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To support older adults during the first wave of COVID-19, we rapidly adapted our effective health-promoting intervention (Choose to Move [CTM]) for virtual delivery in British Columbia, Canada. The intervention was delivered (April–October 2020) to 33 groups of older adults ("programs") who were a convenience sample (had previously completed CTM in person; n = 153; 86% female; 73 [6] years). We compared implementation outcomes (recruitment, dose received, retention, and completion of virtual data collection) to predetermined feasibility targets. We assessed mobility, physical activity, and social health outcomes pre- and postintervention (3 months) with validated surveys. We met most (dose received, retention, and virtual data collection), but not all (recruitment), feasibility targets. Approximately two thirds of older adults maintained or improved mobility, physical activity, and social health outcomes at 3 months. It was feasible to implement and evaluate CTM virtually. In future, virtual CTM could help us reach homebound older adults and/or serve as support during public health emergencies. [ABSTRACT FROM AUTHOR]

Background: The quality of nursing management of diabetic ketoacidosis (DKA) in emergency departments may be associated with either increased or decreased length of hospital stay. Despite that patient with DKA need intensive care unit (ICU) admission, effective initial nursing management of DKA patients at the emergency department is important. Regarding factors influencing the effective management when caring for patients with DKA, it is unknown how Tanzanian nurses perceive these issues. Therefore, this study was aimed to explore nurses' perceived factors influencing nursing management of DKA patients at emergency medical department (EMD) of two selected referral hospitals in Dar es Salaam, Tanzania. Methodology: A descriptive qualitative study design was conducted to explore nurses' perspectives on the factors influencing nursing management of DKA patients. A total of twelve purposively selected nurses participated in in-depth interviews. The interview guide written in Kiswahili was used to collect data. All interviews were audio recorded and transcribed verbatim, and transcripts analyzed using qualitative content analysis. Findings: Two main themes emerged from the study including facilitators of DKA nursing management and barriers to DKA nursing management. Facilitators of DKA management encompassed three categories including nurses' knowledge of DKA, the availability of DKA management protocol, and nurses' skillset to enhance DKA management. On the other hand, barriers to DKA management had eight sub-categories including limited training on DKA management, lack of autonomy, decisions disagreement, delayed electrolyte results, scarcity of medical resources, shortage of nursing staffs, logistics in emergency care, and lack of specific-nursing management guideline. Conclusion: This study highlights facilitators and barriers to DKA management and underscores the need for comprehensive strategies to overcome these barriers and consolidate the facilitators to improve nurses' capacity in managing patients with DKA. [ABSTRACT FROM AUTHOR]

Purpose: Head and neck emergencies in children are frequent cause of visits to the hospital. Imaging plays a critical role in the management of these patients. This review article aims to familiarize radiologists with the common clinical presentations encountered, imaging characteristics of nontraumatic pediatric head and neck emergencies, and improve their ability to recognize associated complications as well as be aware of common mimics. Methods: We researched our database for commonly encountered nontraumatic head and neck emergencies in children. A literature search was done to compare and complete the list of conditions to be discussed in this review. Results: The review was organized according to anatomical location of the emergent condition. Relevant anatomy has been discussed along with clinical presentation, imaging characteristics and complications. We have presented common mimics with each set of disorders. Key imaging characteristics have been delineated using radiology images. Conclusion: Familiarity with the known complications of head and neck emergencies allows the radiologist to actively search for such findings, encourage early institution of appropriate therapy, and improve outcomes. [ABSTRACT FROM AUTHOR]

Background and Aims: The COVID‐19 pandemic significantly disrupted lower limb diabetes care. We aimed to map trends in diabetes‐related lower limb amputation and hospitalisation rates through the COVID‐19 pandemic. Methods: We performed a retrospective cohort study of all individuals who underwent a lower limb amputation for a diabetes‐related foot complication from 2018 to 2021 at the Royal Melbourne Hospital, a quaternary hospital in Australia. Hospitalisation rates with a diabetes‐related foot complication were collected for comparison. The start of the COVID‐19 epoch was defined as 16 March 2020, when a state of emergency was declared in Melbourne. Results: During the study period, 360 lower limb amputations for diabetes‐related foot complications were performed in 247 individuals. The median monthly number of amputations remained stable prior to and during the COVID‐19 epoch; there was a median of 8.0 amputations per month (interquartile range (IQR) = 6.5–11) before COVID‐19, compared to 6.5 amputations (IQR = 5.0–8.3) during the COVID‐19 epoch (P = 0.23). Hospitalisation with a diabetes‐related foot complication significantly increased from a median monthly rate of 11 individuals (IQR = 9.0–14) before COVID‐19 to 19 individuals (IQR = 14–22) during the COVID‐19 epoch (p < 0.001). Conclusions: Despite increased hospitalisations for diabetes‐related foot complications during COVID‐19, there was not a corresponding increase in amputation rates. Face‐to‐face care of diabetes‐related foot complications was prioritised at this centre and may have contributed to stable amputation rates during the pandemic. [ABSTRACT FROM AUTHOR]

Social norms are a promising means in health crisis communication because they can guide collective action to reduce risk. However, recent research on the COVID-19 pandemic suggests that social norms may have not fully supported strategic goals and even contributed to phenomena that hindered risk reduction, calling into question the potential of social norms campaigns. This became most evident during the COVID-19 pandemic in the emergence of alternative norms of measure opposition, stigmatization of norm-deviant individuals, and the issue of free-riding. The article analyzes these phenomena from a social identity and communication perspective and outlines areas for further inquiry in health and crisis communication. The goal is to pave the way for a research agenda dedicated to the dark side of social norms to unlock the full potential of social norms in times of (health) crisis. [ABSTRACT FROM AUTHOR]

Escherichia coli are pathogenic and antibiotic-resistant organisms that can spread to humans through water. However, there is sparse synthesised information on the dissemination of antibiotic-resistant E. coli through drinking water in Africa. This review provides an overview of the environmental spread of antimicrobial-resistant E. coli through drinking water in Africa. We performed a systematic review based on PRISMA guidelines, and 40 eligible studies from 12 countries were identified until June 2023. Four electronic databases (PubMed, Elsevier, AJOL, and DOAJ) were searched. Studies that employed phenotypic tests (n = 24/40) in identifying the bacterium outstripped those that utilised genome-based methods (n = 13). Of the 40 studies, nine and five, respectively, assessed the bacterium for antimicrobial resistance (AMR) phenotype and genotype. Multiple antibiotic resistance indices of 0.04–0.1 revealed a low level of antibiotic resistance. The detection of multidrug-resistant E. coli carrying resistance genes in certain water sources suggests that AMR-surveillance expansion should include drinking water. [ABSTRACT FROM AUTHOR]

