Emergency Health Care Research Articles

Pediatric Resuscitation, Parental Presence, and Provider Perspective

Background Varying opinions and practices exist about parental presence during a pediatric resuscitation. In addition, there is a paucity of literature that investigates the perspectives of health care providers about the efficacy of parental presence in these situations. Objectives The aim of this study was to gain an understanding of the perspectives of emergency health care providers about parental presence during pediatric resuscitation. Methods This pilot study surveyed emergency health care providers about their opinions of parental presence during pediatric resuscitation. All participants were given a survey with closed- and open-ended questions. Data analysis included descriptive statistics for the demographic data and qualitative analysis for the open-ended responses. Results A total of 52 emergency services personnel completed the survey. Of the physician respondents, 78.2% (n = 18) were opposed to parental presence during pediatric resuscitation. Common reasons for opposition included the lack of education, interpersonal team communication skills or experience, and discussion concerning end-of-life issues. Discussion Utilization of formal education and simulation for parental presence during resuscitation could be helpful for increasing providers’ comfort levels with parental presence.

Low physical fitness indicates future injury, mental health, menstrual cycle disruptions and burnout in female emergency service personnel and healthcare providers

Musculoskeletal injury (MSKi), depression, anxiety and burnout place a considerable burden on emergency services personnel and healthcare providers (HCP). Physical fitness is related to both mental and physical health in these populations but females in these are hugely underrepresented in this literature. As female representation in first-responder and HCP roles increases, the need for female specific research is needed. This study examines physical fitness as a short-term indicator of future reproductive health, MSKi, and mental health for females employed as first-responders or HCP. Thirteen first-responders and 29 HCP completed an initial health and demographics questionnaire, a comprehensive physical assessment (e.g., bone mineral density, muscular strength, muscular endurance, muscular power, flexibility, and aerobic capacity), and a health questionnaire 6-7 months after the physical testing. We found that i) bone mineral density, relative upper body strength, and lowerbody power were related to sustaining future MSKi, ii) better lower body endurance and flexibility was related to future menstrual cycle disruptions, and iii) low bone mineral density was related future self-reported burnout and Patient Health Questionnaire score >10. Physical fitness characteristics can be helpful indicators of future MSKi risk, menstrual cycle disruptions, and mental health status in females employed in arduous occupations.

Remote management of worsening heart failure events and subsequent rate of emergency department admission

Abstract Background Worsening heart failure (WHF) is the leading cause of hospitalization among individuals aged ≥ 65 years and constitutes a substantial burden for both the patient and the healthcare systems. Moreover, heart failure contributes to exacerbate the pressure on emergency departments which are involved in 64% of heart failure hospital admission (1). Remote management of heart failure as been shown to reduce the number of days lost due to unplanned cardiovascular hospitalizations and all-cause mortality (2, 3), but little is known about the effect on the emergency healthcare use. We aimed to describe the effect of a telemonitoring program on the rate of emergency admissions for WHF in chronic heart failure patients. Methods All patients enrolled in the heart failure remote management program of two French centers between 13 April 2020 and 31 January 2023 were included in the study. Follow-up data were collected until 31 January 2023. Inclusion criteria were chronic heart failure (HF) with New York Heart Association ≥II and an elevated B-type natriuretic peptide (BNP > 100 pg/mL or N-terminal-pro-BNP > 1000 pg/mL). Remote evaluation included measurements of body weight, blood pressure, heart rate, symptoms, biochemical parameters, and data from cardiac implantable electronic devices when available. Results A total of 1,095 patients (72±11.8 years old, 69.7% male), were followed for a median [IQR] of 437 [182; 739] days with a mean adherence to the remote monitoring system of 67.6±30.3%. Over this period, 198 (18.1%) patients had 949 WHF events, the majority of whom were remotely detected: 830 (87.5%). Overall, 246 (26%) of the WHF episodes required hospitalisation and 109 (11%) prompted an emergency department visit. When the WHF event was remotely detected, hospitalization was only required in 127 (15%) cases and the rate of emergency department visit was reduced to 3%. Conclusion In HF patients engaged in a multiparametric remote management program, the rate of emergency department admission is very low. Adopting such a strategy for patients with chronic HF may be useful in reducing emergency department overcrowding.Baseline characteristics of patientsPatients course and use of resources

