Online ISSN: 2515-8260

Keywords : Emergency department


Using modified DECAF Score in mortality prediction in acute exacerbation of COPD patients presenting to emergency department in a tertiary care hospital

Dr. Shashank Singh Bhardwaj, Dr. Arjit Bose, Dr. Komal Thakur,Dr. Priya Singh, Dr. Debraj Jash, Dr. Kishen Goel

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 2827-2839

Background: Chronic obstructive pulmonary disease (COPD) is a prominent cause of illness and mortality on
a global scale. In 2019, it was predicted to rank as the sixth largest cause of mortality. COPD is one of the
most prevalent non-communicable illnesses in the field of pulmonology. The DECAF score
(Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation) is a risk stratification tool for
patients with AECOPD that can be used at the bedside to guide treatment, such as hospital at home for
low-risk patients. The purpose of this study is to predict the in-hospital mortality in acute exacerbation of
COPD patients with modified DECAF scores. Modified DECAF score includes Dyspnea,
Eosinopenia, Consolidation, Acidemia and Frequency of Hospitalization.
Material and Methods: A total of 50 patients attending Emergency Medicine Department with Acute
Exacerbation of COPD were recruited to this hospital based observational study. This study was conducted
at the Department of Emergency medicine & Pulmonary medicine, at APOLLO GLENEAGLES HOSPITALS, Kolkata.
Results: COPD was more prevalent in the age groups of 41-50 years (28%) and 61-70 years (28%) followed
by those having age between 51-60 years (22%). Majority of the COPD patients were males (88%) compared
to (12%) females. Majority of the COPD patients were males (88%) compared to (12%) females.
Most common co-morbid condition associated with COPD washypertension (16%) followed by
IHD (8%), pulmonary hypertension (6%) and diabetes mellitus (4%). Out of 50 patients with COPD,
11 (22%) had previous history of AECOPD, 38 (76%) were regular user of inhaler, 33 (66%) had
history of influenza vaccination, 16 (32%) had Pneumococcal Vaccination and 2 (4%) patients had
COVID-19 pneumonia. Out of 50 patients, 24 (48%) had Dyspnea (eMRCD) score
of 5a whereas 26 (52%) had Dyspnea (eMRCD) score of 5b as well as 7 (14%) had Eosinopenia
 (<50 cells/mm3) and 20 (40%) had Consolidation.
Conclusion: We conclude that the Modified DECAF score is both sensitive and specific in predicting
in-hospital mortality in AECOPD patients. Modified DECAF is a simple tool that predicts mortality
that incorporates routinely available indices. It effectively stratifies COPD patients admitted with
acute exacerbations into mortality risk categories.

“Study of Non-Traumatic Altered Mental Status in Emergency Department of Tertiary Care Centre”

Dr. Vijay Kumar SS MD, Dr. Shabbir Shekhli MD, S. Nijalingappa Dr.Anila Jose MD

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 555-562

BACKGROUND: The assessment of patients presenting with altered mental status (AMS) in the emergency department (ED) is challenging as these patients are characterized by a broad spectrum of illnesses and disease severity. The present study is to determine the etiology and outcome as well as the role of the GCS score as a prognostic value.
 METHODS: This prospective observational study was done in a tertiary care center, in India over a period of two years where patients with AMS were evaluated and subjected to relevant investigations. All available clinical and laboratory data were used to ascertain the cause of the altered sensorium. Patients were followed up until discharge or death.
RESULTS: Among 1000 study participants 57% were males with a mean age of 52.5years. The most common etiology was Metabolic Encephalopathy (32%) followed by poisoning (20%). Mortality was highest in Cerebrovascular accidents (84.4%) and partial recovery was highest in Neuro-infection. Glasgow Coma Scale score <6 was associated with mortality of 44.4%.
CONCLUSION: AMS is a vital warning signal, because of its potentially fatal and irreversible effects. Timely evaluation with the point of care investigation reduces mortality in metabolic and poisoning causes and greatly improves the cost-effective basis for treatment.

