Department Of Emergency Research Articles

The perspectives of university students on gender roles<p>Üniversite öğrencilerinin toplumsal cinsiyet rollerine ilişkin bakış açıları

Objective: This study was performed as a descriptive study in order to determine the perspectives of university students on gender roles.Method: The population of the study was composed of the students who currently study in the department of Emergency and Disaster at the School of Health in Çanakkale Onsekiz Mart University. The study was performed with a total of 224 students present at the school on the date when the study was carried out and agreed to participate in the study. The study was conducted between 27 March-28 May 2014.A survey form prepared in accordance with the literature and Gender Roles Attitude Scale (GRAS) were utilized in the study so as to gather the data. The data were evaluated by means of descriptive statistics, t-test, Mann-Whitney U and variance (one-way ANOVA) test.Findings: Among the students who participated in the study, 49.6% of them were male whereas 50.4% were female. In the study, the average of the total scores on the GRAS of the female students was 155,17±16,47 while that of the male students was 129,56±20,52. In regard to the analysis of the sub-dimensions of the GRAS by gender, it was determined that the female students hold more “egalitarian attitudes” on gender roles than the male students do. With respect to the effect of socio-demographic characteristics of the students on their attitudes towards gender roles, it was found out that there was no difference among the students in terms of age, grades, the high school that the students graduated from, place of residence, the presence or absence of working parents, economical levels, number of sisters/brothers, educational status of the parents. However, in regard to the type of family, it was found that the students with an elementary family hold more egalitarian attitudes.Result: The study concluded that the perspectives of the female students and those of the male students are different from each other. These results have revealed that the universities with the objective to raise intellectual individuals should enable their students to gain awareness on gender roles as well as acquire the fundamental vocational information. ÖzetAmaç: Bu çalışma üniversite öğrencilerinin toplumsal cinsiyet rollerine ilişkin bakış açılarını belirlemek amacıyla tanımlayıcı olarak yapılmıştır. Yöntem: Araştırmanın evrenini Çanakkale Onsekiz Mart Üniversitesi Sağlık Yüksekokulu Acil Yardım ve Afet Yönetimi Bölümüne devam eden öğrenciler oluşturmuştur. Araştırmanın yapıldığı tarihte okulda bulunan ve araştırmaya katılmayı kabul eden 224 öğrenci çalışma kapsamına alınmıştır. Araştırmanın uygulaması 27 Mart-27 Mayıs 2014 tarihleri arasında yapılmıştır. Çalışmada, veri toplamak amacıyla literatür doğrultusunda hazırlanan anket formu ve Toplumsal Cinsiyet Rolleri Tutum Ölçeği (TCRTÖ) kullanılmıştır. Verilerin değerlendirilmesinde tanımlayıcı istatistikler, t-testi, mann-whitney U ve varyans (one-way anova) testleri kullanılmıştır. Bulgular: Çalışmaya katılan öğrencilerin %49.6’sı erkek, %50.4’ü kız öğrencilerden oluşmaktadır. Araştırmada öğrencilerin TCRTÖ toplam puan ortalamasının kızlarda 155,17±16,47, erkeklerde 129,56±20,52 olduğu belirlenmiştir. Cinsiyete göre TCRTÖ alt boyutları incelendiğinde; kız öğrencilerin erkek öğrencilerden daha fazla, toplumsal cinsiyet rollerine ilişkin ‘eşitlikçi tutuma sahip’ olduğu saptanmıştır. Araştırmada öğrencilerin sosyo-demografik özelliklerinin, toplumsal cinsiyet rollerine ilişkin tutumları üzerindeki etkisine bakıldığında ise, yaş grupları, sınıflar arası, bitirilen lise, yaşadıkları yer, anne babanın çalışma durumu, ekonomik düzeyleri, kardeş sayıları, anne babanın eğitim durumu açısından aralarında fark olmadığı belirlenmiştir. Ancak aile tipi açısından çekirdek aileden gelen öğrencilerin daha eşitlikçi bir yaklaşım sergiledikleri saptanmıştır. Sonuç: Araştırmada kız ve erkek öğrencilerin toplumsal cinsiyet rollerine ilişkin görüşleri arasında fark olduğu saptanmıştır. Bu sonuçlar aydın bireyler yetiştirmeyi hedefleyen üniversitelerde öğrencilere temel mesleki bilginin yanı sıra toplumsal cinsiyet eşitliği konusunda duyarlılık kazandırılması gereğini göstermektedir.

