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The effect of an education program on violence in the emergency department

ANNALS OF EMERGENCY MEDICINE 2002年第1期39卷 47-55页

作者： Fernandes, CMB Raboud, JM Christenson, JM Bouthillette, F Bullock, L Ouellet, L Moore, CF St Pauls Hosp Dept Emergency Med Ctr Hlth Evaluat & Outcome Sci Vancouver BC V6Z 1Y6 Canada St Pauls Hosp Dept Occupational Hlth & Safety Vancouver BC V6Z 1Y6 Canada Univ British Columbia Dept Surg Vancouver BC V5Z 1M9 Canada Univ British Columbia Dept Hlth Care & Epidemiol Vancouver BC V5Z 1M9 Canada Canadian HIV Trials Network Vancouver BC Canada

Study objective: We examine whether a specific educational effort reduces emergency department violence in the short term and quantify the amount of violence in the ED. Methods: Cross-sectional prospective surveys were conducted at a tertiary referral center at baseline (1998) and at 3 and 6 months (1999) after the Prevention and Management of Aggressive Behavior Program (PMABP). ED staff on all shifts for 7 alternate days in a 2-week period were surveyed. We measured the total and mean number of physical and violent events per survey. A generalized estimating equation Poisson regression model examined the effect of the program on the numbers of physically and verbally violent events per shift per employee, after adjusting for other covariates. Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results: Physical violence events per survey at baseline, 3 months posttraining, and 6 months posttraining were 0.27, 0.10, and 0.21, respectively. The number of reported violent interactions at the same intervals were 49, 19, and 46 (adjusted OR 1.0, 0.35 [95% CI 0.15 to 0.84], and 0.79 [95% Cl 0.48 to 1.40]), respectively. Verbal violence events per survey at baseline, 3 months posttraining, and 6 months posttraining were 0.85, 0.31, and 0.51, respectively. The number of reported interactions involving verbal violence at the same intervals were 154, 58, and 69 (adjusted OR 1.0, 0,31 [95% CI 0.21 to 0.46], and 0.47 [95% Cl 0.33 to 0.66]), respectively. Conclusion: Violent events are frequent in the ED. Education programs may reduce the number of events at least temporarily but do not clearly reduce violence in the long term.

关键词：英属哥伦比亚/流行病学横断面研究急诊室医院/统计学和数值数据在职培训职业卫生病人教育(主题) 泊松分布方案评价前瞻性研究暴力/预防和控制暴力/统计学和数值数据人类

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JNCI-JOURNAL OF THE NATIONAL CANCER INSTITUTE 1999年第8期91卷 691-696页

作者： Lam, S LeRiche, JC Zheng, Y Coldman, A MacAulay, C Hawk, E Kelloff, G Gazdar, AF British Columbia Canc Agcy Dept Resp Med Vancouver BC V5Z 3J5 Canada Univ British Columbia Vancouver BC V5Z 3J5 Canada British Columbia Canc Agcy Dept Pathol Vancouver BC V5Z 3J5 Canada British Columbia Canc Agcy Dept Canc Imaging Vancouver BC V5Z 3J5 Canada British Columbia Canc Agcy Dept Canc Prevent Vancouver BC V5Z 3J5 Canada NCI Chemoprevent Branch Div Canc Prevent Bethesda MD 20892 USA Univ Texas SW Med Ctr Hamon Ctr Therapeut Oncol Dallas TX USA Univ Texas SW Med Ctr Dept Pathol Dallas TX USA

