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Three years' experience of collaborative care pathways on a maxillofacial ward

BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第2期38卷 132-137页

作者： Rogers, SN Naylor, R Potter, L Magennis, P Univ Hosp Aintree Reg Maxillofacial Unit Liverpool L9 1AL Merseyside England

Collaborative care pathways (CCPs) provide a framework for multidisciplinary patient care. They provide guidelines and a mechanism for audit, and were first introduced at the Regional Unit, Walton Hospital, Liverpool, in November 1994. They have been designed for many surgical groups. Between August 1996 and 31 July 1997, 955 patients were admitted on to the nine established pathways: fractured mandible (n=213), fractured zygoma (n=117), minor oral surgery (n=244), abscess (n=18), examination under anaesthesia (n=73), nasal surgery (n=73), osteotomy (n=80), salivary (n=63), and temporomandibular joint (n=74). The purpose of this article is to report the introduction of CCP in a maxillofacial ward and give results from a one-year audit. CCP have proved to be an extremely useful tool and have several advantages over traditional documentation. They are more accurate, easily computerized, and facilitate audit. They promote the development of guidelines and standardized perioperative care, and this in turn facilitates training and raises standards of care.

关键词：脓肿/外科学麻醉全身/统计学和数值数据临床路径/统计学和数值数据文献工作/统计学和数值数据英格兰/流行病学下颌骨折/外科学医学审核病案系统计算机化口腔疾病/外科学鼻/外科学口腔外科手术/统计学和数值数据截骨术/统计学和数值数据围手术期医护/标准涎腺/外科学外科口腔/教育外科手术小/统计学和数值数据颞下颌关节/外科学颧骨骨折/外科学人类

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Use of theatre time for dentoalveolar operations under general anaesthesia

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BRITISH JOURNAL OF ORAL & MAXILLOFACIAL SURGERY 2000年第4期38卷 331-334页

作者： Ogden, GR Kershaw, AE Hussein, I Dundee Dent Hosp & Sch Sect Oral & Maxillofacial Surg Dundee DD1 4HR Scotland

Efficient use of hospital resources is essential if waiting lists are to be reduced. We undertook this study because there seems to be little information on the use of theatre time for dentoalveolar surgery under general anaesthesia. The time taken for each sequence of events (from start of case, induction, operation to recovery, and so on) for each patient was recorded. Of the 30 lists examined, 22 lists (73%) finished on time or early, and 8 lists (27%) ran late, The time spent operating occupied less than 50% of theatre time available, The 'total time' for each case was increased (by about 10 minutes a patient) when a junior anaesthetist was anaesthetizing rather than a consultant. The overall time used per list was 79% with the remaining 21% of the list being 'unused', Where these lists did over-run, then this was usually because the operation took longer, although grade of anaesthetist was a factor. We identified several areas in which efficiency could be improved.

关键词：方差分析麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据临床工作能力牙医诊疗模式/统计学和数值数据效率治疗过程片断手术室/利用口腔外科手术/统计学和数值数据前瞻性研究统计学非参数作业完成和分析时间因素人类

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Repeat general anaesthesia for paediatric dentistry

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BRITISH DENTAL JOURNAL 2000年第1期189卷 37-39页

作者： Harrison, M Nutting, L Guys Kings & St Thomas Dent Inst Dept Orthopaed & Paediat Dent London SE1 9RT England

Aims To investigate patterns of referral, disease and treatment for healthy children who had received two or more dental general anaesthetics (DGA) for exodontia. Methods Records from 200 episodes of repeat DGA were studied retrospectively. Results The mean age of patients at first referral was 5y4m, and the mean interval before repeat was 22 months. Self-referrals rose from 14% at DGA1 to 30% at DGA2. New caries at second referral, where all diagnosed disease had been treated at DCA1, accounted for only 15% of the total. Where a specific request was made in the referral, only 8% of letters matched the charting made in hospital. 30% of all specific requests were honoured, but then required treatment for previously diagnosed caries at DGA2. 75% of single-tooth extractions required repeat DGA for caries left at DGA1. Conclusions It may be too optimistic to address only the most grossly diseased teeth when a child requires GA exodontia. A more radical treatment-planning approach, combining primary care, secondary care and public health considerations, may be required to avoid the unnecessary use of DGA.

