Are "goods for guns" good for the community? An update of a community gun buyback program.

BACKGROUND: Gun violence remains a leading cause of death in the United States. Community gun buyback programs provide an opportunity to dispose of extraneous firearms. The purpose of this study was to understand the demographics, motivation, child access to firearms, and household mental illness of buyback participants in hopes of improving the program's effectiveness. METHODS: A 2015 Injury Free Coalition for Kids gun buyback program which collaborated with local police departments was studied. We administered a 23-item questionnaire survey to gun buyback participants assessing demographic characteristics, motivation for relinquishing firearms, child firearm accessibility, and mental illness/domestic violence history. RESULTS: A total of 186 individuals from Central/Western Massachusetts turned in 339 weapons. Participants received between US $25 and US $75 in gift cards dependent on what type of gun was turned in, with an average cost of $41/gun. A total of 109 (59%) participants completed the survey. Respondents were mostly white (99%), men (90%) and first-time participants in the program (85.2%). Among survey respondents, 54% turned in firearms "for safety reasons." Respondents reported no longer needing/wanting their weapons (47%) and approximately one in eight participants were concerned the firearm(s) were accessible to children. Most respondents (87%) felt the program encouraged neighborhood awareness of firearm safety. Three of every five participants reported that guns still remained in their homes; additionally, 21% where children could potentially access them and 14% with a history of mental illness/suicide/domestic violence in the home. CONCLUSION: Gun buybacks can provide a low-cost means of removing unwanted firearms from the community. Most participants felt their homes were safer after turning in the firearm(s). In homes still possessing guns, emphasis on secure gun storage should continue, increasing the safety of children and families. The results of this survey also provided new insights into the association between mental illness/suicide and gun ownership. LEVEL OF EVIDENCE: Epidemiological, level III.

And the survey said.... evaluating rationale for participation in gun buybacks as a tool to encourage higher yields.

BACKGROUND: Gun buyback programs represent one arm of a multipronged approach to raise awareness and education about gun safety. METHODS: The city of Worcester, MA has conducted an annual gun buyback at the Police Department Headquarters since 2002. We analyzed survey responses from a voluntary, 18-question, face-to-face structured interview from December 2009 to June 2015 using descriptive statistics to determine participant demographics and motivations for participation. RESULTS: A total of 943 guns were collected, and 273 individuals completed surveys. The majority of participants were white males older than 55years (42.4%). Participants represented 61 zip codes across Worcester County, with 68% having prior gun safety training and 61% with weapons remaining in the home (27% of which children could potentially access). The top reasons for turning in guns were "no longer needed" (48%) and "fear of children accessing the gun" (14%). About 1 in 3 respondents knew someone injured/killed by gun violence. Almost all (96%) respondents claimed the program raised community awareness of firearm risk. CONCLUSION: The Worcester Goods for Guns Buyback has collected more than 900 guns between 2009 and 2015. The buyback removes unwanted guns from homes and raises community awareness about firearm safety.

The "physician-led chart audit: " engaging providers in fortifying a culture of safety.

OBJECTIVES: Engaging physicians in quality and patient safety initiatives is a well-described challenge. Barriers include time constraints, lack of defined common purpose and leadership support, poorly communicated goals, and scarcity of supporting data (references 1, 2, 3).With reference to strengthening a culture of safety while meeting regulatory and performance standards, health-care systems face a difficult twin objective: educate the medical staff and its trainees and maintain high levels of compliance across inpatient, ambulatory clinic, and procedural areas.In 2010, our institution identified opportunities for improvement in physician performance related to several important patient safety standards. These issues had not been previously corrected by didactic sessions, written communication, and the chain of command. METHODS: To help address these general and site-specific problems, we developed and deployed a set of medical record audit tools entitled "physician-led audits" (PLAs). We trained providers in leadership positions to use the tools and to teach their use to others. We designed a system to capture data on frequency of use and results. The PLA process is distinctive in that it holds physicians accountable for the auditing and for follow-up afterward. RESULTS: With support from department chairs, division chiefs, residency program directors, and other leaders, close to 2000 PLAs were performed over a 10-month study period. CONCLUSIONS: The audits engaged physician leaders and the at-large medical staff, making them key participants in a system-wide improvement campaign. The tool was customized for use in a broad range of clinical settings and was widely and rapidly adopted, leading to important dialogue and a substantive contribution to our safety culture.

Status epilepticus in a child secondary to ingestion of skin-lightening cream.

