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Shortening Door-to-Balloon Time: The Use of Ambulance versus Private Vehicle for Patients with ST-Segment Elevation Acute Myocardial Infarction. 缩短 "门到气球 "时间:对 ST 段抬高急性心肌梗死患者使用救护车与私家车的对比。
IF 1.5 Q2 Nursing Pub Date : 2023-12-18 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S435446
Abdulrhman Saleh Alghamdi, Abdullah Alshibani, Meshary Binhotan, Meshal Alharbi, Saleh S Algarni, Mohammed Musaed Alzahrani, Abdulmalik Nasser Asiri, Faisal Faleh Alsulami, Kamal Ayoub, Abdullah Alabdali

Purpose: Time is critical when dealing with acute myocardial infarction (AMI) patients in the Emergency Department (ED), as 90 min is crucial for overall health. Using non-EMS transportation for critical patients, such as patients with acute myocardial infarction, to a hospital might delay the rapid identification of the underlying medical disease and initiating definitive treatment. We aim to evaluate the association between the mode of transportation and the D2B time in patients presenting at the ED with AMI.

Patients and methods: We conducted a retrospective cohort study with patients who presented at ED with AMI and underwent percutaneous coronary intervention (PCI). The participants were patients with confirmed AMI at the ED of King Abdullah Medical City (KAMC) from January 2019 to December 2019.

Results: In total, 162 AMI patients were enrolled in the study and divided based on the method of transportation. Less than half (n=65, 40.1%) were transported with an ambulance and 97 (59.9%) patients with a private car. The door-to-balloon (D2B) time for the ambulance group was 93.6±38.31 minutes, and the private car group was 93.8±30.88 minutes.

Conclusion: There was no statistical significance when comparing the D2B time between the private car group and the ambulance group (P = 0.1870). Finally, ambulance transport significantly shortened the time to first ED physician contact. However, it was not associated with shortened D2B time when compared to private vehicle transport.

目的:在急诊科(ED)处理急性心肌梗死(AMI)患者时,时间至关重要,因为 90 分钟对整体健康至关重要。将急性心肌梗死患者等危重病人送往医院时使用非急诊科交通方式,可能会延误快速识别潜在疾病和开始明确治疗的时间。我们旨在评估急诊室急性心肌梗死患者的交通方式与 D2B 时间之间的关系:我们对在急诊室就诊并接受经皮冠状动脉介入治疗(PCI)的急性心肌梗死患者进行了一项回顾性队列研究。参与者为2019年1月至2019年12月期间在阿卜杜拉国王医疗城(KAMC)急诊室确诊的AMI患者:共有162名AMI患者被纳入研究,并根据交通方式进行了划分。不到一半的患者(n=65,40.1%)使用救护车运送,97 名患者(59.9%)使用私家车运送。救护车组的门到气球(D2B)时间为(93.6±38.31)分钟,私家车组为(93.8±30.88)分钟:结论:私家车组与救护车组的 D2B 时间比较无统计学意义(P = 0.1870)。最后,救护车运送大大缩短了首次联系急诊科医生的时间。但是,与私家车运送相比,救护车运送与缩短 D2B 时间无关。
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引用次数: 0
Validity of TIMI Risk Score and HEART Score for Risk Assessment of Patients with Unstable Angina/Non-ST Elevation Myocardial Infarction Presented to an Emergency Department in Jordan. TIMI 风险评分和 HEART 评分对约旦急诊科就诊的不稳定型心绞痛/非 ST 段抬高型心肌梗死患者进行风险评估的有效性。
IF 1.5 Q2 Nursing Pub Date : 2023-12-18 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S439423
Muhannad J Ababneh, Mahmoud Mustafa Smadi, Abdullah Al-Kasasbeh, Qutaiba Ali Jawarneh, Mohammad Nofal, Mohanad El-Bashir, Mohamad Ismail Jarrah, Liqaa A Raffee

Purpose: To examine the validity and predictability of thrombolysis in myocardial infarction (TIMI) risk and HEART scores in patients presenting to the emergency department (ED) with chest pain in Jordan (representative of the Middle East and North Africa Region, MENA).

Patients and methods: Risk scores were calculated for 237 patients presenting to the ED with chest pain. Patients were followed-up prospectively for the need for percutaneous coronary intervention, major adverse cardiovascular events, and all-cause mortality, looking for correlation and accuracy between the predicted cardiovascular risk from TIMI risk score and HEART score and the clinical outcome.

