Surprisingly, for all the fun and high-risk adventure that Las Vegas has to offer, one of the most dangerous things that you can do while visiting is to walk the city streets. With over 50 injury-related crashes reported at just a single intersection in 2018, it is believed that approximately 2.5 pedestrians per every 100,000 residents are killed in traffic accidents annually. Moreover, while some of these accidents do occur on the bustling Vegas strip, most crash sites are widely distributed across all of Clark County. With pedestrian accident-related deaths outpacing death rates for influenza, breast cancer, and HIV, the problem was declared an epidemic by the State of Nevada in 2016. As a result, seeking assistance from the top personal injury lawyers in Las Vegas becomes crucial for those affected by such accidents. Following are several reasons why traveling on foot is such a high-risk activity in this city.

1. Distracted Drivers

Las Vegas, Nevada is in many ways, a city of distractions. This is where countless people flock to indulge in the escapism that removes them from the stresses of their everyday lives. With bright lights, entertainment, and countless other things to see and do on both the strip and throughout much of the surrounding areas, it is not uncommon for motorists to take their attention off the road. Moreover, just like drivers in every other part of the country, Las Vegas drivers can also be distracted by their mobile phones and other in-vehicle technologies.

2. Driving While Under the Influence

In Las Vegas, alcohol is always flowing freely. Just as people flock here for escapism, they also come to indulge. According to one report, 33 percent of all Nevada traffic fatalities for 2008 were alcohol-related. Between the years 2003 and 2012, more people were killed in Nevada as the result of drunk driving than anywhere else in the nation.

3. Distracted Pedestrians

Not surprisingly, many pedestrians in Las Vegas are tourists. Unfamiliar with the most dangerous intersections, and busy marveling at their surroundings, these individuals are prone to stepping off curbs at the wrong times, misjudging signal times, and attempting to jaywalk in areas that are incredibly accident-prone. Just as drivers can be distracted by their mobile phones, Las Vegas pedestrians are often guilty of:

• Searching for directions
• Making phone calls
• Taking pictures
• Updating social media accounts

while negotiating the busy city streets. In a location with such a high rate of pedestrian-involved accidents, even looking away from oncoming or cross-traffic for several seconds can result in serious injury.

4. Undesirable Characteristics of Certain Las Vegas Roads

In many cities, a typical pedestrian accident lawsuit is a claim of driver negligence. In Nevada, however, many pedestrian accidents have less to do with distracted motorists than poorly designed roadways. In response to the consistently high number of pedestrian fatalities, Southern Nevada freeway engineers and traffic experts compiled a list of existing road characteristics that are likely contributing to crashes. These include:

• Access points for driveways that exist immediately after or before freeway entrances
• Posted speed limits that are too high to allow for effective reaction times and stopping distances
• Roads that are solely designed for moving vehicles and do not account for high daily levels of foot traffic
• Outdated roads that do not account for community growth

One of the best examples of outdated travel avenues is Boulder Highway. Originally designed in the 1930s, Boulder Highway was built to allow for rapid transit between Henderson and Las Vegas. Now, however, this highway is used by far larger numbers of motorists than it was initially intended to accommodate, and often for far shorter trips. For instance, the average distance of travel on Boulder Highways is approximately just two miles.

5. Poorly Timed Crosswalks

Certain crosswalks at high-traffic intersections in Las Vegas are purposefully timed to ensure that pedestrians can only cross busy stress halfway before the signal changes. This is the case at one of the busiest and most dangerous intersections in Nevada, the intersection of Boulder Highway, Flamingo Road, and Nellis Boulevard. While there is a small strip for pedestrians to wait for the “walk” signal to return, most people rush to make it all the way across the street, even as cross-traffic starts moving forward. Moreover, the posted speed limit at this intersection is believed to be too high for drivers to effectively react to jaywalkers.

Bottom Line

Being involved in an accident in Las Vegas as a pedestrian is always devastating. Pedestrians lack the coverage and protection provided by automobiles, as well as the buffering and safety devices that all modern vehicles include. Whether the resulting injuries of these events have been caused by drunk drivers or poorly designed intersections, injury victims always have the right to seek compensation.

It doesn’t take much to suffer a traumatic brain injury, and, contrary to a popular myth, an impact isn’t required. The sudden jerking motion caused by an impact is enough to force the brain to slam against the inside of the skull, and that can result in bruising.

If this happens to a loved one, you may find yourself taking on the role of caretaker over an extended period of time. This guide will help you learn what to expect.