关键词：麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据儿童口腔保健/统计学和数值数据龋齿/流行病学龋齿/外科学转诊和会诊/统计学和数值数据回顾性研究拔牙/统计学和数值数据儿童学龄前人类

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Provision of dental general anaesthesia for extractions in child patients at two centres

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BRITISH DENTAL JOURNAL 1999年第9期187卷 498-501页

作者： Holt, RD Al Lamki, S Bedi, R Dowey, JA Gilthorpe, M UCL Eastman Dent Hosp Dept Transcultural Oral Hlth London WC1X 8LD England Mancunian Community Hlth & NHS Trust Manchester M21 7RL Lancs England

Aim At two contrasting centres, to describe the provision of dental general anaesthesia (DGA) for simple non-surgical extractions in terms of the type of treatment provided, including the number of primary and permanent teeth extracted, and the characteristics of child patients attending in terms of their age group and gender. Design Retrospective analysis of hospital records. Method Data were drawn from records of services over a 12-month period in 1996/97 at: a) a London dental hospital (Centre 1), and b) in the community dental services inRochdale, Lancashire (Centre 2). Information was collated and analysed using the SPSS statistical software package. Results The majority of patients at both centres were aged less than 9 years. Almost one third (31%) of those seen at Centre 1 were below 5 years of age, but fewer of this age group were treated at Centre 2. Children aged 9 years or less had an average of 5.4 (SD = 3.0) primary teeth extracted at Centre 1 and 3.0 (SD = 2.0) at Centre 2. For permanent teeth, an average of 3.2 (SD = 1.2) and 2.7 (SD= 1.4) were extracted at Centres 1 and 2 respectively. Conclusions Both services were used primarily for the extraction of primary teeth although the services differed in the ages of patients who used them and in the numbers of teeth extracted. Numbers of patients attending the service at Centre 1 had declined over time but numbers of teeth extracted per child had increased.

关键词：麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据儿童口腔保健/统计学和数值数据牙列恒英格兰拔牙/统计学和数值数据牙乳青少年儿童儿童学龄前女(雌)性人类男(雄)性

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Role of cerebral monitoring in carotic surgery

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ANASTHESIOLOGIE INTENSIVMEDIZIN NOTFALLMEDIZIN SCHMERZTHERAPIE 2001年第11期36卷 698-700页

作者： Jantzen, JP Werner, C Univ Erlangen Nurnberg Anasthesiol Klin D-91054 Erlangen Germany

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Orthodontic extractions: a comparative study of inhalation sedation and general anaesthesia

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BRITISH DENTAL JOURNAL 2000年第6期188卷 329-331页

作者： Shepherd, AR Hill, FJ Univ Manchester Dent Hosp Manchester M15 6FH Lancs England Cannon St Hlth Ctr Oldham NHS Trust Oldham OL9 6EP England

Objective To compare directly inhalation sedation and general anaesthesia in terms of treatment success rate, various aspects of morbidity and time taken, when used for patients having orthodontic extractions. Design Patients requiring orthodontic extractions were treated with either inhalation sedation or general anaesthesia. The two groups were matched for age, sex, number of teeth extracted and pre-operative anxiety. Data were collected by questionnaires. Setting Unit of Paediatric Dentistry at the University Dental Hospital of Manchester. Subjects All patients referred for orthodontic extractions between November 1994 and May 1996 were invited to take part in the study. Total number of patients = 101. Interventions Sixty-six patients commenced treatment with inhalation sedation and 35 with general anaesthesia. Routine orthodontic extractions were carried out. Outcome measures Treatment success rate, various aspects of morbidity and total time taken were measured and compared for the two groups. Results Treatment success rates were high for both groups. Significantly less morbidity was found to be associated with inhalation sedation and the total time taken was significantly shorter with inhalation sedation than with general anaesthesia. Conclusions Inhalation sedation is a successful alternative to general anaesthesia for orthodontic extractions with patients experiencing less morbidity and the time taken being shorter.

