Emergency Medical Conditions Research Articles

Legalitas Tindakan Aborsi (Abortus) Akibat Perkosaan Incest Ditinjau dari Hukum Pidana Adat di Wilayah Masyarakat Adat Kabupaten Timor Tengah Selatan

The Timorese tribe has a pamali or prohibition not to be related or marry the same clan in one tribe or blood relations for people who are related by blood will be subject to customary sanctions by the traditional chief. The case of incest rape occurred in Nuapin Village, Fatumnasi District, South Central Timor Regency, this rape resulted in the victim experiencing an unwanted pregnancy by the victim and her family because the victim was pregnant with a child from her blood family which is prohibited in Timorese customary law, so she chose to have an abortion. Law No. 36 of 2009 concerning health and its Implementing Regulations excludes the act of abortion due to rape even though it is prohibited in the Criminal Code. In this case, the act of abortion is carried out as a result of incest rape and will be reviewed based on customary criminal law. The type of research used in this study is empirical research with a sociological juridical approach, namely field research whose object is about events and phenomena that occur in society. Data collection was carried out with two events, namely interviews with 4 people and literature studies. The data obtained were then presented in a qualitative descriptive manner. The results of this study show that: (1) The existence of criminal law prohibits the legalization of abortion due to incest rape, abortion is only allowed in emergency medical conditions in accordance with Law Number 36 of 2009 and Government Regulation Number 61 of 2014. (2). The legality of customary criminal law for abortion due to incest is carried out in Nuapin Village because it is considered to violate customary and pamali law.

Predictability of adult patient medical emergency condition from triage vital signs and comorbidities: a single-center, observational study

BackgroundVital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient’s status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED.MethodsThis prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered “medical emergency conditions”. The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression.ResultsA total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd’s Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities.ConclusionAmong the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs.

An Observational Study to Evaluate Readability and Reliability of AI-Generated Brochures for Emergency Medical Conditions.

Introduction The study assesses the readability of AI-generated brochures for common emergency medical conditions like heart attack, anaphylaxis, and syncope. Thus, the study aims to compare the AI-generated responses for patient information guides of common emergency medical conditions using ChatGPT and Google Gemini. Methodology Brochures for each condition were created by both AI tools. Readability was assessed using the Flesch-Kincaid Calculator, evaluating word count, sentence count and ease of understanding. Reliability was measured using the Modified DISCERN Score. The similarity between AI outputs was determined using Quillbot. Statistical analysis was performed with R (v4.3.2). Results ChatGPT and Gemini produced brochures with no statistically significant differences in word count (p= 0.2119), sentence count (p=0.1276), readability (p=0.3796), or reliability (p=0.7407). However, ChatGPT provided more detailed content with 32.4% more words (582.80 vs. 440.20) and 51.6% more sentences (67.00 vs. 44.20). In addition, Gemini's brochures were slightly easier to read with a higher ease score (50.62 vs. 41.88). Reliability varied by topic with ChatGPT scoring higher for Heart Attack (4 vs. 3) and Choking (3 vs. 2), while Google Gemini scored higher for Anaphylaxis (4 vs. 3) and Drowning (4 vs. 3), highlighting the need for topic-specific evaluation. Conclusions Although AI-generated brochures from ChatGPT and Gemini are comparable in readability and reliability for patient information on emergency medical conditions, this study highlights that there is no statistically significant difference in the responses generated by the two AI tools.

Utilization of emergency medical service and its associated factors among patients visited public hospitals at Hawassa City, Sidama Region, Ethiopia, 2023

