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Curran J, McCulloch H. Discharge communication during transitions from emergency care to home. Healthc Manage Forum 2024:8404704241289252. [PMID: 39412886 DOI: 10.1177/08404704241289252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2024]
Abstract
The healthcare system in Canada is overwhelmed and requires reform. Good discharge communication is a cornerstone of patient safety and quality care. In the Emergency Department (ED), good discharge communications means that patients leave with a clear understanding of their health condition, and the steps they need to take to continue their recovery at home. The fragmented nature of communication in the ED coupled with long wait times and high noise levels pose significant risks to the continuity of information exchange. Additional communication barriers arise for many patients due to a lack of control, language differences, low health literacy, and feelings of fear and uncertainty. Multiple interventions have been evaluated to improve ED discharge communication, but further work is needed to engage all end users in a theory-based approach. Addressing challenges related to successful discharge communication requires a multifaceted approach that includes improving institutional policies, adopting innovative co-designed interventions, and leveraging technology.
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Carroll C, Kundakci B, Muhinyi A, Bastounis A, Jones K, Sutton A, Goodacre S, Marincowitz C, Booth A. Scoping review of the effectiveness of 10 high-impact initiatives (HIIs) for recovering urgent and emergency care services. BMJ Open Qual 2024; 13:e002906. [PMID: 39299774 PMCID: PMC11429364 DOI: 10.1136/bmjoq-2024-002906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 09/01/2024] [Indexed: 09/22/2024] Open
Abstract
INTRODUCTION Prolonged ambulance response times and unacceptable emergency department (ED) wait times are significant challenges in urgent and emergency care systems associated with patient harm. This scoping review aimed to evaluate the evidence base for 10 urgent and emergency care high-impact initiatives identified by the National Health Service (NHS) England. METHODS A two-stage approach was employed. First, a comprehensive search for reviews (2018-2023) was conducted across PubMed, Epistemonikos and Google Scholar. Additionally, full-text searches using Google Scholar were performed for studies related to the key outcomes. In the absence of sufficient review-level evidence, relevant available primary research studies were identified through targeted MEDLINE and HMIC searches. Relevant reviews and studies were mapped to the 10 high-impact initiatives. Reviewers worked in pairs or singly to identify studies, extract, tabulate and summarise data. RESULTS The search yielded 20 771 citations, with 48 reviews meeting the inclusion criteria across 10 sections. In the absence of substantive review-level evidence for the key outcomes, primary research studies were also sought for seven of the 10 initiatives. Evidence for interventions improving ambulance response times was generally scarce. ED wait times were commonly studied using ED length of stay, with some evidence that same day emergency care, acute frailty units, care transfer hubs and some in-patient flow interventions might reduce direct and indirect measures of wait times. Proximal evidence existed for initiatives such as urgent community response, virtual hospitals/hospital at home and inpatient flow interventions (involving flow coordinators), which did not typically evaluate the NHS England outcomes of interest. CONCLUSIONS Effective interventions were often only identifiable as components within the NHS England 10 high-impact initiative groupings. The evidence base remains limited, with substantial heterogeneity in urgent and emergency care initiatives, metrics and reporting across different studies and settings. Future research should focus on well-defined interventions while remaining sensitive to local context.
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Affiliation(s)
- Christopher Carroll
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Burak Kundakci
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Amber Muhinyi
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Anastasios Bastounis
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Katherine Jones
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Steve Goodacre
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Carl Marincowitz
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
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Abdulelah M, Abbas R, Samuel S, Abu-Hishmeh M. When are pulmonologists consulted? Trends and outcomes of pulmonary consultations for unspecified hypoxia. Proc AMIA Symp 2024; 37:763-768. [PMID: 39165825 PMCID: PMC11332629 DOI: 10.1080/08998280.2024.2377010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 08/22/2024] Open
Abstract
Background Clinical judgment is essential in determining the need for specialist consultation. We evaluated patients for whom the pulmonary team was consulted for unspecified hypoxia or acute hypoxic respiratory failure to better understand the characteristics and outcomes of such encounters. Methods We retrospectively studied patients who received consults for unspecified hypoxia or acute hypoxic respiratory failure at a tertiary center. Outcomes evaluated were length of stay, duration of follow-up, and clinical trajectory. Results We identified 103 patients over a 2-year period. The level of care was escalated in 69.9% (n = 72) of patients, and the majority had procedural interventions such as bronchoscopies and chest tube placement. Common diagnoses were pneumonia and volume overload. The mortality rate was 17.5% (n = 18). The mean length of stay was 24 days (standard deviation [SD] 24.1), with an average of 6.6 hospital days (SD 9.9) to consultation. The mean duration of consecutive follow-up was 4.5 days (SD 7.5). Patients who underwent procedures had a shorter duration of follow-up. Conclusion Pulmonary consults were noted for common diagnoses with a high need for escalation in care and procedural interventions, highlighting the importance and appropriateness of specialist consultations. Further studies are needed to explore what triggers an unspecified consult.
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Affiliation(s)
- Mohammad Abdulelah
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
| | - Ramsha Abbas
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
| | - Sherin Samuel
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
| | - Mohammad Abu-Hishmeh
- Department of Internal Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
- Department of Pulmonary and Critical Care Medicine, University of Massachusetts Chan Medical School, Springfield, Massachusetts, USA
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Samadbeik M, Staib A, Boyle J, Khanna S, Bosley E, Bodnar D, Lind J, Austin JA, Tanner S, Meshkat Y, de Courten B, Sullivan C. Patient flow in emergency departments: a comprehensive umbrella review of solutions and challenges across the health system. BMC Health Serv Res 2024; 24:274. [PMID: 38443894 PMCID: PMC10913567 DOI: 10.1186/s12913-024-10725-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 02/14/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Globally, emergency departments (EDs) are overcrowded and unable to meet an ever-increasing demand for care. The aim of this study is to comprehensively review and synthesise literature on potential solutions and challenges throughout the entire health system, focusing on ED patient flow. METHODS An umbrella review was conducted to comprehensively summarise and synthesise the available evidence from multiple research syntheses. A comprehensive search strategy was employed in four databases alongside government or organisational websites in March 2023. Gray literature and reports were also searched. Quality was assessed using the JBI critical appraisal checklist for systematic reviews and research syntheses. We summarised and classified findings using qualitative synthesis, the Population-Capacity-Process (PCP) model, and the input/throughput/output (I/T/O) model of ED patient flow and synthesised intervention outcomes based on the Quadruple Aim framework. RESULTS The search strategy yielded 1263 articles, of which 39 were included in the umbrella review. Patient flow interventions were categorised into human factors, management-organisation interventions, and infrastructure and mapped to the relevant component of the patient journey from pre-ED to post-ED interventions. Most interventions had mixed or quadruple nonsignificant outcomes. The majority of interventions for enhancing ED patient flow were primarily related to the 'within-ED' phase of the patient journey. Fewer interventions were identified for the 'post-ED' phase (acute inpatient transfer, subacute inpatient transfer, hospital at home, discharge home, or residential care) and the 'pre-ED' phase. The intervention outcomes were aligned with the aim (QAIM), which aims to improve patient care experience, enhance population health, optimise efficiency, and enhance staff satisfaction. CONCLUSIONS This study found that there was a wide range of interventions used to address patient flow, but the effectiveness of these interventions varied, and most interventions were focused on the ED. Interventions for the remainder of the patient journey were largely neglected. The metrics reported were mainly focused on efficiency measures rather than addressing all quadrants of the quadruple aim. Further research is needed to investigate and enhance the effectiveness of interventions outside the ED in improving ED patient flow. It is essential to develop interventions that relate to all three phases of patient flow: pre-ED, within-ED, and post-ED.
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Affiliation(s)
- Mahnaz Samadbeik
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia.
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia.
