Elderly patients make up a disproportionately high proportion of emergency department visits and represent a high-risk sub group for urosepsis. As a component of the geriatric syndrome, acutely ill patients will often present to triage lacking the cardinal signs and symptoms of infection. Further research is necessary to describe geriatric urosepsis and provide a foundation for education for emergency department providers and triage staff. A retrospective, descriptive approach was utilized to examine geriatric patients age 50 years and over who presented to the emergency department with clinically validated urinary tract infection and sepsis. Geriatric age sub-groups as well as discharge mortality was used to compare the clinical and demographic features present with advancing age and urosepsis. Patients meeting urosepsis diagnosis criteria between June 2005 and June 2010 at a community hospital were queried and 270 of these met inclusion criteria. A significant difference in means between younger geriatric age groups (50-64 years) versus older groups (65-74, 75-84, and 85 and over) was observed with regard to presenting symptoms of acute change in mental status, dysuria, chills/ rigors, and nausea/ vomiting. Clinical variables also varied between age groups to include platelets, neutrophils, blood urea nitrogen, initial triage temperature, triage heart rate, highest obtained emergency department temperature and heart rate. On average there also existed significant difference in age, hospital length of stay, body mass index, blood urea nitrogen, creatinine, albumin, triage temperature, and highest temperature.

No description available.

Class of 2009 Abstract / OBJECTIVES: The purpose of this work is to explore the correlations between demographics, knowledge, and attitudes that student pharmacists have in regards to oral emergency contraception (OEC) and their dispensing. METHODS: University of Arizona pre-rotation student pharmacists were asked to complete a questionnaire during a regularly scheduled required class. The questionnaire had three sections consisting of general OEC knowledge, specific attitudes regarding OEC, and demographic data. RESULTS: Students who stated moral and/or ethical objections to dispensing OEC had significantly lower knowledge scores. They also showed a response pattern to attitude and belief questions opposite to that of students who stated feeling comfortable dispensing OEC in most situations. There were no significant differences in total correct scores on the knowledge questions between gender or year in school, however, there were significant differences in some specific questions. CONCLUSIONS: Students who did not feel comfortable dispensing OEC or had moral and/or religious objections to dispensing OEC were found to have lower knowledge scores. With the exception of two knowledge questions, total correct scores on OEC knowledge questions increased with year in school. Lack of knowledge about OEC may in part contribute to unease and objections to dispensing them.

There is evidence that older Canadians have a higher incidence of presenting to the emergency department (ED) than any other age group. These visits may be made more complex if individuals are also cognitively impaired or have dementia. The purpose of this study was to explore ED nurses’ experiences of caring for adults with dementia in the ED. Using an interpretive descriptive approach, 12 registered nurses working in different EDs in an urban setting in Western Canada were interviewed about these experiences. Using the thematic analysis process described by Braun and Clarke, four themes were identified: 1) not a priority; 2) not the right place; 3) get them in, get them out; and 4) getting it wrong. The nurses identified that challenges in the care of persons with dementia in the ED are created by the fast-paced and chaotic environment of the ED, staffing, issues with disposition, and safety concerns. Suggestions for improving the care of persons with dementia were provided by the nurses. / October 2016

