Foreign body aspiration in children: experience from 2624 patients.

OBJECTIVES: The objective of this study is to analyze the epidemiological, clinical, radiological and endoscopic characteristics of pediatric foreign body aspiration in Algeria. METHODS: In this retrospective study, the results of 2624 children younger than 18 years admitted in our department for respiratory foreign body removal between 1989 and 2012, were presented. Most of them had an ambulatory rigid bronchoscopy. RESULTS: The children (62.34% males and 37.65% females) were aged 4 months to 18 years with 66% between 1 and 3 years. Choking was related in 65% of cases. The delay between aspiration and removal was 2-8 days in 65.8% and within 24 h in 9.2%. In the most cases, the children arrived with cough, laryngeal or bronchial signs and unilateral reduction of vesicular murmur. The examination was normal in 13%. The most common radiologic finding was pulmonary air trapping (40.7%). The aspirated bodies were organic in 66.7%, dominated by peanuts, while sunflower seeds, beans and ears of wheat were the most dangerous. In the other cases, they were metallic or plastic as pen caps and recently scarf pins. The endoscopic removal by rigid bronchoscopy was successful and complete in 97%. Cases with extraction failure (3%) limited to certain FBs, all of them inorganic were assigned to surgery. The complications related to the endoscopic procedure were 0.29% with a mortality of 0.26%. CONCLUSION: Foreign body aspiration is a real public health problem in Algeria. The best way to manage it is an early diagnosis and a rigid bronchoscopy removal under general anesthesia used by fully trained staff. The prevention of this domestic accident should consider the population lifestyle and cultural habits to be more effective.

Practice and professional development plans (PPDPs): results of a feasibility study.

BACKGROUND: Dissatisfaction with uniprofessional education structures as a means of improving the quality of healthcare has led to proposals to develop ways of integrating professional learning and organisational development. AIMS: Test the feasibility of introducing practice and professional development plans using a centrally sponsored project in Wales. DESIGN: Qualitative observational study. STUDY SAMPLE: All 541 practices in Wales were alerted to the project and invited to apply. A selection process was suggested to Health Authorities but not always efficiently conducted: 23 practices were selected and 18 participated in the process. METHOD: Central funding was made available to health authorities. The project framework was designed by an educational department and conceptualised as the development of personal portfolios linked to one key organisation change in each practice, facilitated by external consultants who would typically hold workshops or other events. An independent researcher using non-participant observation techniques at workshops and practices undertook documentary analysis and fieldwork in four health authorities. RESULTS: Difficulties were encountered with the process of implementing the project: marketing and practice selection inconsistencies delayed the work and it was difficult to recruit practices into the project. The lack of experienced individuals to do the work and practitioner suspicion about perceived 'management' agendas were significant problems. After initial hesitancies most practices appreciated the value of developing wider ownership and commitment to proposed practice changes. Organisations found it difficult to support individual completion of the personal portfolio component of the plans. The ability to develop systems for clinical services was dependent on having already established a culture of effective teamwork in the organisation. CONCLUSIONS: This work supports the view that organisational development has considerable potential for bringing about effective change, and individual contributions could form a valuable component of personal portfolios. We believe that the existing structures in education and management in the health service are not yet able to support these processes. Evidence from the fields of risk management and quality improvement all point to the need to develop effective organisational systems and the results of this feasibility study indicate that alternative models of sustaining organisational development need careful evaluation.

Planning and producing an educational videotape on the cervical screening programme in Wales.

Planning and producing an instructional videotape for health care workers require attention to educational principles but also depend on project management skills. The paper describes an approach to the planning and production of a programme on the cervical screening service in Wales that used focus groups to obtain information about needs assessment and developmental testing. Learning objectives need to be married with content accuracy and policy consensus, often difficult to achieve for health care areas such as cervical screening. For these reasons, effective and close liaison is required between sponsor, content experts, scriptwriter, producer and director.

Public knowledge and attitudes to AIDS.

Three independent cross-sectional surveys of public knowledge and attitudes about AIDS were conducted on a representative sample of people aged 15-54 resident in Wales. 1,303 were interviewed in their homes in February 1987, 683 in September 1987 and 676 in March 1988. The results show that most people knew that having sexual intercourse or sharing needles with people with AIDS represented a high risk of catching AIDS. However there appeared to be considerable misunderstanding about the nature of HIV infection such that one in three thought that a man and woman with a single heterosexual partner was at high or moderate risk of catching AIDS. The high level of concern coupled with considerable confusion appears to have contributed to both unnecessary anxiety and prejudice. One in four people thought that kissing or being spat on by a person with AIDS represented a high or moderate risk, and one in six thought that coughing, sneezing and sharing towels, soap, drinking utensils or lavatory seats were routes of transmission. More than 50% of men and 40% of women said that it was their own fault if homosexuals and drug addicts got AIDS and did not feel sorry for them. It is concluded that action to date to limit the spread of AIDS has informed but not yet adequately educated the public. If unwanted anxieties and prejudice are to be diminished, initiatives by government, health services and others must now concentrate on developing understanding about the nature of HIV infection and its spread through more personal education.(ABSTRACT TRUNCATED AT 250 WORDS)

Heartbeat Wales--a community programme.

Heartbeat Wales is a broadly based initiative designed to decrease the incidence of cardiovascular disease. After three years there are encouraging signs that the people of the Principality are adopting a healthier lifestyle.

In vitro temperature rises during visible-light curing of a lining material and a posterior composite.

The aim of this study was to measure the rise in temperature during: (i) a single cycle of a curing light unit, (ii) the polymerization of a layer of light-cured lining material, and (iii) the polymerization of a light-cured posterior composite material, and also during combinations of these individual procedures. Experimental work was undertaken in vitro and measurements were made using a thermocouple placed centrally in an insulated PTFE well. Large temperature rises occurred with the use of the curing light alone. The lining material itself did not contribute significantly to the rise in temperature during curing, nor did it provide thermal insulation from the output temperature emitted by the light guide. The presence of a layer of posterior composite reduced the temperature transmitted from the light but the residual temperature rise transmitted was still of such a magnitude as to cause concern regarding possible thermal injury to the pulp.

General practitioners' use of written materials during consultations.

Russell et al have shown that the compliance of patients can be enhanced by general practitioners' providing them with written materials.' We examined what educational materials for patients were used by general practitioners and where the materials came from.