Current status of work-related musculoskeletal disorders in nurses in Xinjiang, China

Objective: To investigate the prevalence of work-related musculoskeletal disorders (WMSDs) in nurses in Xinjiang, China, to analyze the influencing factors for the development of WMSDs, and to provide a reference for the prevention and treatment of WMSDs in nurses. Methods: Stratified cluster sampling was used to randomly select 8 422 nurses in 8 tertiary hospitals and 4 secondary hospitals in Xinjiang from January to October, 2015. A questionnaire survey was performed to investigate the prevalence of WMSDs in nurses from departments of internal medicine, surgery, gynecology, pediatrics, emergency, and intensive care and operating rooms and analyze related influencing factors. Results: A total of 3 000 questionnaires were distributed, and 2 851 questionnaires were returned, resulting in a recovery rate of 95.00%. In the nurses who participated in the survey, the prevalence of WMSDs was 78.58%. As for different body parts, the prevalence of WMSDs was 63.36% in the waist, 61.79% in the neck, 52.52% in the shoulder, 41.83% in the back, 35.56% in the knees, 33.35% in the ankles, 26.02% in the wrists, 23.41% in the hip, and 17.62% in the elbows. There were significant differences in the prevalence of WMSDs across the nurses with different ages and working years (χ2=28.29 and 27.73, both P<0.01) , and the prevalence of WMSDs tended to increase with the increasing age and working years (χ2=22.94 and 17.56, both P<0.01) . The results of multivariate logistic regression analysis showed that sex, working years, intensive care/emergency, outpatient service, surgical anesthesia, weekly working hours, physical condition, and fatigue in work were risk factors for WMSDs in nurses. Conclusion: In the nurses in Xinjiang, the prevalence of WMSDs in the neck, shoulder, back, and waist is high, and nurses with different ages, working years, departments, sexes, physical conditions, and weekly working hours have varying degrees of risk of WMSDs.

Intro-neuroendoscopic technique for the treatment of parenchymal hemorrhage

Objective To investigate the application value, technical key points and operation experience of intro-neuroendoscopic technique for removing parenchymal hematoma. Methods From June 2014 to January 2016, the clinical data of 33 patients with parenchymal hemorrhage treated with intro-neuroendoscopic technique at the Department of Emergency, Shenzhen People's Hospital, the Second Clinical Medical College of Jinan University were analyzed retrospectively. There were 24 patients with hypertensive intracerebral hemorrhage, 3 with intracerebral hemorrhage of unknown causes, 4 with traumatic cerebral hemorrhage, and 2 with intracerebral hemorrhage after tumor surgery. All patients were diagnosed with head CT. The mean hematoma volume was 45.22±8.59 cm3. The Glasgow coma score(GCS)scores were 12-5. Hematoma location: 23 patients in the basal ganglion region, 5 in the frontal lobe, 2 in the parietal lobe, and 3 in the occipital lobe. Brain CT scan was performed immediately after procedure in all patients. Results In 33 patients, the postoperative hematoma clearance rate of 20 cases was more than 90%, that of 9 cases was 60%-90%, and that of 3 cases was less than 60%. One patient was converted to craniotomy because of intraoperative bleeding. Two patients had intracranial infection after procedure, and the hematomas of 6 cases were drained with the drainage tube injection of urokinase after procedure. The mean length of operative scalp incisions was 3.0 cm(range, 2-4 cm), the diameter of bone hole was 0.8 cm to 1.1 cm, the mean intraoperative blood loss was 50 ml(range, 40 ml-100 ml), and the mean operation time was 65 min(range, 45 min-120 min). The Glasgow outcome scale(GOS)scores: 5 patients recovered well, 16 had mild disability, 12 had severe disability, and none of them died. Conclusions Intro-neuroendoscopic technique evacuation of parenchymal hematoma only needs to drill one bone hole for completing the operation. It has the advantages of convenient operation, less injury, faster recovery, and less complications. Key words: Neuroendoscopy; Cerebral hemorrhage; Treatment outcome

Les inhibiteurs de pompe à protons : vraie indication ou prescription banalisée ?