Inequalities in access to early child services in Bulgaria

Abstract Background Children’s health has been a major focus of European health policy since 2000, with particular emphasis on early childhood and integrated services for children with chronic diseases. However, research on early child care in Bulgaria is sparse, mainly focusing on the role of nurseries, kindergartens and nursing care. Our aim is to investigate whether there are disparities in access to early childhood health services in Bulgaria. Methods A survey was conducted among mothers of children up to 7 years old between April and June 2022. The questionnaire, containing 49 questions, was based on the theoretical framework from the EU project ‘Models of child health appraise’, covering topics as: geographical and financial access to services, equity, quality, responsiveness to children and family needs, considered key features of outpatient child medical care. Statistical analysis utilized Chi-square, Fisher’s exact and ANOVA tests. Results A total of 413 Bulgarian women, with a mean age of 34.3 (±5.1), participated in the study. Almost all women (91.3%) reported that their children had a primary care provider. The mean time to reach the GP/pediatrician’s office was 16 minutes (95% CI 14.6 - 16.7), longest for residents of small towns and villages (21 minutes), p = 0.004. Parents from small towns (including villages) were six times more likely to experience financial difficulties related to their children’s healthcare services compared to those from the capital city (p = 0.047), as well as parents with low-income (p = 0.031). Emergency healthcare was the most demanded service by families with children under 7 years old, possibly due to its free availability. Parents with secondary education and from small towns lack access to non-medical health-promoting or preventive services such as breastfeeding consultations, speech therapy and others. Conclusions Significant financial and geographic disparities in access to early child health services exist in Bulgaria. Key messages • There are serious social health inequalities related to the access to outpatient child health services in Bulgaria. • There is an urgent need for specific child and family health strategy based on the principles of proportionate universalism.

Beyond Injuries: February 6th Kahramanmaras Earthquakes and Other Patients Transported by Ambulance.

This study evaluates the Emergency Medical Service system and overall emergency preparedness by analyzing ambulance-transported patients during the February 6, 2023 earthquakes, focusing on those without earthquake-related injuries (medical emergencies and traumas not caused by earthquakes). A retrospective, observational case series was conducted, involving patients aged 18 and above transported by ambulance between February 6 and March 6, 2023. Patient demographic characteristics, vital signs, diagnoses, treatments, and outcomes were recorded. Predisposing factors for ambulance transportation including post-earthquake health facility issues, housing problems, hygiene, heating, and smoke exposure were meticulously analyzed. The study included 1872 patients, with a 55.4% hospitalization rate and a 13.7% mortality rate. Cardiovascular emergencies were the primary reason for admission (28.9%). Patients from the hospital in the study's location form Group 1, whereas those from other earthquake-affected provinces constitute Group 2. Significant predisposing factors for ambulance transportation included post-earthquake health facilities (P < 0.001), housing problems (P < 0.001), hygiene (P < 0.001), heating (P = 0.001), and smoke exposure (P < 0.001). In Group 2, pneumonia (P = 0.001), soft tissue infection (P = 0.002), sepsis (P = 0.004), carbon monoxide poisoning (P < 0.001), and diabetic emergencies (P = 0.013) were statistically significantly more frequent. Analyzing post-earthquake ambulance-transported patients is vital to comprehend the demand for emergency health care and address post-disaster health care challenges.

Emergency department frequent users in the paediatric population: a retrospective analysis in Rome

Abstract Background Recent studies have reported the increasing utilisation of the Emergency Departments (EDs) for non-urgent attendances by people aged &amp;lt;18 years. The aim of this study is to describe the characteristic of the paediatric frequent user (FU) population, highlighting the differences between FUs and non-FUs, and to identify factors linked to appropriate ED attendance, comparing the level of variability attributed to the geographical and family physician components. Methods A retrospective cohort study was carried out of the ED attendances in 2022 in the 8 EDs of the Local Health Authority Roma 1 geographical area, in Rome. The cohort was enrolled from the regional Healthcare Emergency Information System. Records included information on number of attendance, age and gender, usage of emergency medical service (EMS), triage code, appropriateness of attendance. Multivariable nested logistic regression was performed to identify the characteristics of FU and non-FU attendances and the predictors for appropriateness of attendances. Results In 2022, the total number of children with at least 1 ED attendance is 24.824 and a total of 35.691 attendances were recorded. The regression analysis highlights that the appropriateness of attendances is associated to the female gender (OR male: 0.84), age &amp;lt;1 year (OR: 2.06), the usage of EMS (OR: 2.00), high triage code and being a FU (OR FU: 1.53). The family physician group have a greater influence of District group but lower influence of single patient characteristics group to determine the appropriateness of paediatric ED attendances (MOR District: 1.73; MOR PCP: 1.84; MOR single patient characteristics: 2.75). Conclusions Frequent use of the ED is partially associated with an inappropriate use of EDs, mostly due to the specific patients’ characteristics. It is therefore necessary to adopt strategies to improve the appropriate use of health service resources in order to provide quality health solutions to real health needs. Key messages • This is the first study that defines an ED paediatric FU profile in Italy. • It compares the level of variability attributed to the geographical component and family physician components.

