Knowledge of general dentists in the current guidelines for emergency treatment of avulsed teeth and dental trauma prevention

A high prevalence of dental trauma exists and its effects on function and esthetics deserve the attention of general dentists. The aim of this study was to assess the level of general dental practitioners' (GDPs) knowledge about guidelines for dental avulsion and its prevention using a questionnaire. The 21-item questionnaire was distributed among 264 GDPs and the survey was realized between August-November 2006. The data obtained were statistically analyzed using descriptive analysis and Pearson's Chi-square test to determine associations between knowledge regarding emergency treatment and dentists from public or private dental schools and years of experience. The results showed that the participants exhibited appropriate knowledge concerning procedures in cases of tooth avulsion and its prevention. The number of correct answers was low in relation to recommended treatment at the site of injury. Storage medium, preparation of the alveolus and splint time for receiving the avulsed tooth received a high number of correct answers. One statistically significant association between years of experience and recommended treatment at the site of the injury in the case an avulsed tooth (KH2 = 9.384, P = 0.009). In conclusion, this survey showed appropriate knowledge of dental avulsion management and its prevention among the surveyed dentists. The findings also showed that communication between dentists and the population is deficient, especially concerning practitioners of high risk and contact sports.

Illinois rape victims emergency treatment act and rules and regulations effective February, 1987 [and,] : title 77 : Public health, Chapter I : Department of Public Health, Subchapter f : Emergency Services and Highway Safety, Part 545 : The treatment of sexual assault.

Includes text of Rape Victims Emergency Treatment Act.

Illinois Sexual Assault Survivors Emergency Treatment Act : and rules and regulations effective December 1, 1988.

"Title 77: Public Health; Chapter I: Department of Public Health; Subchapter f: Emergency services and highway safety; Part 545: The Treatment of sexual assault survivors."

Implementing an emergency department patient admission predictive tool : insights from practice

Purpose: This paper aims to show that identification of expectations and software functional requirements via consultation with potential users is an integral component of the development of an emergency department patient admissions prediction tool. ---------- Design/methodology/approach: Thematic analysis of semi-structured interviews with 14 key health staff delivered rich data regarding existing practice and future needs. Participants included emergency department staff, bed managers, nurse unit managers, directors of nursing, and personnel from health administration. ---------- Findings: Participants contributed contextual insights on the current system of admissions, revealing a culture of crisis, imbued with misplayed communication. Their expectations and requirements of a potential predictive tool provided strategic data that moderated the development of the Emergency Department Patient Admissions Prediction Tool, based on their insistence that it feature availability, reliability and relevance. In order to deliver these stipulations, participants stressed that it should be incorporated, validated, defined and timely. ---------- Research limitations/implications: Participants were envisaging a concept and use of a tool that was somewhat hypothetical. However, further research will evaluate the tool in practice. ---------- Practical implications: Participants' unsolicited recommendations regarding implementation will not only inform a subsequent phase of the tool evaluation, but are eminently applicable to any process of implementation in a healthcare setting. ---------- Originality/value: The consultative process engaged clinicians and the paper delivers an insider view of an overburdened system, rather than an outsider's observations.

Retrospective observational study of patients who present to Australian rural emergency departments with undifferentiated chest pain

Aim To identify the demographic and clinical characteristics of patients who present to Australian rural emergency departments with chest pain. Design Retrospective, observational study Setting Rural emergency departments (ED) in Queensland, Australia Participants 337 consecutive adult patients with undifferentiated chest pain that presented between 1st September 2013 and 30th November 2013. Main outcome measures Service indicators, discharge diagnoses and disposition Results Presentations for undifferentiated chest pain represented 3.5% of all patient presentations during the sampling period. The mean age of patients was 48 years and 54% were male. Overall, 92% of patients left the ED within the 4-hour NEAT target. The majority of presentations were related to cardiac concerns (39%), followed by non-cardiac chest pain (17%), musculoskeletal (15%) and respiratory (10%) conditions. More than half of these patients were discharged at the completion of the ED service (52.8%), 40.6% were admitted, 3.3% left at own risk, 2.4% did not wait and less than 1% of patients required transfer to another hospital directly from the ED. Conclusions This study has provided information on the characteristics and processes of care for patients presenting to Australian rural EDs with undifferentiated chest pain that will inform service planning and further research to evaluate the effectiveness of care for these patients.