Protons Pump Inhibitors (PPIs) are widely used in France. The aim of our study was to determine the rate of exposure to PPIs in old patients and to assess the appropriateness of their prescription according to French guidelines. We performed a descriptive study from 1st June to 30th August 2016, including all patients admitted in the department of geriatric post emergency of the university hospital of Toulouse with a prescription of PPI. Data concerning age, name of PPI, dose, indication, duration of prescription and the modification of PPI prescription were collected. Among 375 patients admitted during this period, 134 (35.7) were exposed to PPIs with a mean age of 85.9±6.6years. About one third of them were exposed to PPI more than one year (N=49). Prescription was inappropriate for the criteria "dose and indication" and "duration" for respectively 59 (44.0%) and 15 (11.2%) cases. In 50 cases (37.3%), the PPI was renewed, stopped in 69 cases (51.5%) and the dose was reduced for 15 patients (11.2%). According to our data, the prescription of PPI was no appropriate in about 40% of included patients. A reassessment of their prescription with awareness of patients should be necessary to improve the good utilization of these "popular" drugs and to prevent some serious adverse reactions after long exposure.

ASSESSINGHEALTH CARE PROVIDER'SKNOWLEDGE ABOUTPERSONAL PROTECTIVE MEASURES

of infection. For that, protecting staff and patients from infection is vital.Therefore, all staff who may have to use personal protective equipment PPE must be knowledgeable about all aspects related to PPE use, wearing and removal. Aim: The aim of this study is to assess health care providers knowledge about personal protective measures. Methods: A cross sectional study design was utilized. One hundred thirty of HCP (54 physicians, 44 nurses, 6 head nurses, 20 technicians, 6 cleaners) were selected from Student University Hospital in Mansoura including; (emergent department, clinics, and laboratories).Tools: Two tools were used for data collection: Demographic& occupational self-administered questionnaire including (age, sex, education, years of experience, nature of work), self-administered questionnaire sheet to assess studied HCP knowledge regarding infection control related PPE. Results: This study showed poor score level of HCP knowledge regarding PPE in studied setting. Conclusion: This study concluded that HCP's knowledge regarding PPE were poor due to lack of adherence to the infection control related universal precautions. Recommendations: study recommended continuous education and training program of HCP to improve and update their knowledge.

Managing snake bite patients – our experience from a tertiary care center of North East India

Introduction: Snake bite is a common problem in North East India as most of the demography includes forests, cultivated land and tea gardens which are a natural habitat to various species of snakes. Snake bite comprises a significant number of hospitalizations with fatalities in this part of the country. We studied all the cases of snake bite poisoning that came to our hospital during the monsoon seasons in the department of medicine of a tertiary care hospital. Materials And Methods: All adult patients coming to the department of Emergency or out patients department in Assam Medical College and Hospital over a period of 1 year from July 2014 to June 2015 were include in our prospective observational study. A detailed clinical history was taken, local examination was done and all necessary laboratory examinations especially those related to bleeding and coagulation profile was done. Results And Observations: 116 patients were included in the study which included 70 (60.3%) male and 46 (39.7%) female patients, the male to female ratio being 1.52:1. Out of 116, 42 (36.2%) were poisonous snake bites and 74 (63.8%) were non poisonous. Out of the 42 cases of poisonous snake bites, 34 (80.9%) patients presented with hematologic symptoms, 8 (19.1%) patients had neurological symptoms and 4 (9.5%) patients expired during their hospital stay. Most common symptom was fright which was noted in 107 (92.2%) patients. This was followed by local swelling (78.4%), tingling and numbness (65.5%) and pain at the site of bite (58.6%). Only 9.5% patients reached tertiary care center within 4 hours of snake bite and majority (55.2%) were delayed by more than 12 hours. The whole blood clotting time, prothrombin time and INR was significantly high in patients with hematotoxic snake bite poisoning. Polyvalent Anti Snake venom (PASV) was administered in 22 (52.4%) cases out of 42 poisonous snake bite cases. 16 (47%) cases of hematotoxic snake bite and 6 (75%) cases of neurotoxic snake bite received PASV. 18 (52.9%) cases of hematotoxic snake bite received only fresh frozen plasma (FFP), 9 (26.5%) received FFP and PASV, 7 (20.6%) received only PASV. Two patients developed reaction to PASV which was managed successfully with adrenalin and steroids. Neostigmine was used in all 8 cases of neurotoxic snake bite poisoning. Conclusion: Though most of the snake bites were non poisonous, use of tourniquet and other alternative medicines caused morbidity. Hematotoxic snake bite was more common but was managed by use of polyvalent anti snake venom (PASV) and/or fresh frozen plasma. Neurotoxic snake poisoning were less common and managed by PASV and neostigmine. Two patient of hematotoxic snake bite died due to renal failure and two cases of neurotoxic snake bite died due to respiratory failure. Keyword : Snake bite poisoning, Polyvalent Anti Snake Venom, Hematotoxic snake, Neurotoxin snake

