A clinical study of dry socket in Sri Lanka

An investigation into the incidence and other features of dry socket in Sri Lanka was considered worthwhile as working conditions, general health of patients and related factors may be different in developing countries. The present study was conducted at two institutes which provide differing facilities and conditions. The overall incidence was found to be 3.5% which is similar to figures reported in the U.K. and Europe. The pattern of dry socket as seen at the two institutes regarding delayed onset, lower molar site specificity, female predominance and relation to difficulty of extraction was similar to each other and to those described in previous studies. These findings support a multifactorial aetiology as does a review of the recent literature.     

A study of condylar fractures in Sri Lankan patients with special reference to the recent views on treatment, healing and sequelae

New opinions have emerged from recent investigations into condylar fractures. With these in mind, 219 patients were investigated with regard to clinical and treatment aspects, healing and complications. These injuries comprised 40.2% of the total number of mandibular fractures. The male:female ratio was 3:1. Single fractures of the condyle occurred in 71.7% while the rest were either bilateral or combined with other mandibular fractures. Treatment was largely conservative, early movement being employed in 68.5%. Open reduction was totally avoided. Restitutional healing of the fractured condyle was observed in children but seldom in adults. Complications were found to be minimal. Ankylosis occurred in 1.4% and growth was deficient in two patients. These findings appear to strengthen the older concepts on treatment although the views on healing of condylar fractures, and mandibular growth may have changed in the last decade.     

Disaster and emergency management: Canadian nurses' perceptions of preparedness on hospital front lines

INTRODUCTION: Three years following the global outbreak of severe acute respiratory syndrome (SARS), a national, Web-based survey of Canadian nurses was conducted to assess perceptions of preparedness for disasters and access to support mechanisms, particularly for nurses in emergency and critical care units. HYPOTHESES: The following hypotheses were tested: (1) nurses' sense of preparedness for infectious disease outbreaks and naturally occurring disasters will be higher than for chemical, biological, radiological, and nuclear (CBRN)-type disasters associated with terrorist attacks; (2) perceptions of preparedness will vary according to previous outbreak experience; and (3) perceptions of personal preparedness will be related to perceived institutional preparedness. METHODS: Nurses from emergency departments and intensive care units across Canada were recruited via flyer mailouts and e-mail notices to complete a 30-minute online survey. RESULTS: A total of 1,543 nurses completed the survey (90% female; 10% male). The results indicate that nurses feel unprepared to respond to large-scale disasters/attacks. The sense of preparedness varied according to the outbreak/disaster scenario with nurses feeling least prepared to respond to a CBRN event. A variety of socio-demographic factors, notably gender, previous outbreak experience (particularly with SARS), full-time vs. part-time job status, and region of employment also were related to perceptions of risk. Approximately 40% of respondents were unaware if their hospital had an emergency plan for a large-scale outbreak. Nurses reported inadequate access to resources to support disaster response capacity and expressed a low degree of confidence in the preparedness of Canadian healthcare institutions for future outbreaks. CONCLUSIONS: Canadian nurses have indicated that considerably more training and information are needed to enhance preparedness for frontline healthcare workers as important members of the response community.     

Are we ready? Evidence of support mechanisms for Canadian health care workers in multi-jurisdictional emergency planning

BACKGROUND: Federal, provincial and municipal leaders in Canada have adopted a culture of preparedness with the development and update of emergency plans in anticipation of different types of disasters. As evident during the 2003 global outbreak of Severe Acute Respiratory Syndrome (SARS), it is important to provide support for health care workers (HCWs) who are vulnerable during infectious outbreak scenarios. Here we focus on the identification and evaluation of existing support mechanisms incorporated within emergency plans across various jurisdictional levels. METHODS: Qualitative content analysis of 12 emergency plans from national, provincial and municipal levels were conducted using NVIVO software. The plans were scanned and coded according to 1) informational, 2) instrumental, and 3) emotional support mechanisms for HCWs and other first responders. RESULTS: Emergency plans were comprised of a predominance of informational and instrumental supports, yet few emotional or social support mechanisms. All the plans lacked gender-based analysis of how infectious disease outbreaks impact male and female HCWs differently. Acknowledgement of the need for emotional supports was evident at higher jurisdictional levels, but recommended for implementation locally. CONCLUSIONS: While support mechanisms for HCWs are included in this sample of emergency plans, content analysis revealed few emotional or social supports planned for critical personnel; particularly for those who will be required to work in extremely stressful conditions under significant personal risk. The implications of transferring responsibilities for support to local and institutional jurisdictions are discussed.     

Demographic, aetiological and survival differences of oral squamous cell carcinoma in the young and the old in Sri Lanka

Oral squamous cell carcinoma (OSCC) is a major oncological problem in many regions of the world where tobacco habits are practiced in the form of chewing and/or smoking with or without alcohol intake. It accounts for 16.5% of all cancers in Sri Lankan patients with a male:female ratio of 4:1. In Sri Lanka nearly 5% of OSCC are diagnosed in young patients. This comparative study describes, demographic, aetiological and survival data from young and old patients with OSCC (n=56). Both younger and older groups showed a marked male predilection (male:female ratio was 4:1 and 3.7:1 in younger and older groups respectively). Tongue was the commonest site for younger group (41%, P<0.01) whilst buccal mucosa (37.5%, P<0.05) and alveolar mucosa (25%, P<0.01) were for older group. 39% of cancers in younger group were not associated with any identifiable risk factor (P<0.01) and 70% of SCC of the tongue has no associated habits (P<0.01). SCC of the tongue in the younger group shows poor prognosis than the older patients. Three-year survival rate for the total number showed no significant difference in two age groups. Survival appeared to be better in patients without associated habits in the older group.