ABSTRACT
Adolescence is a critical period in both physical and psychological development. Skin conditions are very common in this age group, and are known to impart a considerable psychological burden, with higher rates of both anxiety and depression in those with chronic skin disease. The Department of Health has identified the specialized needs of adolescents as they transition from paediatric to adult services as a key priority, with emphasis on providing 'developmentally appropriate healthcare'. However, in spite of this, there are very few dedicated transitional clinics in the UK with appropriate psychosocial support. We have demonstrated in our own clinical practices that a dedicated teenage and young adult dermatology clinic with embedded specialist psychological support can deliver effective dermatological care to young people with a variety of skin conditions. We call for a greater focus on achieving developmentally appropriate care for adolescents across the UK to address the unmet transitional and psychological care needs in this population.
Subject(s)
Adolescent Medicine , Dermatology , Psychology, Adolescent , Skin Diseases/psychology , Adolescent , Chronic Disease/psychology , Humans , Skin Diseases/therapy , Transition to Adult Care , Young AdultABSTRACT
PURPOSE: Rib fixation remains a contentious issue in the current practice of orthopaedic, trauma and thoracic surgeons. Whilst rib fractures are undoubtedly associated with high levels of morbidity and mortality, the optimal surgical approach has not yet been fully elucidated in prospective trials and the volume of procedures performed remains low. METHODS: We evaluated 21 consecutive patients who underwent surgical rib fixation either via a standard thoracotomy approach or following the introduction of a video-assisted technique with minimal thoracic incisions. RESULTS: The average age of patients undergoing rib fixation was 47 and the median length of post-operative stay was 4 days. More than 70 % of patients were found to have concurrent haemothoraces, and 19 % had significant injuries to underlying intra-thoracic structures requiring repair. One patient returned to theatre for persistent blood loss; however, there were no other immediate complications or mortalities. CONCLUSIONS: We discuss the involvement of thoracic surgeons, early assessment of the thoracic cavity with video assistance and optimal peri-operative management with particular reference to cases which demonstrate recent changes in our practice.
Subject(s)
Fracture Fixation, Internal , Minimally Invasive Surgical Procedures/methods , Rib Fractures/surgery , Thoracic Injuries/surgery , Thoracic Surgery, Video-Assisted , Thoracotomy/methods , Wounds, Nonpenetrating/surgery , Aged , Female , Fracture Fixation, Internal/methods , Humans , Length of Stay/statistics & numerical data , Male , Middle Aged , Prospective Studies , Rib Fractures/diagnostic imaging , Rib Fractures/physiopathology , Thoracic Injuries/diagnostic imaging , Thoracic Injuries/physiopathology , Treatment Outcome , Wounds, Nonpenetrating/diagnostic imaging , Wounds, Nonpenetrating/physiopathologyABSTRACT
OBJECTIVE: To investigate the contribution of alcohol ingestion to the radiological workload of an inner city accident and emergency (A&E) department. METHODS: A prospective survey of patients presenting to A&E who required radiographs was performed over a seven day period. The A&E clinician questioned patients about alcohol intake during the six hours before the onset of the presenting complaint or injury, and made an objective assessment of signs of alcohol ingestion or intoxication. An assessment was made also of the relative contribution of alcohol as a cause of patients' injuries. RESULTS: A total of 419 patients who had radiography fulfilled the inclusion criteria, and a questionnaire was completed for 351 (84%). Forty (11%) of 351 were found to have ingested alcohol. Thirty five (87%) of 40 patients who had ingested alcohol were radiographed for trauma, as compared with 171 (55%) of the 311 who had not (p<0.001). Alcohol was considered to have been causative of injury in 30% and a contributory factor in an additional 58%. Radiographs of the skull, face and jaw accounted for 18 (33%) of 55 radiographs from trauma patients who had ingested alcohol compared with 20 (9%) of 212 radiographs from those who had not (p<0.001). There was no significant difference in the proportion of abnormal radiographs between these two groups (27% of radiographs from trauma patients who had ingested alcohol compared with 23% of radiographs from those who had not, p>0.2). CONCLUSION: Patients with alcohol related injuries requiring radiography have a significant impact on the radiological workload of an A&E department, although the prevalence of alcohol ingestion detected in this study was less than expected from previous studies.
