Management Of Emergency Cases Research Articles

Barriers Impact the Primary Healthcare Providers When Dealing With Emergency Cases: A Cross-Sectional Study in Al-Ahsa, Saudi Arabia.

Introduction Being the first in-line care providers, primary healthcare (PHC) physicians may encounter all forms of medical emergencies, ranging from minor complaints to major life-threatening events; therefore, this study aims to assess the PHC physicians' knowledge and attitude related to the diagnosis and management of emergency cases as well as their preferences for emergency medicine training courses and their preferred methods of training. Methods A descriptive cross-sectional study was conducted among physicians working at PHC in Al-Ahsa, Saudi Arabia, between November and December 2023, excluding those who do not work at PHC. The minimum required sample size was 192. A self-administered online questionnaire was developed using Google Forms and distributed conveniently through social media platforms. It consists of 22 items categorized into four sections:The first section focused on demographic information; the second section assessed knowledge related to the diagnosis and management of emergency cases commonly encountered in PHC, along with actual management experiences; the third section gauged physicians' attitudes, and the fourth section explored participants' preferences for emergency medicine courses and their preferred methods of training in this field. The Kruskal-Wallis rank sum and Wilcoxon rank sum tests were employed to identify predictors of knowledge and attitude. Results The study involved 193 participants, with 96 (50%) females and a median age of 30 years. The participants included 43 (22%) consultants, 69 (36%) family residents, 30 (16%) general practitioners, and 50 (26%) specialists. Participants reported a median of 4.0 years of experience in PHC in Saudi Arabia. The majority, 69 (36%), reported working in the hospital emergency department, with a reported median duration of three months. Roughly 84% of PHC physicians had a positive attitude toward emergency cases diagnosis and management, while 92% showed fair diagnostic knowledge of emergency cases, and 73% showed fair management knowledge. Higher knowledge in the diagnosis and management of PHC was linked to increasing age, being consultants, being employed in the emergency department, and having higher years of experience in PHC (p < 0.05). A positive attitude towardPHC was found to be associated with working as a consultant and being employed in the emergency department (p < 0.05). Approximately 133 (68.9%)expressed a preference for a course in wound care trauma, followed by central nervous system emergencies (n = 124, 64.2%), coronary artery disease emergencies (n = 116, 60.1%), and obstetrics/gynecologic emergencies (n = 114, 59.1%) with 160 (82.9%) favored training through practice in PHC under supervision of qualified staff. Conclusion While many PHC centers are well equipped and prepared for early stabilization and management of emergency cases, PHC physicians showed low competency in dealing with emergency cases. This indicates a great need for enhancing physician's knowledge and skills regarding emergency situations. Nevertheless, courses like basic life support (BLS) and advanced trauma life support (ATLS) should be the bare minimum requirements for PHC physicians. Mote advance training and lectures should be organized to enhance PHC physician competencies to deal with different emergencies.

Assessing Medical Emergency E-referral Request Acceptance Patterns and Trends: A Comprehensive Analysis of Secondary Data From the Kingdom of Saudi Arabia.

