Search results for: emergency department

Authors: Zhao Jiashen, Serene Goh, Jerry Goo, Anthony Li, Lim Woan Wui, Paul Drakeford, Chen Qing Yan

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Introduction: Emergency laparotomy (EL) is one of the most common surgeries done in Singapore to treat acute abdominal pathologies. A significant proportion of these surgeries are performed in the geriatric population (65 years and older), who tend to have the highest postoperative morbidity, mortality, and highest utilization of intensive care resources. Frailty, the state of vulnerability to adverse outcomes from an accumulation of physiological deficits, has been shown to be associated with poorer outcomes after surgery and remains a strong driver of healthcare utilization and costs. To date, there is little understanding of the impact it has on emergency laparotomy outcomes. The objective of this study is to examine the impact of frailty on postoperative morbidity, mortality, and length of stay after EL. Methods: A retrospective study was conducted in two tertiary centres in Singapore, Tan Tock Seng Hospital and Khoo Teck Puat Hospital the period from January to December 2019. Patients aged 65 years and above who underwent emergency laparotomy for intestinal obstruction, perforated viscus, bowel ischaemia, adhesiolysis, gastrointestinal bleed, or another suspected acute abdomen were included. Laparotomies performed for trauma, cholecystectomy, appendectomy, vascular surgery, and non-GI surgery were excluded. The Clinical Frailty Score (CFS) developed by the Canadian Study of Health and Aging (CSHA) was used. A score of 1 to 4 was defined as non-frail and 5 to 7 as frail. We compared the clinical outcomes of elderly patients in the frail and non-frail groups. Results: There were 233 elderly patients who underwent EL during the study period. Up to 26.2% of patients were frail. Patients who were frail (CFS 5-9) tend to be older, 79 ± 7 vs 79 ± 5 years of age, p <0.01. Gender distribution was equal in both groups. Indication for emergency laparotomies, time from diagnosis to surgery, and presence of consultant surgeons and anaesthetists in the operating theatre were comparable (p>0.05). Patients in the frail group were more likely to receive postoperative geriatric assessment than in the non-frail group, 49.2% vs. 27.9% (p<0.01). The postoperative complications were comparable (p>0.05). The length of stay in the critical care unit was longer for the frail patients, 2 (IQR 1-6.5) versus 1 (IQR 0-4) days, p<0.01. Frailty was found to be an independent predictor of 90-day mortality but not age, OR 2.9 (1.1-7.4), p=0.03. Conclusion: Up to one-fourth of the elderly who underwent EL were frail. Patients who were frail were associated with a longer length of stay in the critical care unit and a 90-day mortality rate of more than three times that of their non-frail counterparts. PPOSSUM was a better predictor of 90-day mortality in the non-frail group than in the frail group. As frailty scoring was a significant predictor of 90-day mortality, its integration into acute surgical units to facilitate shared decision-making and discharge planning should be considered.

Keywords: frailty elderly, emergency, laparotomy

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Authors: A. Erragh, K. Amanzoui, M. Elharit, H. Salem, M. Ababneh, K. Elfakhr, S. Kalouch, A. Chlilek

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Guillain-Barre syndrome (GBS) is the most common form of acute polyradiculoneuritis (PRNA). It is a medical emergency in pediatrics that requires rapid diagnosis and immediate assessment of the severity criteria for the implementation of appropriate treatment. Retrospective, descriptive study in 24 patients under the age of 18 who presented with GBS between September 2017 and July 2021 and were hospitalized in the multipurpose pediatric intensive care unit of the Abderrahim EL Harouchi children's hospital in Casablanca. The average age was 7.91 years, with extremes ranging from 18 months and 14 years and a male predominance of 75%. After a prodromal event, most often infectious (80%) and a free interval of 12 days on average, 2 types of motor disorders begin either hypo or arereflectic flaccid paralysis of the lower limbs (45.8%) or flaccid quadriplegia hypo or arereflectic (54.2%). During GBS, the most formidable complication is respiratory distress, which can occur at any time. In our study, respiratory impairment was observed in 70.8% of cases. In addition, other signs of severity, such as swallowing disorders (75%) and dysautonomic disorders (8.33%), were also observed, which justified care in the intensive care unit for all of our patients. The use of invasive ventilation was necessary in 76.5% of cases, and specific treatments based on immunoglobulins were administered in all our patients. Despite everything, the death rate remains high (25%) and is mainly due to complications related to hospitalization. Guillain Barré syndrome is, therefore, a pediatric emergency that requires rapid diagnosis and immediate assessment of severity criteria for the implementation of appropriate treatment.

Keywords: guillain barre syndrome, emergency, children, medical

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Authors: Gokul Pathak, Dilip Kumar Yadav

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Background: Unsafe/unprotected and early sexual relations are highly responsible for the problems of unwanted pregnancy, child birth and other adverse consequences. Emergency contraception (EC) refers to methods that women can use to prevent pregnancy after unprotected sexual intercourse, method failure or incorrect use. Aim and Objective: The objective of this research study was to assess the level of knowledge, attitude and behavior on emergency contraception among youth students of Lekhnath Municipality. Methodology: This institution based descriptive study was carried out in August-October 2012 on Lekhnath Municipality, Nepal. Multistage simple random sampling procedure with pretested semi structured questionnaire following self administered technique was used to collect information. Collected data was coded and entered in the EpiData 3.1 ® and exported to Statistical Package for Social Science (SPSS®) version 20.0 for analysis. Chi-square test and Spearman correlation was applied wherever required. Results: A total of 641 students (87.6 %), youth students participated in this study which incorporates 354 male and 287 female youth students, of them 54.3% were from Higher Secondary level and 45.7% were from Undergraduate level. The awareness of EC among respondents was found only 64.7%. 25.8% respondents were found to have fair knowledge level where as 74.2% had poor knowledge level. Level of knowledge was significantly associated with age, educational level, faculty and educational status of mother. The study showed 82.4% respondent’s favorable attitude towards use of EC. 21.1% respondents were found to be sexually active (29.7% male and 10.5% female) and only 28.1% of sexually active respondents had ever used any method of EC. Conclusion: Knowledge about EC was found quiet low among youth. There was significant lack of knowledge about exact time limit of using devices of EC. Similarly several misconceptions regarding EC were found very high among youth. Health education initiatives should target students as they are more likely to be sexually active.

