BACKGROUND Emergency responders face a crisis of rising suicide rates, and many resist seeking help due to the stigma surrounding mental health. We sought to evaluate the feasibility of an urban trauma center to screen for posttraumatic stress (PTS) among emergency responders and to provide mental health services. METHODS Paramedics, firefighters, law enforcement, and corrections officers involved with patients in the trauma unit were asked to complete the Post-Traumatic Growth Inventory (PTGI) and Post-Traumatic Checklist for Diagnostic and Statistical Manual-5 (PCL-5). Additional factors known to affect PTS were correlated: occupation, age, sex, years of service, marital status, children, and pets. Willingness and barriers to seeking interventions for PTS were evaluated. RESULTS A total of 258 responded: 36.7% paramedics, 40.2% law enforcement officers, 18.4% corrections officers, 0.8% firefighters, and 3.5% with multiple positions. Responders had a mean of 14.5 years of service (SD, 9.9 years). Mean PTGI and PCL-5 scores were 52.1 (SD, 25.1) and 17.2 (SD, 16.5), respectively. Overall, 24.7% had diagnostic PTS disorder with no difference seen in rates between professions. Of these, 80.7% had not sought care. Barriers included that they were not concerned (46%), did not recognize symptoms (24%), and were worried about consequences (20%). Concern over career advancement or losing one's job was the greatest barrier cited for seeking care. Among law enforcement, 47.7% were concerned that they would lose their ability to carry a firearm if they sought care for PTS. The PTGI score, divorce, and 46 years to 50 years were the only factors examined that correlated with increased PCL-5 score. There were 82.5% that felt the trauma center was the right place to screen and intervene upon PTS. CONCLUSION Trauma centers are an ideal and safe place to both screen for PTS and offer mental health assistance. Comprehensive trauma-informed care by hospital-based intervention programs must expand to include emergency responders. LEVEL OF EVIDENCE Epidemiological study type, Level II.

Maine et al describe the first national look at surgical outcomes in incarcerated patients in this EAST Multi-center Study. How can we improve trauma and surgical care for this population? #EASTMulticenterStudy #Healthdisparities

BACKGROUND Community violence remains a clinical concern for urban hospitals nationwide; however, research on resilience and posttraumatic growth (PTG) among survivors of violent injury is lacking. This study intends to assess survivors of violent injury for resilience and PTG to better inform mental health interventions. METHODS Adults who presented with nonaccidental penetrating trauma to an urban level 1 trauma center and were at least 1 month, but no more than 12 months, from treatment were eligible. Participants completed the Connor-Davidson Resiliency Scale, Posttraumatic Growth Inventory (PTGI), Primary Care Posttraumatic Stress Disorder screen, and a community violence exposure screen. Additional demographic, injury, and treatment factors were collected from medical record. RESULTS A total of 88 patients participated. The mean resiliency score was 83.2, with 71.1% scoring higher than the general population and 96.4% scoring higher than the reported scores of those seeking treatment for posttraumatic stress disorder (PTSD). Participants demonstrated a mean PTGI score of 78 (SD, 20.4) with 92.4% scoring above the significant growth threshold of 45. In addition, 60.5% of patients screened positive for significant PTSD symptoms, approximately eight times higher than general population. Exposure to other traumatic events was high; an overwhelming 94% of participants stated that they have had a family member or a close friend killed, and 42% had personally witnessed a homicide. Higher resilience scores correlated with PTGI scores (p < 0.001) and lower PTSD screen (p = 0.02). CONCLUSION Victims of violent injury experience a myriad of traumatic events yet are highly resilient and exhibit traits of growth across multiple domains. Resiliency can coexist with posttraumatic stress symptoms. Practitioners should assess for resiliency and PTG in addition to PTSD. Further investigation is needed to clarify the relational balance between resilience and posttraumatic stress. LEVEL OF EVIDENCE Epidemiological study type, Level II.

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Background: Cardiovascular disease affects 121.5 million Americans, or 48% of the adult US population and is the leading cause of death in the United States. The demand for total joint replacement is expected to increase due to an aging population and advances in technology. Given the prevalence of cardiovascular disease and the expected increase in total joint replacement procedures, we sought to examine whether cardiovascular disease was associated with increased postoperative complications in patients undergoing total hip and knee replacements.Methods:CPT codes were used to investigate the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent total hip or knee replacements from 2010 to 2017. Patients were classified as having cardiovascular disease as per the American Health Association guidelines. Patient samples with all possible covariates were included in a multivariate logistic regression analysis. A patient sample size of 119,076 for total hip and 189,297 for total knee replacement was analyzed.Results: Patients with cardiovascular disease were found to have a statistically significant increased risk for the following postoperative complications: sepsis, wound complications, pneumonia, urinary tract infection, myocardial infarction, unplanned intubation, and cardiac arrest. Conclusions: Patients with cardiovascular disease undergoing a total hip or knee replacement have increased risk for wound, infectious and cardiovascular-associated postoperative complications. This finding necessitates the need for more frequent and sooner postoperative visits, a stringent cardiovascular preoperative evaluation, and patient education on the increased postoperative risks of joint replacements to lower the incidence of complications.

Introduction: Neonatal period is characterized by transition to extra uterine life and rapid growth and development. Newborn period, just first 28 days of life, carries the greatest risk of mortality. Despite being less than 2% of total period of under 5 children, the newborn period accounts for over half of under 5 child mortality. Good care therefore not only improves survival of children but lays foundation of optimal log term physical and neurocogitive development. Aim: The aim of the study is to assess the effectiveness of simulation on neonatal BLS(basic life support) among selected colleges of nursing in Greater Noida , UP. The findings of the study can help the teacher to gain knowledge regarding the effectiveness of simulation on neonatal BLS(basic life support). Methodology: Intervention: Simulation of Neonatal BLS(basic life support). Types of studies: True Experimental study. Types of participants: Nursing students Setting: Selected colleges of Greater Noida, UP. Results: This narrative review result has proved that simulation of neonatal BLS(basic life support) has increased in terms of knowledge and skills among nursing students.