Emergency Care Providers Research Articles

Brief description of inpatient care in a number of European countries: Austria, Belgium, Germany and Estonia

The article devoted to the description of some aspects of inpatient care for the population of a number of European countries presents data on the number of hospitalizations, provision of inpatient beds for the population, financing of inpatient services. There are different approaches in the organization of inpatient care and its management, low rates of occupancy of inpatient beds are recorded, which indicates an oversupply of medical services. As an interesting experience, the facts of attracting trained volunteers in Austria to provide emergency care are given. It is noted that it is necessary to continue to reorient the provision of medical care from the inpatient sector to the outpatient one.

Evaluating Standardized Job Competencies for Managing Students at Risk for Anaphylaxis in Elementary School Nurses.

This study aimed to evaluate standardized job competencies of elementary school nurses in managing the health of students at risk for anaphylaxis (SRAs). A total of 166 elementary school nurses from across Korea participated in this study. The tool utilized was a list of standardized job tasks of elementary school nurses in managing SRAs' health. Seven factors were obtained from the factor analysis, with a cumulative variance explained of 68.6%. The importance-performance analysis method was employed to suggest priority areas for training. The factors placed in quadrant II included: (1) "offering psychological support", among elementary school nurses who have been provided with clinical information on anaphylaxis, (2) "providing emergency care", among those who have not been provided with clinical information on anaphylaxis, (3) the factors "utilizing individualized healthcare plans", "conducting health education and staff training", and "evaluating the student", among those who agreed that schools need legal protection to purchase epinephrine auto-injectors, and (4) the factor "preparing a school emergency system", among those with less than five years of experience as a school nurse. When planning continuing education strategies to improve elementary school nurses' management of SRAs, factors such as career experience, access to clinical information, and beliefs regarding legal protection for schools to purchase epinephrine auto-injectors should be considered.

The efficacy of local glucocorticosteroid therapy in nonarteritic anterior ischemic optic neuropathy

BACKGROUND: Non-arteritic anterior ischemic optic neuropathy is the second most common optic neuropathy after glaucoma. The effectiveness of the glucocorticosteroid therapy use for the non-arteritic anterior ischemic optic neuropathy treatment remains a subject of debate. Currently, the search for markers of the diseases therapeutic window is under way.
 AIM: The aim of this study is to evaluate the use of local glucocorticosteroid therapy as an emergency care for non-arteritic anterior ischemic optic neuropathy.
 MATERIALS AND METHODS: 41 patients with non-arteritic anterior ischemic optic neuropathy were enrolled in the study. To evaluate optic nerve head and macula morphometric characteristics, optical coherence tomography was performed, additionally, diameters of arteries and veins were assessed at 4 vascular arcades. Patients were divided into 2 groups according to the presence of intraretinal fluid. The first (main) group consisted of 23 patients with intraretinal fluid, in the second (control) group 18 patients without intraretinal fluid were included. The first group was further divided into two subgroups according to the medical aid recourse periods up to 5 days, and from 6 to 21 days (subgroup 1 9 patients, subgroup 2 14 patients).
 RESULTS: Correlations between the dynamics of optic nerve head edema changes and the caliber of arteries (negative correlation) and that of veins (positive correlation) were revealed. Sub-tenon injection of long-acting glucocorticosteroid did not lead to morpho-functional improvement in first group patients. Local short-acting glucocorticosteroid therapy accomplished in the acute period of the disease made it possible to achieve an improvement in best corrected visual acuity during the first month in group 1 patients without any further worsening of it.
 CONCLUSIONS: When providing emergency care to patients with non-arteritic anterior ischemic optic neuropathy during the first 5 days from the disease onset, the local use of glucocorticosteroid therapy is advisable.

