PubMed · 16603908
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Michele L Deck. Instant teaching tools.. https://doi.org/10.1097/00124645-200603000-00010
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BACKGROUND: Secondhand smoke exposure increases the risk of acute myocardial infarction (AMI). One study (Helena, Mont) examined the issue and found a decrease in AMI associated with a smoke-free ordinance. We sought to determine the impact of a smoke-free ordinance on AMI admission rates in another geographically isolated community (Pueblo, Colo). METHODS AND RESULTS: We assessed AMI hospitalizations in Pueblo during a 3-year period, 1.5 years before and 1.5 years after implementation of a smoke-free ordinance. We compared the AMI hospitalization rates among individuals residing within city limits, the area where the ordinance applied, versus those outside city limits. We also compared AMI rates during this time period with another geographically isolated but proximal community, El Paso County, Colo, that did not have an ordinance. A total of 855 patients were hospitalized with a diagnosis of primary AMI in Pueblo between January 1, 2002, and December 31, 2004. A reduction in AMI hospitalizations was observed in the period after the ordinance among Pueblo city limit residents (relative risk [RR]=0.73, 95% confidence interval [CI] 0.63 to 0.85). No significant changes in AMI rates were observed among residents outside city limits (RR=0.85, 95% CI 0.63 to 1.16) or in El Paso County during the same period (RR=0.97, 95% CI 0.89 to 1.06). The reduction in AMI rate within Pueblo differed significantly from changes in the external control group (El Paso County) even after adjustment for seasonal trends (P<0.001). CONCLUSIONS: A public ordinance reducing exposure to secondhand smoke was associated with a decrease in AMI hospitalizations in Pueblo, Colo, which supports previous data from a smaller study.
ACES (Art, Chaos, Ethics, and Science) is a curriculum developed by 2 residents and a faculty mentor at the Denver Health Medical Center Emergency Medicine Residency Program. The goal of the ACES curriculum is 2-fold: (1) to discuss areas of clinical consequence typically outside the scope of the regular academic curriculum, such as ethical dilemmas and the challenges of professionalism; and (2) to encourage reflection on our roles as caregivers on a personal, public health, and political level. Each bimonthly "doctoring roundtable" session focuses on one of these goals, bringing local and national leaders in the field to the forum to enrich discussion. Attending physicians from academic and private settings within the residency, residents at all levels, rotating medical students, and, for the past year, emergency department nurses participate in the meetings. Thus far, regular voluntary participation has been the only measure of the ongoing program's success. In this descriptive article, we discuss the aim of the program, the curriculum, and how the ACES program enriches the residency's educational goals. Recent accreditation requirements for residency training programs mandate educational experiences that allow residents to demonstrate competency in professionalism and ethical principles. The ACES curriculum developed a unique niche in our residency, creating an open forum for passionate discussion of challenging clinical encounters, unpressured reflection on ethics and decisionmaking, and constructive personal and professional development.
Unmanaged recreation presents a challenge to both researchers and managers of outdoor recreation in the United States because it is shrouded in uncertainty resulting from disagreement over the definition of the problem, the strategies for resolving the problem, and the outcomes of management. Incomplete knowledge about recreation visitors' values and relationships with one another, other stakeholders, and the land further complicate the problem. Uncertainty and social complexity make the unmanaged recreation issue a wicked problem. We describe the wickedness inherent in unmanaged recreation and some of the implications of wickedness for addressing the problem for the Front Range of the Rocky Mountains in Colorado. Conclusions about the nature of the problem are based on a problem appraisal that included a literature review and interviews of key informants. Addressing wickedness calls for institutional changes that allow for and reward the use of trust building, inclusive communication, and genuinely collaborative processes.