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La hiperamonemia constituye una emergencia médica. No existen publicaciones que hagan referencia a la disponibilidad de recursos, insumos y conocimientos necesarios para el manejo inicial de esta por parte del pediatra en nuestro país, pero, según la experiencia de los autores, los recursos necesarios no se encuentran disponibles los 365 días del año en una gran porción de nuestro territorio. Sobre la base de este estado de situación, de una revisión bibliográfica internacional sobre el tema y de la experiencia de los autores, se elaboraron una serie de recomendaciones para el manejo pediátrico inicial de esta emergencia, que tienen como objetivo poder reducir las deficiencias, permitir una sospecha clínica adecuada que lleve a un diagnóstico y tratamiento de emergencia oportunos, con utilización racional de recursos farmacológicos (algunos de ellos de alto costo), para reducir la morbimortalidad que asocia la patología.
Hyperammonemia is a medical emergency. There are no publications regarding the availability of resources, supplies, and knowledge necessary for the initial management of hyperammonemia by pediatricians in Argentina; however, according to the authors' experience, the necessary resources are not available all year round in a large portion of our territory. Based on such state of affairs, an international bibliographic review on this topic and the authors' experience, we developed a series of recommendations for the initial pediatric management of this emergency, with the objective of reducing deficiencies, allowing adequate clinical suspicion leading to a timely diagnosis and emergency management and a rational use of pharmacological resources (some of which are costly) to reduce the morbidity and mortality associated with hyperammonemia.
Subject(s)
Humans , Infant , Child, Preschool , Child , Hyperammonemia/diagnosis , Hyperammonemia/therapy , Urea Cycle Disorders, Inborn/complications , Urea Cycle Disorders, Inborn/diagnosis , ArgentinaABSTRACT
Introducción: las urgencias dentales que se presentan a diario en el campo odontológico son de suma importancia, de ahí que sea necesario saber manejarlas y así evitar consecuencias posteriores que pueden poner en riesgo la vida. Objetivo: diagnosticar cómo se manejan las urgencias odontológicas en el Instituto Ecuatoriano de Seguridad Social Campesino. Materiales y métodos: estudio descriptivo, cuantitativo y transversal, con una muestra de 60 usuarios. Se tomaron, además, criterios de inclusión y de exclusión. Se utilizaron como técnicas de recolección de datos encuestas estructuradas -basadas en los protocolos de odontología del Ministerio de Salud Pública (2014) y el protocolo de urgencias odontológica COVID (2020)-, las que indicaron el manejo de las urgencias en el área mencionada. Se evaluó el servicio mediante los porcentajes que se reflejaron en la encuesta sobre el manejo de urgencias y los tipos de patologías de mayor frecuencia. Resultados: el 82 % de los encuestados manifestó que recibió una atención inmediata a su urgencia dental. Un 95 % refirió que les dieron una atención adecuada según su urgencia de calidad. Además, se evaluaron los tipos de urgencias más frecuentes, destacando infección dental (50 %), caries profunda (20 %), extracción (15 %), fractura (8 %) y tercer molar impactado (2 %). Conclusiones: se concluye que en el Seguro Social Campesino El Porvenir destacó el buen manejo en las urgencias odontológicas. Esto se ve reflejado en la utilización de maniobras y protocolos que están determinados en el área de la odontología.
Introduction: dental urgencies that daily present in the odontological field are of great importance, so it is necessary to know how to manage them and that way to avoid posterior consequences that could put life at risk. Objective: to diagnose how to manage odontological urgencies in the Ecuadorian Institute of Rural Social Security Materials and methods: descriptive, quantitative, cross-sectional study, with a sample of 60 users. Inclusion and exclusion criteria were also taken in to account. Structured inquiries were used as data collection techniques-based on the odontological protocols of the Ministry of Public Health (2014) and the COVID odontological emergency protocol (2020)-, which indicate emergencies management in the mentioned field. The service was evaluated through the percentages reflected in the emergency management enquiry and the most frequent types of pathologies. Results: 82% of those surveyed stated that they received an immediate attention to their dental emergency. 95% said that they were given an adequate attention according to their quality emergency. Besides that, the most frequent emergency types were evaluated, highlighting dental infection (50%), deep caries (20%), extraction (15%), fracture (8%) and impacted third molar (2%). Conclusion: It is concluded that in the Rural Social Security El Porvenir, the good management of odontological urgencies stood out. This is reflected in the use of maneuvers and protocols that are determined in the area of dentistry.