Assessment Of Nurses’ Knowledge Regarding Gcs Among Staff Nurses Working In Emergency Department And In-Patient Department In Tertiary Hospitals In Odisha

Minati Das, Nibedita Mohanty, Smrutirekha Bal, Pamela Majumder, Pritilagna Dash, Rajashree Saran

European Journal of Molecular & Clinical Medicine, 2022, Volume 9, Issue 7, Pages 9276-9281

The Glasgow coma scale is a tool in medical profession, used to objectively evaluate the degree to which a person is unconscious or comatose. It is essential that every nurse working in the areas which needs critical care such as high dependency units, has enough knowledge to assess and intervene appropriately and he or she should also be able to communicate any changes in the condition for multidisciplinary intervention. Conducted a study “Assessing nurses’ knowledge regarding GCS among staff nurses working in emergency department and inpatient department in the tertiary care hospital, Bhubaneshwar Odisha. The study objective was assessing the previous knowledge level and the association between pretest knowledge and selected demographic variables Off Glasgow coma scale among staff nurses working in emergency and in patient department. Total 100 staff nurses who satisfied the inclusion criteria were present during the study. This is a quantitative descriptive cross-sectional study design using the GCS knowledge questionnaire, convenience sampling method was used. Results showed that 6% of nurses had poor knowledge followed by 28% and 14% with good knowledge and average, 52% of nurses had excellent knowledge respectively. The result on the association between knowledge and professional qualification showed a significant association between the two variables (X2=10.065, df=3, n=100 and p<0.005) level. There was also a significant correlation between knowledge and age (X2=11.086, df=2, and p<0.005) level. The study found that only 19.04% nurses have excellent knowledge GCS. Professional qualification and age have a correlation with satisfaction level towards nurse’s knowledge in GCS. Overall, the study supports that excellent and good knowledge to skills are important in assessing GCS levels

A study to assess the determinants affecting the satisfaction level of inpatients getting admitted through the Emergency department in a tertiary care hospital, Odisha

Mrs.Rashmi Ranjita Parhi

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 3, Pages 582-591

Evaluation of Patient satisfaction level who are getting admitted through emergency department (ED) is very necessary because it affects the performance that reflects the high quality, efficiency, and sustainability.
Aim: To assess the level of satisfaction in various points among inpatients following 48 hours of their admission through the emergency department. To find out the quality indicators of patient care through emergency department care Methods: This quantitative cross-sectional study was conducted in the emergency department. The target population was who have been admitted through the emergency department. The data was collected after 48 hours of admission in to the hospital. Result: Total of 98 patients were participated in this study and shared their experiences through a standard questionnaire. Total percentage of highly satisfied patients was 60.2% (n=59) for the services given by the emergency department. Total percentages of satisfied patients were 22.4 %(n=22) and Similarly each of both highly dissatisfied and dissatisfied patients were 2, and neutrals are 13.3 %(n=13). Conclusion: Satisfaction level of patient carries the total image of the hospital. It is also a good quality indicator which enables the contact points of improvement in ED so that the hospital can provide better care and services to the patients.

A study to assess the determinants affecting the satisfaction level of inpatients getting admitted through the Emergency department in a tertiary care hospital, Odisha

Mrs.Rashmi Ranjita Parhi

European Journal of Molecular & Clinical Medicine, 2021, Volume 8, Issue 2, Pages 1618-1627

Evaluation of Patient satisfaction level who are getting admitted through emergency
department (ED) is very necessary because it affects the performance that reflects the
high quality, efficiency, and sustainability.
Aim:
To assess the level of satisfaction in various points among inpatients following 48 hours
of their admission through the emergency department.
To find out the quality indicators of patient care through emergency department care
Methods:
This quantitative cross-sectional study was conducted in the emergency department. The target
population was who have been admitted through the emergency department. The data was
collected after 48 hours of admission in to the hospital.
Result:
Total of 98 patients were participated in this study and shared their experiences through a
standard questionnaire. Total percentage of highly satisfied patients was 60.2% (n=59) for the
services given by the emergency department. Total percentages of satisfied patients were 22.4
%(n=22) and Similarly each of both highly dissatisfied and dissatisfied patients were 2, and
neutrals are 13.3 %(n=13).
Conclusion:
Satisfaction level of patient carries the total image of the hospital. It is also a good quality
indicator which enables the contact points of improvement in ED so that the hospital can
provide better care and services to the patients.

