Ewa Rudnicka-Drożak

Esophageal Foreign Bodies in Pediatric Patients: A Thirteen-Year Retrospective Study

We discuss clinical symptoms and radiological findings of variable esophageal foreign bodies as well as therapeutic procedures in Caucasian pediatric patients. A retrospective study of 192 cases of suspected esophageal foreign bodies between 1998 and 2010 was conducted. Data were statistically analyzed by chi-square test. A foreign body was removed from a digestive tract of 163 children aged 6 months to 15 years (mean age 4.9). Most objects were located within cricopharyngeal sphincter. Dysphagia occurred in 43%, followed by vomiting (29%) and drooling (28%). The most common objects were coins. Plain chest X-rays demonstrated aberrations in 132 cases, and in doubtful situations an esophagram test was ordered. In the group of thirty-seven patients whose radiograms were normal, esophagoscopy revealed fifteen more objects, which were eventually successfully removed. No major complications occurred. Esophagram should be a second X-ray examination if an object is not detected in plain chest X-ray. We recommend a rigid esophagoscopy under general anesthesia in doubtful cases as a safe treatment for pediatric patients.

Are there any differences in medical emergency team interventions between rural and urban areas? A single‐centre cohort study

OBJECTIVE To compare interventions of medical emergency teams in urban and rural areas with particular emphasis on response time and on-site medical rescue activities. DESIGN A retrospective analysis of ambulance call reports from two emergency medical service substations: one in the city and the other in a rural area. SETTING Two emergency medical service substations: one in the city and the other in a rural area. PARTICIPANTS Medical emergency teams. RESULTS Interventions in the city were associated with a substantially shorter response time in comparison to rural areas. In the city, the distances were generally less than 10 km. In the rural area, however, such short distances accounted for only 7.2% of events, while 33.8% were over 30 km. Medical emergency teams more often acted exclusively on-site or ceased any interventions in rural areas. Compared with the city, actions in the rural setting were associated with significantly increased use of cervical collars and decreased use of intravenous access. The presence of a physician in the team raised the probability of pharmacotherapy. CONCLUSION The relationship between medical emergency teams activities and the location of intervention shows the real diversity of the functioning of emergency medical service within a city and rural areas. Further research should aim to improve the generalisability of these findings.

Determinants of Health Behaviors in Individuals of Medical and Non-Medical Professions

Abstract Aim. Determination of health behaviors in the group of people performing medical and non-medical professions. Material and methods. The research covered 598 individuals divided into two groups: those performing medical professions (group M, n = 305) and non-medical (group P; n = 293). Standardized tools were used: Health Behavior Inventory, Multidimensional Health Locus of Control Scale - version B, General Self-Efficacy Scale on risk factors and prevention of civilization diseases (own authorship). The controls were subjected to measurement of blood pressure as well as their height and body mass tests. Results. In group M, the level of self-efficacy, the location of health control in terms of the influence of the others and the chance, age, incidence of cardiovascular diseases in the father, smoking and the level of mean systolic blood pressure explain 17.5% of the variability of health behavior. In group P, the level of self-efficacy, location of health control in terms of the influence of the others and the chance, monthly net income per a family member, the occurrence of neoplasms in siblings, smoking, average blood pressure and the level of knowledge about risk factors and prevention of civilization diseases explain 27.9% of the variance of the health behavior variable. Conclusions. There is a diversification of selected determinants of health behaviors in the group of individuals performing medical and non-medical professions, with their stronger impact on non-medical professionals (17.5% vs. 27.9% of their variability).

Should the family witness cardiopulmonary resuscitation? Perceptions of health professionals in Poland

1Department of Emergency Medicine, Faculty of Health Sciences, Medical University of Lublin, Lublin, Poland 2Chair and Department of Family Medicine, First Faculty of Medicine, Medical University of Lublin, Lublin, Poland 3Division of Teaching and Outcomes of Education, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland 4Department of Emergency Medical Services, Faculty of Health Science, Medical University of Warsaw, Warsaw, Poland 5Polish Medical Air Rescue, Poland

Analysis of Health Behaviors and Personal Values of Childless Women, Pregnant Women and Women Who Recently Delivered

Preconception lifestyle modifications and reduction of several known risk factors may have an influence on future pregnancy outcomes. The aim of the study was to analyze health behaviors and personal values as well as to assess the relationship between these factors in women without children, in pregnant women and in women who had already delivered babies. The questionnaire survey included the Health Behavior Inventory (HBI), the Personal Value List (PVL) and sociodemographic data and was conducted in 538 women. These women were divided into three groups: women who had recently delivered (n = 235), pregnant women (n = 121) and childless women (n = 182). Pregnant women demonstrated a significantly higher level of declared health behaviors, and also, they rated higher on the subscales values “positive mental attitude” and “health practices”, in comparison to women who had recently delivered and to childless women. In all tested groups, the highest rated personal value was “a successful family life”, while the most appreciated symbol of happiness was “love and friendship”. Our results suggest that the system of values and the perception of happiness symbols may influence women’s health behaviors. Positioning “health” in the hierarchy of personal values as the most important one may facilitate the introduction of healthy behaviors. This, in turn, could reduce several adverse pregnancy outcomes that are potentially modifiable with changing preconception health attitudes. Our results also identify several unanswered questions and highlight areas where new research is needed.