Peak Flow Feedback Intervention Improves Under-Perception of Airflow Limitation in Pediatric Asthma: A Randomized Clinical Trial.

Under-perception of asthma symptoms is associated with poor asthma outcomes. We assessed the effects of a behavioral intervention for improving perception of airflow limitation and asthma outcomes. A two-arm randomized controlled trial compared peak expiratory flow (PEF) feedback versus supportive counseling. Latino and Black adolescents with asthma ages 10-17 years old and caregivers were recruited from hospitals in the Bronx, NY. PEF feedback sessions reviewed accuracy of PEF guesses and medication adherence data, and targeted behavior change using motivational interviewing and problem-solving skills training. Supportive counseling received emotional support related to asthma. Both groups received 3 sessions across 6 weeks. All participants were blinded to PEF while guessing PEF during pre-intervention, 1, 6, and 12-month follow-up. Children in PEF feedback saw actual PEF after guesses were locked in during the 6-week intervention. Participants and assessors were blinded to group assignment. The primary outcome was under-perception of airflow limitation (divergence between actual PEF and guesses) on home spirometers. Secondary outcomes included daily PEF and forced expiratory volume in 1 second (FEV1), inhaled corticosteroid adherence measured by electronic monitors, Asthma Control Test, and emergency healthcare use for asthma. The sample comprised 354 children (M = 13.2±2.2 years; 62% Latino, 38% Black) and caregivers. PEF feedback (N = 153 analyzed) demonstrated greater improvements at 1-month follow-up on under-perception of airflow limitation (difference-in-differences, -12.64; 95% CI, -17.54 to -7.74), % personal best PEF (9.89; 95% CI, 7.13 to 12.65), % predicted FEV1 (4.93; 95% CI, 0.95 to 8.90) and ICS adherence (16.02; 95% CI, 7.15 to 24.89) compared with supportive counseling (N = 152 analyzed). At 12-month follow-up PEF feedback maintained improvements on under-perception of airflow limitation (-13.87; 95% CI, -19.03 to -8.71), higher PEF (14.23; 95% CI, 11.37 to 17.08) and %FEV1 (5.62; 95% CI, 1.56 to 9.67), and had smaller declines in ICS adherence (17.51; 95% CI, 7.12 to 27.89) versus pre-intervention than supportive counseling. No between-group differences existed for asthma control or healthcare use. The efficacy and sustainability of PEF feedback was established in improving children's perception of airflow limitation, pulmonary function, and medication adherence. Clinical trial registration available at www. gov, ID: NCT02702687.

Missing Medical Data in Neurological Emergency Care Compromise Patient Safety and Healthcare Resources

Background: Acute care of patients in the emergency department (ED) can be very challenging when patients attend EDs without their important medical information. This is especially problematic for multimorbid patients under polypharmacy. The aim of this study was to assess systematically the frequency and clinical relevance of incomplete medical data upon ED admission. Methods: The study was conducted in the neurological ED of a German tertiary hospital. The availability and accuracy of medical data of all neurological patients in the ED were assessed upon arrival. Treating ED physicians were asked about the acute care of the patients to clarify whether missing data resulted in delays or complications in the emergency treatment. Additionally, doctors responsible for the inpatient care of patients who were admitted to a ward via the ED were questioned about the course of the inpatient stay to monitor how initially missing data might have influenced the hospital stay. Results: Medical data of 27% of the 272 included patients were missing or incomplete upon admission in the ED. The ED physicians had to make additional phone calls to gather information in 57% of these cases (vs. 22% in patients with complete data, p &lt; 0.0001). Delays between 5 and 240 min were documented due to initially missing data. Unnecessary diagnostic procedures (e.g., lumbar puncture) were performed in 5% of these patients, thus compromising patient safety. Even the inpatient stay was complicated by initially missing data, as doctors still had to spend time (between 10 and 180 min) to gain relevant information. Retrospectively, 5% of hospitalizations could have been avoided if all medical information had been available upon ED admission. Conclusions: Missing medical data caused complications and delays in acute as well as inpatient care of patients admitted to the neurological ED. This compromised patient safety and led to a waste of medical resources and valuable time of the responsible medical team. Therefore, a comprehensive, digital data management system is urgently needed to improve patient safety and facilitate efficient patient care in the ED and beyond.

