It's not the task, it's the shifting exploring physicians' and leaders' perspectives on task shifting in emergency departments in Norway.

BACKGROUND: Task shifting is an approach where specific tasks are transferred, when convenient, from health workers with high qualifications to health workers with less training and lower qualifications. This approach is mainly used to utilize the available human resources for health. Tasks that are traditionally linked to the physician role have increasingly been transferred to registered nurses during the last decade. Knowledge regarding the experiences and reflections of physicians and their leaders related to giving up tasks or how such policies can best be implemented is limited. This study aimed to explore physicians' and their leaders' perspectives on task shifting, especially to registered nurses, in different Norwegian emergency departments. METHODS: The study was carried out from June to October 2022. It had an explorative and descriptive qualitative design and an inductive approach, semi-structured interviews was used. The study involved ten physicians and leaders from three different regional hospitals in south-eastern Norway. Manifest and latent content analysis were used to analyse the data. The COREQ guidelines were applied in the study. RESULTS: From the three categories 1) The rationale for task shifting, 2) Teambuilding and 3) Implementation of task shifting, with nine subcategories. One overall main theme emerged: It is not the task, it is the shifting - moving towards a person-centred culture. CONCLUSIONS: The study indicates that developing a person-centred culture and fostering a team approach in emergency departments is more important than simply shifting tasks, as task shifting may lead to fragmented care and resistance from physicians. Hospital leaders must invest time and effort into organising teams and providing clear leadership to support the redesign of professional roles, recognising the cultural and traditional challenges involved. Policymakers should promote guideline development, team training programs, and cooperation methods to support a person-centred culture and effective task shifting in emergency departments.

Malaria Diagnosis at the Pediatric Emergency Unit of a Teaching Hospital in Makurdi, North Central Nigeria.

Background: Globally, there were 241 million cases of malaria in 2020, with an estimated 627,000 deaths with Nigeria accounting for 27% of the global malaria cases. In sub-Saharan Africa, testing is low with only 28% of children with a fever receiving medical advice or a rapid diagnostic test in 2021. In Nigeria, there are documented reports of over-diagnosis and over-treatment of malaria in children. Therefore, this study examined the diagnosis of malaria at the Benue State University Teaching Hospital, Makurdi. Methods: A 5-year (2018-2022) retrospective study was carried out at the Emergency Pediatric Unit (EPU). Records of all children presenting to the EPU with an assessment of malaria were retrieved and reviewed. Data was analyzed using SPSS 23. Results: Out of 206 children reviewed, 128 (62.1%) were tested using either malaria RDT or microscopy while 78(37.9%) were not tested. Out of the number tested, 59(46.1%) were negative while 69(53.9%) tested positive, of which 14(20.3%) had uncomplicated malaria while 55(79.7%) had severe malaria. However, while 97.1% (n=67) of the positive cases were treated with IV artesunate, 69.5% (n=41) of those who tested negative and 88.5% (69) of those who were not tested also received IV artesunate. Moreover, while 85.5% (n=59) of those who tested positive received oral artemisinin-based combination therapy (ACT), 72.9% (n=43) of those who tested negative and 67.9% (53) of those who were not tested also received oral ACT. Conclusion: There was over-diagnosis of malaria, and subsequently, over-treatment. Hence continued emphasis on parasitological confirmation of malaria before treatment is recommended.

Factors influencing nurses' pain assessment and management of road traffic casualties: a qualitative study at a military hospital in Ghana.

BACKGROUND: Evidence shows that patients who visit the surgical and trauma emergency units may be discharged with untreated or increased pain levels. This study explored nurses' pain assessment and management approaches at a trauma-surgical emergency unit in Ghana. METHODS: Seventeen nurses who work in the trauma department participated in this qualitative exploratory descriptive study. In-depth individual interviews were conducted, and the thematic analysis was utilized to identify emerging themes and subthemes. RESULTS: Three main themes were identified: patient pain indicators, pain management, and institutional factors influencing pain management. The study revealed that nurses rely on verbal expressions, non-verbal cues, physiological changes, and the severity of pain communicated. The findings highlighted staff shortage, inadequate resources, and lack of standardized guidelines as factors affecting pain and management. CONCLUSIONS: Although the study offers critical new perspectives on nurses' experiences regarding pain related issues at the trauma-surgical emergency units, its small sample size limited its generalizability.

[The psychotrauma prevention algorithm, a paramedical pilot study]. / L'algorithme de prévention du psychotraumatisme, une étude pilote paramédicale.