Mortui vivos docent : The dead teach the living

There are considerable similarities and intersections between forensic medicine and emergency medicine. This applies especially to frustraneously resuscitated patients or other lethal clinical courses of traumatized patients who are subject to latter forensic autopsy. Cooperation between departments of emergency and forensic medicine not only has emergency medical training potential, but also the possibility of retrospective evaluation of medical emergency measures - both in individual cases and with regard to epidemiological aspects. In particular, the widespread registration of autopsied pre-hospital trauma deaths that occurred despite on-scene resuscitation attempts is useful. The pre-hospital situation represents ahotspot, but also a blind spot in the overall trauma mortality. In recent clinical registers, preclinical deaths go mostly unrecorded, despite the undisputed benefits of clinical registers.

Serum 25-hydroxyvitamin D predicts early recurrent stroke in ischemic stroke patients

Background and aimThis study was conducted to determine 25-hydroxyvitamin D [25(OH) D] levels in serum, and to investigate their associations with stroke recurrence events in a 3-month follow-up study in Chinese patients with first-ever ischemic stroke. Methods and resultsFrom February 2014 to September 2015, consecutive first-ever ischemic stroke patients admitted to the Department of Emergency of our hospital were identified. Serum 25(OH) D levels were measured at admission. We followed the participants for a median of 3 months (range, 2.5–3.5 months) using a standard questionnaire. We used logistic regression models to assess the relationship between 25(OH) levels and risk of recurrent stroke. In this study, 349 ischemic stroke patients were included and completed follow-up. Thirty-seven patients (10.6%) had a stroke recurrence. Serum 25(OH) D levels in patients with recurrent stroke were significantly lower as compared with those in patients without recurrent stroke [9.9 (IQR, 7.9–14.8) ng/mL vs. 17.9 (IQR, 13.4–23.4) ng/mL; P < 0.001). After adjusting for traditional risk factors, serum 25(OH) D levels were negatively associated with the stroke recurrence (OR, 0.897; 95% CI, 0.848–0.950; P < 0.001). Compared with the first quartile of serum 25(OH) D levels, the second quartile OR for recurrent stroke was 0.466 (95% CI, 0.308–707; P = 0.006). For the third and fourth quartiles, it was 0.248 (95% CI, 0.100–0.618; P = 0.001) and 0.173 (95% CI, 0.062–0.482; P < 0.001), respectively. ConclusionsOur findings suggest that reduced serum levels of 25(OH) D can predict the risk of early stroke recurrence in patients with first-ever ischemic stroke.

OUR EXPERIENCE IN THE SURGICAL MANAGEMENT OF PATIENTS WITH RECTAL NEOPLASTIC DISEASE

Colorectal cancer is one of the most commonly incriminated neoplastic pathologies and it has afairly high mortality rate. Although the therapeutic arsenal of rectal cancer has steadily improvedthrough the acquisition of biology, technology and pharmacology, the central role of surgicaltechnique is widely recognized in obtaining local control, on the one hand and a good quality of lifeof operated patient on the other hand. This article is a retrospective analysis of surgical proceduresfor rectal neoplasia conducted in order to determine to what extent technological development andcontinuous improvement of surgical techniques have influenced the evolution of patientmanagement with this pathology. This study was retrospective, observational, descriptive, single-center and it was held in the Department of General Surgery and Emergency III of the UniversityEmergency Hospital Bucharest during 1 January 2007 - March 31, 2016 and included a total of127 patients.

