Search results for: Covid-19 emergency

Authors: Sarah Al-Lumai, Fatima Al-Attar, Nour Jamal, Badria Al-Dabbous, Manal Abdulla

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Today, many commonly used Industrial Engineering tools and techniques are being used in hospitals around the world for the goal of producing a more efficient and effective healthcare system. A common quality improvement methodology known as Lean Six-Sigma has been successful in manufacturing industries and recently in healthcare. The objective of our project is to use the Lean Six-Sigma methodology to reduce waiting time in the Emergency Department (ED), in a local private hospital. Furthermore, a comprehensive literature review was conducted to evaluate the success of Lean Six-Sigma in the ED. According to the study conducted by Ibn Sina Hospital, in Morocco, the most common problem that patients complain about is waiting time. To ensure patient satisfaction many hospitals such as North Shore University Hospital were able to reduce waiting time up to 37% by using Lean Six-Sigma. Other hospitals, such as John Hopkins’s medical center used Lean Six-Sigma successfully to enhance the overall patient flow that ultimately decreased waiting time. Furthermore, it was found that capacity constraints, such as staff shortages and lack of beds were one of the main reasons behind long waiting time. With the use of Lean Six-Sigma and bed management, hospitals like Memorial Hermann Southwest Hospital were able to reduce patient delays. Moreover, in order to successfully implement Lean Six-Sigma in our project, two common methodologies were considered, DMAIC and DMADV. After the assessment of both methodologies, it was found that DMAIC was a more suitable approach to our project because it is more concerned with improving an already existing process. With many of its successes, Lean Six-Sigma has its limitation especially in healthcare; but limitations can be minimized if properly approached.

Keywords: lean six sigma, DMAIC, hospital, methodology

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Authors: Jiří. J. Urbánek, Hana Malachová, Josef Krahulec, Jitka Johanidisová

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The paper deals with crisis situations investigation and modelling within the organizations of critical infrastructure. Every crisis situation has an origin in the emergency event occurrence in the organizations of energetic critical infrastructure especially. Here, the emergency events can be both the expected events, then crisis scenarios can be pre-prepared by pertinent organizational crisis management authorities towards their coping or the unexpected event (Black Swan effect) – without pre-prepared scenario, but it needs operational coping of crisis situations as well. The forms, characteristics, behaviour and utilization of crisis scenarios have various qualities, depending on real critical infrastructure organization prevention and training processes. An aim is always better organizational security and continuity obtainment. This paper objective is to find and investigate critical/ crisis zones and functions in critical situations models of critical infrastructure organization. The DYVELOP (Dynamic Vector Logistics of Processes) method is able to identify problematic critical zones and functions, displaying critical interfaces among actors of crisis situations on the DYVELOP maps named Blazons. Firstly, for realization of this ability is necessary to derive and create identification algorithm of critical interfaces. The locations of critical interfaces are the flags of crisis situation in real organization of critical infrastructure. Conclusive, the model of critical interface will be displayed at real organization of Czech energetic crisis infrastructure subject in Black Out peril environment. The Blazons need live power Point presentation for better comprehension of this paper mission.

Keywords: algorithm, crisis, DYVELOP, infrastructure

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Authors: Dawid Jakimiuk, Krzysztof Mitura, Leszek Szpakowski, Sławomir Pilip, Daniel Celiński

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The Emergency Medical Teams (EMS) of the Ambulance Service in Siedlce serve the population living in the Mazowieckie Voivodeship (the area of eastern Poland with approximately 550,000 inhabitants). They provide health services at the pre-hospital stage to all life-threatening patients. The analysis covered the interventions of emergency medical teams in cases of suicide attempts that occurred in the years 2015-2018. The study was retrospective. The data was obtained on the basis of digital medical records of completed call-outs. When defining the disease entity, the International Statistical Classification of Diseases and Health Problems ICD-10 prepared by WHO was used. The relationship between selected disease entities and the area of EMT intervention, the patient's sex and age, and the time of occurrence of the event were investigated. Non-urban area was defined as the area inhabited by a population below 10,000 residents. Statistical analysis was performed using Pearson's Chi ^ 2 test and presenting the percentage of cases in the study group. Of all the suicide attempts, drug abuse cases were the most frequent, including: X60 (Intentional self-poisoning by and exposure to nonopioid analgesics, antipyretics and antirheumatics); X61 (Intentional self-poisoning by and exposure to antiepileptic, sedative-hypnotic, antiparkinsonian and psychotropic drugs, not elsewhere classified); X62 (Intentional self-poisoning by and exposure to narcotics and psycholeptics [hallucinogens], not elsewhere classified); X63 (Intentional self-poisoning by and exposure to other drugs acting on the autonomic nervous system); X64 (Intentional self-poisoning by and exposure to other and unspecified drugs, medicaments and biological substance) oraz X70 (Intentional self-harm by hanging, strangulation and suffocation). In total, they accounted for 69.4% of all interventions to suicide attempts in the studied period. Statistical analysis shows significant differences (χ2 = 39.30239, p <0.0001, n = 561) between the area of EMT intervention and the type of suicide attempt. In non-urban areas, a higher percentage of X70 diagnoses was recorded (55.67%), while in urban areas, X60-X64 (72.53%). In non-urban areas, a higher proportion of patients attempting suicide was observed compared to patients living in urban areas. For X70 and X60 - X64 in total, the incidence rates in non-urban areas were 80.8% and 56%, respectively. Significant differences were found (χ2 = 119.3304, p <0.0001, n = 561) depending on the method of attempting suicide in relation to the patient's sex. The percentage of women diagnosed with X60-X64 versus X70 was 87.50%, which was the largest number of patients (n = 154) as compared to men. In the case of X70 in relation to X60-X64, the percentage of men was 62.08%, which was the largest number of patients (n = 239) as compared to women (n = 22). In the case of X70, the percentage of men compared to women was as high as 92%. Significant differences were observed (χ2 = 14.94848, p <0.01058) between the hour of EMT intervention and the type of suicide attempt. The highest percentage of X70 occurred between 04:01 - 08:00 (64.44%), while X60-X64 between 00:01 - 04:00 (70.45%). The largest number of cases of all tested suicide attempts was recorded between 16:01 - 20:00 for X70 (n = 62), X60 - X64 (n = 82), respectively. The highest percentage of patients undertaking all suicide attempts studied at work was observed in the age range of 18-30 (31.5%), while the lowest was in the age group over 60 years of age. (11%). There was no significant correlation between the day of the week or individual months of the year and the type of suicide attempt - respectively (χ2 = 6.281729, p <0.39238, n = 561) and (χ2 = 3.348913, p <0.9857, n = 561). There were also no significant differences in the incidence of suicide attempts for each year in the study period (χ2 = 3.348913, p <0.9857 n = 561). The obtained results suggest the necessity to undertake preventive measures in order to minimize the number of suicide attempts. Such activities should be directed especially at young patients living in non-urban areas.

