Madridge Journal of Internal and Emergency Medicine

ISSN: 2638-1621

2nd International Conference on Emergency Medicine and Critical Care

October 2, 2020, Virtual Conference
Accepted Abstracts
DOI: 10.18689/2638-1621.a3.004

Prevalence and Factors associated with Burnout Syndrome among Employees of Emergency Treatment Units at selected Teaching Hospitals in Sri Lanka

A.S Migelheva1*, P. Chathurani Sigera2, M.C.Kaushila Thilakasiri1 and G Senarathna3

1University of Colombo, Sri Lanka
2Faculty of Medicine, University of Colombo, Sri Lanka
3Teaching Hospital Karapitiya, Sri Lanka

Objective: Burnout Syndrome consists of depersonalisation, reduced personal accomplishment and emotional exhaustion.It was shown that among the health care workers those who work in the Emergency Treatment units (ETU) are more prone to be affected by the Burnout Syndrome during their employment period. This study was aim to determine the prevalence and factors associated with Burnout Syndrome among employees of three ETU in Sri Lanka.

Method: A cross-sectional survey was conducted in three ETUs. The data were collected using a self- administered questionnaire developed incorporating Copenhagen Burnout Inventory (CBI), demographical data, general health related questions, and factors which may reduce burnout as perceived by workers.

Results: A convenience sample was collected from 167 participants composed of 78 medical officers (46.7%), 66 nurses (39.5%), 23 health care assistants (13.8%) .The mean personal burnout, work related burnout and client related burnout was respectively 37.1, 37.3 and 33.5. The prevalence of overall burnout 54 (32.3%) .There was no significant difference between the overall burnout level of workers in different ETUs .

Conclusion: The results of our study show that ETU healthcare workers are a vulnerable group for burnout and more than 30% of staff suffer from burnout and more than 75% of staff were in stress. Preventive approaches to burnout are needed to promote quality of work life.

Keywords: Burnout Syndrome, Emergency Treatment units, Prevalence

Cultural Competency: Better Patient Outcomes & Physician Satisfaction at Home and Abroad

Benjamin LaBrot

USC Keck School of Medicine (USA) & Floating Doctors Inc (Panama)

Cultural Competency is a learned skill that greatly facilitates care in any setting and is especially vital in international medical aid work. After observing over 5,000 volunteers from 25 countries working in Haiti, Honduras and Panama, we have seen people at all skill levels (from pre-medical students to retired physicians) frequently lack training or practical experiences in connecting with patients across cultural barriers. This talk will summarize the fundamental concepts of effective cross-cultural interaction and include a variety of specific practical tools that apply equally well in an international mission setting or in your home practice.

Benjamin LaBrot is a native Southern Californian. After qualifying and working as a physician at the Royal College of Surgeons, Ireland, LaBrot subsequently launched and operates the Floating Doctors medical aid organization providing health services and capacity development assistance in remote rural settings that are underserved by existing health care infrastructure. LaBrot is also a professor of clinical medicine at USC School of Medicine as well as the University of California, Irvine medical school.

Human Papillomavirus Infection in Genital Women in Four Regions of Senegal

El Hadji Seydou Mbaye1,2,3*, Tarik Gheit1, Ahmadou Dem3, Sandrine McKay-Chopin1, Ndeye Coumba Toure-Kane2, Souleymane Mboup2, Massimo Tommasino1, Bakary S. Sylla1, and Cheikh Saad Bouh Boye2

1International Agency for Research on Cancer (IARC/WHO), France
2Aristide Le Dantec Hospital, Senegal
3Aristide Le Dantec Hospital, Senegal

Cervical cancer is the most frequent cancer among women in Senegal. However, there are few data concerning the HPV types inducing neoplasia and cervical cancers and their prevalence, in the general population of Senegal. The aim of this study is to determine the prevalence of HPV infection in Senegalese women aged from 18 years and older. A study was performed on 498 cervix samples collected from healthy women aged 18 and older in Dakar. 438 other samples were collected from three other regions, Thiès, Saint Louis and Louga. The samples were screened for 21 HPV genotypes using an HPV type-specific E7 PCR bead-based multiplex genotyping assay (TS-MPG) which is a laboratory-developed method for the detection of HPV. The prevalence for pHR/HR-HPV in the region of Dakar was 20.68%. HPV 52 (3.21%) was the most prevalent HPV type, followed by HPV 16 (3.01%) and HPV 31 (3.01%). In the regions of Thiès, Louga and Saint Louis, the prevalence for pHR/HR-HPV was 29.19%, 23.15% and 20%, respectively. The study revealed the specificity of the HR-HPV prevalence in Dakar and other regions of Senegal. The patterns differ from the one observed in the other regions of the world and raise the issue of the development of vaccination program in the country. Such a program should take into account the real HPV prevalence for an effective protection of HPV-associated diseases.