| | - Andrew Staib
- Princess Alexandra Hospital, Brisbane, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Justin Boyle
- The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Sankalp Khanna
- The Australian E-Health Research Centre, Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government, Brisbane, Australia
| | - Daniel Bodnar
- Queensland Ambulance Service, Queensland Government, Brisbane, Australia
| | - James Lind
- Gold Coast University Hospital, Gold Coast, Australia
| | - Jodie A Austin
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Sarah Tanner
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Yasaman Meshkat
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Barbora de Courten
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
| | - Clair Sullivan
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, Australia
- Faculty of Medicine, Queensland Digital Health Centre, The University of Queensland, Brisbane, QLD, 4072, Australia
- Department of Health, Metro North Hospital and Health Service, Brisbane, Australia
- School of Health and Biomedical Sciences, RMIT University, Melbourne, Australia
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Pearce S, Marr E, Shannon T, Marchand T, Lang E. Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes. Intern Emerg Med 2024; 19:483-491. [PMID: 38041766 DOI: 10.1007/s11739-023-03477-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/30/2023] [Indexed: 12/03/2023]
Abstract
Emergency Department (ED) crowding is defined as a situation wherein the demands of emergency services overcome the ability of a department to provide high-quality care within an appropriate time frame. There is a need for solutions, as the harms of crowding impact patients, staff, and healthcare spending. An overview of ED crowding was previously published by our group, which outlines these global issues. The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarizing the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview was to summarize the interventions at each level of emergency care: input, throughput, and output. The methodology was supported by the current PRIOR statement for an overview of reviews. The study summarized twenty-seven full-text systematic reviews, which encompassed three hundred and eight primary studies. The results of the summary displayed a requirement for increasing studies in input and output interventions, as these showed the best outcomes with regard to ED crowding metrics. Moreover, the results displayed heterogeneous results at each level of ED care; these reflected that generally solutions have not been matched to specific problems facing regional centres. Thus, individual factors need to be considered when implementing solutions in Emergency Departments.
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Affiliation(s)
- Sabrina Pearce
- University of Calgary, Cumming School of Medicine, Calgary, Canada.
- Alberta Health Services, Calgary, Canada.
| | - Erica Marr
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Tara Shannon
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Tyara Marchand
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Eddy Lang
- University of Calgary, Cumming School of Medicine, Calgary, Canada
- Alberta Health Services, Calgary, Canada
- Department of Emergency Medicine, University of Calgary, Calgary, Canada
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Cappellari AM, Bruschi G, Beretta GB, Molisso MT, Bertolozzi G. How Can Specialist Advice Influence the Neuroimaging Practice for Childhood Headache in Emergency Department? CHILDREN (BASEL, SWITZERLAND) 2023; 10:1837. [PMID: 38136039 PMCID: PMC10742139 DOI: 10.3390/children10121837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
Differentiating between primary and secondary headaches can be challenging, especially in the emergency department (ED). Since symptoms alone are inadequate criteria for distinguishing between primary and secondary headaches, many children with headaches undergo neuroimaging investigations, such as brain CT and MRI. In various studies, the frequency of neuroimaging utilization is influenced by several factors, including teaching status, ownership, metropolitan area, insurance status, and ethnicity of patients. However, only a few studies have considered the role of specialist consultations in ordering neuroimaging studies on childhood headaches. We report the contributions of different specialists to the evaluation of children with headaches admitted to the ED and their influence on neuroimaging decisions. We retrospectively reviewed the medical reports of paediatric patients who presented with headaches to the paediatric ED of the Ospedale Maggiore Policlinico of Milano between January 2017 and January 2022. Overall, 890 children with headaches were evaluated (mean age: 10.0 years; range: 1 to 17 years). All patients were examined by the ED paediatricians, while specialist consultations were required for 261 patients, including 240 neurological (92.0%), 46 ophthalmological (17.6%), and 20 otorhinolaryngological (7.7%) consultations. Overall, 173 neuroimaging examinations were required, of which 51.4 and 48.6% were ordered by paediatricians and neurologists, respectively. In particular, paediatricians required 61.4% of brain CT scans, and neurologists required 92.0% of brain MRI scans. In conclusion, paediatricians were responsible for the management of most children with headaches admitted to the ED, while specialist consultations were required only in about a third of the cases. Although there was no significant difference in the number of neuroimaging studies ordered by specialists, brain CT scans were most often used by paediatricians, and MRI scans by neurologists.
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Affiliation(s)
- Alberto M. Cappellari
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Gaia Bruschi
- Postgraduate School of Paediatrics, Università degli Studi di Milano, 20122 Milan, Italy; (G.B.); (G.B.B.)
| | - Gisella B. Beretta
- Postgraduate School of Paediatrics, Università degli Studi di Milano, 20122 Milan, Italy; (G.B.); (G.B.B.)