Effect of ketamine as an adjunct to opioid for pain control in traumatic patients

Mehdi Arzani Shamsabadi; Mohammad Darvishi; Masoud Shahabian; Seyed Zia Hejripour

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4438-4443

Background: Pain management results in better outcomes in traumatic patients in the emergency ward. Use of non-opioids facilitates the elimination of the adverse effects of opioid. Regarding this, the present study was conducted to examine the effect of ketamine as an adjunct to opioids for pain control in traumatic patients in a tertiary healthcare center in Tehran, Iran. Methods and materials: This double-blind randomized clinical trial was conducted on 160 traumatic patients admitted to the Emergency Department of Besat Hospital, Tehran, Iran, in 2018. The study population was randomly assigned into two groups of intervention and placebo. The intervention group one of which received 0.05 mg/kg opioid (i.e., morphine) plus 0.1 mg/kg ketamine, and placebo group the other one was provided with the same amount of morphine opioid plus placebo. The pain was recorded up to 120 min and compared between the groups. Results: Based on the obtained results, 23 (28.8%) and 16 (20%) patients in the ketamine intervention and control placebo groups had side effects, respectively, showing no significant difference (P=0.197). In addition, the pain significantly reduced in both groups (P=0.001). However, the results of repeated measures ANOVA revealed no statistically significant difference between the two groups in terms of pain reduction trend (P=0.275). Conclusion: Based on the results, it can be concluded that ketamine has no superior effect when administered as an adjunct to opioid for pain control in traumatic patients.

Evaluation of medical internship students' satisfaction with education in the hospital emergency department

Farzad Bozorgi; Seyedeh Masoumeh Pashaie; Touraj Assadi; Mohammad Sazgar; Mina Yousefi; Seyed Hosein Montazer; Seyed Mohammad Hosseininejad

European Journal of Molecular & Clinical Medicine, 2020, Volume 7, Issue 1, Pages 4462-4471

Introduction: Educational evaluation has an important role in decision making to find better educational systems and advance educational goals. Accordingly, this study was conducted to evaluate the satisfaction of medical students with education in the emergency department of the hospital. Materials and Methods: This study was a descriptive, analytical and cross-sectional study. The study population consisted of internship medical students who were included in the study by convenience sampling method. Data were collected by a researcher-made questionnaire that included two sections of demographic information and specialized questions (related to satisfaction).Finally, the data were analyzed using SPSS version 18. Results: The highest level of students 'satisfaction with professors was in the items of discipline, creating interest in students and providing the necessary clinical training by professors, while the lowest level of satisfaction was linked to professors' treatment of students. Their level of satisfaction with the nurses was poor. Students' satisfaction with the facilities was good, but they were not very satisfied with the educational and welfare facilities. The highest level of satisfaction of residents was easy access and disciplineof residents and the lowest level of satisfaction was related to creating interest in students and appropriate behavior. There was no statistically significant relationship between the gender of emergency department students and their satisfaction with professors (P = 0.271), nurses (P = 0.974), residents (P = 0.135) and emergency department (P = 0.165). No statistically significant relationship was found between students' age and their satisfaction with professors (P = 0.428), residents (P = 0.213) and emergency department (P = 0.861). A statistically significant relationship was found between the age of interns and their satisfaction with emergency department nurses (P = 0.009). The grade point averageof all students was not significantly related to their satisfaction with professors (P = 0.270), nurses (P = 0.571), and emergency department (P = 0.214). However, there was a statistically significant relationship between the total grade point average of students and their level of satisfaction with residents (P = 0.003). Conclusion: The level of students' satisfaction with the educational situation was reported to be moderate, but the situation of student was found to be far from ideal.

Assessment of Prevalence of Workplace Violence among Nurses and Physicians at Emergency Department in Primary Health Care Centers, Makkah, 2019.

