Patients' Expectations in Emergency Department at King Abdulaziz University Hospital: A Cross-Sectional Survey-Based Study.

BACKGROUND: Emergency departments (EDs) are vital to the timely and necessary care that a significant percentage of patients get. Emergency medicine places a high priority on quality, and to deliver patient-centered care, it is crucial to first investigate patient expectations from ER visits. METHODOLOGY: This is a cross-sectional study of all visits to the King Abdulaziz University Hospital Emergency Department in Jeddah. The study included adult patients who visited the emergency department and were willing to complete a survey and participate in an interview. Data was collected through face-to-face questionnaires. Patient's expectations during their visit to the emergency department were correlated to different parameters using univariate and bivariate analysis. RESULTS: The study included 291 patients. The majority of patients believed that their medical condition required admission to the hospital and agreed that it would be easier to receive treatment if admitted to the hospital. Results showed that 65.6% (n=191) of patients reported that the most serious patients should be seen first, and 65.3% (n=190) reported that a doctor should determine the seriousness of their health problem upon arrival. There was no significant difference found between age groups in relation to other items of expectations. CONCLUSION: It is clear that a sizable percentage of patients place a high value on seeing the most urgent cases first and having a doctor assess each patient's condition when they arrive. Our results show that, in order to guarantee the best patient happiness and care, healthcare practitioners must meet patients' expectations and modify their strategies accordingly.

Pediatric Burns: A Systematic Review and Meta-Analysis on Epidemiology, Gender Distribution, Risk Factors, Management, and Outcomes in Emergency Departments.

Pediatric burns pose a significant public health concern, ranking as the fifth most common nonfatal injury globally. This review consolidates data on the epidemiology, outcomes, and management of pediatric burns presenting to emergency departments. A systematic review was conducted across multiple databases, yielding 22 articles from 1992 to 2020. Utilizing the methodological index for non-randomized studies (MINORS) instrument, non-comparative studies scored from 2 to 11 with an average of 6.87, while comparative studies ranged from 12 to 16, averaging 13.67. The review included a total of 828,538 pediatric patients who were evaluated in the systematic review. Predominantly male victims ranged from 53% to 83%. The youngest victims were aged between 0 to 4 years. Burn etiology was largely attributed to scalds. A majority suffered from second-degree burns, with some studies reporting up to 89%. Limited data on total body surface area (TBSA) were documented, with only 2.5% requiring hospitalization. Common interventions included immediate resuscitation and skin grafting. Essential areas for future research are identified, including household risks, pre-treatment decisions, and the significant role of family dynamics in burn injury recovery. Pediatric burns remain a considerable concern, particularly among males and in household environments. The data underline the imperative for prevention strategies and optimized emergency care to positively influence outcomes for burn victims. Future research areas range from evaluating pre-treatment decisions to assessing community awareness regarding burn first aid.

Food Allergy: Knowledge and Attitude of Primary School Teachers in Makkah Region, Saudi Arabia.

Food allergy is a serious and potentially life-threatening medical condition that affects both adults and children. School teachers are considered to be among the first line of defense in identifying and responding to such situations, as 22% of food allergic reactions occur in schools. It is, therefore, important to understand the knowledge and attitudes of school teachers toward food allergy. This study is a descriptive, cross-sectional investigation conducted using an online questionnaire from December 2022 to February 2023. We collected data from 413 primary school teachers in Makkah region, Saudi Arabia. SPSS version 21 (IBM Corp., Armonk, NY) was used to analyze the data. Out of 413 teachers who met the inclusion criteria, only 14.5% demonstrated good awareness levels (scoring above 60% on the knowledge questionnaire) regarding food allergy, with young teachers making up the highest proportion as 26.1% of younger teachers had good awareness levels compared to 8.8% of teachers aged 51-60 years (p = 0.012). Additionally, 46.7% of the teachers knew the symptoms of a severe allergic reaction, and only 16.7% knew that they should use an epinephrine pen as the first step in managing a severe allergic reaction. School teachers have insufficient knowledge about food allergies, underscoring the importance of establishing school policies to handle food allergies. Such policies should encompass the adoption of a comprehensive food allergy action plan, training programs for school personnel, and educational campaigns.

Demographics and Clinical Presentations of Patients Visiting the Emergency Department During the Holy Month of Ramadan: A Three-Year Retrospective Study in a Muslim-Majority Country.

