bluuebunny/crossref_metadata_2025_split huggingface dataset:
(P2-56) Nurses' Knowledge, Skills and Perception Towards Disaster Response and Emergency Preparedness
Authors: Wee F.C. 
Published: May 2011

BackgroundDisaster response and emergency preparedness has taken a bigger role in our daily operations since the advent of events of September 11 2001. It is essential that nurses be prepared and trained to respond to disaster incidents. Nonetheless, we are largely unaware of how our nurses feel about their readiness to respond to these disaster incidents. This study aims to understand our nurses' knowledge, skills and perception towards disaster response and emergency preparedness.MethodA self administered structured questionnaire survey was conducted for the nurses in our hospital. Using a 5 point Likert scale, the questionnaire covered knowledge, skills and perception of institutional and individual preparedness towards a disaster incident. The data was analyzed using SPSS 17.ResultsA convenient sample of 1143 nurses (response rate 95.5%) was studied over a 2-month period from 1st August to 30th September 2010. 55.7% of the surveyed nurses have not attended any training in disaster response. Despite that, more than 50% of them scored correctly in term of their knowledge in different types of disaster incidents. 75.3% of them have not been trained to don the HAZMET suite within the last 2 years. 72.9% do not know where to get the HAZMET suit in the event of a chemical incident. While 80.2% felt that the institution is able to respond to any disaster incident, only 41.3% felt that they were ready. In addition, 83.6% were willing to participate in future disaster incident response training. 77.1% agreed that being able to respond to a disaster incident should be part of their professional competency.ConclusionsThere is a need for the hospital to incorporate disaster preparedness into nursing education curriculum as a clinical core skill to ensure that nurses are ready to respond to disaster incidents.
(P2-57) When a Glue Sniffer Turns Weak
Authors: Poh J. 
Published: May 2011

Introduction and DiscussionInhalant abuse has become less common in Singapore. Awareness of glue sniffing and its complications has decreased among local physicians. Prolonged toluene exposure can result in renal tubular acidosis, with electrolyte and acid-base derangements, and should be considered in the differential diagnosis of any young patient with unexplained hypokalaemic periodic paralysis and normal anion gap metabolic acidosis. We present a typical case to illustrate the abnormalities and to heighten awareness among emergency physicians who may not have laboratory results on hand when evaluating causes of limb weakness.
(P2-60) Thyroid Storm in the Emergency Department
Authors: Van veelen M.J. , Yurtsever L. , Baggen M. , Dubois E.A. 
Published: May 2011

CaseA 20-year-old woman was referred to the emergency department with rapid acceleration of complaints of palpitations, fever, diarrhea, and agitation that had been present for several weeks. During physical examination, the patient was uncomfortable and restless with a tachycardia of 170/minute, and a fever of 38.5 °C. Palpation of the neck revealed a small ventral, painless, solid elastic mass, more prominent on the right side, clinically suspicious for goiter. An electrocardiograph showed an atrial flutter of 150/min. Initial laboratory results showed an erythrocyte sedimentation rate of 35 mm/hour (0–20 mm/hour) and urine analysis tested positive for ketones.Outcome and TreatmentThe patient was presumed to be suffering from a thyroid storm. She was treated promptly with Propranolol 160 mg and Thiamazole 30 mg twice daily at the emergency department. She was admitted to the Cardiac Care Unit for observation of the heart rhythm, which slowed down to 110/minute the same day and her condition improved clinically. The following day her laboratory result confirmed the diagnosis with a thyroid-stimulating hormone of < 0.01 mIU/L (0.4–4.0 mIU/L) and a free thyroxine (T4) of > 75 pmol/l (10–22 pmol/l). Eventually, she was diagnosed with Graves Disease.DiscussionThyroid storm is an acute, life-threatening, hypermetabolic state induced by excessive release of thyroid hormones. The adult mortality rate is high (90%) if early diagnosis is not made and the patient is left untreated. Therefore, in case of clinical suspicion for thyroid storm, it is critical to start prompt treatment with Beta blockade and Thiamazole before the diagnosis can be confirmed biochemically.
(P2-68) Mental State of Healthcare Workers in a Designated H1N1 Screening Center
Authors: Seow E. , Hsin kai G. , Vasu A. 
Published: May 2011