Autopercepción de las personas responsables en los equipos sanitarios de Andalucía. Estudio cuantitativo y cualitativo

ObjectiveTo determine the perception and self-assessment on leadership among health care team leaders in Andalusia. Material and methodsDesign: Exploratory descriptive study using quantitative and qualitative methodology, developed between 2013 and 2015, using a questionnaire and semi-structured interviews. Place: Andalusia. Participants: All health managers from the Primary Care Management Units and Health Management Areas of the Departments of Paediatrics, Emergency and Internal Medicine, for the quantitative study. A purposive sample of 24 health managers was used for the qualitative study. Methods: Descriptive statistical study and bivariate analysis of comparison of means. Content analysis of the semi-structured interviews: Codification, category tree, and triangulation of results. ResultsThe best self-assessment dimension relates to support, and the worst to considering oneself as a ‘good leader’. The definition of a ‘good leader’ includes: Honesty, trust, and attitudes of good communication, closeness, appreciation, and reinforcement of the health team members. Different leadership styles were perceived. Main difficulties for leadership are related to the economic crisis and the management of personal conflicts. ConclusionsHealth managers describe an adaptive leadership style, based on personal and professional support, and using communication as the main cohesive element for the team project. More studies on leaders’ perspectives are important, in order to better understand their experiences, needs and expectations.

PWE-127 The Extended Effect of An Alcohol Liaison Nurse Service on Attendance at A County’s Emergency Departments: A 3 Year Retrospective Cohort Study

Introduction Worcestershire Acute Hospitals NHS Trust has an Alcohol Liaison Nurse Service (ALNS) across two hospital sites, with two full-time ALNs providing screening, case management support, brief interventions (BI) and referrals into community treatment services. We performed a retrospective cohort study to assess the impact of the ALNS on emergency departement (ED) re-attendance over a 3 year period and estimated the cost saving using the 2012/3 reference costs. Methods All patients who had attended the ED, surgical or medical assessment units and received a BI delivered by the ALNS over a 3 month period, between January to March 2012, was identified via hospital records (Patient First ED computer system and OASIS). Patient attendances to ED for the preceding 12 month period were compared with the 12 month periods after the BI over the following 3 years. Patients were excluded if they lived outside the trust catchment area or were imprisoned or died during the study period. Costs of attendances to ED over the period were estimated as £114 per visit. Statistical analysis was by paired t-test. Results 192 patients (123 males & 69 females) identified as having a BI were included in the cohort. 36 were excluded due to death within the study period and 4 due to incarceration. The median age of the cohort was 44 years (range 17–87 years). The most common reason for presentation related to mental health issues including deliberate self harm and overdose. During the 12 month period before ALNS intervention there were 464 qualifying ED attendances with an average of 2.42 attendances per patient. In the first 12 months following BI, the ED attendance rate fell to 327 (1.7 attendances/patient), and then to 255 in the second 12 months (1.33 attendances/patient), and finally 225 in the third 12 months following BI (1.17 attendances/patient). The reduction in attendance was statistically significant 12 months after intervention compared with the preceding year (p For this 3 month cohort of 192 patients, the cost of ED attendance in the year before BI was estimated at £52, 896. By the end of the study period this had been reduced by 51.5% (twelve monthly cost estimates £37,278, £29,070 and £25,650). Conclusion This pragmatic study suggests that an ALNS may have a sustained effect upon the number and cost of ED attendances. Reference 1 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/261154/nhs_reference_costs_2012-13_acc.pdf Disclosure of Interest None Declared

Study of tumor necrosis factor-α induced protein 8 like-2 expression in peripheral blood mononuclear cells of patients with acute respiratory distress syndrome correlate with disease severity

To demonstrate the effect of tumor necrosis factor-α induced protein 8 like-2 (TIPE2) expression in patients with acute respiratory distress syndrome (ARDS) and its mechanism. A prospective observation was conducted. Thirty-nine patients with ARDS admitted to department of emergency of PLA General Hospital from July 2013 to July 2015 were enrolled, and 35 healthy persons served as control group. The acute physiology and chronic health evaluation II (APACHE II) score within 24 hours after admission, blood gas analysis, procalcitonin (PCT), and C-reactive protein (CRP) were recorded. The mRNA expressions of TIPE2 in peripheral blood mononuclear cell (PBMC) and myxoma resistance protein 1 (MX1) in plasma were determined by real-time quantitative reverse transcription-polymerase chain reaction (RT-PCR). The correlations were analyzed by Spearman rank correlation analysis. The mean of APACHE II score in 39 patients with ARDS was 25±3, the mean of PCT was (1.85±0.41) μg/L, and the mean of CRP was (18.0±3.0) mg/L. The TIPE2 mRNA expression in PBMC of ARDS patients was significantly down-regulated as compared with that of healthy control group (2-Κ ΚCt: 3.28±0.15 vs. 8.87±0.20, P < 0.001), and the MX-1 mRNA expression in plasma was significantly higher than that of healthy control group (2-Κ ΚCt: 39.44±0.46 vs. 20.10±0.32, P < 0.001). It was shown by correlation analysis results that the TIPE2 mRNA expression was negatively correlated with MX1 mRNA expression (r = -0.630, P < 0.001), so as APACHE II score (r = -0.781, P < 0.001), but no correlation was found between TIPE2 mRNA and PCT as well as CRP (r value was 0.143 and 0.330, respectively, both P > 0.05). The MX1 mRNA expression was positively correlated with APACHE II score (r = 0.893, P < 0.001), but no correlation was found between MX1 mRNA and PCT as well as CRP (r value was 0.230 and 0.210, respectively, both P > 0.05). TIPE2 expression was decreased in ARDS patients, which negatively correlate with disease severity, and indicate TIPE2 might be involved in the pathogenic process of ARDS.

Consumer reporting of adverse drug reactions: Systems that allow patients to report side effects of the drugs they are taking have yielded valuable information for improving drugs safety and health care.

Consumer reporting of adverse drug reactions: Systems that allow patients to report side effects of the drugs they are taking have yielded valuable information for improving drugs safety and health care.

A validation study of national early warning score in evaluation of death risk in elderly patients with critical illness

To verify the validity and feasibility of national early warning score (NEWS) in evaluation of death risk in elderly patients with critical illness,in order to find out which scoring method is more suitable for elderly critical illness patients. A prospective case-control study was conducted. The critical illness patients aged over 60 years old with the length of hospital stay over 24 hours, and admitted to Department of Emergency of Qingdao Municipal Hospital from January to December 2015 were enrolled. The clinical data including in emergency and the actual outcome of patients were collected, and the patients were divided into death group and survival group according to 30-day outcome. Patients in the two groups were assessed by using NEWS and risk classification according to the first results of vital signs monitoring. Multivariate logistic regression model was used to analyze the relationship between the NEWS classification and the risk of death in elderly critical ill patients. 1 950 emergency elderly patients with critical illness were enrolled, with 78 cases (4.0％) dead within 30 days and 1 872 survived (96.0％).Compared with the survival group, patients in death group were older (years:79.8 ± 10.8 vs.75.3 ± 8.9,t =4.335,P ＜0.001),and had higher acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score (22.9± 4.6 vs.18.2 ± 4.8,t =8.487,P ＜ 0.001),lower Glasgow coma scale (GCS) score (12.2 ± 4.5 vs.13.4 ± 5.2,t =-2.007,P =0.045),higher incidence of respiratory system diseases (29.5％ vs.17.9％,x 2 =12.742,P =0.013),higher NEWS score (11.2 ± 5.5 vs.3.9 ± 2.7,t =22.063,P ＜ 0.001),as well as higher proportion of patients with NEWS classification of high risk and very high risk (65.4％ vs.15.8％,x 2 =263.125,P ＜ 0.001).With the increase of NEWS risk classification, mortality rate was also increased, and the mortality rate in the patients with low, medium, high and very high risk were 0.81％ (9/1 108),3.63％ (18/496),5.83％ (13/223),30.89％ (38/123),respectively, with statistically significant difference (x 2 =179.741,P ＜ 0.001).It was showed by logistic regression analysis that the NEWS score of elderly patients with critical illness were positively correlated with 30-day death. The 30-day death risk of patients with middle risk, high risk and very high risk was 4.600,9.052 and 54.598 folds of the patients with low risk respectively. NEWS score can be used to assess the risk of death in emergency elderly patients with critical illness. NEWS risk classification can quantify and classify the risk of death in the elderly patients with critical illness.

