Theodore J. Corbin

The Prevalence of Lesbian, Gay, Bisexual, and Transgender Health Education and Training in Emergency Medicine Residency Programs: What Do We Know?

BACKGROUND The Institute of Medicine, The Joint Commission, and the U.S. Department of Health and Human Services all have recently highlighted the need for cultural competency and provider education on lesbian, gay, bisexual, and transgender (LGBT) health. Forty percent of LGBT patients cite lack of provider education as a barrier to care. Only a few hours of medical school curriculum are devoted to LGBT education, and little is known about LGBT graduate medical education. OBJECTIVES The objective of this study was to perform a needs assessment to determine to what degree LGBT health is taught in emergency medicine (EM) residency programs and to determine whether program demographics affect inclusion of LGBT health topics. METHODS An anonymous survey link was sent to EM residency program directors (PDs) via the Council of Emergency Medicine Residency Directors listserv. The 12-item descriptive survey asked the number of actual and desired hours of instruction on LGBT health in the past year. Perceived barriers to LGBT health education and program demographics were also sought. RESULTS There were 124 responses to the survey out of a potential response from 160 programs (response rate of 78%). Twenty-six percent of the respondents reported that they have ever presented a specific LGBT lecture, and 33% have incorporated topics affecting LGBT health in the didactic curriculum. EM programs presented anywhere from 0 to 8 hours on LGBT health, averaging 45 minutes of instruction in the past year (median = 0 minutes, interquartile range [IQR] = 0 to 60 minutes), and PDs support inclusion of anywhere from 0 to 10 hours of dedicated time to LGBT health, with an average of 2.2 hours (median = 2 hours, IQR = 1 to 3.5 hours) recommended. The majority of respondents have LGBT faculty (64.2%) and residents (56.2%) in their programs. The presence of LGBT faculty and previous LGBT education were associated with a greater number of desired hours on LGBT health. CONCLUSIONS The majority of EM residency programs have not presented curricula specific to LGBT health, although PDs desire inclusion of these topics. Further curriculum development is needed to better serve LGBT patients.

Hospital-based violence intervention programs save lives and money.

I prevention activities are a defining characteristic of the modern trauma center. Violent injuryVwith a 5-year reinjury rate as high as 45%Vrepresents a priority area for preventive intervention. Advances in trauma care increase the likelihood that a patient will survive violent injury but do nothing to reduce the chances that they will be reinjured after leaving the hospital. The recurrent nature of violent injury strains trauma systems financially, and the absence of preventive intervention is inconsistent with trauma centers’ commitment to providing optimal care. Hospital-based violence intervention programs (HVIPs) offer a strategy to address these issues. HVIPs combine brief in-hospital intervention with intensive community-based case management and provide targeted services to high-risk populations to reduce risk factors for reinjury and retaliation while cultivating protective factors. Rigorous evaluations of HVIPs have demonstrated promising results in preventing violent reinjury, violent crime, and substance misuse. Violent injury, as a focus of HVIPs, is generally defined as any injury intentionally inflicted by another person by any mechanism, excluding family, intimate partner, and sexual violence. The latter are excluded because they generally involve different dynamics and intervention strategies.

Developing a trauma-informed, emergency department-based intervention for victims of urban violence.

The Surgeon Generals report on youth violence, the Centers for Disease Control and Prevention, and other national organizations are calling for public health approaches to the issue of youth violence. Hospital-based violence intervention programs have shown promise in reducing recurrent violence and decreasing future involvement in the criminal justice system. These programs seldom address trauma-related symptoms. We describe a conceptual framework for emergency department–based and hospital-based violence intervention programs that intentionally addresses trauma. The intervention described—Healing Hurt People—is a trauma-informed program designed to intervene in the lives of injured patients at the life-changing moment of violent injury. This community-focused program seeks to reduce recurrent violence among 8- to 30-year-olds through opportunities for healing and connection. Healing Hurt People considers the adversity that patients have experienced during their lives and seeks to break the cycle of violence by addressing this trauma.

The Prevalence of Trauma and Childhood Adversity in an Urban, Hospital-Based Violence Intervention Program

Hospitals represent a promising locus for preventing recurrent interpersonal violence and its psychological sequella. We conducted a cross-sectional analysis to assess the prevalence of post-traumatic stress disorder (PTSD) and adverse childhood experiences (ACEs) among victims of interpersonal violence participating in a hospital-based violence intervention program. Participants completed PTSD and ACE screenings four to six weeks after violent injury, and data were exported from a case management database for analysis. Of the 35 program participants who completed the ACE and/or PTSD screenings, 75.0% met full diagnostic criteria for PTSD, with a larger proportion meeting diagnostic criteria for symptom-specific clusters. For the ACE screening, 56.3% reported three or more ACEs, 34.5% reported five or more ACEs, and 18.8% reported seven or more ACEs. The median ACE score was 3.5. These findings underscore the importance of trauma-informed approaches to violence prevention in urban hospitals and have implications for emergency medicine research and policy.

