That's not what I expected! Physical injuries in a civil trial

ObjectiveTo review all studies having examined the association between patients with physical injuries and frequent emergency department (ED) attendance or return visits.DesignSystematic review.Data sourceMedline, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases were searched up to and including July 2019.Eligibility criteriaEnglish and French language publications reporting on frequent use of ED services (frequent attendance and return visits), evaluating injured patients and using regression analysis.Data extraction and synthesisTwo independent reviewers screened the search results, and assessed methodological quality using the Joanna Briggs Institute tool for prevalence studies. Results were collated and summarised using a narrative synthesis. A sensitivity analysis was performed to evaluate the repercussions of removing a study that did not meet the quality criteria.ResultsOf the 2184 studies yielded by this search, 1957 remained after the removal of duplicates. Seventy-eight studies underwent full-text screening leaving nine that met the eligibility criteria and were included in this study: five retrospective cohort studies; two prospective cohort studies; one cross-sectional study; and one case-control study. Different types of injuries were represented, including fractures, trauma and physical injuries related to falls, domestic violence or accidents. Sample sizes ranged from 200 to 1 259 809. Six studies included a geriatric population while three addressed a younger population. Of the four studies evaluating the relationship between injuries and frequent ED use, three reported an association. Additionally, of the five studies in which the dependent variable was return ED visits, three articles identified a positive association with injuries.ConclusionsPhysical injuries appear to be associated with frequent use of ED services (frequent ED attendance as well as return ED visits). Further research into factors including relevant youth-related covariates such as substance abuse and different types of traumas should be undertaken to bridge the gap in understanding this association.

Download Full-text

A qualitative evaluation of Southwark Council’s public health response to mitigating the mental health impact of the 2017 London bridge and borough market terror attack

BMC Public Health ◽

10.1186/s12889-021-11447-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Sandra Jumbe ◽

Adrienne Milner ◽

Megan Clinch ◽

Jonathan Kennedy ◽

Richard J. Pinder ◽

...

Keyword(s):

Mental Health ◽

Qualitative Evaluation ◽

Health Impact ◽

Health Needs ◽

Health Impacts ◽

Terror Attack ◽

Terror Attacks ◽

Physical Injuries ◽

Community Stakeholders ◽

Health Response

Abstract Background Over recent years there have been several major terror attacks in cities across Europe. These attacks result in deaths, physical injuries, and pose long-term threats to mental health and wellbeing of large populations. Although psychologists have completed important work on mental health responses to disaster exposure including terrorist attacks, the mental health impacts of such attacks have been comparatively less examined in academic literature than the acute health response to physical injuries. This paper reflects on Southwark Council’s pioneering public mental health response to the June 2017 terror attack at London Bridge and Borough Market. It aims to explore perceptions of the mental health impact of the incident by those living and working in the borough. Methods A rapid qualitative evaluation informed by the logic underpinning Southwark Council’s response was conducted. Seven formative interviews were undertaken with individuals involved in the response planning and/or delivery, enabling the evaluation team to establish the response’s theoretical basis. Subsequently, nineteen semi-structured interviews with consenting Council employees, residents, business owners, and workers from the Borough were conducted to understand perceived mental health impacts of the attack and the success of the Council response. Thematic analysis of transcribed interviews was undertaken to evaluate the extent to which the response was implemented successfully. Results Participants reported feeling the attack had a wide-reaching negative impact on the mental health of residents, those working in the borough and visitors who witnessed the attack. Delivering the response was a challenge and response visibility within the community was limited. Participants suggested a comprehensive systematic approach to health needs assessment informed by knowledge and relationships of key Council workers and community stakeholders is imperative when responding to terrorist incidents. Improved communication and working relationships between statutory organisations and community stakeholders would ensure community groups are better supported. Prioritising mental health needs of terror attack responders to mitigate persisting negative impacts was highlighted. Conclusions This article highlights a potential public health approach and need for developing robust practical guidance in the aftermath of terror attacks. This approach has already influenced the response to the Christchurch mosque shooting in 2019.

Download Full-text

Civil liability and the 50%+ standard of proof

The International Journal of Evidence & Proof ◽

10.1177/13657127211011207 ◽

2021 ◽

pp. 136571272110112

Author(s):

Martin Smith

Keyword(s):

Civil Liability ◽

Alternative Interpretation ◽

Standard Of Proof ◽

Civil Trials ◽

Civil Trial

The standard of proof applied in civil trials is the preponderance of evidence, often said to be met when a proposition is shown to be more than 50% likely to be true. A number of theorists have argued that this 50%+ standard is too weak—there are circumstances in which a court should find that the defendant is not liable, even though the evidence presented makes it more than 50% likely that the plaintiff’s claim is true. In this paper, I will recapitulate the familiar arguments for this thesis, before defending a more radical one: The 50%+ standard is also too strong—there are circumstances in which a court should find that a defendant is liable, even though the evidence presented makes it less than 50% likely that the plaintiff’s claim is true. I will argue that the latter thesis follows naturally from the former once we accept that the parties in a civil trial are to be treated equally. I will conclude by sketching an alternative interpretation of the civil standard of proof

Download Full-text

The Effectiveness of De-Escalation Techniques as Compared to Physical Restraint/Seclusion on Inpatient Psychiatric Units: A Quantitative Systematic Review

CNS Spectrums ◽

10.1017/s1092852920002874 ◽

2021 ◽

Vol 26 (2) ◽

pp. 175-176

Author(s):

Shavar Chase

Keyword(s):