Introduction Patient transfers in emergencies have been linked to reduced mortality rates and enhanced quality of care. The Saudi Medical Appointments and Referrals Centre (SMARC), an e-referral system in the Kingdom of Saudi Arabia (KSA) since 2019, plays a crucial role in ensuring quality and continuity of care. The findings of this study can provide valuable insights into the effectiveness of the e-referral system and identify potential areas for improvement in the management of emergency cases. Objective This study aims to examine e-referral patterns for emergency medical cases throughout all 13 administrative regions of KSA. Concurrently, it estimates the acceptance rate of medical emergency referrals and investigates associated factors among KSA hospitals. Methods This retrospective study utilized secondary data from the SMARC e-referral system, specifically focusing on medical emergency e-referral requests in the entire KSAduring 2021. Descriptive univariate analyses were conducted to characterize the referral requests, followed by bivariate analyses to explore associations between factors and referral acceptance. Adjusted multiple logistic regression analyses were then performed to calculate adjusted odds ratios (ORs) and corresponding 95% confidence intervals, controlling for potential confounding variables. Results A total of 29,660 medical emergency referral requests were initiated across all regions of KSA during the study time frame, and, of these,20,523 (69.19%)were accepted. The average age of patients with a medical emergency referral was 52 years old, and referral requests were higher among Saudis (13,781; 54.18%), males (13,781; 54.18%), and those from the Western region (10,560; 35.60%). Nearly 20,854 (70%) were due to the unavailability of specialized doctors or specialties in facilities. Based on multi-logistic regression, referral request acceptance was high in some factors as follows: compared to the Central region, requests from the Northern, Southern, Eastern, and Western regions had higher acceptance rates at 123%, 64%, 54%, and 46%, respectively. In addition, referral requests that were due to the unavailability of a specialized doctor or medical equipment had higher acceptance rates (19% and 16%), respectively, than those due to the unavailability of a specific specialty. Conclusion This study provides valuable insights into regional variations, sociodemographic factors, and referral reasons within the medical emergency e-referral system in the KSA. By estimating the acceptance rate of medical emergency referrals and investigating associated factors, this analysis confirms the effectiveness of the e-referral system in facilitating access to quality care, particularly for marginalized patients. The study highlights the need for health policy improvements to ensure equitable resource allocation and reduce disparities in healthcare access.

Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice.

Literature is scarce on the management of patients using direct oral anticoagulants (DOACs) undergoing elective, urgent and emergency surgery. Therefore, we summarize the current evidence and provide literature-based recommendations for the management of patients on DOACs in the perioperative phase. A general literature review was conducted on the pharmacology of DOACs and for recommendations on the management of cardiac surgical patients on DOACs. Additionally, we performed a systematic review for studies on the use of direct DOAC reversal agents in the emergency cardiac surgical setting. When surgery is elective, the DOAC cessation strategy is relatively straightforward and should be adapted to the renal function. The same approach applies to urgent cases, but additional DOAC activity drug level monitoring tests may be useful. In emergency cases, idarucizumab can be safely administered to patients on dabigatran in any of the perioperative phases. However, andexanet alfa, which is not registered for perioperative use, should not be administered in the preoperative phase to reverse the effect of factor Xa inhibitors, as it may induce temporary heparin resistance. Finally, the administration of (activated) prothrombin complex concentrate may be considered in all patients on DOACs, and such concentrates are generally readily available. DOACs offer several advantages over vitamin K antagonists, but care must be taken in patients undergoing cardiac surgery. Although elective and urgent cases can be managed relatively straightforwardly, the management of emergency cases requires particular attention.

Surgical Management of a Strangulated Amyand’s Hernia in an Emergency Situation: A Practical Approach

Amyand’s hernia is a rare condition characterized by the presence of the appendix within an inguinal hernia. Although rarely seen, strangulated Amyand’s hernia is a surgical emergency requiring immediate management to avoid potentially serious complications. This condition, named after the French surgeon Claudius Amyand [1], is estimated to affect around 1% of inguinal hernia cases, with a prevalence of appendicular inflammation of only 0.1% [2]. It is more common in children, due to the permeability of the vaginal process [3]. In such situations, a practical approach involving immediate surgical exploration is warranted. Prompt treatment is essential to avoid serious complications, such as appendicular perforation or peritonitis. Surgical expertise, careful clinical assessment and patient-centered decision-making are essential for the successful management of these emergency cases. In conclusion, strangulated Amyand’s hernia is a rare condition that requires prompt surgical management. In emergency situations, early surgical exploration is recommended to avoid potential complications. This clinical observation illustrates the importance of practical decision-making in the management of such emergency cases, and highlights the need for a multidisciplinary approach involving surgical expertise and thorough clinical evaluation.

HASTANE ÖNCESİ SAĞLIK PERSONELİNİN HİZMET İÇİ EĞİTİMİNDE SİMÜLE HASTA UYGULAMASININ ACİL OLGU YÖNETİMİNDEKİ ETKİNLİĞİNİN DEĞERLENDİRİLMESİ

Amaç: Araştırma, hastane öncesi acil sağlık hizmetleri personelinin hizmet içi eğitim programlarında kullanılan simüle hasta uygulamasının acil olgu yönetimindeki etkinliğinin değerlendirilmesi amacıyla yapılmıştır.Gereç ve Yöntem: Araştırma Mart 2020-2022 tarihleri arasında Simülasyon Merkezi’nde düzenlenen hizmet içi modül eğitimlerine davet edilen 198 katılımcı ile gerçekleştirilmiştir. Araştırmada veriler için Kişisel Bilgi Formu, Simüle Hasta Uygulama Etkinlik Ölçeği, Simülasyon Tasarım Ölçeği ve Öğrenmede Öğrenci Memnuniyeti ve Özgüven Ölçeği kullanılmıştır.Bulgular: Araştırmadan elde edilen bulgulara göre Simüle Hasta Uygulama Etkinlik Ölçeği toplam skor ortalaması 114,3±14,4; Simülasyon Tasarım Ölçeği toplam skor ortalaması 4,1 ve Öğrenmede Öğrenci Memnuniyeti ve Özgüven Ölçeği toplam skor ortalaması 50,5±8,4 olarak saptanmıştır. Araştırmamızda katılımcıların cinsiyetler arasında kendilerini yeterli hissetme düzeyi (p&amp;gt;0,04) ve meslek grupları ile kendilerini yeterli hissetme düzeyleri arasında (p&amp;gt;0,182) istatistiksel olarak anlamlı fark bulunmamıştır. Cinsiyetler arasında mesleki anksiyete durumlarının karşılaştırılmasında (p&amp;lt;0,001) ve yaş değişkeni ile Öğrenmede Öğrenci Memnuniyeti ve Özgüven Ölçeği ve Simülasyon Tasarım Ölçeği skorları arasında (p&amp;lt;0,001) istatistiksel olarak anlamlı fark bulunmuştur. Simülasyon tasarımı ile öğrenci memnuniyeti ve özgüveninin simüle hasta uygulamasındaki etkinliğin %59’unu yordayan bir parametre olduğu belirlenmiştir.Sonuç: Hastane öncesi acil sağlık hizmetleri çalışanlarının hizmet içi eğitim programlarında, katılımcıların mesleki öz yeterliliklerini geliştirmek ve kaygı düzeylerini azaltmak için simülasyon temelli öğretim yöntemlerinin kullanımı önerilmektedir.

The Need for Emergency Case Management in Family Medicine: A Capital City Case

The Need for Emergency Case Management in Family Medicine: A Capital City Case

Obstetrics and Gynecology Residents Self-perceived Competency Regarding Female Pelvic Medicine and Surgery: An Internet-based Cross-sectional Survey

Background: The aim of our study was to assess factors associated with residents’ perceived competency regarding female pelvic medicine and reconstruction surgery (FPMRS).&#x0D; Methods: We conducted an Internet-based cross-sectional survey. Obstetrics and gynecology residents’ self-perceived competence in clinical skills for management of pelvic floor disorders were questioned. Competency in different aspects was analyzed concerning the availability of fellowship-trained professor, rotation, and fellowship training program.&#x0D; Results: 1168 residents of four levels of residency participated in this study. 760 (65.06 %) of residents were not trained by a fellowship-trained attendant. Of 409 (35.01%) responders who were trained by board-certified fellowship, 334 had FPMRS rotation in their residency program. Senior residents were significantly more confident than residents in the first and second years. 695 (59.50 %) of residents reported participating in the pelvic floor surgeries; however, only 15.3 % were served as primary surgeons. Where pelvic floor education had been provided by a fellowship-trained attendant, more perceived competency was evident in all fields of clinical skills except performance as primary surgeon and management of emergency cases. Among residents trained by board-certified FPMRS attendants, there were no significant differences regarding FPMRS rotation or fellowship training programs. 88.69 % of residents declared that a comprehensive course in the field of FPMRS is needed in the residency curriculum.&#x0D; Conclusion: This study demonstrates that being trained by board-certified FPMRS attendants has significant effect on residents’ self-perceived competency. Residency education was not compromised by fellowship training program.

Changes in patterns of plastic surgery emergencies at a level I trauma center in India during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has had major effects worldwide, including sudden and forceful setbacks to the healthcare system. The COVID-19 pandemic has also led to changes in the plastic and reconstructive management of emergency cases, including those due to road traffic accidents. This study analyzed changes in patterns of plastic surgery emergencies and modifications in consultation policies to minimize the exposure of healthcare workers. Data on plastic surgery emergency calls received from the trauma and emergency department were collected for a period of 2 months before and during lockdown. The data were then analyzed with respect to the cause, mechanism, and site of the injury, as well as other variables. During lockdown, there was a 40.4% overall decrease in the plastic surgery emergency case volume (168 vs. 100). The average daily number of consultations before lockdown was 2.8 as compared to 1.6 during lockdown. Road traffic accidents remained the most common mechanism of injury in both groups (45.8% vs. 39.0%) but decreased in number during the lockdown (77 vs. 39). Household accidents, including burns, were the second most common cause of injury in both phases (7.7% vs. 20.0%), but their proportion increased significantly from 7.7.% to 20.0% in the lockdown phase (P=0.003). The percentage of minor procedures done in the emergency department increased from 53.5% to 72.0% during lockdown (P=0.002). Procedures in the operating room decreased by 73.1% during lockdown (67 vs. 18, P=0.001). The COVID-19 pandemic and lockdown orders in India greatly influenced trends in traumatic emergencies as observed by the plastic surgery team at our tertiary care center. Amidst all the chaos and limitations of the pandemic period, providing safe and prompt care to the patients presenting to the emergency room was our foremost priority.

Impact of COVID-19 pandemic on mortality count at the Emergency Ward of Hospitals in India: A Cross-sectional study from January 2019 to May 2021

Background: A cute treatment in emergency case management is required for survival and stabilization of critical patients, followed by shifting the patients to the relevant department for further care. However, for the seriously ill critical patients struggling for survival, the care is provided by the Emergency Department/Ward (ED) of the hospital as the situation is not enough to enable transfer because death may occur while transferring and treatment in such situations are given at emergency ward/department. This aspect of emergency management care is often overlooked by policy makers and government which is really serious regarding who dies in the ED. Objective: The aim of this cross sectional research study was to determine impact of COVID-19 pandemic era on mortality count at the emergency ward of public-private-rural-urban hospitals in India across 36 states and union territories. The objective was fulfilled by collecting, observing, analyzing total mortality occurring at the emergency ward of public-private-rural-urban hospitals in India from 1st January 2019 to 31st May 2021(linear regression is not done for forecasting due to two factors, first the COVID-19 situation and mortality is changing as well as largely associated with virulence of strain and to keep data from accredited source intact on real grounds) of emergency department admissions of public and private health facilities. The objective was to find out if there is increase or decrease in mortality of emergency department admissions during the COVID-19 pandemic era by comparing mean mortality of ED per month of public, private, rural, urban health facilities before the pandemic from 1st and 2nd year of pandemic i.e. 2020 and 2021 respectively. Methods: This research study is a cross sectional retrospective mixed qualitative and quantitative analysis of the mortality occurring at the emergency department of public and private, rural, urban hospitals from 1st January 2019 to May31st 2021 with aim to find out impact of COVID-19 pandemic era on mortality at ED. Electronic patient records from HMIS (health management information system) of MoHFW (ministry of health and family welfare) , Government of India is collected, observed, analysed, compared for all patients deaths occurring at Emergency Department (ED) of public and private, rural, urban health facilities (n = 452102) during the study period from 1st January 2019 to 31st May 2021. Results: The study results found that largest total number of death occurred in the ED during may 2021 whereas the least number of deaths occurred in February 2019 (limitation is actual data availability is up to May 2021 from accredited sources and linear regression is avoided to keep study based on real data only, hence forecast for adjustment was avoided). During the first year of the pandemic, mean mortality per month (Jan2020-Dec2020) in the emergency department (ED) of rural, urban, public and private hospitals in India was 16067per month whereas before the pandemic it was 12542 per month while during second year of pandemic i.e. 2021 the mean mortality increased to 21758 per month (up to May 2021).