The popularity of the Internet and online media has led to the increased availability of prescription-strength, skin-lightening products contributing to a rise in their use among people with various skin pigment disorders. These products may contain a wide variety of active ingredients such as heavy metals, hydroquinone, and corticosteroids that can be highly toxic, especially after prolonged application. For decades, there have been case reports of both corticosteroid and heavy metal toxicity related to skin-lightening cream use. We report a case of a child who developed status epilepticus after ingesting a skin-lightening solution containing 2% hydroquinone. The toxicodynamics of hydroquinone and its effects on the central nervous system are discussed.

The reality of teenage driving: the results of a driving educational experience for teens in the juvenile court system.

BACKGROUND: In the United States, one third of all deaths in teens are a result of motor vehicle crashes, accounting for 6,000 deaths annually. Injury Free Coalition for Kids-Worcester in collaboration with Worcester Juvenile Court has developed an interactive program for first-time teenaged driving offenders, Reality Intensive Driver Education (Teen RIDE). This full-day program at the trauma center provides a realistic exposure to the consequences of risky driving behaviors. This article examined the driving offense recidivism rates for Teen RIDE participants versus a comparison group (CG). METHODS: The intervention group (IG) consists of teenagers between 13 years and 17 years who have been arrested for the first time for a serious driving offense and are sentenced by a Worcester Juvenile Court Judge or Magistrate to the Teen RIDE program. They are required to attend the program as a condition of probation, so attendance is mandatory. Each participant in the IG completed the program and was tracked for driving reoffenses for 6 months after completion of the course. The CG consists of also first-time driving offenders. The CG was matched with the IG with respect to age (13-17 years), sex, and offense type. Springfield, Massachusetts, serves as the site for recruitment of the CG, since it is demographically similar to Worcester but 60 mi away. Students in the CG had no exposure to this program. Each CG member was also tracked for 6 months after arrest. RESULTS: The recidivism rate for Teen RIDE participants 6 months after the course is 6% with 0% reoffending more than once. The CG has a recidivism rate of 56% 6 months after the arrest and 14% have more than one reoffense. The CG is 13.062 (4.296-39.713) times more likely to reoffend, and this is significant (p < 0.001). CONCLUSION: The Teen RIDE program provides an impactful exposure of the consequences of risky driving behaviors to teenaged participants. In addition, Teen RIDE participants are significantly less likely to reoffend after completion of the course. LEVEL OF EVIDENCE: Therapeutic study, level III.

On the road with injury prevention--an analysis of the efficacy of a mobile injury prevention exhibit.

BACKGROUND: To assess the effectiveness of a mobile injury prevention vehicle (mobile safety street [MSS]) with a hands-on curriculum on instruction and retention of safety knowledge compared with traditional classroom safety curriculum among grade 5 elementary school children. METHODS: Grade 5 students (n = 1,692) were asked to participate in the study as either the intervention group (MSS experience) or the comparison group (traditional classroom safety curriculum). Each student in the intervention group was asked to complete a series of three surveys. The first survey was given before the MSS visit (Fall 2009), the second immediately following the MSS visit (Fall 2009), and a third given 6 months after the MSS visit (Spring 2010) to measure knowledge retention. Students in the comparison group were asked to complete two surveys. The first survey was given at the same time as the intervention group (Fall 2009) and the second was given after the completion of the traditional classroom safety curriculum (Spring 2010). RESULTS: Students scored on average 5.67 of 10 (5.56-5.80) before any safety instruction was given. After MSS instruction, mean scores showed a significant increase to 7.43 of 10 (7.16-7.71). Such increase was still measurable 6 months after the intervention 7.34 (7.04-7.66). The comparison group saw a significant increase in their mean scores 6.48 (6.10-6.89), but the increase was much smaller than the intervention group. CONCLUSIONS: Community-based injury prevention programs are essential to reducing preventable injury and deaths from trauma. This study demonstrates that a hands-on program is more effective than traditional methods for providing safety knowledge.

Goods for Guns--the use of a gun buyback as an injury prevention/community education tool.

