Agreement between Prehospital and Final Diagnosis in Patients with Acute Allergic Reactions: A Cross-Sectional Study

Introduction: Acute allergic reactions are usually first encountered in the prehospital setting and account for about 0.3% to 0.8% of prehospital runs in different countries. Right, and rapid recognition and treatment are necessary to decrease mortality and morbidity, especially in severe critical cases. This study evaluates the accuracy of prehospital care providers’ diagnosis in patients with acute allergic reactions in comparison with final (discharge) diagnosis as the gold standard. Methods: Patients who were transported to 2 urban referral hospitals between 2008 and 2014 under the dispatch code of “acute allergic reaction” were included in the study, retrospectively. Demographic data, etiology of an allergic reaction, clinical presentations, vital signs stability, and need for epinephrine injection were evaluated. The prehospital care providers’ diagnosis (documented on-call report) was compared with the final diagnosis (documented on discharge summary form). Results: A total of 300 patients were included in the study. In 55 (18.3%) cases the prehospital care providers’ and final diagnoses were different. Diagnoses were similar in 245 (81.6%) patients. Kappa coefficient was calculated as 0.621which shows a moderate-to-substantial agreement between prehospital and final diagnoses. Fifteen patients (5%) were discharged from the hospital with a diagnosis of anaphylaxis and only 4 cases (26.6%) were diagnosed in the prehospital setting. Conclusion: Although the overall agreement between prehospital and final diagnosis of acute allergic reactions calculated in this study was good, the accuracy of diagnosing the anaphylaxis (as the most critical allergic reaction with a potential fatality) was less than optimal.

Download Full-text

Community awareness of which seizure type should present to healthcare providers; a potential risk factor of the epilepsy treatment gap

10.21203/rs.3.rs-992880/v1 ◽

2021 ◽

Author(s):

Ismat Babiker ◽

Mohamed K. Elnaeim ◽

Awab K.Elnaeim

Keyword(s):

Health Care ◽

Health Care Providers ◽

Demographic Data ◽

Healthcare Providers ◽

Seizure Type ◽

Absence Seizure ◽

Care Providers ◽

Treatment Gap ◽

Cross Sectional ◽

Epilepsy Treatment

Abstract Objective: the objective of this study was to assess the awareness of the community in Sudan of which seizure type(s) should present to health care providers.Methods: This is a cross-sectional descriptive internet-based survey that was conducted in Sudan during the period from January to April 2018, using google forms. The survey consisted of demographic data (age, gender, educational level), a statement evaluating participants’ sources of obtaining information regarding epilepsy, a statement assessing awareness about the primary care provider for people with epilepsy (PWE), and a statement describing the symptomatology of different seizure types in simple Arabic, asking what description(s) participants thought should present to health care providers. We included participants residing in Sudan, and those with a college degree or higher education. Four hundred sixty-seven participants completed the survey.Results: 467 participants were included, of whom, 279 (60%) were females. The mean age of participants was 28 years. Two-thirds of participants obtained their information from non-scientific sources. 84% of the participants were aware that doctors are the primary health care providers for people with epilepsy.The majority (92.%) of participants were aware that patients with symptoms corresponding to the generalized tonic-clonic seizure description should present to doctors, compared with two-thirds of participants for focal seizure symptom description, and only 30.6 % of participants for absence seizure symptom description.Conclusion: This study demonstrated poor awareness about the necessity of presentation for focal and absence seizures. We hypothesize that this lack of awareness may contribute to the epilepsy treatment gap, and we recommend further studies to examine this hypothesis.

Download Full-text

Utilization of Non-Pharmacological Methods and the Perceived Barriers for Adult Postoperative Pain Management by the Nurses at Selected National Hospitals in Asmara, Eritrea

10.21203/rs.3.rs-39743/v3 ◽

2020 ◽

Author(s):

Betiel Yihdego Kidanemariam ◽

Traudl Elsholz ◽

Laban L. Simel ◽

Eyasu H. Tesfamariam ◽

Yonatan Mehari Andemeskel

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Health Care Providers ◽

Work Experience ◽

Statistical Significance ◽

Demographic Data ◽

Postoperative Pain Management ◽

Perceived Barriers ◽

Care Providers ◽

Cross Sectional

Abstract Background: Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals.Methods: This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses' utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05.Results: The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p=0.013), level of education (p=0.012), work experience (p=0.001) and place of work (p=0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p<0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified.Conclusion: The use of non-pharmacological methods in the studied hospitals varied greatly on the knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

