جستجوی مقالات مرتبط با کلیدواژه « crowding » در نشریات گروه « پزشکی »

Emergency department (ED) overcrowding may damage patient outcomes in various settings. This systematic review investigated the association between ED crowding and patient mortality.

A search of three electronic databases namely Medline, EMBASE, and Web of Science websites was done to identify all original English language published studies concerning mortalities caused by ED crowding between January 1999 and January 2019.

A total of 45 studies were included in the full-text review. After excluding 17 studies because of poor quality, 28 articles were included in the final review. Twenty articles reported a direct association between ED crowding and emergency patient mortality. With the increase in ED overcrowding, mortality also increased. Nevertheless, eight of the studies reported no association between ED crowding and mortality.

ED overcrowding significantly increased patient mortality regardless of the amount of ED overcrowding and type of diseases in most studies were assessed in this study. Additional studies are required to comprehensively assess the relationship between ED overcrowding and patients’ mortality.

This study aimed to investigate whether the alignment of the teeth while smiling alters the visual perception by laypeople using eye tracking.

Facial images (two males and two females) were digitally edited to show a smile pattern with aligned teeth and one with crowded teeth. Sixty laypeople were selected to observe the images. The number of fixations, fixation duration, and time until the first fixation were recorded using an eye-tracking system. The results were qualitatively calculated with dot maps. Numerical data were analyzed using an independent Student’s t test.

There were no significant differences in fixation duration and the number of fixations in the crowded smile, mainly that of the male. The fixation times for the teeth were significantly different when the participants viewed the male subjects with a crowded smile (P<0.05). Dot maps showed greater attention to the smile with crowded teeth in both genders.

The crowded maxillary incisor smile attracted more visual attention to males from laypeople.

Emergency department (ED) crowding is a universal issue. In Taiwan, patients with common medical problems prefer to visit ED of medical centers, resulting in overcrowding. Thus, a bed-to-bed transfer program has been implemented since 2014. However, there was few studies that compared clinical outcomes among patients who choose to stay in medical centers to those being transferred to regional hospitals. The aim of this study was to explore the transfer rate, delineate the factors related to patient transfer, and clarify the influence upon the program outcomes.

A retrospective cohort study was conducted using demographic and clinical disease factors from the patient electronic referral system, electronic medical records (EMRs) of a medical center in Taipei, and response to referrals from regional hospitals. The study included adult patients who were assessed as appropriate for transfer in 2016. We analyzed the outcomes (length of stay and mortality rate) between the referrals were accepted and refused using propensity score matching.

Of the 1759 patients eligible for transfer to regional hospitals, 420 patients (24%) accepted the referral. Medical records were obtained from the regional hospitals for 283 patients (67%). After propensity score matching, the results showed that interhospital transfer resulted in similar median total length of stay (8.7 days in the medical center vs 7.9 days in regional hospitals; P=.245). In-hospital mortality was low for both groups (3.1% in the medical center vs 1.3% in regional hospitals; P=.344).

Transfer from an overcrowded ED in a medical center to regional hospitals in eligible patients results in non-significant outcome of total length of stay. With the caveat of an underpowered sample, we did not find statistically significant differences in in-hospital mortality. This healthcare delivery model may be used in other cities facing similar problems of ED overcrowding.

Emergency medical services (EMS) staff can play an important role in reducing emergency department (ED) overcrowding by decreasing unnecessary transfers. The present study was designed to evaluate the role of continuous education of EMS staff in decreasing the unnecessary transfers to ED. In this before-after study, analysis of 1500 EMS calls according to transferred and not transferred patients to ED was done and an educational package consisting of indications for transferring patients to ED based on existing references was prepared. EMS staff underwent an educational course by mentioned package and data of patients’ transportation after training was gathered and compared to the period before training. 3000 calls to pre-hospital emergency service were evaluated (1500 cases before and 1500 cases after training). The number of cases not transferred by EMS increased from 243 (16.2%) cases before training to 461 (30.7%) after that and the decreasing number of transfers to ED after training was significant (p<0.001). The highest percentage of decrease in transfer to ED belonged to complaints of lower back pain with 45%, mental problems with 27.7%, and direct extremity trauma with 23.4%, respectively. Patients not transferred to ED on the first call to EMS and coming with daily to ED during one week from the first call with the same complaint decreased from 13.6% (33 cases) to 8% (40 cases) after training. The highest percentage of the delayed coming patient to ED during 1 week after the first call to EMS belonged to cardiac complaints with 4.6% and mental complaints with 2.4%. Based on the findings of the present study, empowering pre-hospital emergency staff by continuous education leads to a 14.5% decrease in unnecessary referral cases and a 5.6% drop in unnecessary visits in ED.

