جستجوی مقالات مرتبط با کلیدواژه "emergency care" در نشریات گروه "پزشکی"

Healthcare advances have contributed to patients living longer with chronic illnesses and diseases with uncertain trajectories impacting quality of life (QOL). Palliative care (PC) is no longer only for dying oncology patients as many healthcare practitioners have adopted the PC concept in diverse care settings and the timing of PC implementation remains ambiguous. There is a need to develop an operational definition of early palliative care (EPC) by clarifying the phenomenon and bridging concepts with empirical data to develop and test possible interventions before integrating EPC into emergency care (EC).

Norris’ concept clarification method was used as the philosophical framework to define, analyze, and clarify EPC. An electronic search of literature from 2000-2024, using CINAHL, PubMed, APA PsychINFO, and Psychology and Behavioral Sciences Collection databases and search terms “early palliative care” AND “emergency care” NOT “animals”, and NOT “pediatrics” were screened for eligible articles.

Of the 826 articles identified; 22 articles were retained for review. Attributes included timing, palliative, and EC; antecedents included symptom burden, access to care, and cognitive awareness; consequences included QOL and resource utilization; an empirical referent used to screen patients is the highly accurate surprise question “Would I be surprised if this patient died within a year?”

Clarifying the concept of EPC leading to an operational definition will advance the development of interventions that support the implementation of EPC in ED clinical practice.

Gastrointestinal bleeding is one of the emergencies that all therapeutic measures should be performed effectively and efficiently in a short time. This study aims to determine the effectiveness of an educational program on the improvement of nurses' knowledge, performance, and response time in the care of patients with upper gastrointestinal bleeding in the Emergency Department. 

This quasi-experimental study employed a single group pre-test and post-test design and was conducted at the Emergency Room of the Institute of Liver and Biliary Sciences (ILBS), New Delhi, India. A total of 20 nurses working in the Emergency Room were recruited through enumeration. Also, 35 events before and 35 events after the intervention were observed. The educational program was implemented through face-to-face lecture-cum discussion in six 30-minute sessions and groups of 3 to 4 nurses over three days. A researcher-made questionnaire was used to measure nurses’ knowledge regarding upper gastrointestinal bleeding, and their performance and response time were observed and calculated through a checklist. The data were described and analyzed using descriptive statistics, the paired t-test, the Kruskal-Wallis H test, and the Mann-Whitney U test in SPSS software, version 20. The significance level was set at P≤0.05. 

A noticeable improvement in the scores of knowledge and performance and a significant decrease in the nurses’ response time were observed (P<0.001). Also, there was a significant relationship between the knowledge score and the work experience of nurses in the Emergency Department (P=0.018).

Periodic evaluation of nurses’ performance in the care and treatment of upper gastrointestinal bleeding emergencies through observation and checklist is recommended. In-service training courses regarding managing upper gastrointestinal bleeding seem to be necessary.

Effective triage is a viable solution to improve performance indicators in the emergency department. This study aimed to compare the effect of conventional triage and team triage methods on the performance indicators of emergency department.

In this descriptive cross-sectional research, all 749 patients referred to the emergency department of Tabriz Sina Hospital were triaged using conventional and team methods for two consecutive weeks in July 2020. A researcher-made checklist was used to collect emergency performance indicators. The data were extracted from patient records and recorded in the checklist. Data analysis was performed using descriptive statistics, Chi-square and Mann-Whitney tests in the SPSS.19 software.

Among the patients, 86.9% in the triage group using the conventional method (52.7% female) and 86.7% in the group using the team method (52% female) were older than 40 years. The results showed that in the team triage group, the number of temporarily hospitalized patients was significantly higher and the frequency of self-responsible exit was lower compared to the conventional method (P < 0.05). In addition, the waiting time for patients triaged with the team method was shorter, and the difference in values was significant for all three triage levels (P < 0.05).

According to our results, team triage had a more positive effect on improving emergency performance indicators compared to the conventional method. Therefore, it is recommended to consider this method in hospital emergency departments to provide better services and increase patient satisfaction.