Features of routing, diagnosis and combined treatment of pathological fractures of long tubular bones of tumor etiology

Introduction. In the structure of fractures of long tubular bones, pathological fractures account for about 1 %, and 2/3 of all cases are pathological fractures associated with bone metastases. Primary bone tumors are complicated by the development of a pathological fracture in 1– 10 % of cases, bone metastases in 8–30 % of cases. With a pathological fracture, as the primary manifestation of the tumor process, as a rule, patients come to the attention of orthopedic traumatologists providing emergency care. In the practice of oncologists, there are often patients with bone tumors who have performed deliberately non-radical surgical interventions associated with insufficient oncological alertness of traumatologists.Aim. To study and present the results of combined treatment of patients with bone tumors complicated by a pathological fracture.Materials and methods. The results of treatment and observation of 159 patients with tumors of long tubular bones complicated by a pathological fracture or the threat of its development, who received combined or surgical treatment and were observed in the polyclinic of the Republican Oncological Dispensary from 2008 to 2020, were analyzed.Results. A pathological fracture that has taken place, in the absence of somatic contraindications, is not a contraindication to neoadjuvant treatment, which allows performing organ-preserving surgical treatment with optimal local and systemic control. However, with verified bone metastases, when segmental bone resections are not shown, and the diagnosis of myeloma (solitary plasmocytoma) is established, it is permissible to perform surgery in a trauma hospital, after consulting an oncologist.Conclusion. The combined approach in the treatment of malignant bone tumors complicated by a pathological fracture makes it possible to perform a functional-saving, organ-preserving surgical intervention, significantly reducing the risk of tumor recurrence and systemic progression.

Leadership in the multiteam system of prehospital medicine.

Emergency Medicine AustralasiaEarly View Trainee Focus Leadership in the multiteam system of prehospital medicine Natalie Kay PGDipClinEd, MBChB, Corresponding Author Natalie Kay PGDipClinEd, MBChB Emergency Medicine Specialist, Prehospital and Retrieval Medicine Doctor [email protected] Te Whatu Ora Counties Manukau, Middlemore Hospital, Auckland, New Zealand Northern Rescue Helicopter Ltd, Auckland, New Zealand Correspondence: Dr Natalie Kay, Northern Rescue Helicopter Ltd, 440 Harvard Lane, Ardmore, Auckland 2582, New Zealand. Email: [email protected]Search for more papers by this author Natalie Kay PGDipClinEd, MBChB, Corresponding Author Natalie Kay PGDipClinEd, MBChB Emergency Medicine Specialist, Prehospital and Retrieval Medicine Doctor [email protected] Te Whatu Ora Counties Manukau, Middlemore Hospital, Auckland, New Zealand Northern Rescue Helicopter Ltd, Auckland, New Zealand Correspondence: Dr Natalie Kay, Northern Rescue Helicopter Ltd, 440 Harvard Lane, Ardmore, Auckland 2582, New Zealand. Email: [email protected]Search for more papers by this author First published: 21 June 2023 https://doi.org/10.1111/1742-6723.14265Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. References 1Hearns S (ed). Reducing the pressure from frazzle to flow. In: Peak Performance Under Pressure, 1st edn. Bridgwater: Class Professional Publishing, 2019; 233– 47. 2Lauria MJ, Gallo IA, Rush S, Brooks J, Spiegel R, Weingart S. Psychological skills to improve emergency care providers' performance under stress. Ann. Emerg. Med. 2017; 70: 884– 90. 3 New Zealand Government. Coordinated Incident Management System (CIMS), 3rd edn. Wellington: Officials' Committee for Domestic and External Security Coordination, Department of the Prime Minister and Cabinet, 2019. 4Stoate JM. Together or apart: modelling the inter-agency workings of emergency response multiteam systems (PhD thesis). Leeds: Leeds University Business School, 2015. 5 Fire and Emergency New Zealand. What We Do and Why We Do It. Wellington: Fire and Emergency New Zealand, 2023. [Cited Apr 2023.] Available from URL: https://fireandemergency.nz/about-us/what-we-do/ 6 Fire and Emergency New Zealand. Annual Report 2022. Wellington: Fire and Emergency New Zealand, 2023. [Cited Jun 2023.] Available from URL: https://www.fireandemergency.nz/assets/Documents/FENZ_Annual_Report_2022.pdf 7Hylander J, Saveman B, Bjornstig U, Gyllencreutz L. Prehospital management provided by medical on-scene commanders in tunnel incidents in Oslo, Norway – an interview study. Scand. J. Trauma Resusc. Emerg. Med. 2019; 27: 78. 8Calland V, Williams P. Scene safety and assessment. In: T Nutbeam, M Boylan, eds. ABC of Prehospital Emergency Medicine. Chichester: Wiley, 2013; 13. 9Low A, Hulme J. ABC of Transfer and Retrieval Medicine, 1st edn. Chichester: Wiley, 2015. 10Salas E, Granados DD, Klein C et al. Does team training improve team performance? A meta-analysis. Hum. Factors 2008; 50: 903– 33. 11Carson JB, Tesluk PE, Marrone JA. Shared leadership in teams: an investigation of antecedent conditions and performance. Acad. Manag. J. 2007; 50: 1217– 34. 12Diviney R. Why Dynamic Subordination Is Required for High-Functioning Teams. [Updated 2 Aug 2022; cited 28 May 2023.] Available from URL: https://theattributes.com/blog/why-dynamic-subordination-is-required-for-high-performing-teams Early ViewOnline Version of Record before inclusion in an issue ReferencesRelatedInformation

