An Observational Study to Determine Whether Routinely Sending Patients Home With a 24-Hour Supply of Topical Tetracaine From the Emergency Department for Simple Corneal Abrasion Pain Is Potentially Safe.

STUDY OBJECTIVE: To determine if the number of emergency department (ED) rechecks, persistent fluorescein uptake, ophthalmology referrals, or complications would be affected by the prescription of topical tetracaine for pain relief from simple corneal abrasions (SCAs). METHODS: This retrospective cohort study was conducted in an ED where policy change allowed physicians to use topical tetracaine hydrochloride 1% eye drops for 24 hours for pain treatment for patients with corneal abrasions. Outcomes were compared between patients who did or did not received tetracaine (adjusting for the propensity for treatment). RESULTS: Of 1,576 initial ED presentations, 532 were SCAs, with 1,044 deemed nonsimple corneal abrasions (NSCAs). Tetracaine was dispensed at the initial visit for 303 SCA presentations (57%) and inappropriately for 141 NSCA presentations (14%). There were no serious complications or uncommon adverse events attributed to tetracaine for all SCAs and NSCAs combined (0/459; upper 95% confidence interval [CI] 0.80%). The relative risks (RRs) of ED recheck and fluorescein staining were increased overall among patients who received tetracaine (RR 1.67, 95% CI 1.25 to 2.23; and RR 1.65, 95% CI 1.07 to 2.53 for recheck and staining, respectively). However, the relative risks for only SCAs receiving tetracaine was 1.16 (95% CI 0.69 to 1.93) and 0.77 (95% CI 0.37 to 1.62), respectively. Referrals to ophthalmology were significantly decreased for all patients (SCAs and NSCAs) dispensed tetracaine (relative risk 0.33; 95% CI 0.19 to 0.59). The number of complications was too small to permit modeling. CONCLUSION: There was no evidence that up to 24-hour topical tetracaine for the treatment of pain caused by SCA was unsafe; however, CIs were wide and some increased risks were observed for NSCAs.

An exploratory study of parental knowledge of early childhood oral health care in Southland, New Zealand.

OBJECTIVES: The primary objective was to clearly assess the oral health care knowledge of Southland parents. The secondary objective was to identify whether inequalities exist between parents with different ethnicity, education or income. DESIGN: An exploratory study based on a simple online/ paper questionnaire. SETTING: Participants were recruited through Southland early childcare centres. Researchers contacted 115 centres, 66 agreed to participate and 58 returned questionnaires. METHODS: Questionnaires were distributed to each centre to be completed by the parents. The questionnaire was able to be completed online or as a paper copy. Centres were supplied with dental brochures, which were distributed after the questionnaires were returned. Questionnaires were collated and the responses analysed. RESULTS: Six hundred and seventy questionnaires were returned, 213 online and 457 paper copies. The typical participant was a mother (93.9%), age 34 years (median), a non-smoker (86.3%), non-Maori (87.1%), with a university degree (33.9%) and an annual household income between $60,001 and $100,000 (36.5%). Twenty of the 47 questions were selected to reflect parental knowledge. Overall, 65.1% of the respondents answered all 20 questions correctly. Differences in knowledge were identified between mothers and other participants (65.4% vs. 59.4%), smokers and non-smokers (61.3% vs. 65.7%), Maori and non-Maori (61.6% vs. 65.6%) and education level (Primary 58.0% vs. Degree 68.7%) (P < 0.05). CONCLUSIONS: This study revealed differences in knowledge in early childhood oral health care. Participants who identified as non-mothers (fathers, step-fathers, legal care givers or other), smokers, Maori or low education displayed significantly less knowledge. Further education and oral health care promotion may be needed to improve this disparity.

Dental attendance, perceptions of cost and self-care of school year 12 and 13 students: A focus on Southland, New Zealand.

BACKGROUND AND OBJECTIVES: Adolescents and emerging adults can provide dentists with many challenges. Little information is available on their perceptions of dental costs once they turn 18 and dentistry is no longer State-funded. The aim of this study was to explore the use of dental care by Southland students in years 12 and 13, their perceptions of the cost of four common dental procedures, self-related oral health and dental self-care habits, time off school related to dental problems, and knowledge and views regarding fluoride. METHODS: After ethical approval, a 26-question survey was conducted of all Southland students in years 12 and 13. Data were statistically analysed in SPSS version 20 with the alpha value set at 0.05. RESULTS: The participation rate was 49.6%. Regular attendance for examinations was reported by 77.5% with non-attendance mainly related to attitudes around lack of importance or necessity. Reported dental attendance varied according to gender, ethnicity and decile rating of school attended. Although some were accurate in their estimations of dental costs, the standard deviation for all procedures was large. The majority thought that costs put people off going to the dentist. While 74.8% brushed their teeth at least twice daily, only 26.6% flossed regularly. Knowledge regarding fluoride was lacking. CONCLUSIONS: It may be advantageous to include education regarding costs of dental care with patients of this age. This may motivate them to improve their self-care and ensure that their oral health is of a high standard before their dental needs are no longer State-funded.