BackgroundThe burden of emergency medical conditions is borne mostly by poorer nations, with a 6 % increase in deaths of adults and children due to emergency conditions between 1990 and 2015. Emergency medical service is crucial to improve outcomes of those injuries and other time-sensitive illnesses. However, access to emergency medical services in Hawassa City is still limited and its’ utilization is influenced by different factors. MethodsA facility-based cross-sectional study was conducted among 422 randomly selected clients who visited the emergency service in public hospitals of Hawassa City. A structured interviewer-administered questionnaire adapted by reviewing previous literature was used. The collected data by using the Kobo toolbox was exported into a statical package for social science software for analysis. Descriptive statistics such as frequency, percentage, mean, and standard deviation were used. A binary logistic regression model at a 95 % confidence interval was used to declare an association between dependent and independent variables using the odds ratio. ResultsAll 422 participants completed the interview with a response rate of 100 %. The mean age of the study participants was 33.73 years with a 14.67 standard deviation. One quarter (24.9 % (95 % CI: 21.1–29.4)) of the study participants have utilized emergency medical services. Urban residence (AOR = 3.48, 95 % CI: 1.69–7.16), ever utilized ambulance service (AOR = 2.37, 95%CI: 1.21–4.67), having Red Cross Association ambulance number (AOR = 2.64, 95%CI: 1.20–5.83) and awareness on presence of free government ambulance (AOR = 3.74, 95%CI: 1.46–9.59) were the predictors of the outcome variable. Conclusionutilization of emergency medical services in the study area was relatively low when compared with other studies. urban residence, ever utilization of ambulance service, awareness of the presence of free government ambulances, and having a Red Cross Association ambulance number were predictors of utilization of emergency medical service.

Knowledge and Attitudes towards Medical Emergencies among Dentists in Iași, Romania.

The aim of this study was to evaluate the level of knowledge of resident dentists and new graduates regarding the etiology, clinical diagnosis, and treatment of the main medical emergency conditions. The study included a sample of 152 new graduates and residents in the first, second, and third year of training in Prosthodontics and General Dentistry from the Faculty of Dental Medicine in Iasi, Romania. Their level of knowledge and the attitudes were assessed using a questionnaire with 24 questions, divided into four sections. The differences among groups were identified using the chi-square test (p < 0.05). A high level of knowledge was found among the three groups of subjects for the questions regarding the recognition of clinical signs in hypoglycemic crisis (88-100%), in anaphylactic shock (83.3-94.5%), and the treatment of angina pectoris (76.2-84.2%). In contrast, a low level of knowledge was found for the questions regarding pulse evaluation in the case of an emergency (26.3-35.7%), the parameters of normal breathing (28.9-43%), and the treatment of hypoglycemic crisis (27.8-44.8%). The study indicated that the dentists had a moderate understanding of dental office medical emergencies and preferred practical training over theoretical courses.

Emergency medical services (EMS) infrastructure development and operations in low- and middle-income countries: Formal, professional-driven (Tier-2) systems

The World Health Organization recognized timely healthcare as a human right and called for the expansion of two-tiered prehospital and out-of-hospital emergency care systems in low- and middle-income countries. Tier-1 systems involve community-based first responder care, and Tier-2 systems involve more formalized emergency medical services designed as a sustainable system of services, including dedicated ambulances, personnel, and equipment. Tier-2 systems can play a crucial role in reducing mortality and disability due to emergency medical and surgical conditions worldwide. However, the implementation and operation of robust Tier-2 systems in low- and middle-income countries face significant challenges. This article examines the current state, challenges, and opportunities of Tier-2 system development and operations in low- and middle-income countries, highlighting the limited coverage and resourcing of existing systems.The challenges faced in developing Tier-2 systems in low- and middle-income countries include a lack of global awareness, financial constraints, regulatory and planning issues, cultural appropriateness, and workforce shortages. Additionally, the availability and maintenance of equipment, technology, transportation, facilities, and interfacility transfers pose significant hurdles. Localized adaptation of emergency medical services models to suit the diverse contexts of different low- and middle-income countries is critical, as are community partnerships in navigating the complexities of specific communities.Furthermore, Tier-2 systems in low- and middle-income countries should prioritize alignment with national policies and integration into their broader healthcare systems. There is also a need for innovative financial sustainability approaches, such as private-public partnerships and cost-sharing schemes, to overcome the upfront costs of establishing Tier-2 system infrastructure.Additionally, strategies for strengthening the emergency medical services workforce, including targeted recruitment and training, are explored. By addressing these challenges and opportunities, Tier-2 systems in low- and middle-income countries can better operate within their available resources and potentially contribute to improved healthcare outcomes. The sharing of best practices and collaborative networks between systems in low- and middle-income countries will also be critical for the development of Tier-2 system infrastructure in these areas.

Bleeding Control Protections Within US Good Samaritan Laws.