Keywords: emergency med, emergency medical team, attempted suicide, pre-hospital

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Authors: Priyanka Bharti

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Decades ago designs were based on common sense and tradition, but after an enhancement in visualization technology and research, we are now able to comprehend the cognitive ability involved in the decoding of the visual information. However, many fields in visuals need intense research to deliver an efficient explanation for the events. Visuals are an information representation mode through images, symbols and graphics. It plays an impactful role in decision making by facilitating quick recognition, comprehension, and analysis of a situation. They enhance problem-solving capabilities by enabling the processing of more data without overloading the decision maker. As research proves that, visuals offer an improved learning environment by a factor of 400 compared to textual information. Visual information engages learners at a cognitive level and triggers the imagination, which enables the user to process the information faster (visuals are processed 60,000 times faster in the brain than text). Appropriate information, visualization, and its presentation are known to aid and intensify the decision-making process for the users. However, most literature discusses the role of visual aids in comprehension and decision making during normal conditions alone. Unlike emergencies, in a normal situation (e.g. our day to day life) users are neither exposed to stringent time constraints nor face the anxiety of survival and have sufficient time to evaluate various alternatives before making any decision. An emergency is an unexpected probably fatal real-life situation which may inflict serious ramifications on both human life and material possessions unless corrective measures are taken instantly. The situation demands the exposed user to negotiate in a dynamic and unstable scenario in the absence or lack of any preparation, but still, take swift and appropriate decisions to save life/lives or possessions. But the resulting stress and anxiety restricts cue sampling, decreases vigilance, reduces the capacity of working memory, causes premature closure in evaluating alternative options, and results in task shedding. Limited time, uncertainty, high stakes and vague goals negatively affect cognitive abilities to take appropriate decisions. More so, theory of natural decision making by experts has been understood with far more depth than that of an ordinary user. Therefore, in this study, the author aims to understand the role of visual aids in supporting rapid comprehension to take appropriate decisions during an emergency situation.

Keywords: cognition, visual, decision making, graphics, recognition

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Authors: Pamela Chia, Tay Yoong Chuan

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Introduction: Severe pulmonary hypertension (PH) patients requiring non-cardiac surgery risk have increased mortality rates ranging. These patients are plagued with cardiorespiratory failure, dysrhythmias and anticoagulation potentially with concurrent sepsis and renal insufficiency, perioperative morbidity. We present a deaf-mute patient with severe idiopathic PH emergently prepared for ruptured ectopic laparotomy. Case Report: A 20 year-old female, 62kg (BMI 25 kg/m2) with severe idiopathic PH (2DE Ejection Fraction was 41%, Pulmonary Artery Systolic Pressure (PASP) 105 mmHg, Right ventricle strain and hypertrophy) and selective mutism was rushed in for emergency laparotomy after presenting to the emergency department for abdominal pain. The patient had an NYHA Class II with room air SpO2 93-95%. While awaiting lung transplant, the patient takes warfarin, Sildanefil, Macitentan and even Selexipag for rising PASP. At presentation, vital signs: BP 95/63, HR 119 SpO2 88% (room air). Despite decreasing haemoglobin 14 to 10g/dL, INR 2.59 was reversed with prothrombin concentrate, and Vitamin K. ECG revealed Right Bundle Branch Block with right ventricular strain and x-ray showed cardiomegaly, dilated Right Ventricle, Pulmonary Arteries, basal atelectasis. Arterial blood gas showed compensated metabolic acidosis pH 7.4 pCO2 32 pO2 53 HCO3 20 BE -4 SaO2 88%. The cardiothoracic surgeon concluded no role for Extracorporeal Membrane Oxygenation (ECMO). We inserted invasive arterial and central venous lines with blood transfusion via an 18G cannula before the patient underwent a midline laparotomy, haemostasis of ruptured ovarian cyst with 2.4L of clots under general anesthesia and FloTrac cardiac output monitoring. Rapid sequence induction was done with Midazolam/Propofol, remifentanil infusion, and rocuronium. The patient was maintained on Desflurane. Blood products and colloids were transfused for further 1.5L blood loss. Postoperatively, the patient was transferred to the intensive care unit and was extubated uneventfully 7hours later. The patient went home a week later. Discussion: Emergency hemostasis laparotomy in anticoagulated WHO Class I PH patient awaiting lung transplant with no ECMO backup poses tremendous stress on the deaf-mute patient and the anesthesiologist. Balancing hemodynamics avoiding hypotension while awaiting hemostasis in the presence of pulmonary arterial dilators and anticoagulation requires close titration of volatiles, which decreases RV contractility. We review the contraindicated anesthetic agents (ketamine, N2O), choice of vasopressors in hypotension to maintain Aortic-right ventricular pressure gradients and nitric oxide use perioperatively. Conclusion: Interdisciplinary communication with a deaf-mute moribund patient and anesthesia considerations pose many rare challenges worth sharing.

Keywords: pulmonary hypertension, case report, warfarin reversal, emergency surgery

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Authors: E. Bennion, A. Acharya, S. Barnes, D. Ferrell, S. Luckett-Cole, G. Mower, J. Nelson, Y. Nguyen

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Objective: This study aimed to evaluate the validity of a firearm injury query in the Early Notification of Community-based Epidemics syndromic surveillance system. Syndromic surveillance data are used at the Utah Department of Health for early detection of and rapid response to unusually high rates of violence and injury, among other health outcomes. The query of interest was defined by the Centers for Disease Control and Prevention and used chief complaint and discharge diagnosis codes to capture initial emergency department encounters for firearm injury of all intents. Design: Two epidemiologists manually reviewed electronic health records of emergency department visits captured by the query from April-May 2020, compared results, and sent conflicting determinations to two arbiters. Results: Of the 85 unique records captured, 67 were deemed probable, 19 were ruled out, and two were undetermined, resulting in a positive predictive value of 75.3%. Common reasons for false positives included non-initial encounters and misleading keywords. Conclusion: Improving the validity of syndromic surveillance data would better inform outbreak response decisions made by state and local health departments. The firearm injury definition could be refined to exclude non-initial encounters by negating words such as “last month,” “last week,” and “aftercare”; and to exclude non-firearm injury by negating words such as “pellet gun,” “air gun,” “nail gun,” “bullet bike,” and “exit wound” when a firearm is not mentioned.