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Grassroots communities, as the forefront of the transformation of national system and mechanism, the reformation of social structure, the change of interest pattern, and the transition of ideological consciousness, have long been the focus of government work, academic research, and social practitioners. Based on the theory of collaborative governance, aiming at the problems existing in the emergency management of public health emergencies in grassroots communities at present, this paper put forward the construction measures of public health emergency collaborative governance system with grassroots communities as the core, including improving the grassroots community emergency management organizational structure, consolidating the standardized foundation of grassroots community emergency collaborative management, enhancing the awareness of grassroots community emergency collaborative management, and strengthening the interactivity of the grassroots community information communication system. It is hoped to provide necessary reference for promoting the reform of public health emergency governance system.
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Objective:To explore the factors affecting the management of medical devices in the COVID-19 pandemic, and to provide guidance for the management of medical devices in public health emergencies.Methods:A total of 184 hospitals caring COVID-19 patients in Jiangsu, Zhejiang, Shanghai, Anhui and Shandong were selected, and clinical engineers were randomly sampled. A self-compiled questionnaire was used to conduct an online survey on factors affecting medical device management during the COVID-19 pandemic from August to December 2021.The index system of influencing factors of medical device management during the COVID-19 pandemic was determined through an exploratory factor analysis, and then the structural equation model was used to verify the rationality and scientificity of the index system, while the relative weight method was used to calculate the weight of the index system.Results:277 valid questionnaires were recovered. Through the exploratory factor analysis, an index system of influencing factors of medical device management was established, which consisted of such level-indexes as the human factor, device factor, material factor, method factor, and environment factor, as well as 17 level-2 indexes. The fitness-indexes of the second-order structural equation model were finally fitted as follows: the chi-square to freedom ratio was 2.606, the approximate root mean square error was 0.076, and the value of value-added adaptation index, non-standard adaptation index and comparative adaptation index were 0.921, 0.903 and 0.920, respectively. The weights of the method factor, human factor, device factor, material factor and environment factor of the level-1 indexes were 0.216, 0.191, 0.175, 0.274 and 0.144, respectively. Such factors as manpower, regulations and institutional processes, and information technology ranked top three among the 17 level-2 indexes, which were 0.090, 0.082 and 0.080 respectively.Conclusions:The influencing factor model of medical device management during the COVID-19 pandemic in this study is ideal; human factors and method factors are the influencing factors deserving high priority in medical device management during the COVID-19 pandemic. Ensuring sufficient human resources, improving laws, regulations and processes, as well as enhancing information management level are breakthroughs expected in medical device management.
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OBJECTIVE To provide reference for the normalization of drug volume-based procurement （hereinafter referred to as “VBP”） and the establishment of local emergency management mechanism. METHODS Based on the equilibrium theory of the whole process of emergency management with Chinese conditions， referring to the “6+1” stage model， the emergency management mechanism of VBP was constructed； 21 provincial-level procurement projects in China from 2019 to 2022 were evaluated accordingly. RESULTS The emergency management mechanism of VBP including 14 measures in 7 stages of preparation， prevention， mitigation， response， recovery， learning and monitoring was successfully constructed. The total score of the 21 provincial-level procurement projects was 3 to 11 points， and the average score of each project in the past 4 years fluctuated slightly within 6 to 7 points. Among the 5 evaluated stages， the scores of the prevention and response stage were relatively high， followed by the mitigation and preparation stage， and the lowest in the recovery stage. Among the 11 rated emergency management measures， more than half had an average score greater than 0.5， but the average score of “determining alternative enterprise selection methods” was only 0.19. CONCLUSIONS Some emergency management measures of drug VBP are lacking， and the emergency management mechanism still needs to be perfected， which is not conducive to the development of emergency management work. The procurement organizer should focus on building a complete emergency management mechanism covering all stages， and clarify the specific measures at each stage， so as to ensure procurement effective and good in operation.
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Medical supply is a key resource for responding to public health emergencies and maintaining people's lives and health. As the medical equipment management department, the medical devices department is mainly responsible for the procurement, supply, technical support, management and coordination of medical equipment and medical consumables, playing an important role in epidemic prevention and control. Through the analysis of the expansion cases of designated hospitals, the experience of emergency management of medical equipment has been accumulated, which has strong practicability and replicability.
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Humans , Public Health , Emergencies , Hospitals , EpidemicsABSTRACT
Justification: Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. Objectives: To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Process: Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Guidelines: Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.
