Six Change Ideas that Significantly Minimize Alternate Level of Care (ALC) Days in Acute Care Hospitals.

A significant issue affecting the healthcare system across Ontario is the number of patients admitted to hospitals that are then subsequently being designated alternate level of care (ALC). In 2016, 14.5% of Ontario in-patient beds were occupied by ALC-designated patients.

Poisonous substances.

Management plans for children with ingestion problems who present to emergency departments often include toxicology screening tests to detect the presence of poisonous substances.

Trauma preparation.

Emergency care practitioners often use a standard approach to advanced trauma life support involving oxygenation, ventilation and circulation. After successful resuscitation however, the challenge of care during the recovery phase is carried out by critical care nurses (CCNs).

Ethics of triage.

As this article makes clear, triage can have adverse consequences for patients receiving emergency care, who can therefore challenge the ethical basis of such practice.

Myocardial infarction.

Heart attacks early in the day are more severe than those that occur later, study results have shown.

Isotretinoin increases skin-surface levels of neutrophil gelatinase-associated lipocalin in patients treated for severe acne.

Background: A clear-cut need exists for safe and effective alternatives to the use of isotretinoin in severe acne. Lack of data regarding the specifics of isotretinoin's mechanism of action has hampered progress in this area. Recently, the protein neutrophil gelatinase-associated lipocalin (NGAL) has been identified as a mediator of the apoptotic effect of isotretinoin on sebocytes.

Breakage incidence with direct-bonded lingual retainers.

This study examined the effects of a number of patient and clinical variables on the breakage of bonded retainers, and consisted of a retrospective review of the survival of 200 bonded retainers. Data was collected from two clinical centres between November 1996 and February 1997. The subjects comprised 198 patients of both sexes divided into three age groups.

Task Group for Orthodontics Report.

The UK Specialist Review Group of the General Dental Council's Education Committee has been charged with taking forward the recommendations in the Chief Dental Officer's report 'UK Specialist Dental Training'. The Specialist Review Group has, in turn, established a number of specialty task groups. This report is from the Task Group for Orthodontics.

Recurrent pneumoperitoneum due to jejunal diverticulosis. With a review of the causes of spontaneous pneumoperitoneum.

In the absence of abdominal operative procedures, symptomless spontaneous pneumoperitoneum is uncommon. The case is described of a patient with jejunal diverticulosis who developed spontaneous pneumoperitoneum on three occasions and brief details are given of six other cases of jejunal diverticulosis with pneumoperitoneum from the literature. Other causes of symptomless pneumoperitoneum include pneumatosis intestinalis, perforation in tabes dorsalis or coma, stercoral ulceration, physiological pneumoperitoneum in women due to exercise in the knee-elbow position, and vaginal douches with a bulb syringe or effervescent fluid.

Large-bowel perforations in patients undergoing sigmoidoscopy and barium enema.

Perforation of the large bowel can occur as a complication of sigmoidoscopy, rectal or sigmoid biopsy, and even of a simple cleansing enema. If the perforation is extraperitoneal there may be no early symptoms and consequently there may be delay in diagnosis. The risk of perforation during these procedures is small but it should not be ignored.

Giant duodenal ulcer.

Twenty-five cases of benign giant duodenal ulcer have been studied. In every case a barium meal examination showed an ulcer crater with a radiographic diameter of at least 2 centimetres. Abdominal pain was the commonest symptom but less than half of the patients had had pain characteristic of chronic peptic ulcer.