Keywords: evaluation, health information system, firearm injury, syndromic surveillance

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Authors: Zicheng Zhang, Linli Zhang

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As China's biggest social media platform, Weibo has taken on essential health communication responsibilities during the pandemic. This research takes 105 posters in 15 health-related official Weibo accounts as the analysis objects to explore COVID19 health information communication and visualisation. First, the interaction between the audiences and Weibo, including forwarding, comments, and likes, is statistically analysed. The comments about the information design are extracted manually, and then the sentiment analysis is carried out to verdict audiences' views about the poster's design. The forwarding and comments are quantified as the attention index for a reference to the degree of likes. In addition, this study also designed an evaluation scale based on the standards of Health Literacy Resource by the Centers for Medicare& Medicaid Services (US). Then designers scored all selected posters one by one. Finally, combining the data of the two parts, concluded that: 1. To a certain extent, people think that the posters do not deliver substantive and practical information; 2. Non-knowledge posters(i.e., cartoon posters) gained more Forwarding and Likes, such as Go, Wuhan poster; 3. The analysis of COVID posters is still mainly picture-oriented, mainly about encouraging people to overcome difficulties; 4. Posters for pandemic prevention usually contain more text and fewer illustrations and do not clearly show cultural differences. In conclusion, health communication usually involves a lot of professional knowledge, so visualising that knowledge in an accessible way for the general public is challenging. The relevant posters still have the problems of lack of effective communication, superficial design, and insufficient content accessibility.

Keywords: weibo, visualisation, covid posters, poster design

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Authors: Fatima Zehra Allahverdi, Nukhet Bayer

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Objective: Three questions were formulated to examine stressful working units (intensive care units, emergency unit nurses) utilizing the self-perception theory and social support theory. This study provides a distinctive input by inspecting the combination of variables regarding stressful working environments. Method: The descriptive research was conducted with the participation of 400 nurses working at Ankara City Hospital. The study used Multivariate Analysis of Variance (MANOVA), regression analysis, and a mediation model. Hypothesis one used MANOVA followed by a Scheffe post hoc test. Hypothesis two utilized regression analysis using a hierarchical linear regression model. Hypothesis three used a mediation model. Result: The study utilized mediation analyses. Findings supported the hypotheses that intensive care units have significantly high scores in virtual communication and virtual tolerance. The number of years on the job, virtual communication, virtual tolerance, and phubbing significantly predicted 51% of the variance of perception of addiction. Interestingly, the number of years on the job, while significant, was negatively related to perception of addiction. Conclusion: The reasoning behind these findings and the lack of significance in the emergency unit is discussed. Around 7% of the variance of phubbing was accounted for through working in intensive care units. The model accounted for 26.80 % of the differences in the perception of addiction.

Keywords: phubbing, social media, working units, years on the job, stress

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Authors: Mimoza Canga, Alketa Qafmolla, Vergjini Mulo, Irene Malagnino

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Aim: Assessment of oral health in young people aged 18-29 years after the Covid-19 pandemic in Albania. Materials and methods: The present study was conducted at the University of Medicine in Tirana, Albania, from March 2023 to September 2023. This is s cross-sectional study. In our research, 104 students participated, of which 64 were females (61.5%) and 40 were males (38.5%). In the present survey, the participants were divided into four age groups: 18-20, 21-23, 24-26, and 27-29 years old. Majority of the sample (69%) were 18-20 years. Participants were instructed to complete the questionnaire. The study had no dropouts. The current study was conducted in accordance to Helsinki declaration. Statistical analysis was performed using IBM SPSS Statistics Version 23.0, Microsoft Windows Linux, Chicago, IL, USA. Data were analyzed using analysis of variance (ANOVA). P ≤ 0.05 was considered statistically significant. Results: This study reported that 80 (76.9%) of the participants had passed Covid-19, while 24 (23.1%) of them had not passed Covid-19. Based on our data analysis, 70 (67.3%) of the participants had symptoms such as of fever 38°C- 40.5°C and headache. They stated that were treated with Azithromycin 500 mg tablets, Augmentin 625 mg tablets, Vitamin C 1000 mg, Magnesium, and Vitamin D. 40(38.4%) of the participants noticed hypersensitivity in gums (p = 0.004) and sensitive teeth (p = 0.001) after having passed Covid-19 compared to pre-pandemic. Nearly 40 (38.4%) of the participants who passed Covid-19 were treated with painful relievers for the gums and teeth, such as ibuprofen (Advil), used Sensodyne Toothpaste for sensitive teeth and Clove oil. Conclusion: Within the limitations of this study conducted in Albania, can concluded that Covid-19 has a direct impact on oral health.

Keywords: albania, Covid19, cross-sectional study, oral health

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Authors: Sikander Nawaz Khan

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Natural disasters like flood, earthquake, cyclone, volcanic eruption and others are causing immense losses to the property and lives every year. Current status and actual loss information of natural hazards can be determined and also prediction for next probable disasters can be made using different remote sensing and mapping technologies. Global Positioning System (GPS) calculates the exact position of damage. It can also communicate with wireless sensor nodes embedded in potentially dangerous places. GPS provide precise and accurate locations and other related information like speed, track, direction and distance of target object to emergency responders. Remote Sensing facilitates to map damages without having physical contact with target area. Now with the addition of more remote sensing satellites and other advancements, early warning system is used very efficiently. Remote sensing is being used both at local and global scale. High Resolution Satellite Imagery (HRSI), airborne remote sensing and space-borne remote sensing is playing vital role in disaster management. Early on Geographic Information System (GIS) was used to collect, arrange, and map the spatial information but now it has capability to analyze spatial data. This analytical ability of GIS is the main cause of its adaption by different emergency services providers like police and ambulance service. Full potential of these so called 3S technologies cannot be used in alone. Integration of GPS and other remote sensing techniques with GIS has pointed new horizons in modeling of earth science activities. Many remote sensing cases including Asian Ocean Tsunami in 2004, Mount Mangart landslides and Pakistan-India earthquake in 2005 are described in this paper.

Keywords: disaster mitigation, GIS, GPS, remote sensing

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Authors: Md. Shakhawat Hossain, Jimma Hossain, Md. Naushad Ali

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Acute pancreatitis is a dangerous medical emergency in the practice of gastroenterology. Management of acute pancreatitis needs multidisciplinary approach with support starts from emergency to ICU. So, there is a chance of mismanagement in every steps, especially in low resource settings. Other factors such as patient’s financial condition, education, social custom, transport facility, referral system from periphery may also challenge the current guidelines for management. The present study is intended to determine the clinico-pathological profile, severity assessment and challenges of management of acute pancreatitis in a government laid tertiary care hospital to image the real scenario of management in a low resource place. A total 100 patients of acute pancreatitis were studied in this prospective study, held in the Department of Gastroenterology, Rangpur medical college hospital, Bangladesh from July 2017 to July 2018 within one year. Regarding severity, 85 % of the patients were mild, whereas 13 were moderately severe, and 2 had severe acute pancreatitis according to the revised Atlanta criteria. The most common etiologies of acute pancreatitis in our study were gall stone (15%) and biliary sludge (15%), whereas 54% were idiopathic. The most common challenges we faced were delay in hospital admission (59%) and delay in hospital diagnosis (20%). Others are non-adherence of patient party, and lack of investigation facility, physician’s poor knowledge about current guidelines. We were able to give early aggressive fluid to only 18% of patients as per current guideline. Conclusion: Management of acute pancreatitis as per guideline is challenging when optimum facility is lacking. So, modified guidelines for assessment and management of acute pancreatitis should be prepared for low resource setting.