Time indices are key elements in prehospital medical emergencies. The number of calls to Emergency Medical Services (EMS) and the number of missions they have undertaken have been impacted by the COVID-19 epidemic. This study's goal was to evaluate prehospital EMS time indices at the apex of the COVID-19 outbreak. Data were extracted retrospectively from the Asayar Automation System, which records details on all emergency medical calls resulting in patient transport. The study period was from March 2018 to March 2021, covering the pre-COVID period and the first through sixth peaks of the pandemic in Iran. Standardized data extraction procedures were used to minimize bias in this retrospective review. In this study, most transport missions occurred during the fifth peak (n = 2811). In addition, the most missions were related to the age group above 60 years (31.1%), and the highest rate of patient transport (65.9%) was observed in male patients. Traumatic events, cardiac emergencies, impaired consciousness, and psychiatric disorders were, respectively, the main causes of patient transport. Moreover, a significant difference was observed between time indices of various COVID-19 peaks (p < 0.001). Even though the structure of Iran's emergency system is based on the American-Anglo model, and rapid patient transfers to medical facilities are prioritized, the COVID-19 epidemic resulted in increased calls and missions and affected time indices. Therefore, it is suggested that the method and type of service provision be modified during similar crises. [ABSTRACT FROM AUTHOR]

Introduction: Behavioral health emergencies (BHEs) are a common patient encounter for emergency medical services (EMS) clinicians and other first responders, in particular law enforcement (LE) officers. It is critical for EMS clinicians to have management strategies for BHEs, yet relatively little information exists on best practices. In 2016, the Los Angeles County EMS Agency's Commission initiated a comprehensive evaluation of the 9-1-1 response for BHEs and developed a plan for improving the quality of care and safety for patients and first responders. Methods: A Behavioral Health Initiative Committee was assembled with broad representation from EMS, LE, health agencies, and the public. Committee objectives included: 1) produce a process map of the BHE response from the time of a 9-1-1 call to patient arrival at transport destination, 2) identify and describe the different agencies that respond, 3) describe the critical decision points in the EMS and LE field responses, 4) acquire data that quantitatively and/or qualitatively describe the services available, and 5) recommend interventions for system performance improvement. Results: The committee generated comprehensive process maps for the prehospital response to BHEs, articulated principles for evaluation, and described key observations of the current system including: 9-1-1 dispatch criteria are variable and often defaults to a LE response, the LE response inadvertently criminalizes BHEs, EMS field treatment protocols for BHEs (and especially agitated patients) are limited, substance use disorder treatment lacks integration, destination options differ by transporting agency, and receiving facilities' capabilities to address BHEs are variable. Recommendations for performance improvement interventions and initial implementation steps included: standardize dispatch protocols, shift away from a LE primary response, augment EMS treatment protocols for BHEs and the management of agitation, develop alternate destination for EMS transport. Conclusion: This paper describes a comprehensive performance improvement initiative in LAC-EMSA's 9-1-1 response to BHEs. The initiative included a thorough current state analysis, followed by future state mapping and the implementation of interventions to reduce LE as the primary responder when an EMS response is often warranted, and to improve EMS protocols and access to resources for BHEs. [ABSTRACT FROM AUTHOR]

The emergency hierarchical medical system, a multi-hospital collaborative approach, is one of the innovative healthcare management modes in China during the COVID-19 epidemic. This study aims to prove the waiting cost-saving effectiveness of the emergency hierarchical medical system. Two discrete event simulation models based on this system and traditional admission system will be constructed, and the M/M/1 queue structure with outpatient phase and hospitalization phase will be used to calculate the waiting time of those two systems. Furthermore, we do sensitivity analyses of hospital level, in-hospital disease cross-infection, and resource allocation to get the least costly strategy and to provide operational guidance. In the result, based on the regional virtual hospital structure constructed, the emergency hierarchical medical system outperforms the traditional system when the number of infection patients exceeds a threshold. Besides, the rate of in-hospital cross-infection does not affect the cost-saving effectiveness of system, and the centralized hospital should be set considering the hospital service ability. Moreover, given limited medical resources during the epidemic, the resource allocation between hospitals and patients can be optimized to improve the system's cost-saving. [ABSTRACT FROM AUTHOR]

Background: Despite the fact that several triage tools have been implemented globally, emergency care, including the triage system, is often one of the weakest parts of the health system in developing countries, as compared to developed countries. Moreover, emergency centers in African countries are very busy, often flooded by high load of trauma patients, chronic medical conditions, acute medical emergencies, and HIV‐related conditions. These disease conditions precipitate the reasons for the prioritization of patients. In South Africa, studies conducted on the use of triage by nurses revealed that most patients are satisfied with the Nurse‐led triage service provided in emergency departments (EDs). At the same time, some Nurses also see the South African Triage Scale (SATS) as one of the easiest Nurse‐led triage tools. Aim: The study aimed at identifying the factors hindering the effective process of triage during care provision at a selected public hospital in KwaZulu‐Natal (KZN). Methods: This study utilized a cross‐sectional survey, employing a nonprobability convenience sampling to recruit its respondents. The recognition primed decision model formed the framework of the study. Ethical clearance was obtained from the University of KwaZulu‐Natal Ethics Review Board, and ethics principles were carefully observed throughout the study. Results: Out of the 100 respondents, 89% (89) of the respondents perceived that various factors still impede the progress of triage, while 11% (11) of the respondents perceived that no factor impedes the progress of triage. Conclusion: The study indicates that several factors still hinder the effective process of triage. Based on the findings of the study, factors like overcrowding, Nurses waiting for doctors when they know what to do, lack of continuous professional development on triage system, inadequate experience, lack of confidence, and lack of adequate training on triage still impede the efficient triage system. [ABSTRACT FROM AUTHOR]

This paper presents an innovative Internet of Things (IoT)-based smart emergency response system that aims to improve safety and efficiency across vehicles, homes and healthcare settings. The proposed system combines advanced sensors, communication technologies, and intelligent algorithms to provide a comprehensive solution for real-time data monitoring and emergency management. Here, the vehicle device is equipped with temperature, gas, flame, GPS, piezo, and accelerometer sensor and the system can detect accidents, hazardous conditions, precise location automatically notifying emergency services. The home devices incorporate Flame Sensor, humidity sensor, DHT11, MQ-2 gas sensor, MQ-4 Gas Sensor, MQ-135 gas sensor, and intrusion detection to ensure immediate alerts and response to potential security threats. Lastly the health device is equipped with temperature, humidity, stress levels, heart rate, oxygen saturation, and fetal heart rate sensor which can monitor vital signs and detect anomalies, triggering alerts for medical emergencies and facilitating timely intervention. The novelty of the proposed study is it incorporates the three devices, processes the data and automatically notifies the emergency responders for further emergency assistance. Moreover, the system utilizes a cloud-based platform to collect, analyze, and disseminate data, enabling seamless coordination between emergency responders such as ambulance for health and accident emergency, fire brigade for fire emergency and affected individuals. We have also developed a MySQL-PHP-Laravel based live dashboard and emergency response system where both the user and relevant stakeholder will have the access which could mitigate the emergency situation in the quickest amount of time without human intervention. The findings of our study reveals that incorporation of IoT and smart infrastructure offers significant improvement of server response time 3 ms, accuracy > 99% and overall effectiveness of emergency management. This integrated approach not only enhances individual safety but also contributes to broader public safety goals, showcasing the potential of IoT technologies in creating smarter, safer environments. Article highlights: This paper presents an innovative Internet of Things (IoT)-based smart emergency response system (SERS) that aims to improve safety and efficiency across vehicles, homes and healthcare settings. The integration of IoT technologies, cloud services, intelligence algorithms, and smart infrastructure significantly improves server response time (3 ms), accuracy (>99%), and overall emergency management efficacy. The user-friendly interface, scalable design, big data analytic capabilities, and rigorous security protocol ensure that the system is accessible, adaptable, expandable, and capable of expanding to meet future demands, saving lives and minimizing damages. [ABSTRACT FROM AUTHOR]