Readiness to manage Ebola Virus Disease among emergency healthcare workers in Uganda: a nationwide multicenter survey

BackgroundEmerging infectious diseases like the Ebola Virus Disease (EVD) pose significant global public health threats. Uganda has experienced multiple EVD outbreaks, the latest occurring in 2022. Frontline healthcare workers (HCWs) are at increased risk, yet there is insufficient evidence of existing knowledge of EVD of these HCWs. We aimed to assess the readiness of Uganda’s emergency HCWs to manage EVD and identify their training needs to inform targeted capacity-building interventions for future outbreaks.MethodsThis multicentre nationwide cross-sectional study was conducted from July to September 2023 among HCWs providing emergency care in 14 secondary and tertiary hospitals across Uganda. Participants were consecutively recruited using the probability-proportional-to-size sampling technique, and data was collected using a self-reported questionnaire. Factors associated with EVD knowledge were identified through a mixed-effect linear model.ResultsData from 691 eligible HCWs with a median age of 32 (IQR: 28–38) was analyzed (response rate: 92%). Only one-third (34.4%, n = 238) had received EVD training in the past year. The median EVD knowledge score was 77.4% (IQR: 71.2 − 83.4%). EVD knowledge was associated with longer professional experience in years (β: 0.21, 95% CI: 0.03 to 0.39, p = 0.024) and higher level of education: diploma (β: 3.37, 95% CI: 1.49 to 5.25, p < 0.001), undergraduate degree (β: 6.45, 95% CI: 4.11 to 8.79) and postgraduate degree (β: 7.13, 95% CI: 4.01 to 10.25, p < 0.001). Being a doctor (β: 2.55, 95% CI: 0.35 to 4.74, p = 0.023), providing care in the obstetrics/gynecology department (β: −1.90, 95% CI: −3.47 to − 0.32, p = 0.018), previous EVD training (β: 2.27, 95% CI: 0.96 to 3.59, p = 0.001) and accessing EVD information through social media (β: 2.52, 95% CI: 1.17 to 3.88, p < 0.001) were also significantly associated with EVD knowledge. HCWs were mostly interested in training on management (92.9%), infection prevention and control (87.1%), and clinical presentation (84.1%), and preferred physical (51.5%) and hybrid (38.2%) training modes.ConclusionOur study shows that the readiness of HCWs in Uganda to respond to EVD outbreaks varies by individual factors and information sources. We recommend targeted training and suggest future research on educational innovations and social media’s potential to fill knowledge gaps.

Artificial Intelligence in Radiology, Emergency, and Remote Healthcare: A Snapshot of Present and Future Applications

This paper critically examines artificial intelligence in the healthcare sector and aims to identify concrete points of challenges and business value propositions first in radiology and then across healthcare more broadly. It discusses current applications in radiology and future uses of AI in healthcare, focusing on three main areas: (i) emergency incidents handling, (ii) intensive care unit treatment and (iii) augmented telemedicine, to which emergency radiology is a critical success factor. Despite some risks and compliance issues that need to be taken care of, this paper clearly shows that AI has the potential (a) to reengineer the business processes of the healthcare sector, using AI-assisted radiology as a driver and (b) to improve the effectiveness of the healthcare system as well as (c) to increase the quality provision of healthcare services. Despite its slow adoption, AI-assisted healthcare can indeed offer business/operational solutions that benefit all healthcare stakeholders.

Teamwork in Rural Emergency Health Care: A Simulation-Based Cross-over Study of Co-located and Distributed Teams.

Despite the increasing use of distributed healthcare teams, performance evaluation is largely lacking. This study examined rural emergency health care in Sweden to determine the effect of teams being either co-located or distributed with remote physicians accessible via telemedicine. In this crossover study, 17 three-person teams were video recorded during co-located and distributed simulated scenarios. Team performance in the video recordings was evaluated using the TEAM instrument. Co-located scenarios had significantly higher Total ratings for the instrument (items 1-11), in the teamwork domain (items 3-9), and in overall performance (item 12) compared with distributed scenarios (P < 0.005). Item-level analysis revealed that co-located teams were better at completing tasks on time (item 4) and showed greater adaptability to changing situations (item 7). The higher rating of the performance of co-located teams underscores the challenges facing distributed teams. Given that distributed healthcare teams are a reality in rural areas in northern Sweden, education and training must be adapted to address these challenges. This adaptation is crucial for ensuring high-quality patient care by distributed teams.

Capgras Syndrome in Dementia: A Systematic Review of Case Studies.

In an ageing population, dementia has become an imminent healthcare emergency. Capgras syndrome, the most common delusion of misidentification (DMS), is frequently found alongside dementia. Previous research showed that Capgras syndrome has significant negative effects on people living with dementia and their carers due to its complex presentation and impact on their lives. This qualitative systematic review explores the evidence base of the effective management and treatment of Capgras syndrome in dementia. As per our knowledge, this is the first systematic review exploring the symptomatology of Capgras syndrome across different types of dementia. Additionally, it aims to identify the treatments used and their efficacy. Four databases (EMBASE, MEDLINE, PsycINFO, and CINHAL) were screened in March, 2023. Twenty-six studies met the inclusion criteria and were included in the review. Thematic analysis was performed to explore and synthesise the qualitative findings of the studies. Three conceptual themes were identified: diagnostic tools, Capgras syndrome symptomatology, and Capgras syndrome treatment. Results showed that Capgras syndrome in dementia is not diagnosed and treated in a standardised manner. Following the pharmacological intervention, 28% of cases showed resolution of symptoms, and another 28% experienced improvement. However, 7% of cases reported worsening symptoms, and 10.7% experienced no change. While some patients had positive outcomes with specific medications, others either did not respond or experienced a deterioration of their condition. The results highlight that there is no single treatment approach for Capgras syndrome in people living with dementia. This underscores the need for person-centred care, where treatment is tailored to individual needs. The review also reveals a heavy reliance on antipsychotic medications and a noticeable lack of psychosocial interventions. Given the limited benefits and significant risks associated with antipsychotics, future research should prioritise developing and testing psychosocial approaches. Additionally, establishing standardised diagnostic criteria and consistent outcome measures for Capgras syndrome in dementia is crucial for evaluating treatment effectiveness and improving care.

Decoding the intricacies: a comprehensive analysis of microRNAs in the pathogenesis, diagnosis, prognosis and therapeutic strategies for COVID-19.

The pandemic of coronavirus disease-19 (COVID-19), provoked by the appearance of a novel coronavirus named severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), required a worldwide healthcare emergency. This has elicited an immediate need for accelerated research into its mechanisms of disease, criteria for diagnosis, methods for forecasting outcomes, and treatment approaches. microRNAs (miRNAs), are diminutive RNA molecules, that are non-coding and participate in gene expression regulation post-transcriptionally, having an important participation in regulating immune processes. miRNAs have granted substantial interest in their impact on viral replication, cell proliferation, and modulation of how the host's immune system responds. This narrative review delves into host miRNAs' multifaceted roles within the COVID-19 context, highlighting their involvement in disease progression, diagnostics, and prognostics aspects, given their stability in biological fluids and varied expression profiles when responding to an infection. Additionally, we discuss complicated interactions between SARS-CoV-2 and host cellular machinery facilitated by host miRNAs revealing how dysregulation of host miRNA expression profiles advances viral replication, immune evasion, and inflammatory responses. Furthermore, it investigates the potential of host miRNAs as therapeutic agents, whether synthetic or naturally occurring, which could be harnessed to either mitigate harmful inflammation or enhance antiviral responses. However, searching more deeply is needed to clarify how host's miRNAs are involved in pathogenesis of COVID-19, its diagnosis processes, prognostic assessments, and treatment approaches for patients.

Socioeconomic inequalities in waiting times for breast cancer surgery.

