Child-related services in general accident and emergency departments

A survey undertaken by the British Paediatric Association (BPA) in 1985 highlighted deficits in the services and facilities provided by accident and emergency (A & E) departments for children. Following this survey several documents were published by professional and voluntary organizations advising on the care of children in such departments. The current study, conducted as part of a larger project, involved the distribution of questionnaires (by post) to the nursing managers of a total of 193 general A & E departments in England, Scotland and Wales. The overall response rate of 87% was very encouraging. This article explores the nurse managers' perceptions of the personnel required to meet the needs of children in A & E. It looks especially at the role of Registered Sick Children's Nurses (RSCNs). The findings suggest that the need for RSCNs is not always accepted. RSCNs seem to be employed in some departments as a token presence. Factors seen by nurse managers as limiting their recruitment are discussed. According to the responses given, the role of the RSCNs currently employed in A & E, varies considerably. The findings give some insight into the degree to which current staffing for children in A & E meet the guidelines published by professional and voluntary bodies.     

Violence in the accident and emergency department

We characterized the regression pattern of retinopathy of prematurity (ROP) for 266 infants examined over a 22-month period. Infants were included in the evaluation with a birth weight of less than or equal to 1500 g. Regression of retinopathy was observed in all but 11 infants, who were treated for threshold ROP. ROP limited to the peripheral retina resolved around term (40 weeks postconceptional age). Posterior ROP and/or stage 3 ROP underwent a protracted course of resolution, often not reaching zone 3 until 42 to 45 weeks after conception. Permanent retinal/vascular sequelae of ROP were observed in 10% of infants with ROP. The most common abnormality was failure to completely vascularize the temporal retinal periphery. Overall, retinal morbidity from ROP was an infrequent occurrence (18 of 266 premature infants--6.8%).     

Use of an accident and emergency department by hospital staff

OBJECTIVE: To assess the number of attendances by hospital staff at an accident and emergency (A&E) department, and reasons for their attendance. METHODS: A&E attendances by hospital staff were studied for a 12 month period. Comparison was made with attendances by non-hospital staff in full or part time employment. Differences between the observed and expected numbers of attendances were analysed using chi 2 analysis. RESULTS: 560 staff attendances were recorded out of 78,103 total attendances. There was an observed excess number of attendances by nursing staff for work related incidents when compared to the control group (P = 0.01). However, there were fewer attendances by nursing staff for non-work related incidents (P = 0.01). Staff other than doctors and nurses attended the A&E department more frequently than the control group for non-work related incidents (P = 0.01), but their attendance for incidents occurring at work were the same as the control group (P = NS). CONCLUSIONS: The increased use of A&E resources by staff other than doctors and nurses may be inappropriate and further research into their reasons for attendance is warranted.     

Attitudes towards the content of general practice teaching

In a study of attitudes towards the content of general practice teaching, it was found that there was good agreement between fifth year medical students and their general practitioner tutors. The social aspects of illness were considered the most important by students and both groups emphasized the value of seeing patients in their homes with time for discussion of cases. These findings are discussed in the context of the development of teaching in general practice at Glasgow University.     

The efficacy of local anaesthetics administered by general dental practitioners

AIM: To obtain empirical evidence for the efficacy of local anaesthesia in dentistry. DESIGN: Retrospective analysis of serial administrations of local anaesthesia. METHODS: Dentist and patient evaluations of the success of differing techniques (infiltration and block) of anaesthesia in a variety of general practice procedures. Results were analysed for correlation between dentist and patient using a 5-point scale. RESULTS: Complete data were analysed for 331 administrations. In the hands of experienced dentists over 93% of operations were assessed by both dentist and patient as comfortable or completely comfortable. Dentists were generally able to judge patient comfort (P < 0.001). Administrations requiring repeat injections were less comfortable. Dentists judged infiltration administrations more comfortable than block administrations (P < 0.001), but patient judgements of comfort failed to distinguish between differing techniques at the P < 0.05 level. CONCLUSIONS: Some variations in success rate exist between dentists the most dental procedures under local anaesthetic in general practice were assessed as being comfortable or better by both dentists and patients.     