The aim of the psychotrauma prevention algorithm is to limit the occurrence of psychotrauma in a subject who has experienced a serious life event, by carrying out an initial assessment to define the severity criterion and the monitoring modality best suited to his or her clinical condition. This approach is in line with the philosophy of outreach and the ethics of concern. Recontacting the patient during the course of treatment helps to maintain the therapeutic link and prevent any deterioration in his condition, thus limiting the risk of his traumatic state becoming chronic.

Brazilian Psychiatric Association Consensus on the physical structure and ideal team for psychiatric emergencies services.

INTRODUCTION: An integral part of Brazil's public health system, the psychiatric emergency service (PES) has been instrumental in improving qualified support for crisis situations of mental disorders, equitable, universally accessible, and humanized. The purpose of this article is to present a systematic review and consensus about the physical area and facilities, and ideal team qualified for psychiatric emergencies services on both Brazilian settings. METHODS: The authors conducted a literature search using electronic databases such as MEDLINE (PubMed), Scielo, the Cochrane Database, and documents from the WHO, the Brazilian Ministry of Health, and others deemed relevant by experts. A total of 6839 manuscripts were found, but only 46 were selected. The analysis of article content summarizes consensus statements using the Delphi method and a series of interactive versions to provide a final report. RESULTS: Changes to PES are evaluated considering various experiences and models. The authors highlighted that The Emergency Care Network (ECN) must be coordinated with qualified management, effective implementation of integration of all health equipment's and units. PES must have adequate infrastructure; qualified staff, including a psychiatrist; sufficient consultation and observational spaces; tools and resources for differential diagnosis; training for all staff members; and communication with the health care network to facilitate referrals following patient discharge are all necessary. CONCLUSION: These standardized models need to be available to public health managers so that they can guide the installation of new services and adjust the existing ones, always looking for improvement. The authors propose requirements for PES as a model to be passed over.

[Relationship between the lung ultrasound and the clinical severity of the patient with seasonal flu]. / Lien entre l'aspect échographique du poumon et la sévérité́ clinique du patient atteint d'une grippe saisonnière.

INTRODUCTION: The seasonal flu is a very important reason for consultation every winter. Symptoms can quickly progress to severe pneumonia. Currently, few tools exist to assess the clinical severity of patients. The aim of this study is to demonstrate the role of lung ultrasound as a marker of severity in patients with influenza. METHODS: 79 patients who arrived at the emergency department with flu-like symptoms were included. A pulmonary ultrasound looking for an interstitial syndrome or consolidation was performed. The qSOFA, the SOFA, the saturation, the PaO2/FiO2 ratio, the oxygen needs, the destination of the patient made it possible to establish the seriousness of the pathology of the patient. Ultrasound was then compared to these different tools. RESULTS: The more the ultrasound became pathological, the more we observed a proportion of qSOFA (p = 0.001) and pathological SOFA (p = 0.009). Most patients with acute respiratory distress syndrome have pathological ultrasound (p < 0.001). The average admission saturation is 89.2 % in the "pathological ultrasound" group compared to 95.8 % in the "normal ultrasound" group (p < 0.001). Patients who required invasive therapies had pathological ultrasound (p < 0.001). Of the 28 patients with pathological ultrasound, 24 required hospitalization (p < 0.001). CONCLUSION: Lung ultrasound is a major asset for assessing the severity of the patient with seasonal flu. In addition, ultrasound allows better monitoring of the patient by being able to influence the destination of the latter towards a return home or monitoring in intensive care.

INTRODUCTION: La grippe saisonnière représente chaque hiver un motif de consultation très important. La symptomatologie peut rapidement évoluer vers une pneumonie sévère. Actuellement, peu d'outils existent pour évaluer la sévérité clinique des patients. Le but de cette étude est de démontrer le rôle de l'échographie pulmonaire comme marqueur de sévérité́ chez les patients atteints d'une grippe. Méthodes : L'étude a comporté 79 patients arrivés aux urgences pour grippe. Une échographie pulmonaire a été réalisée à la recherche d'un syndrome interstitiel ou d'une consolidation. Le qSOFA, le SOFA, la saturation, le rapport PaO2/FiO2, les besoins en oxygène, la destination du patient ont permis d'établir la gravité de la pathologie du patient. L'échographie a alors été comparée à ces différents outils. Résultats : Plus l'échographie devient pathologique, plus on observe une proportion de qSOFA (p = 0,001) et de SOFA pathologiques (p = 0,009). La majorité́ des patients ayant un syndrome de détresse respiratoire aiguë ont une échographie pathologique (p < 0,001). La moyenne des saturations d'admission est de 89,2 % dans le groupe «échographie pathologique¼ contre 95,8 % dans le groupe «échographie normale¼ (p < 0,001). Les patients ayant eu recours à des thérapies invasives ont une échographie pathologique (p < 0,001). Sur les 28 patients ayant une échographie pathologique, 24 ont nécessité́ une hospitalisation (p < 0,001). CONCLUSION: L'échographie pulmonaire est un atout majeur pour l'évaluation de la sévérité du patient atteint d'une grippe saisonnière. De plus, l'échographie permet une meilleure surveillance du patient en pouvant influencer la destination de celui-ci vers un retour à̀ domicile ou une surveillance aux soins intensifs.