Zahid Mohammed Zahid Serdar, Mane Mueen Shalah Alotaibi, Samirah Tawfiq S Albeladi, Adnan Awadh Alwuthaynani, Hanan Abdullah Turkstani, Sara Mohammed Barahim, Hadi Helal Alotaibi, Abdullah Abed Alotaibi, Hayat Abdullah Alzahrani Babaynjy

European Journal of Molecular & Clinical Medicine, 2019, Volume 6, Issue 1, Pages 585-596

Background
Workplace violence (WPV) is a serious worldwide concern, especially for health care professionals when
compared with workers in other industries. Violence in the health care sector harms both patients and health
care professionals and causes enormous economic losses. Victims of WPV show signs of anxiety, depression,
and low efficiency in their work performance, which may decrease the quality of the service that they provide.
Among health care professionals, nurses who have direct contact with patients face numerous risks related to
WPV. Therefore, it is important to recognize risk factors that can be used to reduce the incidence of WPV
against nurses. Emergency healthcare workers (HCWs) have a high risk of exposure to violence with negative
personal consequences. Violence is an occupational hazard in hospitals. Occupational researches have gradually
shifted focus from traditional, visible environmental risk factors, such as physical, chemical, biological exposure
or ergonomic problems, to the invisible, psychological harm that maybe present in the workplace.
Aim of the study: To assessment of Prevalence of Workplace Violence among and Nurses and Physicians at
Emergency Department in Primary Health Care Centers and confirm the factors influencing such violence.
Method: Cross-sectional analytical study has been conducted at emergency departments (EDs), Primary Health
Care Centers in Makkah city, during data collection period 2019, the total sample has been (400) nurses and
physicians.
Results: Regarding the age the highest age were (35.0%) were (30-40) years and the data ranged from (22-57)
by mean ±SD (38.315±9.816), were females (57.0%)while males. The majority of the participated nurse were
(67.0%), followed by doctor were (33.0%). Regarding the qualification, the majority of participated heave
Bachelor were (28.0%) followed by Resident (21.0%), the participated experience in from 6-10 years were (31.
0%).More than half of the participants were yes to physical or verbal violence and their percentage was (75.
0%).Conclusion: Workplace violence was prevalent, and verbal abuse was the commonest type among HCWs in
emergency departments of PHC. Workplace violence, a possible cause of job stress, has recently become an
important concern in occupational health. Almost half of the ED nurses and physicians experienced one or more
WPV incident.

ASSESSMENT OF PREVALENCE OF WORKPLACE VIOLENCE AMONG NURSES AND PHYSICIANS AT EMERGENCY DEPARTMENT IN PRIMARY HEALTH CARE CENTERS, MAKKAH, 2019

European Journal of Molecular & Clinical Medicine, 2019, Volume 6, Issue 1, Pages 351-362

Background:  Workplace violence (WPV) is a serious worldwide concern, especially for health care professionals when compared with workers in other industries. Violence in the health care sector harms both patients and health care professionals and causes enormous economic losses. Victims of WPV show signs of anxiety, depression, and low efficiency in their work performance, which may decrease the quality of the service that they provide. Among health care professionals, nurses who have direct contact with patients face numerous risks related to WPV. Therefore, it is important to recognize risk factors that can be used to reduce the incidence of WPV against nurses. Emergency healthcare workers (HCWs) have a high risk of exposure to violence with negative personal consequences. Violence is an occupational hazard in hospitals. Occupational researches have gradually shifted focus from traditional, visible environmental risk factors, such as physical, chemical, biological exposure or ergonomic problems, to the invisible, psychological harm that maybe present in the workplace.
Aim of the study: To assessment of Prevalence  of Workplace Violence among  and Nurses and Physicians at Emergency Department in  Primary Health Care Centers and confirm the factors influencing such violence.
Method: Cross-sectional analytical study has been conducted at emergency departments (EDs), Primary Health Care Centers in
Makkah city, during data collection period 2019, the total sample has been (400) nurses and physicians.
Results: Regarding the age the highest age were (35.0%) were (30-40) years and the data ranged from (22-57) by mean ±SD (38.315±9.816), were females (57.0%)while males. The majority of the participated nurse were(67.0%), followed by doctor were(33.0%). Regarding the qualification, the majority of participated heave Bachelor were (28.0%) followed by Resident (21.0%), the participated experience in from 6-10 years were (31. 0%).More than half of the participants were yes to physical or verbal violence and their percentage was (75. 0%).Conclusion: Workplace violence was prevalent, and verbal abuse was the commonest type among HCWs in emergency departments of PHC.  Workplace violence, a possible cause of job stress, has recently become an important concern in occupational health. Almost half of the ED nurses and physicians experienced one or more WPV incident.