In the United States, all 50 states and the District of Columbia have Good Samaritan Laws (GSLs). Designed to encourage bystanders to aid at the scene of an emergency, GSLs generally limit the risk of civil tort liability if the care is rendered in good faith. Nation-wide, a leading cause of preventable death is uncontrolled external hemorrhage. Public bleeding control initiatives aim to train the public to recognize life-threatening external bleeding, perform life-sustaining interventions (including direct pressure, tourniquet application, and wound packing), and to promote access to bleeding control equipment to ensure a rapid response from bystanders. This study sought to identify the GSLs in each state and the District of Columbia to identify what type of responder is covered by the law (eg, all laypersons, only trained individuals, or only licensed health care providers) and if bleeding control is explicitly included or excluded in their Good Samaritan coverage. Good Samaritan Laws providing civil liability qualified immunity were identified in all 50 states and the District of Columbia. One state, Oklahoma, specifically includes bleeding control in its GSLs. Six states - Connecticut, Illinois, Kansas, Kentucky, Michigan, and Missouri - have laws that define those covered under Good Samaritan immunity, generally limiting protection to individuals trained in a standard first aid or resuscitation course or health care clinicians. No state explicitly excludes bleeding control from their GSLs, and one state expressly includes it. Nation-wide across the United States, most states have broad bystander coverage within GSLs for emergency medical conditions of all types, including bleeding emergencies, and no state explicitly excludes bleeding control interventions. Some states restrict coverage to those health care personnel or bystanders who have completed a specific training program. Opportunity exists for additional research into those states whose GSLs may not be inclusive of bleeding control interventions.

Experiences of University Nursing Students Regarding Overcrowding by Patients in The Training Health Facilities, Khomas Region Namibia

Overcrowding in healthcare facilities has emerged as a critical issue, posing significant challenges in the delivery of quality patient care. In recent times, there has been an increasing number of patients at the health centres, medical, and surgical emergency conditions, placing more emphasis on the need for quality nursing care. The aim of this study is to explore the causes, consequences and potential solutions surrounding overcrowding in training health facilities. The study employed exploratory, qualitative design. Ninety-eight participants that registered for the academic year 2023 as fourth years at the University of Namibia were recruited and saturated at 9 respondents. Data was coded and analysed using Tesch’s method of data analysis. Three Themes emerged from the exploration and description of nursing students clinical learning experiences. The results indicated that there was indeed overcrowding of patients in the health facilities. The study identified several major challenges confronting nursing students working in the training health facilities which are linked with lack of resources and staff.

Blunt chest trauma-induced myocardial infarction: a case of sudden death by homicide

BackgroundBlunt cardiac injuries, which are typically the result of blunt chest trauma, are not particularly significant clinically. It is vital never to underestimate blunt chest injuries, especially when they occur in the anterior thoracic area. Blunt trauma to the chest is one of the rarest causative factors of myocardial infarction (MI). Blunt cardiac injury encompasses different medical emergency conditions such as gradual damage to the myocardium leading to myocardial ischemia, injuries to the great vessels of the heart, pericardial tamponade, septum or wall ruptures, pump failure, conduction abnormalities, and atrial and ventricular fibrillations. The most common cause of blunt chest trauma is a road traffic accident (RTA), followed by a sports injury. Mostly blunt trauma chest injuries occur below the age group of 45 years.Case presentationA 45-year-old male with a history of physical assault was brought to the emergency department by his neighbor. He was allegedly kicked by his relative over the chest during an altercation sustained blunt-force trauma to the chest and collapsed immediately. On admission, he was given cardiopulmonary resuscitation and declared dead. On autopsy, there were no signs suggestive of external injury or any shoeprints/footprints on the chest. On histopathological examination, a diffuse area of discoloration consistent with an extensive myocardial infarction was noted. Old healed infarcts were seen in the free wall of the left ventricle, left posterior papillary muscle, and left apex. The coronaries showed atheromatous plaque with lumen narrowing and focal calcification.ConclusionsIt is the task of the forensic pathologist to ascertain and record evidence as to whether the myocardial infarction was caused by the alleged blunt trauma to the chest during the autopsy. This is important as it will determine the type of prosecution the accused is likely to be charged with and the extent of the punishment that he will likely receive under the Indian Penal Code.

The use of biomarkers in the diagnosis and management of emergency medical conditions

The use of biomarkers in emergency situations represents a change in modern healthcare. This review examines their impact in emergencies focusing on how they improve the accuracy of diagnoses, provide insights into prognosis and aid in treatment decisions. Notably troponins (I and T) are effective in diagnosing myocardial infarction enabling targeted interventions and risk assessment for cardiovascular emergencies. In cases of sepsis procalcitonin helps distinguish infections and influences decisions about therapy, which is crucial for global efforts against resistance. S100B, a biomarker used in emergencies assists in prioritizing cases of brain injury. To prevent harm, serum markers like creatinine and cystatin C guide interventions for hepatic emergencies. For trauma and hematological emergencies D dimer and lactate provide prognostic information. Ongoing research is exploring biomarkers well as the integration of artificial intelligence offering promising advancements for the future. The clinical significance of biomarkers highlights a commitment to approaches that contribute to the ever-evolving field of emergency medicine and ultimately enhance patient care.

Elevating healthcare through artificial intelligence: analyzing the abdominal emergencies data set (TR_ABDOMEN_RAD_EMERGENCY) at TEKNOFEST-2022.

The artificial intelligence competition in healthcare at TEKNOFEST-2022 provided a platform to address the complex multi-class classification challenge of abdominal emergencies using computer vision techniques. This manuscript aimed to comprehensively present the methodologies for data preparation, annotation procedures, and rigorous evaluation metrics. Moreover, it was conducted to introduce a meticulously curated abdominal emergencies data set to the researchers. The data set underwent a comprehensive central screening procedure employing diverse algorithms extracted from the e-Nabız (Pulse) and National Teleradiology System of the Republic of Türkiye, Ministry of Health. Full anonymization of the data set was conducted. Subsequently, the data set was annotated by a group of ten experienced radiologists. The evaluation process was executed by calculating F1 scores, which were derived from the intersection over union values between the predicted bounding boxes and the corresponding ground truth (GT) bounding boxes. The establishment of baseline performance metrics involved computing the average of the highest five F1 scores. Observations indicated a progressive decline in F1 scores as the threshold value increased. Furthermore, it could be deduced that class 6 (abdominal aortic aneurysm/dissection) was relatively straightforward to detect compared to other classes, with class 5 (acute diverticulitis) presenting the most formidable challenge. It is noteworthy, however, that if all achieved outcomes for all classes were considered with a threshold of 0.5, the data set's complexity and associated challenges became pronounced. This data set's significance lies in its pioneering provision of labels and GT-boxes for six classes, fostering opportunities for researchers. The prompt identification and timely intervention in cases of emergent medical conditions hold paramount significance. The handling of patients' care can be augmented, while the potential for errors is minimized, particularly amidst high caseload scenarios, through the application of AI. • The data set used in artificial intelligence competition in healthcare (TEKNOFEST-2022) provides a 6-class data set of abdominal CT images consisting of a great variety of abdominal emergencies. • This data set is compiled from the National Teleradiology System data repository of emergency radiology departments of 459 hospitals. • Radiological data on abdominal emergencies is scarce in literature and this annotated competition data set can be a valuable resource for further studies and new AI models.

Managing medical emergencies: Sustainable pre-hospital medical education in Rwanda

&#x0D; &#x0D; &#x0D; INTRODUCTION: In Rwanda, non-communicable diseases accounted for 44% of all reported deaths as of 2016. Yet, there is very limited data on pre-hospital management of emergency medical conditions in LMICs. We evaluated the impact of a pre-hospital medical emergencies training course and train-the-trainers program for Service d’Aide Medicale Urgente (SAMU) to address the burden of NCDs.&#x0D; METHODS: A 100-question baseline assessment was administered to 25 SAMU staff to assess knowledge of basic anatomy, physiology, medicine, obstetrics, pediatrics, trauma, and scene safety. A two-day Emergency Medical Care Course (EMCC) was developed. Two cohorts (one for instructors and another one for staff) from ten district and provincial hospitals. EMCC 1 and a one- day educator course were conducted for the instructor core. They then taught the second cohort of trainees (EMCC 2).&#x0D; RESULTS: In the baseline assessment of 25 SAMU staff, the median score was 56% overall and 54% in medical. EMCC 1 median scores were 43% vs 86% (pre vs post), p&lt;0.001 using matched pair analysis of 18 participants. EMCC 2 median scores were 45% vs 82% (pre vs post), p&lt;0.001 using matched pair analysis of 16 participants. A one-way ANOVA mean square analysis showed no statistically significant difference between the two cohorts post-training, with similar post- assessment scores.&#x0D; DISCUSSION: This study showed that the course improved knowledge for an instructor core and staff from district and provincial hospitals, confirming the effectiveness of a train-the-trainers model, which will allow for sustainability in pre-hospital emergency medical training in Rwanda.&#x0D; &#x0D; &#x0D;