research report submitted to the Faculty of Health Sciences, University of the Witwatersrand in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management MAY 2014 / BACKGROUND: One of the key challenges facing the Limpopo Department of Health and Social Development in the area of Casualty Care is the lack of trained personnel and the inappropriate referral and utilisation of these services. There has been no known study conducted in this area in the South African context and therefore this study was undertaken to evaluate the services rendered within the Casualty Department at the Polokwane Mankweng Hospital Complex with specific reference to material and human resources as well as efficiency of the unit. AIM: To evaluate the Hospital Casualty Department in the Polokwane Mankweng Hospital Complex in terms of caseload, influencing factors and implications on resource utilisation during a one year study period. METHODOLOGY: A cross sectional study design was employed in this study. A retrospective record review was done and information was extracted from various sources of hospital information systems. No primary data was collected for this study. The setting of this study was the Casualty Departments at Polokwane Mankweng Hospital Complex. The two hospitals constituting this complex are situated 30 km apart in Polokwane and Turfloop respectively. Data was collected on various variables that are relevant to the functioning of, and resource utilisation in the Casualty Unit of this Complex. Variables including that of caseload, patient profiles, service costs and workload on human resources were measured. RESULTS: This study based on retrospective review of records of 250 patients’ records selected by a simple random sample from a cohort of 14,113 patients who attended the Casualty Department of the Polokwane Mankweng Hospital Complex during one year study period. One fifth of the patients were referred from other health facilities and more than 60% of the patients were discharged after receiving treatment which implied that these patients could be managed at a regional or district hospital. More patients with medical aid bypassed the referral system. Almost half of the patients arrived after-hours (from 18h00 to 6h00). This is the first study in the Limpopo Province which looked at the direct cost per patient at the Casualty Department. In 2008/09, overall expenditure was R 10,321,401.42 (including R 954,168.45 for pharmacy products, other consumables R 177,261.16 and Laboratory tests R 1,866,233.25). Overall the Department accounts for an estimated R 7,323,804 in personnel annual expenditure of the hospital. Unit personnel cost per patient was estimated at R518.94 (70.96% of total recurrent cost), while the unit costs for the Pharmaceuticals, Stores and Laboratory tests were; R67.23 (9.24%), R12.56 (1.72%) and R132.24 (18.08%) per patient respectively. Overall the combined unit cost was estimated at R731.34 per single emergency care patient excluding the capital costs. CONCLUSION: The results of the study will be used to guide the allocation of appropriate resources, and to highlight the need to implement an effective referral system, which will assist in reducing the workload.

MPH (Hospital Management), Faculty of Health Sciences, University of the Witwatersrand

The price of industrial progress is the potential for exposure of an increasingly informed public to chemical hazards in the environment. Of particular concern are acute exposures to chemical incidents, where problematic health risk assessments have highlighted the lack of expertise and resources available to support public health professionals in Wales responsible for protecting the health of populations. A systematic literature review of chemical incident databases, public health surveillance systems and major chemical incidents worldwide was used to guide the development of the first active, multi-agency community-based public health surveillance system for acute chemical incidents to be undertaken in Europe. A total of 642 acute chemical incidents were reported in Wales from all sources over a three year period. Of the 270 incidents reported by the primary source, chemical spills were the most frequently reported type of incident (28%) and operational industrial sites the most common location (25%). Of the estimated 238,000 people exposed, 528 reported symptoms in a total of 57 incidents. A single chemical was implicated in 86% of the incidents. Shortfalls were identified in the current expertise and resources available to public health professionals in Wales, leading to the development of a public health management model for acute chemical incidents. Model development took place in the context of United Kingdom - wide initiatives and involved the conduct of structured interviews with 41 organisations with interests in the field. The model selected for Wales was implemented on 1 February 1997 and comprised three levels of operation: (a) accountability for the protection of public health vested in health authorities at the local level; (b) a subscription-based front-line advisory and support unit to those authorities; (c) and a centrally funded national co-ordinating centre to provide the necessary evidence-base through programmes of surveillance, training, and emergency planning.

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / Cartas al editor / Revisión por pares

Mestrado em Medicina de Emergência / Master Degree Course in Medicine of Emergency / Milhões de pessoas assistem a eventos com multidões ( mass gathering ), sendo estes definidos como os que ocorrem com mais do que 1.000 espectadores, por ano em todo o mundo. As características de um sistema de emergência médica criado para o efeito, bem planeado, são: a) reconhecer e responder rápida e adequadamente ao espectador que necessita de cuidados médicos de emergência; b) ministrar, ao espectador com lesões/ patologia minor tratamento adequado, de forma expedita e eficiente; c) garantir transporte rápido à unidade de saúde apropriada; d) preservar as capacidades habituais do sistema de emergência médica local. Analisa-se a experiência com o Campeonato Europeu de Futebol (EUROTM) 2004 e pretende-se, para os Eventos com Multidões em geral: a) propor uma forma sistematizada de planear; b) definir recursos humanos e logísticos da equipa de emergência médica e c) sugerir ainda uma nova classificação dos Eventos com Multidões .

Mestrado em Medicina de Emergência / Master Degree Course in Medicine of Emergency