The Royal Flying Doctor Service primary care skin cancer clinic: a pilot program for remote Australia.
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INTRODUCTION: The geography and logistics of living in remote Australia provide unique challenges in providing dedicated primary healthcare services to tackle the rising incidence of skin cancer. The aim of this study was to ascertain whether the Royal Flying Doctor Service (RFDS) skin cancer clinic could improve skin cancer health outcomes for the target population while providing care at a level consistent with that documented for metropolitan skin cancer clinics. METHODS: This retrospective longitudinal report compared historical controls with a dedicated fly-in/fly-out primary care skin cancer outreach clinic provided by the RFDS. The clinic was run concurrently with the regular primary care medical service; the entire focus of this additional service was on skin cancer diagnosis and management. This model was used to minimise the additional costs of providing the service. RESULTS: During the study period a total of 316 people were seen at this skin cancer clinic (29% of the total non-Indigenous population) with 39% of those aged over 50 years seen. There was an average of 1.1 consultations per person (343 consultations in total), with a procedure performed in approximately one-third of consultations. The demographic most likely to have a lesion removed were over 50 year-old males (p<0.0001). The rate of skin cancer detection was 15/1000 adults/year. The number of lesions removed per year increased from 37 to 42 after the intervention, with no statistically significant change in the percentage of excised lesions that were malignant (44%). For over 50 year-old males there was a statistically significant increase in the proportion of excised lesions that were melanomas (chi2 = 6.015; p = 0.013). This corresponded to a four-fold rise in melanoma detection from 0.2/1000 people/year pre-intervention to 2/1000 people/year post-intervention. A comparison of the skin clinic's effectiveness with documented results from other Australian non-specialist skin cancer services demonstrated a low number needed to treat for melanoma which is consistent with high diagnostic accuracy. This is also supported by a relatively high consultation to biopsy ratio. The biopsy treatment ratio and percentage of lesions that were malignant were similar to those seen in other Australian settings. CONCLUSION: The RFDS skin cancer clinic outcomes were not dissimilar to those seen in metropolitan skin cancer clinics. The small population and consequently low statistical power mitigated against certainty in concluding that clinical outcomes were enhanced. Further studies would assist in the future development of models for skin cancer clinics in remote areas. (+info)
Scheduled napping as a countermeasure to sleepiness in air traffic controllers.
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Crash rates of scheduled commuter and air carrier flights before and after a regulatory change.
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INTRODUCTION: In 1997, in an effort to reduce the crash rate of scheduled commuter flights, the FAA required aircraft with 10-30 passenger seats to operate under stricter rules. Training and other requirements of 14 CFR Part 121 rules were applied to these midsize commuters, which previously had operated under the less strict Part 135 rules. Published crash rates obscured changes related to aircraft size. This research was undertaken to determine whether the rule change affected crash rates of aircraft with 10-30 passenger seats. METHOD: We determined the number of passenger seats on each Part 135 or Part 121 aircraft that crashed between 1983 and 2007. For aircraft with < 10, 10-30, and > 30 seats, we estimated the numbers of departures and crash rates, adjusting for changes in total departures and numbers of in-service aircraft. RESULTS: The Part 135 crash rate tripled in 1997 when commuters with 10-30 seats were excluded, reflecting the administrative change. However, the crash rate of aircraft with 10-30 passenger seats began to decline 4 yr before the rule change; thereafter, their rate was lower than for larger aircraft. The fleet size of aircraft with 10-30 passenger seats increased from 1983 to 1997, then declined as they were replaced with larger aircraft in response to the rule change. DISCUSSION: No effect of the rule change on crash rates of 10-30-seat aircraft was apparent. The decline in their crash rates began before the rule change and may have been related to the 1992 requirement for ground proximity warning devices. (+info)
The FAA's postmortem forensic toxicology self-evaluated proficiency test program: the second seven years.
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During toxicological evaluations of samples from fatally injured pilots involved in civil aviation accidents, a high degree of quality control/quality assurance (QC/QA) is maintained. Under this philosophy, the Federal Aviation Administration (FAA) started a forensic toxicology proficiency-testing (PT) program in July 1991. In continuation of the first seven years of the PT findings reported earlier, PT findings of the next seven years are summarized herein. Twenty-eight survey samples (12 urine, 9 blood, and 7 tissue homogenate) with/without alcohols/volatiles, drugs, and/or putrefactive amine(s) were submitted to an average of 31 laboratories, of which an average of 25 participants returned their results. Analytes in survey samples were correctly identified and quantitated by a large number of participants, but some false positives of concern were reported. It is anticipated that the FAA's PT program will continue to serve the forensic toxicology community through this important part of the QC/QA for laboratory accreditations. (+info)
Aviation-related injury morbidity and mortality: data from U.S. health information systems.
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INTRODUCTION: Information about injuries sustained by survivors of airplane crashes is scant, although some information is available on fatal aviation-related injuries. Objectives of this study were to explore the patterns of aviation-related injuries admitted to U.S. hospitals and relate them to aviation deaths in the same period. METHODS: The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) contains information for approximately 20% of all hospital admissions in the United States each year. We identified patients in the HCUP NIS who were hospitalized during 2000-2005 for aviation-related injuries based on the International Classification of Diseases, 9th Revision, codes E840-E844. Injury patterns were also examined in relation to information from multiple-cause-of-death public-use data files 2000-2005. RESULTS: Nationally, an estimated 6080 patients in 6 yr, or 1013 admissions annually (95% confidence interval 894-1133), were hospitalized for aviation-related injuries, based on 1246 patients in the sample. The average hospital stay was 6.3 d and 2% died in hospital. Occupants of non-commercial aircraft accounted for 32% of patients, parachutists for 29%; occupants of commercial aircraft and of unpowered aircraft each constituted 11%. Lower-limb fracture was the most common injury in each category, constituting 27% of the total, followed by head injury (11%), open wound (10%), upper extremity fracture, and internal injury (9%). Among fatalities, head injury (38%) was most prominent. An average of 753 deaths occurred annually; for each death there were 1.3 hospitalizations. CONCLUSIONS: Aviation-related injuries result in approximately 1000 hospitalizations each year in the United States, with an in-hospital mortality rate of 2%. The most common injury sustained by aviation crash survivors is lower-limb fracture. (+info)
In-flight automated external defibrillator use and consultation patterns.
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