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Objective:To study development problems and countermeasures of the health emergency management system in a city based on the grounded theory, for references on the construction of a new round of urban health emergency management system.Methods:From June 2020 to April 2021, 61 health emergency management personnel were selected using the objective sampling method from the municipal health commission and disease prevention and control center of a city, and from 11 district health bureaus and disease prevention and control centers, for semi-structured interviews. Grounded theory method was used to analyze the interview data.Results:288 concepts, 79 initial categories, 15 sub-categories, and 5 main categories were extracted from the interview materials. The urban health emergency management system was affected by a variety of constraints such as the weak construction of public health talent team, non-standard plan management, and limited information sharing. There was a fragmentation dilemma in structure and mechanism. It was necessary to strengthen policy support and emergency resource allocation to promote the reconstruction of the health emergency response system. Among them, policy support and emergency resource allocation were prerequisites, and the remodeling of health emergency system was the core process.Conclusions:There were problems such as insufficient resource supply and weak plan management in the construction of the city′s health emergency management system. We should establish a high-level driven policy system, strengthen the resource allocation of peacetime and wartime, and reshape the system and mechanism of coordination and integration, so as to continue to promote the continuous development of the health emergency management system.
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Objective:To analyze the delivery room disaster vulnerabilities of 7 tertiary hospitals in Liaoning Province, evaluate the nursing management disasters vulneratility, and provid support for emergency management of delivery room nursing.Methods:The Kaiser model analysis was used to design a disaster vulnerability assessment form for the delivery room, combined with the actual risk prevention and control in the delivery room. The survey was conducted from March 18 to 27, 2020 by paper questionnaire among 200 nursing staff in the delivery room, and the risk values for emergencies were calculated and the matrix distribution was analyzed and evaluated.Results:Totally 190 valid questionnaires were collected. The top 10 risk events faced by the delivery room were epidemic outbreaks, failure to adequately protective equipment for emergency admission to the delivery room, maternal poor protection awareness, nursing staff were contaminated with amniotic fluid and body fluids, poor maternal compliance with midwife orders, shortage of supplies of medical care protective equipment, nursing staff suffered needlestick injuries, high fever in patients, masks and gloves were worn or removed incorrectly, and doctor-patient tension due to poor compliance.Conclusion:Kaiser model-based hazard vulnerability analysis of delivery rooms can provide an important basis for risk identification and early warning and emergency plan improvement and formulation, which should be applied flexibly with the actual and specific characteristics of delivery rooms and dynamic changes of risks.
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Cloud technology and the Internet of things ( IOT) technology can be used in building the patient-centered critical care medical information platform.The platform could inenable medical staff to efficiently obtain critical care medical information, and raise critical patients′ cure rates. The authors introduced the critical process of rapidly building and improving the urgent care medical information integration platform in a campus of the First Affiliated Hospital of Zhejiang University Medical School.The IOT platform could effectively interconnect a variety of critical care medical equipments, and features such functions as vital signs monitoring and life support, bedside treatment data retrieval, remote diagnosis and treatment, and cloud sharing. The platform featured the advantages of complete information integration, fast construction, and satisfactory system extensibility. It could improve the medical work efficiency, improve the effect of critical care, and reduce the frequency of contact with patients, hence providing references for rapidly establishing a vital care treatment platform for public health events.
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The study analyzed the application of failure mode and effect analysis(FMEA)in the emergency management of emergent infectious diseases. In February 2020, optimization of emergency management procedures for emergent infectious diseases was identified as the research theme. Subsequently, FMEA was applied to study the emergency management process of emergent infectious diseases and analyze corresponding potential failure modes in an infectious disease hospital. The appraisal identified four prioritized risk exposures to correct, including non-standardized personnel protection, delayed personnel arrival, unqualified specimens and inadequate ward preparation. Accordingly pertinent countermeasures were formulated. Three months after measures were taken, the risk priority numbers of the above four risks were decreased significantly. On the other hand, evident increase was found in the on-duty rate of emergency personnel, the rate of standard protection, the qualification rate of sample collection and disposal, as well as the serviceability rate of respirators, ECG monitors and protective equipment in emergency wards. The application of FMEA is conducive to optimizing the emergency response process of emergent infectious diseases, and to upgrading emergency management at large.
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In the COVID-19 outbreak, several general hospitals in Wuhan were transferred to designated hospitals. However, most of the designated hospitals had suffered from insufficient oxygen supply in different degrees. Taking a designated hospital as an example, this paper summarized the emergency management system of oxygen supply from the aspects of engineering transformation, process formulation and safety management through the PDCA cycle theory, discussed the management experience of oxygen supply under the epidemic situation, and explored the management mode of emergency normalization from the perspective of peacetime and wartime integration. The purpose was to provide reference for the management of medical oxygen supply in public health emergencies and normal operation.
