Outcome of Deliberate Self-Poisoning

BackgroundOne of the most important outcomes following an episode of non-fatal deliberate self-poisoning is its repetition.MethodIn a prospective follow-up study the subjects were 992 people responsible for 1096 consecutive episodes of deliberate self-poisoning recorded at a teaching hospital accident and emergency department. Risk factors examined were socio–demographic variables, psychiatric and self-harm history, aspects of the self-poisoning episode, and appearance and behaviour at accident and emergency; the frequency of each was compared between those patients who repeated within one year (n= 116) and those who did not (n = 876).ResultsThose who repeated were more likely to have ingested more than one drug, to report a previous episode of self-poisoning, to be aged 25–54, and to have experienced previous psychiatric care or psychiatric admission. They were less likely to be in paid employment, or to have expressed a threat to another person or written a note. The best predictor – previous psychiatric contact – only had a positive predictive value of 21 % (95% confidence interval 16–25%).ConclusionsRisk factors for repetition of self-poisoning should be kept up-to-date despite modest predictive power. More attention might be paid to clinical rather than socio–demographic aspects of self-harm.

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Audit cycle on young people presenting with self-harm

Psychiatric Bulletin ◽

10.1192/pb.22.2.100 ◽

1998 ◽

Vol 22 (2) ◽

pp. 100-101 ◽

Cited By ~ 4

Author(s):

Elaine Lockhart

Keyword(s):

Young People ◽

Considerable Improvement ◽

Psychiatric History ◽

Precipitating Factors ◽

Accident And Emergency ◽

Self Harm ◽

Accident And Emergency Department ◽

Audit Cycle ◽

One Year

The first part of this audit looked at the demographics of young people presenting to Monklands Hospital and the quality of their assessment. Precipitating factors and past psychiatric history were enquired of in the majority of cases but there was a dearth of information regarding alcohol/drug use and family history. A checklist was devised with the aim of improving the quality of these assessments. The second part of the audit cycle completed one year later revealed considerable improvement in all categories. It is hoped that this will be maintained by displaying the checklist in the accident and emergency department and continuing to include teaching about this vulnerable population to all new medical and nursing staff.

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Self-injury attendances in the accident and emergency department

The British Journal of Psychiatry ◽

10.1192/bjp.183.1.34 ◽

2003 ◽

Vol 183 (1) ◽

pp. 34-39 ◽

Cited By ~ 64

Author(s):

Judith Horrocks ◽

Sally Price ◽

Allan House ◽

David Owens

Keyword(s):

Clinical Importance ◽

Epidemiological Data ◽

Psychosocial Assessment ◽

Self Injury ◽

After Care ◽

Accident And Emergency ◽

History Of ◽

Self Harm ◽

Accident And Emergency Department

BackgroundSelf-injury is a neglected area of self-harm research and we know little about its epidemiology, hospital care and outcome.AimsTo provide epidemiological data on self-injury and compare hospital management of self-injury with that for self-poisoning.MethodData were collected on all self-harm attendances to the general hospitals in Leeds over an 18-month period.ResultsPeople attending hospital for self-injury or self-poisoning do not form mutually exclusive groups. There were higher proportions of self-injury episodes compared with self-poisoning, where a history of self-harm or contact with mental health services had been recorded. Fewer psychosocial assessments were carried out after episodes of self-injury compared with self-poisoning but, when they were, follow-up was recommended more often.ConclusionsThe clinical importance of self-injury is not mirrored by the level of psychosocial assessment and after-care provided.

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THU0254 Risk factors for back pain in a cross sectional and in a one-year follow up study in nurses

10.1136/annrheumdis-2001.798 ◽

2001 ◽

Author(s):

M Brzosko ◽

I Fiedorowicz-Fabrycy ◽

J Fliciñski ◽

H Przepiera-Bêdzak ◽

K Prajs

Keyword(s):

Risk Factors ◽

Back Pain ◽

Cross Sectional ◽

Follow Up Study ◽

One Year

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Hand Infections: An Audit of 160 Infections Treated in an Accident and Emergency Department

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(93)90208-w ◽

1993 ◽

Vol 18 (1) ◽

pp. 115-118 ◽

Cited By ~ 16

Author(s):

J. STEVENSON ◽

I. W. R. ANDERSON

Keyword(s):

Emergency Department ◽

Complete Resolution ◽

Wound Care ◽

Duration Of Treatment ◽

Mean Delay ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

The Mean ◽

Careful Assessment

160 consecutive hand infections presented to an Accident and Emergency department over a four-month period. All but one were treated solely on an out-patient basis. The mean delay to presentation was three days, the mean duration of treatment was six days. Follow-up to complete resolution was achieved in 89% of cases. No patients were treated with parenteral antibiotics. The need for careful assessment, early aggressive surgery, and meticulous attention to the principles of wound care by experienced clinicians is emphasized.

