scholarly journals An Analysis of Unscheduled Return Visits to the Accident and Emergency Department of a General Public Hospital

2003 ◽  
Vol 10 (3) ◽  
pp. 153-161 ◽  
Author(s):  
CP Ng ◽  
CH Chung
Keyword(s):  
Emergency Department ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Related Factors ◽  
Public Emergency ◽  
Upper Respiratory ◽  
Return Visits

Objectives To identify the reasons for unscheduled return visits to a public emergency department and possible strategies to reduce unscheduled return visits. Design Cross-sectional survey. Setting A public emergency department in Hong Kong. Patients Unscheduled return visits within 48 hours in a three-month period from 14 January 2000 to 15 April 2000. Main outcome measures Patients' epidemiological characteristics, reasons, complaints and outcome of the unscheduled return visits. Results During the study period, 3.3% (1,060) of the attendance was unscheduled return visits within 48 hours as recorded in the computerized A&E Information System of the hospital. However, only 738 patients (70%) responded to the questionnaire. These 738 patients formed the study population for further analysis. Illness-related factors accounted for 87% of the total unscheduled return visits. Patient-related factors were responsible for about 10% of unscheduled return visits. Doctor-related factors accounted for about 3% of unscheduled return visits. There was only one system-related unscheduled return visit. For the outcome of return visits, about 76% (559) was discharged after the second consultation. About 5% (40) was referred to specialist clinics. Around 24% (179) of patients was admitted. Of those admitted, 78% (140) was illness-related, 13% (23) was patient-related and 9% (16) was doctor-related. Upper respiratory tract infection was the most frequent complaint (34%), followed by painful conditions (23%) and injuries (10%). For children at or below 10 years of age, upper respiratory tract infection (60%) and febrile illness (15%) were the most frequent complaints. Conclusions The study found that the reasons for return visits were multiple. These “unscheduled return visits” should not be automatically regarded as poor indicator of service. Better patient education, organized family practice system, upgrading of professional training and targeted audit are possible means to reduce unscheduled return visits.

How Evidence-Based is our Practice in a Hong Kong Emergency Department?

2003 ◽  
Vol 10 (4) ◽  
pp. 202-214
Author(s):  
PKM Pang ◽  
B Lim ◽  
KP Lee ◽  
CL Lok ◽  
CS Chung ◽  
...  
Keyword(s):  
Emergency Department ◽  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Daily Practice ◽  
Upper Respiratory Tract Infection ◽  
Evidence Based ◽  
Upper Respiratory Tract ◽  
Positive Interventions ◽  
Upper Respiratory

Objective To evaluate how evidence-based our daily practice was. Design Retrospective study. Setting Emergency department of a public district hospital. Patients and Methods Between 1st August 2000 to 7th August 2000, 91 patients' records were chosen at random. A chief diagnosis was assigned for each patient. Corresponding treatments were reviewed by searching relevant randomised controlled trials (RCTs), systematic reviews and meta-analyses. Each patient had only one chief diagnosis but could have multiple interventions for that diagnosis. Results Out of 91 records, 14 were discarded. All of them had not been given any intervention and 11 required admission. For the remaining 77 records, there were 38 subjects in medical, paediatric, or gynaecological specialties and 39 in surgical or orthopaedic specialties. Intervention(s) given for each subject were then searched electronically through our hospital Knowledge Gateway and the results were expressed as either EBM-positive or EBM-negative. “EBM-positive” interventions denoted a support by RCTs. “EBM-negative” interventions denoted an absence of any supportive RCTs. Each patient might have EBM-positive and/or EBM-negative interventions together if that patient received more than one treatment. There were 52 patients (52/77 = 68%) who had one of their interventions being RCT-supported. The majority were patients with (1) antipyretic use of paracetamol in upper respiratory tract infection, or (2) control of pain by nonsteroidal anti-inflammatory drug, dologesic and paracetamol. There were 25 patients (25/77 = 32%) who did not receive any RCT-supported interventions. Concurrently 53 patients out of 77 (69%) received EBM-negative interventions. The majority were patients with (1) the use of antibiotics, antitussives and antihistamines in upper respiratory tract infection, (2) antispasmodics in gastroenteritis or patients with nonspecific abdominal pain, and (3) the use of analgesic balm in minor orthopaedic complaints. Conclusion Sixty-eight percent of patients had EBM-positive interventions. Thirty-two percent of patients did not receive any EBM-positive intervention. It was quite encouraging as compared to studies in other specialties with similar design. Concurrently 69% of patients had also been given EBM-negative interventions. There were areas for improvement if we were to implement EBM practice in the emergency department.

scholarly journals Toll-Like Receptors: Expression and Roles in Otitis Media

2021 ◽  
Vol 22 (15) ◽  
pp. 7868
Author(s):  
Su Young Jung ◽  
Dokyoung Kim ◽  
Dong Choon Park ◽  
Sung Soo Kim ◽  
Tong In Oh ◽  
...  
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Otitis Media ◽  
Middle Ear ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Toll Like Receptors ◽  
Upper Respiratory

Otitis media is mainly caused by upper respiratory tract infection and eustachian tube dysfunction. If external upper respiratory tract infection is not detected early in the middle ear, or an appropriate immune response does not occur, otitis media can become a chronic state or complications may occur. Therefore, given the important role of Toll-like receptors (TLRs) in the early response to external antigens, we surveyed the role of TLRs in otitis media. To summarize the role of TLR in otitis media, we reviewed articles on the expression of TLRs in acute otitis media (AOM), otitis media with effusion (OME), chronic otitis media (COM) with cholesteatoma, and COM without cholesteatoma. Many studies showed that TLRs 1–10 are expressed in AOM, OME, COM with cholesteatoma, and COM without cholesteatoma. TLR expression in the normal middle ear mucosa is absent or weak, but is increased in inflammatory fluid of AOM, effusion of OME, and granulation tissue and cholesteatoma of COM. In addition, TLRs show increased or decreased expression depending on the presence or absence of bacteria, recurrence of disease, tissue type, and repeated surgery. In conclusion, expression of TLRs is associated with otitis media. Inappropriate TLR expression, or delayed or absent induction, are associated with the occurrence, recurrence, chronicization, and complications of otitis media. Therefore, TLRs are very important in otitis media and closely related to its etiology.

Acupuncture Therapy for Fever Induced by Viral Upper Respiratory Tract Infection (Urti) in Military Medical Service: A Case Series

2014 ◽  
Vol 32 (6) ◽  
pp. 509-511 ◽  
Author(s):  
SeungWon Kwon ◽  
KyoungHo Shin ◽  
WooSang Jung ◽  
SangKwan Moon ◽  
KiHo Cho
Keyword(s):  
Tract Infection ◽  
Respiratory Tract ◽  
Respiratory Tract Infection ◽  
Medical Service ◽  
Case Series ◽  
Treatment Session ◽  
Upper Respiratory Tract Infection ◽  
Upper Respiratory Tract ◽  
Upper Respiratory ◽  
Accompanying Symptoms

We report the cases of eight military patients with fever (≥38°C) induced by viral upper respiratory tract infection (URTI) who requested treatment with acupuncture in the military medical service room. All patients were treated immediately after diagnosis with classical acupuncture (GV14, GB20, TE8 points) and a new type of acupuncture, equilibrium acupuncture ( Feibing and Ganmao points). After one treatment session (20 min), reduction of body temperature was confirmed in all patients. Accompanying symptoms such as headache, myalgia and nasal obstruction also showed a tendency to decrease. Within 3 days of treatment, six of the eight patients had recovered from the URTI. No adverse effects of acupuncture treatment were reported.

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