The precautionary principle in public health emergency regime: Ethical and legal examinations of Vietnamese and global response to COVID-19.

Responses to the COVID-19 pandemic have been widely criticized for being too delayed and indecisive. As a result, the precautionary principle has been endorsed, applauded, and proposed to guide future responses to global public health emergencies. Drawing from controversial issues in response to COVID-19, especially in Vietnam, this paper critically discusses some key ethical and legal issues of employing the precautionary principle in public health emergencies. Engaging with discussions concerning this principle, especially in environmental law where the precautionary principle first appeared as a guiding principle with objective content(s), this paper formulates the precautionary principle as 'in dubio pro salus', which is about advising, justifying and demanding states to proactively prepare for scenarios arising out of any public health emergency. It distinguishes the precautionary principle into moderate and hard versions. A moderate version largely takes a holistic approach and fulfils a series of criteria specified in this paper, while a hard version either permits restrictive measures to be deployed primarily on a hypothetic basis or expresses an instrumental mentality. The hard version should be rejected because of the ethical and legal problems it raises, including risk-risk tradeoffs, internal paradoxes, unjustified causing of fear and unreasonable presupposition. Ultimately, this paper defends the moderate version.

National and subnational governance and decision-making processes during the COVID-19 pandemic in Nigeria: an empirical analysis.

Governance of the COVID-19 pandemic required decision-makers to make and implement decisions amidst uncertainty, public pressure and time constraints. However, few studies have attempted to assess these decision-making processes empirically during health emergencies. Thus, we aimed to understand governance, defined as the process of decision-making and implementation of decisions, during the COVID-19 pandemic in Nigeria. We conducted key informant interviews and focus group discussions with national and subnational government officials, civil society organisation (CSO) members, development partners and academic experts. Our study identified several themes on governance and decision-making processes. First, Nigeria established high-level decision-making structures at the federal and state levels, providing clear and integrated multisectoral decision-making mechanism. However, due to the emergence of conflicts between government levels, there is a need to strengthen intergovernmental arrangements. Second, while decision-makers relied on input from academic experts and CSOs, additional efforts are required to engage such stakeholders in decision-making processes, especially during the early stages of health emergencies. Third, Nigeria's previous experiences responding to disease outbreaks aided the overall response, as many capacities and coordination mechanisms for cohesive action were present. Fourth, while decision-makers took a holistic view of scientific, social and economic factors for decision-making, this process was also adaptive to account for rapidly evolving information. Lastly, more efforts are needed to ensure decisions are inclusive, equitable and transparent, and improve overall public trust in governance processes. This study provides insights and identifies opportunities to enhance governance and decision-making processes in health emergency responses, aiding future pandemic preparedness efforts.

Perfil do doente com traumatismo cranioencefálico atendido num serviço de urgência de uma ULS do norte de Portugal / Profile of patients with traumatic brain injury seen in the emergency department of a ULS in northern Portugal

Um traumatismo cranioencefálico (TCE) ocorre como consequência de uma força mecânica direta ou indireta aplicada na cabeça. É considerado um dos principais problemas de saúde pública de âmbito mundial e as suas características epidemiológicas variam de acordo com cada população, encontrando-se entre os tipos de trauma mais frequentes nos serviços de urgência. As vítimas de TCE exigem intervenções de enfermagem adequadas pelo que, o enfermeiro, enquanto membro fundamental de uma equipa multidisciplinar, necessita de constante atualização e desenvolvimento de competências, numa abordagem holística do doente neurocrítico. Objetivos: O presente trabalho tem por objetivo geral: Caracterizar o perfil do doente com traumatismo cranioencefálico atendido num serviço de urgência de uma ULS do Norte de Portugal. Definiram-se como objetivos específicos: (i) Caracterizar o perfil sociodemográfico da amostra; (ii) Caracterizar a amostra em função da presença de fatores de risco; (iii) Identificar as principais etiologias do traumatismo cranioencefálico; (iv) Determinar a gravidade do TCE, pela avaliação do nível de consciência dos doentes, através da Escala de Coma de Glasgow; (v) Identificar a principal sintomatologia pós TCE nas vítimas; (vi) Identificar o número de doentes em função dos exames complementares de diagnóstico realizados; (vii) Identificar as principais lesões cranioencefálicas associadas ao traumatismo nos doentes; (viii) Avaliar a prevalência de TCE na população atendida no SU no período de recolha de dados definido. Métodos: Para a realização do presente trabalho foi desenvolvido um estudo observacional, descritivo, de abordagem quantitativa. Utilizando um método não- probabilístico, com uma amostragem por conveniência, foi obtida uma amostra de 153 vítimas de TCE que recorreram ao SU de uma ULS do Norte de Portugal, no período compreendido entre 5 de abril a 5 de julho de 2022. Os dados foram colhidos através de um instrumento de recolha de dados elaborado para o efeito, com base na observação, complementados com o resultado de exames de diagnóstico realizados e respetivo diagnóstico médico. Resultados: Os resultados obtidos evidenciam predomínio do sexo masculino (56,9%), com uma média de idades de 63,5 anos (DP 28,79), verificando-se uma maior prevalência de TCE nos pacientes com idade superior ou igual a 85 anos (29,4%) e maioritariamente residentes em ambiente rural (55,6%). A principal etiologia foram as quedas da própria altura (56,3%), com predomínio do TCE Ligeiro (98,6%). O fator de risco predominante foi a idade superior a 65 anos (58,8%) e a principal sintomatologia associada foi a perda de consciência (22,3%). A Tomografia Computorizada cerebral foi o exame complementar de diagnóstico dominante (84,9%) e as lesões na pele/couro cabeludo foram as mais frequentes nos TCE observados (42,5%). Quanto aos traumatismos associados, os mais frequentes foram os traumatismos nos membros (31,4%). Houve predomínio da alta hospitalar após observação clínica (72,5%). A taxa de prevalência de TCE no respetivo SU no período estudado foi de 1,68 %. Conclusão: Conhecer melhor o perfil da vítima de TCE atendida num SU e tendo em consideração que a atuação do enfermeiro especialista na intervenção antecipada e prevenção de complicações na Pessoa em situação Crítica é fundamental uma vez que, no seu percurso desde a lesão até à alta clínica, esta pode sofrer inúmeras complicações. Dessa forma, o perfil encontrado sugere a importância da adoção de medidas de prevenção das principais etiologias do TCE bem como o aprimoramento no atendimento às vítimas.

