Incidence of dentoalveolar injuries in hospital emergency room patients

A retrospective survey over one year of a hospital emergency room population, seen at an oral and maxillofacial surgery clinic, found 271 patients (4.6% of the total population) with dentoalveolar injuries. A very large number of injuries occurred to children between the ages of 0 and 5 years (42.1%), and there was a significant number of injured patients in the adult population (19.1%). The ratio of male to female was 1.9:1. The leading cause of injury was falls (59.8%). The largest number of injuries was seen during summer. The diagnoses were lateral luxation (27.3%), concussion (17.3%), exarticulation (14.3%), tooth fracture (12.5%), intrusive luxation (11.1%), fracture of alveolar process (7.4%), extrusive luxation (3.7%), and cases with more than one diagnosis (6.3%). Most of the involved teeth were maxillary central incisors, in both dentitions.     

Incidence of temporomandibular joint disorders in patients seen at a hospital emergency room

A retrospective survey of a hospital emergency room population seen at an oral and maxillofacial surgery clinic during a 6-month period found 62 patients (2.7% of the total population) with temporomandibular joint disorders. The diagnoses were myofascial pain-dysfunction/temporomandibular joint dysfunction (MPD/TMJ) syndrome (70.9% of the cases) and dislocation (luxation) (22.5% of the cases). The chief complaint was well defined in relation to the diagnoses: facial pain in the MPD/TMJ syndrome cases, and displacement of the mandible in the dislocation cases.     

Alcohol consumption in emergency room patients and the general population: a population-based study

Our purpose was to obtain epidemiological measures of the association between habitual alcohol consumption, alcohol consumption before the event and alcohol abuse/dependence, and emergency room (ER) attendance compared to the general population in Pachuca-Hidalgo, a city located in the central area of Mexico. The study was a population based case-control design. Data consisted of breath samples to estimated blood alcohol concentration, as well as an interviewer-administered questionnaire, collected on a 24-hr basis, during the entire week, in each of the three main ERs of Pachuca. Cases were all patients who visited the three main hospitals ERs during the study period, classified according to their status as an injured or noninjured (medically ill) patient (n = 1511). The general population sample (n = 920) serves as a comparison group for both types of patients. Injured patients in the ER sample were significantly more likely to report high frequency/high quantity of drinking during the last 12 months than the general population [odds ratio and 95% confidence intervals = 5.55 (1.72-17.97)] and to report drinking within 6 hr before the injury. These relationships did not hold for noninjured patients. Both types of patients were more likely to report high frequency of drunkenness during the preceding 12 months, to be positive for alcohol dependence and to report drug use. We found in the city of Pachuca, a large relationship between habitual alcohol consumption and ER injuries. These findings support associations of alcohol consumption and admission to an emergency room found in ER and general population studies in other countries. Due to the increases in the risk found for abuse/dependent in both injured and noninjured patients, they both would benefit with a brief intervention strategy for reducing their alcohol consumption.     

Analysis of the inappropriate utilization of the emergency service of a third-level hospital

OBJECTIVE: a) To find the reasons for inadequate use of Hospital Casualty Departments (HCDs); b) to discover the general population's levels of information concerning non-hospital Emergency Services (NESs); c) to analyse the relationship between the type of Primary Care Centre (PCC), i.e. whether reformed or not, and inadequate use of HCDs. DESIGN: A crossover study. SETTING: The Germans Trias i Pujol Hospital Casualty Department, Badalona. PATIENTS: A random sample of 321 patients over 14 years old, who were attended for pathologies considered emergencies not requiring hospital treatment. MEASUREMENTS AND MAIN RESULTS: The variables gathered were: age, gender, where the patient came from, reason for hospital use, knowledge of NESs and subsequent referral. 83.2% of patients attended on their own initiative. The main reasons given were "advantages of a hospital" and "the persistence of symptoms." 49% of the patients stated they knew of the NESs. 80% of the patients proceeded from PCCs which had not been reformed. There were no statistically significant differences (p > 0.05) when the variables "reason for use" and "knowledge of NESs" were compared in relation to where the patient came from (i.e. reformed or non-reformed PCC). CONCLUSIONS: General practitioners in reformed PCCs are less likely to refer to HCDs. Knowledge and use of NESs should be actively supported.     

Peer counseling in a general hospital

Self-help groups can aid an individual in coping with and adapting to catastrophic illness. The authors describe a therapeutic technique in which a member of a medical team serves as a catalyst in introducing a "veteran" patient to a newly disabled patient with the same disease or problem so that they can share feelings, experiences, and strategies. Two cases are presented in which patients who were severely depressed benefited from peer counseling. Short-term or "one-shot" encounters can be a valuable way to help some disabled patients deal with the anxiety and helplessness they feel in the acute states of serious disease or injury.     