It is widely accepted that musculoskeletal injuries, especially in the lumbar region, are among the most common complaints of people working in emergency medical services (EMS). This study aimed to determine the prevalence of low back pain (LBP) and its associated factors in the field staff of prehospital EMS in northern Iran.

This cross-sectional descriptive correlational study was conducted in 2019 on 156 men selected by convenience sampling from the population of field staff of prehospital emergency medical centers in Gilan, Iran. The participants completed a questionnaire of demographic information and the numerical rating scale. Data analysis was performed in SPSS software, version 24 using unvaried logistic regression at 5%, and multiple logistic regression at 10% significance level.

Of all the participants, 69.9% (n=109) had LBP. The multiple logistic regression analysis showed that workers with a higher number of calls per shift (90% CI, 1.01%-1.32%, OR=1.15, P=0.088), low income (P=0.016), history of underlying diseases (90% CI, 1.40%-54.12%, OR=8.71, P=0.051), level of education with bachelor’s degree or higher (P=0.077) were more likely to have LBP. 

The prevalence of LBP in the field staff of prehospital EMS was remarkably high. The most important factors that predispose these workers to LBP were the number of calls per shift, income level, history of underlying diseases, and bachelor’s degree or higher level of education. The findings can be used to develop guidelines for reducing the prevalence of LBP among the field staff of prehospital EMS.

 
Emergency medical technicians (EMTs) or paramedics may not be able to do according to their moral standards during the COVID-19 pandemic, which can cause burnout and job dissatisfaction.
 
This study aimed to evaluate moral distress (MD), job satisfaction, and burnout among EMTs during the COVID-19 pandemic.
 
This cross-sectional study was conducted in Bam, Iran in 2020. In total, 134 EMTs completed the online survey that included demographic information, a MD scale, the Maslach Burnout Inventory, and an item for assessing job satisfaction. Descriptive statistics along with independent samples t-test, one-way analysis of variance, Mann–Whitney U, and Kruskal–Wallis tests, as well as multiple linear regression analysis were used to analyze data.
 
The mean scores of MD and job satisfaction were 25.44 ± 12.78 and 3.63 ± 1.07, respectively. Concerning severity, the mean scores of emotional exhaustion, depersonalization, and personal accomplishment (PA) were 35.45 ± 5.04, 20.61 ± 3.40, and 33.04 ± 4.07, respectively. All three burnout subscales were significantly correlated with job satisfaction (P < 0.05) and MD (P < 0.05). Access to personal protective equipment and education level significantly predicted MD (P < 0.05).
 
Despite high burnout and moderate MD, EMTs reported high job satisfaction, possibly because of increased social respect and salary. EMTs can avoid MD and burnout by learning how to handle ethical challenges during the COVID-19 pandemic.

Regional disparity is an imperative component of health disparity. In particular, providing emergency care that is equally available in rural areas is an essential part of reducing the urban–rural disparity. The objective of this study was to examine the worsening admission rate among Cambodian emergency patients in a rural area and determine their background characteristics that cause this decline.

To investigate the disparity among patients who visited Sunrise Japan Hospital (SJH), a major general private hospital in the capital, patient data from November 2016 to September 2019 were obtained from the electronic reception patient database. The primary outcome was defined as the proportion of admission patients as an indicator of illness severity. The patients’ addresses were classified into 4 areas based on distance from the capital.

A total of 6167 patients who visited the emergency department at SJH between January 2017 and September 2019 were included in the analysis. The proportion of patients who needed to be hospitalized or transferred increased with the distance from the capital. The proportion of patients who finished consultation decreased with the distance from the capital (P < .01: Chi- square test). The results of the logistic regression analysis showed that the admission rate in rural areas was significantly higher only among males as compared to that of the capital in multivariate analyses adjusted for age, time, and season.

The admission rate of emergency patients who visited a private general hospital in Cambodia’s capital city increased with distance from the capital city. To improve regional disparity among emergency patients, further research is necessary to identify the issues among emergency patients, especially those who are vulnerable.

