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Offbeat

Low speed vehicle run-over incidents remain in the spotlight

31 Mar, 14 | by Bridie Scott-Parker

PubMed abounds with articles exploring the epidemiology of low speed vehicle run-overs (e.g., doi: 10.1136/ip.2010.030304; 10.1111/jpc.12188; 10.1111/wvn.12014; 10.1136/injuryprev-2013-040932; 10.1186/1471-2458-14-245; 10.1186/1471-2458-14-245). The devastating consequences of low speed vehicle run-over incidents has led to a plethora of suggested intervention and ‘tips’ for parents and others interested in child and infant injury prevention (for example, http://www.kidsafewa.com.au/drivewaysafety.html; http://www.safekids.org.nz/index.php/page/driveway-run-over-kit-locations; http://www.keepyourchildsafe.org/child-safety-book/child-driveway-accidents.html). In addition, after-market reversing cameras are available for purchase, and many new cars now come with this option as a standard feature.

Despite these resources, low speed vehicle run-overs continue to occur and they are not an isolated phenomenon unfortunately. Examples are commonly found in the news media (e.g., in Australia earlier this month: http://www.theherald.com.au/story/2153058/baby-hospitalised-after-being-run-over-in-driveway-by-4wd/). In New Zealand, a news report summarising a recent tragedy finished with a summary of 7 other driveway deaths (see http://www.stuff.co.nz/national/9879675/Child-run-over-in-driveway-dies). Similar events are also summarised in an article reporting a 2013 tragedy in Texas (see http://www.theeagle.com/news/local/article_55db2af5-f68b-5344-9e00-60c79f109c6a.html).

So how do we progress in preventing injury to our most vulnerable? Are parents and other caregivers unaware of the potentially-devastating injuries that can be sustained in the family driveway, thus suggesting that education is the key? Or is engineering, in the form of barriers and mandatory cameras, the solution? I would argue that a multilevel approach is needed, and is needed urgently. I welcome your ideas!

 

 

 

A radical step in injury prevention – preventing table-saw injuries

5 Mar, 14 | by Bridie Scott-Parker

 

After blogging “Table saw 1, Injury-free arm and hand 0” on the 20th of May last year, I have remained alert to news regarding installation of injury prevention devices on table saws. Pleasingly my father has left the building industry with all his digits and limbs intact, however other table-saw users have not fared to so well. Last year I noted that the injury prevention technology was available, however it was recognised that the technology was likely to increase the initial purchase price of the table saw.

In a radical step in injury prevention, over the past week I have learned that a federal antitrust lawsuit has been filed by the developer of the injury prevention technology – SawStop LLC – with the complaint naming major power tool companies who feared increased legal liability from table saw injuries if the technology was introduced by some companies and not others. As such, it is claimed that

Defendants engaged in a group boycott of Plaintiff’s safety products for table saws beginning around 2001 or 2002…”

As an injury prevention professional, this statement brings about an almost visceral response as I reflect with sheer horror on the many oft-permanent injuries that could have been prevented if product safety, instead of the almighty dollar, had been a priority for any of these companies at any point over the last dozen years. I hope other injury prevention professionals are just as outraged by this audacity.

Read more at http://www.fairwarning.org/2014/02/power-tool-makers-accused-in-lawsuit-of-thwarting-adoption-of-finger-saving-device/ and http://www.allgov.com/news/controversies/power-tool-makers-fight-against-finger-saving-device-140302?news=852569.