Systematic Review ◽

Best Practices ◽

Physical Restraint ◽

Psychological Injury ◽

Inherent Risk ◽

Physical Injuries ◽

Psychological Injuries ◽

Overwhelming Evidence ◽

Psychiatric Units ◽

Quantitative Systematic Review

AbstractBackgroundRestraint and seclusion were considered a form of treatment but consistently has led to physical and mental injuries to staff and patients. De-escalation has been viewed as a safer option. Understanding which intervention yields decreased injuries, aggression and violence will guide policy and inform practice.ObjectivesTo identify which intervention leads to decreased physical and psychological injury to patients and staff.MethodsThe frequency of physical injuries to patients and staff from aggressive patients; frequency of psychological injuries to patients and staff from violent, aggressive incidents; frequency of violence, agitation and aggression; competence of staff at managing aggression and violence were evaluated.ResultsFourteen studies were included in this review. There are many forms of de-escalation. Studies where techniques were taught to staff, the intervention was effective in decreasing injury in approximately half the studies. De-escalation techniques taught to patients decreased injury in 100% of the studies included in this review.ConclusionConsensus on which intervention works best could not be reached, nor is there overwhelming evidence for a particular type of de-escalation better suited for decreasing aggression and violence. Caution should be exercised when choosing a de-escalation technique for implementation in institutions due to lack of regulating agencies that inform practice and standards. In addition, the literature lacks best practices for de-escalation techniques backed by evidence. Restraint and seclusion should be used as a last resort due to inherent risk associated with the intervention.

Download Full-text

Educating medical professionals about suicide prevention among military veterans

International Journal of Adolescent Medicine and Health ◽

10.1515/ijamh-2013-0051 ◽

2013 ◽

Vol 25 (3) ◽

pp. 187-191 ◽

Cited By ~ 2

Author(s):

Debora Ganz ◽

Leo Sher

Keyword(s):

Risk Factors ◽

Suicide Prevention ◽

Suicide Risk ◽

Medical Professionals ◽

Major Depressive ◽

Physical Injuries ◽

Assessment Techniques ◽

Psychosocial Difficulties ◽

Military Veteran ◽

Careful Assessment

Abstract The aim of this paper was to discuss the results of a review of literature related to suicide in military veteran populations. Suicide in veteran populations has been increasing in recent years, and continues to be a medical and social problem across the globe. For medical health professionals, knowledge of the risk factors for suicide, careful assessment, and appropriate interventions are key to suicide prevention. The main aim of this review is to better understand the risk factors present in veteran suicide and find ways by which to educate medical professionals in suicide prevention. Key suicide risk factors found in veteran populations include posttraumatic stress disorder, major depressive disorder, physical injuries, substance use disorders, traumatic brain injury, combat-related guilt, access to firearms, and insufficient social support. Some psychosocial difficulties are unique to veteran populations, and medical professionals should be culturally sensitive to these factors. Psychosocial changes upon discharge from active duty, as well as stigma against mental health disorders and treatment, should also be considered and assessed. Given that general practitioners may be the first line of defense for these veterans, they should be educated in risk factors for veteran suicide and proper assessment techniques. Any suicide risk in a veteran population should be taken very seriously, and responded to appropriately.

Download Full-text

Letting Compassion Open the Door: Battered Women's Disclosure to Medical Providers

Cambridge Quarterly of Healthcare Ethics ◽

10.1017/s0963180100006289 ◽

1995 ◽

Vol 4 (4) ◽

pp. 459-465 ◽

Cited By ~ 10

Author(s):

Heidi M. Bauer ◽

Michael A. Rodriguez

Keyword(s):

Healthcare Providers ◽

Clinical Settings ◽

Abused Women ◽

Women Patients ◽

Medical Providers ◽

Physically Abused ◽

Physical Injuries ◽

Marital Abuse ◽

Psychiatric Problems ◽

Significant Health

Domestic violence is an important social problem that strongly impacts the healthcare system. It is estimated that two to four million women are physically abused each year by their husbands, ex-husbands, or boyfriends. Many of these abused women enter the medical system as patients with physical injuries, somatic symptoms, or psychiatric problems. These patients represent a large proportion of women patients in a variety of clinical settings: 22–35% of women presenting to emergency departments, up to 37% of obstetric patients, and over 25% of women seeking primary care. Despite the significant health implications of marital abuse, healthcare providers often fail to identify and treat this problem when signs are present.

Download Full-text

Battered Child Syndrome: Review of 130 Patients With Controls

PEDIATRICS ◽

10.1542/peds.54.1.67 ◽

1974 ◽

Vol 54 (1) ◽

pp. 67-70 ◽

Cited By ~ 1

Author(s):

Brian Lauer ◽

Elsa Ten Broeck ◽

Moses Grossman

Keyword(s):

San Francisco ◽

Control Group ◽

Battered Child Syndrome ◽

White Children ◽

Only Children ◽

Battered Child ◽

Physical Injuries ◽

Medical Neglect ◽

Child Syndrome ◽

Ethnic Distribution

The medical and social service records of the 130 battered children under 10 years of age admitted to San Francisco General Hospital during a six-year period, July 1, 1965, to June 30, 1971, were reviewed. Only children with physical injuries were included. A control group was selected from concurrent admissions. The findings showed a steadily rising number of admissions for child abuse. Many of the children suffered from emotional, physical and medical neglect as well as intentional trauma and 44% had been abused previously. Six children died. Sixty-three percent of the battered children were less than 2 years old. Their parents were significantly younger than parents of controls and also much more transient. White children rather than nonwhite children were battered more often than expected when compared to the ethnic distribution of the control group.

Download Full-text