Fall as a cause of hospitalization in the Emergency Department in a population of people over 65 years of age

Introduction. Falls are included among the geriatric giants, as their consequences in older people are major in terms of nursing, medical, social and economic problems. In the case of elders they can lead to fractures and, consequently, even to death. Materials and method. The study retrospectively analysed the medical records of 455 cases of injuries resulting from falls among patients over 65 years of age. Data was gathered in the Emergency Department (ER) of the Independent Public Clinical Hospital No. 1 in Lublin, Poland. The analysis included patients who visited the ER during the period 01.05.2009–30.04.2010. Results. Elderly patients hospitalized in the ER within the given period accounted for 8.10% of all patients. Most of patients over 65 years of age were admitted in December due to falls; slightly fewer cases were recorded in March and April. Mondays and Saturdays were the days of the week with the highest number of reports of elderly patients. Analysis of the collected data incorporating further treatment showed that the great majority of injured patients did not require hospitalization and were discharged home. In the analyzed population of older people, damage to upper and lower limbs dominated, followed by injuries to the head, chest and abdomen. Conclusion. Falls are a major cause of reduced quality of life, disability and death in older people. There are important factors in limb fractures (90%-100%). Preventing falls is a difficult and underestimated problem. There is a need of implementing preventative measures in the case of falls in elderly patients.

Diagnosis of paediatric airway foreign body: is it easy?

Foreign-body aspiration in children results in diagnostic problems, mainly because of nonspecific signs. Therefore, in this study, we placed particular stress on false-positive and -negative predictors. Charts of 139 consecutive paediatric patients aged 6.0 months to 15.5 years who underwent bronchoscopy for a suspected foreign body aspiration were analysed retrospectively. A foreign body was found in 95 cases (68%). The anamnesis was positive in 91%. Cough was the most common clinical symptom (91%) with a sensitivity and specificity of 94% and 23%, respectively. There were no significant correlations between clinical symptoms and the locations of foreign bodies. The majority of focal hyperinflation (24%) and atelectasis (15%) were seen in chest radiographs, with a sensitivity and specificity of 33% and 89% (hyperinflation) and 15% and 82% (atelectasis), respectively. Chest X-rays were normal in 46 cases; however, an object was removed in 25. Persistent infiltrates were present in 14 X-rays, and a foreign body was extracted during bronchoscopy in 4. A highly significant correlation between the type of foreign body and radiological signs was noted (p = 0.00001). Anamnesis, clinical symptoms, and radiological findings are helpful in confirming aspiration, but can be misleading. Chronic or recurrent pneumonia should prompt further bronchoscopic diagnosis.

Analiza struktury i częstości przyjęć pacjentów w stanie zatrucia alkoholem na przykładzie dwóch lubelskich szpitali

Abstract Introduction On June 30th 2002 the sobering station in Lublin was closed as part of public spending cuts. Currently, the city lacks an appropriate facility to provide care for intoxicated individuals. The aim of the work was to investigate the proportion of alcohol intoxicated patients admitted to the Admission Room/Hospital Emergency Department (AR/HED) before the sobering station in Lublin was closed in 2002, and a decade later in 2011. Method The research method comprised an analysis of medical records from the emergency department and admission room of two hospitals in Lublin. In each hospital the records from 4 selected months (January, April, July, and October) were examined. Of the 8625 patient admission cards from AR and HED, 772 records in a state of alcohol intoxication were selected (215 records from 2001 and 2002, and 557 records from 2011), and were analysed in the second stage of the research. The target group of patients was identified with the use of medical diagnostic codes ICD-10: F10.0 (acute intoxication due to use of alcohol) and T51 (the toxic effect of alcohol) to define the principal diagnosis or comorbidity, or according to a doctors explicit annotation in medical records stating that the patient was intoxicated. The obtained research results were statistically analysed. The database and statistical analysis was carried out by means of the STATISTICA 10.0 software (StatSoft, Poland). Results and conclusions Statistical analysis showed that after June 30th 2002 and in 2011, the frequency of the admissions of patients with alcohol intoxication was significantly higher than in 2001 and 2002, i.e. before the sobering station was closed. The research indicated that not all individuals in a state of insobriety required advanced medical intervention in a hospital emergency department, 72 patients were kept in for observation only, and the majority (232 patients) were only administered an intravenous saline solution. A large group of patients admitted in a state of alcohol intoxication left the hospital unauthorised (41.97%) without doctors consent. The reopening of the sobering station in Lublin could relieve patient traffic in hospital emergency departments and admission rooms.