Background: Patient safety is a critical concern in dentistry. Adverse events (AEs) can harm patients, increase costs, and decrease satisfaction. Understanding AE types and frequencies is crucial for effective risk management and quality improvement. This study analyzes incident reports to identify preliminary incident patterns as a starting point for developing risk management strategies. However, under-reporting limits the ability to identify true incident patterns, highlighting the need for improved reporting systems and encouragement of incident reporting. Further research is underway to develop such a system and promote reporting to ensure sufficient data quality for effective risk management. Methods: A retrospective analysis of 1,618 incident reports from December 2018 to August 2023 was conducted. A validated classification system, developed from a 5-year retrospective analysis and approved by 14 experts, categorized patient safety incidents, aligning with Thailand's Hospital Accreditation standards. Descriptive statistics summarized AE frequency and distribution. Results: Of the reports, 752 were patient safety, 503 personnel safety, and 363 organizational safety incidents. Top patient safety incidents included medical record errors (176), accidental damage (66), post-operative complications (65), medical emergencies (64), and communication errors (53). Personnel safety incidents involved inappropriate working conditions (135) and work-related injuries with contact transmission risk (117). Organizational safety incidents mainly concerned policy and operational processes (131). Conclusions: This study reveals the preliminary patterns of adverse events (AEs) in dental settings and underscores the limitations due to under-reporting, which affect the ability to fully understand true incident patterns. To effectively manage risks, there is a critical need for improving the existing incident reporting system and encouraging a culture of comprehensive reporting among dental professionals. Future efforts should focus on enhancing reporting systems to ensure high-quality data, enabling better identification of incident trends and supporting targeted risk management strategies to improve patient safety in dentistry. [ABSTRACT FROM AUTHOR]

Background: On 5 November 2021, a fire incident following a tanker explosion occurred in the Wellington PMB Junction east of Freetown, Sierra Leone, injuring and killing people. WHO facilitated the deployment of international emergency medical teams (EMTs) to support the Ministry of Health (MoH) in providing care to the wounded in four hospitals. Objective: In this study, we document Sierra Leone's experience managing the fire incident and the role of EMTs in responding to it. Method: This is a cross-sectional After-Action Review (AAR) debrief of the response and deployment, including focus group discussion with WHO and MoH staff (n = 14) in a virtual workshop and document reviews on the response. The results thematically cover the event and the different agencies' responses and a review of EMTs' responses. Results: At the onset of the emergency, the National Disaster Management Agency (NDMA) instituted a well-coordinated response mechanism in collaboration with the MoH and managed all response actions, such as medical services, informing partners and the public and coordinating all other agencies. WHO facilitated EMT deployments and mobilised medical supplies and equipment, while the MoH provided accommodation, logistics and coordination. The EMTs dispensed their functions with professionalism, adapted to the environment and available resources, and augmented the care the national health workers provided. They offered additional care: reconstructive surgery, pain management, palliative care, wound care, rehabilitation, physiotherapy and psychosocial counselling, which were initially inadequate at the onset of the disaster. 94 out of 157 patients were discharged home at the end. National clinicians acquired additional skills through the capacity-building activities of EMTs. The community appreciated the teams. Conclusion: The government, partners and EMTs were important in the response and worked with speed and political acceptability using the context experience to provide surge support to the country. This experience brought to focus the idea of developing a national EMT in Sierra Leone, which would be useful to help respond even more swiftly. In collaboration with WHO, there is a need to institute further mechanisms to facilitate rapid response and quality-assured deployment of EMTs at regional and sub-regional levels and strengthen to support future responses. [ABSTRACT FROM AUTHOR]

Objective Method Results Conclusions Despite its potential for informing tailored treatments, the severity of eating disorders (EDs) lacks clear conceptualisation. The present retrospective cohort study examined the clinical validity and utility of severity specifiers for anorexia nervosa (AN) and atypical AN in a Korean population.Data from 696 Korean outpatients with AN or atypical AN were analysed. Severity criteria for AN from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Medical Emergencies in Eating Disorders (MEED) guidance were used. Severity criteria applied for atypical AN were the frequency of intermittent fasting (ED Diagnostic Scale item 17), Eating Disorder Examination Questionnaire global scores, and the degree of weight suppression.Prevalence of extreme cases of AN in our cohort was higher than in Western populations in previous studies. MEED guidance further subclassified extreme AN, revealing distinct psychopathological profiles across severity levels. The proposed severity classification for atypical AN based on the weight loss behaviour of intermittent fasting showed merit.These findings suggest a potential need for a more nuanced AN severity classification that better represents severe medical aspects and encompasses cultural and ethnic diversities. In atypical AN, there is a need to examine severity indices measuring pathological behaviours. [ABSTRACT FROM AUTHOR]

Background: In modern emergency medical services (EMS), ambulances increasingly focus on examining and treating the patient at the scene. This has led to increased levels of non-conveyance. In Finland, for instance, approximately 40% of EMS dispatches end up in non-conveyance. As EMS systems evolve, the proportion of non-conveyance could serve as a cost-effective measure to assess the quality of the dispatch criteria, if a link to the performance of urgency assessment would be established. The purpose of this study was to investigate whether the proportion of non-conveyance is associated with the test performance levels of the urgency assessment. This investigation was done separately within each dispatch category. Methods: A retrospective evaluation of the data was conducted on all EMS dispatches in the Pirkanmaa Hospital District from 1 August 2021 through 31 August 2021. There were a total of 7,245 EMS dispatches during the study period of which 829 were excluded. This study was conducted by comparing the existing test performance levels (sensitivity, specificity and under- or overestimation) of the emergency response centre's urgency assessment with the non-conveyance rate (%) of each dispatch category. The relationships between the variables were measured using Spearman's rank correlation coefficient. Results: The proportion of over-triage was the only urgency assessment's test performance variable that had a statistically significant correlation with the proportion of non-conveyance (r = 0.568; p = 0.003). Other test performance variables of the urgency assessment had no or little correlation to the proportion of non-conveyance. Of the 6,416 EMS dispatches in the study period, 42% (2,672) resulted in non-conveyance of the patient. In nine dispatch categories, at least half (51–69%) of the dispatches ended in non-conveyance. Conclusions: Based on this study, it seems that the percentage of non-conveyance in the dispatch category could be used, with certain limitations, to assess the proportion of over-triage in the dispatch category. The method is particularly applicable in scenarios where the dispatch criteria have undergone modifications and there is a need to monitor the effect of the changes on the level of over-triage. [ABSTRACT FROM AUTHOR]