关键词：麻醉牙科麻醉全身/统计学和数值数据麻醉吸入清醒镇静儿童口腔保健正畸学/方法拔牙儿童女(雌)性人类男(雄)性

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GDC's guidance on anaesthesia

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 1999年第8期92卷 438-439页

作者： Westbury, B 4A Crouch Street Colchester Essex CO3 3ES UK

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Referrals for dental general anaesthetics - How many really need GA?

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BRITISH DENTAL JOURNAL 1999年第8期187卷 440-443页

作者： Tyrer, GL Birch Hill Hosp Community Dent Off Rochdale OL12 9QB England

Aim To fmd out how many patients for whom dental general anaesthesia was requested actually needed it in order to complete treatment. Design Analysis of clinical outcomes supported by telephone canvassing of parents. Method In summer 1998, eighty two child patients were seen in the Community Dental Service in Rochdale with a request for the provision of dental general anaesthesia (DGA) for the extraction of teeth. Their ages ranged from 3 to 14 years and all were required to attend for a pre-anaesthetic visit. Unless objective indicators of a need for DGA applied, the parents and children were actively discouraged from having DGA, and the alternative of local anaesthetic (LA) was offered. Clinical outcomes and parent satisfaction were recorded after treatment was finished. Results In 75% of cases it proved possible to complete the extractions without need for DGA;in the 10% of cases where DGA was necessary, it was to deal with the sequelae of dental caries. Fifteen percent of subjects failed to complete treatment. Subjects found to have a need for DGA tended to be younger and with treatment required in more than one sextant. Pain as a presenting symptom, young age and multiple treatment needs were found to be poor predictors of need for DGA and did not automatically preclude successful treatment without DGA. The satisfaction ascertained from users of the service was high and explanation of proposed treatments, especially the comparative risks and benefits of DGA versus LA, was well received. Conclusion There is score for significant reduction. in provision of dental general anaesthesia if current professional guidelines are followed.

关键词：年龄因素麻醉牙科/统计学和数值数据麻醉全身/统计学和数值数据麻醉局部/统计学和数值数据龋齿/治疗采访(主题) 病人遴选转诊和会诊/统计学和数值数据危险性评估拔牙治疗结果青少年儿童儿童学龄前人类

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An investigation of patient management methods used for orthodontic extractions by general dental practitioners in North West England

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BRITISH DENTAL JOURNAL 2000年第11期188卷 614-616页

作者： Shepherd, AR Hill, FJ Univ Manchester Dent Hosp Manchester M15 6FH Lancs England Oldham NHS Trust Oldham OL9 6EP England

Objective To quantify the patient management methods used by dental practitioners for orthodontic extractions and to determine what factors influence their choice of method. Design Practitioners working in the General Dental Service in the area of the former North West Regional Health Authority were randomly sampled and sent a postal questionnaire. Setting General Dental Service in the North Wrest of England. Subjects 204 completed questionnaires were returned;a response rate of 71.1%, Interventions Practitioners were asked about the patient management methods that they used for orthodontic extractions and what factors were important in choosing to use a general anaesthetic. Outcome measures The mean percentages of patients treated with local anaesthetic alone, general anaesthesia and inhalation sedation with local anaesthesia were calculated for the sample. Factors influencing the choice of method used were scored by the practitioners on a ten point scale. Results Local anaesthesia alone was used for two thirds of orthodontic extraction patients and general anaesthesia for one third. Inhalation sedation was rarely used. Poor patient cooperation and a nervous patient were the most important factors in choosing a general anaesthetic. Conclusions Local anaesthesia is used for the majority of orthodontic extractions. However there remains an overuse of general anaesthesia and an underuse of inhalation sedation.

关键词：麻醉牙科/方法麻醉全身/统计学和数值数据麻醉局部麻醉药吸入/投药和剂量麻醉药局部/投药和剂量卡方分布清醒镇静/统计学和数值数据合作行为决策牙科治疗焦虑/心理学牙医病人关系英格兰开业医生牙科正畸学矫正公费医疗拔牙人类

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