Nature and extent of selection bias resulting from convenience sampling in the emergency department

2021 ◽  
pp. emermed-2021-211390
Author(s):  
Travis Lines ◽  
Christine Burdick ◽  
Xanthea Dewez ◽  
Emogene Aldridge ◽  
Tom Neal-Williams ◽  
...  
Keyword(s):  
Chest Pain ◽  
Selection Bias ◽  
Patient Group ◽  
Vital Signs ◽  
Internal Validity ◽  
Demographic Variables ◽  
Triage Category ◽  
Convenience Sampling ◽  
Time Periods ◽  
Time Of Presentation

BackgroundTo compare the clinical and demographic variables of patients who present to the ED at different times of the day in order to determine the nature and extent of potential selection bias inherent in convenience samplingMethodsWe undertook a retrospective, observational study of data routinely collected in five EDs in 2019. Adult patients (aged ≥18 years) who presented with abdominal or chest pain, headache or dyspnoea were enrolled. For each patient group, the discharge diagnoses (primary outcome) of patients who presented during the day (08:00–15:59), evening (16:00-23:59), and night (00:00-07:59) were compared. Demographics, triage category and pain score, and initial vital signs were also compared.Results2500 patients were enrolled in each of the four patient groups. For patients with abdominal pain, the diagnoses differed significantly across the time periods (p<0.001) with greater proportions of unspecified/unknown cause diagnoses in the evening (47.4%) compared with the morning (41.7%). For patients with chest pain, heart rate differed (p<0.001) with a mean rate higher in the evening (80 beats/minute) than at night (76). For patients with headache, mean patient age differed (p=0.004) with a greater age in the daytime (46 years) than the evening (41). For patients with dyspnoea, discharge diagnoses differed (p<0.001). Asthma diagnoses were more common at night (12.6%) than during the daytime (7.5%). For patients with dyspnoea, there were also differences in gender distribution (p=0.003), age (p<0.001) and respiratory rates (p=0.003) across the time periods. For each patient group, the departure status differed across the time periods (p<0.001).ConclusionPatients with abdominal or chest pain, headache or dyspnoea differ in a range of clinical and demographic variables depending upon their time of presentation. These differences may potentially introduce selection bias impacting upon the internal validity of a study if convenience sampling of patients is undertaken.

scholarly journals A study to assess the risk factors of bronchial asthma in children below 10 years of age

2020 ◽  
Vol 11 (4) ◽  
pp. 5238-5242
Author(s):  
Kalabarathi S ◽  
Kavya K. Nair
Keyword(s):  
Risk Factors ◽  
Bronchial Asthma ◽  
Demographic Variables ◽  
Interview Method ◽  
Descriptive Research ◽  
Asthma Child ◽  
Convenience Sampling ◽  
Asthma In Children ◽  
Structured Questionnaire ◽  
Gas Stoves

Children are profoundly powerless against the negative wellbeing resulting in numerous ecological exposures. Children get proportionately more significant portions of natural toxicants than grown-ups, and the way that their organs and tissues are quickly creating makes them especially vulnerable to synthetic abuse. Asthma is a constant fiery infection of the aviation routes at present influencing over 300 million individuals around the world. The risk factors of asthma include genetic predisposition, irresistible respiratory contamination, allergens, environment, workouts, medications, additives, and occupational stimuli. The descriptive research design was used with 100 samples, which matched Non- probability convenience sampling techniques selected the inclusion criteria. Demographic variables were collected by interview method followed by assessed the risk factors of bronchial asthma in children (below ten years of age) by using a self-structured questionnaire. Out of 100 samples, 50(50%) risk factor of heredity, 71(71%) have problems in taking asthma medications, 44(44%) only use zipped pillow covers, 34(34%) do not use gas stoves in the kitchen, 10(10%) have moisture in the walls, 6(6%) have cases of asthma emergencies, 56(56%) find helpless in dealing with an asthma child.