Keywords: acute pancreatitis, challenges of management, severity, prognosis

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Authors: Gauri Shankar Shah

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Objectives: The Type I diabetes mellitus in children is frequently a missed diagnosis and children presents in emergency with diabetic ketoacidosis having significant morbidity and mortality. The present study was done to find out the clinical presentation and outcome at a tertiary-care centre. Methods: This was retrospective analysis of data of Type I diabetes mellitus reporting to our centre during last one year (2012-2013). Results: There were 12 patients (8 males) and the age group was 4-14 years (mean ± 3.7). The presenting symptoms were fever, vomiting, altered sensorium and fast breathing in 8 (66.6%), 6 (50%), 4 (33.3%), and 4 (33.3%) cases, respectively. The classical triad of polyuria, polydypsia, and polyphagia were present only in two patients (33.2%). Seizures and epigastric pain were found in two cases each (33.2%). The four cases (33.3%) presented with diabetic ketoacidosis due to discontinuation of insulin doses, while 2 had hyperglycemia alone. The hemogram revealed mean hemoglobin of 12.1± 1.6 g/dL and total leukocyte count was 22,883.3 ± 10,345.9 per mm3, with polymorphs percentage of 73.1 ± 9.0%. The mean blood sugar at presentation was 740 ± 277 mg/ dl (544–1240). HbA1c ranged between 7.1-8.8 with mean of 8.1±0.6 %. The mean sodium, potassium, blood ph, pCO2, pO2 and bicarbonate were 140.8 ± 6.9 mEq/L, 4.4 ± 1.8mEq/L, 7.0 ± 0.2, 20.2 ± 10.8 mmHg, 112.6 ± 46.5 mmHg and 9.2 ± 8.8 mEq/L, respectively. All the patients were managed in pediatric intensive care unit as per our protocol, recovered and discharged on intermediate insulin given twice daily. Conclusions: Thus, it shows that these patients have uncontrolled hyperglycemia and often presents in emergency with ketoacidosis and deranged biochemical profile. The regular administration of insulin, frequent monitoring of blood sugar and health education are required to have better metabolic control and good quality of life.

Keywords: type I diabetes mellitus, hyperglycemia, outcome, glycemic control

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Authors: Balakrishna Valluru, Ruth Suckling

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A 16 year old male was found collapsed on the road following stab injuries to the chest and abdomen and was transported to the emergency department by ambulance. On arrival in the emergency department the patient was breathless and appeared pale. He was maintaining his airway with spontaneous breathing and had a heart rate of 122 beats per minute with a blood pressure of 83/63 mmHg. He was resuscitated initially with three units of packed red cells. Clinical examination identified three incisional wounds each measuring 2 cm. These were in the left para-sternal region, right infra-scapular region and left upper quadrant of the abdomen. The chest wound over the left parasternal area at the level of 4tth intercostal space was bleeding intermittently on leaning forwards and was relieving his breathlessness intermittently. CT imaging was performed to characterize his injuries and determine his management. CT scan of chest and abdomen showed moderate size haemopericardium with left sided haemopneumothorax. The patient underwent urgent surgical repair of the left ventricle and left anterior descending artery. He recovered without complications and was discharged from the hospital. This case highlights the fact that the potential to develop a life threatening cardiac tamponade was mitigated by the left parasternal stab wound. This injury fortuitously provided a pericardial window through which the bleeding from the injured left ventricle and left anterior descending artery could drain into the left hemithorax providing an opportunity for timely surgical intervention to repair the cardiac injuries.

Keywords: stab, incisional, haemo-pericardium, haemo-pneumothorax

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Authors: Laleh Boroumand, Muhammad Shiraz, Abdullah Gani, Rashid Hafeez Khokhar

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Cloud computing being the use of hardware and software that are delivered as a service over a network has its application in the area of health care. Due to the emergency cases reported in most of the medical centers, prompt for an efficient scheme to make health data available with less response time. To this end, we propose a mobile global healthcare village (MGHV) model that combines the components of three deployment model which include country, continent and global health cloud to help in solving the problem mentioned above. In the creation of continent model, two (2) data centers are created of which one is local and the other is global. The local replay the request of residence within the continent, whereas the global replay the requirements of others. With the methods adopted, there is an assurance of the availability of relevant medical data to patients, specialists, and emergency staffs regardless of locations and time. From our intensive experiment using the simulation approach, it was observed that, broker policy scheme with respect to optimized response time, yields a very good performance in terms of reduction in response time. Though, our results are comparable to others when there is an increase in the number of virtual machines (80-640 virtual machines). The proportionality in increase of response time is within 9%. The results gotten from our simulation experiments shows that utilizing MGHV leads to the reduction of health care expenditures and helps in solving the problems of unqualified medical staffs faced by both developed and developing countries.

Keywords: cloud computing (MCC), e-healthcare, availability, response time, service broker policy

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Authors: Keiko Naito, Y. Nakashima, S. Yamauchi, Y. Kunitani, Y. Ishigami, K. Numata, M. Mizobe, Y. Homma, J. Takahashi, T. Inoue, T. Shiga, H. Funakoshi

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Background: A presence of severe acidemia, defined as pH < 7.2, is common during endotracheal intubation for critically ill patients in the emergency department (ED). Severe acidemia is widely recognized as a predisposing factor for intubation failure. However, it is unclear that acidemic condition itself actually makes endotracheal intubation more difficult. We aimed to evaluate if a presence of severe acidemia before intubation is associated with the lower first attempt intubation success rate in the ED. Methods: This is a retrospective observational cohort study in the ED of an urban hospital in Japan. The collected data included patient demographics, such as age, sex, and body mass index, presence of one or more factors of modified LEMON criteria for predicting difficult intubation, reasons for intubation, blood gas levels, airway equipment, intubation by emergency physician or not, and the use of the rapid sequence intubation technique. Those with any of the following were excluded from the analysis: (1) no blood gas drawn before intubation, (2) cardiopulmonary arrest, and (3) under 18 years of age. The primary outcome was the first attempt intubation success rates between a severe acidemic patients (SA) group and a non-severe acidemic patients (NA) group. Logistic regression analysis was used to test the first attempt success rates for intubations between those two groups. Results: Over 5 years, a total of 486 intubations were performed; 105 in the SA group and 381 in the NA group. The univariate analysis showed that the first attempt intubation success rate was lower in the SA group than in the NA group (71.4% vs 83.5%, p < 0.01). The multivariate logistic regression analysis identified that severe acidemia was significantly associated with the first attempt intubation failure (OR 1.9, 95% CI 1.03-3.68, p = 0.04). Conclusions: A presence of severe acidemia before endotracheal intubation lowers the first attempt intubation success rate in the ED.