Keywords: emergency contraception, youth, unsafe/unprotected sexual intercourse, knowledge, attitude and behavior

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Authors: Eren Özceylan, Cihan Çetinkaya

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Quality function deployment (QFD) is a technique to assist transform the voice of the customer into engineering characteristics for a product/service. With the difference of existing studies, QFD is applied to an educational area that is a service sector which is not a manufacturing firm. The objective of the study is to design the undergraduate program according to students’ desire and expectations. To do so, third and fourth year students of industrial engineering department of Gaziantep University are considered as customers. Some suggestions about lecturers, courses, exams and facility for how to satisfy students’ demands are presented and as a result, sharing the materials of courses is the most important requirement among others.

Keywords: higher education, quality function deployment, quality house, voice of customer

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Authors: D. Osborn, L. Easthope

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The increasing threat of ‘marauding terror,' utilising improvised explosive devices and firearms, has focused the attention of policy makers and emergency responders once again on the treatment of the critically injured patient in a highly volatile scenario. Whilst there have been significant improvements made in the response and lessons learned from recent disasters in the international disaster community there still remain areas of uncertainty and a lack of clarity in the care of the critically injured. This innovative, longitudinal study has at its heart the aim of using ethnographic methods to ‘slow down’ the journey such patients will take and make visible the ethical complexities that 2017 technologies, expectations and over a decade of improved combat medicine techniques have brought. The primary researcher, previously employed in the hospital emergency management environment, has closely followed responders as they managed casualties with life-threatening injuries. Ethnographic observation of Exercise Unified Response in March 2016, exposed the ethical and legal 'vacuums' within a mass casualty and fatality setting, specifically the extrication, treatment and care of critically injured patients from crushed and overturned train carriages. This article highlights a gap in the debate, evaluation, planning and response to an incident of this nature specifically the incapacitated, unidentified patients and the ethics of submitting them to the invasive ‘Disaster Victim Identification’ process. Using a qualitative ethnographic analysis, triangulating observation, interviews and documentation, this analysis explores the gaps and highlights the next stages in the researcher’s pathway as she continues to explore with emergency practitioners some of this century’s most difficult questions in relation to the medico-legal and ethical challenges faced by emergency services in the wake of new and emerging threats and medical treatment expectations.

Keywords: ethics, disaster, Disaster Victim Identification (DVI), legality, unidentified

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Authors: Fayaz Moosavi, Saeid Moradyfard

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One of the methods in avoiding management fraud and increasing the quality of financial information, is the notification of qualitative features of financial information, including conservatism characteristic. Although taking a conservatism approach, while boosting the quality of financial information, is able to reduce the informational risk and the cost of capital stock of commercial department, by presenting an improper image about the situation of the commercial department, raises the risk of failure in returning the main and capital interest, and consequently the cost of capital of the commercial department. In order to know if conservatism finally leads to the increase or decrease of the cost of capital or does not have any influence on it, information regarding accepted companies in Tehran stock exchange is utilized by application of pooling method from 2007 to 2012 and it included 124 companies. The results of the study revealed that there is an opposite and meaningful relationship between conditional conservatism and the cost of capital of the company. In other words, if bad and unsuitable news and signs are reflected sooner than good news in accounting profit, the cost of capital of the company increases. In addition, there is a positive and meaningful relationship between the cost of capital and lack of information asymmetry.

Keywords: conditional conservatism, lack of information asymmetry, the cost of capital, stock exchange

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Authors: K. Mellou, G. Anastopoulos, T. Zakinthinos, C. Botsi, A. Terzidis

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‘PHILOS – Emergency health response to refugee crisis’ is a programme of the Greek Ministry of Health, implemented by the Hellenic Center for Disease Control and Prevention (HCDCP). The programme is funded by the Asylum, Migration and Integration Fund (AMIF) of EU’s DG Migration and Home Affairs. With the EU Member States accepting, the last period, accelerating migration flows, Greece inevitably occupies a prominent position in the migratory map due to this geographical location. The main objectives of the programme are a) reinforcement of the capacity of the public health system and enhancement of the epidemiological surveillance in order to cover refugees/migrant population, b) provision of on-site primary health care and psychological support services, and c) strengthening of national health care system task-force. The basic methods for achieving the aforementioned goals are: a) implementation of syndromic surveillance system at camps and enhancement of public health response with the use of mobile medical units (Sub-action A), b) enhancement of health care services inside the camps via increasing human resources and implementing standard operating procedures (Sub-action B), and c) reinforcement of the national health care system (primary healthcare units, hospitals, and emergency care spots) of affected regions with personnel (Sub-action C). As a result, 58 health professionals were recruited under sub-action 2 and 10 mobile unit teams (one or two at each health region) were formed. The main actions taken so far by the mobile units are the evaluation, of syndromic surveillance, of living conditions at camps and medical services. Also, vaccination coverage of children population was assessed, and more than 600 catch-up vaccinations were performed by the end of June 2017. Mobile units supported transportation of refugees/migrants from camps to medical services reducing the load of the National Center for Emergency Care (more than 350 transportations performed). The total number of health professionals (MD, nurses, etc.) placed at camps was 104. Common practices were implemented in the recording and collection of psychological and medical history forms at the camps. Protocols regarding maternity care, gender based violence and handling of violent incidents were produced and distributed at personnel working at camps. Finally, 290 health care professionals were placed at primary healthcare units, public hospitals and the National Center for Emergency Care at affected regions. The program has, also, supported training activities inside the camps and resulted to better coordination of offered services on site.