Nonradiology Health Care Professionals Significantly Benefit From AI Assistance in Emergency-Related Chest Radiography Interpretation.

BACKGROUND: Chest radiographs (CXRs) are still of crucial importance in primary diagnostics, but their interpretation poses difficulties at times. RESEARCH QUESTION: Can a convolutional neural network-based artificial intelligence (AI) system that interprets CXRs add value in an emergency unit setting? STUDY DESIGN AND METHODS: A total of 563 CXRs acquired in the emergency unit of a major university hospital were retrospectively assessed twice by three board-certified radiologists, three radiology residents, and three emergency unit-experienced nonradiology residents (NRRs). They used a two-step reading process: (1) without AI support; and (2) with AI support providing additional images with AI overlays. Suspicion of four suspected pathologies (pleural effusion, pneumothorax, consolidations suspicious for pneumonia, and nodules) was reported on a five-point confidence scale. Confidence scores of the board-certified radiologists were converted into four binary reference standards of different sensitivities. Performance by radiology residents and NRRs without AI support/with AI support were statistically compared by using receiver-operating characteristics (ROCs), Youden statistics, and operating point metrics derived from fitted ROC curves. RESULTS: NRRs could significantly improve performance, sensitivity, and accuracy with AI support in all four pathologies tested. In the most sensitive reference standard (reference standard IV), NRR consensus improved the area under the ROC curve (mean, 95% CI) in the detection of the time-critical pathology pneumothorax from 0.846 (0.785-0.907) without AI support to 0.974 (0.947-1.000) with AI support (P < .001), which represented a gain of 30% in sensitivity and 2% in accuracy (while maintaining an optimized specificity). The most pronounced effect was observed in nodule detection, with NRR with AI support improving sensitivity by 53% and accuracy by 7% (area under the ROC curve without AI support, 0.723 [0.661-0.785]; with AI support, 0.890 [0.848-0.931]; P < .001). Radiology residents had smaller, mostly nonsignificant gains in performance, sensitivity, and accuracy with AI support. INTERPRETATION: We found that in an emergency unit setting without 24/7 radiology coverage, the presented AI solution features an excellent clinical support tool to nonradiologists, similar to a second reader, and allows for a more accurate primary diagnosis and thus earlier therapy initiation.

Bacterial contamination on clinical surfaces and oxygen device accessories in the emergency unit of a tertiary health facility in Ghana.

BACKGROUND: Nosocomial infections have gradually become an emerging threat to the healthcare system over the past decades and have been attributed to poor decontamination of hospital articles and weak antibacterial stewardship policies. This study sought to investigate the effect of disinfection on the prevalence and resistance profile of bacterial contaminants on oxygen device accessories, and clinical surfaces at the emergency unit of a tertiary health facility in Ghana. METHODS: The study employed a cross-sectional study design to evaluate the occurrence of bacteria on surfaces in a tertiary hospital. Luminal swabs of the oxygen device accessories and swabs from clinical surfaces used by healthcare providers were collected for isolation and identification of bacteria. The identified bacteria isolates were then tested for their susceptibility to antibacterial agents. Data from this study were analyzed using Excel (Microsoft Office Suite), and GraphPad Prism 8 software programs. RESULTS: A quarter of the total 44 bacterial isolates obtained from both post-disinfected and pre-disinfected surfaces were Gram-positive, with the remaining isolates being Gram-negative. Pseudomonas aeruginosa was the most frequent bacteria species isolated (41%) followed by Citrobacter sp. (21%). P. aeruginosa, S. aureus, and S. pneumoniae were found to be highly resistant to Chloramphenicol (36%), and Sulfamethoxazole (100%); whereas Ciprofloxacin (91%) was the most effective antibacterial drug used. CONCLUSION: The almost equal prevalence of multidrug-resistant bacteria from both post-disinfected and pre-disinfected surfaces of inanimate objects, and oxygen device accessories connote an ineffective disinfection process which may influence resistance in bacterial contaminants. This requires the overhaul of disinfection protocol and training of hospital staff, and rational use of antibacterial agents at the hospital to mitigating the burden of nosocomial infections.

[Analysis of indigenous dengue in an infectious diseases Hospital in Buenos Aires, Argentina]. / Análisis del dengue autóctono en un hospital de enfermedades infecciosas en la ciudad de Buenos Aires, Argentina.