Results: Of the 237 patients, approximately 77% were diagnosed with unstable angina and 23% diagnosed with non-ST elevation myocardial infarction (NSTEMI). about two thirds of the study population were smokers and known to have hypertension and dyslipidaemia. In 50 patients, the primary outcome (need for percutaneous coronary intervention (PCI) and/or major adverse cardiovascular events (MACE) at days 14 and 40, all-cause mortality) was observed. Regarding the predictability of the TIMI score, a larger number of events were observed in the study population than predicted. Patients with TIMI scores of 3 to 5 have about a 5-8% higher event rate than predicted.

Conclusion: Both TIMI and HEART risk scores were able to predict an elevated risk of major cardiovascular adverse events (MACE). The overall impression was that the TIMI risk score tended to underestimate risk in the study population.

目的:研究约旦(中东和北非地区的代表)因胸痛前往急诊科(ED)就诊的患者的心肌梗死溶栓治疗(TIMI)风险和 HEART 评分的有效性和可预测性:对 237 名因胸痛到急诊科就诊的患者进行了风险评分计算。对患者的经皮冠状动脉介入治疗需求、主要不良心血管事件和全因死亡率进行了前瞻性随访,研究 TIMI 风险评分和 HEART 评分预测的心血管风险与临床结果之间的相关性和准确性:在 237 名患者中,约 77% 被诊断为不稳定型心绞痛,23% 被诊断为非 ST 段抬高型心肌梗死(NSTEMI)。在50名患者中观察到了主要结果(需要经皮冠状动脉介入治疗(PCI)和/或在第14天和第40天发生主要不良心血管事件(MACE),全因死亡率)。关于 TIMI 评分的可预测性,在研究人群中观察到的事件数量比预测的要多。TIMI评分为3至5分的患者的事件发生率比预测值高出约5%至8%:结论:TIMI 和 HEART 风险评分都能预测主要心血管不良事件 (MACE) 的高风险。总体印象是,TIMI 风险评分倾向于低估研究人群的风险。
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引用次数: 0
Effects of the Hazardous Area Response Team Training Program on the Knowledge and Confidence in Operational Skills of Prehospital Emergency Medical Personnel in Thailand: A Quasi-Experimental Study. 危险区域应急小组培训计划对泰国院前急救人员操作技能知识和信心的影响:准实验研究》。
IF 1.5 Q2 Nursing Pub Date : 2023-12-14 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S436054
Thongpitak Huabbangyang, Thanidtha Nomrabporn, Watcharan Chiraratchawarich, Rapeeporn Rojsaengroeng

Background: Hazardous areas are places emitting hazardous materials, terrorist- or war-related, which lead to public health risks in developed and developing countries globally. Hence, prehospital emergency medical personnel who work as frontliners should be trained.

Patients and methods: Data via pretest, posttest, and questionnaire surveys regarding the HART's knowledge of and confidence in operational skills were collected using the 5-point Likert scale. The cohort included prehospital emergency medical personnel aged >18 years. The training program comprised lectures, practicals, and examinations and included three subcourses: emergency medicine in the chemical, biological, radiation, and nuclear hazardous area (EM-CBRN) course; Thailand Tactical Emergency Medical Service (TTEMS) course; and cooperation and preparation for disaster (CPD) course.

Results: The HART's mean multiple choice question (MCQ) posttest knowledge score (12.80±3.11) was significantly higher (p<0.001) than the mean pretest knowledge score (7.74±3.71) for the EM-CBRN course. The HART's mean MCQ posttest knowledge score (24.04±2.79) was significantly higher (p<0.001) than the mean pretest knowledge score (14.34±3.92) for the TTEMS course. Further, the HART's mean MCQ posttest knowledge score (21.03±3.49) was significantly higher (p<0.001) than the mean pretest knowledge score (14.40±5.08) for the CPD course. The HART's mean confidence in operational skill score for the EM-CBRN course was significantly higher (p<0.001) after training (4.45±0.59) than before training (2.77±0.90). The HART's mean confidence in operational skill score for the TTEMS course was significantly higher (p<0.001) after training (4.55±0.59) than before training (2.78±0.98). The HART's mean confidence in operational skill score for the CPD course was significantly higher (p<0.001) after training (4.70±0.41) than before training (3.03±0.90).

Conclusion: The HART training program significantly affected the HART's knowledge development and confidence in operational skills, particularly the frontline prehospital emergency medical personnel. Therefore, prehospital emergency medical personnel should undergo training, and learning activities must be developed to reinforce capacity and improve knowledge and confidence.

