RESUMEN
BACKGROUND: Flexible upper aerodigestive endoscopy is often performed in the emergency setting. To prevent nosocomial infection on-call clinicians must have access to decontaminated endoscopes. METHODS: A telephone survey of 104 ENT units in England replicated previous cycles conducted 10 and 20 years ago. The on-call clinician was asked about decontamination practices, training and cross-cover. RESULTS: Seventy-one clinicians participated of which 68 had an endoscope available out-of-hours. Twenty-five (36.8 per cent) used single-use endoscopes. Twenty-three (51.1 per cent) of the 45 clinicians using re-usable endoscopes decontaminated them themselves, an increase from 43.3 per cent in 2013 and from 35.1 per cent in 2002. Overall 91.2 per cent had safe practices, up from 68.7 per cent in 2013 and 48 per cent in 2002. One hundred per cent had been trained in decontamination, compared to 37.3 per cent in 2013 and 12.1 per cent in 2002. On-call clinicians from the ENT department increased to 91.5 per cent, compared to 63 per cent in 2013. CONCLUSION: There has been a dramatic increase in patient safety, underpinned by the introduction of single-use endoscopes, increased training and reduced cross-cover.
Asunto(s)
Carcinoma/complicaciones , Ganglios Sensoriales/patología , Degeneración Cerebelosa Paraneoplásica/complicaciones , Neoplasias de la Tiroides/complicaciones , Anciano , Carcinoma/patología , Carcinoma Papilar , Humanos , Masculino , Degeneración Cerebelosa Paraneoplásica/patología , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides/patologíaRESUMEN
OBJECTIVE: To investigate the natural history of pediatric tympanic membrane perforation using an existing clinical database, with the aim of defining the time beyond which a perforation is unlikely to close naturally. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary center. PATIENTS AND INTERVENTIONS: A database of pediatric ear, nose, throat, and audiology consultations containing 20 years of data was analyzed. A total of 2865 episodes of perforation were followed, with all cases of surgical reconstruction excluded. Cases of perforation after ventilation tube extrusion were tagged. Statistical techniques including survival analysis were used. MAIN OUTCOME MEASURES: Time from diagnosis of perforation to diagnosis of closure, in years. RESULTS: There was a predominance of perforations in boys (59.1% versus 40.9%). Time to closure increased by 7% for each 1-year increase in age at diagnosis. Time-to-closure curves for children older than 12 years diverged considerably from those for younger children after approximately 18 months. Centiles of time to closure were calculated for each 1-year age band. After 2.5 years of follow-up, rates of closure were 90% in children diagnosed younger than 7 years and 75% in children diagnosed between the age of 7 and 12 years. No significant difference was found in time to closure between boys and girls, left-sided and right-sided perforations, or in ventilation tube-related perforations and others. Comparison of membranes suffering a first perforation with those suffering a second perforation suggested a borderline significant time-to-closure disadvantage for first perforations. CONCLUSION: When faced with the clinical question of what period of watchful waiting would be appropriate in monitoring a perforated tympanic membrane, before intervention may reasonably be recommended; there seems to be little advantage in waiting longer than 2.5 years.
Asunto(s)
Perforación de la Membrana Timpánica/patología , Perforación de la Membrana Timpánica/cirugía , Adolescente , Niño , Preescolar , Enfermedad Crónica , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Humanos , Lactante , Estimación de Kaplan-Meier , Masculino , Procedimientos Quirúrgicos Otológicos , Estudios Retrospectivos , Análisis de Supervivencia , Resultado del Tratamiento , Cicatrización de Heridas , Adulto JovenRESUMEN
INTRODUCTION: Fractured nose is a common acute ENT diagnosis, most often sustained in adults as a result of violent trauma. Patients will commonly present within 24 h of injury, and attend the out-patient clinic 7 days later for assessment. An unusual pattern of referrals began to emerge during 2006. PATIENTS AND METHODS: Referral patterns covering the period 2003-2006 were analysed for two London ENT centres. RESULTS: The data show a statistically-unusual peak of referral for fractured nose intensity coinciding with the FIFA World Cup 2006. CONCLUSIONS: If a causal link is to be suggested between the sociological aspects of major international sporting contests and violent injury, it will be interesting to repeat the analysis in subsequent years, to gain an insight into whether 2006 was an isolated example, or part of a wider trend.