You’ll Have To Assess the Individual’s Abilities

Before you even bring your loved one home, you should take the time to assess the changes in their abilities. A traumatic brain injury can cause behavioral changes as well as impacting their cognitive health. This means they will be quite different from the person you knew, and they likely won’t be able to do all of the things they could do before the accident. This may include a tendency to wander off, so be sure your loved one is always wearing some type of identification, such as a medical bracelet.

You’ll also have to make their home safer just as a new parent would child-proof their home. Look for places where they may be likely to fall, trip, or hit their head and install safety features, such as railings, skid resistant flooring, and foam bumpers. In creating a new structure for the individual, make family members and guests aware of the situation and the need for added caution.

Prepare for Long-Term Care

There are many complexities in ensuring the continued financial and legal care for your loved one, so working with an attorney can help. You can call for a free case evaluation, to learn more about what you’ll need to do in pursuing Supplemental Security Income (SSI) and Medicaid for your loved one.

If there was a settlement or lawsuit award as the result of an accident that caused the TBI, you may need legal help to have the funds placed in a special needs trust. Since someone with a traumatic brain injury cannot have access to funds over $2,000, you will have to establish a conservatorship or another type of legal guardianship.

What Specific Changes Can You Expect?

The symptoms your loved one will exhibit will vary based upon the area of the brain that was injured. While they may experience some of these symptoms and only a few to severe degrees, you should be prepared to help them manage or alleviate these symptoms as much as possible. Common TBI symptoms include:

• Short attention span
• Lack of short term memory
• Inhibited problem solving skills
• Inability to follow instructions
• Impaired reading/writing skills
• Inhibited communication skills, including limited vocabulary
• Unable to learn new things

Don’t Forget To Care for Yourself

As you’re caring for your loved one, it’s important to know when you’re taking on too much. You shouldn’t be spending so much time on your loved one that you’re neglecting your other friends and loved ones. You should also be making time to engage in physical activities and stress reduction activities.

In addition to your meals, work, and family obligations, you should also have an hour to yourself to do whatever you enjoy doing. Remember to take care of yourself. If this all seems like too much, this may be a sign that you need help from other family members or from a professional caregiver.

In some cases, a traumatic brain injury is only temporary and may heal in time. In many instances, however, a TBI can lead to a permanent disability. It can affect an individual’s ability to function, recall memories, or maintain positive relationships with others. Taking on the care responsibilities of such an individual can be stressful and time consuming, but there are government resources to help lighten the burden. Be sure to investigate your options to find out if your loved one is entitled to additional benefits.

After “COVID-19,” the term that most people will remember best from 2020 is likely to be “social distancing.” While it most commonly applied to social gatherings with family and friends, it has impacted the way many receive medical care. Historically, the United States has been relatively slow to broadly adopt telemedicine, largely emphasizing in-person visits.

However, the COVID-19 pandemic, especially in the spring of 2020, necessitated increased use of virtual or phone call visits, even prompting the Center for Medicare and Medicaid Services (CMS) to relax some of its regulations, primarily for video-based telemedicine. These large scale changes made telemedicine exponentially more popular than it had been even at the start of the calendar year.

But while this was a positive for those who otherwise would have delayed or foregone care due to the pandemic, a new study led by researchers in the Perelman School of Medicine at the University of Pennsylvania, published in JAMA Network Open, uncovered significant inequities, particularly by race/ethnicity, socioeconomic status, age, and when someone needed to use a language other than English.

“As we begin to establish novel ways of caring for our patients via telemedicine, it is critical that we make the foundation of this new way forward equitable,” said the study’s senior author, Srinath Adusumalli, M.D., an assistant professor of Cardiovascular Medicine and the University of Pennsylvania Health System assistant chief medical information officer for connected health. “We hope that regulatory and payer organizations recognize potential inequities that could be introduced by policies they create — which might include not reimbursing for telephone visits, and potentially leading to lack of access to care for particular patient populations, specifically those disproportionately affected by events like the COVID-19 crisis.”

The researchers, who included the study’s lead author, Lauren Eberly, M.D., a clinical fellow in Cardiovascular Medicine, examined data for nearly 150,000 patients of a large, academic medical system. All of these patients had been scheduled to have a primary care or ambulatory specialty visit via telemedicine between March 16 and May 11, 2020. This time period coincided with the first surge of coronavirus in the health system’s region, and was also amid stay-at-home orders in the area.