INTRODUCTION: Dengue is a disease transmitted by mosquitoes of the Aedes genus; this has presented a historical increase in cases in South America, which represents a public health problem. From the Febrile Emergency Unit (UFU) of Hospital Muñiz, the laboratory results were analyzed and the circulating serotype was identified at the level of the Autonomous City of Buenos Aires (CABA), confirming the proportion of indigenous cases, recording symptoms and epidemiology. The objective of this analysis is to highlight the increase in indigenous cases of dengue in CABA. METHODS: An observational and retrospective study was carried out, from January 1 to May 8, 2023, of the positive PCR results for dengue. RESULTS: 1159 patients with febrile symptoms were assisted, of which 554 (47.7%) were probable cases while the remaining 542 (46.7%) were febrile syndromes of another etiology. Of the probable cases, 162 with positive PCR results (29%) were evaluated, of which 18 (11%) were imported and 144 (89%) native. DENV-2 predominated (86% of confirmed cases). The clinical manifestations were fever (100%), myalgia (100%), headache (98%), arthralgia (87%), nausea (46%), and retroocular pain (39%). DISCUSSION: For 10 years, there has been an increase in the number of indigenous dengue cases in CABA. In the analysis of this article, autochthonous dengue appears as an outbreak at the city level. Notification of the clinic and epidemiology is important to consider public health strategies in the fight against dengue and possible new studies related to outbreaks and epidemics.

Introducción: El dengue es una enfermedad transmitida por mosquitos del género Aedes, que presenta un aumento histórico de casos en América del Sur, y representa un problema en salud pública. Desde la Unidad Febril de Urgencias (UFU) del Hospital Muñiz se analizaron los resultados de laboratorio y se identificó el serotipo circulante en la Ciudad Autónoma de Buenos Aires (CABA), la proporción de casos autóctonos, registrando sintomatología y epidemiología. El objetivo de este análisis fue determinar el incremento de casos autóctonos de dengue en CABA. Métodos: Estudio observacional y retrospectivo, entre 1 de enero y 8 de mayo de 2023, de los casos con PCR positiva para dengue. Resultados: Se atendieron 1159 pacientes con sintomatología febril, de los cuales 554 (47.7%) fueron casos probables, mientras que los restantes 542 (46.7%) fueron síndromes febriles de otra etiología. De los casos probables se evaluaron 162 con PCR positiva (29%), de los que 18 (11%) fueron importados y 144 (89%) autóctonos. Predominó el DENV-2 (86% de los casos confirmados). Las manifestaciones clínicas fueron: fiebre (100%), mialgias (100%), cefalea (98%), artralgias (87%), náuseas (46%), dolor retroocular (39%). Discusión: En los últimos 10 años se registró un aumento en el número de casos de dengue autóctono en CABA. Al análisis de este artículo el dengue autóctono se presenta como un brote a nivel de la ciudad. Es importante la notificación de la clínica y epidemiología para considerar estrategias en salud pública en la lucha contra el dengue y posibles nuevos estudios relacionados con brotes y epidemias.

[Monkeypox: characteristics in female population, Buenos Aires, Argentina]. / Viruela símica: características en población femenina, Buenos Aires, Argentina.

Monkeypox is a zoonotic viral disease caused by a virus of the genus Orthopoxvirus. As of January 1, 2022, it has been reported in 110 WHO Member States. It presents with fever, fatigue, painful lymphadenopathy, and rash. It lasts between 2 and 4 weeks. It is usually self-limited, but severe cases have been described in immunocompromised people. This study describes cases of monkeypox in women, diagnosed between June 2022 and February 2023, and it reports epidemiology, clinical aspects, and complications after infection. A retrospective observational study was carried out in the Febrile Emergency Unit (UFU), reviewing positive cases (RT-PCR) for monkeypox and the population with female biological sex was selected. They were questioned about gynecological complications, menstrual pattern, dyspareunia and pelvic pain. 340 consultations for monkeypox were made, 214 (63%) were positive, 211 cases (99%) male and 3 cases (1%) female. Among these cases is a trans woman, who was not included. The average age is 31 years, immunocompetent, with a negative serology report for HIV, syphilis, hepatitis B and C. Both cases had sexual intercourse without a barrier method. The most frequent symptoms are asthenia and skin lesions, especially in the upper and lower limbs, perianal and genital region. As a risk factor they presented unprotected sexual contact. Within the differential diagnoses, other sexually transmitted infections (STIs) should be considered. There were no gynecological complications reported during follow-up.