Prompt access to cancer care is a policy priority in several OECD countries, because delayed access can exacerbate deleterious health outcomes. Access to care based on need remains a key pillar of publicly-funded health systems. This study tests for the presence of inequalities in waiting times by socioeconomic status for patients receiving breast cancer surgery (mastectomy or breast conserving surgery) in England using the Hospital Episode Statistics. We investigate separately the pre-COVID-19 period (April 2015-January 2020), and the COVID-19 period (February 2020-March 2022). We use linear regression models to study the association between waiting times and income deprivation measured at the patient's area of residence. We control for demographic factors, type and number of comorbidities, past emergency admissions and Healthcare Resource Groups, and supply-level factors through hospital fixed effects. In the pre-COVID-19 period, we do not find statistically significant associations between income deprivation in the patient's area of residence and waiting times for surgery. In the COVID-19 period, we find that patients living in the most deprived areas have longer waiting times by 0.7days (given a mean waiting time of 20.6days).

Routine outcomes to investigate differences between ethnic minorities and White British people presenting to emergency services for injury: the stakeholder consultation.

Research has found differences in processes and outcomes of care between people in ethnic minorities and White British populations in some clinical conditions, although findings have been mixed. The Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries study is investigating differences in presentation, experience and health outcomes between people from ethnic minorities and White British people who seek emergency health care for injury. Our aim was to consult with stakeholders to define measurable outcomes available in routine ambulance and emergency department data; to assess the appropriateness of existing outcome measures for ethnic minorities and White British people; and to identify any gaps. Clinicians, public contributors, researchers, people from the third sector, public health, healthcare inclusion were invited to join an online workshop to discuss routine outcomes. Twenty participants attended the stakeholder consultation, with only one being a public contributor, a limitation. Eleven were from a minority ethnic background and seven were female. The integrated list of outcomes included 25 items, combining routine outcomes from the Building an understanding of Ethnic minority people's Service Use Relating to Emergency care for injuries protocol and literature (n = 17) with additional outcomes (n = 8). Notably, the initial list lacked provisions for safeguarding referrals and cases of treatment refusal, which were new additions. Safety concerns arose due to the lack of safeguarding referrals, treatment refusal and self-discharge. Factors such as pre-existing health conditions, injury location and experiences of discrimination were identified as possible influences on care quality and waiting times for ethnic minority patients. Although the number of stakeholders taking part in our consultation was low, their participation identified outcomes not found in routine data, supporting the adoption of a mixed-methods approach to answer our research questions. A future consultation could look to include more public members and wider range of clinicians including those who work in safeguarding and rehabilitation services. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR132744.

Diagnostic accuracy of point-of-care tests for acute respiratory infection: a systematic review of reviews.

Acute respiratory infections are a common reason for consultation with primary and emergency healthcare services. Identifying individuals with a bacterial infection is crucial to ensure appropriate treatment. However, it is also important to avoid overprescription of antibiotics, to prevent unnecessary side effects and antimicrobial resistance. We conducted a systematic review to summarise evidence on the diagnostic accuracy of symptoms, signs and point-of-care tests to diagnose bacterial respiratory tract infection in adults, and to diagnose two common respiratory viruses, influenza and respiratory syncytial virus. The primary approach was an overview of existing systematic reviews. We conducted literature searches (22 May 2023) to identify systematic reviews of the diagnostic accuracy of point-of-care tests. Where multiple reviews were identified, we selected the most recent and comprehensive review, with the greatest overlap in scope with our review question. Methodological quality was assessed using the Risk of Bias in Systematic Reviews tool. Summary estimates of diagnostic accuracy (sensitivity, specificity or area under the curve) were extracted. Where no systematic review was identified, we searched for primary studies. We extracted sufficient data to construct a 2 × 2 table of diagnostic accuracy, to calculate sensitivity and specificity. Methodological quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. Where possible, meta-analyses were conducted. We used GRADE to assess the certainty of the evidence from existing reviews and new analyses. We identified 23 reviews which addressed our review question; 6 were selected as the most comprehensive and similar in scope to our review protocol. These systematic reviews considered the following tests for bacterial respiratory infection: individual symptoms and signs; combinations of symptoms and signs (in clinical prediction models); clinical prediction models incorporating C-reactive protein; and biological markers related to infection (including C-reactive protein, procalcitonin and others). We also identified systematic reviews that reported the accuracy of specific tests for influenza and respiratory syncytial virus. No reviews were found that assessed the diagnostic accuracy of white cell count for bacterial respiratory infection, or multiplex tests for influenza and respiratory syncytial virus. We therefore conducted searches for primary studies, and carried out meta-analyses for these index tests. Overall, we found that symptoms and signs have poor diagnostic accuracy for bacterial respiratory infection (sensitivity ranging from 9.6% to 89.1%; specificity ranging from 13.4% to 95%). Accuracy of biomarkers was slightly better, particularly when combinations of biomarkers were used (sensitivity 80-90%, specificity 82-93%). The sensitivity and specificity for influenza or respiratory syncytial virus varied considerably across the different types of tests. Tests involving nucleic acid amplification techniques (either single pathogen or multiplex tests) had the highest diagnostic accuracy for influenza (sensitivity 91-99.8%, specificity 96.8-99.4%). Most of the evidence was considered low or very low certainty when assessed with GRADE, due to imprecision in effect estimates, the potential for bias and the inclusion of participants outside the scope of this review (children, or people in hospital). Currently evidence is insufficient to support routine use of point-of-care tests in primary and emergency care. Further work must establish whether the introduction of point-of-care tests adds value, or simply increases healthcare costs. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number NIHR159948.