Of the patients who had telemedicine visits scheduled, a little more than half, roughly 81,000 (54 percent), completed their visits, the data showed. And within that segment, less than half, nearly 36,000, (46 percent) had visits conducted via video.

When these visits were broken down by the patients’ characteristics, some clear inequities were found. Overall, patients who were older than 55 were 25 percent less likely than the average patient to successfully complete a telemedicine visit they had scheduled, with people older than 75 being 33 percent less likely. People who identified as Asian were 31 percent less likely to complete a telemedicine visit, and those who did not speak English were 16 percent less likely. Using Medicaid for insurance also made patients less likely to successfully complete a telemedicine visit by 7 percent.

Because of the relaxation of CMS rules surrounding video-based telemedicine early in the pandemic, it’s important to consider that mode of telemedicine in a class by itself. So when those numbers were examined, some of the same groups showed even less favorable numbers than they had for overall telemedicine use. For instance, people over 55 were at least 32 percent less likely to complete a scheduled video visit, with those over 75 being 51 percent less likely.

Meanwhile, some groups of people were shown to have significant disparities in video-based telemedicine even if they hadn’t displayed them for overall telemedicine use. This likely means that they didn’t have problems accessing telemedicine if it was phone or audio-based, but video was not as accessible to them. More, women were 8 percent less likely to complete a video visit than men, Latinx patients were 10 percent less likely than White patients, and Black people 35 percent less likely than White people. Patients with lower household incomes were also less likely to complete a video visit successfully, with those making less than $50,000 being 43 percent less likely.

While the CMS has recently attempted to make phone call-based telemedicine easier to access from a reimbursement perspective, the researchers believe their findings show that there needs to be equal consideration for all forms of telemedicine moving forward.

“It is critical that complete payment parity for all types of telemedicine visits, by all insurance payers, is guaranteed permanently,” Eberly said. “Less reimbursement for telephone visits may disproportionately and unjustly hurt clinics and providers that care for minority and poorer patients.”

While insurance reimbursement is likely to have been a significant impact on the success of patients using telemedicine, Penn Medicine has long implemented a practical approach to root out technical issues that may play a role in access issues. Specifically, professionals within the health system work with patients to assess whether they have the technical ability to successfully have a visit. That includes checking Wi-Fi speed and whether the patient has devices physically capable of conducting the visit.

Something since the start of the COVID-19 outbreak that Adusumalli said Penn Medicine addressed was the inequity found for non-English speakers.

“One concrete thing that has already been addressed, based on the results of this study, was adding one-click interpreter integration for more than 40 video-based languages and greater than 100 audio-based languages for both inpatient and outpatient telemedical care throughout our enterprise,” he explained.

Moving forward, the researchers hope they can uncover more ways to make telemedicine work for everyone.

“We currently have broader research underway to better characterize what patient-specific and provide-specific barriers exist,” Eberly said. “If we can understand these barriers, it could help guide telemedicine implementation strategies that will benefit everyone.”

Adding age and patient history can improve clinical notes to support both clinical and transitional research studies, according to a study published in BMC Medical Informatics and Decision Making.

Adding patient clinical history, such as age and time information can help determine a patient’s disease risk, predict patient health outcomes, and understand disease progression. For example, a patient has increased cancer risk when she has one or more family members who have cancer.

Clinical histories are becoming more prevalent in EHRs. However, specific age and time clinical events, such as risk factors, surgical interventions, and past diagnoses for patients and family members are not often documented or available for research.

Researchers dissected 138 de-identifed discharge data summaries of past medical history, past surgical history, family history, and social history. According to a separate study, most patients are comfortable with sharing their EHR data and biospecimens for research, but may have sharing preferences.

Study authors said these data summaries have a higher chance of containing age and specific clinical events than acute event history. With this data, researchers developed two natural language processing (NLP) models to integrate this data to address named entities, attributes and values, and relationships between the named entities.

Researchers captured age, procedure, and social determinants of health categories with 8 percent, 10 percent, and 23 percent of all annotated named entities to those categories, respectively. Researchers also observed an agreement of 85 percent for both age and time.

“Age and temporally-specified mentions within past medical, family, surgical, and social histories were common in our lung cancer data set; annotation is ongoing to support this translational research study,” explained the researchers.

In the study, researchers expanded upon the current models to support age, time, and family history information.