BACKGROUND: US children aged between 5 years and 14 years have a rate of gun-related homicide 17 times higher and a rate of gun-related suicide and unintentional firearm injury 10 times higher than other developed countries. Gun buyback programs have been criticized as ineffective interventions in decreasing violence. The Injury Free Coalition for Kids-Worcester (IFCK-W) Goods for Guns buyback is a multipronged approach to address these concerns and to reduce the number of firearms in the community. METHODS: The IFCK-W buyback program is funded by corporate sponsors, grants, and individual donations. Citizens are instructed to transport guns, ammunition, and weapons safely to police headquarters on two Saturdays in December. Participants are guaranteed anonymity by the District Attorney's office and receive gift certificates for operable guns. Trained volunteers administer an anonymous survey to willing participants. Individuals who disclose having unsafely stored guns remaining at home receive educational counseling and trigger locks. Guns and ammunition are destroyed at a later time in a gun crushing ceremony. RESULTS: Since 2002, 1,861 guns (444 rifle/shotgun, 738 pistol/revolver, and 679 automatic/semiautomatic) have been collected at a cost of $99,250 (average, $53/gun). Seven hundred ten people have surrendered firearms, 534 surveys have been administered, and ≈ 75 trigger locks have been distributed per year. CONCLUSIONS: IFCK-W Goods for Guns is a relatively inexpensive injury prevention model program that removes unwanted firearms from homes, raises community awareness about gun safety, and provides high-risk individuals with trigger locks and educational counseling.

Glowing in the dark: time of day as a determinant of radiographic imaging in the evaluation of abdominal pain in children.

BACKGROUND/PURPOSE: Although ultrasound is often the preferred pediatric imaging study, many institutions lack ultrasound access at night; and computerized tomography (CT) becomes the only radiological method available for evaluation of appendicitis in children. The purpose of this study was to characterize patterns of daytime and nighttime use of ultrasound or CT for evaluation of pediatric appendicitis and to measure consequent differences in radiation exposure and cost. METHODS: A retrospective chart review of patients evaluated for appendicitis from October 2004 to October 2009 (N = 535) was performed to evaluate daytime and nighttime use of ultrasound and CT for pediatric patients. RESULTS: Average age was 10.2 years (range, 3-17 years). During the day, 6 times as many ultrasounds were performed as CTs (230 vs 35). At night, half as many ultrasounds were performed (50 vs 110). Average radiation dose per child during the day was significantly lower than at night (day, 0.52 mSv per patient; night, 2.75 mSv per patient). Average radiology costs were lower for daytime patients ($2491.06 day vs $4045.00 night; P < .05). CONCLUSIONS: Dependence on CT at night results in higher average radiation exposure and cost. Twenty-four-hour ultrasound availability would decrease radiation exposure and cost of evaluation of children presenting with appendicitis.

Underuse of analgesia in very young pediatric patients with isolated painful injuries.

STUDY OBJECTIVE: We sought to compare the use of analgesic agents in very young children with that in older children with isolated painful injuries. METHODS: We performed a retrospective chart review of patients seen between 1999 and 2000 in a pediatric emergency department. Patients aged 6 months to 10 years who sustained isolated long bone fractures or second- and third-degree burns were included. Exclusion criteria included head injury, chest or abdominal trauma, and developmental delay or neurologic disorder. Research subjects were separated into 2 study groups: very young (ages 6 to 24 months) and school age (ages 6 to 10 years). RESULTS: One hundred eighty research subjects met the inclusion and exclusion criteria: 96 in the very young group and 84 in the school age group. Research subjects in the very young group received no analgesic agents more often than school age research subjects for all injuries (64.6% versus 47.6%, respectively), all fractures (70.6% versus 48.8%, respectively), displaced fractures (55.0% versus 22.0%, respectively), and all burns (50.0% versus 25.0%, respectively). When analgesic agents were administered, very young patients were less likely to receive narcotics compared with school age patients. Analgesic dosing for both the very young and school age groups was similar and within established guidelines. CONCLUSION: Children younger than 2 years of age receive disproportionately less analgesia than school age children, despite having obviously painful conditions. Emergency physicians should consider special issues involved in assessing and managing pain in very young children.

A prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma.

Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. Participants included 50 patients seeking care for acute asthma. Patients received standard therapy and were randomized to receive albuterol by nebulizer or metered-dose inhaler with spacer every 20 minutes up to 2 hours. Symptoms, physical examination, spirometry, pulsus paradoxus, medication use, and outcome were evaluated. Based on clinical judgment, the attending physician decided to admit or discharge after 1 hour of therapy. Outcome was compared to the EPR-2 guidelines. Post hoc statistical analyses examined predictors of the need for admission from which a prediction model was developed. Maximal accuracy of the admit versus discharge decision occurred at 1 hour of therapy. Using FEV(1) alone as an outcome predictor yielded suboptimal performance. FEV(1) at 1 hour plus ability to lie flat without dyspnea were the best indicators of response and outcome. A model predictive of the need for admission was developed. It performed better (P =.0054) than the admission algorithm of the EPR-2 guidelines. The decision to admit or discharge acute asthmatics from the ED can be made at 1 hour of therapy. No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction.