RESUMO
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Corpos Estranhos , Lactente , Humanos , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/cirurgia , Ingestão de AlimentosRESUMO
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Dispepsia , Praguicidas , Fosfinas , Humanos , Dispepsia/tratamento farmacológico , Compostos de Alumínio , Ingestão de AlimentosRESUMO
Background: Violence against health care workers has been widely reported in Pakistan. Aims: This study, from September 2019 to April 2020, aimed to determine the effect of low-cost interventions to reduce violent events in two tertiary-care emergency departments in Karachi and Peshawar, Pakistan. Methods: In phase one, a surveillance system was established in each department and information on violent events was recorded for three months. In phase two, low-cost interventions designed to reduce violent events were introduced, e.g. awareness-raising material on violence for patients, training for health care workers and visitor identification cards. Violent events were then recorded for another three months and the percentage difference in number of violent events was calculated. Results: In Karachi, 256 violent events occurred before the intervention and 225 after the intervention, a 12.1% reduction. Physical violence events decreased significantly by 42.9% (P = 0.044). The number of events perpetrated by health care workers decreased by 61.9% (P = 0.016) while those perpetrated by patients decreased only by 5.7% (P = 0.538). In Peshawar, 90 violent events occurred before the intervention and 45 events after, a 50.0% reduction (P = 0.009). The number of events perpetrated by health care workers was the same in both phases. Events perpetrated by patients or their companions decreased significantly by 59.72% (P = 0.001). Conclusion: Violence against health care workers can be reduced significantly by improving their prevention and de-escalation skills. Client educational interventions, supplemented with hospital regulations and patient guidance, can also help reduce the incidence of violent events.
Assuntos
Serviço Hospitalar de Emergência , Setor Público , Humanos , Incidência , Paquistão/epidemiologia , Violência/prevenção & controleRESUMO
BACKGROUND: World Health Organization has advocated preemptive readiness of health systems to manage disas-trous events. Pakistan is known to be highly susceptible to disasters on the one hand and significantly lacking in coping ability on the other. Preparedness of health facilities in such locales is especially important, despite which there is little published evidence regarding hospitals' response capacity in Pakistan. METHODS: From 12 most disaster prone districts of the country, a purposive sample of 20 hospitals was assessed us-ing 51 indicators, scored as fully (2), partially (1), or not prepared (0). Two domains, disaster preparedness and mass casualty management, and five subdomains, networking, planning, staff-readiness, materials, and safety, were evalu-ated. Proportions of maximum possible scores achieved by an entity were categorized as acceptable (≥66 percent), par-tial (35-65 percent), or inadequate (<35 percent). RESULTS: Out of the 20 hospitals, 14 (70 percent) were secondary and 3 tertiary level facilities (30 percent). Overall, hospitals were partially prepared with a score of 54.0 percent, 95 percent confidence interval [52.3 percent, 54.7 percent]. Disaster preparedness, 55.2 percent [54.0, 57.0], was significantly better prepared than mass casualty management, 49.2 percent [46.8, 51.6], p < 0.001. Overall, facility safety was the least prepared among the subdomains, 38.3 per-cent [31.8, 44.8], while materials were the best, 75.9 percent [72.6, 79.3]. The least prepared subdomains were staff-readiness in Punjab, 52.1 percent [47.5, 56.8], and facility safety in KP, 29.2 percent [22.1, 36.4]. CONCLUSIONS: Hospitals' preparedness for disaster and mass casualty management is deficient in these most vulner-able districts of Pakistan. Improvement initiatives commensurate with locale vulnerabilities should be instituted.