IntroductionIn Singapore, the H1N1 outbreak lasted 108 days. The study emergency department (ED) was designated as Singapore's H1N1 screening centre for the borders and the country's primary care centers. Our aim was to determine the psychological morbidity among ED physicians, nurses, administrative and ancillary staff during the H1N1 outbreak.MethodsWe conducted a survey on all ED healthcare worker (n = 305) using the 12-item General Health Questionnaire (GHQ-12). The bimodal scoring of GHQ-12 was dichotomised into non-cases (score 0 – 2) and potential cases (score ≥ 3). Participation was strictly voluntary.ResultsThe overall response rate was 273 (89.5%). Most respondents were females (73.3%); the mean age was 33 (SD 10.6) years. The mean GHQ score was found to be 1.9 (SD 2.7) with no gender-related differences. A comparison of the dichotomised GHQ-12 scores, found psychological morbidity to be more common in administrative staff (40%) and physicians (38.1%) than ancillary (24.2%) and nurses (19%) (p = 0.011). The average prevalence of psychological morbidity among ED staff was 25.3%. When we considered the 12 items of the GHQ separately and analyzed them by occupational group, we found physicians scoring the worst on item 6 - “Could not overcome difficulties” - than nurses, administrative and ancillary staff (p < 0.001). Physicians and administrative staff alike felt constantly under strain and were unable to concentrate compared to nurses and ancillary staff (p = 0.001).ConclusionHealthcare workers in an emergency setting unlike those in the rest of the hospital, face a wide range of risks on the job and this has a substantial effect on their mental well-being and job satisfaction.
(P2-70) A Systematic Search and Narrative Review of Existing Literature on the Medium and Long-Term Impact of Injuries
Authors: Turner J. , Chanakira E. 
Published: May 2011

BackgroundA systematic search and narrative review of existing literature on the medium- and long-term impacts of injuries was conducted to provide context for a primary research study.MethodsSearches were undertaken in MEDLINE, CINHAL and Science Citation Index using a combination of free text and Medical Subject Heading (MeSH) terms. Studies were included if they assessed outcomes following injury at least six months post-injury and reported morbidity-related outcomes. A standardized data extraction form was developed, and studies were assessed for quality using standard quality assessment criteria. The main characteristics of included studies were presented in structured tables and synthesized using a narrative summary.ResultsThe search strategy identified 4,969 abstracts and/or titles, of which 125 appeared relevant. Following a detailed reading of the material, 32 studies met the inclusion criteria of this review. Summarizing the results of the studies was difficult, as they were of moderate quality and used many different methods. The main findings were that at 12 months post-injury a proportion of injured patients continue to suffer from physical, psychological, and social problems and this proportion doesn't decline over the next few years. In the medium term (12 months–5 years) about 10–25% of casualties continue to report a variety of health problems associated with their injuries.ConclusionsIt is difficult to synthesize injury outcome studies because of the varying methodological approaches, study populations, follow-up periods, and outcome measures used. The evidence that exists suggests that many casualties demonstrate good early recovery but a significant proportion still show significant social, physical, and psychological sequelae one to five years post-injury.
(P2-71) Topometric Agent-Based System for Disaster and Emergency Medicine
Authors: Trufanov A. , Rossodivita A. , Tikhomirov A. , Caruso A. , Dmitrienko N. , Gursky E. , Laporte R. , Linkov F. , Shunbikov E. 
Published: May 2011

IntroductionA variety of models, methods, and computer-aided systems have been used to predict and analyze disasters and emergencies, and manage a pertinent medical response effectively. The list of these instruments traditionally comprises: computerized databases, geographic information systems (GISs), graph theory, complex networks, mathematical programming, simulation, and agent-based modeling. As a rule, each type of those is applied asunder. It makes sense to put in one silo diverse instruments to get multidisciplinary solution with its synergy effect for problems of disaster and emergency medicine.MethodsWithin this study, an original, agent-based model was developed. The model combines the advantages of the principal computer-aided instruments and considers all the types of information: semantic, topographical, metric, and topological. The model is severely dynamic, fits to real actors and principally covers all the disaster situation.ResultsIn line with the model, a so called Topometric Agent-Based System (TABS) with its key visualization component has been designed. A TABS-specific simulation to investigate behavior of the attacked network of vulnerable actors has been conducted leading to critical findings. It has been shown a severe significance of order within combination of threats: man-made + natural or those of natural + man-made. A well-balanced financial distribution to protect actors of diverse status also has been found.ConclusionsA TABS similar to GIS focuses on mapping. Topometric Agent-Based System mapping brings an efficient and clear language for information sharing not only within national emergency medical services but between experts from different fields and countries.
(P2-72) Diagnostic Accuracy of Bedside Ultrasound for Identifying Fractures in Patients with Orthopedic Trauma Presenting to the Emergency Department of a Level-1 Trauma Center - Aims Ultrasound Fracture Study
Authors: Sinha T.P. , Bhoi S. , Bhasin A. , Rodha M. , Kumar S. 
Published: May 2011