Evaluating the knowledge of sports participants regarding dental emergency procedures

Dental trauma is a common consequence of sports practice to which emergency treatment is critical. The purpose of this study was to evaluate the knowledge of sports participants about dental trauma procedures, particularly tooth avulsion. A specific questionnaire concerning concepts, experiences and behaviors after dental trauma and the use of mouthguard was standardized and validated with 80 people. The validated questionnaire was then distributed to 310 sports participants. The results showed that 28.4% had experienced a kind of dental trauma; 42.6% would look for a dentist for treatment; 51.7% reimplanted or would reimplant the avulsed tooth; 6.5% would maintain the avulsed tooth in milk. Although 47.4% of the participants were aware of the possibility of accidents during sports practice, only 13.9% reported to use a mouthguard. This study showed an overall lack of knowledge of sportsmen and sportswomen with regards to tooth avulsion, thus reinforcing the need for educational campaigns to improve the immediate emergency treatment of tooth avulsion.

Piranha Attacks on Humans in Southeast Brazil: Epidemiology, Natural History, and Clinical Treatment, with Description of a Bite Outbreak

There are many tales describing ferocious schools of piranha attacking humans, but there are few scientific data supporting such behavior. The very few documented instances of humans attacked and eaten by piranha schools include 3 that occurred after death by other causes (eg, heart failure and drowning). These predaceous fishes, however, do occasionally injure bathers and swimmers in lakes and rivers. The characteristic profile of most injuries is a single bite per victim, generally related to the fish defending its brood. This paper describes an outbreak of piranha bites in a dammed river portion in southeast Brazil. The outbreak was caused by the speckled piranha, Serrasalmus spilopleura, a widespread species which benefits from the growing tendency of damming rivers all over Brazil. This article focuses on the epidemiological and clinical aspects of the injuries, as well as on piranha biology, to gain a better understanding of the natural history of bite outbreaks.

Geriatric urolithiasis in the emergency department: risk factors for hospitalisation and emergency management patterns of acute urolithiasis

Urolithiasis is one of the most common conditions seen in emergency departments (ED) worldwide, with an increasing frequency in geriatric patients (>65 years). Given the high costs of emergency medical urolithiasis treatment, the need to optimise management is obvious. We aimed to determine risk factors for hospitalisation and evaluate diagnostic and emergency treatment patterns by ED physicians in geriatric urolithiasis patients to assist in optimising treatment.

Drugs and the respiratory system

17.1 Drugs for bronchial asthma and Chronic Obstructive Pulmonary Disease (COPD) 17.1.1 Introduction to asthma 17.1.2 Introduction to COPD 17.1.3 Drug delivery by inhalation 17.1.4 Drugs to treat 17.1.4.1 β2-adrenoceptor agonists 17.1.4.2 Muscarinic receptor antagonists 17.1.4.3 Leukotriene receptor antagonists 17.1.4.4 Theophylline 17.1.4.5 Oxygen for COPD 17.1.5 Drugs to prevent asthma 31.5.1 Glucocorticoids 31.5.2 Cromolyn sodium 17.1.6 Combination to treat and prevent asthma 17.1.7 Drug for allergic asthma – omalizumab 17.1.8 Emergency treatment of asthma 17.2. Expectorants, mucolytics, cough and oxygen 17.2.1 Introduction to expectorants and mucolytics 17.2.2 Expectorants 17.2.3 Mucolytics 17.2.4 Cough 17.2.5 Oxygen 17.3. Drugs for rhinitis and rhinorrea 17.3.1 Introduction 17.3.2 Histamine and H1-receptor antagonists 17.3.3 Sympathomimetic 17.3.4 Muscarinic receptor antagonists 17.3.4 Cromolyn sodium 17.3.5 Glucocorticoids