Traumatic brain injury (TBI) occurs as a result of direct or indirect mechanical force applied to the head. It is considered one of the major public health problems worldwide, and its epidemiological characteristics vary according to each population, being among the most frequent types of trauma seen in emergency services. TBI victims require appropriate nursing interventions, and nurses, as key members of a multidisciplinary team, need constant updating and constant skill development in a holistic approach to the neurocritical patient. Aim: The main objective of this study is to characterise the profile of patients with traumatic brain injury (TBI) treated at an emergency department of Northern Portugal Local Health Unit (ULS). The following specific objectives were defined: (i) Characterize the socio-demographic profile of the sample; (ii) Characterize the sample according to the presence of risk factors; (iii) Identify the main causes of traumatic brain injury; (iv) Determine the severity of TBI by assessing patients' level of consciousness using the Glasgow Coma Scale; (v) Identify the main post-TBI symptoms in the victims; (vi) Identify the number of patients based on the complementary diagnostic tests performed; (vii) Identify the main head injury associated with trauma in the patients; (viii) Evaluate the incidence of TBI in the population attended at the Emergency Department during the defined data collection period. Methods: To carry out the present study, an observational, descriptive approach with a quantitative method was employed. Using a non-probabilistic technique, with a convenience sampling, we obtained a sample of 153 TBI victims who sought treatment at the Emergency Department of a Northern Portugal Local Health Unit (ULS), between April 5 and July 5, 2022. Data were collected using a specifically designed data collection tool based on observation, complemented with the results of diagnostic tests conducted as well as the corresponding medical diagnosis. Results: The results show a predominance of males (56.9%), with an average age of 63.5 years (SD 28.79), and a higher incidence of TBI in patients aged 85 years or older (29.4%) and mostly living in rural areas (55.6%). The main etiology was falls from standing height (56.3%), with a predominance of mild TBI (98.6%). The predominant risk factor was age over 65 years (58.8%) and the main associated symptom was loss of consciousness (22.3%). Computed tomography of the brain was the dominant diagnostic complementary exam (84.9%) and skin/scalp injuries were the most frequent in the observed TBIs (42.5%). Regarding associated traumas, limb injuries were the most common (31.4%). There was a predominance of hospital discharge after clinical observation (72.5%). The incidence rate of TBI in the respective Emergency Department during the study period was 1.68%. Conclusion: Having a better understanding of the profile of TBI victims treated at an Emergency Department and considering that the role of specialist nurses in early intervention and prevention of complications in critically ill patients is crucial, since they may experience numerous complications from the time of injury until clinical discharge. Therefore, the identified profile emphasizes the importance of adopting measures to prevent the main etiologies of TBI, as well as improving the care provided to the victims.

COVID-19-specific adult basic life support guideline strategies for chiropractors and other healthcare providers to maximize the safety and efficacy of resuscitation: a commentary.