Relation of out of hours activity by general practice and accident and emergency services with deprivation in Nottingham: longitudinal survey

OBJECTIVES: To investigate the relation between out of hours activity of general practice and accident and emergency services with deprivation and distance from accident and emergency department. DESIGN: Six month longitudinal study. SETTING: Six general practices and the sole accident and emergency department in Nottingham. SUBJECTS: 4745 out of hours contacts generated by 45,182 patients from 23 electoral wards registered with six practices. MAIN OUTCOME MEASURES: Rates of out of hours contacts for general practice and accident and emergency services calculated by electoral ward; Jarman and Townsend deprivation scores and distance from accident and emergency department of electoral wards. RESULTS: Distances of wards from accident and emergency department ranged from 0.8 to 9 km, and Jarman deprivation scores ranged from -23.4 to 51.8. Out of hours contacts varied by ward from 110 to 350 events/1000 patients/year, and 58% of this variation was explained by the Jarman score. General practice and accident and emergency rates were positively correlated (Pearson coefficient 0.50, P = 0.015). Proximity to accident and emergency department was not significantly associated with increased activity when deprivation was included in regression analysis. One practice had substantially higher out of hours activity (B coefficient 124 (95% confidence interval 67 to 181)) even when deprivation was included in regression analysis. CONCLUSIONS: A disproportionate amount of out of hours workload fell on deprived inner city practices. High general practice and high accident and emergency activity occurred in the same areas rather than one service substituting for the other.     

A protocol to improve analgesia use in the accident and emergency department

In this experiment, intracellular K+ concentration ([K+]i) and ATPase activity of myocardiocytes were measured in early stage of burn injury. Comparing with control group, it was found that, 1. [K+]i were decreased after burn injury, [K+]i of 1st, 3rd, 8th and 24th hours were decreased to 96.2 +/- 1.3%, 85.8 +/- 1.3%, 65.9 +/- 1.0% and 73.7 +/- 1.1% of normal, respectively. 2. Cardiac sarcolemma total ATPase, Mg(2+)-ATPase and Na(+)-K(+)-ATPase activities were all reduced significantly at 8th hour after injury. These results suggest that, burn injury accelerates K+ efflux current, but inhibits K+ influx current, and the reduction of Na(+)-K(+)-ATPase activity is one reason of decrease of [K+]i after injury.     

Attitudes of general practitioners in Northern Ireland toward abortion and family planning

A survey of the attitudes and practices of general practitioners in Northern Ireland regarding contraception and abortion was carried out in 1994 and 1995 with a randomized sample of 154 physicians. The vast majority of doctors who received requests for contraceptives from their patients fulfilled those request (94%). Overall, 13% of the doctors said a married patient had requested an abortion in the past three months, and 34% had had a similar request from an unmarried patient. Two-thirds thought that a woman together with her physician should decide whether to terminate a pregnancy, 19% did not think the choice should be left with the woman and her physician and 13% were undecided. Sixty-six percent believed that a joint strategy of improving contraceptive use and reducing premarital intercourse is the best approach for preventing unwanted pregnancy among teenagers, 21% specified only improving contraceptive use and 13% indicated only reducing premarital intercourse.     

The management of dental problems presenting to an accident and emergency department

Patients with dental diagnoses, not necessarily traumatic, often present to accident and emergency departments and general medical practitioners. Few doctors have received much, if any, education in the management of these patients. A 6 month prospective study revealed 107 patients (0.3% of new attenders) attending the accident and emergency department of Glasgow Royal Infirmary. Only 19 of these had suffered trauma. Medical staff in the department were only rarely able to make any diagnosis, and management of these patients took place on an empirical, symptomatic basis. Management could be improved by better education of medical students and doctors. Use of an algorithm may be appropriate.     

Antidepressant overdoses and resultant emergency department services: the impact of SSRIs

Suicide is a major source of morbidity and mortality in patients with mental illness. The selective serotonin reuptake inhibitors (SSRIs) and other newer nontricyclic antidepressants appear to have less clinically significant toxicity in overdose, resulting in lower costs of treatment when compared with tricyclic antidepressant (TCA) overdoses. The resource utilization and cost of treatment for SSRI overdoses may not be less if (1) these agents are commonly ingested with other potentially toxic substances, or (2) health care practices have not changed in response to the apparent greater safety of SSRIs. This study evaluates demographic variables of antidepressant overdoses to determine whether differences exist in treatments and monitoring. Additionally, this study evaluates costs associated with care and the impact of co-ingestants on those same factors.     

