The study was aimed to identify the training received in Emergency Medicine by physicians and the limitations and difficulties self-perceived by those physicians to assist in emergencies, as well as ...to analyze the differences according to the work context.Observational cross-sectional study made by a survey using a self-administered questionnaire to a representative simple random sample (with replacement) of 294 doctors (n) working at the Primary Health Care centers out of the total of 851 doctors (N) that form the staff of physicians of Primary Health Care system of Asturias (Spain).In rural areas, the most frequently mentioned reasons were the lack of practical skills (32.65%), absence of adequate material (20.41%), lack of theoretical knowledge (8.16%), and poor equipment conditions (4.08%). In the semi-urban area, the most common reasons were the lack of practical skills (19.61%), lack of theoretical knowledge (10.78%), absence of adequate material (8.82%), and poor equipment conditions (4.90%). Finally, in the urban area, the main reason was the lack of practical skills (23.40%), absence of adequate material (20.21%), lack of theoretical knowledge (9.57%), and poor equipment conditions (4.26%). The differences were significant (P = .003) among the 3 work context.The absence of practical skills is the most frequent cause referred by doctors of the 3 areas as a key to not act correctly in an emergency. The doctors of the rural area perceive that they are better prepared in general to solve emergencies and it is the professionals of 3 areas that report having carried out more basic cardiopulmonary resuscitation, advanced and attention to the polytraumatized patient courses.
Aims
The rate of acute laparoscopic cholecystectomy remains low due to operational constraints. The purpose of this study is to evaluate a service model of index admission cholecystectomy with ...referral protocols, refined logistics and targeted job planning.
Methods
A prospectively maintained dataset was evaluated to determine the processes of care and outcomes of patients undergoing emergency biliary surgery. The lead author has maintained a 28 years prospective database capturing standard demographic data, intraoperative details including the difficulty of cholecystectomy as well as postoperative outcome parameters and follow up data.
Results
Over five thousand (5555) consecutive laparoscopic cholecystectomies were performed. Only patients undergoing emergency procedures (2399,43.2% of entire group) were analysed for this study. The median age was 52 years with 70% being female. The majority were admitted with biliary pain (34%), obstructive jaundice (26%) and acute cholecystitis (16%). 63% were referred by other surgeons. 80% underwent surgery within 5 days (40% within 24 h). Cholecystectomies were performed on scheduled lists (44%) or dedicated emergency lists (29%). Two thirds had suspected bile duct stones and 38.1% underwent bile duct exploration. The median operating time was 75 min, median hospital stay 7 days, conversion rate 0.8%, morbidity 8.9% and mortality rate 0.2%.
Conclusion
Index admission cholecystectomy for biliary emergencies can have low rates of morbidity and mortality. Timely referral and flexible theatre lists facilitate the service, optimising clinical results, number of biliary episodes, hospital stay and presentation to resolution intervals. Cost benefits and reduced interval readmissions need to be weighed against the length of hospital stay per episode.
In 2020 Pakistan's first-ever hackathon on school emergencies was organised, where schools and community stakeholders collaborated to deconstruct problems and develop solutions. The study aimed to ...investigate participants' motivation for and experiences of the hackathon. Qualitative and quantitative data were collected from hackers, mentors, judges and organisers before, during and after the event. Findings indicate diversity amongst participants in terms of age, gender and experiences. The hackers' motivations were both intrinsic and extrinsic. The challenges were insufficient time, absence of investors, inconsistent mentoring, low participation from public schools and imbalanced gender participation. The hackathon provided a unique opportunity for multidisciplinary collaborative problem-solving and accessing experts for creativity and innovation. Future research should focus on increasing participation and fostering social innovations through school-based civic hackathons.
The study analyses the understanding of parents or guardians of children aged zero to five years old about fever, the conduct and care for this condition, carried out in the urgent and emergency ...service. The qualitative research, which used the thematic analysis technique, was carried out through interviews with 14 parents or guardians who sought an urgent and emergency Pediatric Service in a municipality in the countryside of São Paulo for this reason. The experiences of parents who seek these services are associated to three main topics: fear of fever; care for a febrile child; and the experience of care at the urgent and emergency services. It was identified that an exaggerated fear of fever predominates and that parents / guardians feel safe regarding the existing technology found in urgent and emergency services. The adopted precautions, however, are not always those recommended for the existing situation.
Determination and reporting of disease severity in emergency general surgery lacks standardization. Recently, the American Association for the Surgery of Trauma (AAST) proposed an anatomic severity ...grading system. We aimed to validate this system in patients with appendicitis and determine if cross-sectional imaging correlates with disease severity at operation.