Perspectives of Hill Tribe People and Healthcare Providers regarding Emergency Medical Conditions and Interfacility Transfer: A Qualitative Study in Rural Northern Thailand

Interfacility transfers of patients in rural mountain areas have many issues that require further investigation; for example, lack of resources and the inability to provide appropriate treatments for a patient’s conditions are the reasons for interfacility transfer. A qualitative descriptive study was conducted to explore the experience of hill tribe people (n = 16) and healthcare providers (n = 22) regarding emergency medical conditions and interfacility transfer in rural mountain areas of northern Thailand. Data were collectedfrom February to July 2019 via in-depth interviews. All interviews were transcribed verbatim, and the content analysis procedure of Elo and Kyngäs was used for data analysis. The study’s trustworthiness was established using Lincoln and Guba’s criteria. The finding revealed four categories reflecting hill tribe people’s experience of emergency medical conditions and interfacility transfer: 1) perceived barriers to rapid access, 2) helping hands, 3) the polarity of interfacility transfer services, and 4) ways toward a bright future. The healthcare providers’ experience was divided into three categories consisting of 1) the district system of interfacility transfer, 2) making it work: the three sources of power, and 3) hope for better interfacility transfer. These findings may contribute to a better comprehension of the nurses and healthcare providers who actively provide interfacility transfer support for emergency medical conditions suitable for hill tribe populations and healthcare settings.

BACTERIAL INFECTIONS-INDUCED ORAL ERYTHEMA MULTIFORME IN A SEPTIC CHILD: A RARE CASE REPORT

Background: Sepsis is a medical emergency condition that triggers an immune response due to an infectious process. Causative organisms in sepsis including viruses, bacteria, fungi, and parasites. Microorganism infection is one of the etiologies of erythema multiforme. Objective: This case report was aimed to describe the bacterial infection as a trigger for oral erythema multiforme in a septic child. Case: A 12-years-old boy was referred to the Oral Medicine Department. Extraoral showed a symmetric face and he was using a nasogastric tube. There were erosive lesions and tend to bleed, hemorrhagic crusts on the upper and lower lips. Laboratory test results revealed increasing in leukocyte (15,880/µL), procalcitonin (24.58 ng/mL), and C-reactive protein (3.67 mg/L). The identified microorganisms in pus specimens including gram-positive coccus and gram-negative rods as well as the isolated bacterial colonies were Enterococcus faecalis, Klebsiella pneumoniae, and Citrobacter koseri. The diagnosis was oral erythema multiforme induced by bacterial infections. Case management: The medications given by the Pediatric Department were cefotaxime vial 1 gram, metronidazole 500 mg/100 ml, and paracetamol 1 gr/100 ml. The Oral Medicine Department gave the instructions for compressing the lips with gauze soaked in 0.9% Sodium Chloride solution four times a day to remove crusts and accelerate wound healing. Oral lesions showed significant improvement after 7 days of therapy. Conclusion: Oral erythema multiforme in a pediatric patient could be induced by sepsis of bacterial infection. The microbial infection causes the release of endotoxins that trigger erythema multiforme. Keywords: Bacterial infection, Oral erythema multiforme, Sepsis.

Relationship Between CRP, Procalcitonin, I/T Ratio and The Incidence of Sepsis in Children

Background: Sepsis is body immune response due to infection. Sepsis is a medical emergency condition with high-risk of mortality. WHO in 2018 stated that every year there were 2.9 million cases of death due to sepsis. Several markers can be used to suppor

Using telemedicine to manage a patient with a hypertensive emergency due to pheochromocytoma.