Ameliyathane Hemşirelerinin COVID-19 Pandemisindeki Deneyimleri: Nitel Bir Çalışma

Objective: This study was conducted to examine the experiences of operating room nurses care for COVID-19 positive and suspected patients during the surgical process. Material and Methods: This study was conducted qualitatively with operating room nurses between 01-31 May 2021. 22 operating room nurses were interviewed face-to-face-in-depth in the break room of the operating room. Data were analyzed by Colaizzi's seven-step method. The Consolidated Criteria for Reporting Qualitative Research checklist was used in reporting this research. Results: Three themes were determined: Difficulties experienced in the operating room during the COVID-19 epidemic, effect of the COVID-19 epidemic on the operating room organization and the effect of the risk of contamination on the surgical team communication. 7 sub-themes were identified as fear of catching and transmitting the infection, equipment problems, difficulties in the management of emergency cases, operation and working times, changes in the patient transfer line and operating room, social isolation and reduced communication, and fear of medical error. Conclusion: This study reveals difficulties experienced by nurses due to COVID-19, effect of the pandemic on the operating room organization and nurses, and effect of the risk of transmission on the surgical team communication. Nurses have fear of catching and transmitting infection in the operating room, lack of equipment, and experience anxiety in managing emergency cases. The pandemic caused changes in the organization of the operating room. Besides, nurses experienced social isolation and team communication decreased, the use of equipment disrupted communication with the surgical team, and this situation led to fear of medical error.

Barriers facing family physician in primary health care when dealing with emergency cases in Riyadh, Saudi Arabia.

The scarcity of emergency cases presented to the primary health care centers (PHCCs) makes treating such cases by family physicians more difficult To identify the barriers facing family physicians in PHCCs when facing emergency cases in Riyadh, Saudi Arabia. A cross-sectional descriptive design was deployed in the study among a sample of family physicians. A reliable and valid self-reported questionnaire was used. In addition, an observational sheet was used to investigate the preparedness of PHCCs to deal with emergency situations. The study included 162 PHC physicians. Almost two-thirds of them (65.4%) aged 25-34 years, and 52.5% were females. Middle-aged (25--35 years) physicians (P = 0.030), females (P < 0.001), Saudis (P = 0.027), those attended advanced cardiovascular life support (ACLS) since more than 2 years (P = 0.029), those who had no exposure in working in emergency units (P = 0.029), and less experienced physicians (<1 year) (P = 0.010) showed lower "perceived level of competence in performing emergency skills." The commonest barrier facing physicians during the management of emergency cases in thePHC was lack of appropriate equipment (76.5%), followed by lack of exposure to emergency cases (62.3%) and lack of time (50.6%). Dealing with emergency cases is considered part of the medical practice in PHCCs. For primary care physicians, the level of training in emergency medicine courses is suboptimal particularly advanced trauma life support (ATLS) courses in Riyadh. Inregards to emergency services at the PHC level in Riyadh, most of the items were available; however, defects were reported in some. Knowing the barriers facing doctors during dealing with emergency cases helps in improving and providing integrated medical care.