During the very first months of the pandemic, the importance of deferring elective dental treatment and limiting dental care to cases of true emergency was highlighted by authorities. This paper reports a case of lateral tooth luxation that occurred in a young woman after an epileptic seizure. Adhering to governmental guidelines regarding dental care during the pandemic, we managed this case, requiring minimum chair side and dental visits with a simple mandibular removable plate in 6 weeks.

Daily emergency department surges can cause crowding in facilities that do not have adequate physical and personnel resources to meet peak demands. The mismatch between surge and surge capacity results in ED crowding, thus indicating compromised daily ED capacity. This study aimed to analyze the daily ED visits and the relevance of this data in disaster preparedness at the Qassim hospital in Saudi Arabia.
This retrospective analytic study was conducted in the central hospitals of Buraidah City, including King Fahad Specialist Hospital (KFSH), Buraidah Central Hospital (BCH), and Maternity and Children’s Hospital (MCH) in Saudi Arabia. Data were collected from January 2017 to December 2018 using a specially designed data collection form. ED visit information such as visits per month, and per day, were collected.
During the study period, 311805 patients visited the King Fahad Specialist Hospital ED, 131071 patients visited the Maternity and Children’s Hospital ED, and 284693 patients visited the Buraida Central Hospital ED. The highest number of visits per month in 2017 was recorded at KFSH with 18,849 patients, while in 2018, it was at BCH with 11,983 patients. The mean number of ED visits per day and month was significantly different between the three hospitals in 2017 and 2018 (P <.001). A significant association was noted between visits per time of day and hospitals in 2018 (P <.0001).
This study suggests that overcrowding investigated during the selected period occurred less in 2018 compared to 2017 in KFSH due to a strict triage initiative. However, the problem of patient overcrowding in MCH and BCH still needs to be addressed.

Poisoning is one of the most common causes of hospital admission. This study aims at 1- to determine the characteristics of poisoning, 2-to discover the relationship of the patients’ characteristics, and 3- to suggest a pattern of characteristics of poisoning.

In this descriptive cross-sectional study, characteristics’ of patients with poisoning were extracted from the hospital information system (HIS) in a large teaching hospital. Gender, type of admission, the priority of admission, type of referral, cause of referral, insurance organization, age, and month of referral were the variables extracted. Data were analyzed using descriptive and analytical statistical methods in SPSS software version 21.

Of the 15204 patients included in this analysis, 55.2% of the patients were men. Also, 68.5% had non-urgent triage level, and the cause of the 60.7% of the poisoning was medication overdose. Most of the patients (86.2%) aged from 30 to 20 years with the most frequent referral in May, June, July, and August. According to logistic regression results, gender, type of admission, type of referral, cause of referral, insurance organization, age, and referral month has a statistically significant effect on triage level.

The use of preventive measures from the occurrence of poisoning is necessary for the country because this problem occurs due to the lack of awareness about its causative factors. Regarding the more prevalence of intentional poisoning, the necessary steps are needed to be taken to identify the Psychological causes and prevent suicide in at-risk groups.

A Perforation of hollow viscus is the most common cause of pneumoperitoneumafter a blunt thoracoabdominal trauma and demands prompt surgical exploration.Alternative routes into the peritoneal cavity, such as the presence of a diaphragmaticlaceration associated with pneumothorax, although rare, should be considered whenapproaching these patients.

We present the case of a 78-year-old male admitted to the emergencydepartment after being ran over by a car resulting in right thoracoabdominal trauma,presenting with dyspnea and signs of peritoneal irritation. CT scan identified rightpneumothorax, pneumoperitoneum and free abdominal fluid. The pneumothoraxwas drained and posteriorly he underwent exploratory laparotomy where a traumaticlaceration of the diaphragm was identified as the cause of pneumoperitoneum.

Alternative causes of pneumoperitoneum should be considered in bluntthoracoabdominal trauma with possibility of conservative management in the absenceof peritoneal irritation signs. Pneumothorax drainage is mandatory before intubation toavoid creation of a tension pneumothorax.

Clinical competency is the ability of nurses to play a professional role in a clinical environment, in terms of the quality of the services provided.