scholarly journals Guideline adherence among prehospital emergency nurses when caring for patients with chest pain: a prospective cohort study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Kristoffer Wibring ◽  
Markus Lingman ◽  
Johan Herlitz ◽  
Lina Blom ◽  
Otto Serholt Gripestam ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Chest Pain ◽  
Acetylsalicylic Acid ◽  
Hospital Discharge ◽  
Guideline Adherence ◽  
Vital Signs ◽  
Pharmaceutical Treatment ◽  
Emergency Nurses ◽  
Prehospital Emergency

Abstract Background The emergency medical services (EMS) use guidelines to describe optimal patient care for a wide range of clinical conditions and symptoms. The intent is to guide personnel to provide patient care in line with best practice. The aim of this study is to describe adherence to such guidelines among prehospital emergency nurses (PENs) when caring for patients with chest pain. Objective To describe guideline adherence among PENs when caring for patients with chest pain. To investigate whether guideline adherence is associated with patient age, sex or final diagnosis of acute myocardial infarction on hospital discharge. Methods Guideline adherence in terms of patient examination and pharmaceutical treatment was analysed in a cohort of 2092 EMS missions carried out in 2018 in Region Halland, Sweden. Multivariate regression was used to describe how guideline adherence is associated with patient age, sex and diagnosis on hospital discharge. Results Guideline adherence was high regarding examination of vital signs (93%) and electrocardiogram (ECG) registration (96%) but lower in terms of pharmaceutical treatment (ranging from 28 to 90%). Adherence was increased in cases in which the patient ended up with acute myocardial infarction (AMI) as diagnosis on discharge. Patients with AMI were given acetylsalicylic acid by PENs in 50% of cases. Women were less likely than men to receive treatment with acetylsalicylic acid and oxycodone. Conclusions Guideline adherence among PENs when caring for patients with chest pain is satisfactory in terms vital signs and ECG registration. Regarding pharmaceutical treatment guideline adherence is defective. Improved adherence is mainly associated with male sex in patients and a diagnosis of AMI on hospital discharge. Defective adherence excludes measures known to improve patients’ prognoses such as treatment with acetylsalicylic acid.

scholarly journals An Observational Study to Assess the Surgical Asepsis among Nurses Working in Narayana General Hospital, Nellore, Andhra Pradesh

2019 ◽  
pp. 713-718
Author(s):  
V. Jayanthi ◽  
Indira Arumugam ◽  
Latha P
Keyword(s):  
Sampling Method ◽  
Good Practice ◽  
Demographic Variables ◽  
Cross Infection ◽  
The Body ◽  
Staff Nurses ◽  
Level Of Knowledge ◽  
Convenience Sampling ◽  
Knowledge And Practice ◽  
Care Worker

Background: Surgical asepsis refers to destruction of organisms before they enter the body, it is used in caring for open wounds and in surgical procedure. Surgical asepsis is the medical practice of maintaining sterility whenever dressing wound or performing any kind of surgery to prevent cross infection. Aseptic technique are used in infection control to prevent cross infection between health care worker and between patients. Aim: The aim of the study was to assess the level of knowledge and practice of staff nurses regarding surgical asepsis. Objectives: 1. To assess the practice regarding surgical asepsis. 2. To find an association between practice with socio demographic variables. Methodology: 100 staff nurses working in NMCH, Nellore were selected by using convenience sampling method. Results: Regarding the level of practice among staff nurses, 10(10%) of them had good practice 80(80%) of them had moderate practice and 10(10%) had poor practice.

