AIMS:This study examined (1) whether patient and caregiver satisfaction in the emergency room (ER) varies according to patient origin, and (2) whether relevance of visit can explain any variation.METHODS:Data were obtained from a questionnaire survey of walk-in patients and their caregivers at four ERs in Copenhagen. The patient questionnaire was available in nine languages, and addressed patient satisfaction. The caregiver questionnaire addressed caregiver satisfaction and relevance of the patient contact in the ER. A total of 3,809 patients and 3,905 caregivers responded. The response rate among patients was 54%. Only data with both patient and caregiver responses and with patient country of birth were included in the analyses (n=3,426). The effect of patient origin was examined using bivariate, stratified analyses and tested for independence.RESULTS:Patients and caregivers had lower satisfaction rates when patients were of Middle Eastern compared with Danish origin. Satisfaction of both groups was associated with the relevance of the visit as assessed by the caregiver. Visits by patients of Middle Eastern origin were less often assessed as being relevant, but caregivers were less satisfied with visits by these patients even after controlling for relevance. Differences in patient satisfaction by patient origin were no longer significant when stratifying by relevance.CONCLUSIONS:Patient and caregiver satisfaction among patients of foreign origin can be improved by lowering the number of irrelevant visits among patients of foreign origin, e.g. by improving access to general practitioners. Training of caregivers in dealing with patients of different origins might reduce differences in caregiver satisfaction according to patient origin.

BACKGROUNDWe investigated the extent to which immigrants and patients of Danish origin have different motivations for seeking emergency room (ER) treatment, and differences in the relevance of their claims.METHODSData were obtained from a questionnaire survey of walk-in patients and their caregivers at four Copenhagen ERs. The patient survey was available in nine languages, and addressed patient-identified reasons for using the ER. Caregivers were asked if the claim was appropriate to the ER. 3809 patients and 3905 caregivers responded. The response rate among patients was 54%. Only questionnaires in which both patient and caregiver had responded, and in which data on the patient's nationality were available, were included in the analyses (n = 3426). The effect of region of origin was examined using bivariate, stratified analyses and tested for independence.RESULTSMore among immigrant patients than among patients of Danish origin had considered contacting a primary caregiver before visiting the ER, and more immigrants reported going to the ER because they could not contact a general practitioner, or could not explain their problem on the telephone. Compared to immigrants, more patients of Danish origin explained that the ER was most relevant to their need. A higher proportion of claims among immigrants were seen by caregivers as not being appropriate to the ER.CONCLUSIONMigrants have more irrelevant ER claims, presumably because of barriers in access to primary care. Access to primary care should be facilitated for these groups. Alternatively, ERs could include primary care activities as part of their services.

Isoetids are small, submerged vascular plants that often dominate the vegetation of soft-water lakes. The isoetids have short stiff leaves and large roots that might make up more than 50% of plant biomass. Leaves and roots have a system of internal gas spaces that allow efficient intra-plant gas transport and are the morphological basis for the remarkable use of sediment CO2 in photosynthesis by isoetids. This ability allows the plants to exploit the rich CO2 pool in the sediment of soft-water lakes and thereby partly ameliorate the low CO2 availability in the bulk water. The transport of CO2 from roots to leaves is by diffusion in the lacunae. Diffusion is relatively slow over longer distances and appears to set an upper limit to the leaf-length of isoetids. Quantitatively, the use of sediment CO2 accounts for most of the inorganic carbon assimilated by isoetids and only at very high CO2 concentrations in the bulk water significant amounts are taken up through the leaf surface. Physiologically some of the isoetids are unique among submerged macrophytes by featuring the crassulacean acid metabolism (CAM). CAM in isoetids is considered a carbon conserving mechanism and is an ecological advantage in typical isoetid habitats. CAM allows the plants to take up CO2 from the water at night when competition from other plants is eliminated and, since daytime CO2 uptake is unaffected by CAM, the time-slot during which CAM-isoetids can assimilate inorganic carbon is expanded compared to non-CAM species. The unique morphological and physiological traits and adaptations of isoetids allow them to prosper under the conditions prevailing in soft-water lakes. Still, growth is restrained by low resource availability and by an inherent low capacity for growth. Isoetids grow throughout the year with higher rates in summer and lower in winter. Annual leaf turnover rates are low and correspond to a leaf lifetime as long as 700 days in some species. A close relationship between production and mortality of leaves results in a relatively constant biomass over the year with only slightly higher values in summer than winter. However, the small stature and low weight of isoetid plants only allow moderate standing biomass per ground area despite high plant densities and accordingly the low leaf turnover rates result in low annual primary production in isoetid populations.

Sixty-nine patients with bi- or trimalleolar ankle fractures were evaluated in a questionnaire on an average of 9.6 years after their fracture. Patients with primary clinically severely dislocated ankle joints had significantly more complaints than patients with nondislocated ankle joints. The prognostic importance of this condition is emphasized.

Anterior tibial translation was measured in six patients with anterior cruciate ligament insufficiency. The tests were done in 15, 45, and 90 degrees of knee flexion, partly with activated quadriceps or hamstrings, and partly with subjects wearing a 4-point functional DonJoy brace. The translation was evaluated with a computerized electrogoniometer (Acufex KSS). The anterior tibial translation was significantly reduced by use of the hamstrings in all three degrees of knee flexion. The effect of the 4-point brace was only significant in 15 and 45 degrees of flexion. The quadriceps did not reduce the anterior tibial translation.

The intra-articular pressures in the glenohumeral joint in different positions were measured in 12 cadaveric shoulders. The lowest pressure was found in abduction combined with traction. A significant rise in pressure was seen in positions combining flexion or abduction with rotation. The injected volume to produce a certain pressure as well as the maximum pressure attained in each shoulder showed great variation. These factors are important considerations for immobilization of the shoulder and manipulation during arthroscopy.

Patients with a femoral neck fracture often undergo skeletal traction until surgery. These patients may develop hip joint tamponade that can lead to necrosis of the femoral head. We have measured the pressure variations in 20 cadaveric hips using a semiflexion frame and various loads of skeletal traction. We found a significant decrease in pressure with loads of 5 kg or more of skeletal traction. Skeletal traction does not increase the risk of femoral head necrosis.