Topical tetracaine used for 24 hours is safe and rated highly effective by patients for the treatment of pain caused by corneal abrasions: a double-blind, randomized clinical trial.

OBJECTIVES: The objective of this study was to test the hypothesis that topical tetracaine would be safe to use for 24 hours and would not affect corneal healing, that patients would experience more pain relief, and that patients would perceive tetracaine to be more effective than saline eye drops for the treatment of pain caused by corneal abrasions. METHODS: The study was a 12-month, prospective, double-blind, randomized trial of tetracaine versus saline set in the emergency department (ED) of a regional tertiary care teaching hospital. A total of 116 patients presenting with uncomplicated corneal abrasions were included in this study. The intervention was either undiluted, preservative-free, topical tetracaine hydrochloride 1% or saline, applied up to every 30 minutes while awake for 24 hours. Main safety outcome measures were repeat ED examinations at 48 hours with fluorescein staining and slit-lamp examination, 1-week and 1-month telephone interviews with additional examinations as needed, and monitoring of charts for complications. Secondary outcome measures were 100-mm visual analogue scale (VAS) pain scores recorded every 2 hours while awake for 48 hours and patient-perceived overall effectiveness using a numeric rating scale (NRS) of 0 to 10 obtained during telephone interviews. RESULTS: At least one follow-up encounter was completed on each of the 116 patients. No complications specifically attributed to topical anesthetic use occurred in the 59 patients in the tetracaine group, and the binomial probability confidence interval (CI) of this occurring is 0 to 6.1. There was no significant difference in corneal healing as measured by the percentage of patients with persistent fluorescein uptake at 48 hours between the two groups (23.9% vs. 21.3%, difference=2.6%, 95% CI=-14% to 20%, p=0.761) or persistent symptoms at 48 hours (21.7% vs. 21.3%, difference=0.4%, 95% CI=-16% to 17%, p=0.957). There was no clinical difference in VAS pain scores between the groups. Patients in the tetracaine group rated the study drugs' overall effectiveness significantly higher on the NRS (7.7 vs. 3.9) compared to patients in the saline group (difference=3.9, 95% CI=2.4 to 5.3, p<0.0005). CONCLUSIONS: Topical tetracaine used for 24 hours is safe, and while there was no significant difference in patient VAS pain ratings over time, patient surveys on overall effectiveness showed that patients perceived tetracaine to be significantly more effective than saline.

Duck shooting injuries in Southland, New Zealand.

Duck shooting is a common sport in New Zealand. The opening weekend is anticipated and celebrated, often with significant alcohol intake which is cause for concern, and potentially very dangerous. Hunters are annually warned about the dangers. There have been few duck shooting incidents which lead to injury or death. In the last decade two duck shooters in New Zealand have been killed, while 16 suffered non fatal gunshot injuries. We present a series of injuries identified during the 2012 duck shooting season in Southland Province.

Eligibility for medical thromboprophylaxis based on risk-factor weights, and clinical thrombotic event rates.

OBJECTIVES: To measure eligibility for medical thromboprophylaxis using two Australasian guidelines - the Australia and New Zealand Working Party Guidelines [WPG] and the National Health and Medical Research Council Guidelines [NHMRCG]) - and proposed new guidelines based on risk-factor weights; and to measure the incidence of clinical venous thromboembolism (VTE) events in medical patients ("ensuing VTE"). DESIGN, SETTING AND PATIENTS: Prospective case-note audit in an acute medical ward of Southland Hospital, a regional hospital in Invercargill, New Zealand, among all 595 patients who were discharged consecutively from 21 November 2010 to 7 March 2011. Of these, 245 were excluded on clinical grounds or because they were under the care of the authors. MAIN OUTCOME MEASURES: The primary outcome was eligibility for prophylaxis under each guideline. Secondary outcomes included incidence of ensuing VTEs, use of thromboprophylaxis, drug acquisition costs with each guideline, and bedside practicability of a guideline based on risk-factor weights. RESULTS: Nineteen per cent of patients were eligible under the new guidelines, compared with 80%, 88% and 36% under the WPG and two interpetations of the NHMRCG, respectively. One patient had an ensuing VTE. The new guideline had lower drug acquisition costs and was suitable for bedside use. CONCLUSIONS: Clinical VTE events are rare in medical patients, and medical VTE thromboprophylaxis needs to be more focused. The new guideline has performance characteristics th@satisfy this need.