Grumpy over-protective Nanny Barry

2 Mar, 14 | by Barry Pless

Am I the only person in the injury prevention world who watched the Olympics with a mixture of admiration and condemnation? What struck me — and perhaps only me — was that virtually every one of the ‘sports’ were dangerous. The danger element ranged from simple falls on the ice for dancers without helmets to snowboarders flipping over from considerable heights.  Not that I understand it, but only curling seemed reasonably free of danger. I am not exaggerating when I say that as I reviewed all the others in my mind I found no other that I would want to encourage my children or grandchildren to pursue. Of course if athletes want to get on a luge sled or skeleton sled and slide down an icy track at more than 100 mph that is their choice and I would not wish to interfere. But it does trouble me that they are setting examples for children and adolescents who would like to share the fame and, dare I say it, riches that follow successes at the Olympics. The Olympics seems to be all about risk taking to an excessive degree. In Vancouver we had one luge death. In Sochi I can’t remember any serious injuries but lots of near misses to say nothing of those who bravely (but perhaps foolishly) chose to compete while injured. That includes Canada’s very own gold medal winning goalie!

So, yes, I am grumpy; and I am over-protective; and I do believe in the nanny state. By all means explain why you think I am wrong if you disagree. 

Overcoming obstacles encountered in translating research into practice

28 Feb, 14 | by Bridie Scott-Parker

 

Regular readers of the injury prevention blog will know I have commented on a number of occasions regarding the need to (1) share our research findings, and (2) translate research into practice and policy. Whilst this is the ideal, I also realise that there are many obstacles to this being the actual, another topic upon which I have lamented. With this in mind, I was pleased to see an article summarising the efforts of researchers to improve the uptake of “Mayday Safety Procedure” by coaches to manage injury in one of Australia’s most popular sports, rugby union.

With challenges in translating research into practice in mind, the researchers note that

the translation of injury prevention policy into community practice can be enhanced by developing and implementing a theory-informed, context-specific diffusion plan, undertaken in partnership with key stakeholders“.

The statistically significant improvements in Mayday knowledge and practice reported by the authors have bolstered my hopes that research findings can be translated into policy and practice in other safety-critical injury prevention domains.

Read more at http://www.ncbi.nlm.nih.gov/pubmed/24566099.

How to Cite Social Media in Scholarly Writing

22 Feb, 14 | by Barry Pless

I have not posted anything for a week or so but came across this useful item for those who want to get it right when they get to the references section of a paper they are submitting to this or any other scholarly journal. It is timely because, increasingly, information is being used that comes from social media. But how to cite it?   The author is Camille Gamboa at SAGE US.

She writes: ” As it seems that social media will only play a bigger role in future research of all disciplines, I took to doing my own research on how Facebook posts, tweets, YouTube videos, etc. should be cited in academic publications. I came across the following table from TeachBytes that I thought would be helpful to share …

The Chicago Manual of Style

Not included in her chart (see below) is what she out about how to cite social media outlets following the Chicago Manual of Style.  Apparently there are not yet any official guides for Facebook, Twitter, and Youtube.

Blog Posts:

Firstname Lastname, “Title of the Blog Post Entry,” title or description of the blog with (blog), Date posted, url.  * Note – “(blog)” does not need to be included if the word “blog” is part of the name of the blog already. Citations of blog posts are part of the notes and not included in the bibliography unless they are frequently cited in one paper.

Emails:

Firstname Lastname, email message to XX, Date. Citations of emails are usually provided in a note and are rarely listed in a bibliography. Email addresses should not be included.

The chart she mentions is on the website below and applies to MLA and APA publications:

http://connection.sagepub.com/blog/2013/09/17/how-to-cite-social-media-in-scholarly-writing/ 

Proactive rather than ‘The Hindenburg’ response

3 Feb, 14 | by Bridie Scott-Parker

I had a conversation recently with a colleague who is a tireless worker in the safety of pedestrians, and his comment regarding policy response resonated with me so much that I thought I would share it with you. He likened policy response to road safety to the Hindenburg Disaster of 1937 (see www.airships.net/hindenburge/disaster for more information), such that improvements in safety only occur after tragic, highly-visible critical events. This policy response, which certainly is an important one, is frequently characterised by ‘too little, too late’. My colleague found this particularly frustrating when policy based in sound risk assessments and a plethora of evidence-based research can prevent – or at least minimise – the damage from catastrophe in the first place.