Keywords: migrants, refugees, public health, syndromic surveillance, national health care system, primary care, emergency health response

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Authors: Ewa M. Laskowska, Jorn Vatn

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Industry 4.0 focuses on digital optimization of industrial processes. The idea is to use extracted data in order to build a decision support model enabling use of those data for real time decision making. In terms of predictive maintenance, the desired decision support tool would be a model enabling prognostics of system's health based on the current condition of considered equipment. Within area of system prognostics and health management, a commonly used health indicator is Remaining Useful Lifetime (RUL) of a system. Because the RUL is a random variable, it has to be estimated based on available health indicators. Health indicators can be of different types and come from different sources. They can be process variables, equipment performance variables, data related to number of experienced failures, etc. The aim of this study is the analysis of performance variables of emergency shutdown valves (ESV) used in oil and gas industry. ESV is inspected periodically, and at each inspection torque and time of valve operation are registered. The data will be analyzed by means of machine learning or statistical analysis. The purpose is to investigate whether the available data could be used as a health indicator for a prognostic purpose. The second objective is to examine what is the most efficient way to incorporate the data into predictive model. The idea is to check whether the data can be applied in form of explanatory variables in Markov process or whether other stochastic processes would be a more convenient to build an RUL model based on the information coming from registered data.

Keywords: emergency shutdown valves, health indicator, prognostics, remaining useful lifetime, RUL

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Authors: Vesna Šućur-Janjetović, Andrea Rakanović Radonjić

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Department of Social Work of the Faculty of Political Sciences, University of Banja Luka is the only School of Social Work in the Republic of Srpska (entity of Bosnia and Herzegovina). This Department has been implementing students’ practice as mandatory module since it was established in year 2000. As of 2006, the University of Banja Luka initiated the transformation of the education system in accordance with the Bologna Agreement. The Department of Social Work adopted a new Curriculum that anticipated 120 hours of Students’ practice. After ten years, a new process of changing and improving the Curriculum has been initiated, and research was conducted, in order to meet both the needs of practice and academic standards in the field of social work education. From 2006-2016 students were evaluating their practice experience under the mentor’s supervision. These evaluations were subject to the evaluation process of current Curriculum, including students practice module. Additional research was designed in order to assess the opinions of certified mentors on specific aspects of students’ practice, the needs of practice and possibilities for improving the education for social workers. Special research instruments were designed for the purpose of this research. All mentors were graduated social works working in all fields where social work services are provided (social welfare sector, health, education, non-government sector etc.). The third dimension of the research was a qualitative analysis of curriculums of Schools of Social Work in the region of Southeast Europe. This paper represents the results of the research, conclusions and consequences that led towards the improvement of Students’ practice and Curriculum of the Department of Social Work. The new Model anticipates 300 hours of Students’ practice, divided in three years of study, with different and specific learning outcomes.

Keywords: curriculum, Republic of Srpska, social work education, students’ practice

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Authors: Tess Howard, Lily Owens, Maneesha De Silva, Russell Hodgson

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Purpose: This study aims to evaluate the cost-effectiveness of laparoscopic common bile duct exploration (CBDE) compared to endoscopic retrograde cholangiopancreatography (ERCP) and cholecystectomy for the emergency management of common bile duct (CBD) stones. Methodology: A retrospective case note review was conducted on consecutive patients undergoing emergency management of CBD stones using either CBDE, or ERCP and cholecystectomy at a single centre between January 2014-October 2014. Data on admission and procedural costs, length of hospital stay, postoperative complications and further stone related interventions were analysed. Results: A total of 350 patients were analysed. Among them, 299 patients underwent CBDE at the time of cholecystectomy, while the remaining 51 underwent ERCP either pre-, intra- or post cholecystectomy. CBDE was associated with lower overall costs compared to ERCP with an average hospital stay cost of $13,093 vs $22,930 respectively. This was largely attributed to shorter hospital stays (6.5 vs 10.3 days), decreased need for intensive care unit admission and fewer postoperative interventions within the CBDE group. Notably, single procedure laparoscopic cholecystectomy with CBDE demonstrated decreased operative costs compared to laparoscopic cholecystectomy combined with ERCP pre-/intra- or post-operatively ($3,747 vs. $4,641). Conclusion: Emergent CBDE is a cost-effective alternative to ERCP for managing CBD stones when combined with cholecystectomy. The upfront investment in equipment for CBDE and increased cholecystectomy procedural time is counterbalanced by reduced hospital stay, fewer procedures and subsequent cost savings. Economic considerations, in conjunction with clinical outcomes, should inform the selection of the optimal approach for CBD stone management in emergency settings.

Keywords: choledocolithiasis, management, cost-effectiveness, endoscopic retrograde cholangiopancreatography, ERCP, CBDE, common bile duct exploration

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Authors: Joanna Grzybowska, Magdalena Igras, Mariusz Ziółko

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Association rule learning is an approach for discovering interesting relationships in large databases. The analysis of relations, invisible at first glance, is a source of new knowledge which can be subsequently used for prediction. We used this data mining technique (which is an automatic and objective method) to learn about interesting affects associations in a corpus of emergency phone calls. We also made an attempt to match revealed rules with their possible situational context. The corpus was collected and subjectively annotated by two researchers. Each of 3306 recordings contains information on emotion: (1) type (sadness, weariness, anxiety, surprise, stress, anger, frustration, calm, relief, compassion, contentment, amusement, joy) (2) valence (negative, neutral, or positive) (3) intensity (low, typical, alternating, high). Also, additional information, that is a clue to speaker’s emotional state, was annotated: speech rate (slow, normal, fast), characteristic vocabulary (filled pauses, repeated words) and conversation style (normal, chaotic). Exponentially many rules can be extracted from a set of items (an item is a previously annotated single information). To generate the rules in the form of an implication X → Y (where X and Y are frequent k-itemsets) the Apriori algorithm was used - it avoids performing needless computations. Then, two basic measures (Support and Confidence) and several additional symmetric and asymmetric objective measures (e.g. Laplace, Conviction, Interest Factor, Cosine, correlation coefficient) were calculated for each rule. Each applied interestingness measure revealed different rules - we selected some top rules for each measure. Owing to the specificity of the corpus (emergency situations), most of the strong rules contain only negative emotions. There are though strong rules including neutral or even positive emotions. Three examples of the strongest rules are: {sadness} → {anxiety}; {sadness, weariness, stress, frustration} → {anger}; {compassion} → {sadness}. Association rule learning revealed the strongest configurations of affects (as well as configurations of affects with affect-related information) in our emergency phone calls corpus. The acquired knowledge can be used for prediction to fulfill the emotional profile of a new caller. Furthermore, a rule-related possible context analysis may be a clue to the situation a caller is in.

