Patterns of emergency maxillofacial referrals and provision of services

The rising number of maxillofacial injuries in the UK requires a reappraisal of emergency services within our specialty. Although the impact of a dedicated trauma list has been reported, it has not been widely embraced, and we know of few data that help to plan the number or timing of such lists. We designed a minimum dataset to collect information about referral, cause of emergency, assessment of patients, and outcome during 2003 and 2004. Theatre data were examined retrospectively to analyse operations during the same period. We conclude that to serve a population of 2.6 million a minimum of 8 emergency lists are required each week to deal with non-complex cases; this equates to 3 lists/million population. The lists should be concentrated at weekends and early in the week.     

Guidelines for the management of traumatic dental injuries. III. Primary teeth

Abstract –  Trauma to the primary dentition present special problems and the management is often different as compared with permanent teeth. An appropriate emergency treatment plan is important for a good prognosis. Guidelines are useful for delivering the best care possible in an efficient manner. The International Association of Dental Traumatology (IADT) has developed a consensus statement after a review of the dental literature and group discussions. Experienced researchers and clinicians from various specialties were included in the group. In cases in which the data did not appear conclusive, recommendations were based on the consensus opinion of the IADT board members. The guidelines represent the current best evidence based on literature research and professional opinion. In this third article out of three, the IADT Guidelines for the management of traumatic injuries in the primary dentition, are presented.     

Effects of specular component on color differences of different filler type resin composites after aging

Objective

This study evaluated the effects of specular component mode of specular component excluded (SCE) and specular component included (SCI) on color changes of different filler type resin composites after aging of 1 week and 1 year.

Methods

Resin composites and shades used in this study were submicron-filled Estelite Σ (Σ: Inc, A2, A3, B3, C2, OA2, OA3) and nanofilled Filtek Supreme XT (XT: Clear, A2E, A2B, A3B, C2B, A2D, A3D). Resin disks of 2 mm in thickness and final polish with 2400-grit silicon carbide paper were stored in 100% relative humidity. One-week and 1-year after curing, the colors of the composite disks were measured with a spectrophotometer in SCI and SCE modes.

Results

For both 1-week and 1-year specimens, the values of L* with SCI were significantly higher than SCE for all shades of Σ and XT; however, a* and b* were depended on brands and shades. Comparing 1-week and 1-year values, ΔE*ab ranged 1.5 (A3 and B3)–2.9 (Inc) with SCI and 1.4 (A3)–2.9 (Inc) with SCE for Σ, and 1.1 (A3D)–7.1 (Clear) with SCI and 1.4 (A3D)–7.6 (Clear) with SCE for XT. The values of ΔE*ab with SCE were higher than those of SCI for all shades of XT; however, for Σ, the differences varied with shades.

Conclusion

Specular component mode (SCE vs. SCI) significantly influenced L* values; however, the color differences affected by aging were dependent on brands and shades of the resin composites tested.     

Rising to the challenges of the pandemic: Telehealth innovations in U.S. emergency departments

ObjectiveDuring the first 9 months of the coronavirus disease 2019 (COVID-19) pandemic, many emergency departments (EDs) experimented with telehealth applications to reduce virus exposure, decrease visit volume, and conserve personal protective equipment. We interviewed ED leaders who implemented telehealth programs to inform responses to the ongoing COVID-19 pandemic and future emergencies.Materials and MethodsFrom September to November 2020, we conducted semi-structured interviews with ED leaders across the United States. We identified EDs with pandemic-related telehealth programs through literature review and snowball sampling. Maximum variation sampling was used to capture a range of experiences. We used standard qualitative analysis techniques, consisting of both inductive and deductive approaches to identify and characterize themes.ResultsWe completed 15 interviews with EDs leaders in 10 states. From March to November 2020, participants experimented with more than a dozen different types of telehealth applications including tele-isolation, tele-triage, tele-consultation, virtual postdischarge assessment, acute care in the home, and tele-palliative care. Prior experience with telehealth was key for implementation of new applications. Most new telehealth applications turned out to be temporary because they were no longer needed to support the response. The leading barriers to telehealth implementation during the pandemic included technology challenges and the need for “hands-on” implementation support in the ED.ConclusionsIn response to the COVID-19 pandemic, EDs rapidly implemented many telehealth innovations. Their experiences can inform future responses.     