Whilst myself and my colleague are lucky enough to live, work, and indeed use the road environment in a developed country, evidence-based policy and practical responses are never more urgently needed than now in developing countries. The plight of these countries was highlighted in a recent The Economist article (read more at http://www.economist.com/news/international/21595031-rich-countries-have-cut-deaths-and-injuries-caused-crashes-toll-growing). What we in ‘rich countries’ refer to as vulnerable road users such as pedestrians and motor and pedal cyclists are never more vulnerable than when using the road networks of the developing world.

Interestingly, cost cannot be the only obstacle, with The Economist article stating that

iRAP has helped to build fences to separate pedestrians from traffic in Bangladesh, at a cost of just $135 to avert a death or serious injury; and installed rumble strips on hard shoulders in Mexico to alert drivers when they are veering from their lane ($920). Telling people about safety laws—and then making those laws stick—can be surprisingly affordable and effective, too. The share of people wearing seat belts in Ivanovo, Russia, rose from 48% in 2011 to 74% in 2012, after a police crackdown and social-media campaign partly paid for by Bloomberg Philanthropies, the foundation of Michael Bloomberg, New York’s former mayor and one of the few big aid donors to spend heavily on road safety. Dan Chisholm of the WHO calculates that enforcing speed limits and drunk-driving laws in South-East Asia would cost just 18 cents per person per year.”

I would argue that a part of our role as injury prevention practitioners, professionals and researchers in ‘rich countries’ is to help in the journey to identify, then remove or ameliorate, obstacles to developing nations maximising the benefits of our knowledge and experiences.

Would you drive blindfolded?

6 Jan, 14 | by Bridie Scott-Parker

I hope you said ‘no’ in response to that question! If you didn’t, maybe you shouldn’t be sharing the road with the rest of us sane people!

To me, driving whilst distracted is just like driving blindfolded. In either scenario, you cannot and do not see the road in front, to the side, or behind you. You cannot detect or react appropriately to driving hazards that you would otherwise be able to avoid. Yet a simple drive/walk/cycle down any busy street is likely to mean that you will encounter someone who is distracted, that is, someone who is effectively driving whilst blindfolded.

Here in Australia, distracted and inattentive driving is recognised as one of our Fatal Five (e.g., see http://www.police.qld.gov.au/News+and+Alerts/campaigns/fatalfive.htm). Sources of distraction include external mechanisms both inside the vehicle such as mobile phones and in-car navigation devices or outside the vehicle such as roadside advertising, but may also include oft-unrecognised internal mechanisms such as extreme emotions. Whilst distracted driving is not unique to the young driver, by virtue of their driving inexperience they are at increased risk of harm as a result of distracted driving. Naturalistic driving research recently published in The New England Journal of Medicine (see http://www.nejm.org/doi/full/10.1056/NEJMsa1204142?query=featured_home) revealed that the risk of a crash/near-crash among young drivers increased significantly if drivers were

* dialling or reaching for a cell phone,

* sending or receiving text messages,

* reaching for an object other than a cell phone,

* looking at a roadside object, or

* eating.

Crash risk increased significantly for experienced drivers who were dialling a cell phone (risks associated with accessing internet and texting were not measured). The Authors noted that “The secondary tasks associated with the risk of a crash or near-crash all required the driver to look away from the road ahead.” Effectively driving blindfolded. This suggests that efforts should address the ‘blindfolded driving’ not only of young drivers through interventions such as graduated driver licensing programs as recommended by the Authors, but blindfolded driving by all drivers of all ages and driving experiences.

 

 

The festive season or the injury season?

24 Dec, 13 | by Bridie Scott-Parker

I thought as my final blog for 2013 that I would ponder the question: the festive season or the injury season?

I recall spending a Christmas Eve some 20 years ago in hospital as my then fiancée had to be treated for dreadful scalds on his stomach. Needless to say, despite the sweltering heat and ridiculously-high humidity, he has never again cooked a Christmas brisket wearing only shorts!