Download Full-text

Association Between Cervical Length at 18-23 Weeks of Gestation and Spontaneous Preterm Delivery: A Cross Sectional Study

Case Reports in Obstetrics Gynecology and Reproductive ◽

10.31487/j.crogr.2020.03.02 ◽

2020 ◽

pp. 1-4

Author(s):

Trupti Ruge ◽

Emanuel Gracias

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Transvaginal Ultrasound ◽

Demographic Data ◽

Cross Sectional Study ◽

Cervical Length ◽

Sectional Study ◽

Cross Sectional ◽

Mortality And Morbidity ◽

Spontaneous Preterm Delivery

Introduction: Preterm birth is childbirth occurring at less than 37 completed weeks or 259 days of gestation, is a major determinant of neonatal mortality and morbidity and has long-term adverse consequences for health. Identifying ways to address preventable causes of preterm birth should be a top priority in developing regions of the world. the present study was planned to find the association between cervical length at 18 to 23 weeks of gestation done as a routine during all second level scans and spontaneous preterm delivery. Patients and Methods: This is a hospital based cross sectional study conducted during the period from January 2019 to December 2019. A total of 205 women presenting with singleton pregnancies between 18- 23 weeks of gestations were assessed by transvaginal ultrasound for the measurement of cervical length. Patients were interviewed and their demographic data such as age, obstetric index(GPALD), obstetric history such last menstrual period (LMP), estimated delivery date (EDD) and current pregnancy details such as BP, pulse rate, pallor, period of gestation, were recorded in a predesigned pro forma. Results: In a total of 205 subjects, the average age was found to be 23.26 ± 3.49 years with 52.2% of the women being primigravida. The mean gestation age at the time of enrollment was 20.72 ± 1.00 weeks with 33% of women showing a cervical length of 26-30 mm. The delivery outcome was found as 11% preterm, majority (89.27%) was term delivery. Conclusion: The present study showed that a significantly higher number of women with cervical length ≤ 30 mm (assessed at 18 to 23 weeks of gestation) had preterm labour compared to a woman with cervical length > 30 mm.

Download Full-text

Gastrointestinal Zygomycosis Masquerading as Acute Appendicitis

Case Reports in Gastroenterology ◽

10.1159/000444275 ◽

2016 ◽

Vol 10 (1) ◽

pp. 85-91 ◽

Cited By ~ 4

Author(s):

Won-Tak Choi ◽

Tammy T. Chang ◽

Ryan M. Gill

Keyword(s):

Acute Appendicitis ◽

Fungal Infection ◽

Neutropenic Patient ◽

Lower Abdominal Pain ◽

Final Diagnosis ◽

Hematologic Malignancies ◽

Cross Sectional ◽

Mortality And Morbidity ◽

First Case ◽

Initial Symptoms

Zygomycosis is a rare invasive opportunistic fungal infection that occurs in the setting of hematologic malignancies, chemotherapy-induced neutropenia, and immunosuppressive therapies. We report the first case of disseminated appendiceal zygomycosis due to Absidia spp. in a neutropenic patient who initially presented as acute appendicitis. A 63-year-old woman with acute myeloid leukemia presented as acute appendicitis while receiving induction chemotherapy and ultimately succumbed to overwhelming disseminated zygomycosis. Initial symptoms included loose stools and right lower abdominal pain unresponsive to broad-spectrum antibiotics. Clinical examination and cross-sectional imaging suggested acute appendicitis. The final diagnosis was established by histological evaluations of the ileocecectomy specimen, which showed angioinvasive fungal organisms within the necrotic appendiceal wall with characteristics typical of zygomycetes. Fungal cultures demonstrated Absidia spp. The patient was treated with amphotericin B but expired in the setting of fungal sepsis. A diagnosis of a fungal infection, including zygomycosis, should be considered in all chemotherapy-induced neutropenic patients who present with symptoms of acute appendicitis. A high index of clinical suspicion with prompt histologic and culture diagnosis of zygomycosis may reduce the high mortality and morbidity associated with zygomycosis of the gastrointestinal tract.