El Hadji Seydou Mbaye was born in 1978 in Kaolack (Senegal). During 2008-2013, he earned his PhD in Biology and Human Pathologies with the collaboration of the IARC/WHO, Lyon (France); He obtained a Masterʼs of Life and Health, Specialty Biology of microorganisms, Virology; a Masterʼs of Life and Health, option Immuno-physiopathology; a License of Biochemistry in Louis Pasteur University of Strasbourg (France); and a General Degree in Sciences and Technologies in University of METZ (France). He was certified Grade 10/10 by the FIGO, the Accreditation Council of Oncology in Europe, the Institute Catalan of Oncology. These credits were Recognized as Physicianʼs Recognition Award by the American Medical Association, he was certified, by the United Nations, by IARC/WHO. Author of the World Program against Cancer in Low and Middle Incomes Countries, he is lead author of more than 90 peer-reviewed research articles. He is Editorial Board Member of 105 international Journals, associate membership of the World Society for Virology and also, member of BCNet International Working Group, IARC/WHO.

Utilization of Personal Protective Equipment and Associated Factors Among Building Construction Workers in Addis Ababa, Ethiopia, 2019

Messeret Yitayew Tizazu

Assosa University, Ethiopia

Background: Personal protective equipment (PPE) is a material worn by workers to reduce chance of exposure from any harmful that may causes injury, disease, or even death. This study was conducted to assess PPE utilization and associated factors among building construction workers in Addis Ababa, Ethiopia, 2019.

Methods: Cross-sectional study was conducted on construction sites of Addis Ababa city from April 1 to May 18, 2019. Data were collected via interview, entered into Epi info and exported to SPSS for analysis. A p-value of less than 0.05 in multivariate analysis was considered as significantly associated.

Results: Utilization of at least one PPE among construction workers in Addis Ababa was found to be 38%. Majority (41.1%) of the participantsʼ reason for not using PPE were the unavailability of PPE followed by absence of orientation on using PPE (21.3%). Factors associated with utilization of PPE were the presence of training on PPE use (AOR = 4.8; 95% CI: 2.3, 10.3), presence of safety training (AOR = 2,8; 95% CI:1.5, 5.2), safety orientation before commencing work (AOR = 4.0; 95% CI:1.9, 9.0) and presence of supervision (AOR = 5.0; 95% CI:1.9, 13).

Conclusions: PPE utilization among building construction workers in Addis Ababa was low. The main reasons for nonutilization of PPE were unavailability of the materials and the absence of orientation on using PPE. There should be continuous supervision of construction sites to assure all workers get material and training on how to use it. Keywords: Personal protective equipment, Construction workers, Ethiopia.

Messeret Yitayew Tizazu is a Meseret 28 male Ethiopian; He had Bsc degree in Nursing from Debre Markoʼs University , Msc on Emergency medicine and critical care from Addis Ababa University and Msc in Social work. He working exposures were st Paulʼs hospital and ABET trauma nurse, Ethiopia Public health institution as maternal health survey coordinator. Messeret Yitayew Tizazu is Currently working as lecturer in Assosa University health Science College. The main influencer for this paper and path was my hospital stay; many of my clients were falling down and car accidents which push me to seek grow up on the area of emergency medicine.

Prediction Score for Cervical Spine Fracture in Trauma Patient

S. Leela-Amornsin*, C. Yuksen, S. Wongwaisayawan, P. Leelapattana and C. Jenpanitpong

Assosa University, Ethiopia

Background: Cervical spine (C-spine) injury may cause cervical spine fracture due to various mechanisms. The incidence of cervical spine fracture is approximately 2-5%. NEXUS criteria and Canadian C-spine rule are recommended by ATLS® to identify patients with lower likelihood of C-spine fracture and therefore do not require diagnostic imaging. In Thailand, unavailable 24/7 CT scan and high costs are important limitations. We aim to develop more accurate clinical decision tool to decide which trauma patients require C-spine CT scan for evaluating C-spine fracture, in order to minimize cost, resource utilization and unnecessary exposure to radiation.

Method: A diagnostic prediction rule, retrospective cross-sectional study was conducted between 2016, 1 August and 2018, 31 December at the Emergency Medicine department in Ramathibodi Hospital. Our study included all C-spine injury were age over 16 years and having received a cervical spine CT scan at Emergency department. The predictive model and prediction score for C-spine fracture were developed by multivariate logistic regression analysis. Discrimination of the prediction score was presented as AUROC curve and 95% CI of the clinical risk score for C-spine fracture. Calibration of the prediction score was presented by using the Hosmer– Lemeshow goodness-of-fit test.