Keywords: acidemia, airway management, endotracheal intubation, first-attempt intubation success rate

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Authors: Emily Moore, Andrew Gaukroger, Matthew Solan, Lucy Bailey, Alexandra Boxall, Andrew Carne, Chintu Gadamsetty, Charlotte Morley, Katy Western, Iwona Kolodziejczyk

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Introduction: Rupture of the Achilles tendon is common and has a long recovery period. Most cases are managed non-operatively. Foot and Ankle Surgeons advise an ultrasound scan to check the gap between the torn ends. A large gap (with the ankle in equinus) is a relative indication for surgery. The definitive decision regarding surgical versus non-operative management can only be made once an ultrasound scan is undertaken and the patient is subsequently reviewed by a Foot and Ankle surgeon. To get to this point, the patient journey involves several hospital departments. In nearby trusts, patients reattend for a scan and go to the plaster room both before and after the ultrasound for removal and re-application of the cast. At a third visit to the hospital, the surgeon and patient discuss options for definitive treatment. It may take 2-3 weeks from the initial Emergency Department visit before the final treatment decision is made. This “wasted time” is ultimately added to the recovery period for the patient. In this hospital, Achilles rupture patients are seen in a weekly multidisciplinary OneStop Heel Pain clinic. This pathway was already efficient but subject to occasional frustrating delays if a key staff member was absent. A new pathway was introduced with the goal to reduce delays to a definitive treatment plan. Method: A retrospective series of Achilles tendon ruptures managed according to the 2019 protocol was identified. Time taken from the Emergency Department to have both an ultrasound scan and specialist Foot and Ankle surgical review were calculated. 30 consecutive patients were treated with our new pathway and prospectively followed. The time taken for a scan and for specialist review were compared to the 30 consecutive cases from the 2019 (pre-COVID) cohort. The new pathway includes 1. A new contoured splint applied to the front of the injured limb held with a bandage. This can be removed and replaced (unlike a plaster cast) in the ultrasound department, removing the need for plaster room visits. 2. Urgent triage to a Foot and Ankle specialist. 3. Ultrasound scan for assessment of rupture gap and deep vein thrombosis check. 4. Early decision regarding surgery. Transfer to weight bearing in a prosthetic boot in equinuswithout waiting for the once-a-week clinic. 5. Extended oral VTE prophylaxis. Results: The time taken for a patient to have both an ultrasound scan and specialist review fell > 50%. All patients in the new pathway reached a definitive treatment decision within one week. There were no significant differences in patient demographics or rates of surgical vs non-operative treatment. The mean time from Emergency Department visit to specialist review and ultrasound scan fell from 8.7 days (old protocol) to 2.9 days (new pathway). The maximum time for this fell from 23 days (old protocol) to 6 days (new pathway). Conclusion: Teamwork and innovation have improved the experience for patients with an Achilles tendon rupture. The new pathway brings many advantages - reduced time in the Emergency Department, fewer hospital visits, less time using crutches and reduced overall recovery time.

Keywords: orthopaedics, achilles rupture, ultrasound, innovation

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Authors: Thidathit Prachanukool, Chaiyaporn Yuksen, Welawat Tienpratarn, Sorravit Savatmongkorngul, Panvilai Tangkulpanich, Chetsadakon Jenpanitpong, Yuranan Phootothum, Malivan Phontabtim, Promphet Nuanprom

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Background: Ruptured appendicitis has a high morbidity and mortality and requires immediate surgery. The Alvarado Score is used as a tool to predict the risk of acute appendicitis, but there is no such score for predicting rupture. This study aimed to developed the prediction score to determine the likelihood of ruptured appendicitis in an Asian population. Methods: This study was diagnostic, retrospectively cross-sectional and exploratory model at the Emergency Medicine Department in Ramathibodi Hospital between March 2016 and March 2018. The inclusion criteria were age >15 years and an available pathology report after appendectomy. Clinical factors included gender, age>60 years, right lower quadrant pain, migratory pain, nausea and/or vomiting, diarrhea, anorexia, fever>37.3°C, rebound tenderness, guarding, white blood cell count, polymorphonuclear white blood cells (PMN)>75%, and the pain duration before presentation. The predictive model and prediction score for ruptured appendicitis was developed by multivariable logistic regression analysis. Result: During the study period, 480 patients met the inclusion criteria; of these, 77 (16%) had ruptured appendicitis. Five independent factors were predictive of rupture, age>60 years, fever>37.3°C, guarding, PMN>75%, and duration of pain>24 hours to presentation. A score > 6 increased the likelihood ratio of ruptured appendicitis by 3.88 times. Conclusion: Using the Ramathibodi Welawat Ruptured Appendicitis Score. (RAMA WeRA Score) developed in this study, a score of > 6 was associated with ruptured appendicitis.

Keywords: predictive model, risk score, ruptured appendicitis, emergency room

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Authors: Abdullah Arafat, Ali Al-Farhan, Amir Omair

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Objectives: To review and assess the effectiveness of the implemented modified five-levels triage and acuity scale triage system in AL-Yarmook Urgent Care Center (UCC), King Abdulaziz Residential city, Riyadh, Saudi Arabia. Method: The applied study design was an observational cross sectional design. A data collection sheet was designed and distributed to triage nurses; the data collection was done during triage process and was directly observed by the co-investigator. Triage system was reviewed by measuring three time intervals as quality indicators: time before triage (TBT), time before being seen by physician (TBP) and total length of stay (TLS) taking in consideration timing of presentation and level of triage. Results: During the study period, a total of 187 patients were included in our study. 118 visits were at weekdays and 68 visits at weekends. Overall, 173 patients (92.5%) were seen by the physician in timely manner according to triage guidelines while 14 patients (7.5%) were not seen at appropriate time.Overall, The mean time before seen the triage nurse (TBT) was 5.36 minutes, the mean time to be seen by physician (TBP) was 22.6 minutes and the mean length of stay (TLS) was 59 minutes. The data didn’t showed significant increase in TBT, TBP, and number of patients not seen at the proper time, referral rate and admission rate during weekend. Conclusion: The CTAS is adaptable to countries beyond Canada and worked properly. The applied CTAS triage system in Al-Yarmook UCC is considered to be effective and well applied. Overall, urgent cases have been seen by physician in timely manner according to triage system and there was no delay in the management of urgent cases.

Keywords: CTAS, emergency, Saudi Arabia, triage, urgent care

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Authors: Jiří F. Urbánek, Alena Oulehlová, Hana Malachová, Jiří J. Urbánek Jr.

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Crisis situations investigation and modelling are introduced and made within the complex system of energetic critical infrastructure, operating on peril´s environments. Every crisis situations and perils has an origin in the emergency/ crisis event occurrence and they need critical/ crisis interfaces assessment. Here, the emergency events can be expected - then crisis scenarios can be pre-prepared by pertinent organizational crisis management authorities towards their coping; or it may be unexpected - without pre-prepared scenario of event. But the both need operational coping by means of crisis management as well. The operation, forms, characteristics, behaviour and utilization of crisis management have various qualities, depending on real critical infrastructure organization perils, and prevention training processes. An aim is always - better security and continuity of the organization, which successful obtainment needs to find and investigate critical/ crisis zones and functions in critical infrastructure organization models, operating in pertinent perils environment. Our DYVELOP (Dynamic Vector Logistics of Processes) method is disposables for it. Here, it is necessary to derive and create identification algorithm of critical/ crisis interfaces. The locations of critical/ crisis interfaces are the flags of crisis situation in organization of critical infrastructure models. Then, the model of crisis situation will be displayed at real organization of Czech energetic crisis infrastructure subject in real peril environment. These efficient measures are necessary for the infrastructure protection. They will be derived for peril mitigation, crisis situation coping and for environmentally friendly organization survival, continuity and its sustainable development advanced possibilities.

