Frontiers in Emergency Medicine最新文献

{"title":"Determination of emergency department patient utilization and staffing at the University of the Philippines-Philippine General Hospital (UP-PGH)","authors":"S. M. Tabuñar, P. M. N. Pagkatipunan","doi":"10.18502/fem.v7i4.14472","DOIUrl":"https://doi.org/10.18502/fem.v7i4.14472","url":null,"abstract":"Objective: In developing staffing plans for emergency departments (EDs), a multifaceted approach must be considered without compromising quality of care, patient safety and personnel satisfaction. This study aims to determine the temporal trend of patient attendance and staffing in a major tertiary hospital ED to assist in establishing an optimal staffing pattern. Methods: A 1-year retrospective ED census review of adult patients at the University of the Philippines-Philippine General Hospital (UP-PGH) was undertaken. One-way analysis of variance (ANOVA) with post hoc Fisher-Hayter pairwise comparisons were utilized to determine if the ED consults and admissions were significantly (P<0.05) associated with the month of the year and day of the week. Results:  A total 43,632 consults at the UP-PGH ED, averaging of 3,636 per month or 121 per day, were seen in 2019. Results indicated statistically significant differences between monthly [F (11,353) =16.45; P<0.0001] and between daily means [F (6,358) =4.19; P=0.0004]. The most number of consults occur during August, September, October and November while admissions were highest during April and October.  It was busiest during Mondays and afternoon shifts (1400-2200 hours) with majority arriving as urgent in acuity. Mortality was also highest during the afternoon shifts.  Conclusion: The temporal variations in patient visits and acuity described in our study can be used as a template for workforce scheduling and resource allocation to meet the demands in the provision of care at the ED.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"410 ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139170729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Veganism and hypercoagulable state - hyperhomocysteinemia presenting as pulmonary thrombo-embolism in a vegetarian living at high altitude","authors":"Aarti Vaid, Ashish Behera, Navneet Sharma","doi":"10.18502/fem.v7i4.14477","DOIUrl":"https://doi.org/10.18502/fem.v7i4.14477","url":null,"abstract":"Hyperhomocysteinemia as a hypercoagulable state has been debatable, but when associated with other high-risk factors like severe vitamin B12 and folate deficiency, smoking, high altitude, and antiphospholipid syndrome can present with thromboembolism. Vegans are at high risk of severe B12 deficiency as the primary source is animal products. Right now, the total number of vegans, vegetarians, and all related categories, is close to 14 per cent of the world population. We here present a young vegan with severe B12 deficiency presenting with sub-massive thromboembolism.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"71 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139169280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The crisis, disasters and catastrophes afflicting Yemen and its people","authors":"Ayman Alhadheri, Sadia Alam, Saud Ahmed, Mohammed Alsabri","doi":"10.18502/fem.v7i2.12772","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12772","url":null,"abstract":"It would be inaccurate to state that Yemen’s difficulties began with the current civil war in September of 2014. While the war brought about its own list of insurmountable tribulations, it also exacerbated already present disasters. This article explores the many dynamics that have led to what has been referred to as the world’s worst humanitarian crisis. These include war, internal displacement, economic disaster, healthcare collapse, outbreaks in refugee camps, vaccination concerns, malnutrition, food insecurity, water sparsity, and infectious disease catastrophes. Along with accurate depictions of what is happening on the ground, this article suggests a few potential solutions worth investigating further, ranging from national and international efforts. With an ever-changing climate, this article serves to provide the most up to date impression of the current crisis and disasters.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"109 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124674513","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endometriosis as a rare cause of small bowel obstruction","authors":"T. Zandbaf, Mohammad Ebrahim Kalantari, Soheil Ahmadyar, Ali Esparham","doi":"10.18502/fem.v7i2.12774","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12774","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000The Article Abstract is not available. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"73 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133936963","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Emergency department management for an unusual case of penile entrapment and strangulation","authors":"H. A. Ramawad, A. Rhodes","doi":"10.18502/fem.v7i2.12775","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12775","url":null,"abstract":"\u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000The Article Abstract is not available. \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000 \u0000  \u0000 \u0000 \u0000 \u0000  \u0000","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"72 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134114854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The diagnostic value of the field assessment stroke triage as an emergency destination tool in identifying the obstruction of large cerebral vessels: a systematic review and meta-analysis","authors":"Amirhossein Nasiri-Valikboni, Yazdan Baser, H. A. Ramawad, R. Miri, M. Yousefifard","doi":"10.18502/fem.v7i2.12771","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12771","url":null,"abstract":"Objective: In this study, we investigate the diagnostic value of the field assessment stroke triage for emergency destination (FAST-ED) tool in the diagnosis of large vessels occlusion (LVO) in a systematic review and meta-analysis. \u0000Methods: We conducted a search in Medline (PubMed), Embase, Scopus, and Web of Science databases until the 21st of September 2022, as well as a manual search in Google and Google scholar to find related articles. Studies of diagnostic value in adult population were included. Screening, data collection and quality control of articles were done by two independent researchers. The data were entered and analyzed in STATA 17.0 statistical program. \u0000Results: The data from 30 articles were entered. The best cut-off points for FAST-ED were 3 or 4. The sensitivity and specificity of FAST-ED at cut-off points 3 were 0.77 (95% CI:0.73,0.80) and 0.76 (95% CI:0.72,0.80), respectively. These values ​​for cut-off point 4 were 0.72 (95% CI:0.65,0.78) and 0.79 (95% CI:0.75,0.82), respectively. Meta-regression showed that the sensitivity and specificity of FAST-ED performed by a neurologist was more accurate compared to emergency physician (P for sensitivity=0.01; P for specificity<0.001) and emergency medical technicians (P for sensitivity=0.03; P for specificity<0.001). Finally, it was found that the sensitivity of FAST-ED performed by the emergency physician and the emergency medical technician has no statistically significant difference (P=0.76). However, the specificity of FAST-ED reported by the emergency physician is significantly higher (P<0.001). The false negative rate of this tool at cut-off points 3 and 4 is 22.5% and 28.8%, respectively.  \u0000Conclusion: Although FAST-ED has an acceptable sensitivity in identifying LVO, its false negative rate varies between 22.5% and 28.8%. A percentage this high is unacceptable for a screening tool to aid in the diagnosis of strokes considering it has a high rate or morbidity and mortality. Therefore, it is recommended to use another diagnostic tool for the stroke screening.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"61 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130945007","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A narrative review of emergency department design strategies to prevent violence against healthcare personnel: an Indian perspective","authors":"Wajeeha Musharraf, Sudhir Shankar Mane, Habeeba Musharraf","doi":"10.18502/fem.v7i2.12773","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12773","url":null,"abstract":"Workplace violence in hospitals, specifically in emergency departments (ED), has become a growing concern in recent years. This violence can come from patients, their families, or visitors and can take the form of verbal or physical attacks. Preventing violence in EDs can be achieved through design modifications with minimal personnel and infrastructure requirements. Infrastructure design plays a crucial role in reducing the risk of violence. Private lockers should be available at the ED entrance to limit dangerous objects being brought into the department. Furnishings should be fixed to prevent them from being used as weapons, and evacuation should be facilitated through open rows of seating. Positive distractions, such as gardens or natural areas visible through windows, can reduce stress in patients and lower aggression. Ligature points should be eliminated and tamper-resistant items should be provided to reduce dangers in the built environment. The triage desk should be positioned in a secure area with access control and panic buttons available for staff. Hidden exits should be provided in case of violence and emergency exits should open outward and be lockable only from the outside. It seems that preventing violence in EDs requires a combination of management, technology, planning, and physical design. Proper infrastructure design can play a crucial role in reducing the risk of violence, and healthcare professionals, administrators, and architects should be aware of best practices in ED design.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127244502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of vitamin C on coagulation factors and endothelium function in patients with sepsis","authors":"Kiumarth Amini, M. Mojtahedzadeh, A. Najafi, H. Sharifnia, Aliasghar Tabatabaei Mohammadi","doi":"10.18502/fem.v7i2.12768","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12768","url":null,"abstract":"Objective: Sepsis is one of the leading causes of mortality in intensive care unit. Despite advances in its management, its mortality rate remains high. Recently, high dose of vitamin C in sepsis treatment has attracted the attention of researchers. In the current study, the impacts of 25 mg/kg of vitamin C every 6 hours as a bolus for 3 days were assessed in septic patients in intensive care unit (ICU). \u0000Methods: This was a prospective cohort study that was performed on adult patients with diagnosis of sepsis. Patients were assigned to control