Cost−Benefit Analysis Simulation of a Hospital-Based Violence Intervention Program

BACKGROUND Violent injury is a major cause of disability, premature mortality, and health disparities worldwide. Hospital-based violence intervention programs (HVIPs) show promise in preventing violent injury. Little is known, however, about how the impact of HVIPs may translate into monetary figures. PURPOSE To conduct a cost-benefit analysis simulation to estimate the savings an HVIP might produce in healthcare, criminal justice, and lost productivity costs over 5 years in a hypothetical population of 180 violently injured patients, 90 of whom received HVIP intervention and 90 of whom did not. METHODS Primary data from 2012, analyzed in 2013, on annual HVIP costs/number of clients served and secondary data sources were used to estimate the cost, number, and type of violent reinjury incidents (fatal/nonfatal, resulting in hospitalization/not resulting in hospitalization) and violent perpetration incidents (aggravated assault/homicide) that this population might experience over 5 years. Four different models were constructed and three different estimates of HVIP effect size (20%, 25%, and 30%) were used to calculate a range of estimates for HVIP net savings and cost-benefit ratios from different payer perspectives. All benefits were discounted at 5% to adjust for their net present value. RESULTS Estimates of HVIP cost savings at the base effect estimate of 25% ranged from

The Affordable Care Act's Medicaid expansion creates incentive for state Medicaid agencies to provide reimbursement for hospital-based violence intervention programmes

82,765 (narrowest model) to

Gender differences in posttraumatic stress symptoms among participants of a violence intervention program at a pediatric hospital: a pilot study

4,055,873 (broadest model). CONCLUSIONS HVIPs are likely to produce cost savings. This study provides a systematic framework for the economic evaluation of HVIPs and estimates of HVIP cost savings and cost-benefit ratios that may be useful in informing public policy decisions.

Intimate Partner Violence Among Men Having Sex with Men, Women, or Both: Early-Life Sexual and Physical Abuse as Antecedents

Mass casualty shootings push violence to the forefront of the US publics attention. While the events at the Washington Navy Yard, Aurora, Newtown, and Oak Creek were horrific tragedies, many Americans live in communities where violent injury is an everyday event. In 2012, mass casualty shootings resulted in 88 fatal and 102 non-fatal injuries.1 Yet, in the same year, 388 fatal and 8662 non-fatal aggravated assault injuries were reported to the police in Philadelphia alone.2 Nationwide, the Centers for Disease Control and Prevention (CDC) estimate that 1.7 million non-fatal assault injuries were treated at hospitals in 2011.3 The year prior, homicide was responsible for 16259 deaths. The incidence of violent injury is disproportionately high among racial and ethnic minority males in low-income communities. In 2011, African–American men aged 18–27 years were treated in hospitals across the country for an estimated 90 854 non-fatal assault injuries—approximately one injury per 38 individuals in this demographic group, compared with one injury per 86 non-Hispanic white men of the same age. Homicide is the leading cause of death among African–Americans aged 15–34 years, and the second leading cause of death among Hispanics in this age group, but only the fifth cause among non-Hispanic whites. With violent injury contributing to excess mortality and racial and ethnic health disparities in the USA, many have deemed interpersonal violence to be an ‘epidemic’ that should be treated like an ‘infectious disease.’4 Although this analogy is useful in promoting a public health approach to violence prevention, it also likens violent injury to an acute illness and shapes the design of preventive interventions that treat it as such. Evidence of the recurrent nature of violent injury and its sequelae, however, suggest that violent injury might be more appropriately viewed through the lens of a chronic disease model.5 , …

Hospitals as a locus for violence intervention

Hospital-based violence intervention programs (HVIPs) have emerged as a strategy to address posttraumatic stress (PTS) symptoms among violently injured patients and their families. HVIP research, however, has focused on males and little guidance exists about how HVIPs could be tailored to meet gender-specific needs. We analyzed pediatric HVIP data to assess gender differences in prevalence and type of PTS symptoms. Girls reported more PTS symptoms than boys (6.96 vs 5.21, P = .027), particularly hyperarousal symptoms (4.00 vs 2.82, P = .002) such as feeling upset by reminders of the event (88.9% vs 48.3%, P = .005). Gender-focused research represents a priority area for HVIPs.