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Long-term effects of an intensive prevention program (IPP) after acute myocardial infarction – the IPP Follow-up and Prevention Boost Trial

European Heart Journal ◽

10.1093/ehjci/ehaa946.2961 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

H Wienbergen ◽

A Fach ◽

S Meyer ◽

J Schmucker ◽

R Osteresch ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Risk Factor ◽

Prevention Program ◽

Study Endpoint ◽

Funding Source ◽

Risk Factor Control ◽

One Year

Abstract Background The effects of an intensive prevention program (IPP) for 12 months following 3-week rehabilitation after myocardial infarction (MI) have been proven by the randomized IPP trial. The present study investigates if the effects of IPP persist one year after termination of the program and if a reintervention after >24 months (“prevention boost”) is effective. Methods In the IPP trial patients were recruited during hospitalization for acute MI and randomly assigned to IPP versus usual care (UC) one month after discharge (after 3-week rehabilitation). IPP was coordinated by non-physician prevention assistants and included intensive group education sessions, telephone calls, telemetric and clinical control of risk factors. Primary study endpoint was the IPP Prevention Score, a sum score evaluating six major risk factors. The score ranges from 0 to 15 points, with a score of 15 points indicating best risk factor control. In the present study the effects of IPP were investigated after 24 months – one year after termination of the program. Thereafter, patients of the IPP study arm with at least one insufficiently controlled risk factor were randomly assigned to a 2-months reintervention (“prevention boost”) vs. no reintervention. Results At long-term follow-up after 24 months, 129 patients of the IPP study arm were compared to 136 patients of the UC study arm. IPP was associated with a significantly better risk factor control compared to UC at 24 months (IPP Prevention Score 10.9±2.3 points in the IPP group vs. 9.4±2.3 points in the UC group, p<0.01). However, in the IPP group a decrease of risk factor control was observed at the 24-months visit compared to the 12-months visit at the end of the prevention program (IPP Prevention Score 10.9±2.3 points at 24 months vs. 11.6±2.2 points at 12 months, p<0.05, Figure 1). A 2-months reintervention (“prevention boost”) was effective to improve risk factor control during long-term course: IPP Prevention Score increased from 10.5±2.1 points to 10.7±1.9 points in the reintervention group, while it decreased from 10.5±2.1 points to 9.7±2.1 points in the group without reintervention (p<0.05 between the groups, Figure 1). Conclusions IPP was associated with a better risk factor control compared to UC during 24 months; however, a deterioration of risk factors after termination of IPP suggests that even a 12-months prevention program is not long enough. The effects of a short reintervention after >24 months (“prevention boost”) indicate the need for prevention concepts that are based on repetitive personal contacts during long-term course after coronary events. Figure 1 Funding Acknowledgement Type of funding source: Foundation. Main funding source(s): Stiftung Bremer Herzen (Bremen Heart Foundation)

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MEAN 6 YEAR CLINICAL OUTCOMES, SURVIVORSHIP, AND RETURN TO SPORTS AFTER ARTHROSCOPIC CAPSULAR REPAIR WITH SUTURE ANCHORS FOR ADOLESCENT MULTIDIRECTIONAL SHOULDER INSTABILITY

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121s00021 ◽

2021 ◽

Vol 9 (7_suppl3) ◽

pp. 2325967121S0002

Author(s):

Brendon C. Mitchell ◽

Matthew Y. Siow ◽

Alyssa Carrol ◽

Andrew T. Pennock ◽

Eric W. Edmonds

Keyword(s):