Abstract P263: Symptomatic Post-Acute SARS-CoV-2-Infection Hypertension Syndrome

Hypertension ◽  
2021 ◽  
Vol 78 (Suppl_1) ◽  
Author(s):  
Lauren East ◽  
Zainab Mahmoud ◽  
Amanda Verma
Keyword(s):  
Blood Pressure ◽  
Chest Pain ◽  
Vital Signs ◽  
Wilcoxon Test ◽  
Initial Visit ◽  
Office Visits ◽  
Paired Data ◽  
Cardiology Clinic ◽  
Blood Pressures

Introduction: The Post-COVID Cardiology Clinic at Washington University evaluates and treats patients with ongoing cardiovascular symptoms following acute COVID-19 infection. One clinical manifestation seen in the clinic is an increase in blood pressure, with associated symptoms like chest pain. Our investigation aims to describe the increase in blood pressure seen in symptomatic patients presenting to the Post-COVID Cardiology Clinic. Methods: The study employed a retrospective cohort design of consecutive adult patients who presented between September 2020 to May 2021 with cardiovascular symptoms following COVID-19 infection. Demographic information, symptoms, vital signs, and follow-up visit data were collected for the patients. To determine a baseline blood pressure, two blood pressure readings from office visits prior to COVID-19 infection were averaged. The blood pressure values were compared between baseline and cardiology office visits using a non-parametric Wilcoxon test for paired data. Results: One-hundred patients were included in the cohort (mean age 46.4 years (SD 46.4); 81% (81) female). At the initial visit, there was a significant increase in systolic (median 128 mmHg) and diastolic (median 83.5 mmHg) blood pressure from baseline (systolic median 121.5, p=0.029; diastolic median 76, p<0.001). All patients with an increase in blood pressure reported symptoms like chest pain. In the subset of 36 (36%) patients that have followed up, 35 (97%) patients were prescribed a new anti-hypertensive or required an increased dose of a prior anti-hypertensive at their initial visit. Blood pressures at follow-up were not significantly different from baseline (median systolic delta= 1.0mmHg, diastolic delta= -1.0mmHg; p>0.05), and 83% (30) reported improvement in symptoms. Conclusions: Patients presenting with cardiovascular symptoms post-acute COVID-19 show increased blood pressure when compared to blood pressure prior to infection. During subsequent follow-up appointments, patients showed improvement in their blood pressure and symptoms. While the pathophysiology has yet to be determined, it is likely related to the effects of a proinflammatory state, endothelial dysfunction, dysautonomia, or altered effects of the RAAS.

scholarly journals Nurse-initiated, titrated intravenous opioid analgesia reduces time to analgesia for selected painful conditions

CJEM ◽  
2005 ◽  
Vol 7 (03) ◽  
pp. 149-154 ◽  
Author(s):  
Anne-Maree Kelly ◽  
Catherine Brumby ◽  
Caroline Barnes
Keyword(s):  
Opioid Analgesic ◽  
Data Management System ◽  
Biliary Colic ◽  
Opioid Analgesia ◽  
Narcotic Drug ◽  
Drug Register ◽  
Triage Category ◽  
Analgesic Dose ◽  
Time Of Presentation ◽  
The Impact

ABSTRACTObjectives:Traditionally, patients have to wait until assessed by a physician for opioid analgesia to be administered, which contributes to delays to analgesia. Western Hospital developed a protocol enabling nurses to initiate opioid analgesia prior to medical assessment for selected conditions. The aim of this study was to determine the impact of this protocol on time to first opioid dose in patients presenting to the emergency department (ED) with renal or biliary colic.Methods:This was an explicit medical record review of all adult patients with an ED discharge diagnosis of renal or biliary colic presenting to a metropolitan teaching hospital ED. Patients were identified via the ED data management system. Data collected included demographics, condition, triage category, time of presentation, whether analgesia was nurse-initiated or not, and interval from arrival to first opioid analgesic dose. The narcotic drug register for the relevant period was also searched to cross-check whether opiates were doctor- or nurse-initiated.Results:There were 58 presentations in the nurse-initiated opioid analgesia group and 99 in the non-nurse-initiated analgesia group. Groups were reasonably well matched for gender, triage category and time of presentation, but there was a higher proportion of biliary colic in the non-nurse-initiated analgesia group. Median time to first analgesic dose was 31 minutes in the nurse-initiated group and 57 minutes in the non-nurse-initiated analgesia group (effect size, 26 minutes; 95% confidence interval 16-36 min;p&lt; 0.0001]. There were no major adverse events in either group.Conclusion:A nurse-initiated opioid analgesia protocol reduces delays to opioid analgesia for patients with renal and biliary colic.

