Assessment of quality of care in a pediatric emergency unit of a tertiary hospital, Ethiopia.

Background: Information on causes of death is needed to assess trends in disease burden, prioritize interventions, plan for their delivery, and ascertain the effectiveness of disease-specific interventions. The aim of this study was to review the postneonatal mortality pattern in the different pediatric emergency units of the tertiary hospitals across the country, and to propose ways of strengthening the emergency units for more effective health service delivery. Materials and Methods: Available literature on mortality in pediatric emergency units across the tertiary health institutions in Nigeria was reviewed. Neonates as well as studies that combined ward admissions with emergency room admissions were excluded. Analysis was mainly descriptive and results presented using prose, tables, and charts. Results: A total of 11 studies were analyzed. The crude mortality rate was 82 per 1000 admissions. Approximately 60% of the deaths occurred within the first 24h of presentation. The major causes of death were severe malaria (17.9%), sepsis (14.5%), acute gastroenteritis (13.7%), pneumonia (8.9%), and protein-energy malnutrition (97.7%). Sepsis and severe anemia had the highest case fatality rates, with 20.0% and 19.6%, respectively. Late presentation, unconsciousness, seizure, and severe pallor were some of the identified risk factors. Conclusion: Communicable diseases remain the major cause of mortality in our emergency units. Strengthening and restructuring of the emergency units in terms of manpower and services will help in lowering the mortality rates.

Background and Aim: Occupational violence increasingly has been known as a problem in health care system. Emergency personnel, because of direct contact with patients and their relatives are exposed of the most invasions. Multiple refers to emergency unit than other hospital parts increase threat occurrences, physical and verbal violence and cause to physical and mental injury in medical personnel. In Gerberich et al viewpoint, working in ICU (intensive care unit), psychological and emergency unit is of important factors for exposure of violence. This study aims to determine the vulnerable factors of occupational violence against practitioner medical personnel in the emergency units of training hospitals of Arak city. Materials and Methods: In this descriptive-sectional study, 108 of practitioner medical personnel of the emergency units were studied in verbal and physical violence in 1394. Studied society were practitioner medical personnel of emergency unit of training hospitals of Vali-Asr, Amir- Almumenin and Amir-Kabir of Arak. Entry measures were self-desire of personnel in all educational levels and occupational grades with one year work experience in current unit in turning shift. In order to collect information of violence in work place questionnaire in health units were used which include four parts (demographic information, threat, verbal and physical violence). This questionnaire is derived from standardized questionnaires of international labor office, WHO, international council of nurses, public services international which are balanced based on environmental and social conditions and its reliability and validity were confirmed. Data were analyzed by SPSS software version 21. Ethical Considerations: This paper is a part of issued investigational plan of medical sciences of Arak University, by ethical committee confirmation of IR.ARAKMU.REC.1394.148. The goal of study was explained for participants and secrecy and anonymity were ensured to them. Also, verbal satisfaction was obtained from medical personnel for contribution in study. Findings: Participants had average age of 31.45±6.26 years, total work experience mean 6.85±5.09 years and work experience mean 3.49±3.22 years in emergency unit. 28.7% of medical personnel were exposed of physical violence and 77.1% of them were exposed of verbal violence. 17.9% of participants reported verbal violence very much, 20.2% moderate and 36.9% low or very low. The most motivating reason of violence was crowdedness of unit and the most factors resulted to physical and verbal violence was patient's relatives. The most physical violence factor (856.4%) and verbal (60.5%) were for relatives. Conclusion: Findings showed high prevalence of violence, especially verbal violence against medical personnel. According to occupational characteristics of practitioner personnel in emergency unit, it can be said that violence emergence in work place is inevitable and impossible work. Therefore, the best approach is to identify amount and vulnerable factors in regions violence and to program for reducing its occurrences as low as possible. It should be noted that workplace violence is a multidimensional problem which its destructive dimensions has adverse effects on emergency personnel performance and also on hospital performance. Thus, creating a supportive environment, preparing continual training programs, financial resources and enough human force, restricting visit hours, also observation and answering in patients care are recommended in order to successful performing care programs. In this study, violence was forced from patient relatives more which can be prevented by managing, planning and public training. Please cite this article as: Harorani M, Varvanifarahani P, Yazdanbakhsh SA, Pakniyat AG, Sadeghi H, Norozi M, Golitaleb M. Evaluation of the vulnerable factors of occupational violence against practitioner medical personnel in the emergency units of training hospitals of Arak city. Med Ethics J 2017; 11(39): 55-61.