| | - Maria T. Molisso
- Department of Neuroscience and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giuseppe Bertolozzi
- Pediatric Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
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Snyder KB, Ball J, Lees J, Skaggs JC, Sami A, Hunter CJ, Landmann A. Anecdotes Drive Attitudes, Data Drives Decisions: Optimizing the Emergency Department Workup Prior to Surgical Consultations. JOURNAL OF SURGICAL EDUCATION 2023; 80:1682-1686. [PMID: 37357106 DOI: 10.1016/j.jsurg.2023.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/25/2023] [Accepted: 05/30/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE Emergency department (ED) wait times and ED length of stay (LOS) have a significant impact on patient morbidity and mortality and patient satisfaction. Consultation-to-decision time can contribute to increased wait times and LOS in the ED. Up to 40% of patients presenting to the ED require consultation from subspecialty services. We hypothesize that in surgical patients, completion of workup prior to consultation will decrease consultation-to-decision time, ED wait times, and LOS in the ED. METHODS A retrospective review was conducted at a single site including all overnight general surgery consultations from the ED over 2-months. Data collected included wait times, LOS, and workup completed prior to consultation. Summary statistics were calculated and bivariate tests were performed using t-tests for continuous variables. RESULTS Time to final surgical plan and LOS in ED were evaluated for 137 patients comparing "complete" and "incomplete" workups at time of consultation. It was considered a "complete" workup if labs and imaging were resulted prior to time of consult. If any baseline tests were not ordered prior to time of consult, it was considered an "incomplete" workup. Analysis demonstrated an average time of 4.9 and 2.5 hours for consultation-to-decision time for "incomplete" and "complete" workups respectively (p < 0.0001). For LOS in ED, there was an average of 11.4 and 7.9 hours for "incomplete" and "complete" workups respectively (p < 0.0001). CONCLUSIONS There is a significant difference in consultation-to-decision time and LOS in the ED when consultation is performed following a complete versus incomplete workup for surgical patients independent of inherent wait times for testing to result and the need for additional testing requested from consulting services. Developing strategies to optimize workups from the ED prior to surgical consultation, including the development of care pathways, could significantly decrease patient wait times and LOS in the ED.
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Affiliation(s)
- Katherine B Snyder
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jonathan Ball
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Jason Lees
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joanne C Skaggs
- Department of Internal Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Areej Sami
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Catherine J Hunter
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Alessandra Landmann
- Department of Surgery, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Ygiyeva D, Pivina L, Messova A, Urazalina Z, Semenova Y, Dyussupov A, Dyussupov A, Belikhina T, Syzdykbayev M, Batenova G, Akhmetova A, Adams A. Paramedic To Provider Consultation Challenges in the Emergency Department in Kazakhstan: An Online Survey. Open Access Emerg Med 2023; 15:69-77. [PMID: 36923062 PMCID: PMC10010182 DOI: 10.2147/oaem.s401331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Objective Consultation is an important and necessary aspect of patient care in the emergency department. We prospectively examined difficulties during the consultation process between paramedics and providers in emergency departments in Kazakhstan. Methods The paramedics were interviewed using various platforms and face-to-face meetings. Questionnaires were administered to paramedics to gather feedback on the current consultation process. In our survey, 202 paramedics of ambulance from the cities of Semey, Pavlodar, and Ust-Kamenogorsk, located in the North and East of Kazakhstan took part. Results Serious barriers to effective consultation were identified during consultations with cardiologists, pediatricians, and traumatologists. Weekends, as well as nighttime, are associated with more consultation difficulties. The most common problems for paramedics are non-attendance of the consultant, refusal of hospitalization by the consultant, and referral to other specialists and departments. More than 40% of the respondents noted the desire to share responsibility for the patient with medical consultants, which indicates uncertainty in their own knowledge due to the limited work experience of the majority of respondents. Conclusion Barriers that arise during the consultation process of patients with emergency conditions can lead to unfavorable outcomes. Strategies to address these barriers are needed to improve the quality of patient care. This review aims to understand and evaluate the issues that arise during the consultation process.
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Affiliation(s)
- Diana Ygiyeva
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Lyudmila Pivina
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Assylzhan Messova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Zhanar Urazalina
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Yuliya Semenova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Almas Dyussupov
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Altay Dyussupov
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Tatyana Belikhina
- Nuclear Medicine Department, Center of Nuclear Medicine and Oncology, Semey, Abay Region, Kazakhstan
| | - Marat Syzdykbayev
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Gulnara Batenova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Ayaulym Akhmetova
- Department of Emergency Medicine, Semey Medical University, Semey, Abay Region, Kazakhstan
| | - Amber Adams
- JoAnne Gay Dishman School of Nursing, Lamar University, Beaumont, TX, USA
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