Integrating heart rate variability, vital signs, electrocardiogram, and troponin to triage chest pain patients in the ED

2018 ◽  
Vol 36 (2) ◽  
pp. 185-192 ◽  
Author(s):  
Jeffrey Tadashi Sakamoto ◽  
Nan Liu ◽  
Zhi Xiong Koh ◽  
Dagang Guo ◽  
Micah Liam Arthur Heldeweg ◽  
...  
Keyword(s):  
Heart Rate ◽  
Heart Rate Variability ◽  
Chest Pain ◽  
Vital Signs ◽  
Pain Patients

scholarly journals DETERMINANTS OF THE PERCEIVED IMAGE OF NIGERIAN TOURISM INDUSTRY

2017 ◽  
Vol 2 (2) ◽  
pp. 16-26
Author(s):  
Edith Onowe Odia ◽  
Barnabas Aigbojie Agbonifoh
Keyword(s):  
Social Power ◽  
Political Stability ◽  
Demographic Variables ◽  
Tourism Industry ◽  
Negative Effects ◽  
Equality Of Means ◽  
Strong Source ◽  
Regression Techniques ◽  
The Mean ◽  
Convenience Sampling

The image of a country’s tourism has become a strong source of economic and social power for the nation’s survival hence the need for its constant measure. This study examines the perceived image of the Nigerian Tourism Industry (NTI) among foreign tourists and residents in Nigeria and the demographic variables that influence perception of the industry. A convenience sampling method was adopted to select total 150 respondents. A questionnaire with twelve key evaluative factors was used in measuring the image of NTI. Exploratory Factor Analysis (EFA), T-Test for equality of means and multiple regression techniques were applied in the analysis of data. The results show that the mean index obtained for the perception of the tourism industry was fairly positive. NTI was perceived to be most reputable in the areas of hospitality under culture and heritage dimension and weakest in political stability under infrastructure dimension. Respondents’ demographic characteristics were not significant in explaining the overall perception of NTI. In the circumstance, we recommend that, to effectively reposition the NTI in the international arena, the Nigerian government needs to be more diligent in conducting its elections in order to ensure fairness and stability. The friendliness of the Nigerian people could be used to mitigate the negative effects of insecurity in the country. Nigeria’s rich cultural heritage and friendly weather should be emphasized in the promotion of NTI.

Intuitive versus Algorithmic Triage

2018 ◽  
Vol 33 (4) ◽  
pp. 355-361 ◽  
Author(s):  
Alexander Hart ◽  
Elias Nammour ◽  
Virginia Mangolds ◽  
John Broach
Keyword(s):  
Vital Signs ◽  
Mass Casualty ◽  
Publication Type ◽  
Local Police ◽  
Triage Category ◽  
Government Leadership ◽  
Cluster Randomized ◽  
High Degree ◽  
Adult Volunteers ◽  
Very High

AbstractIntroductionThe most commonly used methods for triage in mass-casualty incidents (MCIs) rely upon providers to take exact counts of vital signs or other patient parameters. The acuity and volume of patients which can be present during an MCI makes this a time-consuming and potentially costly process.HypothesisThis study evaluates and compares the speed of the commonly used Simple Triage and Rapid Treatment (START) triage method with that of an “intuitive triage” method which relies instead upon the abilities of an experienced first responder to determine the triage category of each victim based upon their overall first-impression assessment. The research team hypothesized that intuitive triage would be faster, without loss of accuracy in assigning triage categories.MethodsLocal adult volunteers were recruited for a staged MCI simulation (active-shooter scenario) utilizing local police, Emergency Medical Services (EMS), public services, and government leadership. Using these same volunteers, a cluster randomized simulation was completed comparing START and intuitive triage. Outcomes consisted of the time and accuracy between the two methods.ResultsThe overall mean speed of the triage process was found to be significantly faster with intuitive triage (72.18 seconds) when compared to START (106.57 seconds). This effect was especially dramatic for Red (94.40 vs 138.83 seconds) and Yellow (55.99 vs 91.43 seconds) patients. There were 17 episodes of disagreement between intuitive triage and START, with no statistical difference in the incidence of over- and under-triage between the two groups in a head-to-head comparison.Conclusion:Significant time may be saved using the intuitive triage method. Comparing START and intuitive triage groups, there was a very high degree of agreement between triage categories. More prospective research is needed to validate these results.HartA, NammourE, MangoldsV, BroachJ. Intuitive versus algorithmic triagePrehosp Disaster Med.2018;33(4):355–361.