Background: A frequent caller is defined by The Frequent Caller National Network (FreCaNN) as an adult who makes five or more emergency calls in a month or twelve or more in three months, related to individual episodes of care. However, we believe that when limiting the definition to those who call themselves, one underestimates the impact frequent contacts have on the Emergency Medical Communication Center (EMCC) and the Emergency Medical Services (EMS). Method: We conducted a descriptive retrospective cross-sectional database review of frequent contacts; defined as persons who have ≥ 5 contacts in a month or ≥ 12 contacts in three months. Data were provided from Oslo EMCC, between 1. January 2017 and 31. December 2022. Contrary to the FreCaNN definition, we included all types of contacts and callers, both emergent and non-emergent, regarding patients of all ages. Results: During the study period, 2.149.400 contacts were registered. Of these 129.700 were contacts from frequent callers, where the patients called themselves. When including contacts frequently made on behalf of a patient, we found that 268.723 fit the definition of frequent emergency contacts. When also taking non-emergent contacts into account, a total of 437.361 contacts fit the definition of frequent contacts. Conclusion: When limiting the criteria to only frequent callers, one underestimates the impact persons who have frequent contacts, have on the EMCC and the EMS. We were able to distinguish between three categories—contacts from frequent callers, frequent emergency contacts, and frequent contacts. We believe broadening the definition can benefit both research and audits, when accessing the use of emergency resources to patients with frequent requests for help to the EMCCs. [ABSTRACT FROM AUTHOR]

Background: Vital signs and comorbid diseases are the first information evaluated in patients admitted to the emergency department (ED). In most EDs, triage of patients takes place with vital signs and admission complaints only. Comorbidities are generally underestimated when determining the patient's status at the triage area. This study aims to assess the relationship between initial vital signs, comorbid diseases, and medical emergency conditions (MEC) in patients admitted to the ED. Methods: This prospective study was designed as a single-center observational study, including patients admitted to a tertiary ED between 16.06.2022 and 09.09.2022. Patients younger than 18, readmitted to the ED within 24 h, or absence of vital signs due to cardiac arrest were excluded from the study. Vital signs and comorbid diseases of all patients were recorded. The mortality within 24 h, the need for intensive care unit admission, emergency surgery, and life-saving procedures were considered "medical emergency conditions". The role of vital signs and comorbid diseases in predicting emergencies was analyzed by binary logistic regression. Results: A total of 10,022 patients were included in the study; 5056 (50.4%) were female, and 4966 (49.6%) were male. Six hundred four patients presented with an MEC. All vital signs -except diastolic hypertension and tachycardia- and comorbidities were found statistically significant. Hypoxia (Odd's Ratio [OR]: 1.73), diastolic hypotension (OR: 3.71), tachypnea (OR: 8.09), and tachycardia (OR: 1.61) were associated with MECs. Hemiplegia (OR: 5.7), leukemia (OR: 4.23), and moderate-severe liver disease (OR: 2.99) were the most associated comorbidities with MECs. In our study, an MEC was detected in 3.6% (186 patients) of the patients with no abnormal vital signs and without any comorbidities. Conclusion: Among the vital signs, hypoxia, diastolic hypotension, tachypnea, and tachycardia should be considered indicators of an MEC. Hemiplegia, leukemia, and moderate-severe liver disease are the most relevant comorbidities that may accompany the MECs. [ABSTRACT FROM AUTHOR]

Acute severe ulcerative colitis (ASUC) is a medical emergency that affects approximately 25% of patients with ulcerative colitis at some point in time in their lives. Outcomes of ASUC are highly variable. Approximately 30% of patients do not respond to corticosteroids and up to 50% of patients do not respond to rescue therapy (infliximab or cyclosporin) and require emergency colectomy. Data are emerging on infliximab dosing strategies, use of cyclosporin as a bridge to slower acting biologic agents and Janus kinase inhibition as primary and sequential therapy. In this review, we outline contemporary approaches to clinical management of ASUC in the setting of failure to respond to traditional rescue therapies. [ABSTRACT FROM AUTHOR]

In May 2022, a global outbreak of mpox (formerly monkeypox virus) affected thousands of mainly gay and bisexual men. Mpox is usually a time-limited illness that can involve fever, pain, and skin lesions, but may require hospitalisation. There is scant research into the firsthand experiences of people affected by mpox, including experiences of symptoms, healthcare, and recovery. This study considers the different illness narratives of people who experienced mpox in Australia in 2022. In-depth interviews and 6-month follow-up interviews were conducted with 16 people, including 13 people diagnosed with mpox and three close contacts. All participants were cisgender gay or bisexual men living in Australia. Participants' accounts described minor to severe periods of sickness, negative and stigmatising experiences engaging with healthcare, and some participants experienced long-term effects on their sexual well-being and complications from mpox. The emergency outbreak context meant that mpox was highly distressing, making it difficult to manage and producing varying forms of disruption to everyday life. Mpox was narrated as disruptive in different ways: as a minor interruption to holiday plans, a prolonged period of poor health, or a biographically disruptive event prompting a re-evaluation of sexual values and health. This analysis demonstrates that an unfamiliar emergent disease outbreak related to sexual practices and sociality can reconfigure personal life and sexual well-being, suggesting a need to focus on providing quality patient care in outbreaks of mpox and other infectious diseases. [ABSTRACT FROM AUTHOR]

Definition of near miss mortality - a woman who survives a severe life-threatening condition (either after receiving emergency medical or surgical intervention or otherwise) during pregnancy, childbirth or within 42 days of termination of pregnancy.1 Maternal mortality is the death of a woman during pregnancy, childbirth or 42 days after termination of pregnancy. Women with life threatening condition (WLTC) refers to all women whowere either maternal near miss or who died. (WLTC = MNMM + MM) Objectives: To study the incidence of maternal near miss mortality and underlying factors leading to maternal near miss mortality. Methodology: The present a facility based prospective observational study carried from January 2021 till June 2022, i.e., for 18 months involving all the cases that fulfilled criteria for near miss mortality that came to this institute were considered for this study. Results: Majority of patients were booked and registered under government setups - 77 (81.05%). Majority of patients were near miss on admission - 78 (82.10%). According to this study, most common underlying causes of MNMM at this tertiary care centre are Hypertensive disorders - 46 (48.42%), followed by anaemia - 18 (18.94 %) cases. Maternal near miss incidence ratio in our study was 9.6 every 1000 livebirths. Maternalnearmissrate in our study was 8.8 every 1000 obstetricadmissions. Severe maternal outcome ratio was 15.18 every 1000 live births. Conclusion: Maternal near miss incidence ratio in our study was 9.6 every 1000 live births. Maternalnear miss rate in our study was 8.8 every 1000 obstetricadmissions. Severe maternal outcome ratio was 15.18 every 1000 live births. Most common underlying causes of MNMM at this tertiary care centre are Hypertensive disorders - 46 (48.42%), followed by anaemia - 18 (18.94 %) cases. [ABSTRACT FROM AUTHOR]

Short-term exposure to air pollution has previously been studied in relation to certain neurological disorders, but there is still a lack of convincing data linking air pollution to epileptic seizures. The study's goal was to investigate how exposure to ambient nitrogen dioxide (NO2) affected the number of patients seeking assistance at the Wuhan Emergency Medical Center due to epileptic seizures. We gathered data on medical emergency calls (MECs), daily ambient air pollution concentrations (SO2, NO2, PM2.5, PM10, CO, and O3), and meteorological variables in Wuhan, China, spanning from January 1, 2017, to November 30, 2019. To investigate the potential influence of ambient nitrogen dioxide on MECs for epileptic seizures, we carried out a time-series investigation using the general additive model (GAM). Additionally, analyses stratified by season, age, and gender were performed. A total of 8989 records of MECs for epileptic seizures were enrolled in our study during the period. Statistical analysis indicates that a rise of 10 μg/m3 in NO2 concentration is linked to a 0.17% increase in daily MECs for epileptic seizures (95% confidence interval [CI]: 0.02%, 0.32%). Furthermore, people aged 14–59 years were more susceptible(2.25%, P < 0.05). The short-term effects of NO2 exposure on daily MECs for epileptic seizures were stronger in warm seasons than in cool seasons (0.55% vs. -0.10%, P < 0.0001). Our findings suggests that short-term exposure to ambient NO2 was positively correlated with daily MECs for epileptic seizures in Wuhan, China. Additionally, we observed that these associations were stronger in patients aged above 14 but under 60 years and the warmer seasons (from April to September). [ABSTRACT FROM AUTHOR]