Ischemic Stroke in Young Adults

Stroke is the second leading cause of death and the leading cause of disability worldwide. Of all strokes, up to 80% to 85% are ischemic, and of these, less than 10% occur in young individuals. Stroke in young adults—most often defined as stroke occurring under the age of 45 or 50—can be particularly devastating due to long expected life-span ahead and marked socio-economic consequences. Current basic knowledge on ischemic stroke in this age group originates mostly from rather small and imprecise patient series. Regarding emergency treatment, systematic data on use of intravenous thrombolysis are absent. For this Thesis project, we collected detailed clinical and radiological data on all consecutive patients aged 15 to 49 with first-ever ischemic stroke between 1994 and 2007 treated at the Helsinki University Central Hospital. The aims of the study were to define demographic characteristics, risk factors, imaging features, etiology, and long-term mortality and its predictors in this patient population. We additionally sought to investigate, whether intravenous thrombolysis is safe and beneficial for the treatment of acute ischemic stroke in the young. Of our 1008 patients, most were males (ratio 1.7:1), who clearly outnumbered females after the age of 44, but females were preponderant among those aged <30. Occurrence increased exponentially. The most frequent risk factors were dyslipidemia (60%), smoking (44%), and hypertension (39%). Risk factors accumulated in males and along aging. Cardioembolism (20%) and cervicocerebral artery dissection (15%) were the most frequent etiologic subgroups, followed by small-vessel disease (14%), and large-artery atherosclerosis (8%). A total of 33% had undetermined etiology. Left hemisphere strokes were more common in general. Posterior circulation infarcts were more common among those aged <45. Multiple brain infarcts were present in 23% of our patients, 13% had silent infarcts, and 5% had leukoaraiosis. Of those with silent brain infarcts, majority (54%) had only a single lesion, and most of the silent strokes were located in basal ganglia (39%) and subcortical regions (21%). In a logistic regression analysis, type 1 diabetes mellitus in particular predicted the presence of both silent brain infarcts (odds ratio 5.78, 95% confidence interval 2.37-14.10) and leukoaraiosis (9.75; 3.39-28.04). We identified 48 young patients with hemispheric ischemic stroke treated with intravenous tissue plasminogen activator, alteplase. For comparisons, we searched 96 untreated control patients matched by age, gender, and admission stroke severity, as well as 96 alteplase-treated older controls aged 50 to 79 matched by gender and stroke severity. Alteplase-treated young patients recovered more often completely (27% versus 10%, P=0.010) or had only mild residual symptoms (40% versus 22%, P=0.025) compared to age-matched controls. None of the alteplase-treated young patients had symptomatic intracerebral hemorrhage or died within 3-month follow-up. Overall long-term mortality was low in our patient population. Cumulative mortality risks were 2.7% (95% confidence interval 1.5-3.9%) at 1 month, 4.7% (3.1-6.3%) at 1 year, and 10.7% (9.9-11.5%) at 5 years. Among the 30-day survivors who died during the 5-year follow-up, more than half died due to vascular causes. Malignancy, heart failure, heavy drinking, preceding infection, type 1 diabetes, increasing age, and large-artery atherosclerosis causing the index stroke independently predicted 5-year mortality when adjusted for age, gender, relevant risk factors, stroke severity, and etiologic subtype. In sum, young adults with ischemic stroke have distinct demographic patterns and they frequently harbor traditional vascular risk factors. Etiology in the young is extremely diverse, but in as many as one-third the exact cause remains unknown. Silent brain infarcts and leukoaraiosis are not uncommon brain imaging findings in these patients and should not be overlooked due to their potential prognostic relevance. Outcomes in young adults with hemispheric ischemic stroke can safely be improved with intravenous thrombolysis. Furthermore, despite their overall low risk of death after ischemic stroke, several easily recognizable factors—of which most are modifiable—predict higher mortality in the long term in young adults.