Risk Factors ◽

Surgical Treatment ◽

Shoulder Instability ◽

Surgical Intervention ◽

Operation Time ◽

Demographic Variables ◽

Return To Sports ◽

Suture Anchors ◽

Surgical Failure

Background: Multidirectional shoulder instability (MDI) refractory to rehabilitation can be treated with arthroscopic capsulolabral reconstruction with suture anchors. No studies have reported on outcomes or examined the risk factors that may contribute to poor outcomes in adolescent athletes. Hypothesis/Purpose: To identify risk factors for surgical failure by comparing anatomic, clinical, and demographic variables in adolescents who underwent surgical intervention for MDI. Methods: All patients undergoing arthroscopic shoulder surgery at one institution between January 2009 and April 2017 were reviewed. Patients >20 years old at presentation were excluded. Multidirectional instability was defined by positive drive-through sign on arthroscopy plus positive sulcus sign and/or multidirectional laxity on anterior and posterior drawer testing while under anesthesia. Two-year minimum follow-up was required, but those whose treatment failed earlier were included for reporting purposes. Demographics and intraoperative findings were recorded, as were Single Assessment Numeric Evaluation (SANE) scoring, Pediatric and Adolescent Shoulder Survey (PASS), and the short version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) results. Results: Eighty adolescents (88 shoulders) were identified for having undergone surgical treatment of MDI. Of these 80 patients, 42 (50 shoulders; 31 female, 19 male) were available at a minimum of 2-year follow-up. Mean follow-up was 6.3 years (range, 2.8-10.2 years). Thirteen (26.0%) shoulders experienced surgical failure defined by recurrence of subluxation and instability, all of which underwent re-operation. Time to re-operation occurred at a mean of 1.9 years (range, 0.8-3.2). Our cohort had an overall survivorship of 96% at 1 year after surgery and 76% at 3 years. None of the anatomic, clinical, or demographic variables tested, or the presence of generalized ligamentous laxity, were correlated with subjective outcomes or re-operation. Number of anchors used was not different between those that failed and those that did not fail. Patients reported a mean SANE score of 83.3, PASS score of 85.0, and QuickDASH score of 6.8. Return to prior level of sport (RTS) occurred in 56% of patients. Conclusion: Multidirectional shoulder instability is a complex disorder that can be challenging to treat. Adolescent MDI that is refractory to non-surgical management appears to have long-term outcomes after surgical intervention that are comparable to adolescent patients with unidirectional instability. In patients who do experience failure of capsulorraphy, we show that failure will most likely occur within 3 years of the index surgical treatment. [Table: see text][Figure: see text]

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Impacted urethral stone presenting as urinary retention in a child

BMJ Case Reports ◽

10.1136/bcr-2020-235022 ◽

2021 ◽

Vol 14 (1) ◽

pp. e235022

Author(s):

Kelly Storm Hoffmann ◽

Alok Godse

Keyword(s):

Urinary Retention ◽

Urethral Catheter ◽

Calcium Oxalate Stone ◽

Accident And Emergency ◽

Urethral Catheterisation ◽

History Of ◽

Accident And Emergency Department ◽

Urethral Stone ◽

Definitive Management

A seven-year-old boy was referred to our Accident and Emergency department with a history of urinary retention secondary to urinary tract infection and an inability to pass a urethral catheter. He had been treated a month before for suspected pyelonephritis by the referring hospital. Attempts at urethral catheterisation failed, and he was taken to theatre for cystourethroscopy and catheter placement. At this time, an impacted urethral stone was discovered. Because it could not be dislodged, a suprapubic catheter was placed, and the child was brought back at a later date for definitive management. Investigations revealed a pure calcium oxalate stone that was secondary in origin. There has been no recurrence during a follow-up period of 6 months.This illustrates that while rare, urethral stones do occur in children and should be considered in children presenting with urinary retention, haematuria and/or abdominal pain.

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Weight loss with very-low-calorie diet and cardiovascular risk factors in moderately obese women: One-year follow-up study including ambulatory blood pressure monitoring

International Journal of Obesity ◽

10.1038/sj.ijo.0800644 ◽

1998 ◽

Vol 22 (7) ◽

pp. 661-666 ◽

Cited By ~ 16

Author(s):

T Pekkarinen ◽

I Takala ◽

P Mustajoki

Keyword(s):

Risk Factors ◽

Blood Pressure Monitoring ◽

Obese Women ◽

Pressure Monitoring ◽

Very Low Calorie Diet ◽

Follow Up Study ◽

Low Calorie Diet ◽

Calorie Diet ◽

One Year

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Ice skating injuries: a survey of cases seen in an Accident and Emergency department

Journal of The Royal Naval Medical Service ◽

10.1136/jrnms-77-71 ◽

1991 ◽

Vol 77 (2) ◽

pp. 71-74

Author(s):

A. P. Newton

Keyword(s):

Risk Factors ◽

Emergency Department ◽

Epidemiological Data ◽

Ice Skating ◽

Accident And Emergency ◽

Accident And Emergency Department ◽

Sporting Activities ◽

Patterns Of Injury

AbstractParticipating in sporting activities has its risks as well as its benefits. A simple study is described which documents the patients presenting at a casualty department after injury at an ice rink. Epidemiological data, risk factors and patterns of injury are discussed.

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