Attitudes to the use of health outcome questionnaires in the routine care of patients with diabetes: a survey of general practitioners and practice nurses

BACKGROUND: Despite the increasing availability of multidimensional health status and outcome measures of the patient's physical and emotional functioning, and a number of national initiatives to promote their use, little is known about the attitudes and behaviour of general practitioners (GPs) and practice nurses (PNs) regarding their use in evaluating the effectiveness of health care. What evidence there is remains largely anecdotal but supports the view that health outcome data is currently not used in the routine management of the patient. AIM: To investigate the attitudes and behaviour of GPs and PNs regarding the use of health outcome data in the routine care of patients with diabetes. METHOD: A questionnaire comprising 20 attitudinal and behavioural statements covering the use and benefits of health outcome data in the routine care of patients with diabetes were sent to 156 GPs and 114 PNs in the Doncaster area together with a covering letter and two examples of multidimensional health outcome measures. RESULTS: Completed questionnaires were received from 90 (58%) GPs and 49 (50% corrected for out of scope) nurses. Median response scores showed that both GPs and nurses expressed a positive overall attitude towards health outcome measurement giving responses favourable to it in 15 (75%) and 18 (90%) of the statements respectively. A key finding was that 48% and 46% of GPs and PNs were unclear as to how they would use health outcome data. CONCLUSION: While our findings reflect a favourable view towards the use of health outcome data for the routine management of the patient with diabetes in a general practice setting, a number of important barriers to their implementation have been identified. These include insufficient knowledge on their use, the need for easily interpretable data, and a lack of resources.     

Review of a general practice attachment for accident and emergency training

The changes occurring in the health care delivery system afford ideal opportunities for call centers to expand their essential functions. Two obvious and timely services that can be adapted to the call center are outcomes management and disease management. These services benefit from the central role that telephonic nurses can play in clinical assessment and data collection and analysis. Other new services, such as gate-keeping functions, may also be relevant to call centers. The information and technology specialization of expert clinicians who practice "sightless" nursing make call centers the new clinical epicenter in the service capabilities of health care networks.     

Attitudes and views of physicians and nurses towards cancer patients dying at home

Liquid chromatography-mass spectrometry (LC-MS), after long-term development that has introduced seven major interfacing techniques, is finally suitable for application in the field of analytical toxicology. Various compound classes can be analyzed, and sensitivities for more or less polar analytes that are as good as or better than those of gas chromatography-mass spectrometry can be obtained with modern interfaces. In addition, because ionization is often softer than classical electron impact, some LC-MS interfaces are able to handle fragile species that are otherwise not amenable to MS. This review is intended to present LC-MS to less familiarized readers and to give an extensive overview of the application of the different coupling techniques to doping agents, drugs of abuse, forensic analysis, toxic compounds of various nature, and several toxicologically relevant therapeutic drugs. Experimental parameters such as the interfaces used, ionization methods, detection limits, and experimental details for exemplary applications are given.     

Management of eye emergencies in the accident and emergency department by senior house officers: a national survey

OBJECTIVE: To assess the training that accident and emergency (A&E) senior house officers (SHOs) receive in dealing with eye emergencies, their own perceived level of confidence and competence in managing such cases, and the availability of appropriate equipment in their departments. METHODS: Prospective telephone survey using a standardised structured questionnaire. One SHO from each United Kingdom A&E department listed in the BAEM directory of 1993 was chosen at random and interviewed. RESULTS: 226 A&E departments were contacted and 192 SHOs were successfully interviewed (response rate 84.9%); 26.0% received no training in the management of eye emergencies, 68.8% had only a little or no confidence in dealing with these cases, and 42.2% worked in A&E departments which had no slit lamp. CONCLUSIONS: There is a lack of adequate basic ophthalmic training for A&E SHOs, leading to a lack of confidence on their part in the management of eye emergencies. In just over 40% of A&E departments in the United Kingdom, the management of these cases may be less than optimal because of the absence of a slit lamp.     

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior crossbites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.