Past-Year Intentional and Unintentional Injury Among Teens Treated in an Inner-City Emergency Department

An inner-city emergency department (ED) visit provides an opportunity for contact with high-risk adolescents to promote injury prevention. Objectives: To identify the prevalence of injuries sustained over the past year by teens presenting to an inner-city ED, and to identify factors associated with recent injury to inform future ED-based injury prevention initiatives. Methods: Over 1 year, 7 days a week, from 1:00–11:00 p.m., patients aged 14–18 years presenting to the ED participated in a survey regarding past-year risk behaviors and injuries. Results: Of the entire group of teens presenting to the ED (n = 1128) who completed the survey (83.8% response rate), 46% were male, and 58% were African-American. Past-year injuries were reported by 768 (68.1%) of the teens; 475 (61.8%) of those reported an unintentional injury and 293 (38.1%) reported an intentional injury. One-third of all youth seeking care reported a past-year sports-related injury (34.5%) or an injury related to driving or riding in a car (12.3%), and 8.2% reported a gun-related injury. Logistic regression found that binge drinking (adjusted odds ratio [AOR] 1.95) and illicit weapon carrying (AOR 2.31) predicted a past-year intentional injury. African-American youth (AOR 0.56) and those receiving public assistance (AOR 0.73) were less likely to report past-year unintentional injuries. Conclusions: Adolescents seeking care in an inner-city ED, regardless of the reason for seeking care, report an elevated prevalence of recent injury, including violence. Future injury screening and prevention efforts should consider universal screening of all youth seeking ED care.     

A Preliminary Survey of Impression Trays Used in the Fabrication of Fixed Indirect Restorations

Purpose: A variety of impression trays are used in the fabrication of fixed indirect restorations. Impressions used in the construction of fixed indirect restorations were examined for tray type, manner of use, and overall impression quality.
Materials and Methods: A commercial dental laboratory provided 1403 impressions used to fabricate fixed indirect restorations during a 3-month period. Impressions were examined for tray type, quantity and type of recorded abutments, the impression of intact teeth adjacent to and opposing the abutment, the presence of the canine in the impression, and an assessment of the quality of the impression.
Results: A majority of trays examined were plastic (864, or 61.6%). Dual-arch trays comprised 73.1% of the total. Most of these were metal posterior (n = 499) or plastic posterior (n = 280). Among partial dual-arch impressions, 561 (55.7%) were for the single abutment restoration, bounded by intact teeth anterior and posterior, and with an intact opposing tooth. Eleven percent of plastic dual-arch impressions failed to register the canine. Regarding restoration type, there were 955 impressions for the single-tooth crown, 46 for implant-supported restorations, and 11 for veneers. Twenty impressions were for posts, inlays, or onlays. Impressions for multiple single-tooth crowns and fixed partial dentures comprised the remainder. In terms of overall quality, 85.3% of impressions were excellent or good. The lowest performance in terms of excellent quality was in the anterior plastic single-arch impression (44.8%), whereas the best rate of excellent quality noted was for the posterior dual-arch impression (82.4%).
Conclusions: Within the limitations of this study, dual-arch trays were the most commonly used tray. Recommendations for the use of the dual-arch tray were not followed in a substantial number of impressions examined.     

Senior Health Clinics: Are They Financially Viable?

Are hospital‐based outpatient interdisciplinary clinics a financially viable alternative for caring for our burgeoning population of older adults in America? Although highly popular, with high patient satisfaction rates among older adults and their families, senior health clinics (SHCs) can be expensive to operate, with limited quantifiable health outcomes. This study analyzed three geriatric hospital‐based interdisciplinary clinics in rural Arkansas by examining their patient profiles, revenues, and expenses. It closely examined the effects of the downstream revenue using the multiplier effect and acknowledged other factors that weigh heavily on the success of SHCs and the care of older adults. The findings highlight the similarities and differences in the three clinics' operating and financial structures in addition to the clinics' and providers' productivity. The analysis presents an evidence‐based illustration that SHCs can break even or lose large amounts of money.     

Top Ten List of Long‐Term Care Facility Preparations for the Upcoming Influenza Season

A novel influenza A partly of virus of swine origin (2009 H1N1) emerged this spring, resulting in an influenza pandemic. This pandemic is anticipated to continue into the next influenza season. Given that the 2009 H1N1 and seasonal influenza A appear to be somewhat different in the human populations affected and that two influenza vaccines will be recommended this fall, those who manage long‐term care facilities and treat patients in them will be faced with many uncertainties as they approach the 2009/10 influenza season. Ten specific suggestions are offered to those responsible for the care of patients in long‐term care facilities regarding the upcoming influenza season. These practical suggestions are the clinical opinions of the authors and do not represent official recommendations of the American Geriatrics Society or any agency.     

Determinants of Physician Vacancy Rates in Rural Hospitals

This study examines the determinants of physician vacancy rates in rural hospitals from the perspective of the rural hospital administrator. Data on community characteristics, hospital characteristics, and hospital recruitment strategies are examined for 50 rural hospitals in Kentucky using questionnaire and archival data. Physician vacancy rates in this sample were quite high (mean of 37 percent). Results indicate lower physician vacancy rates in hospitals with a chain affiliation. In addition, the "job shopping" model for physicians decisions on where to practice (Johnson, 1978) is supported. Hospitals that target physician candidates with more work experience display lower physician vacancy rates. Generally, hospital characteristics were more significant predictors of physician vacancy rates than were community characteristics. Implications for rural hospital physician recruitment/retention strategies are discussed.