Introduction: NIV for acute hypercapnic respiratory failure (AHRF) in COPD, obesity related morbidity, chest wall and neuromuscular conditions has become widespread in the UK. In terms of acute NIV set up, the British national guidance (2008) recommends starting with an inspiratory positive airway pressure (IPAP) of 10 cm H2O and expiratory positive airway pressure (EPAP) of 4–5 cmH2O, with small increments in IPAP aiming for a pressure target of 20 cm H2O or until therapeutic response is achieved. We analysed trends in maximum pressures achieved since 2004 in our 11-bedded ward-based NIV unit. Methods: Comparison of in-house NIV registry data 01/08/04 -31/01/06 (Period 1) with 01/01/11 – 30/06/12 (Period 2), looking at maximum IPAP and maximum EPAP achieved. There were 281 episodes of AHRF treated in Period 1; 240 in Period 2 with similar distribution of gender. Results: There were 281 episodes of AHRF in period 1 and 240 in period 2. Maximum IPAP achieved in period 2 was significantly higher than period 1 (median IPAPmax 20 cmH2O vs. 14 cmH2O; p=2.2x10-16). Maximum EPAP followed same trend (median EPAPmax 5cm H2O vs. 4cm H2O; p=8.068x10-6). Discussion: Adequate therapeutic response is achieved with median IPAP max of 16.7 and median EPAP max of 5.2 cmH2O (Ali A et al. ERJ 2011; 38: 55. 683s.). However, with more experience over an 8-year period, we are achieving significantly higher maximum IPAP and maximum EPAP. This is probably in keeping with the increasing severity of AHRF that is being treated in the unit with similar in-hospital mortality (around 22%). Further analysis of population characteristics and comparison with units of similar size are needed.

Medical emergencies can be alarming to any clinicians, but these situations can be managed well if proper preparation has been made. The objectives of this study are to evaluate USIM dental graduate’s knowledge in dealing with medical emergencies in dental practice, to assess perceived level of competency of USIM dental graduate’s in dealing with medical emergencies in dental practice and to determine the need for further improvement in medical emergencies undergraduate training. A standardised questionnaire form consisting of demographic data, experience, knowledge and perceived level of competency of dental practitioner in dealing with medical emergencies were distributed to USIM dental graduate.123 respondents answered the online questionnaire. Around 58.5% of them had experienced medical emergencies during dental treatment. All of them answered correctly on management of hypoglycaemia but only 44.7% answered correctly on management of unresponsive patient and 65% answered correctly on position of syncope patient. Most of the respondents were not confident in administrating intravenous medication (46.3%), handling foreign body aspiration (24.4%) and using Automated External Defibrillator (AED) (38.2%). This study can be used to guide further improvement in medical emergency training for undergraduates and enhancing the proficiency level of the USIM dental graduates.

Medical emergencies in dental practice is not uncommon and it can be alarming to any clinician but it managed well with proper preparation beforehand. This study is aimed to evaluate private dental practitioner's knowledge in dealing with medical emergencies in dental practice, to assess perceived level of competency of private dental practitioners in dealing with medical emergencies in dental practice and to determine private dental practitioners need for further improvement in medical emergencies training. A standardised questionnaire form consisting of demographic data, experience, knowledge and perceived competency in management of medical emergencies in dental practice was used. Most respondent answer correctly regarding medication indicated in angina attack (92.6%), meanwhile the question on first action in dealing with unresponsive patient got the least correct answer (25%). Most of the respondent felt incompetent in conducting certain procedures especially in administration of intravenous drugs where. Majority of the practitioners (66.2%) felt competent in performing measurement of vital signs. Nonetheless, all respondents showed the desire to obtain further knowledge in medical emergencies management. The results of this study can provide an insight for further improvement in medical emergencies management including the necessary skills and knowledge required by dental practitioners in order to deliver a safe and reliable dental practice.

Dentists should provide a safe environment for all patients and this also includes preparing for the occurrence of medical emergencies in dental setting. Managing medical emergencies must be considered in the initial set up of a dental clinic. Some emergencies are indeed unavoidable hence all dental clinic members must be prepared and well trained to manage medical emergencies. Among the steps that should be taken in preparing dental clinic for medical emergencies are development of emergency plan, evaluation of patients’ risk, monitoring of vital signs, training of staff and availability of emergency drugs and equipment.

Missed dental appointments drastically affect treatment proficiency and productivity of dental care facility. This study aimed to determine the prevalence and reasons for missed dental appointments among patients treated by clinical dental students of Universiti Sains Islam Malaysia (USIM). A total of 202 folders from year 2018 to 2020 treated by year 3 to year 5 dental students were retrieved from a pool of patient’s record files using simple random sampling methods. Information on missed appointments was recorded. Other patients’ information was kept confidential. The percentage of missed dental appointments among patients under clinical dental students’ care was 37.1% (95% CI=30.7, 44.0). The majority of patients who missed dental appointments were male (37.6%), adults (38.7%) and employee (40.2%) patients. The most reported reason for the missed dental appointment was due to personal matters (36%) and the least was forgetfulness (0.6%) and miscommunication (0.6%). In conclusion, missed dental appointment commonly occurs among patients and frequently it was due to personal matters. A proper explanation by the students before scheduling an appointment is crucial to avoid any future missed dental appointments.