factors and refinancing on admission.Patients were identified due to a retrospective query in the hospital information system (HIS) according to the ICD-10 German modification codes at discharge. A total of 117 patients were enrolled over a period of 2 years. The classification was carried out according to the accident mechanism and the division into age groups. In addition, the cost calculation was based on department and clinic-specific daily rates.In terms of etiology low impact falls in the domestic environment were the most common cause (48.7%), followed by high-energy trauma (22.8%). Within the group with domestic falls, the mean age was 77.8 years. This group also showed the longest length of stay (LOS) with 5.2 days. As part of the calculated costs, the group of domestic falls showed the highest costs of 2596.24 € with an average DRG cost revenue of 1464.51 €.The evaluation of the clinic internal data confirmed the subjective perception that the majority of patients admitted with the diagnosis of contusions came from the age group65 years. Admission is primarily based on the increasing comorbidities and to avert secondary diseases and the consequences of immobilization. It could also be shown that the resulting costs are relevant to health economics and that the treatment does not appear to cover the costs.HINTERGRUND: Die stationäre Aufnahme von Patienten mit Prellungen wird in Kliniken der Akutversorgung regelhaft praktiziert. Dabei stehen die pathophysiologischen Unfallfolgen oft im Hintergrund. Ziel dieser retrospektiven monozentrischen Untersuchung war die Untersuchung der Ätiologie sowie der kostenverursachenden Faktoren und Refinanzierung bei Aufnahmen durch Prellungen.Es erfolgte die Abfrage der Patienten entsprechend den Entlassdiagnosen aus dem krankenhausinternen Informationssystem (KIS). Eingeschlossen wurden 117 Patienten in einem Zeitraum von 2 Jahren. Es erfolgten hier die Klassifizierung nach Unfallmechanismus sowie die Einteilung in Altersgruppen. Des Weiteren erfolgte die Kostenkalkulation anhand von abteilungs- und klinikspezifischen Tagessätzen.Bezüglich der Ätiologie war der häusliche Sturz die häufigste Ursache (48,7 %), gefolgt von dem Hochrasanztrauma (22,8 %). Innerhalb der Gruppe des häuslichen Sturzes lag das Durchschnittsalter im Mittel bei 77,8 Jahre. Diese Gruppe zeigte die längste Verweildauer (VWD) mit 5,2 Tagen. Im Rahmen der kalkulierten Kosten zeigte die Gruppe nach häuslichem Sturz die höchsten Kosten mit 2596,24 € bei einem mittleren DRG-Erlös von 1464,51 €.Die Auswertung der klinikinternen Daten bestätigte die subjektive Wahrnehmung, dass ein Großteil der nach Prellung aufgenommenen Patienten aus der Altersgruppe65 Jahre stammt. Die Aufnahme erfolgt hier vor dem Hintergrund der in dieser Altersgruppe zunehmenden Komorbiditäten sowie zur Abwendung von Folgeerkrankungen und Folgen der Immobilisierung. Ebenfalls konnte gezeigt werden, dass die Versorgungskosten gesundheitsökomisch relevant sind und die Behandlung in diesen Fällen nicht kostendeckend ist.

Background Emergency care research into ‘Silver Trauma’, which is simply defined as major trauma consequent upon relatively minor injury mechanisms, is facing many challenges including that at present, there is no clear prioritisation of the issues. This study aimed to determine the top research priorities to guide future research. Methods This consensus-based prioritization exercise used a three-stage modified Delphi technique. The study consisted of an idea generating (divergent) first round, a ranking evaluation in the second round, and a (convergent) consensus meeting in the third round. Results A total of 20 research questions advanced to the final round of this study. After discussing the importance and clinical significance of each research question, five research questions were prioritised by the experts; the top three research priorities were: What are older people’s preferred goals of trauma care? Beyond the Emergency Department (ED), what is the appropriate combined geriatric and trauma care? Do older adults benefit from access to trauma centres? If so, do older trauma patients have equitable access to trauma centre compared to younger adults? Conclusion The results of this study will assist clinicians, researchers, and organisations that are interested in silver trauma in guiding their future efforts and funding toward addressing the identified research priorities.