Experiences of Healthcare Providers Who Provide Emergency Care to Migrant Children Who Arriving in Spain by Small Boats (Patera): A Qualitative Study.

The phenomenon of migration from regions with more limited resources is a reality of the globalized world. It is estimated that at the end of 2019, almost 80 million migrants were displaced around the world, with 46% of them being children. Almost 20% of the irregular immigrants who arrived in Spain were child irregular migrants, who travelled alone or accompanied by family members after leaving their countries of origin seeking, to find a better future. Child irregular migrants have specific healthcare needs. The objectives of our present study were to describe and understand the experiences of healthcare providers in relation to the healthcare needs and the process of emergency care for child irregular migrants who come to Spain in small vessels. In this descriptive qualitative study, two focus groups were convened, and in-depth interviews with 21 participants were conducted, followed by inductive data analysis using ATLAS.ti 9.3 software. Three main themes emerged from the analysis: (1) more vulnerable groups for whom the priority is emergency care; (2) the health and social care of child migrants; and (3) challenges and advances in the care of child migrants. For healthcare providers, protecting children, placing value on the family unit, and ensuring that children feel safe at all times are very important. Learning about the experiences of healthcare providers can contribute towards improving the health and social care of children in emergency care.

The wrong of mercenarism: a promissory account

The wrong of mercenarism: a promissory account

Identifying misconceptions and knowledge gaps in functional neurological disorders among emergency care providers

BackgroundFunctional Neurologic Disorders (FND) are a common but heterogeneous group of disabling conditions. The Emergency Department (ED) is an important venue for care and referral as it is often the first point of contact when patients with FND are faced with a crisis or exacerbation of symptoms. MethodsED providers (n = 273) practicing in the Cleveland Clinic Foundation Northeast Ohio network were invited to participate through secure web application electronic surveys. Data were collected on practice profiles, knowledge, attitudes, management of FND, and awareness of available resources for FND. ResultsSixty providers completed the survey (22% response rate; n = 50 ED physicians, 10 advanced care providers) with 95.0% (n = 57) reporting a lack of understanding about FND. The terms Psychogenic Nonepileptic Seizures and stress induced/stress related disease were used by 60.0% (n = 36) and 58.3% (n = 35) respectively. Ninety percent (n = 53) rated their experience with managing FND patients as at least more difficult. Eighty- five percent (n = 51) agreed with “rule out others” and 60% (n = 36) agreed with “caused by psych stress”. Eighty six percent (n = 50) believe that there is a difference between FND from malingering. Only one respondent was familiar with any FND resources and 79% (n = 47) reported the need for FND specific educational materials. ConclusionThis survey revealed major gaps in knowledge, inaccurate perceptions, and management that differs from the current standard of care among ED providers caring for patients with FND. Educational opportunities are needed to guide diagnosis and evidence-based treatment to optimize management of patients with FND.

