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Can Fam Physician
Vol. 53, No. 1, January 2007, pp.101 - 102
Copyright © 2007 by The College of Family Physicians of Canada
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When patients are placed on wait lists for surgery, one worry is that they will require emergency surgery while waiting. This worry intensifies if the list is particularly long. Does the length of the waiting list at the time patients are registered increase the likelihood of unplanned emergency admission and surgery among those booked for coronary artery bypass grafting (CABG)? A recent study from British Columbia investigated this question.

The results were quite interesting. The researchers found that the length of a wait list at registration had no effect on the probability that a semiurgent (surgery recommended within 6 weeks) or nonurgent (surgery recommended within 12 weeks) patient would have CABG through unplanned emergency admission. Patients who underwent CABG immediately after diagnosis without having been registered on a wait list in the same hospital did not change the odds of unplanned emergency surgery for those on the list. One quarter of those on a long list (clearance time of more than 1 month) were still waiting for surgery at 29 weeks.

Source
Sobolev B, Kuramoto L, Levy A, Hayden R. Unplanned emergency surgery in relation to length of wait lists at registration. Clin Invest Med 2006;29:193-200.[Medline]


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Injuries, such as falls from heights, burns, scalds, and poisonings, cause almost half of deaths among children aged 1 to 4 years. Many of these injuries can be prevented by removing hazards from the home. A multicentre Canadian trial looked at the homes of children aged 7 or younger who had presented to the emergency department with injuries from falls, burns, scalds, ingestions, and chokings. The homes of children who presented during the same time period for acute conditions that were not related to injuries were assessed as well.

Many hazards were found in the homes. More than half of the homes did not have fire extinguishers, and 17% did not have functioning smoke alarms. Baby walkers were found in more than 20% of homes with small infants. The mean proportion of hazards was similar in both groups. After controlling for siblings, maternal education, and employment, however, cases differed from controls in 5 areas—presence of baby walker; choking hazards within a child’s reach; no child resistant lids in the bathroom; no smoke alarm; and no functioning smoke alarm. The researchers warn that the presence of 1 hazard might indicate increased risk of home injuries beyond those directly related to the hazard found.

Home injury prevention checklists can be found on the following websites.

Source
LeBlanc JC, Pless IB, King WJ, Bawden H, Bernard-Bonnin AC, Klassen T, et al. Home safety measures and the risk of unintentional injury among young children: a multicentre case-control study. CMAJ 2006;175:883-7.[Abstract/Free Full Text]


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What is the best length and gauge of needle for administering vaccinations to infants? Almost 700 infants were enrolled in a UK study that looked at immunogenicity and local and general reactions to vaccination using 3 different needle sizes.

Researchers found that long (25 mm) needles for infant immunizations can significantly reduce local reactions, while achieving comparable immunogenicity to that of short (16 mm) needles. Little difference was found between different gauges of the same length of needle in local reactions or immune response. There was no difference in general reactions using any of the needles.

Source
Diggle L, Deeks JJ, Pollard AJ. Effect of needle size on immunogenicity and reactogenicity of vaccines in infants: randomised controlled trial. BMJ 2006;333:571. Epub 2006 August 4.[Abstract/Free Full Text]





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