Late mandibular incisor crowding is a fairly common phenomenon experienced by growing adults. The etiology of late mandibular incisor crowding, however, is controversial and inconclusive. Hence, this study aimed to investigate the correlation between mandibular third molar and mandibular incisor crowding using Cone-beam computed tomography (CBCT) data.

The study consisted of 40 samples of CBCT images divided into two groups (n=20). Group A comprised CBCT images without third molars, and group B included CBCT images with third molars. The images were observed in the axial view and manually marked to calculate the amount of crowding using Little’s irregularity index. The obtained values were statistically analyzed using Pearson’s correlation test. SPSS 23 was used for statistical analysis.

The results showed a positive correlation between the mandibular third molars and mandibular incisor crowding, which was significant (P=0.033). The mean Little’s irregularity index score for groups A and B were 4.26 and 6.799, respectively (P=0.033).

The positive correlation between the two groups suggests an association between the mandibular third molars and mandibular incisor crowding.

The under‑5 mortality rate in Indonesia is 32 per 1,000 live births, still higher than the SDG target. Acute respiratory infections (ARIs), as one of the leading causes of death, must be prevented. Arguments emerge concerning the association of home crowding, health behavior, and the incidence of ARI.

A cross‑section analysis with the Indonesia Demographic and Health Survey (IDHS) 2017 dataset is performed. Samples are restricted to 16,555 children aged 0–59 months who lived with their mother (eligible women interviewed) during the survey. For each of the variables observed during this study, missing data must be omitted as exclusion criteria. A 100 per cent answer rate was achieved. Logistic regression was used to determine ARI‑associated factors, by examining the effect of each explanatory factor (independent variables) on the odds ratio of ARI (one dependent binary variable).

The prevalence of ARI was more common among children living in the poorest households (AOR 1.66; 95% CI, 1.20 – 2.28) and those exposed to indoor tobacco smoke pollution (AOR 1.27; 95% CI, 1.04–1.56). On the other hand, those aged 0–5 months (AOR 0.59; 95% CI, 0.43–0.82), living at home with improved sanitation (AOR 0.74; 95% CI, 0.61–0.89), and exclusively breastfed (AOR 0.85; 95% CI, 0.73–0.99) were less likely to have ARI.

Home crowding is not associated with ARI. Efforts should be focused on preserving family health behavior. The family functioned as a health‑support system for their under‑5 children by establishing an indoor tobacco smoking‑free zone, practicing exclusive breastfeeding, and enhancing hygiene facilities.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was transported from China to Iran via passengers. The virus is transmitted through droplets from coughing, sneezing, talking and contact with infected surfaces. Due to high transmissibility in places such as clinics, medical offices, buses and offices where there are large crowds, it spread rapidly in Iran and caused the mortality of a significant number of people, especially the elderly with underlying disease. Preventing travel and gatherings, as well as applying house quarantine in Apr 2020, reduced COVID-19 somewhat but then due to lack of attention to social distancing, reducing the use of masks by the people and inappropriate decisions by the national committee on combating coronavirus (NCCC), including reducing the working hours of public offices and shops, reducing the staff of government offices, monopoly on the distribution of essential materials and supplies, the presence of overcrowding in clinics of medical centers, hospitals, and private clinics caused the decline of the disease in the country to decrease. Measures can be taken to prevent the spread of the virus as much as possible, including: rapid detection of infected people, their isolation, contact tracing, quarantine of people over 65 and under 15, protection of the elderly, prevention of gatherings, forcing the use of protective equipment in possible gatherings, and electronicizing public services.