Emergency admissions to a general hospital. Why emergency admission? Is there an alternative?

A study was conducted where the GPs in a district answered a questionnaire on reasons for hospital admission, divided into the categories: needed hospital investigation, hospital treatment, or needed care and nursing. They judged whether the admission could have been prevented. Finally, a multidisciplinary panel discussed ways to obtain better courses of admission. Of 266 admissions, 40 (15%) were due to a need for care and nursing. Ninety-seven (37%) of the admissions could be replaced by a short one-day stay, and 52 (20%) could have been postponed until the next day if that was possible. The panel discussion showed that municipalities can do more to strengthen the local professional support. It is concluded that the interface between primary care and the hospital should offer better opportunities for one-day admissions or sub-acute admissions, and that municipalities must be more aware of their responsibility for the care of fragile and ill people.     

Monitoring of rotavirus infection in a paediatric hospital by RNA electrophoresis

During the spring of 1987 and the autumn of 1988, stool specimens were collected from infants and young children in the paediatric unit at H. F. Verwoerd Hospital, Pretoria, and examined for the presence of rotaviruses to assess the potential for hospital-acquired infection in the paediatric wards. Stool samples were also collected from children admitted to the hospital for causes unrelated to gastro-enteritis to investigate the possible asymptomatic carriage of rotavirus in this population. Hospital-acquired rotavirus infection was determined in only 9% of cases. Very little asymptomatic carriage of the virus was identified. Electrophoretic analysis of the rotavirus strains showed that the majority of the infections (20 of 42) were associated with a particular strain with a long RNA profile, while 7 minor strains co-circulated (5 with a long electrophoretype and 2 with a short one). An apparent small outbreak of nosocomial infection with a single strain was observed to occur in one of the paediatric wards during the spring and early summer.     

The psychologist as front-line mental health consultant in a general hospital.

Describes the experiences and diverse functions of a psychologist who acts as an independent mental health consultant in a general hospital. Particular attention is paid to problems that arise when psyche and soma interface, because these problems require knowledge of biology as well as of psychology. The appropriateness of this role for the psychologist and its acceptability to referring physicians are examined. The particular strengths of the psychologist as a behavioral scientist and the need for continuing education in differential diagnosis when psychological and physiological factors interact are also explored. Professional boundaries and role relations between psychology and related professions are reviewed. (25 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The difficulties encountered in completing an audit cycle in a district general hospital

Clinical audit has brought about tremendous improvements in the quality of clinical practice in all aspects of health care. However, completing an audit cycle presents many obstacles. We present our experience in the difficulties encountered in implementing changes to current practice. The factors involved are discussed.     

Predictive equation for acquisition of hepatitis B in hospital workers in a general hospital

A cross-sectional study was performed to obtain risk factors for hepatitis B disease, HBsAg carriers and immunised personnel, among 2470 workers in a general hospital in Madrid, Spain. The data obtained were analyzed with multiple logistic regression to obtain beta coefficients for variables. The results of the analysis show that being a nurse or being regularly exposed to blood are the most important risk factors for hepatitis B acquisition. The length of time working at the same job activity was also a risk factor. The resulting beta coefficients allow the construction for a hepatitis non-immunised, HBsAg carrier and immunised HBV status, which can select subjects for a hepatitis B vaccination program.     

The rapid access paediatric clinic: a way to reduce inappropriate admissions to hospital

With documented evidence of increased numbers of paediatric admissions to a reduced number of beds, it is important that children are admitted to hospital for appropriate reasons. Some hospitals have set up rapid access or emergency consultation clinics to try to avoid unnecessary paediatric admissions. This study examined the presenting problem of 451 patients referred by general practitioners (GPs) to the paediatric emergency clinic at Southampton General Hospital over a five month period, and the outcome for the children in terms of investigation, admission or follow-up. The most common presenting problems were gastrointestinal (26.8%), respiratory (22.8%) or infectious (19.1%). Cough or "chestiness" was the single most common presenting symptom. A total of 328 investigations was performed. After the clinic visit, 35.3% of children were discharged, 18.8% were asked to return to the clinic for a follow-up visit and 19.1% were admitted to the ward. 16.4% were given a future paediatric outpatient appointment, 7.3% were referred for specialist opinion in a different speciality, and 6.7% were advised to return to the GP for follow-up. The authors consider that the emergency paediatric clinic is appropriately used by GPs referring acute and sub-acute problems and believe that local satellite clinics run along similar lines would be welcomed by GPs, health visitors and parents. Although there is little documented evidence that rapid access paediatric clinics reduce admission, the authors consider that unnecessary admission was avoided for many of the children seen in the emergency clinic. Prospective studies are needed to confirm this.