“Annotator training and feedback yielded some notable observations,” wrote the study authors. “Firstly, AGE and TIMEX3 classes were placed in consistent locations through the text and followed easily identifiable patterns likely explaining fewer inter-annotator inconsistencies. Other classes required extensive training to achieve acceptable IAA for attribute annotation.”

To come to these observations, researchers added biological information that assessed disease risk that was linked to genetic heritability. The research team also added temporal information that is related to age and placed on a patient timeline.

Looking forward, researchers said further work can be done by integrating similar models into existing models to extract medical named entities.

“The long-term goal is to develop a hybrid rule-based and deep learning NLP system to automatically extract age and temporal information, for the construction of longitudinal clinical profiles for any patient, including our lung cancer cohort,” concluded the study authors.

“We then build a prototypical NLP tool to assess the amount of work necessary to extract such new information, and to serve as a foundation for a future automation efforts.”

Most patients are comfortable with sharing their EHR data and biospecimens for research purposes but may have sharing preferences based on researchers’ affiliations and specific data items, according to a study published in JAMA Network Open.

Of the 1246 study participants, only 3.7 percent declined to share their health information with their own healthcare providing institution. A total of 352, or 28.3 percent, declined to share with nonprofit institutions, and 590, or 47.4 percent, declined to share with for-profit institutions.

A total of 291 participants, or 23.4 percent, indicated that they were willing to share any data with any researcher, while 46 participants (3.7 percent) were not willing to share any data with any institution.

A total of 909 patients (72.9 percent) said they would be willing to share their data selectively, or had a general preference for sharing within a certain institution.

Emergency department (ED) boarding of patients with psychiatric illness is a critical issue. These patients are twice as likely as medical patients to require inpatient admission1 and five times more likely to board (waiting for more than a set number of hours – often 4 hours – for an inpatient bed).

A new study in the January 2021 issue of The Joint Commission Journal on Quality and Patient Safety, “Keeping Patients at Risk for Self-Harm Safe in the Emergency Department: A Protocolized Approach,” by Abigail L. Donovan, MD, and colleagues at Massachusetts General Hospital, Boston, describes the implementation of a comprehensive safety precautions protocol for ED patients at risk for self-harm.

A multidisciplinary team developed the protocol to include several comprehensive safety precautions, including:

• Creating safe bathrooms
• Increasing the number and training of observers
• Managing access to belongings
• Managing clothing search or removal
• Implementing additional interventions for exceptionally high-risk patients

The researchers measured events of attempted self-harm for 12 months before and after the new safety precautions were enacted.

Findings showed in the 12 months prior to the protocol initiation, among 4,408 at-risk patients, there were 13 episodes of attempted self-harm (2.95 per 1,000 at-risk patients) and 6 that resulted in actual self-harm (1.36 per 1,000 at-risk patients). In the 12 months after the protocol was introduced, among 4,523 at-risk patients, there were 6 episodes of attempted self-harm (1.33 per 1,000 at-risk patients) and only 1 that resulted in actual self-harm (0.22 per 1,000 at-risk patients).

The researchers conclude that comprehensive safety precautions can be successfully developed and implemented in the ED and stress the importance of including multidisciplinary staff in the development of the safety precautions protocol.

“We commend the use of a multidisciplinary approach to improve ED behavioral health processes and focus on a team-based methodology for patient safety, protocol development and education,” adds an accompanying editorial by Scott Zeller, MD and Seth Thomas, MD. “This recommended collaboration parallels recent best-practice guidelines for behavioral health patients in EDs as crafted by the Institute for Healthcare Improvement and the Emergency Medicine Council.”

The January issue is available free to the public through January 31, 2021. Also featured in the issue:

What Safety Events Are Reported for Ambulatory Care? Analysis of Incident Reports from a Patient Safety Organization (University of California, San Francisco)
Improving Ambulatory Safety: When Will the Time Come? (editorial)
Resilience vs. Vulnerability: Psychological Safety and Reporting of Near Misses with Varying Proximity to Harm in Radiation Oncology (University of California, Los Angeles)
A Path to Clinical Quality Integration Through a Clinically Integrated Network: The Experience of an Academic Health System and Its Community Affiliates (University of California, San Diego)
Nurses’ Perceived Causes of Medication Administration Errors: A Qualitative Systematic Review (Villanova University, Pennsylvania)
Conducting Safety Research Safely: A Policy-Based Approach for Conducting Research with Peer Review Protected Material (Massachusetts General Hospital, Boston)
Bracing for the Storm: One Health Care System’s Planning for the COVID-19 Surge (University of Washington Medicine, Seattle)