Keywords: data mining, emergency phone calls, emotional profiles, rules

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Authors: Abdelghani Leghouchi

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This study aims to predict the consequences associated with the propagation of the flood wave that may occur after the failure of the Taksebt dam and suggest an efficient emergency action plan (EAP) for mitigation purposes. To achieve the objectives of this study, the hydrodynamic model HEC-RAS 2D was used for the flood routing of the dam break wave, which gave an estimate of the hydraulic characteristics downstream the Taksebt dam. Geospatial analysis of the simulation results conducted in a Geographic information system (GIS) environment showed that many residential areas are considered to be in danger in case of the Taksebt dam break event. Based on the obtained results, an emergency actions plan was suggested to moderate the causalities in the downstream area at risk. Overall, the present study showed that the integration of 2D hydraulic modeling and GIS provides great capabilities in providing realistic view of the dam break wave propagation that enhances assessing the associated risks and proposing appropriate mitigation measures.

Keywords: taksebt dam, dam break, wave propagation time, HEC-RAS 2D

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Authors: Han Gul Lee

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When water treatments utilities are designed, an initial construction site risk assessment is conducted. This helps us to understand general safety risks that each utility needs to be complemented in the designing stage. Once it’s built, an additional risk reassessment process secures and supplements its disaster management and response plan. Because of its constantly changing surroundings with city renovation and developments, the degree of various risks that each facility has to face changes. Therefore, to improve the preparedness for spill incidents or disasters, emergency managers should run spill simulations with the available scientific technologies. This research used a two-dimensional flow routing model to simulate its spill disaster scenario based on its digital elevation model (DEM) collected with drone technologies. The results of the simulations can help emergency managers to supplement their response plan with concrete situational awareness in advance. Planning based on this simulation model minimizes its potential loss and damage when an incident like earthquakes man-made disaster happens, which could eventually be a threat in a public health context. This pilot research provides an additional paradigm to increase the preparedness to spill disasters. Acknowledgment: This work was supported by Korea Environmental Industry & Technology Institute (KEITI) through Environmental R&D Project on the Disaster Prevention of Environmental Facilities Program funded by Korea Ministry of Environment (MOE) (No.202002860001).

Keywords: risk assessment, disaster management, water treatment utilities, situational awareness, drone technologies

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Authors: Vijayabhaskar Reddy Kandula, Peter Provost Taillac, Balasubramanya M. A., Ram Krishnan Nair, Gokul Toshnival, Vibhu Dhawan, Vijaya Karanam, Buffy Cramer

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Introduction: The lack of Emergency Care Services (ECS) is a cause of extensive and serious public health problems in low- and middle-income countries (LMIC), Many LMIC countries have ambulance services that allow timely transfer of ill patients but due to poor care during the ‘Golden Hour’ many deaths occur which are otherwise preventable. Lack of adequate training as evidenced by a study in India is a major reason for poor care during the ‘Golden Hour’. Adapting developed country models which includes staffing specialty-trained doctors in emergency care, is neither feasible nor guarantees cost-effective ECS. Methods: Based on our assessment and felt needs by first-line doctors providing emergency care in 2014, Rajiv Gandhi Health Sciences University’s JeevaRaksha Trust in partnership with the University of Utah, USA, designed, piloted and successfully implemented a 4-day Comprehensive-Emergency Care and Life Support course (C-ECLS) for allopathic doctors. 1730 doctors completed the 4-day course between June 2014 and December- 2020. Subsequently, we conducted a survey to investigate the utilization rates and usefulness of the training. 1662 were contacted but only 309 completed the survey. The respondents had the following designations: Senior faculty (33%), junior faculty (25), Resident (16%), Private-Practitioners (8%), Medical-Officer (16%) and not-working (11%). 51% were generalists (51%) and the rest were specialists (>30 specialties). Results: 97% (271/280) felt they are better doctors because of C-ECLS. 79% (244/309) reported that training helped to save life- specialists more likely than generalists (91% v/s 68%. P<0.05). 64% agreed that they were confident of managing COVID-19 symptomatic patients better because of C-ECLS. 27% (77) were neutral; 9% (24) disagreed. 66% agreed that training helps to be confident in managing COVID-19 critically ill patients. 26% (72) were neutral; 8% (23) disagreed. Frequency of use of C-ECLS skills: Hemorrhage-control (70%), Airway (67%), circulation skills (62%), Safe-transport and communication (60%), managing critically ill patients (58%), cardiac arrest (51%), Trauma (49%), poisoning/animal bites/stings (44%), neonatal-resuscitation (39%), breathing (36%), post-partum-hemorrhage and eclampsia (35%). Among those who used the skills, the majority (ranging from (88%-94%) reported that they were able to apply the skill more effectively because of ECLS training. Conclusion: JeevaRaksha’s C-ECLS is the world’s first comprehensive training. It improves the confidence of front-line doctors and enables them to provide quality care during the ‘Golden Hour’ of emergency. It also prepares doctors to manage unknown emergencies (e.g., COVID-19). C-ECLS was piloted in Morocco, and Uzbekistan and implemented countrywide in Bhutan. C-ECLS is relevant to most settings and offers a replicable model across LMIC.