The correct way to deal with the definitivesurgical airway

Dealing with adifficult airway is familiar to emergency care providers in both the prehospital and clinical settings. In anesthesiology and emergency medical care different algorithms almost equal in their wording have been introduced, indicating that an emergency front of neck airway access (eFONA) has to be established in the case of acannot ventilate-cannot oxygenate situation. In asurvey (Surveymonkey®) data concerning the level of experience with eFONA, devices required, previous training and complications were allocated among acute and emergency care providers of different backgrounds (doctors and paramedics). Furthermore, we asked about individual attitudes to and frequency of previous situations, in which an eFONA was not established despite strong indications. Of the respondents 15% (n = 63) answered that they had experienced this type of situation. eFONA had been performed by 28% of the interviewed (n = 117), reflecting the high number of military and EMT (emergency medical team) physicians participating in the survey. The number of experiences are rarely representative for the civilian setting. Different adjuncts may be helpful to detect the cricothyroid ligament. To use ultrasound seems obvious but it doubles the time for the detection of the cricothyroid ligament. Laryngeal masks can be employed as asupraglottic airway device (SAD) during "planB". Stabilizing the airway with aSAD almost doubles the success of identifying laryngeal landmarks in females. The crew resource management (CRM) guidelines are more than essential in threatening situations demanding measures like eFONA. Providers should anticipate emerging problems and whenever feasible call for help and finally speak up. Naming afailed airway should be avoided as it implies afailure of the provider or of the entire airway team. In fact, the term non-accessible airway should be introduced. This might help to avoid the implication of amajor failure. So far, an ideal simulator to train eFONA has not been introduced but it is mandatory to train procedures and algorithms on different types of simulators and manikins to achieve mastery.

Provider-identified barriers to performance at seven Nigerian accident & emergency units: A cross-sectional study.

Nigeria hosts much of Africa's morbidity and mortality from emergency medical conditions. We surveyed providers at seven Nigerian Accident & Emergency (A&E) units about (i) their unit's ability to manage six major types of emergency medical condition (sentinel conditions) and (ii) barriers to performing key functions (signal functions) to manage sentinel conditions. Here, we present our analysis of provider-reported barriers to signal function performance. 503 Health Providers at 7 A&E units, across 7 states, were surveyed using a modified African Federation of Emergency Medicine (AFEM) Emergency Care Assessment Tool (ECAT). Providers indicating suboptimal performance ascribed this performance to any of eight multiple-choice barriers [infrastructural issues, absent and broken equipment, inadequate training, inadequate personnel, requirement of out-of-pocket payment, non-indication of that signal function for the sentinel condition, and hospital-specific policies barring signal function performance] or an open-ended "other" response. The average number of endorsements for each barrier was obtained for each sentinel condition. Differences in barrier endorsement were compared across site, barrier type and sentinel condition using a three-way ANOVA test. Open-ended responses were evaluated using inductive thematic analysis. Sentinel conditions were Shock, Respiratory Failure, Altered Mental Status, Pain, Trauma, and Maternal & Child Health. Study sites were the University of Calabar Teaching Hospital, the Lagos University Teaching Hospital, the Federal Medical Center, Katsina, the National Hospital Abuja, the Federal Teaching Hospital Gombe, the University of Ilorin Teaching Hospital (Kwara), and the Federal Medical Center Owerri (Imo). Barrier distribution varied widely by study site. Just three study sites shared any one barrier to signal function performance as their most common. The two barriers most commonly endorsed were (i) non-indication of, and (ii) insufficient infrastructure to perform signal functions. A three-way ANOVA test found significant differences in barrier endorsement by barrier type, study site and sentinel condition (p<0.05). Thematic analysis of open-ended responses highlighted (i) considerations disfavoring signal function performance and (ii) lack of experience with signal functions as barriers to signal function performance. Interrater reliability, calculated using Fleiss' Kappa, was found to be 0.5 across 11 initial codes and 0.51 for our two final themes. Provider perspective varied with regards to barriers to care. Despite these differences, the trends seen for infrastructure reflect the importance of sustained investment in Nigerian health infrastructure. The high level of endorsement seen for the non-indication barrier may signal need for better ECAT adaptation for local practice & education, and for improved Nigerian emergency medical education and training. A low endorsement was seen for patient-facing costs, despite the high burden of Nigerian private expenditure on healthcare, indicating limited representation of patient-facing barriers. Analysis of open-ended responses was limited by the brevity and ambiguity of these responses on the ECAT. Further investigation is needed towards better representation of patient-facing barriers and qualitative approaches to evaluating Nigerian emergency care provision.

Closing the Loop: The Value of Outcome Letters for Prehospital Pediatric Care.