背景:在全球发达国家和发展中国家,危险区域是指散发危险材料的地方,这些材料与恐怖活动或战争有关,导致公共健康风险。因此,作为前线工作者的院前急救人员应接受培训:采用李克特五点量表,通过前测、后测和问卷调查收集有关院前急救人员对操作技能的了解和信心的数据。培训对象包括年龄大于 18 岁的院前急救人员。培训课程包括讲座、实践和考试,其中包括三个子课程:化学、生物、辐射和核危险区域急救医学(EM-CBRN)课程;泰国战术紧急医疗服务(TTEMS)课程;灾难合作与准备(CPD)课程:结果:HART 的平均选择题(MCQ)测试后知识得分(12.80±3.11)明显高于其他课程(ppppppp):HART培训项目极大地影响了HART的知识发展和操作技能信心,尤其是院前急救一线医务人员。因此,院前急救医务人员应接受培训,并开展学习活动以强化能力,提高知识和信心。
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引用次数: 0
The Burden and Contributing Factors of Cardiogenic Pulmonary Edema Among Acute Heart Failure Patients Admitted to Tertiary Hospital, Eastern Ethiopia. 埃塞俄比亚东部三级医院急性心力衰竭患者心源性肺水肿负担及影响因素
IF 1.5 Q2 Nursing Pub Date : 2023-11-09 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S436352
Natanim Degefu, Abera Jambo, Shambel Nigusse, Mesay Dechasa, Tigist Gashaw, Melaku Getachew

Background: Despite cardiogenic pulmonary edema is the most common phenotype of acute heart failure (AHF), studies on its burden and associated factors are limited. This study aimed to assess the burden and contributing factors of cardiogenic pulmonary edema in patients with acute heart failure admitted to a tertiary hospital in eastern Ethiopia.

Patients and methods: An institution-based cross-sectional study was conducted on the medical records (n = 276) of patients with AHF between February 01, 2018, and January 31, 2023. A simple random sampling technique was used to select participants from the study population. Bivariable and multivariable logistic regression analyses were used to assess factors associated with the development of cardiogenic pulmonary edema. A P-value ≤0.05 was considered as statistically significant.

Results: The prevalence of cardiogenic pulmonary edema was 47.8% in AHF patients. Rural residence (adjusted odds ratio (AOR),9.54), smoking (AOR,3.17), comorbidity (AOR,2.1), and underlying cardiovascular disease (ischemic heart disease, chronic rheumatic valvular heart disease, and hypertensive heart disease with AOR: 6.71, 8.47, and 12.07, respectively) were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

Conclusion: Nearly half of the patients with AHF had cardiogenic pulmonary edema. Being a rural dweller, cigarette smoking, comorbidities, and underlying cardiac illness were significantly associated with the development of cardiogenic pulmonary edema in patients with AHF.