Keywords: comprehensive emergency care and life support, training, capacity building, low- and middle-income countries, developing countries

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Authors: Wisit Wichitkosoom

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Objectives: To find out the more effect of early cardiologist consultation using a simple technology on the diagnosis and early proper management of patients with Non-STEMI at emergency department of district hospitals without cardiologist on site before transferred. Methods: A cohort study was performed in Udonthani general hospital at Udonthani province. From 1 October 2012–30 September 2013 with 892 patients diagnosed with Non-STEMI. All patients mean aged 46.8 years of age who had been transferred because of Non-STEMI diagnosed, over a 12 week period of studied. Patients whose transferred, in addition to receiving proper care, were offered a cardiologist consultation with average time to Udonthani hospital 1.5 hour. The main outcome measure was length of hospital stay, mortality at 3 months, inpatient investigation, and transfer rate to the higher facilitated hospital were also studied. Results: Hospital stay was significantly shorter for those didn’t consult cardiologist (hazard ratio 1.19; approximate 95% CI 1.001 to 1.251; p = 0.039). The 136 cases were transferred to higher facilitated hospital. No statistically significant in overall mortality between the groups (p=0.068). Conclusions: Early cardiologist consultant can reduce length of hospital stay for patients with cardiovascular conditions outside of cardiac center. The new basic technology can apply for the safety patient.

Keywords: critical, telemedicine, safety, non STEMI

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Authors: Yohtahe Woldegerima Berhe, Tadesse Belayneh Melkie, Girmay Fitiwi Lema, Marye Getnet, Wubie Birlie Chekol

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Introduction: Anxiety was repeatedly reported as the worst aspect of the perioperative time. The objective of this study was to assess the prevalence of preoperative anxiety among adult surgical patients at the University of Gondar Comprehensive Specialized Hospital (UoGCSH), Northwest Ethiopia. Methodology: Hospital-based cross-sectional study was conducted among surgical patients at the university hospital. After obtaining ethical approval, 407 surgical patients were approached during the preoperative period. Preoperative anxiety was assessed by the State-Trait Anxiety Inventory. The association between variables was determined by using binary logistic regression analysis. The strength of association was described in adjusted odds ratio (AOR) and a p-value < 0.05 at a 95% confidence interval which was considered statistically significant. Results: A total of 400 patients were included in this study, with a 98.3% response rate. Preoperative anxiety was observed among 237 (59.3%) patients, and the median (IQR) STAI score was 50 (40 – 56.7). age ≥ 60 years (AOR: 5.7, CI: 1.6 – 20.4, P: 0.007), emergency surgery (AOR: 2.5, CI: 1.3 – 4.7, P: 0.005), preoperative pain (AOR: 2.6, CI: 1.2 – 5.4, P: 0.005), and rural residency (AOR: 1.8, CI: 1.1 – 2.9, P: 0.031) were found significantly associated with preoperative anxiety. Conclusions: The prevalence of preoperative anxiety among surgical patients was high. Older age (≥ 60 years), emergency surgery, preoperative pain, and rural residency were found to be significantly associated with preoperative anxiety. Assessment for preoperative anxiety should be a routine component of preoperative assessment of both elective and emergency surgical patients. Preoperative pain should be appropriately managed as it can help to reduce preoperative anxiety. Optimal anxiety reduction methods should be investigated and implemented in the hospital.

Keywords: preoperative anxiety, anxiety, anxiety of anesthesia and surgery, state-trait anxiety inventory, preoperative care

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Authors: Lee Boudreau, Ash Kumar Khaitu, Laura A. S. MacDonald

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In April 2015, a magnitude 7.8 earthquake struck Nepal, killing, injuring, and displacing thousands of people. The earthquake also damaged water and sanitation service networks, leading to a high risk of diarrheal disease and the associated negative health impacts. In response to the disaster, the Environment and Public Health Organization (ENPHO), a Kathmandu-based non-governmental organization, worked with the Centre for Affordable Water and Sanitation Technology (CAWST), a Canadian education, training and consulting organization, to develop two training programs to educate volunteers on water, sanitation, and hygiene (WASH) needs. The first training program was intended for acute response, with the second focusing on longer term recovery. A key focus was to equip the volunteers with the knowledge and skills to formulate useful WASH advice in the unanticipated circumstances they would encounter when working in affected areas. Within the first two weeks of the disaster, a two-day acute response training was developed, which focused on enabling volunteers to educate those affected by the disaster about local WASH issues, their link to health, and their increased importance immediately following emergency situations. Between March and October 2015, a total of 19 training events took place, with over 470 volunteers trained. The trained volunteers distributed hygiene kits and liquid chlorine for household water treatment. They also facilitated health messaging and WASH awareness activities in affected communities. A three-day recovery phase training was also developed and has been delivered to volunteers in Nepal since October 2015. This training focused on WASH issues during the recovery and reconstruction phases. The interventions and recommendations in the recovery phase training focus on long-term WASH solutions, and so form a link between emergency relief strategies and long-term development goals. ENPHO has trained 226 volunteers during the recovery phase, with training ongoing as of April 2016. In the aftermath of the earthquake, ENPHO found that its existing pool of volunteers were more than willing to help those in their communities who were more in need. By training these and new volunteers, ENPHO was able to reach many more communities in the immediate aftermath of the disaster; together they reached 11 of the 14 earthquake-affected districts. The collaboration between ENPHO and CAWST in developing the training materials was a highly collaborative and iterative process, which enabled the training materials to be developed within a short response time. By training volunteers on basic WASH topics during both the immediate response and the recovery phase, ENPHO and CAWST have been able to link immediate emergency relief to long-term developmental goals. While the recovery phase training continues in Nepal, CAWST is planning to decontextualize the training used in both phases so that it can be applied to other emergency situations in the future. The training materials will become part of the open content materials available on CAWST’s WASH Resources website.

Keywords: water and sanitation, emergency response, education and training, building resilience

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Authors: Jimmy L. Caldoza, Erlito M. Albina

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Information Systems are increasingly being used to monitor and assess government projects as well as improve transparency and combat corruption. With reference to existing information systems relevant to monitoring and evaluation systems adopted by various government agencies from other countries, this research paper aims to help the Philippine government, particularly the Department of Agriculture, in assessing the impact of their programs and projects on their target beneficiaries through the development of the web-based Monitoring and Evaluation Information System with the application of a short messaging system (sms) technology.