The present study aimed to compare the clinical competence of emergency department nurses using self-assessments and evaluations by head nurses.

A descriptive-analytical study was conducted from July to September 2019. The census method was used to select 70 nurses working in the emergency departments of three hospitals. Data was collected by using self-assessment questionnaires and evaluations by head nurses. The instrument was a clinical competency questionnaire with questions related to seven functional fields and 73 skills.

The viewpoints of nurses and head nurses on the clinical competencies of nurses were assessed at a moderate level in the majority of domains. Nurses defined their clinical competencies at a significantly higher level than the head nurses (P < 0.05).

Based on the results, it is assumed that using more than one method and simultaneously applying multiple methods in an assessment will provide more accurate results about nurses’ clinical competence.

Optimizing care processes, especially in the emergency trauma departments, is considered an important issue in health care systems. Moreover, exploring strategies with the participation of stakeholders can significantly affect patient outcomes.

This study was conducted to identify, prioritize and optimize care strategies for trauma and emergency patients in Shiraz, in 2019.

Data using semi-structured interviews, Focus Group Discussions, and executive meetings with managers were collected, and the prioritization matrix was used to optimize strategies. Sampling was done purposefully until data saturation. The collected data were analyzed using qualitative inductive content analysis.

26 necessary corrective and preventive strategies were mentioned. After analyzing the data, various strategies such as rectifying managerial issues of the emergency system, specialized trauma nursing care, enhancing trauma emergency response preparedness, and adoption of a team approach were proposed.

The exploration of care strategies using employee participation provides to facilitate the development of care processes, especially in complex spaces such as trauma emergency wards. Therefore, the healthcare authorities such as nurse managers should pay special attention to these strategies. Moreover, nurses should provide more effective care in the trauma emergency departments based on the appropriate and applicable strategies.

Clinical competency is the ability of nurses to play a professional role in a clinical environment, in terms of the quality of the services provided.

The present study aimed to compare the clinical competence of emergency department nurses using self-assessments and evaluations by head nurses.

A descriptive-analytical study was conducted from July to September 2019. The census method was used to select 70 nurses working in the emergency departments of three hospitals. Data was collected by using self-assessment questionnaires and evaluations by head nurses. The instrument was a clinical competency questionnaire with questions related to seven functional fields and 73 skills.

The viewpoints of nurses and head nurses on the clinical competencies of nurses were assessed at a moderate level in the majority of domains. Nurses defined their clinical competencies at a significantly higher level than the head nurses (P < 0.05).

Based on the results, it is assumed that using more than one method and simultaneously applying multiple methods in an assessment will provide more accurate results about nurses’ clinical competence.

Caregiving for trauma patients has many challenges. Inadequate knowledge of these challenges can affect the patients and worsen their conditions.

We aimed to explore the caregivers’ experiences about these challenges and problems of caring for patients with trauma emergencies.

The study adopted a concurrent triangulation mixed-method and was conducted in Shahid Rajaee Hospital, southern Iran, in 2019. Semi-structured interviews, focus groups, observation and ward document assessments were conducted with focusing on the challenges experienced by the caregivers. A checklist was used to assess the performance of caregivers and measure the indices related to the care process. Statistical results and qualitative data on the main categories were compared and integrated for data analysis.

In total,307 codes were extracted by analyzing the content of the interviews and available evidence. The codes were summarized in 20 subcategories, and six main categories were extracted as follows: lack of professional capability, uncoordinated team response, deficits in managerial commitments, inadequate work motivation, complex nature of trauma emergency, and lack of clinical communication. The quantitative results indicated that caregivers’ performance was considerably far from the expected scores and also many indices indicated a waste of time in responding to the patient needs.

Various dimensions of trauma care challenges indicate that professional capability, team coordination and communication, managerial commitments and work motivation considering the complex nature of trauma emergency wards are crucial to enhance patients' access to optimum quality care. Caregivers’ performance and quality of indices also affect the care process. Future studies are required for compiling strategies and protocols for the quality of care for trauma patients.