Providing emergency care to acutely ill or injured children is stressful and requires a high level of training. Paramedics who provide prehospital care are typically not involved in the circle of care and do not receive patient outcome information. The aim of this quality improvement project was to assess paramedics' perceptions of standardized outcome letters pertaining to acute pediatric patients that they had treated and transported to an emergency department. Between December 2019 and December 2020, 888 outcome letters were distributed to paramedics who provided care for 370 acute pediatric patients transported to the Children's Hospital of Eastern Ontario in Ottawa, Canada. All paramedics who received a letter (n = 470) were invited to participate in a survey that collected their perceptions and feedback about the letters, as well as their demographic information. The response rate was 37% (172/470). Approximately half of the respondents were Primary Care Paramedics and half Advanced Care Paramedics. The respondents' median age was 36 years, median years of service was 12 years, and 64% identified as male. Most agreed that the outcome letters contained information pertinent to their practice (91%), allowed them to reflect on care they had provided (87%), and confirmed clinical suspicions (93%). Respondents indicated that they found the letters useful for 3 reasons: 1) increases capacity to link differential diagnoses, prehospital care, or patient outcomes; 2) contributes to a culture of continuous learning and improvement; and 3) gives closure, reduces stress, or provides answers for difficult cases. Suggestions for improvement included providing more information, provision of letters on all patients transported, faster turnaround time between call and receipt of letter and inclusion of recommendations or interventions/assessments. Paramedics appreciated receiving hospital-based patient outcome information after their provision of care and reported that the letters offered opportunities for closure, reflection, and learning.

Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study.

Pain management and emergency care in adolescent patients with hidradenitis suppurativa: a cross-sectional hospital-based study.

Implementation and Evaluation of the WHO Basic Emergency Care Course in Rwanda

Introduction:Improving access to emergency health services can reduce morbidity and mortality for patients with acute emergent conditions. The WHO and ICRC developed the Basic Emergency Care course to train frontline providers in a systematic approach to common and treatable life-threatening conditions. This study aims to evaluate the knowledge retention of Rwandan emergency care providers after implementation of this course.Method:A prospective, quasi-experimental, nonrandomized study was conducted at the University Teaching Hospital of Kigali (CHUK) in Rwanda. A formal survey was conducted to understand the current composition and training of Rwandan emergency care providers. Baseline and post-course assessments of knowledge were collected via an existing 25 multiple choice question survey tool which is an already established part of the BEC curriculum. Forty providers who care for patients with acute emergent illness were included. Data collected included age, gender, preferred language, as well as information about professional background, knowledge and skills. Providers with both baseline and post-test results were included in the analysis (n=40).Results:Of the 40 Rwandan providers, 47.5% (n=19) male and 52.5% (n=21) female, 26 were nurses, six were doctors, six were prehospital providers, one was both a prehospital provider and nurse, and one was a midwife. The mean age was 36.3. Out of 25, the mean baseline score was 17.8 (SD=3.2) and this significantly increased to a mean posttest score of 21.9 (SD=2.4). 85% (n=34) of providers’ knowledge improved, 2.5% (n=1) of provider’s knowledge stayed the same, and 12.5% (n=5) of providers' knowledge decreased. The difference between the pre and post-test scores was found to be statistically significant, 4.1 (SD=3.4), (P&lt;0.0001).Conclusion:This study demonstrated that implementing the BEC course has significantly improved the emergency provider knowledge base. Further studies are needed to demonstrate the impact of BEC training on patient care and morbidity/mortality outcomes.

Focused Needs Assessment and Tailored Training Pilot for Emergency Care Providers in Rwanda

Introduction:In lower- and middle-income countries (LMIC), 45% of deaths could be prevented by implementation of emergency care systems. Prehospital care is critical for emergency medical services (EMS) worldwide, and basic affordable training improves EMS systems. This study conducted a needs assessment in addition to a tailored prehospital training intervention. Subsequent changes in prehospital care as well as patient outcomes were measured.Method:Thirty providers identified through the prehospital medical command office participated. A prospective, nonrandomized interrupted time-series approach was utilized for a needs assessment and training intervention. Data collected included age, gender, training level, and a knowledge assessment, and was used to create an 18-hour training, with immediate and 11-month posttests. Prehospital process indicators evaluated on-the-ground application of skills, including airway intervention, intravenous fluid administration, and glucose administration. Linked prehospital and hospital care datasets allowed for evaluation of patient outcomes.Results:Of 30 providers, 60% (n=18) female and 40% (n=12) male, 19 were nurses and 11 were nurse anesthetists. Median age was 36 and median years providing care was 10 (IQR: 7,11). 24 (80%) participants completed immediate and post-test assessments, showing a 56% (95%CI: 36.2, 75.8) relative increase in mean knowledge score across 12 core skills that was maintained across post-tests. 324 of 572 total patients transported to the ED during the study were transported during the pre-training period (56.4%). Prehospital oxygen administration for patients with a saturation level of &lt;95% increased pre- to post-intervention (66.7% to 71.7%; Δ = 5.0%; Δ95%CI: 1.9, 8.1%).Conclusion:This study is the first LMIC-based prehospital provider training efficacy study that includes analysis of patient outcomes and clinical process indicators. Results offer important insights on Rwanda’s prehospital care system and demonstrate that affordable, tailored educational interventions targeting process indicators have positive impacts on provider knowledge and practice.