Keywords: monitoring and evaluation system, web-based information system, short messaging system technology, database structure and management

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Authors: Itsaree Padphai, Jiranan Pakpeian, Suksun Niponchai

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This study is a descriptive research which aims to: 1) Compare the difference of knowledge before and after using the e-Learning program entitled “Basic Cardiopulmonary Resuscitation for Students in an Emergency Medical Technician Diploma Program”, and 2) Assess the students’ satisfaction after using the said program. This research is a kind of teaching and learning management supplemented with the e-Learning system; therefore, the purposively selected samples are 44 first-year and class-16 students of an emergency medical technician diploma program who attend the class in a second semester of academic year 2012 in Sirindhorn College of Public Health, Khon Kaen province. The research tools include 1) the questionnaire for general information of the respondents, 2) the knowledge tests before and after using the e-Learning program, and 3) an assessment of satisfaction in using the e-Learning program. The statistics used in data analysis percentage, include mean, standard deviation, and inferential statistics: paired t-test. 1. The general information of the respondents was mostly 37 females representing 84.09 percent. The average age was 19.5 years (standard deviation was 0.81), the maximum age was 21 years, and the minimum age was 19 years respectively. Students (35 subjects) admitted that they preferred the methods of teaching and learning by using the e-Learning systems. This was totally 79.95 percent. 2. A comparison on the difference of knowledge before and after using the e-Learning program showed that the mean before an application was 6.64 (standard deviation was 1.94) and after was 18.84 (standard deviation 1.03), which was higher than the knowledge of students before using the e-Learning program with the statistical significance (P value < 0.001). 3. For the satisfaction after using the e-Learning program, it was found that students’ satisfaction was at a very good level with the mean of 4.93 (standard deviation was 0.11).

Keywords: e-Learning, cardiopulmonary resuscitation, diploma program, Khon Kaen Province

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Authors: Dinka Fikadu, Mulugeta Shegaze

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Background: Currently in health facility, provider-initiated human immunodeficiency virus testing is the key entry point to prevention, care, treatment and support services, but most people remains unaware of their HIV status due to various reasons. In many high-prevalence countries, fewer than one in ten people with HIV are aware of their HIV status. HIV, the virus that causes AIDS, “acquired immunodeficiency syndrome, "has become one of the world’s most serious health and development challenges. Reaching individuals with HIV who do not know their serostatus is a global public health priority. Objective: To assess utilization of provider initiated HIV testing and counseling and associated factors among adult outpatient department patients. Methods: Health facility based cross sectional study was conducted among 392 adult outpatient department patients in Wonchi woreda from February 24 to March 24 /2013. The study participant was recruited patients from all adult outpatient department patients of all four public health facilities of wonchi woreda using systematic sampling. A structured interviewer administered questionnaire was used to elicit all important variables from the study participants and multiple logistic regression analysis was used. Result: A total of 371 adult outpatient department patients aged between 15 to 64 years were actively participated in the study and 291(78.4%) of them utilized provider initiated HIV testing and counseling and 80(21.6%) of them refused. Knowledge on HIV is low in the study population; majority of the participants didn’t have comprehensive knowledge (64.7%) and (35.3%) fail to reject misconception about means of HIV transmission and prevention. Utilization of provider-initiated HIV testing and counseling were associated with divorced/widowed marital status[AOR (95%CI) = 0.32(0.15, 0.69)], being male sex [AOR (95%CI) =1.81(1.01, 3.24)], having comprehensive knowledge on HIV [AOR (95%CI) =0.408(0.220,0.759)],having awareness about provider initiated HIV testing and counseling [AOR(95%CI) =2.89(1.48,5.66)] and receiving test on HIV before[AOR (95%CI)=4.15(2.30, 7.47)]. Conclusion: Utilization of provider initiated HIV testing and counseling among adult outpatient departments in wonchi woreda public health facility was [(78.4%)].Strengthening health information through mass media and peer education on HIV to address barrier to testing in the community such as low awareness on PITC, to increase up take of PITC among adult OPD patients.

Keywords: utilization, human immune deficiency, testing, provider, initiate

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Authors: Eman Elsebaie, A. Sedrak, R. Ziada

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Introduction: In the recent decades, heart failure (HF) has become one of the most prevalent cardio-vascular disease (CVDs), especially in the elderly and the main cause of hospitalization in Egypt cardiology departments. By 2030, the prevalence of HF is expected to increase by 25%. Total direct costs will increase to $818 billion, and the total indirect cost in terms of lost productivity is close to $275 billion. The current study was conducted to estimate the economic costs of services delivered for heart failure patients at the cardiology department in Cairo University Hospitals (CUHs). Aim: To gain an understanding of the cost of heart failure disease and its main drivers aiming to minimize associated health care costs. Subjects and Methods: Economic cost analysis study was conducted for a prospective group of all cases of HF admitted to the cardiology department in CUHs from end of March till end of April 2016 and another retrospective randomized sample from patients with HF, during the first 3 months of 2016 to measure estimated average cost per patient per day. Results: The mean age of the prospective group was 48.6 ± 17.16 years versus 52.3 ± 11.5 years for the retrospective group. The median (IQR) of Length of stay was 15 (15) days in the prospective group versus 9 (16) days in the retrospective group. The average HF inpatient cost/day in the cardiology department during April 2016 was 362.32 (255.5) L.E. versus 391.2(255.9) L.E. during January and February 2016. Conclusion: Up to 70% of expenditure in the management of HF is related to hospital admission. The average cost of such an admission was 5540.03 (IQR=7507.8) L.E. and 4687.4 (IQR=7818.8) L.E. with the average cost per day estimated at 362.32 (IQR=255.5) L.E. and 386.2(IQR=255.9) L.E. in prospective and retrospective groups respectively.