La viruela símica es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus. Desde el 1 de enero de 2022, se ha notificado en 110 Estados Miembros de la OMS. Se presenta con fiebre, astenia, linfoadenopatías dolorosas y exantema. Dura entre 2 y 4 semanas. Suele ser autolimitada y se han descrito casos graves en personas inmunocomprometidas. El presente trabajo describe casos de viruela símica en mujeres, diagnosticados entre junio del 2022 y febrero del 2023 Se realizó un estudio observacional retrospectivo en la Unidad Febril de Urgencias (UFU), revisando casos positivos (RT-PCR) para viruela símica y se seleccionó la población con sexo biológico femenino. Se consultó sobre complicaciones ginecológicas, patrón menstrual, dispareunia y dolor pélvico. Se realizaron 340 consultas por viruela símica, 214 (63%) fueron positivos, 211 casos (99%) de sexo masculino y 3 casos (1%) femeninos. Dentro de estos casos se encuentra una mujer trans, la cual no se incluyó. La edad promedio es de 31 años, inmunocompetentes, con reporte de serologías negativas para HIV, sífilis, hepatitis B y C. Ambos casos mantuvieron relaciones sexuales sin método de barrera. Los síntomas más frecuentes fueron astenia y lesiones en piel, sobre todo en miembros superiores e inferiores, región perianal y genital. Como factor de riesgo presentaron contacto sexual sin protección. Dentro de los diagnósticos diferenciales, debe tenerse en cuenta otras infecciones de transmisión sexual (ITS). En seguimiento epidemiológico no refirieron complicaciones ginecológicas.

Viruela símica: características en población femenina, Buenos Aires, Argentina / Monkeypox: characteristics in female population, Buenos Aires, Argentina

Resumen La viruela símica es una enfermedad viral zoonótica debida a un virus del género Orthopoxvirus. Desde el 1 de enero de 2022, se ha notificado en 110 Estados Miembros de la OMS. Se presenta con fiebre, astenia, linfoadenopatías dolorosas y exantema. Dura entre 2 y 4 semanas. Suele ser autolimitada y se han descrito casos graves en personas inmunocomprometidas. El presente trabajo describe casos de viruela símica en mujeres, diagnosticados entre junio del 2022 y febrero del 2023 Se realizó un estudio observacional retrospectivo en la Uni dad Febril de Urgencias (UFU), revisando casos positivos (RT-PCR) para viruela símica y se seleccionó la población con sexo biológico femenino. Se consultó sobre compli caciones ginecológicas, patrón menstrual, dispareunia y dolor pélvico. Se realizaron 340 consultas por viruela símica, 214 (63%) fueron positivos, 211 casos (99%) de sexo masculino y 3 casos (1%) femeninos. Dentro de estos casos se encuentra una mujer trans, la cual no se incluyó. La edad promedio es de 31 años, inmunocom petentes, con reporte de serologías negativas para HIV, sífilis, hepatitis B y C. Ambos casos mantuvieron relacio nes sexuales sin método de barrera. Los síntomas más frecuentes fueron astenia y lesiones en piel, sobre todo en miembros superiores e inferiores, región perianal y genital. Como factor de riesgo presentaron contacto sexual sin protección. Dentro de los diagnósticos diferenciales, debe tenerse en cuenta otras infecciones de transmisión sexual (ITS). En seguimiento epidemiológico no refirieron complicaciones ginecológicas.

Abstract Monkeypox is a zoonotic viral disease caused by a virus of the genus Orthopoxvirus. As of January 1, 2022, it has been reported in 110 WHO Member States. It presents with fever, fatigue, painful lymphadenopathy, and rash. It lasts between 2 and 4 weeks. It is usually self-limited, but severe cases have been described in immunocompromised people. This study describes cases of monkeypox in women, diagnosed between June 2022 and February 2023, and it reports epidemiology, clinical aspects, and complications after infection. A retrospective observational study was carried out in the Febrile Emergency Unit (UFU), reviewing positive cases (RT-PCR) for monkeypox and the population with female biologi cal sex was selected. They were questioned about gyne cological complications, menstrual pattern, dyspareunia and pelvic pain. 340 consultations for monkeypox were made, 214 (63%) were positive, 211 cases (99%) male and 3 cases (1%) female. Among these cases is a trans woman, who was not included. The average age is 31 years, immunocompetent, with a negative serology report for HIV, syphilis, hepatitis B and C. Both cases had sexual intercourse without a barrier method. The most frequent symptoms are asthenia and skin lesions, especially in the upper and lower limbs, perianal and genital region. As a risk factor they presented unpro tected sexual contact. Within the differential diagnoses, other sexually transmitted infections (STIs) should be considered. There were no gynecological complications reported during follow-up.

The use of point-of-care ultrasound in Tshwane public and private sector emergency units.