 The velocity of providing services in health centers is crucial to reduce mortality and adverse outcomes.

 The present study aimed at determining the waiting time from entering the emergency department (ED) up to physician visiting based on congestion in the triple shift at Shahid Mohammadi Hospital in Bandar Abbas, Iran.

 The current cross-sectional, analytical study was conducted in 2019 on 1285 subjects selected from three shifts. The data collection tools included demographic data and standard triage forms, as well as a timetable with a stopwatch. The time between patient arrival and physician visit was recorded. SPSS software version 21 was employed to analyze the data.

 The highest percentage of patients, 65.1% (n = 837), was non-traumatic, 38.98% (n = 501) referred during the evening shift, and 47.54% (n = 611) were related to the triage level 3. The maximum average waiting time from the beginning to the end of the triage was 4.46, and up to the physician, the visit was 12.8 minutes. Waiting time from entering ED up to physician first visit in terms of gender, refer to ED, and cause of referral statistically divulged a significant difference (P < 0.05). Estimation of the maximum congestion in the department was from 16:00 to 20:00, which showed a significant difference with other day times (P < 0.05).

 The average waiting time for patients was higher than the global standard. The interventions based on the maximum congestion in ED can be effective in reducing patient waiting time.

The aim of this study was to evaluate vertical dimension of face and position of incisors following extraction of four first premolars in patients with class I malocclusion and bimaxillary dentoalveolar protrusion and/or crowding.

 This study evaluated 22 patients with class I molar relationship, bimaxillary dentoalveolar protrusion and/or crowding with the treatment plan of extraction of all four first premolars. The change in U1-PP, L1-MP, IMPA, U1-SN, saddle angle, articular angle, gonial angle, and the sum of Bjork was determined by assessing the before and after-treatment cephalograms. The changes in cephalometric parameters were analyzed by ANOVA and paired t-test.

 The U1-SN, IMPA, U1-PP and sum of Bjork significantly changed following extraction of the four first premolars (P<0.05). However, the changes in saddle, articular and gonial angles and L1-MP were not significant (P>0.05).

 We observed retraction and extrusion of incisors and increase of vertical dimension following extraction. Retraction of incisors will relatively retract lips. Also, it is not advisable to extract premolars to improve vertical dimension, although extrusion of incisors will facilitate the bite closure.

Emergency Department (ED) crowding is a global public health phenomenon affecting access and quality of care. In this study, we seek to conduct a systematic review concerning the challenges and outcomes of ED crowding. This systematic review utilized original research articles published from 1st January 2007, to 1st January 2019. Relevant articles from the PubMed (MEDLINE), EMBASE, and Google scholar databases were extracted using predesigned keywords. Following the PRISMA guidelines, two reviewers independently evaluated the quality of the studies using Critical Appraisal Skills Programme for cohort studies and qualitative studies, and Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument for studies. Out of the total of 73 articles in the final record, we excluded 15 of them because of poor quality. This systematic review synthesized the reports of 58 original articles. The outcomes of multiple individual patients and healthcare-related challenges are comprehensively assessed. ED crowding affects individual patients, healthcare systems and communities at large. The negative influences of crowding on healthcare service delivery result in delayed service delivery, poor quality care, and inefficiency; all negatively affecting the emergency patients' healthcare outcomes, in turn.