P951The factors influencing total ischaemic time in patients presenting with STEMI in an Irish tertiary referral centre

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C T O'connor ◽  
C Maguire ◽  
I Abdalla ◽  
A Buckley ◽  
J Kumar ◽  
...  
Keyword(s):  
Chest Pain ◽  
Cohort Analysis ◽  
Coronary Intervention ◽  
Patient Delay ◽  
Referral Centre ◽  
Tertiary Referral ◽  
Tertiary Referral Centre ◽  
Factors Influencing ◽  
European Society Of Cardiology ◽  
Time Of Presentation

Abstract Background Despite highly functioning primary percutaneous coronary intervention (PPCI) programmes, STEMI is still associated with significant morbidity and mortality. The European Society of Cardiology STEMI guidelines in 2017 introduced a novel metric relating to STEMI patients: “total ischaemic time”. This time-period starts at the onset of chest pain and ends at wire cross, and it is thought to accurately reflect burden of myocardial destruction. Aims To assess the total ischaemic time of patients presenting with STEMI in an Irish tertiary referral centre and the factors influencing delays in presentation and treatment. Methods Prospective cohort analysis was conducted on all patients presenting with STEMI from October 2017 to January 2019. Patients were included if they had a culprit lesion that was successfully revascularized. All information was recorded at time of presentation. Bayesian statistics were employed to conduct the analysis. Results 158 patients were recruited. Mean age was 61 (range29–96). Male:female ratio 5:1 in this cohort. Average total ischaemic time was 409.4mins ±501.4. The average time from chest pain to “call for help” (i.e. patient delay) was 208.3mins ±397.8, which represented 50.89% of the total ischaemic time (see Figure 1). The average time from “call for help” to first medical contact (FMC) was 18.4mins ±30.07. Average time from FMC to ECG was 44.9mins ±151.16, and was dependent upon type of FMC (Primary care 127mins vs paramedic 25mins p=0.030932). After FMC, 48.7% of patients had an ECG performed in under 10mins as per guidelines. After ECG was performed, 46.4% of patients had ECG to “wire cross” time under 90mins as per guidelines; 65.8% were within 120 mins and 91.4% were within 180mins. Those presenting to their general practitioner as FMC were significantly less likely to have both an ECG <10mins (NNH 2.84 95% CI 1.79–6.91) and ECG to wire time of <90mins (NNH 6.13 95% CI 2.88–48.70). As age increased, so too did total ischaemic time (Pearson R=0.164, p=0.043), which was dependent on increasing patient delay with age (Pearson R=0.2181, p=0.0066). Women had a higher total ischaemic time than men (546 vs 382mins p=0.0233). This was determined to be as a result of: a numerically higher patient delay (220 vs 206 mins, p=0.214) and women having a longer time from FMC to ECG (104mins vs 34mins, p=0.0021). Conclusion Over 50% of the total ischaemic time was due to patient delay, suggesting a role for cardiovascular awareness programmes. Increasing age was associated with longer patient delay, indicating a need for directed awareness in this demographic. Women had a higher total ischaemic time, and waited a significantly longer time for ECG following FMC; highlighting the need for awareness amongst healthcare professionals of atypical clinical features associated with STEMI in women. Patients who attended their GP waited longer for an ECG and, once performed, were less likely to be revascularised within 90mins.

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