Assessment of asthma control in users of oral anti-asthma medications

BACKGROUND: Despite guidelines recommending inhalation therapy as the preferred choice, oral therapy is still widely used in the treatment of asthma in India. However, data about the level of asthma control and healthcare use in patients on oral anti-asthma medications are scarce.METHODS: A retrospective study was conducted to assess the level of asthma control and healthcare use in patients taking oral anti-asthma medications.RESULTS: The study population consisted of 381 adults randomly selected from health screening programmes. All subjects were already receiving oral anti-asthma medications; however, up to 72% had not been diagnosed with asthma by their treating doctors prior to the screening programmes. The cohort had a mean age of 48.26 ± 13.83 years (70% males) and mean peak expiratory flow of 245 ± 78.93 mL/sec. The mean Asthma Control Questionnaire 5 (ACQ-5) score was 2.53 ± 1.15, with respectively 33%, 49.3% and 32.6% reporting at least one episode of breathlessness, one emergency doctor visit and one hospitalisation due to asthma or its symptoms in the past year.CONCLUSION: Underdiagnosis and inappropriate management, as indicated by the poor asthma control and increased hospitalisations seen in this study, is probably a key contributor to the increased burden of the disease in India.

New Professional Competences of Inpatient Emergency Department Staff

The purpose of the study is to determine the professional competencies that are in demand among emergency medical personnel when they provide medical care in an inpatient department. Materials and research methods. We compared the impersonal reports on the work done by 20 doctors of specialized substations of the emergency medical service in St. Petersburg for 2015–2017 with the information about work in the mode of daily activities in 2017 of 10 doctors in the intensive care unit of the inpatient department of the Emergency Medical Service of the First St. Petersburg State Medical University named after academician I.I. Pavlov, stored in the qMS medical information system of the University. The volume of instrumental examination of patients who sought medical help, received it in the required volume and were discharged in a satisfactory condition within the first day, was assessed. We compared the results of ultrasound diagnostics performed by the emergency doctors in the screening mode using portable equipment with the results of the work of a consultant-specialist. 701 medical records of inpatients from among those admitted to the Medical University were analyzed. By studying 4573 medical records, possibility and effectiveness of independent primary triage of the incoming patients by the nursing staff was determined. In addition, with the help of the FlexSim HealthCare program, which allows to effectively predict and to simulate changes in work processes within medical institutions, computer simulation of the department’s work was carried out in the conditions of autonomous work of an emergency doctor. Statistical comparison was performed using the Mann-Whitney test, Student’s t-test for unrelated values, and analysis of four-field tables using the χ-square test. Research results and their analysis. Analysis of the research results showed: fundamental principles of work of the staff of inpatient department — multidisciplinarity, multitasking, autonomy. An ambulance doctor working in a stationary environment must be able to independently diagnose, to treat patients with various pathologies, and to simultaneously supervise several patients; having the level of practical and theoretical training specified in the professional standard, the emergency doctor can effectively provide resuscitation care in the volume of I – II levels, which is especially important, given the short time spent by patients in the department; professional standard of the emergency doctors requires to master ultrasound diagnostics to identify gross pathological conditions and to perform a number of manipulations; nursing staff working in the inpatient department must be able to work in an autonomous environment. Triage by nurses is effective and allows to identify patients who need an immediate examination by an EMS doctor. The use of a three-level sorting algorithm does not contradict basic principles of medical triage used in world practice.

Telenotarzt

As part of the digitization of the healthcare system, tele emergency doctor systems are being established. The aim of these systems is to improve emergency care. This book analyzes the issues raised by professional law, liability law, medical product law and data protection law. It is based on a legal opinion commissioned by the state of North Rhine-Westphalia and is aimed at decision-makers in the healthcare sector. The authors are proven experts in medical law and liability law.

Alvarado Score System, how useful is in Emergency Department? Some consideration about it.

Background; “Acute Appendicitis” is one of the most usual causes of emergency hospital admissions and appendectomy is one of the most common emergency procedures performed in the contemporary medicine. This study aims to identify the Alvarado Score System as a simplified tool for the emergency doctor in the abdominal emergency in general and for the Acute Appendicitis in particular. Materials and methods; The study is of retrospective character and includes 130 cases presented with abdominal Pain in University Hospital Centre” Mother Theresa” Tirana, Albania, in the period 1 April 2019 - 30 May 2019 from which 100 allegedly suspected with “Appendicitis Acute”. Results; Gender distribution has a slight male predominance. The predominant age group was 14-21 years old. The most frequent clinical data has been the tenderness in right iliac fossa. In our study 3% of cases belonged to the group 1-4 Alvarado points, 17% of the cases belonged to the group 5-6 Alvarado points and 80% of the cases belonged to the group 7-10 Alvarado points. Conclusions; In underdeveloped or developing countries where the decision to operate depends on clinical judgment, the Alvarado Score can serve as a precise and consistent tool to exclude Acute Appendicitis. Alvarado Score can also serve the emergency doctor as a tool with predictive value in the abdominal emergency. Key Words: Acute Appendicitis, appendectomy, Alvarado Score

Respiratory Medicine

This chapter on respiratory medicine contains 12 clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and their accompanying symptoms of respiratory origin that may present in the emergency department include asthma, chronic obstructive pulmonary disease, pneumonia, and massive haemoptysis. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.

Maxillofacial Surgery

This chapter on maxillofacial emergency contains five clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible emergencies of maxillofacial origin that may present in the emergency department include fractured mandible, orbital fracture, and parotid trauma, among many others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.

Gastroenterology

This chapter on gastroenterology contains seven clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Possible disorders and accompanying symptoms of gastrointestinal origin that may present in the emergency department include hepatitis A, spontaneous bacterial peritonitis, acute pancreatitis, ulcerative colitis, and haemorrhoids, among others. It will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.

Dermatology

This chapter on dermatology contains six clinical Short Answer Questions (SAQs) with explanations and sources for further reading. Rashes (which may be itchy or painful, or both), swelling of the lips (e.g. angioedema), cellulitis of the lower limb, and erythroderma may be indicative of potentially serious conditions, and it will be up to the emergency doctor to assess, diagnose, and decide upon a treatment path for each patient. The cases described in this chapter are all situations any emergency doctor is likely to encounter at some point in his or her career. The material in this chapter will greatly aid revision for the Final FRCEM examination.