BACKGROUND: The emergence of an unprecedented novel severe acute respiratory syndrome coronavirus-2 (SARS-C0V-2), which causes the coronavirus disease 2019 (COVID-19) pandemic, has created new scenarios in basic life support (BLS) management. According to current evidence, SARS-CoV-2 can be transmitted airborne in aerosol particles during resuscitation. Research evidence found an alarming global increase in out-of-hospital cardiac arrests during the COVID-19 pandemic. Healthcare providers are legally obliged to respond to cardiac arrest as soon as possible. Chiropractors will likely encounter potential exercise-related and non-exercise-related cardiac emergencies at some point in their professional lives. They have a duty of care to respond to emergencies such as cardiac arrest. Chiropractors are increasingly involved in providing care, including emergency care, for athletes and spectators at sporting events. Also, exercise-related cardiac arrest in adult patients may occur during exercise testing or rehabilitation with exercise prescriptions in chiropractic and other healthcare settings. Little is known about the COVID-19 BLS guidelines for chiropractors. Knowledge of the current COVID-19-specific adult BLS guidelines is essential to developing an emergency response plan for the on-field and sideline management of exercise-related cardiac arrest and non-athletic, non-exercise-related cardiac arrest. MAIN TEXT: Seven peer-reviewed articles on the COVID-19-specific BLS guidelines, including two updates, were reviewed for this commentary. Responding to the COVID-19 pandemic, the national and international resuscitation organizations recommended interim COVID-19-specific BLS guidelines with precaution, resuscitation, and education strategies. BLS safety is paramount. A precautionary approach with the bare minimum of appropriate personal protective equipment for resuscitation is recommended. There was disagreement among the COVID-19 BLS guidelines on the level of personal protective equipment. All healthcare professionals should also undergo self-directed BLS e-learning and virtual skill e-training. The summarized COVID-19-specific adult BLS guideline strategies and protocols are tabled, respectively. CONCLUSIONS: This commentary provides a practical overview and highlights current evidence-based intervention strategies of the COVID-19-specific adult BLS guidelines that may help chiropractors and other healthcare providers reduce BLS-related exposures to SARS-CoV-2 and the risks of SARS-CoV-2 transmission and maximize the efficacy of resuscitation. This study is relevant to and impacts future COVID-19-related research in areas such as infection prevention and control.

Interteam PERINAT - interprofessional team collaboration in undergraduate midwifery and medical education in the context of obstetric emergencies: Presentation of simulation scenarios and empirical evaluation results.

To promote the expansion of interprofessional training objectives in the curriculum of health professions curriculum at the Medical Faculty, University of Leipzig, the interprofessional teaching project between the Department of Obstetrics, the Skills and Simulation Centre and the School of Midwifery was selected to promote innovative teaching projects, supported by the University of Leipzig [https://www.stil.uni-leipzig.de/] grant "StiL - Studying in Leipzig". Using scenarios with simulated patients, students were to recall and apply theoretically learned procedures and immediate measures in an obstetric emergency under supervision and to communicate these clearly in the team. Final-year medical students from the Medical Faculty (n=15) and midwifery students (n=17) from the vocational school went through teaching situations together, in which two simulation scenarios (shoulder dystocia and postpartum haemorrhage) were implemented. The aim of the project was to integrate interprofessional collaboration into training and to learn together under simulated conditions in the Skills and Simulation Center protected environment. The following questions was intended to be clarified in the project in addition to the establishment of a sub-professional teaching unit What do students benefit most from in interprofessional teaching units? Are there differences between midwifery and medical students? Is the learning success the same for team-communicative and professional learning goals? To clarify the questions, an evaluation was carried out using an exploratory questionnaire with a Likert scale. All students particularly liked the exchange and contact with other professional groups, the communicative aspect and situational action in unforeseen emergency situations. The participants stated that they had benefited from both interprofessional teaching units, in terms of team communication as well as in professional terms. However, medical students experienced significantly higher cognitive overload regarding prior acquired knowledge compared to vocational midwifery students. Overall, the team communication learning objectives were more difficult to fulfill.

Structural empowerment of midwifery students following simulation-based training of management of obstetric emergencies.

BACKGROUND: Having the ability of managing obstetric emergencies is the necessary capability for providing care during labor and delivery.Simulation is considered to be a valuable strategy for empowering midwifery students in managing emergencies. So, this study was conducted to determine the structural empowerment of midwifery students following the simulation-based training of management of midwifery emergencies. METHODS: This semi-experimental research was conducted from August 2017 to June 2019 in the Faculty of Nursing and Midwifery, Isfahan, Iran. 42 subjects of the third-year midwifery students were included in the study through convenience sampling method (n = 22 in the intervention group, n = 20 in the control group). Six simulation-based educational sessions were considered for the intervention group. Conditions for Learning Effectiveness Questionnaire, was used at the beginning of the study, one week after it and one year later. Repeated measures ANOVA was used to analyze the data. RESULTS: In the intervention group, the significant difference was observed between the mean score of the students' structural empowerment before and after the intervention (MD=-28.41, SD = 3.25) (p < 0.001), before and one year after the study (MD=-12.45, SD = 3.47) (p = 0.003), and immediately after and one year after the study (MD = 15.95,SD = 3.67) (p < 0.001). In the control group, no significant difference was observed. Before the intervention, there was no significant difference between the mean score of the students' structural empowerment in the control and intervention groups (MD = 2.89, SD = 3.50) (p = 0.415); but, immediately after the intervention, the mean score of structural empowerment in the students of the intervention group was significantly higher than those of the control group (MD = 25.40, SD = 4.94 ) (p < 0.001). One year after the study, there was no significant difference between the two groups in terms of the mean score of the structural empowerment (MD = 6.89, SD = 3.58 ) (p = 0.061). CONCLUSION: Simulation contributed to the structural empowerment of midwifery students by providing the opportunity for personal and professional growth and strengthening of the formal and informal power in the area of midwifery emergency management but these benefits were not seen at one year.

Dr. Google's Advice on First Aid: Evaluation of the Search Engine's Question-Answering System Responses to Queries Seeking Help in Health Emergencies.

INTRODUCTION: The ever-growing penetration of internet and mobile technologies into society suggests that people will increasingly use web searches to seek health-related information, including advice on first aid in medical emergencies. When a bystander is incompetent in first aid and has no immediate support from Emergency Medical Services (EMS), as it happens in low-resource settings or in disasters, instructions found online could be the sole driver for administering first aid before arrival of professional help. STUDY OBJECTIVE: The aim of this study was to evaluate quality of advice on first aid generated by a web search engine's question-answering system (QAS) in response to search queries concerning provision of help in common health emergencies. METHODS: In December 2022-January 2023, an English-language search was carried out in Google with ten queries based on the keyword combinations (what to do OR how to help) AND (bleeding OR chest pain OR choking OR not breathing OR seizure). The search engine's QAS responses (up to 11 per search query) were evaluated for compliance with the International Federation of Red Cross First Aid Guidelines 2020 using the pre-developed checklists. RESULTS: Out of 98 QAS items generated by Google, 67.3% (n = 66) were excluded, mainly because the QAS answers did not address original queries. Eligible unique QAS responses (n = 27) showed poor coverage of the guideline-compliant instructions on first aid. Mean percentage of QAS responses providing a first aid instruction with complete adherence to the guidelines varied from 0.0 for choking to 19.5 for seizure. Only three (11.1%) QAS responses contained an explicit instruction to access EMS, while 66.7% (n = 18) included directions either contradictory to the guidelines and potentially harmful (eg, use of home remedies in chest pain) or inapplicable for an untrained person (eg, use of tourniquet in bleeding). CONCLUSION: Although the search engine's QAS responds to user's inquiries concerning assistance in health emergencies, the QAS-generated answers, as a rule, omit potentially life-saving evidence-based instructions on first aid and oftentimes give advices noncompliant with current guidelines or inadequate for untrained people, and thus create risks for causing harm to a victim.

Building referral mechanisms for neonatal care in humanitarian emergency settings: A systematic review.

AIM: During humanitarian emergencies, women and children are particularly vulnerable to health complications and neonatal mortality rates have been shown to rise. Additionally, health cluster partners face challenges in coordinating referrals, both between communities and camps to health facilities and across different levels of health facilities. The purpose of this review was to identify the primary referral needs of neonates during humanitarian emergencies, current gaps and barriers, and effective mechanisms for overcoming these barriers. METHODS: A systematic review was performed using four electronic databases (CINAHL, EMBASE, Medline, and Scopus) between June and August 2019 (PROSPERO registration number CRD42019127705). Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was neonates born during humanitarian emergencies. Studies from high-income countries and prior to 1991 were excluded. The STROBE checklist was used to assess for risk of bias. RESULTS: A total of 11 articles were included in the analysis; these were mainly cross-sectional, field-based studies. The primary needs identified were referrals from homes to health facilities before and during labour, and inter-facility referrals after labour to more specialised services. Some of the main barriers included a lack of roads and infrastructure for transport, staff shortages-especially among more specialised services, and a lack of knowledge among patients for self-referral. Mechanisms for addressing these needs and gaps included providing training for community healthcare workers (CHWs) or traditional birth attendants to identify and address antenatal and post-natal complications; education programmes for pregnant women during the antenatal period; and establishing ambulance services in partnership with local Non-Governmental Organizations. CONCLUSION: This review benefited from a strong consensus among selected studies but was limited in the quality of data and types of data that were reported. Based on the above findings, the following recommendations were compiled: Focus on local capacity-building programmes to address programmes acutely. Recruit CHWs to raise awareness of neonatal complications among pregnant women. Upskill CHWs to provide timely, appropriate and quality care during humanitarian emergencies.

Strengthening midwives' competencies for addressing maternal and newborn mortality in Tanzania: Lessons from Midwifery Emergency Skills Training (MEST) project.

INTRODUCTION: In Low- and Middle-Income Countries (LMICs), maternal and infant mortality remains a significant problem. Inadequate healthcare provider competencies, including those of midwives, are cited as one of the major contributors to the high maternal and newborn mortality rates. Thus, enhancing the skills of midwives is a prerequisite for enhancing positive maternal and newborn health outcomes. This study describes the lessons learned from a Midwifery Emergencies Skills Training (MEST) project implemented in Tanzania between 2013 and 2018. METHODS: An exploratory qualitative study was used to purposefully recruit and interview twelve health facility in-charges and eighteen midwives from twelve selected health facilities in six districts of Tanzania mainland to discover their perceptions about the midwifery practice after MEST training. The data were transcribed verbatim and analysed with qualitative content analysis. RESULTS: Four categories were generated from the analysis (i) enhanced knowledge and skills in the provision of midwifery care and management of obstetric emergencies, (ii) improved midwives' communication skills, (iii) increased trust and support between midwives and community and (iv) transformed attitudes of midwives toward continued professional development (CPD). CONCLUSION: MEST enhanced the knowledge and skills of midwives in the management of obstetric emergencies and referral protocol practice. However, notable gaps remain in the capacity of midwives to provide human rights-based respectful maternity care. Continued professional development for nurses and midwives through training, mentorship and supervision programs is recommended for improving maternal and newborn health.