The Effects of Reduction Mammaplasty

Symptomatic hypertrophic breasts cause a health burden with physical and psychosocial morbidity. The value of reduction mammaplasty in the treatment of symptomatic breast hypertrophy has been consistently reported by patients and has been well recognised by plastic surgeons for a long time. However, the scientific evidence of the effects of reduction mammaplasty has been weak or lacking. During the design of this study most of the previous studies were retrospective and the few prospective studies had methodological limitations. Therefore, an obvious need for prospective randomised studies was present. Nevertheless, practical and ethical considerations seemed to make this study design impossible, because the waiting time for the operation was several years. The legislation and subsequent introduction of the uniform criteria for access to non-emergency treatment in Finland removed these obstacles, as all patients received their treatment within a reasonable time. As a result, a randomised controlled trial with a six-month follow-up time was designed and conducted. In addition, a follow-up study with two to five years follow-up was also carried out later. The effects of reduction mammaplasty on the patients breast-related symptoms, psychological symptoms, pain and quality of life was assessed. In addition, factors affecting the outcome were investigated. This study was carried out in the Hospital District of Helsinki and Uusimaa, Finland. Eighty-two out of the approximately 300 patients on the waiting list in 2004 agreed to participate in the study. Patients were randomised either to be operated (40 patients) on or to be followed up (42 patients). The follow-up time for both groups was six months. The patients were operated on by plastic surgeons or trainees at the Department of Plastic Surgery at Helsinki University Central Hospital or at the Department of Surgery at Hyvinkää Hospital. The patients completed five questionnaires: the SF-36 and the 15D quality of life questionnaires, the Finnish Breast-Associated Symptoms questionnaire (FBAS), a mood questionnaire (Raitasalo s modification of the short form of the Beck Depression Inventory, RBDI), and a pain questionnaire (The Finnish Pain Questionnaire, FPQ). Sixty-two out of the original 82 patients agreed to participate in the prospective follow-up study. In this study, patients completed the 15D quality of life questionnaire, the Finnish Breast-Associated Symptoms questionnaire, and the RBDI mood questionnaire. After six months follow-up, patients who had undergone reduction mammaplasty had a significantly better quality of life, fewer breast-associated symptoms and less pain, and they were less depressed or anxious when compared to patients who had not undergone surgery. The change in quality of life was more than two times the minimal clinically important difference. The patients preoperative quality of life was significantly inferior when compared to the age-standardised general population. This health burden was removed with reduction mammaplasty. The health loss related to symptomatic breast hypertrophy was comparable to that of patients with major joint arthrosis. In terms of change in quality of life, the intervention effect of reduction mammaplasty was comparable to that of hip joint replacement and more pronounced than that of knee joint replacement surgery. The outcome of reduction mammaplasty was affected more by preoperative psychosocial factors than by changes in breast dimensions. The effects of reduction mammaplasty remained stable at two to five years follow-up. In terms of quality of life, symptomatic breast hypertrophy causes a considerable health loss comparable to that of major joint arthrosis. Patients who undergo surgery have fewer breast-associated symptoms and less pain, and they are less depressed or anxious and have an improved quality of life. The intervention effect is comparable to that of major joint replacement surgery, and it remains stable at two to five years follow-up. The outcome of reduction mammaplasty is affected by preoperative psychosocial factors.