IntroductionAccidents involving dog attacks are very common, which makes this type of accident a global public health issue. The estimates point to 20% of the victims of such accidents seeking care in health units, and half of them being children. In addition to acute injuries, dog attacks might result in fractures, infections, scars, and psychological traumas. This study aimed to describe the epidemiological profile of dog attacks to children under 14 years old assisted in a pediatric emergency service in Brazil.MethodsThe database of the Information and Toxicological Assistance Center of Campinas was surveyed to identify cases of children under 14 years old assisted after a dog attack in a 9-years period. Demographic data, number and type of lesions, type of exposure, part of the body affected, dog origin and condition, and the accident location and cause were analyzed. The data were presented in a descriptive way, and the age groups were classified as follows: 0–3 years old, 4–6 years old, and 7–14 years old. The different age groups were compared one to another regarding the markers evaluated using the chi-square test and the Fisher’s exact test. A 0.05 alpha was adopted in all analyses.ResultsThe number of children assisted in the study period totaled 1,012. The 7–14-year-old group was the most affected (n = 498; 49.2%), male patients were also majority (n = 660; 65.2%). Most injuries were found on the head/neck area (n = 378; 37.4%). However, the older the patients were, the higher the frequency of lesions on upper and lower limbs was, as well as attacks occurred in external environments, thus involving animals that could not be observed. A significant increase in accidents with provoked causes was observed in younger patients.ConclusionAccidents involving dog attacks are more likely to happen among boys. Younger children run higher risks of becoming victims of these accidents inside homes, being attacked by pets, and showing a greater incidence of head and neck lesions. Older children present more injuries on their limbs, which are caused by dogs that cannot be observed.

Background:In many developing countries, malnutrition remains an important cause of morbidity and mortality particularly in under-five children. The factors responsible for malnutrition could be immediate, underlying or basic, acting either alone or together. It has been shown that children who are malnourished have poorer outcomes from other illnesses than well-nourished children. It is important therefore to periodically describe the extent and pattern of childhood malnutrition so that effective preventive measures can be put in place.Objective:To describe the prevalence and pattern of malnutrition in children presenting with acute illnesses at the Jos University Teaching Hospital.Patients and Methods:A cross-sectional descriptive study in children aged 6 to 59 months seen at the paediatric emergency unit from April to October 2012. The subjects were recruited consecutively. Each child had both clinical assessment and appropriate laboratory evaluations done alongside anthropometric measurements. The nutritional/dietary and socio-demographic histories were also obtained.Results:Of the 379 children, 224 (59.1%) were males and 155 (40.9%) females. The median age was 17 months, range (6-57). Wasting (WFH z-scores ≤−3 to <−1SD) was evident in one hundred children, giving an overall prevalence of 26.9%. Severe wasting (WFH z-score <−3), was present in 22 (5.9%) children indicating the prevalence of marasmus, whereas only two children (0.53%) had oedematous malnutrition (kwashiorkor). Stunting or chronic malnutrition, (HFA z-scores ≤−3 to <−1SD) was present in 67 children (18.0%). Seventeen (4.6%) were severely stunted (HFA z-score <−3).Conclusions:Wasting was the most common form of malnutrition in the study.

Profile of children attending in a Pediatric Emergency Unit of an urban teaching hospital over a period of one year was analyzed. The total number of patients seen between September 1999 to August 2000 was 9205; there was a prepondence of boys (73%). The maximum number of patients were seen in the monsoon month of July and August. About half (52.5%) of the patients were infants. Fever (29.5%), breathing difficulty (17.4%) and diarrhea (14.5%) were the most common presenting symptoms. Respiratory and gastrointestinal illnesses were the two commonest pediatric emergencies. About 2% (n-198) patients died within 24 hours of hospitalization; 42.3% deaths were in the age group of 0-28 days. Sepsis was the most common diagnosis in patients who died. This information may help in planning and development of a Pediatric Emergency unit and prioritizing residents, training.