WOS:000636456800011 PMID: 33390328 Introduction: Our purpose was to determine the bleeding risk of obligate and potential carriers, highlight the prophylactic applications before interventions for families and physicians. Method: Forty-six sisters who had at least one family member with hemophilia A or B were included. Laboratory parameters were tested.Bleeding tendency interrogated by a detailed questionnaire.The results were compared with 43 healthy female controls. Results: Mean factor activity levels were significantly lower in sisters than control subjects (p = 0,004). Bleeding score was higher in sisters than controls (p = 0.001). Prolonged bleeding after minor injury was significantly higher in the sisters than control subjects (p = 0.008). Requiring further treatment due to prolonged bleeding after tooth extraction was significantly higher in sisters (p = 0.001). Sisters had postpartum hemorrhage lasting longer than 6 weeks than controls (p = 0.025). Menstrual period lasted longer in the sisters than controls (p < 0.001). Spontaneous epistaxis, oral and gingival bleeding were more frequently observed in sisters whose factor activity levels were 60 % or below (p = 0.014 and p = 0.047, respectively). There was no statistically significant difference between the severity of hemophilia in the affected family member and the factor levels in the sisters (p = 0.398).Spontaneous epistaxis has found to be significantly associated with the hemophilia severity in the family (p = 0.004). Conclusion: Clotting factor levels were found to be lower in the sisters and associated with spontaneous epistaxis, oral and gingival bleeding.Also, regardless of clotting factor levels, sisters significantly experienced more bleeding problems.Our study demonstrated the importance of taking precautions for prolonged bleeding in cases where medical interventions are inevitable in these patients.

We report the uncommon clinical case of our patient, an 83-year-old woman with Alzheimer disease, who acquired a potentially fatal tropical infection in an open-air swimming pool in the Alps. Chromobacterium violaceum is a rare gram-negative anaerobe bacillus, generally associated with serious waterborne infections in tropical and subtropical regions. The patient presented to our emergency department with a 2-day history of fever and a small non-necrotic wound on the right leg after a minor injury 9 days before. It turned out to be the first infection in Switzerland due to C. violaceum, a deadly bacterium typical of tropical regions. C. violaceum appeared for the first time in Europe in the 2011. This is now the third documented case in less than a year and the second autochthonous infection ever in our continent. A delay in adequate treatment of this emerging pathogen may be associated with high fatality rates.

The subcutaneous fungal infections sporadically occur and are mainly seen in tropical environments, although large clusters of infection with sporotrichosis occur from time to time. Both mycetoma and chromoblastomycosis are listed by the World Health Organization (WHO) as neglected tropical diseases (NTDs). The usual route of infection follows transcutaneous inoculation after minor injury, and onset is usually slow; in the case of mycetoma, it may take more than a year for the first signs to appear. Diagnosis in the laboratory depends on either histopathology or culture. Although some of the antifungal drugs are effective against these infections, greater selection and more research into effective treatments are needed.

ObjectiveTo identify how causative agents and mechanisms of injury influence the location of an accidental contact burn in children and whether these factors differ in cases referred for child protection (CP) assessment.DesignProspective multicentre cross-sectional study.Setting20 hospital sites across England and Wales, including: emergency departments, minor injury units and regional burn units.PatientsChildren less than 5 years old who attended hospital for a contact burn (August 2015 to September 2018).Main outcome measuresLocation of burns with respect to agent and mechanism for accidental contact burns. Secondary outcome: mechanism, agent and location of burns referred for CP assessment.Results816 accidental burns and 92 referrals for CP assessment. The most common for accidental burns: mechanism was reaching while stationary (68%, 553/816), agent was oven (24.5%, 200/816) and site was the hand (69.2%, 565/816). Burns to head and trunk were rare at 3.7% (30/816). The data enabled a tabulation of the locations of burns as predicted by agent and mechanism of injury. The location of the burn was most strongly influenced by mechanism.Burns from irons (pindependent of the child (p=0.01), unwitnessed burns (phead and trunk (pConclusionsBy overlaying agent, mechanism and site it was possible to tabulate and quantify simple narratives of accidental contact burns in population of young children. These findings have the potential to aid clinicians in recognising accidental contact burns.

The performances of the cement-based materials can be improved by the incorporation of polypropylene fiber, but the damage processes become more complex with different fiber contents at the same time. The acoustic emission (AE) technology can achieve the global monitoring of internal damage in materials. The evolution process of failure mode and damage degree of polypropylene fiber reinforced mortar and concrete were analyzed by measuring the AE energy, RA value, AF value and b value. It was found that the cement matrix cracked on the initial stage, the cracks further developed on the medium stage and the fibers were pulled out on the last stage. The matrix cracked with minor injury cracks, but the fiber broke with serious damage cracks. The cumulative AE energy was proportional to the polypropylene fiber reinforced concrete and mortar’s ductility. The damage mode and damage degree can be judged by identifying the damage stage obtained by the analysis of the AF value.