Meaning of aromatherapy massage in mental health

Objective: To understand the meaning of the aromatherapy massage intervention in mental health for the patient during psychiatric hospitalization.Methods: A qualitative study including 22 participants with a diagnosis of personality disorder hospitalized in a psychiatric unit of a general hospital. We used semi-structured interviews with a guiding question for participants, for whom the aromatherapy massage intervention was performed. The content of the interviews was assessed according to content analysis.Results: Among the study subjects, there was a predominance of females and the majority presented a diagnosis of Emotionally Unstable Personality Disorder. Two categories that emerged were identified from qualitative data: "Identifying the benefits of aromatherapy" and "Enabling self-knowledge."Conclusion: The meaning of the aromatherapy massage intervention was represented by improvements in nursing care and treatment during psychiatric hospitalization, while assisting in the reduction of anxiety symptoms and coping with mental illness.

Behavioral measures to reduce non-adherence in renal transplant recipients: a prospective randomized controlled trial

Solid-organ transplant recipients present a high rate of non-adherence to drug treatment. Few interventional studies have included approaches aimed at increasing adherence. The objective of this study was to evaluate the impact of an educational and behavioral strategy on treatment adherence of kidney transplant recipients. In a randomized prospective study, incident renal transplant patients (n = 111) were divided into two groups: control group (received usual transplant patient education) and treatment group (usual transplant patient education plus ten additional weekly 30-min education/counseling sessions about immunosuppressive drugs and behavioral changes). Treatment adherence was assessed using ITAS adherence questionnaire after 3 months. Renal function at 3, 6, and 12 months, and the incidence of transplant rejection were evaluated. The non-adherence rates were 46.4 and 14.5 % in the control and treatment groups (p = 0.001), respectively. The relative risk for non-adherence was 2.59 times (CI 1.38-4.88) higher in the control group. Multivariate analysis demonstrated a 5.84 times (CI 1.8-18.8, p = 0.003) higher risk of non-adherence in the control group. There were no differences in renal function and rejection rates between groups. A behavioral and educational strategy addressing the patient's perceptions and knowledge about the anti-rejection drugs significantly improved the short-term adherence to immunosuppressive therapy.

Educação em saúde bucal na visão de acadêmicos de odontologia

Aim: To analyze dental students' view concerning Oral Health Education. Materials and Methods: The present research, using both qualitative and quantitative approaches, addresses aspects related to dental students' understanding of Oral Health Education, the value that they attach to this practice in the school environment, as well as the importance of their participation in these and other activities during their studies in dentistry. Results: Although dental students recognize the importance of Oral Health Education in the school environment,as well as the importance of their own participation within these activities, their perception of "Oral Health Education" is reductionist and focused primarily on the disease. Conclusion: It is well-known that these findings are reflections and consequences of an established context within a university education. It is therefore necessary that these professional educators perform an in-depth rethinking of the dental practice, in an attempt to develop methodologies based on Health Education in their own teaching practices.

Role of glycated hemoglobin in the care of diabetes mellitus

Introduction: Persistently high glycemic levels are extremely harmful to the organism and can lead patients to several complications of diabetes mellitus. Glycated hemoglobin represents the glycemic levels for what patient is chronically exposed. Methods: Two virtual databases were surveyed in two languages: Portuguese and English. 12 articles were selected and reviewed. Results and discussion: The HbA1c is used since 1958 in the assessment of glycemic control in diabetic patients. It is formed by a chemical reaction between hemoglobin A and acarbohydrate. Each percentage point of glycated hemoglobin represents approximately 35mg/dL in patient's averageglycemia. Conclusion: The glycated hemoglobin should be measured at least twice per year in patients with diabetes in general. In case of change of hypoglycemic therapy, this frequency should be doubled.

Validação de constructo de tecnologia educativa para pacientes mediante aplicação da técnica Delphi

OBJETIVO: Descrever o processo de validação de uma tecnologia educativa para pacientes submetidos à cirurgia ortognática, mediante a aplicação da técnica Delphi. MÉTODOS: Participaram do estudo, dez juízes (quatro cirurgiões bucomaxilofaciais, duas enfermeiras, duas nutricionistas e duas fonoaudiólogas) que indicaram os assuntos a serem abordados no material destinado à primeira fase da técnica Delphi. Após a construção do material e a obtenção dos resultados da primeira fase, iniciou-se as segunda e terceira fases dessa técnica com validação da pertinência das informações contidas nessa tecnologia educativa. RESULTADOS: Na segunda rodada, obteve-se, pelo menos, 90,0% de concordância em todas as categorias. Na terceira, houve um aumento de 12% para o item conteúdo, melhora de 6,7% em linguagem, de 12,5% em ilustrações, de 3,3% no layout, de 10% em cultura, mantendo-se constante o item motivação. CONCLUSÃO: A técnica Delphi, pode ser uma importante ferramenta na construção e validação de tecnologias educativas.