Public health crises can significantly impact the emotional well‐being of healthcare workers. Network analysis is a novel approach to exploring interactions between mental disorders at the symptom level. This study aimed to elucidate the characteristics of post‐traumatic stress disorder (PTSD), anxiety, depression, and insomnia symptoms network among frontline nurses under sudden public health crisis. A cross‐sectional survey was conducted online among 556 frontline nurses through convenience sampling in Hubei Province, China, from 21 February 2020, to 10 March 2020. Symptoms of PTSD, anxiety, depression, and insomnia were assessed by the Post‐Traumatic Stress Disorder Checklist (PCL‐5), Generalized Anxiety Disorder scale (GAD‐7), Patient Health Questionnaire (PHQ‐9) and Insomnia Severity Index, respectively. Central symptoms (the most important symptoms, activation has the strongest influence the other nodes) and bridge symptoms (nodes where deactivation can prevent activation from spreading from one disorder to another) were identified via centrality and bridge centrality indices, respectively. Network stability was examined using the case‐dropping procedure. We found that the correlation between PHQ‐9 item 9 'suicidal thoughts' and PCL‐5 item 16 'reckless or self‐destructive behaviour' was the strongest. Moreover, 'reckless or self‐destructive behaviour' was the strongest central symptom, and PHQ‐9 item 3 'sleep problems' was the most important bridge symptom. Other major symptoms included GAD‐7 item 6 'uncontrollable anxiety' and PHQ‐9 item 2 'depressed or sad mood'. Timely, systemic targeting interventions on central symptoms and bridge symptoms may effectively alleviate co‐occurring experiences of psychopathological symptoms among frontline nurses. [ABSTRACT FROM AUTHOR]

This report describes opportunities to address emergency preparedness to incorporate the needs of pregnant and postpartum populations. This report briefly summarizes data on the impacts of weather and climate disasters on maternal and infant health and outlines opportunities for individuals, health care providers, and public health practitioners to increase capacity to prepare for these occurrences, which are becoming more frequent and costly. Specific resources from the U.S. Centers for Disease Control and Prevention's Division of Reproductive Health are shared to support individual preparedness, communication of disaster safety messages, and emergency preparedness planning capacity among health care providers and health departments. [ABSTRACT FROM AUTHOR]

The term slow code refers to an intentional reduction in the pace or intensity of resuscitative efforts during a medical emergency. This can be understood as an intermediate level between full code (full resuscitation efforts) and no code (no resuscitation efforts) and serves as a symbolic gesture when intervention is considered medically futile. While some previous research acknowledges the slow code as an integral part of clinical practice, many ethicists have condemned the practice as dishonest and causing unnecessary pain for the patient. As the public's views on this issue have been largely absent from the discussion to date, two vignette experiments were performed to investigate their perceptions. The findings indicate that laypersons believe that slow codes are commonplace and often prefer them over a no code. While a full code was perceived as the standard approach and rated most ethical and least punishable, the present results do not support the widespread assumption that laypersons generally oppose slow codes, and this finding should inform ethical discussion and clinical practice. [ABSTRACT FROM AUTHOR]

This article examines how settler legal orders in Eastern Navajo Agency produce conditions of impasse that defer investments in life sustaining infrastructures, like roads. Focusing on the conjuncture of infrastructural decay and jurisdictional friction amid an oil and gas boom, I elaborate a concept of “gridlock” as a deadly effect of settler governance. Unfolding stories about road maintenance, school access, and emergency medical transport, the article describes gridlock as a space of both impasse and improvisation that Diné residents inhabit in moving through a region engineered for their immobility. [ABSTRACT FROM AUTHOR]

This Medical News article is an interview with emergency management and medical experts from Oregon and Washington who experienced the record-breaking heat wave in June of 2021. [ABSTRACT FROM AUTHOR]

Background & Objective: Evaluating the academic performance and competencies of medical students is essential in the medical field. Written tests play a big part in this situation. This study's primary goal was to comprehend medical students' experiences with their exams. Materials & Methods: The study was carried out from 2020 to 2022 at the Fasa University of Medical Sciences in the Iranian province of Fars, using a qualitative research methodology using a phenomenological approach. In-depth one-on-one interviews with the investigators were conducted with twenty-three medical students from a variety of professions, including health, medicine, nursing, operating room technology, anesthesiology technology, and medical emergencies. The interpretive phenomenological approach was used to analyze the data, including observations made during written exams and in-depth interviews. Results: The results of the study revealed four general themes that reflected the views of the medical students about their exam experiences. The themes that emerged were emotional fluctuations, stressful difficulty, coping strategies, and blessings in disguise. Conclusion: Despite the participants' initial uncertainty, the study participants saw the exams as a blessing in disguise. They saw exams as essential learning resources and a means of gaining access to stable job chances. However, because of the psychological strain and scoring direction, the exam also presented a hard challenge. Furthermore, students experienced a range of positive and negative emotional changes as a result of the test. In order to manage their test anxiety, the students used both positive and negative strategies for coping. These results have substantial implications for policies that might be implemented in the field of education. [ABSTRACT FROM AUTHOR]

Objectives. To compare the incidence, case-hospitalization rates, and vaccination rates of COVID-19 between people experiencing sheltered homelessness (PESH) and the broader community in Chicago, Illinois, and describe the impact of a whole community approach to disease mitigation during the public health emergency. Methods. Incidence of COVID-19 among PESH was compared with community-wide incidence using case-based surveillance data from March 1, 2020, to May 11, 2023. Seven-day rolling means of COVID-19 incidence were assessed for the overall study period and for each of 6 distinct waves of COVID-19 transmission. Results. A total of 774 009 cases of COVID-19 were detected: 2579 among PESH and 771 430 in the broader community. Incidence and hospitalization rates per 100 000 in PESH were more than 5 times higher (99.84 vs 13.94 and 16.88 vs 2.14) than the community at large in wave 1 (March 1, 2020–October 3, 2020). This difference decreased through wave 3 (March 7, 2021–June 26, 2021), with PESH having a lower incidence rate per 100 000 than the wider community (8.02 vs 13.03). Incidence and hospitalization of PESH rose again to rates higher than the broader community in waves 4 through 6 but never returned to wave 1 levels. Throughout the study period, COVID-19 incidence among PESH was 2.88 times higher than that of the community (70.90 vs 24.65), and hospitalization was 4.56 times higher among PESH (7.51 vs 1.65). Conclusions. Our findings suggest that whole-community approaches can minimize disparities in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission between vulnerable populations and the broader community, and reinforce the benefits of a shared approach that include multiple partners when addressing public health emergencies in special populations. (Am J Public Health. 2024;114(S7):S590–S598. https://doi.org/10.2105/AJPH.2024.307801) [ABSTRACT FROM AUTHOR]