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Sudden chemical poisoning accidents have the characteristics of suddenness, groups, complexity and difficulty in rescue. It usually brings serious harm and far-reaching social impact. Establishing a good emergency management and rescue system from the four stages of prevention, response, rescue and recovery can reduce the adverse effects of accidents, casualties, and social burden. The prevention of sudden chemical poisoning accidents focuses on finding the cause and putting forward effective preventive measures. Emergency response can be carried out from three aspects: response and acceptation, hazard assessment and operation of corresponding emergency plans. Emergency rescue of sudden chemical poisoning accidents should fully consider both rescue technology and emergency management. The former includes pre-hospital patient screening and pre-hospital detoxification, while the latter includes dealing with the uncertainty of rescue process, allocation of medical resources and health care for emergency rescuers. In the recovery stage of the accidents, attention should be paid to long-term post-disaster monitoring of the population and emergency rescuers. Using the treatment time and development sequence as the framework, we can more comprehensively describe the characteristics of sudden chemical poisoning accidents, which is helpful in finding the key points of prevention and treatment of such accidents, and provide a basis for exploring the emergency managing methods of such accidents.
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Complying with overall requirements of the government and regulations on public health emergences, as well as the clinical features of diagnosis and treatment of dental illness, this paper refers to previous guidelines and studies on the infection prevention and control in dental diagnosis and treatment in China and foreign countries. Nanjing Stomatological Hospital has implemented the emergency management practices for the prevention and control of novel coronavirus pneumonia (NCP), mainly focusing on the implementation of prevention and control training programs for medical staffs and the infection control projects on the hospital environment. This study could provide reference for rapid response and emergency management for the prevention and control of NCP in the departments of stomatology.
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Since the outbreak of COVID-19 in Wuhan, cabin hospitals have played an important role in preventing the spread of the epidemic and admitting all the patients and suspected ones. As one of the first three cabin hospitals in Wuhan, Jianghan cabin hospital under care of Wuhan Union Hospital has efficiently fulfilled its purpose of admitting patients of mild symptoms. Measures taken by the cabin hospital include clearing its positioning, optimizing its layout, establishing organization structure, setting up the rules and regulations, and strengthening the prevention and control of hospital infection. This article briefly summed up the operation and management practices of the cabin hospital, and analyzed its management difficulties, hence putting forwards suggestions on medical emergency management system of China, for references of hospitals and authorities in charge.
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At present, we are fighting against the outbreak of novel coronavirus pneumonia (NCP) in China. For the purposes of diagnosis and treatment of NCP patients, Hangzhou Xixi Hospital, as a designated hospital, make available the wards quickly, initiated the management system of public health emergencies, and established a "tolerate admission- strict discharge" patients management program. Meanwhile, the hospital has established an emergency supply and coordinated distribution mechanism for medical protection materials, and a full-system and multi-model training system, ensuring smooth progress of the diagnosis and treatment work.
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Objective: To analyze emergency management measures in large public hospitals during epidemic prevention of corona virus disease 2019 (COVID-19) in order to promote control efficiency and quality of COVID-19 in the emergency room of public hospitals. Methods: A retrospective analysis was made on the amount of emergency visits and management measures of Shanghai Sixth People's Hospital, Shanghai Jiao Tong University from January to February, 2020, including optimizing the process of emergency treatment during epidemic prevention, strengthening the management of key areas such as pre-examination and triage, emergency room, observation room, fluid room and the intensive-care unit and so on, enhancing the management and education of patients, optimizing the deployment model of medical staff, strengthening personal protection and other management measures. Results: During epidemic prevention, there was no missed diagnosis of COVID-19 in the hospital and no nosocomial cross infection in the emergency room. Conclusion: Enhancement of emergency management model in large public hospitals during COVID-19 epidemic prevention can improve the screening of possible patients and triage of patients so as to prevent nosocomial infection.
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Objective: To understand the implementation of the emergency management plan of nursing in the general hospitals in non-epidemic areas under the outbreak of coronavirus disease 2019 and propose strategies. Methods: Nine experts were interviewed by the method of focus group interviews method and the data were collected and analyzed by the method of Colaizzi data analysis method. Results: The important themes of nursing emergency management included the deployment and training of human resources, the development and implementation of material management system, and ward visiting system, the training and reserve of specialist nurses, as well as the psychological assistance and humanistic care. Conclusion: The emergency management of nursing in the general hospitals in non-epidemic areas is a systematic project. Nursing managers should further complete the construction of team and system for nursing emergency management, and improve the emergency nursing abilities and the mental health of nurses.