Melhora da dor, do cansaço e da qualidade subjetiva do sono por meio de orientações de higiene do sono em pacientes com fibromialgia

OBJETIVO: Avaliar a efetividade das orientações para higiene do sono em mulheres portadoras de fibromialgia. MATERIAIS E MÉTODOS: Setenta mulheres completaram o estudo. Na avaliação foram aplicados o Questionário de Impacto da Fibromialgia(FIQ), o Índice de Qualidade do Sono de Pittsburgh (PSQI) e um questionário geral, com dados pessoais e informações de hábitos de vida. Todas as pacientes receberam informações quanto à doença, além de um diário do sono, e apenas o grupo-experimental recebeu orientações para higiene do sono. Foi solicitado às pacientes que realizassem a higiene do sono, e as mesmas foram reavaliadas após três meses. RESULTADOS: A idade média das pacientes do grupo-controle foi 55,2 ± 7,12 anos, e a do grupo-experimental foi 53,5 ± 8,89 anos (P = 0,392). Nessas pacientes foram observadas diminuições da medida de Escala Visual Analógica de dor (P = 0,028), de cansaço (P = 0,021) e do componente 1 do PSQI (P = 0,030). O grupo que recebeu orientações para higiene do sono mostrou redução significativa na dificuldade de retorno ao sono quando acordava de madrugada (P = 0,031). O grupo-experimental apresentou aumento na porcentagem de relatos de "ambiente sem ruído" (variando de 42,9% para 68,6%), diminuição da porcentagem de relatos de "ambiente com pouco ruído" (variando de 40% para 22,9%) e diminuição na porcentagem de relatos de "ambiente com muito ruído" (variando de 17,1% para 8,6%). As alterações facilitaram o retorno ao sono quando as pacientes acordavam durante a madrugada. CONCLUSÃO: Uma cartilha com orientações de higiene do sono permitiu a alteração do comportamento das pacientes, que obtiveram melhora da dor e do cansaço, aumento da qualidade subjetiva do sono, além de facilitação do retorno ao sono após despertar durante a madrugada.

La professione docente tra rappresentazioni e progetto formativo. Un'analisi pedagogica della competenza degli insegnanti secondari

This thesis deals with the professional characteristics of secondary school teachers, with particular regard to their competence and their education. The topic will be approached starting from the characteristics and trasnformations social research has identified concerning Italian teachers, focusing on secondary teacher training. After a brief look at Europe, the attention will be directed to Italy, with particular regard to the Postgraduate Schools of Specialisation for Secondary School Teachers (SSIS); hence the need for an analysis that focuses on teaching per se and its concrete pratice. For its nature to be fully grasped, teaching must be reconsidered as an independent object of study, a performance in which competence manifests itself and a form of action involving a set of tacit and personal knowledge. A further perspective opens up for analysis, according to which the professional characteristics of teachers are the result of an education in which the whole history of the subject is involved, in its educative, formative, professional and personal aspects. The teaching profession is imbued with implicit meanings which are inaccessible to conscience but orient action and affect the interpretation of experience. Through the analysis of three different empirical data sets, collected among teachers-in-training and teachers qualified at SSIS, I will try to investigate the actual existence, the nature and the features of such implicit knowledge. It appears necessary to put the claims of process-product approaches back in their right perspective, to the benefit of a holistic conception of teaching competence. The teacher is, at the same time, “he who is teaching” and offers a concrete receiver the fruit of an endless work of study, reflection, practice and self-update. To understand this process will mean to penetrate more and more deeply into the core of teaching and teaching competence , a competence that in some respects “is” always “that” teacher, with his or her own story, implicit knowledge and representations.