BACKGROUND: The use of point-of-care ultrasound (POCUS) is an essential skill in the practice of emergency medicine (EM), with benefit to patient care by improving diagnostic accuracy. Despite this, there exists little data evaluating the use of POCUS in South African emergency units (EUs.). METHODS: One hundred and seventeen doctors working in 12 public and private sector EUs in Tshwane were included. A questionnaire was used comprising of descriptive data regarding doctor demographics, levels of experience, and outcome data including POCUS frequency use, training level, indications for, and barriers to its use. RESULTS: Many participants were general practitioners working in EUs (58.1%) followed by EM specialists and EM registrars. Of these participants, 88% used POCUS. Seventy one percent received informal POCUS training only. The indications for POCUS use were similar for both public and private sector, with no significant differences in overall use. The only significant association to POCUS use was age ( 33.3 years) and number of years since qualification ( 6.9 years.) Lack of and/or access to training were the main reasons for not using POCUS (18.8%.) There were no significant differences in the barriers to the use of POCUS between the sectors. CONCLUSION: Point-of-care ultrasound is used similarly in both public and private sector EUs in Tshwane. Lack of and/or access to POCUS training are the main barrier to its use.Contribution: This study underlines the state of POCUS use in Tshwane and highlights the barriers to its use, thus allowing academic heads and hospital managers to address them.

Impact of Obesity on Outcomes of Emergency Department Visits for Cardiac Chest Pain: Insights From a Nationwide Emergency Department Study.

Background Obesity, a widespread national epidemic that impacts one in three U.S. adults, is closely linked with the development and exacerbation of cardiovascular disease. The objective of this study was to assess and contrast the outcomes of adults, both obese and non-obese, who present with cardiac chest pain in the emergency department (ED). Methodology A retrospective analysis of the 2020 Nationwide Emergency Department Sample database was conducted. Multivariate regression models were utilized to examine the association between obesity and mortality, discharge disposition, number of procedures, complications, and hospital costs. Results No significant difference in mortality odds was observed between obese and non-obese patients presenting with cardiac chest pain in the ED (adjusted odds ratio (aOR) = 0.92; 95% confidence interval (CI) = 0.59-1.46; p = 0.736). However, obesity was found to be associated with a decreased likelihood of being discharged home from the ED (aOR = 0.57; 95% CI = 0.52-0.63; p < 0.001), as well as an increased likelihood of hospital admission from the ED (aOR = 1.66; 95% CI = 1.53-1.81; p < 0.001). Obesity also correlated with higher odds of non-home discharge (aOR = 1.74; 95% CI = 1.54-1.97; p < 0.001), elevated mean total hospital costs (mean = $13,345 vs. $9,952; mean increase = $3,360; 95% CI = $2,816-$3,904; p < 0.001), and increased risks of cardiac arrests (aOR = 1.52; 95% CI = 1.05-1.88; p < 0.001) and acute respiratory failures (aOR = 1.43; 95% CI = 1.25-1.96; p < 0.001). Obese patients with cardiac pain underwent more procedures on average than non-obese patients (19 vs. 15; aOR = 3.57; 95% CI = 3.04-4.11; p < 0.001). Conclusions Obesity is associated with higher odds of hospital admission from the ED, non-home discharges, higher total hospital costs, and a greater number of procedures.

An investigation into the use of Full-body Low Dose X-rays Imaging system in South Africa: Radiographer's perspective.

Introduction: A low dose x-rays alias Lodox© statscan was originally developed in South Africa to detect smuggled diamonds in the mines. Later, hospital trauma units began to use it as a screening tool for gross pathology on trauma patients. This imaging system became popular because of its use of low radiation doses and its ability to perform anterior posterior (head to toe image) image in under 13 seconds. Anecdotal evidence confirms that patients were referred for additional regional images on conventional x-ray systems after Lodox imaging. Thus, patients were subjected to additional ionising radiation, long waiting times as well as additional charges for secondary radiological examinations. Objective: This research aimed at investigating the extent to which Lodox was used in trauma units (n=28) in South Africa. Method: In this descriptive cross-sectional research. researcher invited one radiographer from each of the 28 hospitals in South Africa that were using Lodox. Results: Out of twenty radiographers who responded, it was found that most hospitals were referring patients for additional conventional x-ray images (Figure 1); for example, for chest x-rays. This was done despite the patient having undergone radiological procedures and examinations by the Lodox imaging system that was similar to those performed by conventional x-ray systems. Conclusion: Lodox was used for a successful diagnosis Thus, researcher recommends an imaging protocol for Lodox to be developed for guiding the referral of patients after the Lodox scanning has been performed.

Direct or early Discharge of Acute Bacterial Skin and Skin Structure Infection patients from the Emergency Department/Unit: place in therapy of dalbavancin.