Background: Worldwide and particularly in Africa paediatric emergencies are a public health priority. Deaths in hospitals frequently occur within the early hours following admission. The aim of our study was to provide data on the prevalence, aetiologies and outcome of medical paediatric emergencies of children admitted at the emergency, paediatric and intensive care units of the Buea and Limbe Regional hospitals. Methodology: We carried out a hospital-based cross-sectional of patients aged 1 month to 15 years admitted at the emergency, paediatric and intensive care units of Buea and Limbe Regional Hospitals from January and March 2023 who had a medical pathology and at least one emergency sign according to the WHO ETAT (convulsion, coma, severe dehydration, respiratory distress, shock, severe anemia). Data was analyzed using Statistical package for social sciences (SPSS) version 25. Results: A total of 294 children were enrolled out of 597 paediatric admissions giving a hospital prevalence of medical paediatric emergencies of 49.2%. The sex ratio was 1.4:1 with male predominance. The mean age was 2.7 years and 83% of the children were less than 5 years old. Almost half of the emergencies were convulsion (41.2%), respiratory distress and severe dehydration represented 32.3% and 30.3% respectively. Severe malaria accounted for 61.9% of the aetiologies. The death rate from paediatric medical emergencies was 9.9% and represented 69% of total paediatric deaths in both regional hospitals. Renal injury (p=0.014), severe community acquired pneumonia (p=0.026) and poisoning (p=0.027) were associated with mortality. Conclusion: Paediatric medical emergencies constitute a significant proportion of admissions; the most common emergency is convulsion and the main aetiology was severe malaria. Renal injury, poisoning and severe community acquired pneumonia were associated with mortality.

Social disadvantage has an influence on the health of individuals. In developed countries, the prevalence, pattern of social disadvantage, and the outcome of admissions in socially disadvantaged children are under-studied. To determine the prevalence of social disadvantage, pattern of diseases, and illness outcomes among socially disadvantaged children. This was a prospective hospital-based study involving 400 patients who presented at the pediatric emergency unit (PEU) of a tertiary hospital in Southwest Nigeria. Information on socio-demography and history of illness was obtained from consecutive children using a proforma. The data was analyzed using SPSS version 20. The 400 participants comprised 276 male and 124 female giving a ratio of 2.2:1. Their age range was 1-14 years; the mean ± SD age was 4.6 ± 2.3. Three hundred (75%) of the children were socially disadvantaged. The social factors associated with social disadvantage were low income, unemployment of mothers, polygamous setting, single parenting, rural residence, and low registration for health insurance. There was a significant association between social disadvantage and the development of malaria (P = 0.03), pneumonia (P = 0.01), septicemia (P = 0.03), diarrhea diseases (P = 0.04), neonatal jaundice (P = 0.04), meningitis (P = 0.04), and protein-energy malnutrition (P = 0.003). Death was significantly worse among the children who are socially disadvantaged (P = 0.0001). Many children admitted to the PEU in Osogbo are socially disadvantaged. Children of low-income parents, unemployed mother, single parent, residents of rural places, and those without health insurance are more vulnerable to developing infectious disease as well as neonatal jaundice and protein-energy malnutrition. Socially disadvantage increases the risk of poor illness outcome (death).

Background: Psychiatric emergencies are characterized by acute conditions of disturbances of affect or mood, behavior, and thoughts, which, if not managed with immediate therapeutic intervention, can cause great harm to the patient and surroundings. In most of the institutions, due to lack of emergency psychiatric units, these are managed by general hospital emergency units, which is the reason for underreporting of psychiatric cases in developing countries like India.Aim: The aim is to study the pattern of psychiatric presentation of the patients coming to the psychiatric emergency unit of a tertiary care teaching hospital in West Bengal.Methods: This prospective, longitudinal, hospital-based study was conducted for a period of 3 months on patients attending the psychiatric emergency unit of a tertiary care teaching hospital in West Bengal. Clinical details of the patient, source and reason for referral, and presenting complaints were recorded and analyzed.Results: Out of 200 patients attending the psychiatric emergency unit, most were female aged between 21 and 40 years. The three most prevalent presenting complaints among subjects were abnormal behavior with somatic complaints, excitement, and violent behavior followed by substance use. The foremost reason for a referral from other departments was either due to the absence of any physical illness or no abnormalities detected in the investigations conducted.Conclusions: The results from the study could help in gaining knowledge regarding emergency psychiatric conditions, increase in preparedness for their rapid management, and improvement of emergency psychiatry services to meet the mental healthcare demands in our country.

Consultations et réadmissions avant l'âge d'un mois aux urgences pédiatriques, Brazzaville (Congo)