Result: 375 patients were met study criteria. 29 patients (7.73%) were found C-spine fracture in CT. Whereas 346 patients didnʼt have C-spine fracture. Five independent factors (High risk mechanism of injury, paraparesis, paresthesia, limit range of motion of neck and associated injury with chest or facial) were found to be good predictors of C-spine fracture. Clinical prediction score for C-spine fracture was developed with accuracy of 79.03% by divided patient in 3 probability groups (low; score0-1, moderate; score 2-5 and high; score 6-11). Score 2-5 had LR+ of C-spine fracture by 1.46 times. Furthermore, score 6-11 had LR+ of C-spine fracture by 7.16 times.

Conclusion: Clinical prediction score greater than or equal to 2 was associated with cervical spine fracture. Patients who met moderate-high probability groups should be performed C-spine CT scan for evaluate cervical spine fracture.

Keywords: Cervical spine injury, Traumatic neck injury, Cervical spine fracture, Cervical spine CT scan, risk score

Clincal Profile and Outcome of Patients with Acute Kidney Injury- an Experience from Tertiary Hospital of Developing Country

Merahi Kefyalew

Tikur Anbessa Specialized Hospital, Ethiopia

Acute kidney injury (AKI) is a major health problem, causing morbidity in 13 million people annually, among which, 85% occur in developing countries. It is therefore one of important issue in Africa where there is resource limitation at large, and appreciation of its pattern can help understand itʼs causes, complications and outcome better which are determinants for its early prevention and management.

Objective: To evaluate Patterns and outcome of AKI patients who are admitted in Tikur Anbessa specialized hospital(TASH) Adult Emergency Unit, Addis Ababa, Ethiopia Methodology: Prospective Crossectional study was done from August 1, 2018 to May 1, 2019.:The research was done at TASH adult ED. SPSS software version 25 was used for analysis. The area selected for this research was TASH adult emergency unit, Addis Ababa, Ethiopia where the sample was collected from the patients who fulfill the inclusion criteria. SPSS software was used for analysis. Binary logistic regression was done for identification of mortality predictors. Patientsʼ laboratory results on admission and discharge were compared by paired samples T-test. Survival time was estimated by Kapan- Meier and log rank test with a 95% CI. A P-value of <0.05 was considered to denote statistical significance.

Result: A total of 144 cases of AKI were included in the study. The mean age of presentation at a younger age of 46.16 ± 16.6. The most common causes of AKI were Sepsis (43.2%), volume depletion (25%), cardio renal syndrome-1(16%) and obstructive uropathy (16%). Uremic encephalopathy, sepsis and hyperkalemia were factors that were identified as mortality predictors in overall AKI patients. AKI patients with sepsis were found to have lower hospital survival than those without sepsis. From the laboratory findings, there was significant difference between creatinine values on admission and discharge.

Conclusion: As sepsis was the dominant cause of AKI as well as mortality predictor and cause of lower hospital survival, early initiation of antibiotics in the Emergency unit would be beneficial in order to improve the in hospital outcome of patients with AKI.

Merahi Kefyalew has completed his undergraduate study of medicine from Addis Ababa University at the age of 26 years and he immediately started his specialization study in the departement of Emergency medicine and critical care from same university. He is currently final year resident to be graduated after 5 months as Emergency physician.

The Role and Experience of Sudan in Assisting to Develop and Implement National Drug Policies

Abdeen Omer

Occupational Health Administration, Sudan

The strategy of price liberalisation and privatisation had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatisation policy, the government introduced radical changes in the pharmacy regulations. The 2001 Pharmacy and Poisons Act and its provisions established the Federal Pharmacy and Poison Board (FPPB). All the authorities of the implementation of Pharmacy and Poisons Act were given to this board. This article provides an overview of the impact of the pharmaceutical regulations on the quality of medicines on the Sudanese market from the perspective of the pharmacists working with drug importing companies. The information necessary to conduct the evaluation was collected from 30 pharmacists who are the owners or shareholders in medicinesʼ importing companies. The participants were selected randomly. 89% of respondents considered the medicines on the Sudanese market are generally of good quality. The design of the research itself may be considered inadequate with regard to selection process. However, the authors believe it provides enough evidence, and the current pharmaceutical regulations have some loopholes. The Pharmacy, Poisons, Cosmetics and Medical Devices Act-2001 and its regulation should be enforced. The overall set-up including the Act itself needs to be revised. The emerging crisis in pharmacy human resources requires significant additional effort to gather knowledge and dependable data that can inform reasonable, effective, and coordinated responses from government, industry, and professional associations. Furthermore research should be carried out to understand the scope, magnitude directions of the migratory flows, within and outside the country, as well as the characteristics and skills of the emigrated pharmacists.