INTRODUCTION: Acute Bacterial Skin and Skin Structure Infections (ABSSSIs) are a common reason of Emergency Department (ED) access and account for a considerable number of hospital admissions and a high economic burden for the healthcare system. The long-acting lipoglycopeptides (LALs) allow for an outpatient management of subjects with ABSSSIs, still requiring parenteral therapy, but who do not need hospitalization. AREAS COVERED: The following topics were addressed: i) microbiological activity, efficacy, and safety of dalbavancin, ii) critical steps for the management of ABSSSIs in the ED (decision to hospitalize, risk of bacteremia and infection recurrence), iii) feasibility of direct/early discharge from the ED and potential advantage of dalbavancin. EXPERT OPINION: Authors' expert opinion was focused on drawing the profiles of patients who could benefit most from an antimicrobial therapy with dalbavancin in the ED and positioning this drug as a direct or early discharge strategy from the ED in order to avoid hospitalization and its complications. We have provided a therapeutic and diagnostic algorithm based on evidence from the literature and authors' expert opinion and suggest the use of dalbavancin in patients with ABSSSIs who are not eligible for oral therapies or Outpatient Parenteral Antibiotic Therapy (OPAT) programs and who would have otherwise been hospitalized only for antibiotic therapy.

Weighing up the pros and cons of dysphagia triage in South Africa.

BACKGROUND:  Early identification of dysphagia followed by intervention reduces, length of hospitalisation, degree of morbidity, hospital costs and risk of aspiration pneumonia. The emergency department offers an opportune space for triage. Triaging offers risk-based evaluation and early identification of dysphagia risk. A dysphagia triage protocol is not available in South Africa (SA). The current study aimed to address this gap. OBJECTIVES:  To establish the reliability and validity of a researcher-developed dysphagia triage checklist. METHOD:  A quantitative design was used. Sixteen doctors were recruited from a medical emergency unit at a public sector hospital in SA using non-probability sampling. Non-parametric statistics and correlation coefficients were used to determine the reliability, sensitivity and specificity of the checklist. RESULTS:  Poor reliability, high sensitivity and poor specificity of the developed dysphagia triage checklist was found. Importantly, the checklist was adequate in identifying patients as not being at risk for dysphagia. Completion time for dysphagia triage was 3 minutes. CONCLUSION:  The checklist was highly sensitive but not reliable or valid for use in identifying patients at risk for dysphagia.Contribution: The study provides a platform for further research and modification of the newly developed triage checklist, which is not recommended for use in its current form. The merits of dysphagia triage cannot be ignored. Once a valid and reliable tool is confirmed, the feasibility of implementation of dysphagia triage must be considered. Evidence to confirm that dysphagia triage can be conducted, when considering the contextual, economic, technical and logistic aspects of the context, is necessary.

The impact of COVID-19 pandemic on obstetrics and gynecology hospitalization rate and on reasons for seeking emergency care: a systematic review and meta-analysis.

BACKGROUND: During the lockdown due to COVID-19 pandemic, utilization of emergency care units has been reported to be reduced for obstetrical and gynaecological reasons. The aim of this systematic review is to assess if this phenomenon reduced the rate of hospitalizations for any reason and to evaluate the main reasons for seeking care in this subset of the population. METHODS: The search was conducted using the main electronic databases from January 2020 to May 2021. The studies were identified with the use of a combination of: "emergency department" OR "A&E" OR "emergency service" OR "emergency unit" OR "maternity service" AND "COVID-19" OR "COVID-19 pandemic" OR "SARS-COV-2" and "admission" OR "hospitalization". All the studies that evaluated women going to obstetrics & gynecology emergency department (ED) during the COVID-19 pandemic for any reason were included. RESULTS: The pooled proportion (PP) of hospitalizations increased from 22.7 to 30.6% during the lockdown periods, in particular from 48.0 to 53.9% for delivery. The PP of pregnant women suffering from hypertensive disorders increased (2.6 vs 1.2%), as well as women having contractions (52 vs 43%) and rupture of membranes (12.0 vs 9.1%). Oppositely, the PP of women having pelvic pain (12.4 vs 14.4%), suspected ectopic pregnancy (1.8 vs 2.0), reduced fetal movements (3.0 vs 3.3%), vaginal bleeding both for obstetrical (11.7 vs 12.8%) and gynecological issues (7.4 vs 9.2%) slightly reduced. CONCLUSION: During the lockdown, an increase in the proportion of hospitalizations for obstetrical and gynecological reasons has been registered, especially for labor symptoms and hypertensive disorders.

Patient safety culture and attitudes among emergency care unit nurses in Türkiye.