Neue Aspekte zur effektiven bronchialen Applikation inhalativer Medikamente im Kindesalter

Zur bronchialen Deposition von Arzneimitteln stehen im Wesentlichen drei Inhalationssysteme zur Verfügung: (1) Dosier-Aerosole (pressurized Metered Dose Inhaler, pMDI), (2) Trockenpulver-Inhalatoren (Dry Powder Inhaler, DPI) und (3) Druckluftvernebler zur Feuchtinhalation. Der Erfolg einer Inhalationstherapie hängt neben anderen Faktoren (s.u.) wesentlich vom Depositionsverhalten des als Aerosol inhalierten Medikamentes ab. Wie viel wirksame Substanz lagert sich an welchen Stellen der Atemwege ab und welche Dosis erreicht letztlich die kleinen Atemwege? Einflussfaktoren sind hier vor allem die Partikelgröße und die Inhalationstechnik. So verlangen beispielsweise DPI’s einen respiratorischen Spitzenfluss (PIF) von mindestens 30 l/min, wohingegen bei der Verwendung von pMDI’s ein gleich bleibender PIF von 40 bis 90 l/min erwünscht ist. Die für das jeweilige Inhalationssystem optimale Atemtechnik muss also vom Patienten erlernt werden. Mit den eigenen Arbeiten soll das Verständnis inhalativer Vorgänge sowie die bronchiale Deposition von inhalativen Medikamenten bei pädiatrischen Patienten verbessert werden. Aus der Vielzahl der Inhalatoren wählten wir für unsere Versuche fünf Systeme aus, deren unterschied-liche Anforderungen an den Patienten repräsentativ überprüft wurden: (1) DPI mit mittlerem Widerstand: Diskus®, (2) DPI mit hohem Widerstand: Turbohaler®, (3) pMDI: Autohaler®, (4) pMDI für Säuglinge: Budiair® mit verschiedenen Vorsatzkammern (Babyhaler®, AeroChamber® Plus small und medium) und (5) nachfüllbarer DPI mit niedrigem Widerstand: MAGhaler®. Für unsere Studien unverzichtbar war außerdem ein Testsystem, mit dem die Fähigkeit der Patienten überprüft und verbessert werden kann, einen bestimmten Inhalator effektiv zu benutzen, d.h. das gewünschte Atemmanöver durchzuführen und damit eine optimale Medikamenten-Deposition zu erreichen. Erste Untersuchungen ergaben, dass die kommerziell auf dem Markt verfügbaren Testsysteme suboptimal sind, weil sie sich nur auf die Messung des PIF’s konzentrieren und andere für die Deposition wichtige Parameter (Beschleunigung, Inhaltionsdauer etc.) außer Acht lassen. Wir entwickelten daher den Inhalation-Manager, der die Dokumentation des gesamten Atemmanövers ermöglicht. Es handelt sich dabei um ein computerbasiertes Mess- und Kontrollsystem, das unmittelbar nach der Inhalation ein optisches feedback des gesamten Manövers inklusive des generierten Partikelspektrums liefert. Die daraus weiterentwickelte Schulungssoftware ermöglicht die individuelle Schulung verschiedener Inhalationsmanöver auch mit neuen Inhalatoren. Patient und Arzt erhalten eine optische Rückmeldung, die den Erfolg oder Misserfolg der Inhalation erkennen lässt. Erste Schulungen mit dem neuen System von pädiatrischen Patienten mit Asthma bronchiale verliefen positiv: der Anteil der optimalen Inhalationsmanöver und damit auch der Therapieerfolg stiegen an. Allerdings zeigte sich auch, dass verschiedene Systeme nicht gleichzeitig geschult werden sollten. Generelle Schwierigkeiten bereitet die Inhalationstherapie von Kindern bis etwa zum 4. Geburtstag, da diese meist gar kein Inhalationsmanöver erlernen können. Die Medikamente müssen somit durch den Ruheatemfluss ins Bronchialsystem transportiert werden, wobei Dosieraerosole mit Vorsatzkammern (Spacer) oder Vernebler mit Masken zum Einsatz kommen sollten. Bei der Inhalation mit Spacer war bislang unklar, wie viel Prozent der Nominaldosis letztlich in die Lunge gelangen und therapeutisch wirksam werden. Unsere in-vitro Studien mit einem Dosieraerosol und verschiedenen Spacern zeigten, dass nach fünf Atemzügen maximal 20% der Nominaldosis das Gerät bzw. den Spacer verlassen. Nach nur einem Atemzug und bei Verwendung bestimmter Spacer (großes Totraumvolumen) beträgt dieser Wert sogar nur 5%. Dieses Ergebnis belegt, dass man vom Säuglings- bis zum Erwachsenenalter nahezu die gleiche Nominaldosis verabreichen kann, da durch unterschiedliche Inhalationsmanöver und –systeme die wirksame Dosis extrakorporal auf die altersentsprechende Dosis reduziert wird. Ein besonderes Problem ergibt sich schließlich bei der Feuchtinhalation mit Druckluftverneblern. Hier darf die Kompatibilität von unterschiedlichen Inhalationslösungen nicht außer Acht gelassen werden. So gaben in unserer Mukoviszidose-Ambulanz viele Betroffene an, aus Zeitgründen unterschiedliche Inhalationslösungen bei der Feuchtinhalation zu mischen. Physikalisch-chemische Inkompatibilitäten können dann die Wirksamkeit der Therapie beeinträchtigen und auch zu unerwünschten Nebenwirkungen führen. In einer interdisziplinären Arbeitsgruppe mit Chemikern und Pharmazeuten untersuchten wir daher die Mischbarkeit von häufig genutzten Inhalationslösungen (Salbutamol, Ipratropium, Cromoglicinsäure, Budenosid, Tobramycin und Dornase Alpha) und stellten die Ergebnisse (mögliche Inhaltionskombinationen) tabellarisch zusammen.