Background and objective Ramadan is the Muslim's holiest month; it is a time when believers engage in special practices that include fasting from dawn till dusk and making cultural and dietary modifications in their everyday lives. The impact of Ramadan on human activity, sleeping patterns, and circadian rhythms of hormones have been addressed in the literature. Fasting, which constitutes the main pillar of practices during Ramadan and lasts from sunrise to sunset, can significantly affect common health conditions, leading many to seek medical care in the Emergency Department (ED). Hence, it is important to understand the pattern of ED visits and understand the impact caused by fasting during this holy month in a Muslim-majority country. In light of this, this study aimed to gather new insights into the pattern of ED visits during Ramadan at a busy tertiary care center in the period from 2019 to 2021. Methods This study was conducted by reviewing the hospital health information system to gather relevant information in May 2022. Data of patients who visited the ED during Ramadan were collected, as well as during a month prior to and after Ramadan for the purpose of comparison. Sociodemographic characteristics and clinical profiles were collected for analysis.  Results The total number of ED visits in the three months of Ramadan during the study period (three years) was 33,142, all of which were included in our analysis. Sociodemographic data were analyzed for patients who visited the ED during the month of Ramadan and the two lunar months that precede and succeed Ramadan (Shaban and Shawal). Fever was the most common complaint (16.5%), followed by abdominal pain (14%). When analyzing the findings based on patient age groups, fever was found to be the most prevalent complaint in both adults (15.6%) and pediatric patients (34.4%). Of the total ED patient visits, 7,527 patients were admitted for further care, and 197 patients deceased. Conclusion Our study findings illustrate the change in ED visit patterns during the month of Ramadan in a Muslim-majority country. Also, the type of complaints was affected significantly due to the ongoing coronavirus disease 2019 (COVID-19) pandemic during the study period. The outcomes in patients reflected substantial progress and outcomes in the ED. These findings highlight that analyzing ED data can help provide accurate information that can be used to help modify/adjust the quality of services provided in the ED. However, these modifications may affect all hospital facilities, not just the ED.

Patients' Impression of Health Care Providers' Attire in the Emergency Department.

Background The level of patient satisfaction and, ultimately, the assessment of the quality of care are greatly influenced by physicians' capacity to leave a positive impression on patients during provider-patient interactions. The way doctors dress affects how people view their care. There have been few studies on the impact of doctors' attire on patient confidence and trust. The objective of this study is to assess patients' preferences concerning specific cultural attire and its influence on patients' trust, compliance, and perceptions of the quality of care in the emergency department. Methods A cross-sectional study was performed using the survey methodology for patients in emergency departments. Participants completed a written survey after reviewing doctors' portraits in different dress styles. Respondents were asked questions about the importance of the health service providers' attire in the emergency department on the patient's perception. The Statistical Package for Social Sciences version 21 (SPSS; IBM Inc., Armonk, New York) was used to perform the analysis after the data were entered into Microsoft Excel 2016 (Microsoft, Redmond, Washington). The categorical analysis was performed using the Chi-squared test to explore for relationships between the results and various variables. Result A self-administered questionnaire was completed by 395 patients; two responses were excluded for lack of completeness of the answers in it: 33.8%) were males (66.2%) were females (56.7%) were married (73.8%) completed university education (44.8%) were employed and (74.5%) with excellent health conditions. The questionnaire was devoted to the local setting, with pictures of the health care provider (male and female), in different types of doctor's attire included. Respondents overwhelmingly prefer male emergency physicians to dress in medical scrub (50%, p=.0001) and prefer female emergency physicians to dress in a medical scrub with a white coat (68.7%, p=.0001).  Conclusion First impressions based on a physician's appearance serve as the foundation for assumptions about trust, confidence, and competency, particularly in circumstances when patients or family members do not already have a relationship with the provider.

Effects of social networking services on academic performance and self-esteem: A cross-sectional study among medical students.

Background: Social networking services (SNS) are a subcategory of social media that provide a useful tool for an individual's practical life and social relations. Since the impact of SNS on students' lives is a relatively neglected topic, we aimed to investigate the effect of social media on academic performance and self-esteem. Methods: A cross-sectional study was conducted with 373 medical students distributed across different academic years. Data was collected and analyzed using measures of central tendency to describe numerical variables, while frequencies and percentages were used for categorical variables. Pearson's chisquared test, Pearson's correlation coefficient, independent sample t-test, and the one-way analysis of variance (ANOVA) were used to identify relationships between the variables. All P values < 0.05 were considered significant using a 95% confidence interval and a 5% margin of error. Results: The majority of our sample believed that SNSs were useful, and 37.5% believed that social media positively affected their academic performance. However, no significant relationship was found between the time spent on social media and the students' grade point average (GPA). Conversely, there was a significant relationship between students' perceived addiction to social media and their self-worth, along with a positive correlation between GPA and self-esteem. Conclusion: Almost half of our participants agreed that social media is a helpful method for finding useful information. Nevertheless, excessive usage has been found to have a harmful effect on the students' health and self-esteem.