Keywords: algorithms, energetic infrastructure complex system, modelling, peril´s environment

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Authors: Angelis P. Barlampas

Abstract:

Purpose: A 29 years old woman presented in the emergency department with psychiatric symptoms. The psychiatrist ordered a computed tomography scan as part of a general examination. Material and methods: The CT showed bilateral enlarged choroid plexus structures mimicking papillomata and situated in the trigones of the lateral ventricles. The left choroid plexus was heavily calcified, but the right one has no any obvious calcifications. Results: It is well kown that any brain mass can present with behavioral changes and even psychiatric symptomatology. Papillomata of the ventricular system have been described to cause psychotic episodes. According to literature, choroid plexus papillomas are seldom neuroepithelial intraventricular tumors, which are benign and categorized as WHO grade 1 tumors. They are more common in the pediatric population, but they can occur in the adults, too1. In addition, the distinction between choroid plexus papilloma and carcinoma is very difficult and impossible by imagine alone. It can only be implied with more advanced imaging, such as arterial spin labeling and MRI. The final diagnosis is, of course, after surgical excision. The usual location in adults is the fourth ventricle, but in children, it is the lateral ventricles. Their imaging appearance is that of a solid vascular tumor, which enhances intensely after the intravenous administration of contrast material. One out of fourth tumors presents speckled calcifications1. In our case, there are symmetrically sized masses at the trigones, and there are no calcifications in one of them, whereas the other one is grossly calcified. Also, there is no obvious hydrocephalus or any other evidence of increased intracranial pressure. General conclusions: When there is a new psychiatric patient, someone must undergo any possible examination, and of course, a brain CT study should be done to exclude any rare organic causes that may be responsible for the disease.

Keywords: phycosis, intraventricular masses, CT, brain calcifications

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Authors: María Reveles-Miranda, Daniella Pacheco-Catalán

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Sierra Papacal commissary is located north of Merida, Yucatan, México, where the indigenous Maya population predominates. Due to its location, the region has an elevation of fewer than 4.5 meters above sea level, with a high risk of flooding associated with storms and hurricanes and a high vulnerability of infrastructure and housing in the presence of strong gusts of wind. In environmental contingencies, the challenge is providing an autonomous electrical supply using renewable energy sources that cover vulnerable populations' health, food, and water pumping needs. To address this challenge, a hybrid energy storage module is proposed for the emergency photovoltaic (PV) system of the community shelter in Sierra Papacal, Yucatán, which combines high-energy-density batteries and high-power-density supercapacitors (SC) in a single module, providing a quick response to energy demand, reducing the thermal stress on batteries and extending their useful life. Incorporating SC in energy storage modules can provide fast response times to power variations and balanced energy extraction, ensuring a more extended period of electrical supply to vulnerable populations during contingencies. The implemented control strategy increases the module's overall performance by ensuring the optimal use of devices and balanced energy exploitation. The operation of the module with the control algorithm is validated with MATLAB/Simulink® and experimental tests.

Keywords: batteries, community shelter, environmental contingencies, hybrid energy storage, isolated photovoltaic system, supercapacitors

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Authors: S. M. Amin Hosseini, Oriol Pons, Albert de la Fuente

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An earthquake hit the Kermanshah province, which is located in the west of Iran, on 12th November 2017 at 18:18 UTC (21:48 Iran Standard Time). This earthquake caused several deaths and injured people. In this disaster, substantial homes were destroyed and many homes were damaged. The Iranian government, local authorities, and several non-governmental organizations responded to affected populations’ needs, such as foods, blanket, water, a tent as a temporary shelter, etc. Considerable national groups, including governmental, non-governmental organizations, and people from non-organized groups, directly and indirectly, tried to bring donated goods to the affected populations. However, some of these aids could not satisfy all the affected populations. Moreover, these impossibilities led to waste extensive resources. In this regard, this research study aims to assess the problems of the Kermanshah disaster responses. At the same time, this project searches possible solutions in order to increase emergency management efficiencies for encountering future events. To this end, this study assesses the problem from all beneficiaries´ point of views. In this regard, a survey and a questionnaire were designed for statistical analyses of the responses of people, who were involved in the Kermanshah earthquake recovery program. Additionally, this research study takes into account diverse strategies, which have been applied in other recovery programs, with the Kermanshah case in order to determine similarities and differences. Finally, this study presents possible solutions taken from other recovery programs that could be applied for the Kermanshah emergency responses. However, the results demonstrate that it is required to customize applied strategies based on local conditions and requirements.

Keywords: disaster response, Kermanshah earthquake, natural disasters, NGOs

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Authors: Jacqueline Eleonora Ek, Michael Spiteri, Chris Giordimaina, Pierre Agius

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Background: Malta is known for being a key player as a frontline country with regard to irregular immigration from Africa to Europe. Every year the island experiences an influx of migrants as boat movement across the Mediterranean continues to be a humanitarian challenge. Irregular immigration and applying for asylum is both a lengthy and mentally demanding process. Those doing so are often faced with multiple challenges, which can adversely affect their mental health. Between January and August 2020, Malta disembarked 2 162 people rescued at sea, 463 of them between July & August. Given the small size of the Maltese islands, this regulation places a disproportionately large burden on the country, creating a backlog in the processing of asylum applications resulting in increased time periods of detention. These delays reverberate throughout multiple management pathways resulting in prolonged periods of detention and challenging access to health services. Objectives: To better understand the spatial dimensions of this humanitarian crisis, this study aims to assess disparities in the acute medical management of migrants presenting to the emergency department (ED) with acute mental health presentations as compared to that of local and non-local residents. Method: In this retrospective study, 17795 consecutive ED attendances were reviewed to look for acute mental health presentations. These were further evaluated to assess discrepancies in transportation routes to hospital, nature of presenting complaint, effects of language barriers, use of CT brain, treatment given at ED, availability of psychiatric reviews, and final admission/discharge plans. Results: Of the ED attendances, 92.3% were local residents, and 7.7% were non-locals. Of the non-locals, 13.8% were migrants, and 86.2% were other-non-locals. Acute mental health presentations were seen in 1% of local residents; this increased to 20.6% in migrants. 56.4% of migrants attended with deliberate self-harm; this was lower in local residents, 28.9%. Contrastingly, in local residents, the most common presenting complaint was suicidal thought/ low mood 37.3%, the incidence was similar in migrants at 33.3%. The main differences included 12.8% of migrants presenting with refused oral intake while only 0.6% of local residents presented with the same complaints. 7.7% of migrants presented with a reduced level of consciousness, no local residents presented with this same issue. Physicians documented a language barrier in 74.4% of migrants. 25.6% were noted to be completely uncommunicative. Further investigations included the use of a CT scan in 12% of local residents and in 35.9% of migrants. The most common treatment administered to migrants was supportive fluids 15.4%, the most common in local residents was benzodiazepines 15.1%. Voluntary psychiatric admissions were seen in 33.3% of migrants and 24.7% of locals. Involuntary admissions were seen in 23% of migrants and 13.3% of locals. Conclusion: Results showed multiple disparities in health management. A meeting was held between entities responsible for migrant health in Malta, including the emergency department, primary health care, migrant detention services, and Malta Red Cross. Currently, national quality-improvement initiatives are underway to form new pathways to improve patient-centered care. These include an interpreter unit, centralized handover sheets, and a dedicated migrant health service.