背景:尽管心源性肺水肿是急性心力衰竭(AHF)最常见的表型,但对其负担和相关因素的研究有限。本研究旨在评估埃塞俄比亚东部一家三级医院收治的急性心力衰竭患者的负担和心源性肺水肿的影响因素。患者和方法:对2018年2月1日至2023年1月31日期间AHF患者的医疗记录(n = 276)进行了一项基于机构的横断面研究。采用简单的随机抽样技术从研究人群中选择参与者。采用双变量和多变量logistic回归分析来评估与心源性肺水肿发展相关的因素。p值≤0.05认为有统计学意义。结果:AHF患者心源性肺水肿发生率为47.8%。农村居住(调整优势比为9.54)、吸烟(调整优势比为3.17)、合并症(调整优势比为2.1)和潜在心血管疾病(缺血性心脏病、慢性风湿性瓣膜病和高血压心脏病,调整优势比分别为6.71、8.47和12.07)与AHF患者心源性肺水肿发生显著相关。结论:近半数AHF患者为心源性肺水肿。作为农村居民,吸烟、合并症和潜在的心脏疾病与AHF患者心源性肺水肿的发生显著相关。
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引用次数: 0
Outcome of Poisoning and Associated Factors Among Patients Admitted at Referral Hospitals in Northwest Ethiopia, 2022: A Multicenter Retrospective Study 2022年埃塞俄比亚西北部转诊医院入院患者中毒结局及相关因素:一项多中心回顾性研究
Q2 Nursing Pub Date : 2023-11-01 DOI: 10.2147/oaem.s414743
Gashachew Bayleyegn Reda, Hailemichael Kindie Abate, Hidja Mustofa Mekonnen, Agerie Zerihun Gared, Zerko Wako Beko
Background: Poisonings are the most common reason for visiting emergency departments and hospitals globally. Poisoning-related mortalities increase instantly, and it is a principal public health problem in Ethiopia. Hence, understanding the treatment outcome and identifying the associated factors is necessary to reduce poisoning-related mortality. Objective: To assess outcome of poisoning and associated factors among patients admitted to Referral Hospitals in Northwest Ethiopia, 2022. Methods: An institutional-based retrospective cross-sectional study was conducted in Western Amhara referral hospitals from June 2019 to May 2022. A total of 400 medical charts were reviewed. A stratified sampling technique was used. The data were entered into Epi Info version 7.2.1.0 and exported to SPSS version 25.0 software for analysis. Multivariable binary logistic regression analysis was used to determine factors associated with the outcome of poisoning. Results: The mortality rate of poisoning was 18% (95% CI: 14.4– 22.1). Being rural dwellers (AOR=2.65, 95% CI: 1.07– 6.63), being unconscious (AOR=4.86, 95% CI: 1.89– 12.48), not treated in triage area (AOR=4.64, 95% CI: 1.608– 13.407), transport by Bajaj (AOR=6.78, 95% CI: 1.86– 24.73), spo 2 < 95% (AOR=4.42, 95% CI: 1.19– 10.78), and stayed > 48 hours in the hospital (AOR=0.08, 95% CI: 0.02– 0.36) were significantly associated with a mortality of poisoning. Conclusion: The mortality rate from poisoning was considerably high. Residence, level of consciousness, treatment at the triage area, mode of arrival, Spo2, and prolonged hospital stay were significantly associated. All stakeholders should focus on planning and improving care for patients with poisoning. Improving ambulance service in rural areas and providing treatment at the triage area for all patients are recommended. Keywords: emergency departments, poisoning, referral hospital, treatment outcome
背景:在全球范围内,中毒是到急诊室和医院就诊的最常见原因。与中毒有关的死亡率立即增加,这是埃塞俄比亚的一个主要公共卫生问题。因此,了解治疗结果并确定相关因素对于降低中毒相关死亡率是必要的。目的:评估2022年埃塞俄比亚西北部转诊医院收治的患者中毒结局及相关因素。方法:于2019年6月至2022年5月在西阿姆哈拉转诊医院进行基于机构的回顾性横断面研究。共审查了400份医疗图表。采用分层抽样技术。数据输入Epi Info 7.2.1.0版本,导出到SPSS 25.0版本进行分析。采用多变量二元logistic回归分析确定与中毒结局相关的因素。结果:中毒死亡率为18% (95% CI: 14.4 ~ 22.1)。农村居民(AOR=2.65, 95% CI: 1.07 ~ 6.63)、昏迷(AOR=4.86, 95% CI: 1.89 ~ 12.48)、未在分诊区接受治疗(AOR=4.64, 95% CI: 1.608 ~ 13.407)、Bajaj转运(AOR=6.78, 95% CI: 1.86 ~ 24.73)、spo 2 < 95% (AOR=4.42, 95% CI: 1.19 ~ 10.78)、住院时间> 48小时(AOR=0.08, 95% CI: 0.02 ~ 0.36)与中毒死亡显著相关。结论:中毒致死率较高。居住地、意识水平、分诊区治疗、到达方式、Spo2和住院时间延长显著相关。所有利益攸关方应将重点放在规划和改善中毒患者的护理上。建议改善农村地区的救护车服务,并在分诊区为所有患者提供治疗。关键词:急诊科,中毒,转诊医院,治疗结果
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引用次数: 0
Factors Associated with Postintubation Hypotension Among Patients with Suspected Sepsis in Emergency Department 急诊疑似脓毒症患者插管后低血压的相关因素分析
Q2 Nursing Pub Date : 2023-11-01 DOI: 10.2147/oaem.s426822
Panvilai Tangkulpanich, Chuenruthai Angkoontassaneeyarat, Thavinee Trainarongsakul, Chetsadakon Jenpanitpong
Purpose: Postintubation hypotension (PIH) is a recognized complication that increases both in-hospital mortality and hospital length of stay. Sepsis is reportedly a factor associated with PIH. However, no study to date has examined which factors, including the intubation method, may be clinical predictors of PIH in patients with sepsis. This study aims to investigate factors associated with the occurrence of PIH in patients with suspected sepsis in emergency department. Patients and Methods: This retrospective cross-sectional study was performed over a 5-year period (January 2013–December 2017) and involved patients with suspected sepsis who underwent endotracheal intubation in the emergency department of Ramathibodi Hospital. The patients were divided into those with and without PIH, and factors associated with the occurrence of PIH were analyzed. PIH was defined as any recorded systolic blood pressure of < 90 mmHg within 60 minutes of intubation. Results: In total, 394 patients with suspected sepsis were included. PIH occurred in 106 patients (26.9%) and was associated with increased in-hospital mortality (43.00% in the PIH group vs 31.25% in the non-PIH group, P = 0.034). Multivariable logistic regression showed that the factors associated with PIH were an age of ≥ 61 years (adjusted odds ratio [aOR] 2.25; 95% confidence interval [CI] 1.14– 4.43; P = 0.019) and initial serum lactate concentration of > 4.4 mmol/L (aOR 2.00; 95% CI 1.16– 3.46; P = 0.013). Rapid sequence intubation and difference types of induction agents was unrelated to PIH. Conclusion: Monitoring the development of PIH in patients with sepsis is essential because of its correlation with higher in-hospital mortality. This is particularly critical for older individuals and those with severe infections and high initial lactate concentrations. Keywords: postintubation hypotension, sepsis, emergency department intubation
目的:插管后低血压(PIH)是一种公认的并发症,可增加住院死亡率和住院时间。脓毒症是PIH的一个相关因素。然而,迄今为止还没有研究检查哪些因素(包括插管方法)可能是脓毒症患者PIH的临床预测因素。本研究旨在探讨急诊疑似脓毒症患者发生PIH的相关因素。患者和方法:这项回顾性横断面研究进行了5年时间(2013年1月- 2017年12月),涉及在Ramathibodi医院急诊科接受气管插管的疑似脓毒症患者。将患者分为有PIH组和无PIH组,分析发生PIH的相关因素。PIH定义为插管后60分钟内任何记录的收缩压< 90mmhg。结果:共纳入疑似脓毒症患者394例。106例(26.9%)患者发生PIH,并与住院死亡率增加相关(PIH组43.00% vs非PIH组31.25%,P = 0.034)。多变量logistic回归显示,与PIH相关的因素为年龄≥61岁(校正优势比[aOR] 2.25;95%置信区间[CI] 1.14 - 4.43;P = 0.019),初始血清乳酸浓度> 4.4 mmol/L (aOR 2.00;95% ci 1.16 - 3.46;P = 0.013)。快速序贯插管和不同类型诱导剂与PIH无关。结论:监测脓毒症患者PIH的发展是必要的,因为它与较高的住院死亡率相关。这对老年人和严重感染和初始乳酸浓度高的人尤其重要。关键词:插管后低血压,败血症,急诊科插管
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引用次数: 0
Impact of Different Treatments for Disseminated Intravascular Coagulation on Patients with or without Biliary Drainage for Severe Biliary Tract Infection 播散性血管内凝血不同治疗方法对重症胆道感染患者行或不行胆道引流的影响
Q2 Nursing Pub Date : 2023-11-01 DOI: 10.2147/oaem.s423097
Makoto Kobayashi, Shun Takai, Kyohei Sakurai, Yoshimatsu Ehama
Objective: Sepsis caused by severe acute cholangitis requires biliary drainage to decrease the intra-biliary pressure. Furthermore, several studies showed that anticoagulant treatment can improve the outcomes of patients with sepsis-associated disseminated intravascular coagulation (DIC). There were reports examining the efficacy of anti-DIC drugs in patients undergoing biliary drainage with sepsis-associated DIC, and no reports compared the efficacy of DIC treatments when no drainage is performed. In this study, the influence of antithrombin (AT) replacement therapy and recombinant thrombomodulin (rTM) preparations on the overall survival (OS) of patients with and without biliary drainage was analyzed. Patients and Methods: This retrospective cohort study in a single institution involved patients with sepsis-associated DIC caused by severe biliary tract infection. In total, 71 patients treated by either AT replacement therapy or rTM preparation were assessed for inclusion. The two groups were patients with biliary drainage (n = 45) and without drainage (n = 26). To assess the clinical efficacy of anti-DIC drugs in each group, the 60-day OS was determined through estimated survival analysis. Results: Focusing on the effects of different therapeutic agents for DIC, in the group of patients with biliary drainage, OS showed no difference between patients treated by rTM and AT. However, in patients without biliary drainage, the survival curves of patients treated with AT replacement were lower than those of patients with rTM preparation. Conclusion: This study revealed that the OS of patients without biliary drainage differed depending on the DIC therapeutic agent for sepsis-associated DIC caused by acute cholangitis. We would recommend the use of rTM preparation over AT replacement therapy for patients who cannot undergo biliary drainage. Keywords: sepsis, antithrombin, recombinant thrombomodulin, DIC treatment, acute cholangitis
目的:重症急性胆管炎致脓毒症需要胆道引流以降低胆道内压。此外,一些研究表明抗凝治疗可以改善脓毒症相关弥散性血管内凝血(DIC)患者的预后。有报道研究了抗DIC药物对胆道引流合并脓毒症相关性DIC患者的疗效,但没有报道比较不引流时DIC治疗的疗效。本研究分析了抗凝血酶(AT)替代治疗和重组凝血调节素(rTM)制剂对胆道引流和非胆道引流患者总生存期(OS)的影响。患者和方法:该回顾性队列研究在单一机构中纳入了由严重胆道感染引起的脓毒症相关DIC患者。共有71名接受AT替代疗法或rTM制剂治疗的患者被纳入评估。两组分别为行胆道引流(n = 45)和不行胆道引流(n = 26)。为了评估各组抗dic药物的临床疗效,通过估计生存分析确定60天生存期。结果:关注不同治疗药物对DIC的影响,在胆道引流组,rTM与AT治疗组的OS无差异。然而,在没有胆道引流的患者中,AT替代治疗患者的生存曲线低于rTM制剂患者。结论:本研究显示,急性胆管炎所致脓毒症相关性DIC患者无胆道引流的OS随DIC治疗剂的不同而不同。对于不能行胆道引流的患者,我们建议使用rTM制剂而不是AT替代疗法。关键词:脓毒症,抗凝血酶,重组凝血调节蛋白,DIC治疗,急性胆管炎
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引用次数: 0
The Clinical Value of Comprehensive Nursing Intervention in Preventing Severe Lymphopenia and Improving the Survival Rate Among Patients with Sepsis. 综合护理干预对预防脓毒症患者严重淋巴细胞减少及提高生存率的临床价值。
IF 1.5 Q2 Nursing Pub Date : 2023-10-21 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S433980
Lin Zhang, Chao Xu, Lin Bai, Lin Li, Jinyan Guo, Yanyi Li