Abdeen Mustafa Omer (BSc, MSc, PhD) is an Associate Researcher at Occupational Health Administration, Ministry of Health and Social Welfare, Khartoum, Sudan. He has been listed in the book WHOʼS WHO in the World 2005, 2006, 2007 and 2010. He has published over 300 papers in peer-reviewed journals, 200 review articles, 7 books and 150 chapters in books.

Therapeutic Hypothermia: Past, Present and Future

Santiago Herrero

The Jilin Heart Hospital, China

Therapeutic hypothermia (TH) has gained popularity in recent years for its use in a variety of clinical situations and is currently one of the main research fields. Mild TH is the process of lowering the central body temperature between 32-34 °C in those patients with acute brain injury, such as those who survive cardiac arrest but remain in a comatose state.

Among the potential indications: near drowning, traumatic cardiac injury, rhythms other than VF (asystole, complete heart block or pulseless ventricular tachycardia), stroke, central nervous system infections, hepatic encephalopathy, status epilepticus, heart failure and the adult respiratory distress syndrome have been suggested.

The historical development of TH dates back millennia; however, its use in modern clinical medicine has been documented for the last 200 years. TH was introduced in the 1950s as a protective measure for the brain and has been used routinely in the operating room to provide prolonged neuro-anesthesia. Professor Peter Safar, in the early 1960ʼs, recommended TH as an important part of the assistance after cardiac resuscitation.

However, it was not until 2002 when two randomized, controlled, clinical trials documented a significant improvement in survival without neurological damage with TH as compared with normothermia in patients with out of hospital cardiac arrest and coma.

The future is open, there are different methods and devices available to induce systemic HT, however, in the last decade, other possibilities, including brain cooling without reducing core body temperature (selective cerebral hypothermia), have evolved to minimize possible adverse effects.

Santiago Herrero is Clinical Director of Postoperative Cardiac ICU at The Jilin Heart Hospital, Changchun, Jilin Province, China. Board-certified critical care physician of the Spanish Society of Critical Care Medicine since 1989. He has received your Research Proficiency by the University of Oviedo (2008). Fellow of the American College of Chest Physicians since 2004. He has more than 110 articles published, several chapters in different books and the last two editions (4th and 5th , Varon J, Herrero S. Appendix: Civetta, Taylor, & Kirby's Critical Care. 2008- 2018,Lippincott-Raven). Awarded with The Mountain Changbai Friendship Award by the Jilin Government, China.

Accuracy of Emergency and Critical Care Residents Reading of Emergency Cranial CT Scans as Compare to the Neuroradiologist Experience from Two Medical Schools in Ethiopia

Nathan Muluberhan

Emergency and Critical Care Resident PGY3, Ethiopia

Introduction: Emergency departments are crucial entry points to healthcare services and usually overcrowded. The use of cranial CT in ED patients could be influential in clinical decision making by improving diagnostic confidence and have impact on treatment plan. While the accuracy of interpretation of brain CT scan by emergency physicians is of crucial importance, many EM residency programs do not allocate enough time to brain CT scan interpretation trainings.

Objectives: was to determine accuracy of emergency medicine residents of Addis ababa university(AAU) and St Paul mellinium medical collegue(SPMMC) in the assessment of cranial CT scans, May 2019.

Methodology: A prospective cross-sectional study was employed to assess the CT scan interpretation skills of EMCC residents of AAU, and SPMMC. Data collected from May 2019 - June 2019 by using structured questionnaires as well as through radiant view software by displaying the full slices of the cranial CT scans. Data was entered, cleaned, edited and analyzed by using SPSS 20.0 version statistical software. And analysis was also done by excel 2016.

Results: Forty two emergency and critical care residents were enrolled in this study. Over all accuracy rate in interpretation cranial CT scans was 57.6%, The overall discrepancy rate was very high (42.4%) compared to prior studies. The sensitivity of the residents in detecting normal radiographs was 62.6% with specificity of 96%, PPV of 66.3% and NPV of 95.3%. Most residents correctly identified haemorrhage (97.6%) & hydrocephalus (90.5%). All resident missed CT scan of herniation and 92.9% of the residents missed meningeal enhancement. Being female and book reading habit were independently associated with better interpretation of cranial CT scans (p-0.036, p-0.04 respectively).

Conclusion: The skills of residents in interpreting cranial CT results are very low regardless of the prevalence of the condition in the ER or the relative clinical importance of the conditions. Poor sensitivity and high false positive results with misinterpretations were common. This can result in potentially dangerous patient mismanagement.

Nathan Muluberhan is a young physician from Ethiopia, he had studied a medical doctor at Haramaya University and he currently a last year emergency and critical care resident at Addis Ababa university.