Attivita' fisica adattata nella riabilitazione post-ictus: Risultati al follow-up di 12 mesi

L’ictus è un importante problema di salute pubblica, è causa di morte e disabilità nella popolazione anziana. La necessità di strategie di prevenzione secondaria e terziaria per migliorare il funzionamento post-ictus e prevenire o ritardare altre condizioni disabilitanti, ha portato l’Italia a sviluppare un intervento di Attività Fisica Adattata (AFA) per l’ictus, che permettesse di migliorare gli esiti della riabilitazione. Obiettivo dello studio è di valutare se l’AFA unita all’Educazione Terapeutica (ET), rispetto al trattamento riabilitativo standard, migliora il funzionamento e la qualità di vita in pazienti con ictus. Studio clinico non randomizzato, in cui sono stati valutati 229 pazienti in riabilitazione post-ictus, 126 nel gruppo sperimentale (AFA+ET) e 103 nel gruppo di controllo. I pazienti sono stati valutati al baseline, a 4 e a 12 mesi di follow-up. Le misure di esito sono il cambiamento a 4 mesi di follow-up (che corrisponde a 2 mesi post-intervento nel gruppo sperimentale) di: distanza percorsa, Berg Balance Scale, Short Physical Performance Battery, e Motricity Index. Le variabili misurate a 4 e a 12 mesi di follow-up sono: Barthel Index, Geriatric Depression Scale, SF-12 e Caregiver Strain Index. La distanza percorsa, la performance fisica, l’equilibrio e il punteggio della componente fisica della qualità di vita sono migliorate a 4 mesi nel gruppo AFA+ET e rimasti stabili nel gruppo di controllo. A 12 mesi di follow-up, il gruppo AFA+ET ottiene un cambiamento maggiore, rispetto al gruppo di controllo, nell’abilità di svolgimento delle attività giornaliere e nella qualità di vita. Infine il gruppo AFA+ET riporta, nell’ultimo anno, un minor numero di fratture e minor ricorso a visite riabilitative rispetto al gruppo di controllo. I risultati confermano che l’AFA+ET è efficace nel migliorare le condizioni cliniche di pazienti con ictus e che gli effetti, soprattutto sulla riabilitazione fisica, sono mantenuti anche a lungo termine.