group (administration of placebo) or intervention group, i.e., those receiving a 25 mg/kg dose of vitamin C every 6 hours as a bolus for 3 days. Clinical data were recorded before and after the experiment. Also, plasma levels of antithrombin III, syndecan-1, fibrin degradation product (FDP), D-dimer, and C-reactive protein (CRP) were measured at 0, 24, 48, and 72 hours. \u0000Results: In septic patients receiving vitamin C, a significant upregulation of antithrombin III and significant decreases in the levels of syndecan-1 (at 48 hours; P-value=0.046 and at 72 hours; P-value=0.007), D-dimer and CRP were observed compared to the control. Reductions in sequential organ failure assessment (SOFA) score, in-hospital mortality, and ICU length of stay were seen in septic patients receiving vitamin C. \u0000Conclusion: Prescribing high dose of intravenous vitamin C can reduce the mortality of sepsis patients and reduce the length of stay in the ICU.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114647454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measuring the effect of vehicle safety on road traffic crash severity in Iran: using structural equation modeling","authors":"A. Zemestani, A. Kavousi, Homayoon Sadeghi-bazargani, H. Soori","doi":"10.18502/fem.v7i2.12769","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12769","url":null,"abstract":"Objective: Vehicle safety plays a key role in reducing the number of road traffic deaths and serious injuries. This study aims to investigate the effect of vehicle safety on the severity of traffic crashes in Iran using structural equation modeling (SEM). \u0000Methods: This was a comparative cross-sectional study of all imported vehicles with Aras free trade zone license plate as well as all domestic vehicles (cars produced in Iran) commuting on Tabriz-Jolfa road. The study population included drivers who had accidents on Tabriz-Jolfa road over a period of one year from September 22, 2020 to September 21, 2021 and were injured or  their vehicles had been damaged (n=652). Data was collected using set of questionnaires with 10 sections. The effect of independent variables, as exogenous latent variables (human, vehicle, and environmental factors), on a dependent variable, as an endogenous latent variable (crash severity) was measured using SEM. All data were analyzed using Mplus 8.0 software. \u0000Results: In the structure part of the model with foreign vehicles group, the effect sizes of three exogenous variables, i.e., human, environmental, and vehicle factors, on the dependent variables were found to be 0.412, 0.396 and 0.358, respectively. The effect sizes in the model with domestic vehicles were found to be 0.312, 0.702 and 0.820, respectively.   \u0000Conclusion: Vehicle factors (variables related to car safety) had a high impact on crash severity in the national license plate and domestically manufactured vehicle group, indicating the necessity of improving vehicle safety.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122671293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of three methods of cardiopulmonary resuscitation training in terms of improving the skills of emergency medical technicians; a pretest–posttest study","authors":"Shirin Madadian, M. Rahimi, P. Saberian, Parisa Hasani-Sharamin, Amirhossein Orandi, Alireza Jalali, Seyed Khalil Pestechi, Sepide Aarabi, Mahshid Faghani","doi":"10.18502/fem.v7i2.12766","DOIUrl":"https://doi.org/10.18502/fem.v7i2.12766","url":null,"abstract":"Objective: There are several methods for teaching emergency medical technicians (EMTs) cardiopulmonary resuscitation (CPR); but choosing the most effective option depends on several factors. This study was designed to compare the effectiveness of three different CPR training methods, including traditional, peer, and virtual methods, for EMTs. \u0000Methods: This study was a pretest-posttest study, which was performed from March to September 2020 in Tehran, Iran. Participants were EMTs working in the operations department of the EMS center. In the first step, for the pretest evaluation, an Objective Structured Clinical Evaluation (OSCE) exam was held for all participants. Thereafter, the subjects were divided into 3 groups including master-centered traditional collective education, peer training, and virtual courses. Then the participants underwent educational intervention and after that, another OSCE exam was held about 1 week after the sessions to evaluate the effect of interventions. \u0000Results: At first, 156 volunteers entered the study and participated in the pretest OSCE exam, of which 125 volunteers participated in the posttest OSCE exam. Of these, 51 volunteers participated in the peer education group, 35 volunteers were in the virtual education group, and 39 volunteers in the classic education group. The mean score of the participants in all 4 assessed skills, including endotracheal intubation, laryngeal mask airway insertion, basic life support, and advanced life support, increased significantly after educational intervention in all 3 groups (p<0.05); and this increase was higher in the virtual group compared to the other two groups (p<0.05). \u0000Conclusion: We found that virtual training was more effective than classic and peer training for CPR training of EMTs.","PeriodicalId":385617,"journal":{"name":"Frontiers in Emergency Medicine","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131385117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}