Background: Intensive care unit (ICU) patients with sepsis who experience severe lymphopenia are at a higher risk of mortality, and they serve as a more accurate indicator of bacteremia compared to traditional infection markers.

Aim: Our study aimed to examine the influence of severe lymphopenia on ICU mortality and outcomes in sepsis patients, while also evaluating the clinical significance of comprehensive nursing intervention in preventing severe lymphopenia.

Methods: Patients with sepsis in the ICU at our hospital between January 2015 and January 2021 were split into a control group and a test group.The control group received regular nursing care, while the test group was provided with comprehensive nursing care in addition to the control group. The results encompassed mortality rates of 28 days, mortality rates of 1 year, and lengths of stay in the ICU.

Results: Our attention was directed towards day 4 absolute lymphocyte counts, taking into account the receiver operating characteristic (ROC) outcome. Patients with severe lymphopenia were older, more patients with 2 above comorbidities, higher co-infection rates and SOFA score. In addition, patients with severe lymphopenia required longer days stay in ICU (P<0.001), and presented with higher 28-day mortality (P=0.038) and 1-year mortality (P=0.004). Patients in control group have a higher incidence of severe lymphopenia (P=0.006), 28-day mortality (P=0.015) and 1-year mortality (P=0.019) compared with the test group.

Conclusion: Comprehensive nursing intervention can prevent the occurrence of severe lymphopenia, improve patients satisfaction and reduce mortality.