Ambienti innovativi per l'apprendimento: Modelli interpretativi e contributi di esperienze. Uno studio sull'organizzazione di Scuola-Città Pestalozzi a Firenze

La tesi affronta il tema dell'innovazione della scuola, oggetto di costante attenzione da parte delle organizzazioni internazionali e dei sistemi educativi nazionali, per le sue implicazioni economiche, sociali e politiche, e intende portare un contributo allo studio sistematico e analitico dei progetti e delle esperienze di innovazione complessiva dell'ambiente di apprendimento. Il concetto di ambiente di apprendimento viene approfondito nelle diverse prospettive di riferimento, con specifica attenzione al framework del progetto "Innovative Learning Environments" [ILE], dell’Organisation For Economic And Cultural Development [OECD] che, con una prospettiva dichiaratamente olistica, individua nel dispositivo dell’ambiente di apprendimento la chiave per l’innovazione dell’istruzione nella direzione delle competenze per il ventunesimo Secolo. I criteri presenti nel quadro di riferimento del progetto sono stati utilizzati per un’analisi dell’esperienza proposta come caso di studio, Scuola-Città Pestalozzi a Firenze, presa in esame perché nell’anno scolastico 2011/2012 ha messo in pratica appunto un “disegno” di trasformazione dell’ambiente di apprendimento e in particolare dei caratteri del tempo/scuola. La ricerca, condotta con una metodologia qualitativa, è stata orientata a far emergere le interpretazioni dei protagonisti dell’innovazione indagata: dall’analisi del progetto e di tutta la documentazione fornita dalla scuola è scaturita la traccia per un focus-group esplorativo attraverso il quale sono stati selezionati i temi per le interviste semistrutturate rivolte ai docenti (scuola primaria e scuola secondaria di primo grado). Per quanto concerne l’interpretazione dei risultati, le trascrizioni delle interviste sono state analizzate con un approccio fenomenografico, attraverso l’individuazione di unità testuali logicamente connesse a categorie concettuali pertinenti. L’analisi dei materiali empirici ha permesso di enucleare categorie interpretative rispetto alla natura e agli scopi delle esperienze di insegnamento/apprendimento, al processo organizzativo, alla sostenibilità. Tra le implicazioni della ricerca si ritengono particolarmente rilevanti quelle relative alla funzione docente.

Significance of Periodontal Risk Assessment in the recurrence of periodontitis and tooth loss

Aim: To investigate the association of the Periodontal Risk Assessment (PRA) model categories with periodontitis recurrence and tooth loss during supportive periodontal therapy (SPT) and to explore the role of patient compliance. Material and Methods: In a retrospective cohort, PRA was performed for 160 patients after active periodontal therapy (APT) and after 9.5 ± 4.5 years of SPT. The recurrence of periodontitis and tooth loss were analysed according to the patient's risk profile (low, moderate or high) after APT and compliance with SPT. The association of risk factors with tooth loss and recurrence of periodontitis was investigated using logistic regression analysis. Results: In 18.2% of patients with a low-risk profile, in 42.2% of patients with a moderate-risk profile and in 49.2% of patients with a high-risk profile after APT, periodontitis recurred. During SPT, 1.61 ± 2.8 teeth/patient were lost. High-risk profile patients lost significantly more teeth (2.59 ± 3.9) than patients with moderate- (1.02 ± 1.8) or low-risk profiles (1.18 ± 1.9) (Kruskal–Wallis test, p=0.0229). Patients with erratic compliance lost significantly (Kruskal–Wallis test, p=0.0067) more teeth (3.11 ± 4.5) than patients compliant with SPT (1.07 ± 1.6). Conclusions: In multivariate logistic regression analysis, a high-risk patient profile according to the PRA model at the end of APT was associated with recurrence of periodontitis. Another significant factor for recurrence of periodontitis was an SPT duration of more than 10 years.

Advanced heart failure - treatment options beyond medical management

Improvement of heart failure therapy has led to a far better survival and quality of life of patients. Treatment of the underlying disease, patient education and improvement of compliance and consequent upgrading of medical heart failure therapy often delays further progression to an advanced stage of heart failure. Nevertheless heart failure remains a chronic progressive disease and it is up to the treating clinician to identify the signs of advanced heart failure in a timely manner in order to evaluate patients for further treatment strategies such as heart transplantation. This article should help define advanced heart failure and illustrate how patients are evaluated for further therapy. Outcome of heart transplantation or mechanically assisted circulatory support is strongly associated to proper patient selection and timing.