Download Full-text

Utilization of non-pharmacological methods and the perceived barriers for adult postoperative pain management by the nurses at selected National Hospitals in Asmara, Eritrea

BMC Nursing ◽

10.1186/s12912-020-00492-0 ◽

2020 ◽

Vol 19 (1) ◽

Author(s):

Betiel Yihdego Kidanemariam ◽

Traudl Elsholz ◽

Laban L. Simel ◽

Eyasu H. Tesfamariam ◽

Yonatan Mehari Andemeskel

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Health Care Providers ◽

Work Experience ◽

Statistical Significance ◽

Demographic Data ◽

Postoperative Pain Management ◽

Perceived Barriers ◽

Care Providers ◽

Cross Sectional

Abstract Background Pharmacological methods are widely used for postoperative pain management however, poorly controlled pain continues to pose a significant challenge. Non pharmacological methods could contribute to the unresolved postoperative pain management in assisting nurses’ routine care and reducing the need for medication. This study aimed to assess nurses’ utilization of non-pharmacological methods in postoperative pain and the perceived barriers for their implementation at the National Hospitals. Methods This was a descriptive cross sectional study conducted among 154 nurses working at the National Referral Hospitals and Sembel Private Hospital. A standardized five-point Likert-scale questionnaire which assesses nurses’ utilization of selected non-pharmacological methods and the perceived barriers for the implementation was used to collect data. Descriptive statistics for the demographic data, independent samples t-test, one way ANOVA and factorial ANOVA were used to analyze the data. Statistical significance level was set at P < 0.05. Results The study found out that emotional support (45.5%), helping with daily activities (67.5%) and creating a comfortable environment (61%) were mostly used while, cognitive-behavioral (5.9%) and physical methods (5.8%) were hardly used. The results also showed that, characteristics such as, age (p = 0.013), level of education (p = 0.012), work experience (p = 0.001) and place of work (p = 0.001), were significantly related to the use of non-pharmacological methods at bivariate level. However, hospitals were the only determinants of the non-pharmacological methods at multivariable level with a statistical significance of (p < 0.001). On the perceived barriers; heavy work load (87.7%), shortage of time (84.4%), limited resources (82.5%), deficit in the guidelines for pain management (77.3%), patient’s uncooperative behavior (57.1%), language difference (64.4%), nurse’s lack of knowledge (50%) and experience (40.3%) were identified. Conclusion The use of non-pharmacological methods in the studied hospitals varied greatly due to knowledge and experience of the nurses. Therefore, it is recommended that exposure and training for all health care providers at all level is a paramount importance in order to appreciate the benefits of non-pharmacological methods applicable to postoperative pain management. This could be achieved through on job training, seminars, scientific conferences and other brainstorming forums.

Download Full-text

Prehospital Care Algorithm for Blast Injuries due to Bombing Incidents

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00008815 ◽

2010 ◽

Vol 25 (6) ◽

pp. 595-600 ◽

Cited By ~ 4

Author(s):

G. Bobby Kapur ◽

M. Tyson Pillow ◽

Ira Nemeth

Keyword(s):

Interpersonal Violence ◽

Large Scale ◽

Prehospital Care ◽

The United States ◽

Mass Casualty ◽

Prehospital Setting ◽

Blast Injuries ◽

Care Providers ◽

Universal Algorithm ◽

Emergency Medical Services Personnel

AbstractTerrorist bombings continue to remain a risk for local jurisdictions, and retrospective data from the United States show that bombings occur in residential and business areas due to interpersonal violence without political motives. In the event of a mass-casualty bombing incident, prehospital care providers will have the responsibility for identifying and managing blast injuries unique to bombing victims. In a large-scale event, emergency medical services personnel should be required to provide prolonged medical care in the prehospital setting, and they will be able to deliver improved care with a better understanding of blast injuries and a concise algorithm for managing them. Blast injuries are categorized as primary, secondary, tertiary, and quaternary, and these injuries are related to the mechanism of injury from the blast event. After an initial evaluation, the emergency healthcare provider should consider following a universal algorithm to identify and treat blast injuries within these categories to prevent further morbidity or mortality in the prehospital setting.