Keywords: emergency department, communication, health, migration

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Authors: Hind Alshoubaki

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The world is now confronting a widespread urban phenomenon: refugee camps, which have mostly been established in ‘rushing mode,’ pointing toward affording temporary settlements for refugees that provide them with minimum levels of safety, security and protection from harsh weather conditions within a very short time period. In fact, those emergency settlements are transforming into permanent ones since time is a decisive factor in terms of construction and camps’ age. These play an essential role in transforming their temporary character into a permanent one that generates deep modifications to the city’s territorial structure, shaping a new identity and creating a contentious change in the city’s form and history. To achieve a better understanding for the transformation of refugee camps, this study is based on a mixed-methods approach: the qualitative approach explores different refugee camps and analyzes their transformation process in terms of population density and the changes to the city’s territorial structure and urban features. The quantitative approach employs a statistical regression analysis as a reliable prediction of refugees’ satisfaction within the Zaatari camp in order to predict its future transformation. Obviously, refugees’ perceptions of their current conditions will affect their satisfaction, which plays an essential role in transforming emergency settlements into permanent cities over time. The test basically discusses five main themes: the access and readiness of schools, the dispersion of clinics and shopping centers; the camp infrastructure, the construction materials, and the street networks. The statistical analysis showed that Syrian refugees were not satisfied with their current conditions inside the Zaatari refugee camp and that they had started implementing changes according to their needs, desires, and aspirations because they are conscious about the fact of their prolonged stay in this settlement. Also, the case study analyses showed that neglecting the fact that construction takes time leads settlements being created with below-minimum standards that are deteriorating and creating ‘slums,’ which lead to increased crime rates, suicide, drug use and diseases and deeply affect cities’ urban tissues. For this reason, recognizing the ‘temporary-eternal’ character of those settlements is the fundamental concept to consider refugee camps from the beginning as definite permanent cities. This is the key factor to minimize the trauma of displacement on both refugees and the hosting countries. Since providing emergency settlements within a short time period does not mean using temporary materials, having a provisional character or creating ‘makeshift cities.’

Keywords: refugee, refugee camp, temporary, Zaatari

Procedia PDF Downloads 108

Authors: Krishna Gopal Lageju

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On 25th April 2015, a 7.6 magnitude earthquake struck Gorkha district of Nepal, which resulted over 8,790 deaths and 22,300 injuries. In addition, almost one-third of the country’s healthcare service has been disrupted. A total of 1,211 health facilities became non-operational, due to 446 completely and other 765 partially damaged. Nearly 84 percent (375 out of 446) of the completely damaged health facilities are in the 14 most affected districts. As a result, the ability of health facilities to respond to health care needs has been harshly affected. In addition, 18 health workers lost their lives and 75 are injured, which added further challenges in the delivery of health services. Thus, to address the immediate health needs in the most devastated areas, Nepal Red Cross Society (NRCS) in coordination with IFRC and Nepal Government, 8 Field hospitals established with surgical capacities, where around 492 international Emergency Response Units (ERUs) Members are mobilized for 3 months period. More than 54,000 patients have been treated in the Red Cross operated field hospitals. Trauma cases accounted 9,180 (17%) of the total patients off which 1,285 (14%) are major surgical cases. Most of the case loads 44,830 (83%) are outpatients and 9,180 patients got inpatients service. Similarly, 112 births have been performed in the field hospitals. Inpatient mortality rate remained 1.5% (21 deaths), many of them are presented with critical injuries or illnesses. No outbreak has been seen during the ERU operation. Deployment of ERUs together with national health workers are very important to address the immediate health needs of the affected communities. This will ease for transition and handover of emergency service and equipments to local provider. Likewise, capacity building of local staff as on the job training on various clinical teachings would be another important issue to look at before phasing out such services.

Keywords: trauma management, critical injuries, earthquake, health

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Authors: P. Donnelly, G. Mitchell

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Traumatic Brain Injury (TBI) is a major contributor to the global burden of disease; despite its ubiquity, there is significant variation in diagnosis, prognosis, and treatment between clinicians. This study aims to examine the spectrum of approaches that currently exist at a Level 1 Trauma Centre in Australasia by surveying Emergency Physicians and Neurosurgeons on those aspects of mTBI. A pilot survey of 17 clinicians (Neurosurgeons, Emergency Physicians, and others who manage patients with mTBI) at a Level 1 Trauma Centre in Brisbane, Australia, was conducted. The objective of this study was to examine the importance these clinicians place on various elements in their approach to the diagnosis, prognostication, and treatment of mTBI. The data were summarised, and the descriptive statistics reported. Loss of consciousness and post-traumatic amnesia were rated as the most important signs or symptoms in diagnosing mTBI (median importance of 8). MRI was the most important imaging modality in diagnosing mTBI (median importance of 7). ‘Number of the Previous TBIs’ and Intracranial Injury on Imaging’ were rated as the most important elements for prognostication (median importance of 9). Education and reassurance were rated as the most important modality for treating mTBI (median importance of 7). There was a statistically insignificant variation between the specialties as to the importance they place on each of these components. In this Australian tertiary trauma center, there appears to be variation in how clinicians approach mTBI. This study is underpowered to state whether this is between clinicians within a specialty or a trend between specialties. This variation is worthwhile in investigating as a step toward a unified approach to diagnosing, prognosticating, and treating this common pathology.