A representative of St George Hospital in the Australian state of New South Wales recently advised “Our emergency department usually experiences an increase in presentations of up to 40 per cent during the Christmas and New Year period.”

Common injuries to be on the lookout for including

* those involving water (and especially pools in the hot Australian summer);

* breaks, sprains and strains which may result from using Christmas presents such as scooters and trampolines;

* burns (see above);

* and cuts (especially when opening gifts with knives).

Apparently hanging Christmas decorations is particularly risky (read more about this injury prevention issue at http://www.medicaldaily.com/holiday-decorating-injuries-rise-when-stringing-christmas-lights-lands-you-er-264564), with injuries ranging from slips and falls from ladders (and make-shift ladders like tables), electrocutions from faulty wiring and watering trees whilst lights are still plugged in, and children biting into baubles.

I have really enjoyed blogging this year, sharing my thoughts and experiences with you.

I hope you and yours have a happy and safe break as 2013 draws to a close, Bridie : )

 

 

Beware evidence-based evangelists

10 Dec, 13 | by Barry Pless

A colleague recently sent me a link to this piece in JAMA by RS Braithwaite, MD, MS  that cautions against placing too much weight on some ‘evidence based’ decisions. When the term became popular (was it really 20 years ago) I often referred to many of its more vocal proponents as evangelists.  I still think it is often oversold. Although I realize this piece applies far more to clinical decisions than those that are population based, I have the impression that when politicians want to avoid adopting a policy they often cover themselves in this sort of jargon and false reasoning. If you think I am way off base, please comment and say so. Incidentally, the colleague was Tom Lang who replied to my note of appreciation by adding that for clinicians the three most dangerous words are “In my experience..”

EBM’s Six Dangerous Words

 The six most dangerous words in evidence-based medicine (EBM) do not directly cause deaths or adverse events. They do not directly cause medical errors or diminutions in quality of care. However, they may indirectly cause these adverse consequences by leading to false inferences for decision making. Consider the following statements, each of which includes the six most dangerous words:

• There is no evidence to suggest that hospitalizing compared with not hospitalizing patients with acute shortness of breath reduces mortality.

• There is no evidence to suggest that ambulances compared to taxis to transport people with acute GI bleeds reduces prehospital deaths.

• There is no evidence to suggest that looking both ways before crossing a street compared to not looking both ways reduces pedestrian fatalities.

All of these statements are clearly absurd as foundations for decision making, yet they are technically correct. In each case, these hypotheses have been untested and therefore there is no evidence to suggest otherwise, presuming a definition of “evidence” that requires formal hypothesis testing in an adequately powered study.1 Indeed, as of this writing, “there is no evidence to suggest” appears in MEDLINE 3055 times, nearly as often as “decision analysis” (3140 times), a common framework for using evidence to make decisions. My anecdotal experience suggests that “there is no evidence to suggest” is a mantra for EBM practitioners, in a wide variety of settings. And it is infrequently followed by the clarifying aphorism “absence of evidence is not evidence of absence”2 or discussions of more inclusive definitions of “evidence.”3,4

Deciding not to intervene when “there is no evidence to suggest” the favorability of an intervention makes sense from a decision analytic perspective when the act involves potential harm or large resource commitments.5 However, deciding to intervene when “there is no evidence to suggest” also may make sense, particularly if the intervention does not involve harm or large resource commitments, and especially if benefit is suggested by subjective experience (eg, the qualitative analogue of the Bayesian prior probability).6