Toward a Continuum of Measures to Mitigate Primary and Secondary Impacts of COVID-19 and Other Public Health Emergencies.

The global COVID-19 response focused heavily on nonpharmaceutical interventions (NPIs) until vaccines became available. Even where vaccination coverage is low, over time governments have become increasingly reluctant to use NPIs. Inequities in vaccine and treatment accessibility and coverage, differences in vaccine effectiveness, waning immunity, and immune-escape variants of concern of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reinforce the long-term need for mitigation. Initially, the concept of NPIs, and mitigation more broadly, was focused on prevention of SARS-CoV-2 transmission; however, mitigation can and has done more than prevent transmission. It has been used to address the clinical dimensions of the pandemic as well. The authors propose an expanded conceptualization of mitigation that encompasses a continuum of community and clinical mitigation measures that can help reduce infection, illness, and death from COVID-19. It can further help governments balance these efforts and address the disruptions in essential health services, increased violence, adverse mental health outcomes, and orphanhood precipitated by the pandemic and by NPIs themselves. The COVID-19 pandemic response revealed the benefits of a holistic and layered mitigation approach to public health emergencies from the outset. Lessons learned can inform the next phases of the current pandemic response and planning for future public health emergencies.

Engaging emergency medical services to improve postacute management of behavioural health emergency calls: a protocol of a scoping literature review.

INTRODUCTION: The public health crisis of escalating mental health, behavioural and substance-related emergencies has revealed the need to approach these complex events from a health perspective, rather than the traditional criminal justice standpoint. Despite law enforcement officers often being the first responders to emergency calls concerning self or bystander harm, they are not optimally equipped to manage these crises holistically or to connect affected individuals to necessary medical treatment and social support. Paramedics and other emergency medical services (EMS) providers are well positioned to deliver comprehensive medicosocial care during and in the immediate aftermath of these emergencies, moving beyond their traditional role in emergency evaluation, stabilisation and transport to a higher level of care. The role of EMS in bridging this gap and helping shift emphasis to mental and physical health needs in crisis situations has not been examined in prior reviews. METHODS AND ANALYSIS: In this protocol, we delineate our approach to describing existing EMS programmes that focus specifically on supporting individuals and communities experiencing mental, behavioural and substance-related health crises. The databases to be searched are EBSCO CINAHL, Ovid Cochrane Central Register of Controlled Trials, Ovid Embase, Ovid Medline, Ovid PsycINFO and Web of Science Core Collection, with search date limits being from database inception to 14 July 2022. A narrative synthesis will be completed to characterise populations and situations targeted by the programmes, describe programme staffing and composition, detail the interventions and identify collected outcomes. ETHICS AND DISSEMINATION: All data in the review will be publicly accessible and published previously, so approval by a research ethics board is not needed. Our findings will be published in a peer-reviewed journal and shared with the public. TRIAL REGISTRATION NUMBER: https://doi.org/10.17605/OSF.IO/UYV4R.

Acupuncture for Management of Endodontic Emergencies: a Review.

Root canal treatment (RCT) employed for painful endodontic conditions like apical periodontitis and irreversible pulpitis is associated with a high incidence of postoperative pain. Pharmacological management for this purpose is effective, but not entirely free from side effects and in some cases may fail to provide adequate relief. Furthermore, concerns have been raised regarding the transmission of coronavirus disease-2019 (COVID-19) as a result of the aerosols generated and prolonged chair side time required for RCT. Acupuncture is a traditional Chinese therapy commonly employed as an alternative for the treatment of pain. And what's more, the use of acupuncture has been recently reported as treatment for the management of endodontic pain as well as on the anesthetic success in patients with irreversible pulpitis. This review aims to evaluate the current evidence for acupuncture in endodontics and its potential role in emergency pain relief and management for patients. To combat this, a thorough search for literature within the field was performed in five electronic databases. Retrieved studies were screened according to the pre-defined eligibility criteria. After both an electronic and manual search, five studies were selected for review. These studies reported the beneficial effects of acupuncture in reducing the failure of nerve block in patients with irreversible pulpitis and in controlling both intraoperative and postoperative pain following RCT. In addition, it was also reported to reduce anxiety surrounding the dental procedure and minimized the intake of analgesics after the endodontic procedure, which can result in some unwanted side effects. However, more in depth clinical research is required before any recommendation regarding the application of acupuncture in endodontic patients can be made.

Models of integrated care for young people experiencing medical emergencies related to mental illness: a realist systematic review.