Improving the process of occupational risk ­management according to the Haddon matrix

Purpose. Improving the process of managing occupational risk (OR) in occupational safety and health management systems, due to the distribution of dangerous factors which increase the probability of a dangerous event into several phases: before the occurrence of a dangerous event and after its occurrence. Methodology. The method of morphological analysis is used, which is based on the selection of possible solutions for individual parts of the task based on several morphological typical features important for the problem being solved, and the compilation of all possible combinations of hazardous factors and precautionary measures that will allow reducing the amount of occupational risk. Findings. A new approach to occupational risk management is proposed, which involves the division of all dangerous factors into several phases: before the occurrence of a dangerous event, after its occurrence, provision of pre-medical assistance, provision of emergency and medical care. Typical dangerous factors are defined that increase the probability of the occurrence of a dangerous event, which relate to the first phase (before the occurrence of a dangerous event), as well as dangerous factors that affect the severity of accidents and are characteristic of the second, third and fourth phases (after the occurrence of a dangerous event). A concept was developed for calculating the magnitude of occupational risks, based on the consequences of the occurrence of a dangerous event or by the type of injury with the area of responsibility of the enterprise; from the consequences of pre-medical care or the condition of an injured person with the area of responsibility of the enterprise and with the consequences of emergency and inpatient medical care or the state of loss of health of the employee with the area of responsibility of the medical institution. The hierarchy of preventive measures has been improved due to the addition of protective measures consisting of pre-medical care, emergency medical care, in-patient medical care. Originality. When assessing professional risks, it is proposed to determine the amount in accordance with the area of responsibility of the enterprise and and medical institution taking into account dangerous factors corresponding to a specific phase. Practical value. Examples of three matrices for assessing the occupational risk have been developed, taking into account the classification of the severity of the consequences for the health of the employee, which occurred immediately after the occurrence of a dangerous event (accident), after the provision of pre-medical care and after the provision of emergency and medical care. A description of preventive actions to reduce the severity of the consequences is proposed, taking into account the sphere of responsibility.

Analisis Farmakokinetik Klinik Dosis Obat Pasien Hipertensi Komplikasi Gagal Di RSUD Dr. Pirngadi Medan

Background: Hospitals are health service providers providing emergency care, outpatient and inpatient. Hypertension occurs when blood pressure is above normal. Clinical conditions that require dialysis treatment have a tendency to kidney failure. This effort is related to the field of clinical pharmacokinetics. Objective: The study was conducted to analyze the dose of drug administration in conditions complicated by kidney failure in hypertensive patients. Methods: The study went through a sampling stage of data from hypertensive patients complicated by kidney failure, data according to inclusion criteria, calculation of creatinine clearance, analysis of dose adjustments and creatinine clearance. Results: The study obtained 170 data, which met the inclusion criteria of 30 data. Drugs with a narrow therapeutic index and worsening kidney function that patients received included: digoxin, captopril, ranitidine, furosemide, ciprofloxacin, and cefriaxone in 2, 13, 9, 12, 3, and 8 cases respectively. Conclusion: According to dose adjustment calculations for patient creatinine clearance, it was found that the drug exceeded the individual dose in 6 out of 9; 8 of 13; and 2 cases each using ranitidine, captopril, digoxin

A New Source of Mutilating Hand Injuries: The Side-by-Side Utility Terrain Vehicle.

Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy. Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions. A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively). Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes. Risk, II.