The COVID-19 pandemic has led to the emergence of telemedicine on a global scale. In endocrinology, telemedicine has mainly been used in relation to chronic diseases, including diabetes. Herein, we report the case of an 18-year-old woman with a hypertensive emergency due to a pheochromocytoma who was quickly diagnosed and treated using telemedicine. The patient was referred to a cardiovascular hospital because of fatigue and sweating that did not improve with carvedilol. She had fluctuating blood pressure and tachycardia. Subsequently, since her thyroid function was normal, endocrine hypertension not due to thyroid dysfunction was suspected; a case consultation was made by phone to our clinic. Plain computed tomography (CT) was recommended owing to the high possibility of a pheochromocytoma; the CT scan showed an adrenal tumor with a 30 mm diameter. To assess her condition, endocrinologists, together with the attending doctor, interviewed her and her family directly using an online tool to obtain detailed information. We thus determined that she was at risk of a pheochromocytoma crisis. She was transferred to our hospital immediately for treatment, was diagnosed with pheochromocytoma, and underwent surgery. Telemedicine, especially involving doctor-to-patient with doctor consultations, can be effective in treating rare and emergent medical conditions such as pheochromocytoma crisis. Telemedicine can be used for chronic diseases and emergency conditions. Online doctor-to-patient with doctor (D-to-P with D) consultations are useful when the expert opinion of a highly specialized physician present in a different geographical location is required. Telemedicine, especially D-to-P with D online consultations, can be effectively used for the diagnosis of rare and emergent medical conditions, such as pheochromocytoma crisis.

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.

Management of emergency medical conditions related to arterial hypertension in the prehospital setting

Management of emergency medical conditions related to arterial hypertension in the prehospital setting

Patients' perceived quality of care and their satisfaction with care given for MDR-TB at referral hospitals in Ethiopia.

There is presently dearth of evidence in Ethiopia on patients' perception on quality of care given for multi-drug resistant tuberculosis (MDR-TB) and their satisfaction with the care and services they receive for the disease. Moreover, there is no evidence on the experiences and practices of caregivers for MDR-TB regarding the functionality of the programmatic management of MDR-TB at referral hospitals in Ethiopia. Thus, this study was conducted to address these gaps. Evidence in these areas would help to institute interventions that could enhance patient satisfaction and their adherence to the treatment given for MDR-TB. This study employed an inductive phenomenological approach to investigate patients' perception of the quality of care given for MDR-TB, level of their satisfaction with the care they received for MDR-TB and the experiences and practices of caregivers for MDR-TB on the functionality of the programmatic management of MDR-TB at referral hospitals in Ethiopia. The data were analysed manually, and that helped to get more control over the data. The majority of the patients were satisfied with the compassionate communication and clinical care they received at hospitals. However, as no doctor was dedicated exclusively for the MDR-TB centre of the hospitals, patients could not get timely medical attention during emergent medical conditions. Patients were dissatisfied with the poor communication and uncaring practice of caregivers found at treatment follow-up centres (TFCs). Patients perceived that socio-economic difficulties are both the cause of MDR-TB and it has also challenged their ability to cope-up with the disease and its treatment. Patients were dissatisfied with the poor quality and inadequate quantity of the socio-economic support they got from the programme. Despite the high MDR-TB and HIV/AIDS co-infection, services for both diseases were not available under one roof. Socio-economic challenges, inadequate socio-economic support, absence of integrated care for MDR-TB and HIV/AIDS, and the uncaring practice of caregivers at treatment follow-up centres are found to negatively affect patients' perceived quality of care and their satisfaction with the care given for MDR-TB. Addressing these challenges is recommended to assist patients' coping ability with MDR-TB and its treatment.

A Review on Attyayik Chikitsa Yog in Bhaishajyratnavali-Vishchikitsa Prakaranam

Importance of Ayurveda is now worldwide accepted. In lifestyle orientated and chronic diseases conditions like arthritis, skin diseases, Ayurveda medicines are proven and accepted by the world. But in emergency medical conditions like Snake bite scorpion bite which shows emergency sign and symptoms. Respiratory distress, Palpitations, there is need to study. In this article a review on the emergency conditions like Poisoning by Poisonous plants, Snake bite, insect bite, Scorpion bite etc. and the combination of drugs (kalpa) from Bhaishajy ratnavali Vish Chikista prakaranam used in such emergency condition is elaborated specifically in Snake bite &amp; Scorpion bite.