Mental illness heightens risk of medical emergencies, emergency hospitalisation, and readmissions. Innovations for integrated medical-psychiatric care within paediatric emergency settings may help adolescents with acute mental disorders to get well quicker and stay well enough to remain out of hospital. We assessed models of integrated acute care for adolescents experiencing medical emergencies related to mental illness (MHR). We conducted a systematic review by searching MEDLINE, PsychINFO, Embase, and Web of Science for quantitative studies within paediatric emergency medicine, internationally. We included populations aged 8-25 years. Our outcomes were length of hospital stay (LOS), emergency hospital admissions, and rehospitalisation. Limits were imposed on dates: 1990 to June 2021. We present a narrative synthesis. This study is registered on PROSPERO: 254,359. 1667 studies were screened, 22 met eligibility, comprising 39,346 patients. Emergency triage innovations reduced admissions between 4 and 16%, including multidisciplinary staffing and training for psychiatric assessment (F(3,42) = 4.6, P < 0.05, N = 682), and telepsychiatry consultations (aOR = 0.41, 95% CI 0.28-0.58; P < 0.001, N = 597). Psychological therapies delivered in emergency departments reduced admissions 8-40%, including psychoeducation (aOR = 0.35, 95% CI 0.17-0.71, P < 0.01, N = 212), risk-reduction counselling for suicide prevention (OR = 2.78, 95% CI 0.55-14.10, N = 348), and telephone follow-up (OR = 0.45, 95% CI 0.33-0.60, P < 0.001, N = 980). Innovations on acute wards reduced readmissions, including guided meal supervision for eating disorders (P = 0.27), therapeutic skills for anxiety disorders, and a dedicated psychiatric crisis unit (22.2 vs 8.5% (P = 0.008). Integrated pathway innovations reduced readmissions between 8 and 37% including family-based therapy (FBT) for eating disorders (X2(1,326) = 8.40, P = 0.004, N = 326), and risk-targeted telephone follow-up or outpatients for all mental disorders (29.5 vs. 5%, P = 0.03, N = 1316). Studies occurred in the USA, Canada, or Australia. Integrated care pathways to psychiatric consultations, psychological therapies, and multidisciplinary follow-up within emergency paediatric services prevented lengthy and repeat hospitalisation for MHR emergencies. Only six of 22 studies adjusted for illness severity and clinical history between before- and after-intervention cohorts and only one reported socio-demographic intervention effects.

Should rocuronium and sugammadex replace succinylcholine for airway emergencies in class B ambulatory anesthesia settings?

INTRODUCTION: In class B surgical facilities, where only oral or intravenous (IV) sedation is employed without the administration of volatile anesthetics, laryngospasm is among the most common airway complications. However, these facilities generally do not stock succinylcholine to avoid the cost of storing dantrolene for the treatment of malignant hyperthermia (MH). High dose IV rocuronium with sugammadex reversal has been suggested as an alternative to succinylcholine for airway emergencies. The aim of this paper was to evaluate the clinical utility, patient safety, and financial implications of replacing succinylcholine with rocuronium and sugammadex in lieu of stocking dantrolene in class B facilities. EVIDENCE ACQUISITION: A systematic review of the literature concerning neuromuscular blockade for airway emergencies in class B settings in adult patients was conducted. The MEDLINE and EMBASE databases were searched for published studies from January 1, 1990, to October 1, 2021. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence. EVIDENCE SYNTHESIS: The search strategy yielded 1124 articles. After review, 107 articles were included, with 49 graded as "strong" evidence to provide recommendations for the posed questions. CONCLUSIONS: The use of succinylcholine in isolation without volatile agents has a low incidence of triggering MH. Laryngospasm is a common airway emergency that requires immediate treatment to avoid morbidity and mortality. Both succinylcholine and rocuronium-sugammadex provide adequate treatment of airway emergencies and rapid return of spontaneous ventilation, but succinylcholine has a superior economic and clinical profile.

Fatores associados à visita à emergência ou hospitalização em cuidados paliativos oncológicos domiciliares: uma revisão integrativa / Factors associated with emergency room visit or hospitalization in care oncolagy home care: an integrative review / Factores asociados a la visita a urgencias o a la hospitalización en cuidado atención oncológica a domicilio: una revisión integradora

Objetivo: identificar os fatores associados à visita à emergência ou hospitalização dos pacientes oncológicos em cuidados paliativos domiciliares. Método: revisão integrativa nas bases PubMed, LILACS, Web of Science e Embase. Perguntou-se "quais os fatores associados à visita a serviços de emergência ou hospitalização de pacientes oncológicos em cuidados paliativos domiciliares?". Descritores foram neoplasias; cuidados paliativos; hospitalização; serviços médicos de emergência; serviços de assistência domiciliar. Critérios de elegibilidade foram texto na íntegra; entre 2012 e 2022; idioma inglês, português ou espanhol; idade adulta. Resultados:foram selecionados 16 artigos. As causas mais comuns de visita à emergência/hospitalização foram dor, falta de ar, infecção, sintomas digestivos, delirium e queda do estado geral/fadiga. Conclusão: este estudo identificou lacunas em que os cuidados paliativos domiciliares podem ser aprimorados.