背景:重症监护室(ICU)脓毒症患者经历严重淋巴细胞减少症的死亡率更高,与传统的感染标志物相比,它们是更准确的菌血症指标。目的:我们的研究旨在探讨严重淋巴细胞减少症对败血症患者ICU死亡率和预后的影响,同时评估综合护理干预在预防严重淋巴细胞减少病中的临床意义。方法:将2015年1月至2021年1月在我院ICU的败血症患者分为对照组和试验组。对照组接受常规护理,试验组在对照组的基础上进行综合护理。结果包括28天的死亡率、1年的死亡率和在ICU的住院时间。结果:我们的注意力集中在第4天的绝对淋巴细胞计数上,考虑到受试者的操作特征(ROC)结果。严重淋巴细胞减少症患者年龄较大,有2种以上合并症的患者较多,合并感染率和SOFA评分较高。此外,严重淋巴细胞减少症患者需要更长的ICU住院天数(P=0.038)和1年死亡率(P=0.004)。与试验组相比,对照组患者的严重淋巴细胞减少病发生率(P=0.006)、28天死亡率(P=0.015)和1周死亡率(P=0.019)更高。结论:综合护理干预可预防严重淋巴细胞减少症的发生,提高患者满意度,降低死亡率。
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引用次数: 0
Perioperative Adverse Outcome and Its Predictors After Emergency Laparotomy Among Sigmoid Volvulus Patients: Retrospective Follow-Up Study. 乙状结肠扭转患者急诊剖腹手术后围手术期不良结局及其预测因素:回顾性随访研究。
IF 1.5 Q2 Nursing Pub Date : 2023-10-19 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S430193
Tilahun Deresse, Esubalew Tesfahun, Zenebe Abebe Gebreegziabher, Mandante Bogale, Dawit Alemayehu, Megbar Dessalegn, Tewodros Kifleyohans, George Eskandar

Background: Acute sigmoid volvulus is a surgical emergency with closed-loop obstruction of the colon that often requires emergency laparotomy, which is associated with a multitude of post-operative complications. Although sigmoid volvulus is the main cause of intestinal obstruction in Ethiopia, local studies of its management outcomes are limited.

Objective: To assess the magnitude and predictors of adverse perioperative outcomes of emergency laparotomy for acute sigmoid volvulus in the Debre Markos Comprehensive Specialized Hospital (DMCSH), Amhara region, Ethiopia in 2023.

Methods: This was a retrospective follow-up study. Descriptive statistics were used to measure perioperative outcomes and other study variables. Bivariable and multivariable logistic regression models were used to identify the predictors of adverse surgical outcomes. Associations were considered significant at p < 0.05 (95% confidence interval).

Results: In total, 170 study participants were enrolled, with a response rate of 91.4%. Forty-nine patients (28.8%) developed perioperative adverse outcomes. Pneumonia (29 patients, 28.1%), surgical site infection (19 patients, 18.4%), and wound dehiscence (10 patients, 9.7%) were the most common complications. Pre-operative shock [AOR: 3.87 (95% CI: (1.22, 12.28))], pus or fecal matter contamination of the peritoneum [AOR: 4.43 (95% CI: (1.35, 14.47)], and a higher American Society of Anesthesiologists (ASA) score [AOR: 2.37 (95% CI: (1.05, 5.34))] were identified as predictors of perioperative adverse events.

Conclusion: The perioperative adverse outcomes in this study were higher than those reported in Ethiopian national and global reports following emergency laparotomies. Hypotension at presentation, pus and/or fecal matter contamination of the peritoneum, and higher ASA scores are strong predictors of increased perioperative adverse outcomes. Therefore, healthcare providers and institutions involved in the delivery of emergency surgical care should emphasize the importance of early surgical intervention, adequate resuscitation, and patient monitoring to improve perioperative outcomes.

背景:急性乙状结肠扭转是一种结肠闭环梗阻的外科紧急情况,通常需要紧急剖腹手术,这与许多术后并发症有关。尽管乙状结肠扭转是埃塞俄比亚肠梗阻的主要原因,但当地对其治疗结果的研究有限。目的:评估2023年埃塞俄比亚阿姆哈拉地区Debre Markos综合专科医院(DMCSH)急诊剖腹治疗乙状结肠扭转的围手术期不良后果的程度和预测因素。方法:这是一项回顾性随访研究。描述性统计用于测量围手术期结果和其他研究变量。使用双变量和多变量逻辑回归模型来确定不良手术结果的预测因素。在p<0.05(95%置信区间)时,相关性被认为是显著的。结果:总共有170名研究参与者入选,有效率为91.4%。49名患者(28.8%)出现围手术期不良结果。肺炎(29例,28.1%)、手术部位感染(19例,18.4%)和伤口裂开(10例,9.7%)是最常见的并发症。术前休克[AOR:3.87(95%CI:(1.22,12.28))]、腹膜脓液或粪便污染[AOR:4.43(95%CI:(1.35,14.47)]和较高的美国麻醉师协会(ASA)评分[AOR:2.37(95%CI:(1.05,5.34)]被确定为围手术期不良事件的预测因素。结论:本研究中的围手术期不良结果高于埃塞俄比亚国家和全球报告中报道的紧急剖腹产术后的不良结果。表现时的低血压、腹膜的脓液和/或粪便污染以及较高的ASA评分是围手术期不良结果增加的有力预测因素。因此,参与提供紧急手术护理的医疗保健提供者和机构应强调早期手术干预、充分复苏和患者监测的重要性,以改善围手术期结果。
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引用次数: 0
Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit. 评估苏丹紧急情况下新冠肺炎疑似病例的分类:临床审计。
IF 1.5 Q2 Nursing Pub Date : 2023-10-18 eCollection Date: 2023-01-01 DOI: 10.2147/OAEM.S433240
Bayan E Ibrahim, Rahba Osman El-Amin, Safia Tarig Adam Abdulla