Life events, anxiety and depression among doctors and nurses in the emergency department: a study from eleven general hospitals in Hunan province, China

bjectives:To evaluate life events, levels of anxiety and depression among doctors and nurses in the emergency department (ED). Design:An anonymous self-reported survey was employed from January 2013 to April 2013 that included Life Event Scale (LES), Zung's Self-Rating Anxiety Scale (SAS), Zung's Self-Rating Depression Scale (SDS) and other Likert-style questions. Participants:A total sample of 412 participants (124 doctors and 288 nurses) from department of emergency in eleven grade-3 and grade-2 general hospitals in Hunan Province, China was involved in this study. Results:Both doctors and nurses from ED experienced more negative life events than positive life events (mean total score: 14.13 VS. 6.41). Among all family, work and social life events, high pressures of work as negative life event was the most frequently reported one. 6.34% (5.65% in doctors and 6.60% in nurses) suggestive anxiety symptoms and 17.73% (14.5% in doctors and 18.8% in nurses) suggestive depression symptoms were reported among them. Negative, but not positive, life events correlated with symptoms of depression and anxiety. Doctors experienced much more work related negative events than nurses did. However, nurses showed higher levels of anxiety and depression that that of doctors. Conclusion:These findings suggest doctors and nurses from emergency department experienced much more negative life events than positive life events, and those negative life events, especially work related negative events, may have harmful impact on their mental health (risk for depression and anxiety). Development of a range of coping strategies for decreasing the harmful effects of those negative life events and minimizing or controlling the occurrence of anxiety and depressive symptoms should be emphasized for doctors and nurses who work in a hospital’s emergency department

0475 : Strategy management of myocardial infraction admitted after H12

Acute coronary syndrome with ST elevation represents the most severe form of coronary disease. Its management is based on the urgent unblocking the occluded artery. Unfortunately, about 30% of patients do not receive reperfusion strategy, because of a delay consultation. To study the characteristics of patients admitted for MI after 12 H beyond the pain, and the support arrangements for this group of patients. Single-center study conducted on 217 patients hospitalized for AMI between H12 and J5 of pain, during the period between July 2013 and July 2015. 217 patients were collected. The average age is 63.07±12.09 years, with male predominance (sex ratio 2.2). 84% of patients admitted through the emergency department. 37.7% of patients live more than 100 km from the hospital. 36% of patients were admitted between H12 and H24. Age is the most frequent cardiovascular risk factor. 18% of our patients are older than 75 years. The Factors associated with delays consultation are age, the distance over 100 km from the hospital, the atypical nature of pain and the admission from the emergencies department. 3/4 of patients have LV dysfunction. More than half of patients is multi-truncal. The LAD is responsible for the MI in 64,5% of cases. During the hospital period, 10% of patients presented heart failure and 6% have an arrhythmia or conduction disorder. The hospital mortality was 6.95%. The patient output order contains aspirin in 98.5% of patients, clopidogrel in 93% of cases and a statin in 98.5% of cases. ACE inhibitors or AIIRAs is prescribed in 78% of cases before the beta- blocker which is prescribed in 64% of patients. The late MI seen is a real public health problem in our country. Non-revascularized patients have a poor prognosis and even more so that the necrotic area is extended. Reducing the management delay and the multi-sectoral collaboration are key to improving the prognosis. The author hereby declares no conflict of interest

A THROMBUS IN TRANSIT THROUGH PATENT FORAMEN OVALE WITH UNDERLYING SILENT DEEP VENOUS THROMBOSIS AND PULMONARY EMBOLISM

Patent foramen ovale (PFO) has become an increasingly investigated cause of cryptogenic embolic stroke. An entrapped thrombus through foramen ovale is an extremely rare finding. A 78 year old gentleman with no significant medical or drug history of importance presented to emergence department with

CORRELATION BETWEEN THE INITIAL DIAGNOSIS IN PEDIATRIC MEDICAL EMERGENCIES DEPARTMENT AND THE FINAL DIAGNOSIS CONFIRMED AT THE LEVEL OF PEDIATRIC HOSPITAL DEPARTMENT