Background: Patients with emergency surgical conditions (ESCs) experience higher complication rates than those without emergency conditions. Our purpose was to improve time-based key performance indicators (KPIs) of care for ESC patients, including diagnostic workup, empiric stabilization, and referral to definitive care. Methods: A rapid response program (ESTAT) was developed to screen for and coordinate optimal, timely care for a spectrum of high-risk ESCs, from the patient's index clinical encounter up to definitive care. The Mann-Whitney test assessed whether any differences in KPIs were statistically significant (P < .05) before compared to after the implementation of ESTAT. Results: 98 patients were identified: 44 in ESTAT group (70% age ≥55, 57% male); 54 in control group (57% age ≥55, 44% male). There were significant decreases from time of index clinical encounter to resuscitation (5 min. vs 34 min., P < .001), to diagnostic imaging (52 min. vs 1 hr. 19 min., P = .004), and to definitive care (2 hr. 17 min. vs 3 hr. 51 min., P = .007) in the ESTAT group compared to the control group, respectively. Discussion: Improving time-based KPIs for delivery of clinical services is a common goal of medical emergency response systems (MERS) in numerous specialties. Implementation of an ESTAT program provides a screening tool for at-risk patients and reduces time to stabilize, diagnose and triage to definitive surgical intervention. These time benefits may ultimately translate to reduced complication rates for ESC patients. ESTAT may also represent a patient onboarding mechanism for surgical specialty verification programs promoted by quality improvement committees of various professional societies. [ABSTRACT FROM AUTHOR]

Context: Since COVID-19, the European Commission (EC) has sought to expand its activities in health through the development of a European Health Union and within it the Health Emergencies Preparedness and Response Authority (HERA). Methods: The authors applied a discourse analysis to documents establishing HERA to investigate how the EC legitimated the creation of this institution. They focused on how it framed health emergencies, how it framed the added value of HERA, and how it linked HERA to existing EU activities and priorities. Findings: Their analysis demonstrates that security-based logics have been central to the EC's legitimation of HERA in alignment with a "securitization of health" occurring worldwide in recent decades. This legitimation can be understood as part of the EC's effort to promote future integration in health in the absence of new competences. Conclusions: Securitization has helped the EC raise its profile in health politically without additional competences, thereby laying the groundwork for potential future integration. Looking at the discursive legitimation of HERA sheds light not only on whether the EC is expanding its health powers but also how it strategizes to do so. HERA, while constrained, allows the EC to further deepen security-driven integration in health. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has caused widespread disruptions globally, resulting in a state of health emergency with numerous deaths reported and an overall implementation of quarantine and isolation. Strict lockdowns have been implemented to curb the spread of the virus, requiring social distancing and limiting physical interactions. These measures had far-reaching impacts on all aspects of life, including education. Education was one of the most affected sectors, with difficulty delivering quality education in schools, colleges, and universities. It was hard to provide quality education, a basic need of humanity. In this research paper, we propose an adequate solution to overcome the difficulties of maintaining educational quality during and after the COVID-19 pandemic and its multiple variants. The proposed solution is a hybrid model for an autonomous lecture recording system that facilitates students to attend physical classes and attend lectures virtually. The solution proposed is a cost-effective and convenient way for students to access lectures. The application involves hardware and software components that record and preserve lectures' audio and visual aspects. The system will allow lectures to be delivered directly to the students' devices. The major modules of the project include Python scripting, model training, UI/UX design, and app development. [ABSTRACT FROM AUTHOR]

Drawing on the social capital theory, the research examines the impact of network size, network centrality, trust, and regulation on the knowledge integration and robustness of emergency medical logistics. Additionally, the research seeks to provide deeper insight into the link between the variables by studying how knowledge integration mediates the relationship between independent variables and the robustness of emergency medical logistics. The study utilized structural equation modeling to assess the underlying assumptions of the research model. A total of 465 valid questionnaires were collected from government departments, hospitals, social teams, and enterprises. The data processing and analysis were conducted using SPSS 23.0 and AMOS 24.0 software. The study's outcome indicated that network size and network centrality have indirect effects on the robustness of emergency medical logistics through the intermediate variable of knowledge integration, but neither has a direct effect. Moreover, knowledge integration has a significant positive impact on the robustness of emergency medical logistics. Both trust and regulation have positive effects on the robustness of emergency medical logistics, and they also have positive effects on the robustness of emergency medical logistics through knowledge integration. This study is the inaugural exploration of the correlation between knowledge integration and the robustness of emergency medical logistics. It adds to the literature by providing evidence that knowledge integration is an essential emergency organization's aide in promoting the robustness of emergency medical logistics. The findings of this study establish a strong theoretical foundation and practical significance for ensuring and improving the level of effectiveness in emergency medical logistics management. [ABSTRACT FROM AUTHOR]

School nurses are critical components of school-based interdisciplinary teams supporting student behavioral health. The purpose of the present study is to understand the extent to which school nurses in New Mexico across grade levels manage emergencies related to behavioral health, violence, and trauma. The study also seeks to identify which topics the school nurses received continuing education (CE) for, and which topics they consider to be important to their practice. Analyses of 2019 statewide survey data show a considerable number of school nurses in New Mexico provide management for behavioral health, violence, and trauma-related emergencies, and nurses in secondary schools are significantly more likely than nurses in primary schools to report managing these emergencies and to have received CE on behavioral health topics. Our findings reaffirm the essential role of school nurses in addressing emergent student health issues and underscore the need for practice- and competency-based behavioral health CE opportunities. [ABSTRACT FROM AUTHOR]

The professional experiences of school nurses who work outside of urban areas are not often described. We used data from a 2019 statewide survey of school nurses to describe differences between the urban and non-urban (urban cluster and rural) school nurse workforce in New Mexico. Non-urban school nurses were twice as likely as urban nurses to provide clinical services to multiple school campuses (P <.001) and more likely to serve both elementary and secondary school settings (P =.002). They were less likely than urban school nurses to be bachelor's prepared, or to have received recent continuing education on diabetes (P <.001), reproductive health (P = 0.02), LGBQ+ and transgender student health (P <.001, for each), and suicide risk assessment and screening (P =.012). Our findings underscore concerns about geographic differences in the school nursing workforce in terms of educational preparation and student access that could potentially limit the school nurse role in advancing child health equity. [ABSTRACT FROM AUTHOR]

Background: Trend of medico legal cases is a fundamental part of the prevention of avoidable causalities in future and to study the crime rate in area. In present study an attempt is made to know the burden of medico legal cases. The aim of present study is to describe the profile, pattern and trend of medico-legal cases and identify errors in the medico-legal reports. Method: This is a Retrospective, descriptive, non-interventional study, conducted in emergency department of Government Medical College and Hospital Jalaun during the period from 1st January 2023 to 31th December 2023. This is a tertiary care teaching hospital where patients are referred from most of private hospitals. Patients from district hospitals of the region are also admitted in this college. Conclusions: In majority of places, duty of casualty medical officer is accomplished by MBBS doctor who is not expert in handling of medico legal cases. Therefore medico-legal work should be done under the direction of forensic medicine expert to avoid inaccuracy in giving the opinion. The present study showed that male out numbered female and maximum cases were of younger generation. Most common aetiology was of road traffic injuries. Such incidences can be prevented by giving awareness through proper education and training of safety standards by administrators through road safety programs. [ABSTRACT FROM AUTHOR]