The reason behind patients’ overcrowding in emergency departments (ED) may be due to several factors such as great number of referring patients or inaccessibility of facilities or hospital beds.
The present study aimed at evaluating the overcrowding of ED in Tabriz Imam Reza hospital in 2015 using 2 scales: National Emergency Overcrowding Scale (NEDOCS), and Emergency Department Work Index (EDWIN).
This was a cross-sectional descriptive study conducted in the ED of Imam Reza hospital affiliated to Tabriz University of Medical Sciences, Iran, in a one-year period (Jan- Dec 2015). Convenience sampling method was used for data collection. During the study, the researchers randomly selected 10 days out of every month and started to collect index variables 4 times a day at 6 AM, 12 noon, 6 PM, and 12 midnight. In total, 488 samples were gathered and both NEDOCS and EDWIN were implemented for each sample. Then, the frequency of overcrowding in the emergency department was reported based on the obtained results.
Based on NEDOCS, ED was extremely busy, but not overcrowded in 51 cases (10.5%), it was overcrowded in 298 (61.1%) cases, severely overcrowded in 138 cases (28.3%), and it was busy only in one case (0.2%). However, based on the EDWIN scale, the ED was active but manageable in 91 cases (18.6%), very busy in 36 cases (7.4%), and extremely busy in the remaining 361 cases (74%).
EDWIN scale depicted August, July, December, June, and April to be, respectively, the most overcrowded months. This finding revealed EDWIN scale to perform better when trying to have an overall assessment of ED during the whole year, which helps us have clear- cut results for analysis and policy making in managing EDs.

Creating a calm and stress-free environment affects education significantly. The effects of the emergency department overcrowding (EDO) on the training of emergency medicine residents (EMR) is a highly debated subject. Therefore, this study aimed to evaluate the effect of EDO on efficiency of EMR’s education. In this cross-sectional study, the effects of overcrowding on EMR’s education in the resuscitation room and acute care unit. Data collection was done using a questionnaire, which was filled out by the second year EMRs. The crowding level was calculated based on the national emergency department overcrowding scale (NEDOCS). The relationship between the two studied variables was evaluated using independent sample t-test and SPSS 21 statistical software. 130 questionnaires were filled out during 61 shifts. 47 (77.05%) shifts were overcrowded. The attend’s ability to teach was not affected by overcrowding in the resuscitation room (p=0.008). The similar results were seen regarding the attend’s training ability in the acute care unit. It seems that the emergency department overcrowding has no effect on the quality of education to the EMRs.

One of the core parts of clinical orthodontics is the analysis of dentofacial growth. Changes that occur in the shape, form and size of dentoalveolar arch may result in various problems during diagnosis and treatment planning. The aim of this study was to investigate the late changes of alignment in the anterior teeth of mandible during 4-years follow up in young adults with normal occlusion in Qazvin This was a longitudinal descriptive survey with 23 samples (13 girls and 10 boys). Subjects with an age range of 13±1 were selected for dentoalveolar change assessment. Two dental models were prepared from each subject one at the start of the investigation and one at the 4 years follow up; photographs of each model were taken at the time. Inter-canine distance, anterior arch depth, arch shape index, anterior teeth width (6 anterior teeth), anterior arch circumference (ATSALD) were measured using AutoCAD 2004 software and digital caliper. Means and standard deviations were measured using Npar test analysis. Data were compared at 0 and 4 years and between two genders using Wilcoxon test (P<0.05). The most prevalent changes in samples belonged to ATSALD (2.2mm increase) over the four years. The least changes were detected in arch shape index. Anterior arch circumference and ATSALD were the dominant changes in boys and girls, respectively. During this critical growth period, anterior crowding of mandibular teeth increases in both boys and girls, while the inter-canine distance and arch shape index decrease.

Despite a substantial body of literature refuting an association between third molar eruption and crowding of the lower anterior dentition, the issue continues to be controversial. This study sought to assess the correlation between angulations of impact mandibular third molars and anterior crowding of the lower arch. 127 patients were examined in this analytical-descriptive study. Clinical and paraclinical records were obtained to assess different impaction angulations and the rate of crowding. Patients with history of previous extractions, orthodontic treatment, Bolton discrepancy and skeletal orthodontic malformations were excluded. Kruskal —Wallis test was used for statistical analysis. Of the 127 patients studied, mcsioangular impaction was observed in 61 patients (48%). This study showed no significant correlation between different angulations of mandibular third molar impaction and crowding (P>0.05). This study seems to confirm that the role of the lower third molars is not a significant factor in causing late anterior crowding.