Indeed, the fundamental problem with the phrase “there is no evidence to suggest” is that it is ambiguous while seeming precise. For example, it does not distinguish between the vastly different evidentiary bases of US Preventive Services Task Force (USPSTF) grades I, D, or C, each of which may have distinct implications for decision making.7There is no evidence to suggest” may mean “this has been proven to have no benefit” (corresponding to USPSTF grade D), which has very different implications than alternative meanings for “there is no evidence to suggest” such as “scientific evidence is inconclusive or insufficient” (corresponding to USPSTF grade I) or “this is a close call, with risks exceeding benefits for some patients but not for others” (corresponding to USPSTF grade C). As a result, these six dangerous words may mask the uncertainty of experts. They even may be used to deny treatments with potential benefit, if they are interpreted as the equivalent of USPSTF grade D (“this has been proven to have no benefit”) but really mean the equivalent of USPSTF grade I (“scientific evidence is inconclusive or insufficient”).

Beyond its ambiguity, “there is no evidence to suggest” creates an artificial frame for the subsequent decision. It may signal to patients, physicians, and other stakeholders that they need to ignore intuition in favor of expertise, and to suppress their cumulative body of conscious experience and unconscious heuristics in favor of objective certainty. Suppressing intuition may be appropriate when the evidence yields robust inferences for decision making, but is inappropriate when the evidence does not yield robust inferences for decision making. Yet “there is no evidence to suggest” is compatible with either scenario. Because decisions are particularly sensitive to patient preferences when the favorability of an intervention is unclear (eg, USPSTF grade C), “there is no evidence to suggest” may inhibit shared decision making and may even be corrosive to patient-centered care.8 Indeed, it is instructive to note that most people make patient-centered decisions every day without high-quality (eg, randomized controlled trial) evidence, and these decisions are not always wrong. Furthermore, foundational papers in the EBM field make it explicitly clear that EBM was never meant to exclude information derived from experience and intuition.4 While some may argue that misuse of this phrase is only a symptom of not having received appropriate training in EBM, my experience with practitioners of EBM across the clinical, educational, research, and policy spectra suggests the contrary.

I suggest that academic physicians and EBM practitioners make a concerted effort to banish this phrase from their professional vocabularies. Instead, they could substitute one of the following 4 phrases, each of which has clearer implications for decision making: (1) “scientific evidence is inconclusive, and we don’t know what is best” (corresponding to USPSTF grade I with uninformative Bayesian prior) or (2) “scientific evidence is inconclusive, but my experience or other knowledge suggests ‘X’” (corresponding to USPSTF grade I with informative Bayesian prior suggesting “X”), (3) “this has been proven to have no benefit (corresponding USPSTF grade D), or (4) “this is a close call, with risks exceeding benefits for some patients but not for others” (corresponding to USPSTF grade C). Each of these four statements would lead to distinct inferences for decision making and could improve clarity of communication with patients.

EBM practitioners should abandon terms that may unintentionally mislead or inhibit patient-centered care. “There is no evidence to suggest” is a persistent culprit. Informed implementation of EBM requires clearly communicating the status of available evidence, rather than ducking behind the shield of six dangerous words

JAMA. 2013;310(20):2149-2150. doi:10.1001/jama.2013.281996.

More on driving safety measures in Quebec

3 Dec, 13 | by Barry Pless

Perhaps it is because Quebec has no-fault car insurance – another of those wicked socialist ideas in the view of some of my American friends – but on many road safety matters it leads the pack in Canada. For much of Montreal, we still have no right turns on red lights or stop signs and I think this helps reduce injuries.  What we don’t have is enough speed or red light cameras but I think this is only a matter of time.  The latests good news announcement was a proposal from Quebec that all provinces agree to authorize random breath testing for drivers as has been proposed by a governmental advisory body.  This would be following the lead in Britain and parts of Australia where random testing has significantly reduced drunk driving. In the Australian states the declines in fatalities over a 5 year periods were between 19% and 35%!  At present the Canadian Charter of Rights and Freedoms requires police to have reason to stop drivers.  Another anomaly being addressed is that drivers under 18 cannot be fined more than $100 for speeding or other traffic offenses.  (K Dougherty, Gazette, Nov 9, 2013)

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