BackgroundRadiography is the standard observation tool for examining orthopedic injuries. Bedside Ultrasound (BUS) may be a faster, non-invasive alternative to effectively identify bone fractures in the emergency department (ED) setting. The study compares the diagnostic utilities of BUS and radiography for identifying long bone fractures.MethodsProspective observation study with convenience sampling was conducted in ED in patients > 5 years, with post-traumatic upper and lower limb injuries requiring standard radiological examination after informed consent. The BUS examinations were performed by a emergency physician (EP) who had a brief training session to detect fractures. For every subject, radiographs were taken and reviewed for the presence of fracture by blinded orthopedic specialist. Statistical analysis was done by SPSS.ResultsA total of 133 patients were enrolled in the study. Only 42 had fracture, out of which 36 were picked up by BUS. The overall sensitivity of the BUS in detecting fracture was 85.7% with a confidence interval (CI) of 0.70–0.94 and specificity of 100% with a CI = 0.95–1.00. The positive predictive value (PPV) of USG was 100% with a CI = 0.86–1.00 and negative predictive value (NPV) of 93.8% with a CI = 0.86–0.97. There were six additional fractures which were recognized on x-ray and were not picked up by ultrasound.ConclusionsBUS can be utilized by EP after brief training to accurately identify long-bone fractures. It may gain a more prominent role in pregnant and pediatric population as well as in mass-casualty scenarios.
(P2-79) Retrospective Review of Mortality in Patients with Traumatic Brain Injury from Rural India
Authors: Baisakhiya N. , Agrawal A. , Kakani A. , Galwankar S. , Dwivedi S. 
Published: May 2011

ObjectiveTrauma is one of the leading causes of morbidity and mortality across the world with traumatic brain injury (TBI) being an important cause of trauma related deaths. The aim of our study was to review the medical charts of patients who died within 24 hours of presentation to our Hospital after head injury.MethodsWe received approval from the institutional review board to conduct a retrospective review of patient charts at Acharaya Vinoba Bhave Rural Hospital, in Sawangi (M), Maharashtra (India). All patients who died within 24 hours of the presentation to the emergency department (ED) and had been diagnosed with TBI were included in the study. We collected data from 113 charts between January 2007 and December 2009.ResultsDuring this three year period, 113 patients died within 24 Hours of admission to the hospital. Of these, 37% (42/113) were diagnosed with (TBI). We conducted a chart review of these 42 patients. All our patients were brought to the ED by relatives or bystanders in non-ambulance vehicles. At the time of presentation to the ED, nearly all patients were normotensive, with only one patient with hypotension The Majority of our patients had a Glasgow Coma Scale of less than 5.ConclusionOur study brings to light various deficiencies in rural India, trauma care which include immediate rescue and transportation. Although patients were provided the optimum care in the ED, however it was not associated with favorable outcome. This highlights the need of a Trauma Registry to record real-time data which will help to improve care and systems.
(P2-84) Upper Gastrointestinal Tract Bleeding (UGIB) Management: Belgian Guidelines for Adults and Children
Authors: Dhondt E.L. , Penaloza A. , Colle I. , Wilmer A. , Laterre P. ,   Belgian interuniversity UGIB guidelines consensus group
Published: May 2011