Patients 18 years or older undergoing treatment for acute appendicitis between 2013 and 2015 were identified. Baseline demographics, procedure types were recorded, and AAST grades were assigned based on intraoperative and radiologic findings. Outcomes including length of stay, 30-day mortality, and complications based on Clavien-Dindo categories and National Surgical Quality Improvement Program variables. Summary statistical univariate, nominal logistic, and standard least squares analyses were performed comparing AAST grade with key outcomes. Bland-Altman analysis compared operative findings with preoperative cross-sectional imaging to compare assigning grades.
Three hundred thirty-four patients with mean (±SD) age of 39.3 years (±16.5) were included (53% men), and all patients had cross-sectional imaging. Two hundred ninety-nine underwent appendectomy, and 85% completed laparoscopic. Thirty-day mortality rate was 0.9%, complication rate was 21%. Increased (median interquartile range, IQR) AAST grade was recorded in patients with complications (2 1-4) compared with those without (1 1-1, p = 0.001). For operative management, (median IQR) AAST grades were significantly associated with procedure type: laparoscopic (1 1-1), open (4 2-5), conversion to open (3 1-4, p = 0.001). Increased (median IQR) AAST grades were significantly associated in nonoperative management: patients having a complication had a higher median AAST grade (4 3-5) compared with those without (3 2-3, p = 0.001). Bland-Altman analysis comparing AAST grade and cross-sectional imaging demonstrated no difference (-0.02 ± 0.02; p = 0.2; coefficient of repeatability 0.9).
The AAST grading system is valid in our population. Increased AAST grade is associated with open procedures, complications, and length of stay. The AAST emergency general surgery grade determined by preoperative imaging strongly correlated to operative findings.
Epidemiologic/prognostic study, level III.
The World Health Organization has not only signaled the health risks of COVID-19, but also labeled the situation as infodemic, due to the amount of information, true and false, circulating around ...this topic. Research shows that, in social media, falsehood is shared far more than evidence-based information. However, there is less research analyzing the circulation of false and evidence-based information during health emergencies. Thus, the present study aims at shedding new light on the type of tweets that circulated on Twitter around the COVID-19 outbreak for two days, in order to analyze how false and true information was shared. To that end, 1000 tweets have been analyzed. Results show that false information is tweeted more but retweeted less than science-based evidence or fact-checking tweets, while science-based evidence and fact-checking tweets capture more engagement than mere facts. These findings bring relevant insights to inform public health policies.
Nurses' household preparedness is critical if they are to avoid role conflict and report for duty during an emergency. To date, the alignment between nurses' perceived and actual household ...preparedness remains under examined. Investigating one of these variables in isolation fails to consider that perceived and actual household preparedness must be high and aligned. If misaligned, vulnerabilities could surface during emergencies, like concerns about family safety, potentially impacting a nurse's commitment to duty during a crisis, or nurses may lack the actual preparedness to continue working long hours during an emergency. An online questionnaire was distributed to registered nurses in Ireland. The questionnaire was informed by a review of the literature and captured nurses' perceived and actual household preparedness, attitudes towards and exposure to a range of emergencies, and pertinent demographic characteristics. The results showed a relationship between how nurses view their household preparedness and their actual preparedness. Regression analyses indicate that while there is an overlap, the factors associated with how prepared nurses think they are and how prepared they are can differ. This means that strategies to boost actual preparedness may differ from those needed to boost perceived preparedness. This finding underscores the importance of psychosocial preparedness. Feeling prepared is crucial as it can influence how one responds in an emergency. Considering both the perceived and actual aspects of household preparedness can lead to a more effective response during emergencies.
The oral health status of inmates in South Korean correctional institutions is poor, mainly due to limited resources and an unestablished triage system. Hence, this study aimed to develop a newly ...structured dental triage system for South Korean correctional institutions, using the British triage system as a reference.
This study included 32 public health dentists working at correctional institutions in South Korea in 2020, accounting for the entire population of public health dentists that year. Data on the dentists' evaluation of resources and perceptions of dental service items were collected using a self-administered online survey including 19 dental service items from the British triage system to assess the level of agreement on dental triage items. All responses were recorded within 1 week of request, and a hierarchical cluster analysis was performed to develop a new dental triage system.
The survey included 31 respondents working at 47 correctional institutions; 16, 14, and one respondent provided dental services at one, two, and three institutions, respectively. Among the correctional institutions, 2%, 74%, and 23% were the National Forensic Hospital, prisons, and detention centres, respectively. The hierarchical cluster analysis identified four adjusted dental triage categories: emergency, urgent, routine, and checkups, mainly in accordance with those in the British system, but a few items were reallocated. The new dental triage system was compared to the existing system and found to have higher specificity and sensitivity, indicating that it may be more effective at meeting the oral health needs of inmates in South Korean correctional institutions.
This study developed a newly structured dental triage system by adjusting the British system and evaluated its efficacy compared to the existing system. The new system may help improve the oral health status of inmates in South Korean correctional institutions by providing a more organized approach to dental care provision.
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