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Existing research into online credibility assessment has focused on how users assess the credibility of individual websites. The present study broadens the scope of existing research by investigating the role [...]

Study objective: To examine specific risks for occupational injury deaths in New Mexico. Design: Retrospective review of state medical investigator reports from 1980 through 1991 with regard to industry, agent of death, gender, ethnicity, location, and alcohol and other drug involvement. Participants: New Mexico residents who were fatally injured while on the job. Results: We identified 613 deaths: 87.1% unintentional, 10.6% homicides, and 2.3% suicides. Industries with the most fatalities were construction (11.8%), oil/gas (10.6%), and farming (8.6%). The primary agents of death were motor vehicles (41.7%), firearms (10.1%), and falling objects (10.0%). Almost all (95.6%) of the decedents were male. However, females were overrepresented among homicide deaths (P<.0001). Most unintentional injuries occurred in rural areas (69.1%), whereas most homicides (73.4%) and suicides (71.4%) occurred in urban areas. Drug or alcohol use was evident in 19.4% of cases. Conclusion: New Mexico has a high rate of occupational injury death, which appears to be associated with rural location and use of motor vehicles and alcohol. [Fullerton L, Olson L, Crandall C, Sklar D, Zumwalt R: Occupational injury mortality in New Mexico. Ann Emerg Med October 1995;26:447-454.]

Study objective: To determine whether recognition of domestic violence in the emergency department is affected by restructuring of the ED chart to include a specific question about domestic violence, to evaluate whether training concerning domestic violence further increases its recognition, and to develop a profile of women who present to the ED as a result of domestic violence. Methods: We collected prospective data on all females aged 15 to 70 years who presented to an urban Level I trauma center during a 3-month period. Two keywords were used to define domestic violence: (1) mechanism (eg, kicked, hit, pushed) and (2) perpetrator (eg, current/former boyfriend, spouse). We used the first month to define the baseline number of domestic violence cases. We modified charts in the second and third months (intervention months) to include, ''Is the patient a victim of domestic violence?'' In addition, the third month included a 1-hour educational lecture on the identification of domestic violence in the ED. Results: We identified 123 cases of domestic violence from a survey population of 4,073: 25 (2.0%) in the baseline month, 49 (3.4%) in the chart-modification month, and 49 (3.6%) in the education month. The proportion of cases identified during the intervention months was 1.8 times higher than during the control month (relative risk [RR], 1.78; 95% confidence interval [CI], 1.15 to 2.75), but did not differ between each other (RR, 1.06; 95% CI, .72 to 1.57). Women identified as domestic violence cases ranged in age from 15 to 61 years (median, 28.5 years). Most of the identified domestic violence patients presented with a triage classification of assault (54.5%), trauma (8.1%), or abdominal complaints (7.3 %). Triage complaint differed for domestic violence and non-domestic violence cases (@g^2=830; P<.0001). Nearly one third of domestic violence patients (31.7%) presented between 11 PM and 6:59 AM, compared with 19.0% of non-domestic violence patients (@g^2=12.4; P=.005). Conclusion: Modification of the chart significantly increased the recognition rate of domestic violence. An educational intervention did not significantly improve this rate. The profile of a woman presenting to the ED differs from those of other women with respect to chief complaint and time of presentation. [Olson L, Anctil C, Fullerton L, Brillman J, Arbuckle J, Sklar D: Increasing emergency physician recognition of domestic violence. Ann Emerg Med June 1996;27:741-746.]

A letter to the editor is presented in response to the article "Health Care Crisis" ин the January 1, 1973 issue.

AimsTo improve the follow up of outstanding jobs from the neonatal unit and post-natal ward. Outstanding jobs were often being left for prolonged periods with no dedicated person to follow up and with no record of jobs having been completed. This resulted in poor patient care, inadequate communiation and potential for clinical risk.MethodsA quality improvement project was initiated and a plan, study, do, act cycle was used. Initial review showed that oustanding jobs were put onto the bottom of the clinical handover list and random junior doctors were irreguarly asked to review it during their clinical time. Some jobs had been present for more than a 3 month period with most jobs having inadequate information detailing reasons required for follow up. A number of jobs were inappropriate for junior doctor follow up thereby identifying a lack of education and under utilisation of pathways already in place. We set up a weekly neonatal ‘virtual’ clinic and amended the rota in conjunction with management and previously allocated admin time for the registrars. Aims and rules of the list were created and the junior doctors were educated as to the changes. A registrar was assigned during their admin time to run a ‘virtual’ phone clinic, once a week, where they would chase results and contact parents and/or other health professioanls whilst documenting their actions on electronic patient records.ResultsAfter a 12 month period, there were significantly fewer outstanding jobs with no jobs waiting longer than 3 months and all jobs deemed appropriate for ‘virutal’ clinic follow up. There were no clinical risk incidents. Families have informally expressed their satisfaction with having direct hospital contact and promises made as an inpatient fulfilled. This implementation has become a permanent change wihtin the neonatal department.ConclusionThis quality improvement initiative shows that patients can be safely followed up ‘virtually.’ Communication and documentation between health professionals needs to be sound and of high quality. This can improve the quality of care delivered and improve satisfaction amongst our patients and families.