Background: Ground crossing borders are considered a threat to health security due to their complex and challenging environments. The objective of this scoping review is to identify the main themes crucial for implementing effective health management at ground crossing borders to maintain health security. Methods: This scoping study was conducted following the methodological framework developed by Arksey and O'Malley and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Documents published from January 2005 to December 2023 were searched for using PubMed, Scopus, Web of Science, and UN databases. Two reviewers screened and reviewed eligible studies in three stages: duplicate identification and elimination, title and abstract screening, and full-text assessment. Data were charted and grouped into themes, the frequency of each theme and its percentage was calculated, and then thematic analysis was conducted. Results: Forty-five studies met the inclusion criteria. Areas of research were grouped into eight themes: "Infection Prevention and Control measures (IPC) (17%)", "Collaboration, Coordination, and Partnership (17%)", "Research and Data Sharing (15%)", "Build Border Health Capacity (13.5%)", "Planning (13.5%)", "Communication (13%)", "Legislations and Frameworks (7%)", and "Services and Assistance for At-Risk Groups (4%)". Through this scoping review, we found that the eight themes are interconnected, and are crucial for implementing effective health management at the ground crossing borders and for better emergency preparedness responses among countries. [ABSTRACT FROM AUTHOR]

Introduction: Traumatic brain injury (TBI) poses a significant public health challenge with profound impacts at individual, family, community, and societal levels. Early during the COVID-19 pandemic, the neighborhood of Elmhurst, Queens in New York City was a hotspot dubbed the "epicenter of the epicenter" of the crisis in the United States, requiring major changes in healthcare resource allocation. This study investigates how different phases of the COVID-19 pandemic affected the incidence, severity, and clinical outcomes of TBI in this geographical area. Methods: TBI admissions to NYC Health + Hospitals/Elmhurst, a Level 1 Trauma Center, during the first six months of 2019, 2020, and 2021 were retrospectively analyzed. Data were grouped into three periods: pre-pandemic (1/1/19–6/30/19 and 1/1/20–2/29/20) [Group 1], first COVID-19 wave (3/1/20–6/30/20) [Group 2], and second COVID-19 wave (1/1/21–6/30/21) [Group 3]. Univariate analyses were conducted to explore factors potentially associated with TBI outcomes; variables that reached statistical significance (p < 0.05) were included in a binary logistic regression analysis dichotomized into good outcome (discharge to home or acute rehabilitation disposition) and poor outcome (discharge to skilled nursing facility/subacute rehabilitation, hospice, or in-hospital mortality). Results: Analysis of 443 TBI patients (median age 56 [range 38, 73]; mean admissions/week 5.6 ± 2.7) demonstrated no significant variance in age (H = 0.92; p = 0.63), sex (χ2 = 1.4, p = 0.51), or ethnicity (χ2 = 17.1; p = 0.07) across groups. Group 2 had significantly fewer weekly admissions (3.9 ± 2.6) compared to Groups 1 (5.9 ± 2.2; p = 0.02) and 3 (6.1 ± 2.9; p = 0.01). Over the course of the pandemic, the proportion of uninsured patients decreased from 15 to 4%, while Medicaid and Medicare coverage rates rose from 25 to 41% and 20% to 28%, respectively (p < 0.001). A binary logistic regression model dichotomized by discharge outcome for all 443 TBI patients confirmed that increasing age (OR = 0.95; 95% CI 0.93–0.97; p < 0.001) and Injury Severity Score (OR = 0.88; 95% CI 0.83–0.93; p < 0.001) were inversely correlated with good outcome, while higher Glasgow Coma Scale (OR = 1.26; 95% CI 1.17–1.36; p < 0.001) was positively correlated. Of particular interest, Black/Hispanic ethnicity (OR = 0.36; 95% CI 0.19–0.66; p = 0.002) and public health insurance (Medicaid/Medicare) coverage (OR = 0.83; 95% CI 0.68–1.00; p = 0.05) were both associated with less favorable outcomes. Neither group designation, patient sex, COVID-19 status, or need for neurosurgical intervention was correlated with outcome (p > 0.05). Conclusion: Despite the changes in TBI admission patterns throughout New York City during the COVID-19 pandemic, the quality of patient outcomes at our institution remained relatively consistent across the pandemic's different phases, as assessed by discharge disposition. However, two important socioeconomic factors—ethnicity and health insurance status—were significantly associated with outcome, underscoring the need for systemic changes to address ongoing disparities in neurotrauma care. [ABSTRACT FROM AUTHOR]

Aims Design Methods Results Conclusion Implications for Patient Care Impact Reporting Method Patient or Public Contribution To identify facilitators and barriers and tailor implementation strategies to optimize emergency clinician's use of adult and paediatric sepsis pathways.A qualitative descriptive study using focus group methodology.Twenty‐two emergency nurses and ten emergency medical officers from four Australian EDs participated in eight virtual focus groups. Participants were asked about their experiences using the New South Wales Clinical Excellence Commission adult and paediatric sepsis pathways using a semi‐structured interview template. Facilitators and barriers to use of the sepsis pathways were categorized using the Theoretical Domains Framework. Tailored interventions were selected to address facilitators and barriers, and a re‐implementation plan was devised guided by the Behaviour Change Wheel.Thirty‐two facilitators and 58 barriers were identified corresponding to 11 Theoretical Domains Framework domains. Tailored strategies were selected to optimize emergency clinicians' use of the sepsis pathways including refinement of existing education and training programmes, modifications to the electronic medical record system, introduction of an audit and feedback system, staffing strategies and additional resources.The implementation of sepsis pathways in the Emergency Department setting is complex, impacted by a multitude of factors requiring tailored strategies to address facilitators and barriers and optimize uptake.This study presents a theory‐informed systematic approach to successfully implement and embed adult and paediatric sepsis pathways into clinical practice in the Emergency Department.Optimizing uptake of sepsis pathways has the potential to improve sepsis recognition and management, subsequently improving the outcome of patients with sepsis.The Consolidated Criteria for REporting Qualitative research guided the preparation of this report.Nil. [ABSTRACT FROM AUTHOR]