BackgroundUGIB remains a common disease affecting 100 to 170 adults per year, with an associated mortality ranging from 5 to 14%, causing thereby an important burden to healthcare resources. UGIB in children is uncommon (1–2/10,000 per year) but potentially life threatening. Since various specialists (general practitioners, emergency physicians, gastroenterologists and hepatologists, pediatricians, intensivists, radiologists and surgeons) may be involved and given the absence of evidence-based medical (EBM) recommendations - for adults as well as for children - there is considerable variability in the management of UGIB. Moreover, as even RCTs on the management of UGIB in children are lacking, many treatment strategies are simply deducted from the management of adult UGIB.AimTo provide EBM guidelines for the care of adults and children presenting with bleeding caused by gastro-duodenal ulcer or variceal rupture.Method and ResultsAn interuniversity interdisciplinary team of Belgian experts was launched. Statements based on the published literature up to September 2010 were collected and proposed after expert opinions reconciliation and graded accordingly to the class of evidence. The current guidelines for the management of UGIB include recommendations for the diagnosis process, general supportive care, pharmacological therapy aiming at bleeding control, specific and endoscopic treatment of acute bleeding and follow-up for both gastro-duodenal ulcers and portal hypertension induced bleeding. Specificities and differences in the approach to UGIB in children compared to adults are highlighted.ConclusionInterdisciplinary guidelines for the management of UGIB based on current standards for EBM will provide an opportunity for clinicians to improve the management of their patients. However, clinical guidelines are not mandatory tenets appropriate for all patients, but should constitute a canon or principle tailored to the individual patient. In addition, EBM might provide quality indicators for the assessment of care to bleeding patients at a local, national or international level.
(P2-100) Prognosis of Unknown and Unattended Patients in the Neurosurgical Department
Authors: Mathew A.S. 
Published: May 2011

BackgroundIn 2009 in Delhi, 7,516 road traffic crash victims were admitted to hospitals as unknown or unattended.ObjectiveThe aim of this study was to assess the morbidity and mortality of unknown or unattended patients and problems they faced relative to the provision of nursing care.MethodsThis is a retrospective analysis from February 2010 to August 2010 wherein all unknown or unattended patients with head injuries (Glasgow Coma Scale (GCS) score = 1–15) admitted to the neurosurgery department were included. The duration of hospital stay, admission GCS, and outcome were assessed and an attempt also was made to analyze the problems faced by nursing personnel.ObservationsThe total number of patients enrolled was 38. Of these, 22 were unknown, and 16 were unattended. The average hospital stay of unknown and unattended victims was 35 (1–151), and 21 (7–120) days, respectively. The mean GCS score of unknown patients upon admission was 9 (3–15), and during discharge, 8 (3–15). The mean GCS scores of unattended patients during admission and discharge was 12 (13–15) and 14 (3–15). respectively. Of the 22 unknown patients, 24% were identified during their stay, 33% were transferred to rehabilitation homes, and 43% died without being identified. Of the 16 unattended patients, 25% went home, 63% were transferred to rehabilitation homes, and 12% expired. The most common problems faced during nursing care were contractures (8%) and pressure sores (11%), due mainly to their long hospital stays.ConclusionsPatients remaining unknown/unattended is a unique problem as far as developing countries are concerned. Managing these patients is difficult, as they occupy hospital beds for a longer duration, and require more nursing care, and have higher mortality and morbidity. It remains surprising that in spite of advancements in the field of mass communication, almost 76% of the unknown patients remain unidentified.
A Pre‐Post Retrospective Study of Patients With Cystic Fibrosis and Gastrostomy Tubes
Authors: Best Chad , Brearley Ann , Gaillard Philippe , Regelmann Warren , Billings Joanne , Dunitz Jordan , Phillips James , Holme Bonnie , Schwarzenberg Sarah J. 
Published: May 2011