Introduction: Medical practice in the emergencies is particularly prone to diagnostic errors resulting not only in a potential delay risk of an effective treatment in therapeutic urgent cases, but also in the risk of subscribing unnecessary or even harmful treatments.&#x0D; Objective: The purpose of this study is to analyze the correlation between the initial diagnosis identified at the level of the emergencies department and the diagnosis being confirmed at the hospital medical department, with the aim of elaborating an action plan for a clinical approach to reduce diagnostic errors in the emergency department.&#x0D; Materials and methods: This study is a prospective and descriptive analytical one that builds on a compilation of the diagnostic hypotheses of patients who are admitted and hospitalized on the day of their admission to the pediatric emergencies department of the pediatric hospital Rabat. Patients with purely clinical confirmatory diagnoses as well as patients having a previously confirmed diagnosis were excluded from this study. The diagnostic hypotheses are discussed in the daily morning meeting of the department in order to discuss and retain the most probable initial diagnosis. The correlation is checked by following up on the file of the patient admitted in the pediatric department.&#x0D; Results: The study covered 100 initial diagnoses in the pediatric emergency department. The correlation was positive for 95 diagnoses (95% of the cases). There was a 5% negative correlation as follows: convulsion (1% of the cases), infectious endocarditis (1% of the cases), congenital heart disease (1% of the cases), pyelonephritis (1% of the cases), acid-ketotic decompensation (1% of the cases).&#x0D; Conclusion: It is crucial to have a structured and chronological questionnaire starting from the first abnormal symptom, and declining the main diagnostic hypotheses favoring therapeutic emergencies.

Comparison of treatment effectiveness and medical costs for different long-acting injectable antipsychotics in patients with schizophrenia in Taiwan: A nationwide population-based cohort study

ObjectiveTo assess the comparative effectiveness and medical costs of five long-acting injectable (LAI) antipsychotics, flupentixol, fluphenazine, haloperidol, risperidone, and clopentixol/zuclopentixol, in patients with schizophrenia. MethodWe conducted a retrospective cohort study of patients with schizophrenia using data from Taiwan's National Health Insurance Research Database. Patients aged 15years or older who began treatment with LAI antipsychotics between June 1, 2004 and December 31, 2008 were enrolled and followed for 1year. We evaluated the medical costs and treatment effectiveness, which was assessed using the rates of treatment discontinuation, psychiatric hospitalization, and emergency department visits. Risperidone was used as a reference group. ResultsCompared to risperidone, flupentixol was associated with higher hazard ratios of treatment discontinuation and psychiatric hospitalization, fluphenazine was associated with higher hazard ratios of treatment discontinuation, and haloperidol was associated with higher rates of psychiatric hospitalization and emergence department visits. However, fluphenazine, flupentixol, and haloperidol were associated with lower medical costs compared to risperidone. Clopentixol/zuclopentixol was inferior to risperidone in treatment effectiveness and medical cost. ConclusionsOur findings suggest that patients taking the LAI risperidone may be more effective in some but not all outcome measures; however, risperidone was also associated with higher medical costs in the Taiwanese healthcare setting.

Frequent attendance: A clinical and epidemiological study

BackgroundFrequent attenders (F a) are patients who attend a health care facility repeatedly. The frequency of frequent attendance at emergencies department has been defined as 4 or more attendances/annum. F a are few in number but they produce a high number of attendances.aimsTo determine prevalence of F a, mean attendances/year generated by F a and frequency of visits by months.Methodsa retrospective study was performed on psychiatry's emergency department database from January until December 2013. F a was defined as those with ≥ 4 attendances at emergency services in a year.Prevalence of F a, attendances’ prevalence, diagnosis’ prevalence, Mean attendances generated by F a and frequency of visits by months were analysed.Resultsamong 4824 attendances we found 181 F as (5.98%). Men represented 50.80% and women 49.20%. F a presented a mean of 6.33 attendances/year, while non-F a presented a mean of 1.29 attendances/year.in accordance with frequency of visits by months, it was observed that number of attendances was increased in april and May, in both F a and non-F a.ConclusionPrevalence of F a was 5.98%, F a generated a 23.74% of attendances. Most prevalent F a’ diagnoses were: anxiety disorder, personality disorder non-specified and schizophrenia.F a at emergency department contributes to overcrowd them. for this reason, it is important to take into account these results to develop new strategies to improve F a’ attention and prevent its occurrence.Disclosure of interestThe authors have not supplied their declaration of competing interest.