Evaluation of dental intern's satisfaction and self-competence in treating emergency cases during the first year of the coronavirus pandemic

Background: The study aimed to identify the level of satisfaction and confidence of dental intern students in emergency care emergency room (ER) during COVID-19 Pandemic in order to determine factors that influence their satisfaction such as patient's age, gender, and ethnicity. Materials and Methods: A cross-sectional survey-based study was conducted at Al-Madinah Al-Munawwarah-Taibah University Dental-College and Hospital. The overall sample included in analysis was 105 dental interns with an average age of 24.7 years who were treating patients between July 2019 and August 2020 in emergency dental clinics at TUCDH. Results: The survey response rate was 100% and 51.4% of the participants felt comfortable and 80% felt confident on emergency days. However, male interns were significantly more comfortable and confident than females (P = 0.001 and 0.022 respectively). Endo-emergency constituted 77% of dental emergencies followed by surgery. 81.9% believe that age is the most challenging factor affecting their ER work, and most of them do not believe that patient's gender and ethnicity affect their performance. Stock shortages were the biggest challenge for their supervisor-led management. Conclusion: Majority of interns feel satisfied with their management of emergency cases during COVID-19 Pandemic with superior male significant meaning. More emergency training programs should be established in the educational dental curriculum to improve their satisfaction and confidence rate, especially for females during pandemics.

Types of Primary Healthcare Emergencies in Muscat, Oman: A retrospective cross-sectional study of five primary care centres.

ObjectivesEmergencies can occur at any time and be life-threatening or cause permanent damage. Accordingly, the management of emergency cases is an integral part of primary healthcare (PHC). This study aimed to estimate the proportion and types of emergency cases presented to PHC centres in Muscat, Oman.MethodsThis retrospective cross-sectional study was conducted from March to August 2016 at five PHC centres in the Muscat Governorate. A total of 800 emergency cases (i.e. those labelled in the health information system as an accident and emergency) of Omani patients aged ≥5 years presented during this period. Every second case, based on arrival to the registration desk, was selected for analysis. Electronic medical records were reviewed to collect data regarding demographic features, presenting complaints, time and season of presentation, management provided and method of transportation if referred to tertiary care.ResultsThe proportion of emergency cases was <2.5% (range: 1–2.5%). The most common type of emergency was musculoskeletal issues/trauma (34.3%) followed by gastroenterological (15.1%) and genitourinary (10.0%) emergencies. Most patients were either 21–39 or 5–12 years old (35.0% and 21.6%, respectively). The majority (59.6%) were treated directly at the health centre, while the remaining patients (40.4%) were referred to tertiary care. At referral, only 12.1% were transported by ambulance and the rest via private transport.ConclusionMusculoskeletal issues/trauma was the most common type of emergency seen at the selected PHC centres in Muscat. Further research is needed to determine whether PHC centres have the capability and resources necessary to appropriately manage emergency cases.

HOW CAN WE IMPROVE THE NURSING STUDENTS’ EMERGENCY CASE MANAGEMENT SKILLS?

Aim: The objective of the study was to examine the effectiveness of simulation practices in improving the emergency case management skills of nursing students. Method: The study was designed as quasi-experimental research and carried out with nursing students (n=42) in three phases. In the first phase, theoretical training on emergency situations was delivered. The students were involved in the emergency case scenarios interacting with high-fidelity simulators and standardized patients, and their performances were recorded in the second phase. In the third phase, debriefing sessions were conducted. Pre- and post-tests and written feedback forms were used to gather the data. Results: The levels of knowledge (mean score of pre-test: 2.83; post-test: 5.95) were statistically significant (p<0.05). A positive change was revealed in the levels of self-confidence among the students after the training program. Conclusion: It was concluded that simulation practices were effective in the improvement of students’ self-confidence and knowledge in emergency case management.