Download Full-text

Physical assessment in pharmacy practice: Perspectives from pharmacists, nonpharmacist health care providers and the public

Canadian Pharmacists Journal / Revue des Pharmaciens du Canada ◽

10.1177/17151635211004975 ◽

2021 ◽

pp. 171516352110049

Author(s):

Christine Leong ◽

Leila Soufi

Keyword(s):

Health Care ◽

Health Care Providers ◽

Online Survey ◽

Vital Signs ◽

Pharmacy Practice ◽

Care Providers ◽

Cross Sectional ◽

Physical Assessment ◽

The Public ◽

The Future

Background: Physical assessment in pharmacy practice is not a new concept, yet the idea is still unfamiliar to many people. Canadian pharmacy graduates are expected to be trained in physical examination as it relates to drug therapy. However, standard delivery of course content in this area has not been clearly established, and previous publications have reported low uptake of this practice despite formal training. To aid the future development of a physical assessment course for pharmacists that is relevant to practice and will contribute to patient care, it is important to gather insight from practising pharmacists, health care providers and the public. Objective: To determine the type of physical assessment skills that would be of value to pharmacy practice and the benefits and barriers of these skills in practice from the perspectives of pharmacists, health care providers and the public. Methods: This was a cross-sectional online survey of pharmacists, nonpharmacist health care providers and the public. Descriptive statistics and thematic analysis were used to describe data. Results: A total of 348 respondents (98 pharmacists, 154 nonpharmacist health care providers, 96 public) completed the survey. Most (64%) nonpharmacist providers were physiotherapists or occupational therapists (only 6.5% physicians). Most respondents felt that performing basic vital signs was relevant to pharmacy practice (79% pharmacists, 69% other providers, 79% public) and felt confident and comfortable about pharmacists using these skills. Palpation, percussion and auscultation were rated less favourably (<50% for most respondents). Nonpharmacist providers tended to be less favourable than pharmacist and public respondents. Seven themes related to benefits and 13 themes related to disadvantages of pharmacists performing physical assessment were identified. Conclusion: These findings provide insight into opinions about the value of pharmacists performing physical assessments. Consensus recommendations on performance expectations to improve recognition of pharmacists in this area is needed in the future. Can Pharm J (Ott) 2021;154:xx-xx.

Download Full-text

Attitude Examination Related to Breast Cancer Among Women in Bács-Kiskun County, Hungary

Practice and Theory in Systems of Education ◽

10.1515/ptse-2016-0021 ◽

2016 ◽

Vol 11 (3) ◽

pp. 223-232

Author(s):

Annamária Pakai ◽

András Oláh ◽

Gabriella Farkasné-Buzánczky ◽

Mónika Sélleyné-Gyúró ◽

Éva Brantmüller

Keyword(s):

Breast Cancer ◽

Health Status ◽

Demographic Data ◽

Principal Component ◽

Its Region ◽

Cross Sectional ◽

Mortality And Morbidity ◽

History Of ◽

The Mean ◽

Population Mortality

AbstractBreast cancer is the most commonly diagnosed type of cancer and a leading cause of mortality among women both in developed and developing countries all over the world. Our research questions were the following: 1. What is the ratio of women participating in mammography screening? 2. What factors influence the attendance of the screening? A quantitative, cross-sectional, and descriptive study (2013) examined women aged 35-65 without a history of breast cancer from Kecskemét City and its region. Non-random, convenience sampling method was applied in the study. The self-edited and self-administered questionnaire included the following groups of questions: socio-demographic data, attitude examination related to screening, reasons for absence. Besides SPSS Statistics, 20.00 test, x2 test, t-test, and ANOVA were used (p<0.05). During the Principal Component Analysis, 23 variables of the motivational scale were grouped into six theoretical subgroups, and the Cronbach-alpha value was 0.758. The mean age of the participants was 49.96±8.91 years.71% of the interviewees never attended breast cancer screening. Regarding the sample, the mean age of women participating in the screening for the first time was 39.66±12.21 years. Women with college/university degree attained high scores on the knowledge test (p<0.05). A significant part of women went to the screening because they feel responsibility for their health status or due to the family history of breast cancer. Fear, shame, or inconveniencies during examination did not affect participation in screening. Prevention programs play a significant role in the improvement of the health status of the Hungarian population. Mortality and morbidity indicators can be reduced by regularly organized, preventive activities based on appropriate knowledge. Thus, the number of healthy years can be increased.