Vaccine Acceptance, Knowledge, Attitude and Practices Regarding the COVID-19 Pandemic: Cross-Sectional Study among Dentists in Trinidad and Tobago.

This study's aim was to assess Trinidad and Tobago dentists' vaccine acceptance, knowledge, attitude and practices regarding the COVID-19 pandemic. All dentists registered with the Trinidad and Tobago Dental Association were invited to complete an online anonymous questionnaire between June and October 2021. A total of 46.2% of dentists responded. The majority of respondents had excellent knowledge of COVID-19 (94.8%), use of personal protective equipment (98.7%) and N95 masks (93.5%), but had poor knowledge about the reuse of N95 masks (27.5%). A total of 34.9% were comfortable providing emergency care to positive or suspected cases of COVID-19, and 64.5% were afraid of becoming infected from a patient. PPE usage was reported at 97.4% and 67.3% for N95 masks. All surfaces of waiting areas were disinfected every 2 h by 59.2%. A total of 90.8% agreed to be vaccinated straight away if a vaccine were made available. Dentists in Trinidad and Tobago have good levels of knowledge, attitude, practices regarding COVID-19. Dentists also have high levels of vaccine acceptance and can play a role in advocating for the COVID-19 vaccine.

International practices of organizing emergency medical care for foreign citizens

The article discusses the international practices of organizing emergency care for foreigners when specialized assistance companies directly coordinate the process. The involvement of the national health care system in the provision of emergency and acute care to non-residents directly shapes the global reputation of the country as a healthcare and tourist destination. This reflects the objectives laid down by the Government of the Russian Federation in the national project policies.&#x0D; Purpose: to study the role of specialized medical assistance companies in the Russian health care system for foreigners, to identify aspects of their work and evaluate their potential contribution to shaping and developing global reputation of the Russian healthcare system.&#x0D; Results and conclusion. Study shows that today assistance companies are an underestimated participant on the Russian medical tourism market that could help strengthen the regional and federal healthcare destinations and provide new opportunities for Russian medical organizations. Few Russian studies have investigated impact of assistance companies, which in turn limits the tools for raising tourist attractiveness of the Russian Federation and its constituent entities.&#x0D; For citation: Petrova GD, Afanasiev VA, Bezzubenko OI. International practices of organizing emergency medical care for international patients. City Healthсare. 2023;4(1): 61-67 doi: 10.47619/2713-2617.zm.2023.v.4i1;61-67

A systematic review of the modelling of patient arrivals in emergency departments.

Accident and Emergency Department (AED) is the frontline of providing emergency care in a hospital and research focusing on improving decision-makings and service level around AED has been driving a rising number of attentions in recent years. A retrospective review among the published papers shows that related research can be classified according to six planning modules: demand forecasting, days-off scheduling, shift scheduling, line-of-work construction, task assignment and staff assignment. As patient arrivals demand forecasts enable smooth AED operational planning and help decision-making, this article conducted a systematic review on the statistical modelling approaches aimed at predicting the volume of AED patients' arrival. We carried out a systematic review of AED patient arrivals prediction studies from 2004 to 2021. The Medline, ScienceDirect, and Scopus databases were searched. A two-step screening process was carried out based on the title and abstract or full text, and 35 of 1,677 articles were selected. Our methods and results follow the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. We categorise AED methods for modelling patient arrivals into four main classes: regression, time series, artificial intelligence and time series regression. Choice of prediction model, selection of factors and model performance are compared. Finally, we discuss the advantages and limitations of the models and suggest future research directions. A total of 1,677 papers that fulfilled the initial searching criteria was obtained from the three databases. Based on the first exclusion criteria, 1,603 articles were eliminated. The remaining 74 full text articles were evaluated based on the second exclusion criteria. Finally, 35 articles were selected for full review. We find that the use of artificial intelligence-based model has risen in recent years, from the view of predictive model selection. The calendar-based factors are most commonly used compared with other types of dependent variables, from the view of dependent variable selection. All AEDs are inherently different and different covariables may have different effects on patient arrivals. Certain factors may play a key role in one AED but not others. Based on results of meta-analysis, when modelling patient arrivals, it is essential to understand the actual AED situation and carefully select relevant dominating factors and the most suitable modelling method. Local calibration is also important to ensure good estimates.