Background: Lung cancer is the most common cause of cancer death in North American women, Because smoking-related changes in the bronchial epithelium and in lung function have not been studied in detail in women, we used fluorescence bronchoscopy-directed biopsy to determine the prevalence of high-grade preinvasive lesions in former and current smokers of both sexes. Methods: Spirometry, white-light bronchoscopy, and fluorescence bronchoscopy were performed in 189 women and 212 men older than 40 years of age who had smoked 20 pack-years or more (pack-years number of packs of cigarettes smoked per day x number of years of smoking). Results: Carcinoma in situ was found in 1.8% of the subjects, severe dysplasia was found in 6.5%, and moderate dysplasia was found in 14% (all preinvasive lesions). Compared with men, women had a lower prevalence of high-grade preinvasive lesions in the observed airways (14% versus 31%;odds ratio = 0.18;95% confidence interval = 0.04-0.88), and women with preinvasive lesions had fewer such lesions (two-sided P = .048), The prevalence of preinvasive lesions did not change substantially for more than 10 years after cessation of smoking. Lung function was associated with the prevalence of preinvasive lesions, but the association was weaker in women than in men, If the presence of airflow obstruction was defined by an FEV1/FVC (forced expiratory volume in 1 second/forced vital capacity) value of 70% or less, only 56% of the men and 44% of the women with preinvasive lesions had abnormal lung function. Conclusion: In developing strategies for chemoprevention or early detection of lung cancer in high-risk populations, it is important to consider the effect of sex and arbitrarily chosen lung function values on the prevalence of preinvasive airway lesions.

关键词：活组织检查/方法英属哥伦比亚/流行病学支气管/病理学支气管肿瘤/流行病学支气管肿瘤/病因学支气管肿瘤/病理学支气管镜检查癌原位/流行病学癌原位/病因学癌原位/病理学上皮/病理学荧光比值比患病率呼吸功能试验性别因素吸烟/流行病学戒烟肺量测定法时间因素成年人老年人女(雌)性人类男(雄)性中年人

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Sharps injuries: Defining prevention priorities

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AMERICAN JOURNAL OF INFECTION CONTROL 1999年第5期27卷 447-452页

作者： Bryce, EA Ford, J Chase, L Taylor, C Scharf, S Vancouver Gen Hosp Div Med Microbiol Vancouver BC V5Z 1M9 Canada

Objective: An institutional review of sharps injuries was conducted to assist in establishing priorities for resource allocation in a sharps prevention program. Design: A retrospective review of 221 sharps injuries occurring during a 1-year period was conducted by a 4-member multidisciplinary team. Each injury was categorized as either moderate/high, low, or unknown risk for acquisition of bloodborne diseases by using modified provincial definitions of occupational risk for exposure to bloodborne pathogens. Results: A total of 119 injuries were considered to be moderate/high risk, and 93 were at low risk for acquisition of bloodborne disease. Nine injuries could not be categorized. In 59% of high-risk injuries, education or changes in technique were identified as the primary preventive intervention. Passive devices such as needleless intravenous administration sets could theoretically address prevention of the majority of low-risk injuries. Known available safety devices could have prevented 33 (28%) high-risk injuries. Conclusion: Disposition of resources must take into consideration the risk of bloodborne disease acquisition and the efficiency and expense of the preventable methods employed. Institutional review of injuries combined with a cost analysis revealed that resources were best allocated to protective devices at source (eg, safety syringes) and on a comprehensive, multidisciplinary, and sustained educational program. Needleless intravenous infusion sets would mainly prevent low-risk injuries at significant cost.

关键词：英属哥伦比亚/流行病学成本及成本分析交叉感染/预防和控制卫生保健公平提供卫生工作重点医院专科病房/统计学和数值数据输注泵/经济学职业回顾性研究危险因素创伤非贯通性/分类创伤非贯通性/流行病学创伤非贯通性/预防和控制人类

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A case series of acquired immunodeficiency syndrome patients with initial neoplastic diagnoses of intraoral Kaposi's sarcoma

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ORAL SURGERY ORAL MEDICINE ORAL PATHOLOGY ORAL RADIOLOGY AND ENDODONTOLOGY 2000年第5期90卷 612-617页

作者： Gorsky, M Epstein, JB Univ British Columbia Vancouver BC V5Z 1M9 Canada Tel Aviv Univ IL-69978 Tel Aviv Israel Univ Washington Seattle WA 98195 USA