Background: The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan.

Methods: A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators.

Results: Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau.

Conclusion: The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.

背景:不可避免的2019冠状病毒病全球大流行严重影响了苏丹脆弱的医疗系统。作者分享了苏丹喀土穆州五家公立医院急诊科新冠肺炎分诊的经验。方法:2020年12月,使用疾病控制和预防中心新冠肺炎疑似病例分诊检查表和监测工具进行临床审计。该工具分为5个领域和38个指标。结果:只有三家医院在其分诊区设有手部卫生站:易卜拉欣·马利克、乌姆杜尔曼和阿尔瑙。乌姆杜尔曼教学医院是唯一一家设有指定呼吸候诊区的医院。在Al Nau和Omdurman医院,所有有呼吸道症状的患者都戴着口罩或其他口罩。Ibrahim Malik和Bahri教学医院的合规率分别为60%和50%,而El Tamayouz医院没有。穿脱区没有张贴海报或工作辅助用具。只有易卜拉欣·马利克(50%)和乌姆杜尔曼(20%)佩戴了重型手套。Ibrahim Malik和Omdurman医院100%的员工穿着封闭式鞋类,El-Tamayouz医院75%,Bahri医院63%,Al-Nau医院没有。为了更好地应对未来的疫情,必须进行系统性改进,并对员工进行一致的培训、标准的分诊算法和充足的个人防护装备。
{"title":"Evaluating the Triage of Suspected COVID-19 Cases in Sudan's Emergency Settings: A Clinical Audit.","authors":"Bayan E Ibrahim,&nbsp;Rahba Osman El-Amin,&nbsp;Safia Tarig Adam Abdulla","doi":"10.2147/OAEM.S433240","DOIUrl":"10.2147/OAEM.S433240","url":null,"abstract":"<p><strong>Background: </strong>The inevitable coronavirus disease 2019 global pandemic has severely affected Sudan's fragile healthcare system. The authors share the experience of COVID-19 triage in the emergency departments of five public hospitals in Khartoum state, Sudan.</p><p><strong>Methods: </strong>A clinical audit was conducted in December 2020 using the Centers for Disease Control and Prevention Checklist and Monitoring Tool for Triage of Suspected COVID-19 Cases. The tool was categorised into 5 domains and 38 indicators.</p><p><strong>Results: </strong>Only three hospitals had hand hygiene stations in their triage areas: Ibrahim Malik, Omdurman, and Al-Nau. Omdurman Teaching Hospital was the sole hospital with a designated respiratory waiting area. At Al-Nau and Omdurman Hospitals, all respiratory symptomatic patients wore a facemask or alternative. Ibrahim Malik and Bahri Teaching Hospitals had 60% and 50% compliance, respectively, while none at El-Tamayouz Hospital did. No posters or job aids were present in donning and doffing areas. Heavy duty gloves were worn only at Ibrahim Malik (50%) and Omdurman (20%). 100% of staff wore closed-toe footwear at Ibrahim Malik and Omdurman, 75% at El-Tamayouz, 63% at Bahri, and none at Al-Nau.</p><p><strong>Conclusion: </strong>The healthcare facilities displayed significant shortcomings in preparedness and response to COVID-19, with variations across hospitals in infrastructure, human resources, and procedures. To better combat future outbreaks, systemic improvements and a focused approach on consistent staff training, standard triage algorithms, and adequate PPE availability are imperative.</p>","PeriodicalId":45096,"journal":{"name":"Open Access Emergency Medicine","volume":null,"pages":null},"PeriodicalIF":1.5,"publicationDate":"2023-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b5/aa/oaem-15-373.PMC10590591.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49693013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Open Access Emergency Medicine
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