Objective: to identify the factors associated with the emergency visit or hospitalization of cancer patients in palliative home care. Method: integrative review in PubMed, LILACS, Web of Science and Embase. The question was "what factors are associated with visiting emergency services or hospitalization of cancer patients in palliative home care?". Descriptors were neoplasms; palliative care; hospitalization; emergency medical services; home care services. Eligibility criteria were full text; between 2012 and 2022; English, Portuguese or Spanish language; adulthood. Results: 16 articles were selected. The most common causes of emergency room visits/hospitalization were pain, shortness of breath, infection, digestive symptoms, delirium, and poor general condition/fatigue. Conclusion: this study identified gaps in which palliative home care can be improved.

Objetivo: identificar los factores asociados a la visita a urgencias u hospitalización de pacientes oncológicos en cuidados paliativos domiciliarios. Método: revisión integrativa en PubMed, LILACS, Web of Science y Embase. La pregunta fue "¿qué factores se asocian con la visita a los servicios de emergencia o la hospitalización de pacientes oncológicos en cuidados paliativos domiciliarios?". Descriptores fueron neoplasias; Cuidados paliativos; hospitalización; servicios médicos de emergencia; servicios de atención domiciliaria. Los criterios de elegibilidad fueron texto completo; entre 2012 y 2022; idioma inglés, portugués o español; edad adulta. Resultados:se seleccionaron 16 artículos. Las causas más comunes de visitas a la sala de emergencias/hospitalización fueron dolor, dificultad para respirar, infección, síntomas digestivos, delirio y mal estado general/fatiga. Conclusión: este estudio identificó brechas en las que se pueden mejorar los cuidados paliativos domiciliários.

Saúde mental na universidade: atendimento psicológico online na pandemia da covid-19 / Mental health at the university: online psychological care during the covid-19 pandemic / Salud mental en la universidad: atención psicológica en línea en la pandemia de covid-19

Com a pandemia da covid-19, o contexto universitário, que já vinha sendo palco de discussões em relação à saúde mental, tem vivenciado crises mais severas pelos estudantes. Diante deste cenário, foi desenvolvido o projeto Escuta Solidária, voltado à saúde mental dos discentes de graduação e de pós-graduação. Neste artigo, temos como objetivo discutir o atendimento psicológico online com estudantes do curso de psicologia durante o período de isolamento social rígido (maio a junho de 2020). Fizemos, com os psicólogos voluntários, um grupo focal direcionado para a experiência de atendimento psicológico online de curta duração no contexto pandêmico. Trata-se de um estudo qualitativo, realizado com os 11 psicólogos clínicos participantes do referido projeto. A partir de uma análise fenomenológica crítica, os resultados foram divididos em cinco categorias: a) limitações e contribuições do projeto; b) a importância da capacitação e supervisão clínica para a qualidade do projeto; c) atendimento psicológico online; d) ser psicólogo clínico durante a crise da covid-19; e e) demandas emergentes nos atendimentos psicológicos na quarentena. Por fim, discutimos a importância da desmistificação do atendimento psicológico em situações de crise, especialmente na modalidade online, fomentando questionamentos à formação e atuação dos profissionais, no sentido de estarmos atentos às demandas psicológicas que o contexto de crise acarreta na sociedade.(AU)

With the COVID-19 pandemic, the university context, which had already been the stage for discussions regarding mental health, has experienced more severe crises by students. In view of this scenario, the Solidarity Listening project was developed, aimed at the mental health of undergraduate and graduate students. In this article, we aim to discuss online psychological care with psychology students during the period of strict social isolation (May to June 2020). We carried out, with volunteer psychologists, a focus group aimed at the experience of short-termonline psychological care in the pandemic context. This is a qualitative study, carried out with 11 clinical psychologists participating in the aforementioned project. From a critical phenomenological analysis, the results were divided into five categories: a) limitations and contributions of the project; b) the importance of training and clinical supervision for the quality of the project; c) online psychological care; d) being a clinical psychologist during the COVID-19 crisis; and e) emerging demands in psychological care in quarantine. Finally, we discuss the importance of demystifying psychological care in crisis situations, especially in the online modality, promoting questions regarding the training and performance of professionals, to be aware of the psychological demands that the context of crisis entails in society.(AU)