Download Full-text

Workplace violence among prehospital care providers in India: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2019-033404 ◽

2019 ◽

Vol 9 (11) ◽

pp. e033404 ◽

Cited By ~ 2

Author(s):

Benjamin Lindquist ◽

Kathryn Koval ◽

Aditya Mahadevan ◽

Christine Gennosa ◽

William Leggio ◽

...

Keyword(s):

Workplace Violence ◽

Tamil Nadu ◽

Prehospital Care ◽

Survey Study ◽

Medical Attention ◽

Physical Assault ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Indian States

ObjectivesThe purpose of this study was twofold: (1) establish the prevalence of safety threats and workplace violence (WPV) experienced by emergency medical technicians (EMTs) in a low/middle-income country with a new prehospital care system, India and (2) understand which EMTs are at particularly high risk for these experiences.SettingEMTs from four Indian states (Gujarat, Karnataka, Tamil Nadu and Telangana) were eligible to participate during the study period from July through November 2017.MethodsCross-sectional survey study.Participants386 practicing EMTs from four Indian states.ResultsThe overall prevalence of any WPV was 67.9% (95% CI 63.0% to 72.5%). The prevalence of physical assault was 58% (95% CI 52.5% to 63.4%) and verbal assault was 59.8% (95% CI 54.5% to 65%). Of physical assault victims, 21.7% were injured and 30.2% sought medical attention after the incident. Further, 57.3% (n=216) of respondents reported they were ‘somewhat worried’ and 28.4% (n=107) reported they were ‘very worried’ about their safety at work.ConclusionWPV and safety fears were found to be common among EMTs in India. Focused initiatives to counter WPV in countries developing prehospital care systems are necessary to build a healthy and sustainable prehospital healthcare workforce.

Download Full-text

Analysis of Factors Associated with Stunted Growth in Children Aged 12-60 Months Living in Lenda Village, Manggarai Regency, NTT

Jurnal Keperawatan Soedirman ◽

10.20884/1.jks.2020.15.3.1216 ◽

2020 ◽

Vol 15 (3) ◽

Author(s):

Oliva Suyen Ningsih ◽

Yohanes Jakri ◽

Erika Nur Cahyani

Keyword(s):

Health Care Providers ◽

Negative Impact ◽

Demographic Data ◽

Growth Management ◽

Analysis Data ◽

Care Providers ◽

Maternal Knowledge ◽

Cross Sectional ◽

Stunted Growth ◽

Factors Associated

<div class="WordSection1"><p align="center">Stunting is one of the main health problems in Indonesia resulting from poor nutrition. Stunted growth can have a negative impact on children's development and long-term growth. The prevalence of stunted growth in NTT Province in 2017 reached 22.30%. Lenda Village became the priority village for an integrated stunted growth prevention program in 2018. The purpose of this study was to determine the factors associated with the incidence of stunted growth in children aged 12-60 months (n = 82) in Lenda Village, from October 2018-April 2019 using a cross-sectional study. The sample technique used was purposive sampling.The instruments used were: a questionnaire (including demographic data, birth history, diarrhea, mother’s knowledge), microtoise and weight scales.The analysis data involved a chi-square test and binary logistic regression. The results showed that most children were stunted (58 children (70.7%)). There was a significant association between exclusive breastfeeding (AOR = 5.193, 95 % CI= 1.275-21.158, p = 0.022), immunization status (AOR= 0.110, 95 % CI = 0.025-0.477, p =0.003), diarrhea (AOR = 13.386, CI 95 % = 2.270-78.949, p= 0.004), knowledge (AOR = 0.049, 95 % CI = 0.008-0.290, p= 0.001) and stunted growth. Integrated stunted growth management needs to be provided through cross-sectoral collaboration to increase the coverage of health care providers, improve sanitation, increase the level of maternal knowledge and improve health outcomes during both antenatal and postnatal care</p></div>

Download Full-text