Emergency showstopper- factors behind delays in final disposition

Introduction: Clinical management outcome of emergency patients with delays are directly related to blocked access to the next level of care from emergency department. It predicts delay to the definitive procedure plan to manage the patient and is also a marker of hospital functional flaws

Objective: To study the frequency and associated factor of delays behind final disposition of patients presenting to the Emergency Department of a tertiary care hospital in Pakistan

Methods: This is comparative cross sectional study, conducted at Aga Khan University Hospital. Both adult and pediatric patients were included. Comparison was done between delayed and non-delayed emergency department patients. Six hour was taken as cut-off. SPSS version 19 and MS excel 2010 were used for analysis

Results: Out of 365 cases, 133 [36%] were pediatric and 232 [64%] were adults patients. There were 184 [50%] males. More than six hour delay was noted in 94 patients [27%]. Adult patients were delayed more than pediatric patients [p<0.001]. Laboratorial, radiological test and generated consults were all found highly significant difference for the delays [p<0.001]. 297 [81%] were discharged home, while 17 [5%] of them were admitted

Discussion: Overcrowding is common in Emergency Department [ED] and hence the chances of delay in disposition of patients from ED are very high which will ultimately compromise the patient care. Reducing the number of comparatively stable patients with effective triaging, ED clinics and diverting available resources towards more critical patients can reduce congestion, input and throughput. Reducing consults and unnecessary investigations with the provision of more experienced physicians and nurses is an important factor to reduce delays

Conclusion: Extended length of stay in ED may exceed the potential capability to deliver quality care within appropriate time frame; this may lead to drastic decrease in patient and family satisfaction, leading to compromised clinical care

Retrograde ureteropyeloscopic holmium laser lithotripsy for shockwave refractory renal calculi

To assess the efficacy and safety of the retrograde ureteropyeloscopic holmium laser for treating renal stones that are refractory to treatment with extracorporeal shock wave lithotripsy [ESWL]. A total of 23 patients [4 females and 19 males] with a mean age of 42.7 +/- 9.8 years [range 27 to 63 years] underwent flexible ureteroscopy and holmium: YAG laser lithotripsy. They had been treated with a mean of 2.87 previous SW sessions. Mean stone size was 1.23 +/- 0.4cm [range 0.5 to 2.3cm] and the mean number of stones per patient was 2 stones [range 1 to 6 stones] for a total of 45 stones overall. Nineteen patiets had intrarenal stones, 3 had combined ureteral and renal stones and one had ureteral stone. Success was defined as stone-free status or residual fragments less than 3mm and it was assessed by postoperative abdominal radiography, CT or ultrasonography. The overall success rate of stone fragmentation was 78.2%. Eighteen patients had no stone fragments or residual fragments less than 3mm that were expected to pass spontaneously. Of the 23 patients 4 had lower pole residual stones more than 5mm in size, 3 of them underwent second ureteroscopic procedure and one underwent PCNL as the stones were not accessible because of lower pole infundibular stricture. After the second treatment, the success rate reached 91.3%. There were no major complications, 3 patients had postoperative fever and significant irritative bladder symptoms secondary to the internal stent in 5 cases [21.7%]. Mean operative time was 72.39 +/- 22.25 minutes and mean hospital stay was 3.22 +/- 1.27 days. Ureteroscopic laser lithotripsy can be used effectively and safely to treat upper tract stones unresponsive to SWL. Patients with stone burden > 10 mm and those with an abnormal renal anatomy require more than one procedure

Mother' responsiveness to the needs of preschool children correlates with their development at urban area

In addition to food, sanitation and access to health facilities children require adequate care at home for survival and optimal development. Responsiveness, considering a mothers/care-givers prompt and appropriate interaction with the child, is a vital parenting tool with wide-ranging benefits for the child from better cognitive and psychosocial development to protection from disease and mortality [Shonkoff and Philips, 2000]. The purpose of this study was to examine mother's responsiveness to the needs of preschool children in relation to their assessed development at MCH center. The total sample consisted of 138 mothers with their preschool child. The instruments used were Identification data sheet, Socioeconomic Questionnaire [Fahmy and Sherbine, 1985], Knowledge Questionnaire, Attitude questionnaire, Maternal Responsiveness Interaction questionnaire [Wenk and Stock, 1990], and Denver II Scale [Frakenburg, 1994]. Results showed that mothers responsiveness behaviors were correlated positively to the developmental achievement of preschool children in the all domains [personal-social, language, gross-motor, and fine-motor] of child development except for fine motor one [r= 0.279, p<0.000, r=0.211 p<0.000, r=0.25, p<0.000, r= 0.074, p<0.109]. The study results recommended that community health nurse should enhance mother's knowledge and behaviors to be responsive to the needs of preschool child focusing on personalsocial needs that ultimately leads to improved developmental outcomes. Intervention about mother's responsiveness should be integrated into child survival strategies to increase chances to meet the Millennium Development Goal contributing to decrease children deaths

Environmental stressors in relation to behavioral problems among homeless school-age children resident at shelter

Homeless children living at shelters, have many stressors facing them daily in the surrounding environment that contributing to behavioral problems [Bassuk, and Gallagher, 1994]. The purposes of this study were to assess a] stressors among school age homeless children resident at Helwan's shelter, b] behavioral problems among school age children resident at Helwan's shelter, and c] to examine the relation between the assessed stressors and behavioral problems of school age homeless children resident at Helwan's shelter. The sample of this study consisted of 30 homeless school age children resident at Helwan's shelter. Five tools were used to collect the data: 1] Structured interviewing questioner, 2] the Homeless Interview Schedule-Child's Version [HCIS], 3] Child Adaptive Inventory [CABI], 4] Life event's children Scale, and 5] The Beck Depressive Inventory [BDI]. The results depicted that the areas most frequently reported by school age homeless children as stressful were environmental shelter-life [83%]. The most [96.6%] had antisocial behavior problems. Children's Stressors, life events and children's depressive symptoms were positively correlated with children's behavioral problems [r=0.3 1, P<0.0 1, r=0.20, P<0.05, r=0.25, P<0.01 respectively]. Based on this study finding, it is concluded that Community health nurse can raise the awareness of parent during home visiting to reinforce importance of developing positive parent-child interactions to prevent fleeing children at street. Because the main stressors related to environmental shelter life so training programs should be done for workers at shelter for providing children free environmental stressors and building good communication skills, contributing to developing a sense of empowerment among children to overcome developing stressors and behavioral problems

Life events of pregnant and infertile women in relation to their social activities at out patient clinics

The purpose of this study was to examine the relationship between the life event and social activities of pregnant and infertile women. The total sample consisted of 195 women [100 were currently pregnant women and 95 infertile women] at outpatient maternity hospital. The instruments used were demographic data questionnaire sheet, social activities questionnaire sheet, the Center Epidemiological Studies- Depression Scale [CES-D] and the Holmes and Rahe [1967] Social Readjustment Rating scale. The results showed that life events and level of somatic features of depression scores were positively correlated in pregnant women and infertile women. Life event scores negatively correlated with social activities in both groups. Multiple regression analysis showed that change in social activities in responsible about 87% of change in life events scores. Multiple regression analysis showed that change in both life events scores and social activities is responsible for 90% of the change in levels of somatic features of depression scores