Quality and safety is an important challenge in healthcare systems all over the world particularly in developing parts. 

This survey aimed to assess patient safety culture (PSC) in emergency departments (EDs) in Yemen and identify its associated factors. 

A questionnaire containing the Hospital Survey on Patient Safety Culture (HSOPSC) was distributed to ED physicians, nurses, and clinical, and non-clinical staff at three public teaching general hospitals. The percentages of positive responses on the 12 patient safety dimensions and the summation of PSC and two outcomes (overall patient safety grade and adverse events reported in the past year) were assessed. Factors associated with PSC aggregate score were analyzed. 

finally, out of 400 questionnaires, 250 (64%) were analyzed. In total, 207 (82.3%) participants were nurses and physicians; 140 (56.0%) were male; 134 (53.6%) were less than 30 years old; and 134 (53.6%) had a university degree. Participants provided the highest ratings for the “teamwork within units” PSC composite (67%). The lowest rating was for “non-punitive response to error” (21.3%). A total of 120 (48.1%) participants did not report any events in the past year and 99 (39.7%) gave their hospital an “excellent/very good” overall patient safety grade. There were significant differences between the hospitals’ EDs in the rating of “handoffs and transitions” (p=0.016), “teamwork within units” (p=0.018), and “frequency of adverse events reported” (p=0.016). Staff working in intensive care units (8.4%, n=21) had lower patient safety aggregate scores. 

PSC ratings appear to be low in Yemen. This study emphasizes the need to create and maintain a PSC in EDs through the implementation of quality improvement strategies and environment of transparency, open communications, and continuous learning.

This study intended to measure radiation doses to various organs and calculate the risk of cancer incidence from neck computed tomography and head computed tomography scans of trauma patients by using a thermoluminescent dosimeter.
We assessed 93 patients who presented to the Emergency Department. Based on their health conditions, different computed tomography scans were performed. We used a fixed tube current of 200 mAs and tube voltage of 120 kVp for all patients. Next, we derived the effective radiation dose by multiplying the dose length product and conversion factor of each computed tomography scan based on the International Commission on Radiological Protection 103. Organ dose estimations were calculated from the dosimeter readout. We calculated the life attributable risk for cancer incidence based on the Committee on the Biological Effects of Ionizing Radiation VII preferred models.
Neck computed tomography scans had a mean effective dose of 2.18 mSv. The mean effective dose for head computed tomography scans was 1.53 mSv. The highest mean equivalent organ dose was for the thyroid with the neck computed tomography scan and the lenses of the eyes with the head computed tomography scan. There was no significant difference between scan lengths in each computed tomography acquisition. There was a noticeable correlation observed between effective radiation dose and tube current. As anticipated, young people had a higher life attributable risk of cancer compared to the elderly. This amount was less than 0.011 per 100 persons for both computed tomography studies.
Our data showed a significant organ radiation dose in both neck and head computed tomography scans, not only for the thyroid and the lenses of the eyes, but also for the chest.

Patients’ satisfaction (PS) is recognized as an important emergency department service design and it has received a high interest and attention in the health management where many studies have focused on determining factors affecting PS in health-related circumstances. In this study, we aimed to examine PS in emergency department (ED) of the European Gaza Hospital (EGH) in the Gaza Strip (GS).
A descriptive-analytical cross sectional study was performed at ED-EGH between March, 15 and June 20, 2015. Press Ganey questionnaire was used as a tool for data collection. For each patient, a self-administered questionnaire including 22 questions was filled based on a Likert scale. Results were analyzed using SPSS version 22.
Overall, 200 respondents were included in the study. About 73% of respondents were satisfied with overall medical services. The term of nurses’ concern provided to patients elicited the highest score (83.1%), followed by physicians’ concern with patients (72.0%) and communication skills with patients (71.4%), while the lowest score was reported in waiting time and security staff. Furthermore, our findings show an association between PS and level of education, gender differences, living area, and work shifts.
The study results conclude that areas of medical and nursing care, respects of staff, physical comfort and waiting time ED-EGH is highly acceptable and offer in appropriate manners.