Self‐rated preparedness of Australian prevocational hospital doctors for emergencies

Objective: To determine perceived preparedness of Australian hospital‐based prevocational doctors for resuscitation skills and management of emergencies, and to identify differences between doctors who perceive themselves well prepared and those who perceive themselves poorly prepared for emergencies, in demographics and exposure to desired learning methods. Methods: Questionnaire consisting of a mix of graded Likert scales and free‐text answers distributed to 36 Australian hospitals for secondary distribution to hospital medical officers. Results: From 2607 questionnaires posted, 470 (18.1%) were returned. Thirty‐one per cent (95% confidence interval [CI] 26–35%) felt well prepared for resuscitation and management of emergencies, 41% (CI 37–45%) felt adequately prepared and 28% (CI 24–32%) felt they were not well prepared. Those who felt well prepared reported that they had experienced more exposure to a range of educational methods, including consultant contact, supervisor feedback, clinical skills, high fidelity simulator sessions and unit meetings. Well‐prepared and poorly prepared doctors had similar opinions of the usefulness of various learning methods, but the poorly prepared group more frequently expressed a desire for increased exposure to contact with registrars and consultants, clinical skills sessions and hospital and unit meetings. There were no differences in gender, age or country of origin (Australia vs international medical graduates) between those who felt well or poorly prepared. Conclusions: Many prevocational hospital doctors feel inadequately prepared for the management of emergencies. Perceived preparedness is associated with more exposure to particular educational activities. Increasing exposure to learning of emergencies in undergraduate and prevocational years could reduce the number of junior doctors who feel poorly prepared for emergencies.     

Integrating public health students into interprofessional education

ABSTRACT

Recognizing the public health professional are critical members of interprofessional teams, the Council on Education for Public Health (CEPH) recently added a required Masters of Public Health (MPH) student competency focused on interprofessional education (IPE). A student-centered approach to the design and evaluation of an emergency preparedness-focused curricular program to meet the interprofessional needs of MPH students was used to meet this expectation at the University of Washington. Curriculum design was informed by two 80-minute listening sessions with MPH students to better understand their current interprofessional educational experiences and needs, and how an emergency preparedness-focused two-hour Interprofessional Active Learning Series (iPALS) session could help them develop interprofessional competency. The resultant iPALS session was assessed with a short, paper-based questionnaire. We found MPH students have an interest in participating in IPE, and that all students who participated in the emergency preparedness-focused iPALS session reported significant increases in their interprofessional and disaster response abilities based on their pre- and post-session evaluations. Student-centered IPE curriculum focused on emergency preparedness can enhance the self-reported ability of students across the health sciences to perform on interprofessional teams while engaging in a topic that has relevance to MPH students.     

Surgical delay in acute admissions on warfarin: are we doing enough?

Warfarin anti-coagulation can cause significant delay in acute surgical admissions. We reviewed fracture neck of femur patients operated over a period of 4 years in our unit. There was an average delay to surgery of 4.36 days in patients on warfarin as against an average delay of 1.78 days in patients not on warfarin (p < 0.001). The review was followed up with a questionnaire-based survey of consultant haematologists, and a general agreement towards a protocol-based use of vitamin K(1) was noted. The reasons for limited use of vitamin K(1) include the lack of studies and guidelines specifically addressing the pre-operative emergency admissions. We highlight a practical problem shared across different specialities and identify the areas for future studies.     

2型糖尿病健康教育的研究进展

从2型糖尿病健康教育团队的组成、教育模式、教育内容（2型糖尿病的危害、预防、饮食、运动、心理、药物及血糖监测的护理）及效果评价概括2型糖尿病健康教育的研究进展，归纳总结出2型糖尿病健康教育中存在的不足，并提出相关对策，以提高2型糖尿病健康教育的质量。