MANAJEMEN PASIEN DENGAN KASUS KEGAWATDARURATAN BEDAH MULUT DALAM MASA PANDEMI COVID-19

Introduction: During the COVID-19 pandemic, oral surgery services were prioritized for emergency cases such as malignancy, head and neck infection, and open or comminuted fracture. COVID-19 that spread by droplets need specific handling considering the work area of an oral surgeon is around the oral cavity and often has close contact with patients. Review: It is important to understand more about COVID-19. In emergency cases that need to be treated immediately, the management to prevent transmission by doing pre-operative, operative, and postoperative procedures will help oral surgery services can be done without the risk of transmission between dentist, patient, and paramedics. Conclusion: Management of emergency cases in oral surgery during pandemic COVID-19 can still be done, if everyone performs proper preventive procedures, not only the dentist but also the patient and paramedics. Conducting telescreens before the visit, early assessment of the patient, preoperative and operative procedures, management of medical waste, and also disinfection of the working area will help to avoid the transmission of COVID-19.

Modification of Clinical Implications in Neurosurgery Practices in Covid Era

oronavirus disease 2019 (COVID-19) has posed unparalleled threats and challenges to communities and healthcare systems worldwide. 1 In most nations, the increased burden of this pandemic disease has had a significant impact on the entire health system, including neurosurgical practice. 2-3 Intensive changes with clinical implications are made in neurosurgical practice in surgical scheduling, inpatient and outpatient clinics, emergency case management, and even research and educational programs.

An Exploratory Screening Study for Type 2 Diabetes in Hospitalized Adult Medicine Patients

ObjectivesLiterature from stroke and cardiac hospital admissions demonstrate a higher prevalence of undiagnosed type 2 diabetes compared with the general population. Fewer diabetes screening studies exist in the general medicine population, none of which have been based in Canada. Our primary objective in this study was to determine the prevalence of probable undiagnosed diabetes (glycated hemoglobin [A1C]≥6.5%) in hospitalized medicine patients. Secondary objectives were to identify the prevalence of undiagnosed dysglycemia (A1C≥6.0%) and the subsequent management of emergent cases. MethodsIn this prospective cohort study, adult patients admitted to internal medicine at a tertiary hospital in Ontario were screened for diabetes using an A1C test over a 3-month period. Baseline demographics and outcomes were compared using t tests, chi-square tests and Fisher’s exact tests for normoglycemia, undiagnosed dysglycemia and probable undiagnosed diabetes. A regression analysis was performed to identify any relationships between various cardiovascular-related risk factors and A1C. ResultsA total of 53 adult patients were enrolled. The prevalence of probable undiagnosed diabetes and undiagnosed dysglycemia was 7.5% (n=4) and 30.2% (n=16), respectively. Implementation of diabetes management strategies and/or documentation of the finding occurred in 4 of 16 patients. Regression analysis showed no relationship between either cardiovascular-related risk factors or admission glucose with A1C. ConclusionsA broader screening approach may capture previously undiagnosed cases of diabetes that do not belong to traditionally at-risk populations. Future studies should focus on identifying risk factors for undiagnosed dysglycemia in hospitalized patients, including ethnicity and barriers to community access, so that appropriate screening programs can be developed.

Paediatric Emergency Triage, Assessment and Treatment (ETAT) – preparedness for implementation at primary care facilities in Malawi