活性炭纤维(ACF)吸附法处理河流突发污染事故模拟研究

环境突发污染事故给人民生活、经济发展和生态环境造成重大影响，研究污染物泄漏造成河流突发污染事故的应急处理方法十分必要。本论文选取苯酚、苯胺和亚甲基蓝等典型污染物为实验对象，采用吸附容量大、密度与水接近的活性炭纤维(ACF)为吸附剂。在自制的河流模型中，研究了ACF以苯酚、苯胺和亚甲基蓝为典型污染物的吸附过程，考察了吸附剂投加量、污染物浓度、吸附剂比表面积、吸附剂投加方式、水流速度与水质等对吸附速率与吸附效果的影响。实验结果表明，ACF能以较快的速率吸附苯酚、苯胺和亚甲基蓝，吸附率都在95％以上； ACF投加量是影响吸附速率最重要的因素，当一次性投加ACF质量之比为 1:2:4时，吸附速率常数之比近似为1:2:4；污染物浓度对吸附速率的影响显著，浓度较低时吸附速率较高。苯酚初始浓度为7mg·L-1时，经过86分钟的吸附，处理后的浓度可以达到地表水Ⅴ类水中挥发酚的限值要求(0.1mg·L-1)；在吸附11分钟左右追加适量的ACF，能够明显提高吸附速率；河水流速和河流中的天然有机物、浊度、河水硬度对ACF吸附都不产生显著影响，这说明ACF作为河流突发污染事故应急处理的吸附剂，有广泛的适应性。在实际河水中，ACF对苯酚的吸附过程与在模拟河水中相似，吸附效果显著。实验结果还表明，ACF对苯酚的吸附是放热反应，符合Freundlich模型和Langmuir模型。事故应急处理后，应该及时将吸附了污染物的ACF打捞上来，有利于进行后续处理。 Emergency environmental pollution accidents pose significant impacts on our living, economic development and ecological environment. The study on the approach of emergency control for the contingency caused by leakage of pollutants in rivers is very necessary. In the experiment, phenol, aniline and methylene blue were selected as representative pollutant and activated carbon fiber (ACF) was selected as adsorbent, which has strong adsorption capacity and similar density to water. In the self-made river model, the effects of ACF dosage, pollutant concentration, ACF surface area, ACF adding ways, water flow rate and water quality on adsorption courses were investigated. The experimental results showed that ACF could adsorb pollutant quickly and effectively. The ACF dosage was the most important factor that affected adsorption rate .When the ACF dosage rate was 1:2:4, the constants of adsorption rate was approximately 1:2:4. The effect of pollutant concentrations on the adsorption rate was notable. Faster adsorption rates were achieved at low pollutant concentrations. Phenol concentration reached the limits of volatile phenol in Category Ⅴ surface water (0.1 mg·L-1) after 86 minutes of adsorption with initial phenol concentration of 7 mg·L-1. After 11 minutes of adsorption, certain amount of ACF was added and the adsorption rate was improved significantly. River flow rate and water quality have little effect on the adsorption rate. The adsorption results obtained in actual river water were comparable with that in simulating river water. The results also showed that, ACF on the absorption of phenol is exothermic reaction, witch matched with the Freundlich model and the Langmuir model. After emergency treatment, the ACF absorbed pollutants should be promptly salvaged for follow-up treatment.