Background. Oral Kaposi's sarcoma (KS) may represent the initial clinical manifestation of immunosuppression in human immunodeficiency virus disease. This article reviews the treatment provided to these patients and the outcome of the disease and provides the opportunity to assess the impact of improvements in the medical therapy of acquired immunodeficiency syndrome on disease outcome. Methods. A tumor registry was examined to identify patients in whom oral KS was the first neoplastic diagnosis. Results and conclusions. Thirty-seven cases of oral KS representing 1.9% of all cases of KS were identified as the first malignant diagnosis in patients with acquired immunodeficiency syndrome. Patients with oral KS have limited survival;the cause of death is either infection or malignancy. In our study, the palate was the most common sire of primary involvement in the oral cavity. Recently diagnosed patients remained alive longer than those diagnosed earlier, and the patients with the most recently diagnosed cases were alive at the completion of the study, suggesting that medical management of human immunodefciency virus has improved with new therapies.

关键词：获得性免疫缺陷综合征/并发症获得性免疫缺陷综合征/诊断英属哥伦比亚/流行病学死亡原因口腔肿瘤/诊断口腔肿瘤/病因学口腔肿瘤/死亡率口腔肿瘤/治疗腭肿瘤/诊断腭肿瘤/病因学腭肿瘤/死亡率腭肿瘤/治疗登记肉瘤卡波西/诊断肉瘤卡波西/病因学肉瘤卡波西/死亡率肉瘤卡波西/治疗存活率成年人人类男(雄)性中年人

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Detection and isolation of Salmonella from naturally contaminated alfalfa seeds following an outbreak investigation

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JOURNAL OF FOOD PROTECTION 1999年第6期62卷 662-664页

作者： Inami, GB Moler, SE Calif Dept Hlth Serv Microbial Dis Lab Berkeley CA 94704 USA

Naturally contaminated alfalfa seeds, epidemiologically linked to foodborne disease outbreaks in Oregon and British Columbia, were tested for the presence of Salmonella. Ten sample units from the suspected lot were sprouted and grown for 4 days. After enrichment of the grown sprouts, an enzyme immunoassay (EIA) and culture method (modified procedure of the Food and Drug Administration Bacteriological Analytical Manual) were used for the detection and isolation of Salmonella. Four of the 10 sample units were positive with the ELA;however, 5 of the 10 sample units were culture positive (four were positive for Salmonella serotype Newport and a fifth was positive for Salmonella serotype Albany and serotype Schwarzengrund). The positive alfalfa seed sample units were further tested after shredding, soaking, and washing before culturing. Results suggest that sprouting and shredding methods may yield greater detection and recovery rates of Salmonella, but more research with a larger sample size is warranted.

关键词：英属哥伦比亚/流行病学培养基疾病暴发流行免疫酶技术紫苜蓿/微生物学紫苜蓿/生理学俄勒冈/流行病学沙门菌属/分离和提纯沙门菌食物中毒/流行病学沙门菌食物中毒/微生物学种子/微生物学种子/生理学人类

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Excerpts from: On "tick paralysis" in sheep and man following bites of Dermacentor venustus. 1913.

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Wilderness & environmental medicine 2000年第2期11卷 115-121页

作者： Hadwen, S. Pathologist to the Dominion Department of Agriculture Experimental Farm Agassiz B.C. Canada

Please refer to Parasitology, Vol 6, No 3, 1913, pp 285-297 for a copy of this article.

关键词：咬伤和蜇伤/流行病学咬伤和蜇伤/历史英属哥伦比亚/流行病学革蜱属绵羊绵羊疾病/流行病学绵羊疾病/历史蜱性麻痹/流行病学蜱性麻痹/历史动物历史 20世纪人类

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Overall pattern of health care and social welfare use by injured workers in the British Columbia cohort

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INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 1999年第5-6期22卷 581-601页

作者： Hertzman, C McGrail, K Hirtle, B Univ British Columbia Fac Med Dept Hlth Care & Epidemiol Vancouver BC V6T 1Z3 Canada Univ British Columbia Ctr Hlth Serv & Policy Res Vancouver BC V6T 1Z3 Canada

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