Background: Nurses have a key role in ensuring the safety of patients, reducing the likelihood of errors and improving patient outcomes. Aims: This study aimed to determine the factors affecting patient safety, with a focus on the culture and attitudes of nurses working in emergency units. Method: This cross-sectional, descriptive, correlational study was conducted between 10 January and 30 August 2015 among 282 nurses who worked at emergency units of 19 hospitals in the north-central Black Sea Region of Türkiye Data were obtained using descriptive information forms, the Patient Safety Attitude Scale (PSAS) and the Patient Safety Culture Scale (PSCS). Results: The mean total PSAS score was 152.26 [standard deviation (SD) 22.54; range 46-230], while the mean total PSCS score was 2.56 (SD 0.52; range 1-4). Around a quarter of the participants reported errors, such as medication errors and patient falls, which threatened patient safety in the emergency units. The case report forms were not filled when these errors occurred. Conclusion: Attitude and culture of nurses in hospital emergency units towards patient safety differed according to their sociodemographic and work-life characteristics, including being satisfied with working in the emergency room, quality of work-life balance, level of job satisfaction, and number of years working in the emergency room.

S100B serum level: A relevant biomarker for the management of non-traumatic headaches in emergency care?

BACKGROUND: The diagnostic of primary or secondary headaches in emergency units is mostly based on brain imaging, which is expensive and sometimes hardly accessible. An increase in serum S100B protein has already been found in several neurological conditions inducing brain damage. The objective of this study was to assess the diagnostic performance of S100B serum assay to distinguish primary and secondary headaches among patients with non-traumatic headaches in the emergency department. METHODS: This was a phase 2, prospective, monocentric diagnostic study. Eighty-one adult patients with non-traumatic headaches in the emergency department were included. In addition to the usual management, a blood assay of the S100B protein was performed in the emergency department, as well as a brain MRI between 48 and 96 h if not performed during the initial management. The primary or secondary headache diagnosis was made at one month by an expert committee, blindly of the results of the S100B assay. The primary outcome was the blood assay of the S100B protein. RESULTS: There was 63 patients for analysis in the primary headache group and 17 in the secondary headache group. The S100B protein assay was significantly higher in secondary headaches than primary headaches, with an AUC of the ROC curve of 0.67. The optimal threshold of 0.06 µg.L-1 allowed to obtain those diagnostic characteristics: sensitivity 75% [48; 93], specificity 62% [48; 74], PPV 35% [20; 54] and NPV 90% [76; 97]. The association between the S100B protein level and the onset of pain was significantly higher for patients with headaches <3 h. CONCLUSION: The assay of the S100B protein could be useful in the management of this pathology in emergencies. Future studies taking into account dosing time and etiologies could be conducted in order to refine its use in practice.

[Psychological impact of involvement of medical and psychological emergency unit professionals in the medical and psychological care system of the COVID-19 epidemic]. / Impact psychologique de l'implication des professionnels des CUMP dans le dispositif de soins médico-psychologique face à l'épidémie COVID-19.

Objectives: COVID-19 pandemic and its consequences have put into great difficulty health professionals, and the general population, fostering the emergence of various psychological and psychiatric disorders. Medical and psychological emergency units' mission is the medical and psychological emergency care of people impacted during a traumatic event. Given their expertise in crisis management, they set up an important medical and psychological support system adapted to the health crisis' characteristics. The unusual modalities of intervention, the specific clinic that these professionals faced in this context of great tension may have unsettled workers and generate a psychological impact. This study aims to assess the existence of such repercussions among medical and psychological emergency unit professionals involved in this new system. Method: In all, 313 medical and psychological emergency unit professionals agreed to participate at the online survey. They filled surveys and visual analog scales assessing the difficulties encountered in the system, as well as their level of satisfaction, post-traumatic stress, burnout, level of anxiety and depression and coping strategies put in place. Results: Results show few significant emotional difficulties. However higher scores are found among women, among professionals who felt a negative impact on their personal lives, as well as for those who thought they had been infected with COVID-19. The establishment of coping strategies such as active coping, planning, expressing feelings, positive reinterpretation and acceptance helped to decrease the level of emotional complexities and brought more compassionate satisfaction. We note that participants with more medical and psychological emergency unit experience tend to show less emotional hardship and more compassionate satisfaction. It appears that older as well as younger professionals have lower burnout scores, as do workers who conducted more interviews for the same person. Likewise, participants who were satisfied of the system organization and of the support - a majority in this study - report less emotional challenges and more compassionate satisfaction. Conclusion: Psychological impact in this new system among medical and psychological emergency unit professionals is overall low. It appears that some coping strategies, perceived usefulness, satisfaction with the organization and the received support are associated with a lower level of emotional difficulties. A supportive framework and an operative organization of the medical and psychological emergency unit system in times of crisis has a protective effect on the participants.