功能菌强化应急处理苯胺突发污染事故研究

近年来各种环境污染事故频发，据统计仅2001~2003年间，发生的各类环境污染事故就高达5606次，其中水污染事故3235次，占全部的57.7%。这些事故不仅给人民生命财产造成巨大损失，也给生态环境造成严重的破坏。因此开发安全高效的应急处理技术迫在眉睫。本研究以筛选高效苯胺降解菌为基础，通过对高效菌降解性能的研究指导将高效菌作为功能郡主投加到已有生物处理系统强化应急处理苯胺突发污染事故废液，取得了良好的效果。 苯胺高效降解菌AN-P1为红球菌（Rhodococcus sp.），其通过间位途径降解苯胺，AN-P1利用苯胺生长和降解的最佳pH为6，最适浓度为2000 mg/L，最适温度为30 ℃，最佳接种量为0.3‰。AN-P1降解含500 mg/L、1000 mg/L、2000 mg/L苯胺的培养物分别经过28 h、24 h、32 h降解，出水苯胺含量能达到《污水综合排放标准》（GB8978-1996）一级标准。但由于苯胺降解过程中释放了大量氨氮，出水氨氮仍较高未能达标排放。而常规SBR系统应急处理效果较差，苯胺和COD去除率均低于10%，出水未能达标排放。活性碳吸附后的回收和后续处理也会带来操作不变和二次污染问题，且处理后出水往往难于达标排放，尚需进行进一步处理。 生物处理系统应急处理后恢复运行处理效果监测和PCR-DGGE图谱分析显示，用AN-P1菌强化应急处理系统后不仅能快速高效的去除苯胺，而且可以有效保障处理系统对污染物的净化性能，有效的保护系统中的功能微生物免受苯胺毒害。 研究结果表明，从实际处理效果、对原有生物系统性能保护及实际应用操作等多方面考虑，用AN-P1菌强化应急处理苯胺突发污染事故在技术上都是可行的。本研究为应急处理苯胺突然污染事故废液提供了新的方法。 Recent years, environment pollution accidents happened frequently, the data showed that there are 5606 accidents between 2001 and 2003, including 3235 water environment accidents, which is 57.7% of all. These accedents not only caused money lost and life lost but also caused serious damage to the ecologicl environment. So exploring highly-effective and secure methods to solve these accidents is an urgent mission. We screened a highly-effective aniline-degrading bacterium and did some researches on its ability to degrade aniline, in order to guide the emergency treatment of aniline containing wastewater that caused by sudden accident pollution with bioaugmentation. A highly-effective aniline-degrading bacterium AN-P1 was isolate and characterized as Rhodococcus sp. It degrades aniline through meta-cleavage pathway. The optimal pH and temperature for cell growth and aniline degradation were 6 and 30 ℃, respectively, and the opitimal concentration of aniline was 2000 mg/L, the optimal inoculation amount was 0.3‰.It took bacterium AN-P1 only 18 h, 24 h and 32 h, respectively, for the treatment of MSB containing 500 mg/L, 1000 mg/L, 2000 mg/L aniline to meet the first grade of national some of the NH4+-N which caused by aniline degradation. It took bacterium AN-P1 only 10 h, 20 h and 32 h, respectively, for the treatment of wastewater containing 500 mg/L, 1000 mg/L, 2000 mg/L aniline to meet the first grade of national integrated wastewater discharge standard. The bacterium AN-P1 can also remove some of the NH4+-N which caused by aniline degradation. It took bacterium AN-P1 only 10 h, 20 h and 32 h, respectively, for the treatment of wastewater containing 500 mg/L, 1000 mg/L, 2000 mg/L aniline to meet the first grade of national integrated wastewater discharge standard. By combing AN-P1 with regular SBR system, it took only 36 h for the emergency treatment of wastewater containing 2000 mg/L aniline under simulating engineering conditions to meet the discharge standard. While the NH4+-N of effluent can not meet the standard because of the high amount NH4+-N caused by aniline degradation. The regular SBR system was not good at aniline and COD removal. The removal efficiency of which are less than 10%. It cost 67.8 g activated carbon to absorbed 1000 mg aniline. It is inconvenient to transport and use it for the emergency treatment of aniline when the sudden pollution accident happened. Meanwhile, it was complex ad hard to recycle the activated carbon and treat the aniline wastewater get from activated carbon recycling too. Hard to meet the effluent standard was also a problem of activated carbon absorption method. According to the PCR-DGGE profile and removal efficiency of pollutants and COD when the systerm recover from emergency treatment, AN-P1 can efficiently protect the microbial community of regular activated sludge system against the aniline. It proved that combing AN-P1 with regular biological system is a feasible strategy for emergency treatment of aniline sudden pollution accident. The research offered a new way for emergency treatment of aniline sudden pollution accident.