Pre- and posttransplant management of solid organ transplant recipients: risk-adjusted follow-up

Solid organ transplant recipients (SOTR) have an increased risk of skin cancer due to their long-term immunosuppressive state. As the number of these patients is increasing, as well as their life expectancy, it is important to discuss the screening and management of skin cancer in this group of patients. The role of the dermatologist, in collaboration with the transplant team, is important both before transplantation, where patients are screened for skin lesions and the individual risk for skin cancer development is assessed, and after transplantation. Posttransplant management consists of regular dermatological consultations (the frequency depends on different factors discussed below), where early skin cancer screening and management, as well as patient education on sun protective behavior is taught and enforced. Indeed, SOTR are very sensitive to sun damage due to their immunosuppressive state, leading to cumulative sun damage which results in field cancerization with numerous lesions such as in situ squamous cell carcinoma, actinic keratosis and Bowen's disease. These lesions should be recognized and treated as early as possible. Therapeutic options discussed will involve topical therapy, surgical management, adjustment of the patient's immunosuppressive therapy (i.e. reduction of immunosuppression and/or switch to mammalian target of rapamycin inhibitors) and chemoprevention with the retinoid acitretin, which reduces the recurrence rate of squamous cell carcinoma. The dermatological follow-up of SOTR should be integrated into the comprehensive posttransplant care.

Clinical evaluation of 3 overdenture concepts with tooth roots and implants: 2-year results

PURPOSE: In the present cohort study, overdentures with a combined root and implant support were evaluated and compared with either exclusively root- or implant-supported overdentures. Results of a 2-year follow-up period are reported, namely survival of implants, root copings, and prostheses, plus prosthetic complications, maintenance service, and patient satisfaction. MATERIALS AND METHODS: Fourteen patients were selected for the combined overdenture therapy and were compared with 2 patient groups in which either roots or implants provided overdenture support. Altogether, 14, 17, and 15 patients (in groups 1, 2, and 3, respectively) were matched with regard to age, sex, treatment time, and observation period. The mean age was around 67 years. Periodontal parameters were recorded, radiographs were taken, and all complications and failures were registered during the entire observation time. The patients answered a 9-item questionnaire by means of a visual analogue scale (VAS). RESULTS: One implant failed and 1 tooth root was removed following longitudinal root fracture. Periodontal/peri-implant parameters gave evidence of good oral hygiene for roots and implants, and slight crestal bone resorption was measured for both. Technical complications and service performed were significantly higher in the first year (P < .04) in all 3 groups and significantly higher in the tooth root group (P < .03). The results of the VAS indicated significantly lower scores for satisfaction, speaking ability, wearing comfort, and denture stability with combined or exclusive root support (P < .05 and .02, respectively). Initial costs of overdentures with combined or root support were 10% lower than for implant overdentures. CONCLUSION: The concept of combined root and implant support can be integrated into treatment planning and overdenture design for patients with a highly reduced dentition.

Outcome and patients' satisfaction after functional treatment of acute lateral ankle injuries at emergency departments versus family doctor offices

BACKGROUND: In some Western countries, more and more patients seek initial treatment even for minor injuries at emergency units of hospitals. The initial evaluation and treatment as well as aftercare of these patients require large amounts of personnel and logistical resources, which are limited and costly, especially if compared to treatment by a general practitioner. In this study, we investigated whether outsourcing from our level 1 trauma center to a general practitioner has an influence on patient satisfaction and compliance. METHODS: This prospective, randomized study, included n = 100 patients who suffered from a lateral ankle ligament injury grade I-II (16, 17). After radiological exclusion of osseous lesions, the patients received early functional treatment and were shown physical therapy exercises to be done at home, without immobilization or the use of stabilizing ortheses. The patients were randomly assigned into two groups of 50 patients each: Group A (ER): Follow-up and final examination in the hospital's emergency unit. Group B (GP): Follow-up by general practitioner, final examination at hospital's emergency unit. The patients were surveyed regarding their satisfaction with the treatment and outcome of the treatment. RESULTS: Female and male patients were equally represented in both groups. The age of the patients ranged from 16 - 64 years, with a mean age of 34 years (ER) and 35 years (GP). 98% (n = 98) of all patients were satisfied with their treatment, and 93% (n = 93) were satisfied with the outcome. For these parameters no significant difference between the two groups could be noted (p = 0.7406 and 0.7631 respectively). 39% of all patients acquired stabilizing ortheses like ankle braces (Aircast, Malleoloc etc.) on their own initiative. There was a not significant tendency for more self-acquired ortheses in the group treated by general practicioners (p = 0,2669). CONCLUSION: Patients who first present at the ER with a lateral ankle ligament injury grade I-II can be referred to a general practitioner for follow-up treatment without affecting patient satisfaction regarding treatment and treatment outcome.