Brucellosis is a systemic infectious zoonotic disease andit is still an important public health problem in Arabian Peninsula. The clinical presentation of brucellosis is non-specific, and the infection varies in its course and severity. Objective To evaluate common presentations and complications of involvement of acute Brucella infection in children presented to the paediatric emergency unit of Aladanhospital Methods Design: Retrospective study Setting: Paediatric emergency unit and paediatric department of Aladdin hospital, Kuwait between April 2008 and April 2013. Subjects: Sixty two children with acute brucellosis The diagnosis of brucellosis was made with compatible clinical findings, positive Brucella agglutination 1/160 titers, and/or the isolation of Brucella species. Complication was defined as the presence of symptoms or physical signs of infection at a particular anatomic site in a patient with active brucellosis. Data of the patients were reviewed in the medical records specially clinical presentation, complications, laboratory results, and treatment given. Results Out of 62 patients, 36(58.1%) were male and 26(41.9%) were female. The mean age was 9.5 ± 3.2 years. Arthritis (42 patients,67.7%) was the most frequent, presentation followed by fever without source (24 patients, 38.7%), and gastrointestinal system (11 patients, 17.7%). The diagnosis depended on increase of brucella titer more than 1/160 in 57 patients (91.9%). Source of infection in patients was mostly ingestion of unpasteurized milk. Conclusion Brucellosisis still an important health problem in Kuwait and must be taken inconsideration in children presented with fever without a source or arthritis.

Background:Psychiatric emergencies are characterized by acute conditions of disturbances of affect or mood, behaviour, and thoughts, if not managed with immediate therapeutic intervention can cause great harm to the patient and surroundings. In most of the institutions due to lack of emergency psychiatric units, these are managed by general hospital emergency units which is the reason for underreporting of psychiatric cases in developing countries like India.Aim:To study sociodemographic profile and pattern of psychiatric presentation of patients coming to the Psychiatric Emergency Unit of a tertiary care teaching hospital in West Bengal.Methods:This prospective, longitudinal, hospital-based study was conducted for a period of 6 months on patients attending the Psychiatric Emergency Unit of tertiary care teaching hospital in West Bengal. Sociodemographic and clinical details of the patient, source, and reason for referral, presenting complaints were recorded and analysed.Results:Out of 200 patients attending the Psychiatric Emergency Unit, most were female between the age of 21-40 years. The three most prevalent presenting complaints among subjects were abnormal behaviour with somatic complaints, excitement, and violent behaviour followed by substance use. The foremost reason for a referral from other departments were either due to absence of any physical illness or no abnormalities detected in the investigations conducted.Conclusions:The results from the study could help in gaining knowledge regarding emergency psychiatric conditions, increase preparedness for their rapid management, and improvement of emergency psychiatry services to meet the mental healthcare demands in our country.

Quality assurance and clinical indicators in emergency medicine

ABSTRACTBackground:The aim of this study was to evaluate surplus drugs left over from medications used via the intravenous and intramuscular routes in a pediatric emergency unit of a tertiary hospital in Turkey and to determine the financial burden imposed by drug wastage.Materials and Methods:The study was planned prospectively on patients presenting to the pediatric emergency department of a tertiary university hospital between January 1 and April 30, 2017, on weekdays and between 08:00 and 16:00, for any reason, and receiving intravenous and/or intramuscular drug administration resulting in drug wastage after treatment.Results:The number of patients enrolled in the clinical trial was 1620 (35.9%). Twenty-one different medications were administered via the intravenous or intramuscular (IM) routes during the study. The proportion of total medication wastage at the end of trial was estimated to be 0.425. The drug with the highest proportion of mean wastage to drug form was paracetamol (1000mg vial) at 0.79. The total cost of the drugs used for the patients in the study was US$580.98, and the overall burden of drug wastage was US$288.09. The three medications involving the highest wastage costs were methylprednisolone, ondansetron, and dexamethasone. The total wastage cost/total drug cost ratio was 0.495.Conclusion:If commercial drugs with intravenous and IM formulations are used by the pediatric age group, then dosage formulations appropriate for pediatric age group use also need to be produced. The development by manufacturers of ampoules and similar products suitable for multiple use will also reduce drug wastage. Reducing levels of drug wastage will inevitably reduce the drug expenditure.

The study had the purpose to characterize the health professionals and analyze care strategies adopted with children and adolescents victims of violence. This is an exploratory-descriptive study with a quantitative approach. The subjects were professionals from the health team that acted in Emergency and Pediatrics units in hospitals of Cruz Alta/RS. For data collection an instrument with closed questions was used. Data were analyzed by descriptive statistics. Thirty-four health professionals were interviewed, 19 of them were female. The more evidenced care strategies, according to professional category, were: clinical care, medical, psychological support, routing to specialist and to the Tutelary Council; the nurses promote clinical and psychological assistance, carry out nursing records and direct the victim to the emergency room physician. Nursing technicians calm down, talk to the victims, and carry out technical procedures. The study in question contributes to the visibility of the phenomenon of violence against children and adolescents, as well as to the formulation of care practices in health. Specifically, for the health professionals, it was sought elements of understanding of the care practices, considering this event a real problem on the health assistance.

Intoxications médicamenteuses volontaires chez 58 adolescents : étude prospective sur l’impact somatique et les complications biologiques