Совершенствование правового регулирования использования лекарственных препаратов при оказании первой помощи: проблемные и дискуссионные вопросы

Summary. Investigation purpose – based on the analysis of the range of medicines approved for medical use in the Russian Federation and their practical application in certain types of medical care, identify groups and a list of medicines for their possible use in providing first aid to victims by certain categories of first aid participants, as well as related problems requiring legislative regulation. Material and methods of the investigation. Research materials – normative legal acts reflecting the provision of first aid and medical, including emergency and primary health care, emergency and urgent care, namely: 5 federal laws; 4 Decrees of the President of the Russian Federation; 3 administrative documents of the Government of the Russian Federation; 26 administrative documents of the Ministry of Health of the Russian Federation; 1 administrative document of the Department of Health Moscow; 31 instructions for the use of medicines for medical use. Research methods: analytical, logical and information modeling. Investigation results and their analysis. Groups and a list of medicines that can be used in providing first aid to victims are proposed for consideration and discussion. Problematic issues requiring legislative regulation in the use of medicines at the stage of first aid have been identified. Groups and a list of medicines for first aid to victims are offered for consultations and discussions with representatives of scientific institutions of the medical community and government agencies that determine health policy in the Russian Federation in order to develop management decisions aimed at achieving a high level of preservation of human life and health in emergency situations.

Association Between Caregiver Strain and Emergency Health Care Resource Utilization in Survivors of Critical Illness

Association Between Caregiver Strain and Emergency Health Care Resource Utilization in Survivors of Critical Illness

Nurse Perceptions of Pediatric Mental Health Emergency Care: A Qualitative Study

The key goal of the mental health nurse practicing in emergency mental health care services is ensuring that their patients have access to best practice mental health care. The aim of this study was to examine mental health nurses’ perceptions of their role in and preparation for providing mental health care services for pediatric emergency department patients. A qualitative constructivist method was employed. Inductive data were gathered using a focus group discussion model employing open-ended questions as probes. The participants were nine experienced practicing mental health nurses. Discussion was facilitated through detailed probing of the nurses’ experiences in providing care for clients in emergency departments. Four principal themes emerged from the data about mental health nurses’ experiences during the provision of emergency care: (i) barriers to adequate care provision; (ii) problems among populations; (iii) pediatric special needs; and (iv) the general need for improvements to mental health care. Each participant in this study asserted that they endorse the introduction of care by specialized mental health nurses in emergency care departments to better serve this population in Saudi Arabia. Inclusion and acceptance of psychiatric mental health nurses as full members of the multidisciplinary emergency department team, improved education and training opportunities, standards-based evaluation by collegial supervisors, availability of tools for assessment, and recognition of the role of pediatric psychiatric mental health nurses in emergency department care were goals expressed by the focus group members.

Evaluation of moral intelligence in prehospital emergency healthcare employees: the case of BoluDüzce

Evaluation of moral intelligence in prehospital emergency healthcare employees: the case of BoluDüzce