Everyday because of developing new materials and techniques, more adults become interested in orthodontic treatments. Soft positioner and its new generation in the name of Invisalign System is an example. The present case report was designed to study the effects of soft elastic foils as serial aligners on treat-ing the mild to moderate crowding.

Three teenage patients with crowding not more than 6 millimeters were select-ed. After the preparation of orthodontic diagnostic records and filling the periodontal chart, manual teeth setup was carried out on working casts with a maximum 0.5 millimeter displacement. Aligners were made up of bioplast foils. The appliance was worn by patient full time for at least 2 weeks. Then the new one was made and this procedure was continued until complete tooth alignment. The last aligner was used as retainer for three months later. These variables were evaluated after treatment : dental alignment , over jet . overbite, inclination of upper & lower incisors, lips relation to E line, mandibular plan angle, clicking in TMJ, periodontal status and tooth pain. Active treatment period lasted between 3-5 months.

Anterior crowding was completely corrected in all patients. Protrusion of upper & lower incisors were seen in lateral cephalograms. Overbite, mandibular plan angle and lips relation to E line did not change. Improvement of periodontal status were recorded in all patients. Low to moderate toothache was reported during the first 2 days .

Mild to moderate crowding could be corrected successfully with soft elastic foils (Serial Aligners) without deleterious effects on TMJ and periodontium however manual tooth setup was time consuming. (IJO 2006; 1: 75 - 78)

Malocclusion may be caused by tooth size discrepancy and it is impossible to achieve perfect treatment results without regarding this etiologic factor. The aim of present study was to determining and comparing the mesiodistal width of permanent teeth in normal occlusion group and patients with class 1 crowding malocclusion in Hamedan.
Based on Andrews normal occlusion criteria among 3335 students of Hamedan pre-university schools 32 persons were selected as normal group. In matched sex and range of age , 32 patients with class 1 crowding malocclusion were selected from a private office . Orthodontic dental casts of all samples were prepared. Mesiodistal width of all teeth (except 2nd molars), overbite, over-jet and Bolton indices were measured 3 times. Student t test and Mann whiteny u test were used for analysis.
In crowding group the mesiodistal width of all teeth except for the first molars, were significantly greater than normal group specially in upper lateral incisors and lower premolars. Maxillary tooth material was 5.3 millimeter (p=0.0005) and mandibular tooth material was 5.4 millimeter (p=0.0036) greater in crowding patients. In crowding patients, overjet was significantly less and overbite was significantly more than normal group (p=0.0001) There was not significant difference in Bolton index between 2 groups.
It seems there is more crowding tendency in cases with large teeth. According to results. Bolton discrepancy (tooth size discrepancy) cannot be considered as a frequent factor in developing class 1 crowding. 2006; 1: 66 - 69)

Everyday because of developing new materials and techniques, more adults become interested in orthodontic treatments. Soft positioner and its new generation in the name of Invisalign System is an example. The present case report was designed to study the effects of soft elastic foils as serial aligners on treat-ing the mild to moderate crowding.
Three teenage patients with crowding not more than 6 millimeters were select-ed. After the preparation of orthodontic diagnostic records and filling the periodontal chart, manual teeth setup was carried out on working casts with a maximum 0.5 millimeter displacement. Aligners were made up of bioplast foils. The appliance was worn by patient full time for at least 2 weeks. Then the new one was made and this procedure was continued until complete tooth alignment. The last aligner was used as retainer for three months later. These variables were evaluated after treatment : dental alignment , over jet . overbite, inclination of upper & lower incisors, lips relation to E line, mandibular plan angle, clicking in TMJ, periodontal status and tooth pain. Active treatment period lasted between 3-5 months.
Anterior crowding was completely corrected in all patients. Protrusion of upper & lower incisors were seen in lateral cephalograms. Overbite, mandibular plan angle and lips relation to E line did not change. Improvement of periodontal status were recorded in all patients. Low to moderate toothache was reported during the first 2 days .
Mild to moderate crowding could be corrected successfully with soft elastic foils (Serial Aligners) without deleterious effects on TMJ and periodontium however manual tooth setup was time consuming. (IJO 2006; 1: 75 - 78)