Keywords: health care cost, heart failure, hospitalization, inpatient

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Authors: Daniel Alfonso Reséndiz-García, Luis Antonio García-Villanueva

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As a result of the high industrial activity, which arises from the search to satisfy the needs of products and services for society, several chemical accidents have occurred, causing serious damage to different sectors: human, economic, infrastructure and environmental losses. Historically, with the study of this chemical accidents, it has been determined that the causes are mainly due to human errors (inexperienced personnel, negligence, lack of maintenance and deficient risk analysis). The industries have the aim to increase production and reduce costs. However, it should be kept in mind that the costs involved in risk studies, implementation of barriers and safety systems is much cheaper than paying for the possible damages that could occur in the event of an accident, without forgetting that there are things that cannot be replaced, such as human lives.Therefore, it is of utmost importance to implement risk studies in all industries, which provide information for prevention and planning. The aim of this study is to compare risk methodologies by identifying the consequences of accidents related to the storage of flammable, dangerous goods for decision making and emergency response.The methodologies considered in this study are qualitative and quantitative risk analysis and consequence analysis. The latter, by means of modeling software, which provides radius of affectation and the possible scope and magnitude of damages.By using risk analysis, possible scenarios of occurrence of chemical accidents in the storage of flammable substances are identified. Once the possible risk scenarios have been identified, the characteristics of the substances, their storage and atmospheric conditions are entered into the software.The results provide information that allows the implementation of prevention, detection, control, and combat elements for emergency response, thus having the necessary tools to avoid the occurrence of accidents and, if they do occur, to significantly reduce the magnitude of the damage.This study highlights the importance of risk studies applying tools that best suited to each case study. It also proves the importance of knowing the risk exposure of industrial activities for a better prevention, planning and emergency response.

Keywords: chemical accidents, emergency response, flammable substances, risk analysis, modeling

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Authors: Ogwueleka Francisca Nonyelum, Jiya Muhammad

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Poor communication between the victims of the burglaries, road and fire accidents and the agencies, and lack of quick emergency response by the agencies is solved through Machine-to-Machine (M2M) communication. A distress caller is expected to make a call through a network to the respective agency for emergency response but due to some challenges, this often becomes arduous and futile. This research puts forth an Internet-based architecture for Machine-to-Machine (M2M) communication to enhance information dissemination in National Public Security Communication System (NPSCS) network. M2M enables the flow of data between machines and machines and ultimately machines and people with information flowing from a machine over a network, and then through a gateway to a system where it is reviewed and acted on. The research findings showed that Internet-based architecture for M2M communication is most suitable for deployment of a public security network which will allow machines to use Internet to talk to each other.

Keywords: machine-to-machine (M2M), internet-based architecture, network, gateway

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Authors: Ibrahim Burki

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Unfortunately, all organizations (Industrial and Humanitarian/ Non-governmental organizations) are prone to fraud and corruption in their supply chain management routines. The reputational and financial fallout can be disastrous. With the growing number of companies using suppliers based in the local market has certainly increased the threat of fraud as well as corruption. There are various potential threats like, poor or non-existent record keeping, purchasing of lower quality goods at higher price, excessive entertainment of staff by suppliers, deviations in communications between procurement staff and suppliers, such as calls or text messaging to mobile phones, staff demanding extended periods of notice before they allow an audit to take place, inexperienced buyers and more. But despite all the above-mentioned threats, this research paper emphasize upon the effectiveness of well-maintained vendor/s records and sorting/filtration of vendor/s to cut down the possible threats of corruption and fraud. This exercise is applied in a humanitarian organization of Pakistan but it is applicable to whole South Asia region due to the similarity of culture and contexts. In that firm, there were more than 550 (five hundred and fifty) registered vendors. As during the disasters or emergency phases requirements are met on urgent basis thus, providing golden opportunities for the fake companies or for the brother/sister companies of the already registered companies to be involved in the tendering process without declaration or even under some different (new) company’s name. Therefore, a list of required documents (along with checklist) was developed and sent to all of the vendor(s) in the current database and based upon the receipt of the requested documents vendors were sorted out. Furthermore, these vendors were divided into active (meeting the entire set criterion) and non-active groups. This initial filtration stage allowed the firm to continue its work without a complete shutdown that is only vendors falling in the active group shall be allowed to participate in the tenders by the time whole process is completed. Likewise only those companies or firms meeting the set criterion (active category) shall be allowed to get registered in the future along with a dedicated filing system (soft and hard shall be maintained), and all of the companies/firms in the active group shall be physically verified (visited) by the Committee comprising of senior members of at least Finance department, Supply Chain (other than procurement) and Security department.

Keywords: corruption reduction, fraud prevention, supplier management, industrial/humanitarian organizations

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Authors: Eleni Stefania Kalapoda

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Recurring heat waves due to the global climate change emergency pose continuous risks to human health and urban resources. Local and state decision-makers incorporate Heat Vulnerability Indices (HVIs) to quantify and map the relative impact on human health in emergencies. These maps enable government officials to identify the highest-risk districts and to concentrate emergency planning efforts and available resources accordingly (e.g., to reevaluate the location and the number of heat-relief centers). Even though the framework of conducting an HVI is unique per municipality, its accuracy in assessing the heat risk is limited. To resolve this issue, varied housing-related metrics should be included. This paper quantifies and classifies NYC’s single detached housing typology within high-vulnerable NYC districts using detailed energy simulations and post-processing calculations. The results show that the variation in indoor heat risk depends significantly on the dwelling’s design/operation characteristics, concluding that low-ventilated dwellings are the most vulnerable ones. Also, it confirmed that when building-level determinants of exposure are excluded from the assessment, HVI fails to capture important components of heat vulnerability. Lastly, the overall vulnerability ratio of the housing units was calculated between 0.11 to 1.6 indoor heat degrees in terms of ventilation and shading capacity, insulation degree, and other building attributes.

Keywords: heat vulnerability index, energy efficiency, urban heat, resiliency to heat, climate adaptation, climate mitigation, building energy

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Authors: Masoud Swalehe, Semra Günay

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Developed countries are losing many lives to non-communicable diseases as compared to their developing counterparts. The effects of these diseases are mostly sudden and manifest at a very short time prior to death or a dangerous attack and this has consolidated the significance of emergency medical system (EMS) as one of the vital areas of healthcare service delivery. The primary objective of this research is to reduce ambulance response times (RT) of Eskişehir province EMS since a number of studies have established a relationship between ambulance response times and survival chances of patients especially out of hospital cardiac arrest (OHCA) victims. It has been found out that patients who receive out of hospital medical attention in few (4) minutes after cardiac arrest because of low ambulance response times stand higher chances of survival than their counterparts who take longer times (more than 12 minutes) to receive out of hospital medical care because of higher ambulance response times. The study will make use of geographic information systems (GIS) technology to dynamically reallocate ambulance resources according to demand and time so as to reduce ambulance response times. Geospatial-time distribution of ambulance calls (demand) will be used as a basis for optimal ambulance deployment using system status management (SSM) strategy to achieve much demand coverage with the same number of ambulance resources to cause response time reduction. Drive-time polygons will be used to come up with time specific facility coverage areas and suggesting additional facility candidate sites where ambulance resources can be moved to serve higher demands making use of network analysis techniques. Emergency Ambulance calls’ data from 1st January 2014 to 31st December 2014 obtained from Eskişehir province health directorate will be used in this study. This study will focus on the reduction of ambulance response times which is a key Emergency Medical Services performance indicator.

