IntroductionSexual assault is disturbingly common, yet little is known about those occurring at mass gatherings, defined as a group of people congregated for a common purpose. Our objectives were to examine patterns of variation in sexual assault associated with mass gatherings and to determine factors associated with assaults occurring at mass gatherings.MethodsWe performed a case series analysis from January to December, 2013. We included all patients >16 years presenting within 30 days of their sexual assault to the Ottawa Hospital Sexual Assault and Partner Abuse Care Program (SAPACP). Cases were stratified by whether or not they occurred at mass gatherings. We abstracted from the SAPACP records: patient and sexual assault characteristics, alcohol or drug consumption and medical and forensic care accepted. We performed descriptive analyses and multiple logistical regression to identify factors associated with mass gathering assaults.ResultsWe found 204 cases of sexual assault, of which 53 (26%) occurred at mass gatherings. Relative frequencies of mass gathering sexual assaults peaked during New Year's Eve, Canada Day, university frosh week and Halloween. We found the following factors were statistically significantly associated with sexual assault at mass gatherings: younger age (OR=0.95, 95% CI 0.91 to 0.99); voluntary consumption of drugs and alcohol (3.88, 95% CI 1.34 to 11.23); assault occurring on a holiday (2.37, 95% CI 1.00 to 5.64) and the assailant unknown to the victim (2.43, 95% CI 1.15 to 5).InterpretationThis study is the first to describe patterns of variation in sexual assault incidents associated with occurrence of mass gatherings as well as factors associated with such assaults. We will disseminate these results to key stakeholders in order to develop prevention-minded policies for future mass gatherings.
Background 3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed. Objective This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances. Methods A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills. Results Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians. Conclusion The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.
“We talk about people with mental illness, and people with diabetes, and smokers and the obese, and so on and so on. We’re talking about the same people – just with different labels.”– Health care professional [1, p. 6]Severe mental illness (SMI) most commonly refers to mental disorders with a psychotic component and significantly reduced functioning despite the presence of inherent differences in risk factors, etiologies, and treatments [1]. The most common disorders that fall under this term include schizophrenia and bipolar disorder [1]. Over a decade of research into the morbidity and mortality of individuals with SMI has consistently revealed mortality rates two to three times higher and a life expectancy of 25-30 years shorter compared to the general population [1-4]. Contrary to popular belief, the main causes of early death are not drug overdose or suicide, but rather, preventable illnesses such as cardiovascular disease, diabetes, and HIV/AIDS [1,3,5-7]. Incidence of other preventable conditions, such as obesity and respiratory disease, is also much higher among patients with SMI, and when present, is associated with a more severe course of mental illness and a reduced quality of life [3,8]. Such findings bring significant questions: what is the cause of this disparity in mortality/ morbidity? What can health care professionals do to help reduce this gap?A recent report by the Early Onset Illness and Mortality Working Group [1] outlines several factors that may contribute to poor physical health of people with SMI. Some factors, such as those related to the mental illness itself (e.g., cognitive impairment, a lack of communication skills, medication side-effects) and socioeconomic status (e.g., poverty, poor education) may be less amenable to modification, but should nevertheless be a target for action. Other contributing factors include behaviour and lifestyle (e.g., physical inactivity, obesity, tobacco smoking), and poor preventative medical care (e.g., disparity in quality of medical care), both of which are more easily modifiable with the assistance of medical care practitioners. Here we will summarize the factors responsible for poor physical health in SMI, specifically focusing on the mental illness itself, socioeconomic status, behaviour and lifestyle, health care system barriers, and insufficient preventative medical care. We will then propose future directions and ways in which medical students and current medical professionals can help reduce this gap.
ObjectivesWe aimed to determine the rate of adverse events during interfacility transport of cardiac patients identified as low risk by a consensus-derived screening tool and transported by primary care flight paramedics (PCP(f)).MethodsWe conducted a health records review of adult patients diagnosed with a cardiac condition who were identified as low risk by the screening tool and transported by PCP(f). We excluded patients transported by an advanced care crew, those accompanied by a clinical escort from hospital, and those transported from a scene call, by rotary wing or ground vehicle. We recorded patient and transportation parameters using a piloted-standardized collection tool. We defined adverse events during transport a priori. We report descriptive statistics using mean (standard deviation), [range], (percentage).ResultsWe included 400 patients: mean age 66.9 years old, 66.5% male. Mean transport duration was 136.2 (74.9) minutes. Most common comorbidities were hypertension (50.3%) and coronary artery disease (39.5%). Most transports originated out of Northern Ontario and were for cardiac catheterization (61.8%) or coronary artery bypass grafting (26.8%). Overall, the adverse event rate was low (0.3%), with no serious event such as cardiac arrest, death, or airway intervention.ConclusionsA screening tool can identify cardiac patients at low risk for clinical deterioration during air-medical transport. We believe patients screened with this tool can be transported safely by a PCP(f) crew, leading to potentially significant resource savings.
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