Improving first-pass success rates during emergency intubation at an academic emergency department: a quality improvement initiative.

BACKGROUND: Airway management is a high-stakes procedure in emergency medicine. Continuously monitoring this procedure allows performance improvement while revealing safety issues. We instituted a quality improvement initiative in the emergency department to improve first-pass success rates in the emergency department. METHODS: This was a quality improvement initiative at an academic emergency department from 2018 to 2020. We developed a rapid sequence intubation guideline for procedure standardization and introduced an intubation procedure note for performance monitoring. Data were entered directly by the primary physician and nurse during intubation. The quality improvement team thereafter collected the data retrospectively and entered into a local airway database. More importantly, we introduced a culture of quality improvement and safety in airway management via regular education and feedback. RESULTS: We included a total of 146 intubations. The first-pass success rate started at 57.1% and increased to 80.0% during the study period (P < 0.01). Fifty-six percent were male, and the mean age (±SD) was 55.56 (±17.64). Video laryngoscopy was used in 101 (69.2%) patients, while direct laryngoscopy was used in only 44 (30.8%) patients. A logistic regression analysis was conducted to determine the independent factors associated with first-pass success. These factors included the use of video laryngoscopy (odds ratio (OR) 2.47 95% confidence interval (95% CI) [1.62-3.76]) (adjusted OR 3.87 [1.13-13.23]) and good Cormack-Lehane views (grades 1-2) (OR 2.71 95% CI [1.74-4.20]) (adjusted OR 7.88 [2.43-25.53]). CONCLUSION: Our study shows that implementing and maintaining an airway quality improvement program improves first-pass intubation success. Moreover, the use of video laryngoscopy and obtaining good Cormack-Lehane views (grades 1-2) are independently associated with improved first-pass success.

The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission.

STUDY OBJECTIVE: We examine adult emergency department (ED) admission rates for the top 15 most frequently admitted conditions, and assess the relative contribution in admission rate variation attributable to the provider and hospital. METHODS: This was a retrospective, cross-sectional study of ED encounters (≥18years) from 19 EDs and 603 providers (January 2012-December 2013), linked to the Area Health Resources File for county-level information on healthcare resources. "Hospital admission" was the outcome, a composite of inpatient, observation, or intra-hospital transfer. We studied the 15 most commonly admitted conditions, and calculated condition-specific risk-standardized hospital admission rates (RSARs) using multi-level hierarchical generalized linear models. We then decomposed the relative contribution of provider-level and hospital-level variation for each condition. RESULTS: The top 15 conditions made up 34% of encounters and 49% of admissions. After adjustment, the eight conditions with the highest hospital-level variation were: 1) injuries, 2) extremity fracture (except hip fracture), 3) skin infection, 4) lower respiratory disease, 5) asthma/chronic obstructive pulmonary disease (A&C), 6) abdominal pain, 7) fluid/electrolyte disorders, and 8) chest pain. Hospital-level intra-class correlation coefficients (ICC) ranged from 0.042 for A&C to 0.167 for extremity fractures. Provider-level ICCs ranged from 0.026 for abdominal pain to 0.104 for chest pain. Several patient, hospital, and community factors were associated with admission rates, but these varied across conditions. CONCLUSION: For different conditions, there were different contributions to variation at the hospital- and provider-level. These findings deserve consideration when designing interventions to optimize admission decisions and in value-based payment programs.

Inability to walk due to scurvy: A forgotten disease.

Scurvy has become rare in modern societies, but should be considered in malnourished persons, alcoholics, and in infants on unsupplemented milk diets who present with musculoskeletal pain or a bleeding tendency. The diagnosis of scurvy can be challenging because of the rare incidence and vague and nonspecific early symptoms. We report here a case of scurvy in a young boy who presented with an inability to walk and severe musculoskeletal pain. The diagnosis was established based on his clinical picture, radiological appearance, and low serum level of vitamin C. The patient responded well to vitamin C supplementation with full resolution of his symptoms. He regained his ability to walk and his family was happy and satisfied with the outcome of treatment. Although the incidence of scurvy has become low in Saudi Arabia, it can still occur and early recognition is important because of the excellent prognosis.

Sporadic creutzfeldt jacob disease.

We report a 65-year-old lady who presented with rapidly progressive dementia and was found to have Creutzfeldt-Jacob disease (CJD). On reviewing the literature, there have been only 3 case reports of CJD from Saudi Arabia. Our aim is to report this rare disease and to include it in the differential diagnosis of rapidly progressive dementia in our practice.