Keywords: emergency medical services, system status management, ambulance response times, geographic information system, geospatial-time distribution, out of hospital cardiac arrest

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Authors: Amani K. Abu-Shaheen, Abdullah Nofal, Humariya Heena

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Introduction: Parental perceptions and practices are important for improving the asthma outcomes in children; indeed, evidence shows that parents of asthmatic children harbor considerable misperceptions of the disease. Objective: To identify the prevalence of asthma and to investigate the perceptions and practices of parents toward asthma and its management in Saudi children. Methods: A two-stage cross-sectional survey of 2000 parents of children aged 3–15 years from schools located in all five districts of Riyadh province located in central Saudi Arabia, was conducted. Data collection was accomplished using a self-administered questionnaire based on information obtained from the literature. Results: Of 1450 children whose parents participated in the study, 600 had asthma, dyspnea, or chest allergy. The overall number of children with parental reports of ever having been diagnosed with asthma was 478 (32.9%). The majority of parents (321, 53.5%) believed that asthma was a hereditary disease. Of these parents, 361 (60.3%) were concerned about side effects of inhaled steroids, and 192 (32%) about development of dependency on asthma medications. Three hundred sixty seven (61.2%) parents reported that they could treat the asthma attack at home and almost 76% of parents went to pediatric emergency department during asthma attack. Conclusions: In this study, the overall prevalence of children whose parents reported that they were diagnosed with asthma was high (32.9%). Furthermore, parents of children with asthma had misperceptions regarding asthma and exhibited ineffective practices in its management. To improve asthma care and compliance, adequate education should be provided to parents.

Keywords: asthma, management, parents, quality of life

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Authors: Berrak Yildiz, Hinal Shah, Justine Fernandez, Nazje James, Anna Brown

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Cervical ectopic pregnancy, a rare type of ectopic pregnancies, is defined by blastocyst implantation within the cervical canal rather than the endometrium. Its rarity and potential for severe hemorrhage make cervical ectopic pregnancy a diagnostic and therapeutic challenge. A 39-year-old woman, G5P2022, with a history of two cesarean sections and two elective terminations, presented to the emergency department with vaginal bleeding and pelvic pain. Initial assessment showed a beta-hCG level of 2,853 mIU/mL, and transvaginal ultrasound revealed a small, irregular gestational sac at the level of the internal cervical os. Serial betahCG measurements over subsequent visits showed a declining trend, consistent with a nonviable pregnancy. The patient was ultimately treated with methotrexate at a dose of 50 mg/m² (total 100 mg), following which she reported no further symptoms. On follow-up, her beta-hCG level returned to the normal non-pregnant range, with no additional intervention needed. This case highlights the importance of early diagnosis in cervical ectopic pregnancy to avoid complications like hysterectomy. Methotrexate is an effective first-line treatment in hemodynamically stable patients, offering a conservative approach that can preserve fertility. The success in this patient underscores the role of prompt diagnosis and careful management in achieving resolution while minimizing invasive procedures.

Keywords: beta-hCG, cervical, ectopic, methotrexate

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Authors: Young S. Bang, Dong H. Yoon, Seung H. Yoo

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Emergency Core Coolant Bypass (ECC Bypass) has been regarded as an important phenomenon to peak cladding temperature of large-break loss-of-coolant-accidents (LBLOCA) in nuclear power plants (NPP). A modeling scheme to address the ECC Bypass phenomena and the calculation of LBLOCA using that scheme are discussed in the present paper. A hydraulic form loss coefficient (HFLC) from the reactor vessel downcomer to the broken cold leg is predicted by the computational fluid dynamics (CFD) code with a variation of the void fraction incoming from the downcomer. The maximum, mean, and minimum values of FLC are derived from the CFD results and are incorporated into the LBLOCA calculation using a system thermal-hydraulic code, MARS-KS. As a relevant parameter addressing the ECC Bypass phenomena, the FLC to the break and its range are proposed.

Keywords: CFD analysis, ECC bypass, hydraulic form loss coefficient, system thermal-hydraulic code

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Authors: Giuseppe Timperio, Robert De Souza

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The combination of factors such as temperamental climate change, rampant urbanization of risk exposed areas, political and social instabilities, is posing an alarming base for the further growth of number and magnitude of humanitarian crises worldwide. Given the unique features of humanitarian supply chain such as unpredictability of demand in space, time, and geography, spike in the number of requests for relief items in the first days after the calamity, uncertain state of logistics infrastructures, large volumes of unsolicited low-priority items, a proactive approach towards design of disaster response operations is needed to achieve high agility in mobilization of emergency supplies in the immediate aftermath of the event. This paper is an attempt in that direction, and it provides decision makers with crucial strategic insights for a more effective network design for disaster response. Decision sciences and ICT are integrated to analyse the robustness and resilience of a prepositioned network of emergency strategic stockpiles for a real-life case about Indonesia, one of the most vulnerable countries in Asia-Pacific, with the model being built upon a rich set of quantitative data. At this aim, a network optimization approach was implemented, with several what-if scenarios being accurately developed and tested. Findings of this study are able to support decision makers facing challenges related with disaster relief chains resilience, particularly about optimal configuration of supply chain facilities and optimal flows across the nodes, while considering the network structure from an end-to-end in-country distribution perspective.

Keywords: disaster preparedness, humanitarian logistics, network optimization, resilience

Procedia PDF Downloads 175