Although prehospital emergency anesthesia (PHEA), with a specific focus on intubation attempts, is frequently studied in prehospital emergency care, there is a gap in the knowledge on aspects related to adherence to PHEA guidelines. This study investigates adherence to the "Guidelines for Prehospital Emergency Anesthesia in Adults" with regard to the induction of PHEA, including the decision making, rapid sequence induction, preoxygenation, standard monitoring, intubation attempts, adverse events, and administration of appropriate medications and their side effects. This retrospective study examined PHEA interventions from 01/01/2020 to 12/31/2021 in the city of Aachen, Germany. The inclusion criteria were adult patients who met the indication criteria for the PHEA. Data were obtained from emergency medical protocols. A total of 127 patients were included in this study. All the patients met the PHEA indication criteria. Despite having a valid indication, 29 patients did not receive the PHEA. 98 patients were endotracheally intubated. For these patients, monitoring had conformed to the guidelines. The medications were used according to the guidelines. A significant increase in oxygen saturation was reported after anesthesia induction (p < 0.001). The patients were successfully intubated endotracheally on the third attempt. Guideline adherence was maintained in terms of execution of PHEA, rapid sequence induction, preoxygenation, monitoring, selection, and administration of relevant medications. Emergency physicians demonstrated the capacity to effectively respond to cardiorespiratory events. Further investigations are needed on the group of patients who did not receive PHEA despite meeting the criteria. The underlying causes of decision making in these cases need to be evaluated in the future. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Triage is the key to success in managing many injured people with limited resources. Therefore, triage training for crisis team medical staff is critical. This study aimed to evaluate the effectiveness of asynchronous learning on immediate care personnel based on the Simple Triage and Quick Treatment System (START) triage system. METHODS: In this quasi-experimental study, asynchronous learning based on the START triage system was performed on the immediate care staff of Ahvaz Jundishapur University of Medical Sciences from February 2021 to December 2021. Sixty pre-hospital emergency medical staff were randomly assigned to intervention and control groups. Intervention group participants were provided an asynchronous digital training module, and control group participants received the usual training. Data were collected in both groups as pre-test and post-test with demographic information and knowledge assessment questionnaires. RESULTS: Distance triage training based on the START triage system has a significant effect on the level of awareness of the need for triage and knowledge (awareness) and performance (individual efficiency) of immediate care in the intervention group compared to before training (P < 0.001). CONCLUSION: Considering the positive results of the pre-organizing model on raising the level of awareness of immediate care personnel, the use of this training method in triage in emergency medicine and retraining workshops could be considered. [ABSTRACT FROM AUTHOR]

Background: Prehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. Since then, much attention has been given to guideline development and training. This study evaluated the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective. Methods: This was a retrospective analysis of a German helicopter-based EMS database from January 1, 2012, to December 31, 2020. All registered patients were included in the primary analysis. The results were analysed using SPSS 27.0.1.0. Results: Out of 227,459 emergency medical responses overall, a total of 18,087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these patients, airway management devices were used by ground-based EMS staff, with an intubation rate of 96.6% (n = 7861), and alternative airways were used in 3.2% (n = 285). Overall, the rate of endotracheal intubation success was 94.7%, while adverse events in the form of tube misplacement were present in 5.3%, with a 1.2% rate of undetected oesophageal intubation. Overall tube misplacement and undetected oesophageal intubation occurred more often after intubation was carried out by paramedics (10.4% and 3.6%, respectively). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation, with rates of 5.6% and 6.4%, respectively. Difficult airways with a Cormack 4 status were present in 2.1% (n = 213) of HEMS patients, accompanied by three or more intubation attempts in 5.2% (n = 11). Conclusions: Prehospital airway management success has improved significantly in recent years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat to patient safety. Trial registration: The study was registered in the German Register for Clinical Studies (number DRKS00028068). [ABSTRACT FROM AUTHOR]

Background: Growing data indicates that thiamine deficiency occurs during acute illness in the absence of alcohol use disorder. Our primary objective was to measure clinical factors associated with thiamine deficiency in patients with sepsis, diabetic ketoacidosis, and oncologic emergencies. Methods: This was an analysis of pooled data from cross-sectional studies that enrolled adult emergency department (ED) patients at a single academic center with suspected sepsis, diabetic ketoacidosis, and oncologic emergencies. We excluded patients who had known alcohol use disorder or who had received ED thiamine treatment prior to enrollment. Investigators collected whole blood thiamine levels in addition to demographics, clinical characteristics, and available biomarkers. We defined thiamine deficiency as a whole blood thiamine level below the normal reference range and modeled the adjusted association between this outcome and age. Results: There were 269 patients, of whom the average age was 57 years; 46% were female, and 80% were Black. Fifty-five (20.5%) patients had thiamine deficiency. In univariate analysis, age >60 years (odds ratio [OR] 2.5, 95% confidence interval [CI], 1.3–4.5), female gender (OR 1.9, 95% CI 1.0–3.4), leukopenia (OR 4.9, 95% CI 2.3–10.3), moderate anemia (OR 2.8, 95% CI 1.5–5.3), and hypoalbuminemia (OR 2.2, 95% CI 1.2–4.1) were associated with thiamine deficiency. In adjusted analysis, thiamine deficiency was significantly higher in females (OR 2.1, 95% CI 1.1–4.1), patients >60 years (OR 2.0, 95% CI 1.0–3.8), and patients with leukopenia (OR 5.1, 95% CI 2.3–11.3). Conclusion: In this analysis, thiamine deficiency was common and was associated with advanced age, female gender, and leukopenia. [ABSTRACT FROM AUTHOR]

Naphthalene, an aromatic hydrocarbon prevalent in mothballs and deodorizers, poses significant health risks upon exposure, primarily through ingestion or dermal absorption. Herein, we report the case of a previously healthy 28-year-old male who presented with hemolysis, methemoglobinemia, and acute renal failure. The patient had a history of ingestion of mothballs, mistaking them for candy, prompting consideration of naphthalene intoxication as the clinical diagnosis, which was subsequently confirmed by laboratory findings. Given concurrent hepatic dysfunction and a diagnosis of glucose-6-phosphate dehydrogenase (G6PD) deficiency, N-acetyl cysteine was administered instead of methylene blue. The patient's condition improved after he was managed with aggressive fluid resuscitation, noninvasive ventilation, blood transfusions, and hemodialysis. Naphthalene ingestion can result in hemolysis, methemoglobinemia, and acute kidney injury, with heightened susceptibility observed in patients with G6PD deficiency. [ABSTRACT FROM AUTHOR]

Multiple myeloma (MM) is a hematological malignancy marked by the abnormal proliferation of plasma cells that invade the bone marrow and, in most cases, secrete a monoclonal protein. While typically diagnosed in older individuals with an average age of 70, MM is rarely observed in young adults. Here, we present a unique case of MM in a 27-year-old man with nodular lesions on the trunk, histologically confirmed as cutaneous MM. Laboratory investigations revealed acute renal impairment, hypercalcemia, and the presence of IgG-Lambda paraprotein. The myelogram confirmed plasmacytosis in more than 12% of the bone marrow mononuclear cells. This case highlights the relevance of considering MM in the differential diagnosis of young patients with unusual cutaneous manifestations. [ABSTRACT FROM AUTHOR]

As awareness of the environmental impact of healthcare facilities, including laboratories, grows, there is a pressing need to adopt sustainable practices within laboratory medicine. Sustainability is therefore a key goal in the quickly evolving healthcare landscape. This review explores forward steps in green medical laboratory practices and offers perspectives on sustainability in healthcare, specifically within the context of laboratory medicine. The review assesses the environmental footprint of laboratory operations, considering factors such as energy consumption, resource utilization, chemical usage, and waste generation. Technological advancements and educational initiatives aimed at fostering a culture of sustainability are also discussed as essential components of the transition toward greener medical laboratory practices. This review underscores the importance of integrating sustainability principles into laboratory medicine to mitigate environmental impact while ensuring the delivery of high-quality healthcare services for present and future generations. [ABSTRACT FROM AUTHOR]