La pandemia del covid-19 provocó que las universidades, que ya habían sido escenario de discusiones sobre la salud mental, experimentaran crisis más severas entre los estudiantes. Ante este escenario, se desarrolló el proyecto Escucha Solidaria, dirigido a la salud mental de estudiantes de grado y posgrado. Este artículo pretende discutir la atención psicológica en línea con estudiantes de Psicología durante el período de aislamiento social más estricto (mayo/junio de 2020). Se conformó un grupo focal con los psicólogos voluntarios orientado a la práctica de la atención psicológica en línea, a corto plazo, en el contexto de una pandemia. Se trata de un estudio cualitativo, realizado con 11 psicólogos clínicos que participaron en el mencionado proyecto. A partir del análisis fenomenológico crítico, los resultados se dividieron en cinco categorías: a) limitaciones y aportes del proyecto; b) importancia de la capacitación y la supervisión clínica para la calidad del proyecto; c) atención psicológica en línea; d) ser psicólogo clínico durante la crisis del covid-19; y e) demandas emergentes en atención psicológica en la cuarentena. Se concluye que es importante desmitificar la atención psicológica en situaciones de crisis, especialmente en la modalidad en línea, al promover principalmente preguntas sobre la formación y el desempeño de los profesionales con el fin de ser conscientes de las demandas psicológicas que el contexto de crisis conlleva la sociedad.(AU)

¿Se puede humanizar el Servicio de Atención de Pacientes Críticos del Hospital El Cruce? / Is it possible to humanize the Critical Patient Care Service of El Cruce Hospital?

[RESUMEN]. Muchas instituciones sanitarias continúan con un enfoque del modelo biomédico centrando sus acciones en los procedimientos y no en la persona y en su integridad, propiciando la deshumanización de la atención y reduciendo lo humano a lo biológico. Este paradigma ha ido cambiando en el último tiempo. La Organización Mundial de la Salud, OMS define a la salud como: "un estado completo de bienestar físico, mental y social, y no solamente la ausencia de afecciones o enfermedades" (1). La atención humanizada de la salud se centra en la persona, como ser multidisciplinario y único respetando sus valores y su libertad de elección. Realizamos un estudio descriptivo y observacional basado en el registro de intervenciones del área de cuidados humanizados realizadas en el Servicio de Atención del paciente crítico, APC entre enero y septiembre de 2023. Las mismas fueron realizadas luego de la solicitud de interconsultas realizadas por los médicos tratantes del servicio de APC. Durante el período de estudio, se llevaron a cabo un total de 117 intervenciones que reflejan acciones concretas de cuidados humanizados. Estas incluyeron 34 intervenciones en comunicación efectiva, 29 acompañamientos familiares, 22 sesiones de soporte psicoespiritual, 16 tratamientos para el dolor, 11 adecuaciones del esfuerzo terapéutico, 4 cuidados integrales en etapas terminales de la vida y 1 seguimiento del duelo. Estos indicadores sugieren un avance hacia una atención más humanizada al reconocer y abordar las necesidades de pacientes y familias mediante una comunicación empática, lo cual refleja una búsqueda activa de mejora en la calidad de vida en momentos críticos.

[ABSTRACT]. Many health institutions continue with an approach to the biomedical model, focusing their actions on procedures and not on the person and their integrity, promoting the dehumanization of care and reducing the human to the biological. This paradigm has been changing in recent times. The World Health Organization defines health as: "a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity." Humanized health care focuses on the person, as a multidisciplinary and unique being, respecting their values and their freedom of choice. We carried out a descriptive and observational study based on the record of interventions in the humanized care area carried out in the APC between January and September 2023. They were carried out after the request for interconsultations carried out by the treating physicians of the APC service. During the study period, a total of 117 interventions were carried out that reflect concrete actions of humanized care. These included 34 interventions in effective communication, 29 family accompaniment, 22 psychospiritual support sessions, 16 pain treatments, 11 adaptations of the therapeutic effort, 4 comprehensive care in terminal stages of life and 1 grief follow-up. These indicators suggest progress towards more humanized care by recognizing and addressing the needs of patients and families through empathetic communication, which reflects an active search for improvement in quality of life in critical moments.

Evaluation of online interprofessional simulation workshops for obstetric and neonatal emergencies.

Objectives: To explore student perceptions of learning and interprofessional aspects of obstetric and neonatal emergencies through online simulation-based workshops. Methods: This qualitative study was conducted at Monash University, Australia. Data were obtained from six separate online Obstetric Neonatal Emergency Simulation workshops held between May 2020 and August 2021. A total of 385 students attended and were invited to participate in the study by completing an online survey two-three weeks later. Of the attendees, 144 students completed the survey (95 medical, 45 midwifery), equating to a response rate of 37%. Survey responses were downloaded from online survey platform and separated into medical and midwifery responses. Thematic analysis of data was performed using a coding framework, resulting in development of themes and subthemes. Results: Main themes were adaptability, connectivism, preparedness for practice, experiential learning, learning through modelling and dynamics of online interaction. Students reported that online workshop was a useful alternative method to experience simulation-based learning, increase their readiness for clinical practice and foster positive interprofessional relationships. Consistent with existing literature evaluating similar in-person programs, midwifery students were most interested in interprofessional interaction (predominant theme: dynamics of online interaction), whilst medical students were more concerned with developing clinical skills (predominant themes: learning through modelling, experiential learning). Conclusions: Online learning may be a useful and convenient way of delivering interprofessional simulation-based education during the pandemic, in remote areas and as an adjunct to in-person teaching. Future studies should evaluate the impact of online learning with a mixed methods study and in comparison, to in-person programs.