were 12-14 years. Male and female proportions were equivalent. Almost three-fifths lived in town (59%) with about one-fifth living on a farm (19%) or in the country, but not on farm (22%). Just over two-fifths (42%) stated their families owned an ATV. Overall, 77% had ridden an ATV. Of those that had ridden an ATV in the past year, two-fifths (40%) reported riding at least weekly. Although the majority (51%) used ATVs for recreation only, over two-fifths (43%) used them for both work and recreation and 6% used them for work only. In the previous 12 months, over one-fifth (21.8%) of riders reported having had a crash (rollover, collision or ejection), and of these, 17% had an injury requiring medical attention. Of adolescents who had ridden an ATV in the past year, only 8% had completed an ATV safety training certification course. Those with higher proportions having taken a course included younger riders, males, those whose families owned ATVs, and more frequent riders. However, the percentage having taken a course was no higher than 14% for any of these demographic groups. Those completing a safety course had higher proportions that wore helmets (30% always or almost always vs. 21% of those who had not taken a course, p<0.0001) and lower proportions that reported riding with passengers (63 vs. 79%, p<0.0001), but had higher proportions that reported riding on roads and having been in a crash.Conclusion: Iowa adolescents in the study had high exposures to ATVs and crashes were common. Formal safety training was infrequent but those that received training demonstrated greater helmet use and less riding with passengers than other riders. Multi-targeted approaches including education/training and enforced safety regulations are needed to increase safe riding behaviors in adolescents and decrease ATV-related deaths and injuries.
Pulmonary ultrasound is a useful tool in the diagnosis and resuscitation of emergency department (ED) patients with dyspnea. We present the case of a patient who was diagnosed with E‐cigarette or vaping product use‐associated lung injury (EVALI) using pulmonary ultrasound. Many of these cases are diagnosed using x‐ray, computerized tomography, or bronchoscopy and to our knowledge this is the first published case that demonstrates utility of ultrasound in diagnosing EVALI. While more investigation is needed on the use of this technique, the patient in this case was diagnosed with EVALI based on positive history, presence of normal cardiac function, non‐cardiogenic pulmonary edema on ultrasound, and absence of pulmonary infection.
appropriate antibiotic selection with a total of 5,062 patients. Comparator groups for intervention were hours without a pharmacist present in 6 studies, pre-protocol implementation in 9 studies, and alternative provider culture follow-up in 9 studies. Pharmacist involvement in stewardship was associated with a greater likelihood of receiving appropriate antibiotics (OR 3.23; 95% CI 1.98, 5.27). Among methods of intervention, pharmacist presence in the ED (OR 3.13; 95% CI 2.27, 4.32) and pharmacist-led algorithm and education (OR 6.13; 95% CI 2.85, 13.18) were associated with appropriate antibiotics. Pharmacist-led culture review was not significantly associated (OR 1.89; 95% CI 0.88, 4.06). Heterogeneity was high for all assessments.Conclusion: Though the overall quality of evidence was low, it appears that pharmacist involvement in antibiotic stewardship in the ED may significantly improve appropriate antibiotic selection. Pharmacist presence in the ED and pharmacist-led algorithm and education development may have a greater impact than pharmacist-led culture review.
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