ABSTRACTObjectives:The aim of the study was to assess the efficacy of gastrostomy tube (GT) placement on improving nutritional status and pulmonary function in patients with cystic fibrosis (CF).Patients and Methods:Data were collected from the Minnesota Cystic Fibrosis Database. Subjects with at least 5 percent‐predicted forced expiratory volume in 1 second (ppFEV1) and 1 BMI percentile (pBMI) measurements before and after GT placement were included. Median pBMI values were compared 2 years before and 1, 2, and 4 years after GT placement using a signed rank test. Longitudinal mixed model analysis was used to assess the effect of GT placement on ppFEV1. To assess the effect of ppFEV1 at GT placement on efficacy, the estimated ppFEV1 change was regressed against the ppFEV1 level at placement.Results:Forty‐six subjects with CF who met entry criteria were identified. Mean estimated step changes in ppFEV1 at placement for men, women, boys, and girls were 2.16% (P = 0.52), 0.43% (P = 0.92), 0.99% (P = 0.65), and −0.91% (P = 0.74), respectively. Mean estimated slope changes of ppFEV1 after GT placement were 5.01% (P = 0.02), 4.48% (P = 0.07), 1.49% (P = 0.23), and 4.02% (P = 0.01) per year for men, women, boys, and girls, respectively. Median change in pBMI in the second year after GT placement was 13.3% (P ⩽ 0.0001). Estimated coefficients for the effect of ppFEV1 level at placement on the ppFEV1 step and slope change were −0.041 (P = 0.28) and −0.005 (P = 0.84), respectively.Conclusions:GT placement in patients with CF results in significant improvement in both pBMI and ppFEV1, except in women. The change in lung function after GT placement is not dependent on the level of lung function at placement.
Gut–Bone Interactions and Implications for the Child With Chronic Gastrointestinal Disease
Authors: Klein Gordon L. 
Published: May 2011

ABSTRACTBone is not simply a framework on which to hang viscera and connective tissue; it is also a dynamic interactive organ system with roles in immunoregulation, adipogenesis, and vascular calcification, among others. Bone is intimately affected by chronic disease, including gastrointestinal disease. The mechanisms for bone loss in conditions such as inflammatory bowel disease, celiac disease, and cystic fibrosis are discussed with regard to the role of the inflammatory response. Furthermore, we raise the issue of effects of inflammation on both intestinal and renal calcium and phosphate transport, although the ways in which these actions affect bone are not explained and require further research. The stress response, a prominent feature following burn injury, is also elucidated and its relation to gastrointestinal disease is examined. We then discuss the importance of knowing the mechanism of bone loss to determine proper prevention and treatment for the bone loss in specific gastrointestinal conditions.
K+ Transport by the OsHKT2;4 Transporter from Rice with Atypical Na+ Transport Properties and Competition in Permeation of K+ over Mg2+ and Ca2+ Ions
Authors: Horie Tomoaki , Brodsky Dennis E. , Costa Alex , Kaneko Toshiyuki , Lo Schiavo Fiorella , Katsuhara Maki , Schroeder Julian I. 
Published: May 2011

Abstract
Members of class II of the HKT transporters, which have thus far only been isolated from grasses, were found to mediate Na+-K+ cotransport and at high Na+ concentrations preferred Na+-selective transport, depending on the ionic conditions. But the physiological functions of this K+-transporting class II of HKT transporters remain unknown in plants, with the exception of the unique class II Na+ transporter OsHKT2;1. The genetically tractable rice (Oryza sativa; background Nipponbare) possesses two predicted K+-transporting class II HKT transporter genes, OsHKT2;3 and OsHKT2;4. In this study, we have characterized the ion selectivity of the class II rice HKT transporter OsHKT2;4 in yeast and Xenopus laevis oocytes. OsHKT2;4 rescued the growth defect of a K+ uptake-deficient yeast mutant. Green fluorescent protein-OsHKT2;4 is targeted to the plasma membrane in transgenic plant cells. OsHKT2;4-expressing oocytes exhibited strong K+ permeability. Interestingly, however, K+ influx in OsHKT2;4-expressing oocytes did not require stimulation by extracellular Na+, in contrast to other class II HKT transporters. Furthermore, OsHKT2;4-mediated currents exhibited permeabilities to both Mg2+ and Ca2+ in the absence of competing K+ ions. Comparative analyses of Ca2+ and Mg2+ permeabilities in several HKT transporters, including Arabidopsis thaliana HKT1;1 (AtHKT1;1), Triticum aestivum HKT2;1 (TaHKT2;1), OsHKT2;1, OsHKT2;2, and OsHKT2;4, revealed that only OsHKT2;4 and to a lesser degree TaHKT2;1 mediate Mg2+ transport. Interestingly, cation competition analyses demonstrate that the selectivity of both of these class II HKT transporters for K+ is dominant over divalent cations, suggesting that Mg2+ and Ca2+ transport via OsHKT2;4 may be small and would depend on competing K+ concentrations in plants.