Objective To compare an accelerated intervention incorporating early therapeutic exercise after acute ankle sprains with a standard protection, rest, ice, compression, and elevation intervention. Design Randomised controlled trial with blinded outcome assessor. Setting Accident and emergency department and university based sports injury clinic. Participants 101 patients with an acute grade 1 or 2 ankle sprain. Interventions Participants were randomised to an accelerated intervention with early therapeutic exercise (exercise group) or a standard protection, rest, ice, compression, and elevation intervention (standard group). Main outcome measures The primary outcome was subjective ankle function (lower extremity functional scale). Secondary outcomes were pain at rest and on activity, swelling, and physical activity at baseline and at one, two, three, and four weeks after injury. Ankle function and rate of reinjury were assessed at 16 weeks. Results An overall treatment effect was in favour of the exercise group (P=0.0077); this was significant at both week 1 (baseline adjusted difference in treatment 5.28, 98.75% confidence interval 0.31 to 10.26; P=0.008) and week 2 (4.92, 0.27 to 9.57; P=0.0083). Activity level was significantly higher in the exercise group as measured by time spent walking (1.2 hours, 95% confidence interval 0.9 to 1.4 v 1.6, 1.3 to 1.9), step count (5621 steps, 95% confidence interval 4399 to 6843 v 7886, 6357 to 9416), and time spent in light intensity activity (53 minutes, 95% confidence interval 44 to 60 v 76, 58 to 95). The groups did not differ at any other time point for pain at rest, pain on activity, or swelling. The reinjury rate was 4% (two in each group). Conclusion An accelerated exercise protocol during the first week after ankle sprain improved ankle function; the group receiving this intervention was more active during that week than the group receiving standard care. Trial registration Current Controlled Trials ISRCTN13903946.

Objectives-to determine the incidence of verbal abuse and physical violence in accident and emergency (A&E) departments and to discover the extent of provision of security measures and instructions for staff on how to deal with these problems. Design-A postal questionnaire. Setting-A&E departments in the UK and the Republic of Ireland. Subjects-Two hundred and seventy three consultants named in charge of 310 departments. Subjects and methods A questionnaire was sent to 310 A&E departments throughout the UK and Republic of Ireland, representing a total of 273 consultants in A&E medicine. After six weeks, a second questionnaire was sent to those departments that had failed to reply initially.Respondents were asked to indicate the annual number of new attendances, the department type (inner city/urban/country), and the number and type of standard security methods in current use. They were asked to try to assess their staffs' perceptions as to how safe or vulnerable they felt at work.All respondents were asked to enumerate, as accurately as possible, the number of episodes of verbal and physical abuse in the previous year from their records, to indicate the frequency of verbal and physical abuse, that is daily, weekly, etc, to identify the nature of physical injuries sustained, to indicate the types of staff most commonly in receipt of abuse, and which members of the public were most likely to behave in an abusive manner.They were asked to describe departmental policy for recording and dealing with incidents and to indicate if any legal or civil action had been undertaken by trusts to support staff and prosecute offenders. They were also asked to indicate why they thought abuse occurred and to give an opinion as to possible measures that could be taken to try to alleviate these problems if, indeed, problems of this nature were found to be widespread. They were also asked to indicate the effect that abuse had on staff morale. ResultsOf the 310 departments mailed replies were received from 233 (75%) departments, involving 219 (80%) consultants. Department types were given as follows: 53 country (23%), 50 inner city (17%), 117 urban (50%), two inner city/urban, and eight (3%) urban/country. Three departments did not categorise themselves.

Background: Cryotherapy (the application of ice for therapeutic purposes) is one of the most common treatment modalities employed in the immediate management of acute soft tissue injury. Despite its widespread clinical use, the precise physiological responses to therapeutic cooling have not been fully elucidated, and effective evidence-based treatment protocols are yet to be established. Intermittent ice applications are thought to exert a significant analgesic effect. This could facilitate earlier therapeutic exercise after injury, potentially allowing for a quicker return to activity. The primary aim of the forthcoming study is therefore to examine the safety and effectiveness of combining intermittent ice applications with periods of therapeutic exercise in the first week after an acute ankle sprain.

Eleven people were killed and 60 injured in the Enniskillen bombing of November 1987. Survivors were psychologically appraised six months and one year later. At six months 50% had developed post-traumatic stress disorder (PTSD). This group comprised more females than males. However, all victims had high scores on the GHQ. We found no correlation between psychological injury (as measured by the GHQ) and physical injury (as measured by the ISS), calling into question previous assertions.

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