ABSTRACT Background The majority of deaths amongst children under 5 years are still due to preventable infectious causes. Emergency care has been identified as a key health system weakness, and referrals are often challenging. Objective We aimed to establish how prepared frontline facilities in Malawi are to implement WHO Emergency Triage Assessment and Treatment (ETAT) guidelines, to support policy and planning decisions. Methods We conducted a concurrent mixed-methods study, including facility audit; healthcare provider survey; focus group discussions (FGD) and semi-structured interviews with facility staff. The study was conducted in two districts in Malawi, Zomba and Mchinji, between January and May 2019. We included all frontline facilities, including dispensaries, primary health centres, rural and community hospitals. Quantitative data were described using proportions, means and linear regression. Qualitative data was analysed using a framework approach. Data were analysed separately and then triangulated into common themes. Results Forty-seven facilities and 531 healthcare providers were included in the audit and survey; 6 FGDs and 5 interviews were completed. Four common themes emerged: (1) current emergency case management; (2) referral practices; (3) trained staff capacity; (4) opportunities and barriers for ETAT. Triage was conducted in most facilities with various methods described, and 53% reporting all staff are responsible. Referrals were common, but challenging due to issues in transportation. Twelve percent of survey respondents had ETAT training, with clinical officers (41%) reporting this more frequently than other cadres. Training was associated with increased knowledge, independent of cadre. The main barriers to ETAT implementation were the lack of resources, but opportunities to improve quality of care were reported. Conclusions Malawian frontline facilities are already providing a level of emergency paediatric care, but issues in training, drug supplies and equipment were present. To effectively scale-up ETAT, policies need to include supply chain management, maintenance and strengthening referral communication.

Use of Clinical Algorithms for Evaluation and Management of Pediatric and Adult Sepsis Patients in Low-Resource Clinical Environments

Introduction:Acute infection in post-disaster settings is associated with increased morbidity and mortality. Sepsis management in low resource settings is controversial with recent research suggesting that aggressive fluid resuscitation may cause greater harm than benefit. However, the vast majority of international sepsis guidelines still suggest large initial fluid boluses as part of sepsis algorithms.Aim:To create an adult and pediatric sepsis algorithm to be applied in low resource clinical settings. This is part of a larger project to create clinical algorithms to provide standardization of emergency case management for low-resource clinical environments.Methods:A literature search was performed through PubMed identifying and reviewing fluid resuscitation in adult and pediatric sepsis patients in high and low resource clinical environments. The pathways were created based on interpretation of the available evidence-based literature. Focus groups were conducted in Zambia in March 2018 for feedback from local practitioners regarding feasibility of pathways. The pathways were then modified, reviewed by experts peer-review and revised.Results:Final pediatric and adult sepsis clinical algorithms were created and posted to the free web-based application AgileMD™. They will be available via app access, an online platform, or printable pathways for use in the clinical environment.Discussion:The study is currently undergoing IRB approval with a plan for implementation of multiple clinical algorithms at a referral hospital site in Zambia in January 2019. Site direction at Ndola Hospital will be conducted under the leadership of an Emergency Medicine trained physician, who will assist in implementation of algorithms and collection of data. Initial data review will be conducted in May 2019. There will be incremental site visits by organizing researchers throughout the implementation and data collection period. Statistical analysis will examine sepsis associated processes and outcome indicators pre and post-intervention to further delineate sepsis management in low resource clinical environments.

Uniportal video-assisted thoracoscopic surgery for the treatment of thoracic emergencies.

While video-assisted thoracoscopic surgery (VATS) is well accepted in the management of thoracic emergencies, uniportal VATS has not yet been studied for this indication. This paper reports the results of the treatment of chest trauma patients by uniportal VATS in a single center with extensive experience in uniportal VATS. In this prospective study all patients who underwent uniportal VATS for thoracic surgical emergency cases, between 06/2012 and 09/2017, were included and the data were reviewed retrospectively. Six hundred forty-two uniportal VATS procedures were performed. Among those, 12 emergency cases could be identified. The indication was a hemothorax with active bleeding in all cases and the uniportal VATS approach was carried out after carefully evaluating all clinical factors and risks related to such a special setting. The location, extent and severity of the injuries were diagnosed and treated intraoperatively. The conversion rate was zero. The mean surgical time was 106.25 minutes [63-240], the chest tube was removed after 6.75 days in average (range, 1-25). All patients were transferred to the post anesthesia care unit (PACU) or intensive care unit (ICU) for at least one night (range, 1-25). The mean postoperative hospital stay was 10.67 days [4-26]. In expert hands, uniportal VATS approach seems to be a safe and feasible procedure for both, the diagnostics and management of emergency cases, such as active thoracic bleeding in cardiopulmonary stable patients.