Training for major incidents.

Major incidents are serious events with broad-reaching consequences that require extraordinary solutions to be implemented. They call for a team-based approach and efficient communication at all levels in addition to effective command, control and oversight. While consolidation of care into major trauma centres has led to improved outcomes for patients, it also means that clinicians may miss out on real-life experience of major incident or severe trauma casualties. It is therefore important to factor training, exercises and planning into individual and organizational preparedness. While several recent major incidents have occurred and provided further experience and lessons, such as the Grenfell Fire, Manchester Arena bombings and London Bridge stabbings, the global COVID-19 pandemic has required clinicians and organizations around the world to re-examine major incidents and the extent of their impacts. This has reinforced the importance of all members of the clinical team possessing an appropriate level of awareness and understanding of major incidents.

Office-based dental rehabilitation in children with special healthcare needs using a pediatric sedation service model.

PURPOSE: 1) To review our experience with office-based sedation/anesthesia for children with special healthcare needs who underwent dental rehabilitation at our institution. 2) To compare the cost to comparable patients who underwent similar procedures in the operating room. PATIENTS AND METHODS: Retrospective review of patients' medical records and the sedation service database. Group CL: 114 patients who underwent office-based dental rehabilitation (135 procedures). Group OR: 23 patients who underwent dental rehabilitation under general anesthesia in the operating room for cost comparison. OUTCOMES: 1) EFFICACY (procedure completion rate and unplanned admissions); 2) SAFETY (complications and interventions); 3) Comparison of mean hospital charges billed between groups. RESULTS: Demographics were similar in both groups. The most common specific underlying diagnoses were autism (38%), cerebral palsy/developmental delay (18%) and ADHD (4%) in both groups. EFFICACY: procedure completion rate was 98.5% (2 aborted). There was 1 (0.7%) unplanned postanesthetic care unit admission due to an adverse drug event. SAFETY: 2 (1.5%) patients required invasive airway control. Eighteen (13.3%) patients developed transient hypoxemia. Twenty-three (17%) patients had airway obstruction needing simple intervention, and 1 (0.7%) patient had hypotension. There were no serious complications. Cost: mean total hospital charges were considerably higher in group OR ($6,126), versus group CL ($1,277), even after adjustment for inflation and length of procedure (P<.0001). CONCLUSION: Office-based dental rehabilitation using a pediatric sedation service model in children with special needs is efficient, and can achieve average savings of $4,849 in hospital charges per patient.

Analysis of a Picard modular group.

Our main goal is to analyze the geometric and spectral properties of the Picard modular group with Gaussian integer entries acting on the two-dimensional complex hyperbolic space.