Keywords: mild traumatic brain injury, adult, clinician, survey

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Authors: Angelis P. Barlampas

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An 89 years old woman came to the emergency department complaining of long-lasting headaches and nausea. A CT examination was performed, and a homogeneous midline anterior cranial fossa lesion was revealed, which was situated near the base and measured 2,4 cm in diameter. The patient was allergic, and an i.v.c injection could not be done on the spot, and neither could an MRI exam because of metallic implants. How could someone narrow down the differential diagnosis? The interhemispheric meningioma is usually a silent midline lesion with no edema, and most often presents as a homogeneous, solid type, isodense, or slightly hyperdense mass ( usually the smallest lesions as this one ). Of them, 20-30% have some calcifications. Hyperostosis is typical for meningiomas that abut the base of the skull but is absent in the current case, presumably of a more cephalad location that is borderline away from the bone. Because further investigation could not be done, as the patient was allergic to the contrast media, some other differential options should be considered. Regarding the site of the lesion, the most common other entities to keep in mind are the following: Metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma, giant aneurysm of the anterior cerebral artery, midline lesion. Appearance will depend on whether the aneurysm is non-thrombosed, or partially, or completely thrombosed. Non-contrast: slightly hyperdense, well-defined round extra-axial mass, may demonstrate a peripheral calcified rim, olfactory neuroblastoma, midline lesion. The mass is of soft tissue attenuation and is relatively homogeneous. Focal calcifications are occasionally present. When an intracranial extension is present, peritumoral cysts between it and the overlying brain are often present. Final diagnosis interhemispheric meningioma (Known from the previous patient’s history). Meningiomas come from the meningocytes or the arachnoid cells of the meninges. They are usually found incidentally, have an indolent course, and their most common location is extra-axial, parasagittal, and supratentorial. Other locations include the sphenoid ridge, olfactory groove, juxtasellar, infratentorial, intraventricular, pineal gland area, and optic nerve meningioma. They are clinically silent entities, except for large ones, which can present with headaches, changes in personality status, paresis, or symptomatology according to their specific site and may cause edema of the surrounding brain tissue. Imaging findings include the presence of calcifications, the CSF cleft sign, hyperostosis of adjacent bone, dural tail, and white matter buckling sign. After i.v.c. injection, they enhance brightly and homogenously, except for large ones, which may exhibit necrotic areas or may be heavily calcified. Malignant or cystic variants demonstrate more heterogeneity and less intense enhancement. Sometimes, it is inevitable that the needed CT protocol cannot be performed, especially in the emergency department. In these cases, the radiologist must focus on the characteristic imaging features of the unenhanced lesion, as well as in previous examinations or a known lesion history, in order to come to the right report conclusion.

Keywords: computed tomography, emergency radiology, metastasis, tumor of skull base, abscess, primary brain tumors, meningioma, giant aneurysm of the anterior cerebral artery, olfactory neuroblastoma, interhemispheric meningioma

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Authors: Davina Von Hagt, Genevieve Gibbons, Matt Henderson, Tom Bowles

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Purpose: Food bolus obstructions are common emergency surgical presentations, but there is no established management guideline in a rural setting. Intervention usually involves endoscopic removal after initial medical management has failed. Within a rural setting, this falls upon the general surgeon. There are varied endoscopic techniques that may be used. Methodology: A review of the past fifty cases of food bolus obstruction managed at Albany Health Campus was retrospectively reviewed to assess endoscopic findings and techniques. Operation notes, histopathology, imaging, and patient notes were reviewed. Results: 50 patients underwent gastroscopy for food bolus obstruction from August 2017 to March 2021. Ages ranged from 11 months to 95 years, with the majority of patients aged between 30-70 years. 88% of patients were male. Meat was the most common bolus (20% unspecified, 20% steak, 10% chicken, 6% lamb, 4% sausage, 2% pork). At endoscopy, 12% were found not to have a food bolus obstruction. Two patients were found to have oesophageal cancer, and four patients had a stricture and required dilatation. A variety of methods were used to relieve oesophageal obstruction ranging from pushing through to stomach (24 patients), using an overtube (10 patients), raptor (13 patients), and less common instruments such as Roth net, basket, guidewire, and pronged grasper. One patient had an unsuccessful endoscopic retrieval and required theatre for laparoscopic assisted removal with rendezvous endoscopic piecemeal removal via oesophagus and gastrostomy. Conclusion: Food bolus obstruction is a common emergency presentation. Within the rural setting, management requires innovation and teamwork within the safety of the local experience.

Keywords: food bolus obstruction, regional hospital, surgical management, innovative surgical treatment

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Authors: Omer Shujat Bhatti, Afshan Huma

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Online educational system were considered a great opportunity for distance learning. In recent days of COVID19 pandemic, it enable the continuation of educational activities at all levels of education, from primary school to the top level universities. One of the key considered element in supporting the online educational system is video lectures. The current research explored the usefulness of the video lectures delivered to technical students of masters level with a focus on MSc Sustainable Environmental design students who have diverse backgrounds in the formal educational system. Hence they were unable to cope right away with the online system and faced communication and understanding issues in the lecture session due to internet and allied connectivity issues. Researcher used self prepared video lectures for respective subjects and provided them to the students using Youtube channel and subject based Whatsapp groups. Later, students were asked about the usefulness of the lectures towards a better understanding of the subject and an overall enhanced learning experience. More than 80% of the students appreciated the effort and requested it to be part of the overall system. Data collection was done using an online questionnaire which was prior briefed to the students with the purpose of research. It was concluded that video lectures should be considered an integral part of the lecture sessions and must be provided prior to the lecture session, ensuring a better quality of delivery. It was also recommended that the existing system must be upgraded to support the availability of these video lectures through the portal. Teachers training must be provided to help develop quality video content ensuring that is able to cover the content and courses taught.

Keywords: video lectures, online distance education, synchronous instruction, asynchronous communication

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Incisional and ventral hernias are highly prevalent, with primary ventral hernias occurring in approximately 20% of adults and incisional hernias developing in up to 30% of midline abdominal incisions. Recent data from the United States have shown an increasing incidence of elective incisional and ventral hernia repair (IVHR) and emergency repair of complicated hernias. This study examines Australian population trends in IVHR over a two-decade study period. Methods: This retrospective study was performed using procedure data from the Australian Institute of Health and Welfare, and population data from the Australian Bureau of Statistics captured between 2000 and 2021 to calculate incidence rates per 100,000 population by age and sex for selected subcategories of IVHR operations. Trends over time were evaluated using simple linear regression. Results: There were 809,308 IVHR operations performed in Australia during the study period. The cumulative incidence adjusted for the population was 182 per 100,000; this increased by 9.578 per year during the study period (95% CI = 8.431- 10.726, p<.001). IVHR for primary umbilical hernias experienced the most significant increase in population-adjusted incidence, 1.177 per year. (95% CI = 0.654- 1.701, p<.001). Emergency IVHR for incarcerated, obstructed, and strangulated hernias increased by 0.576 per year (95% CI = 0.510 -0.642, p<.001). Only 20.2% of IVHR procedures were performed as day surgery. Conclusions: Australia has seen a significant increase in IVHR operations performed in the last 20 years, particularly those for primary ventral hernias. IVHR for hernias complicated by incarceration, obstruction, and strangulation also increased significantly. The proportion of IVHR operations performed as day surgery is well below the target set by the Royal Australasian College of Surgeons. With the increasing incidence of IVHR operations and an increasing proportion of these being emergent, elective IVHR should be performed as day surgery when it is safe.

Keywords: ventral, incisional, hernia, trends

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