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Gmünder M, Gessler N, Buser S, Feuz U, Fayyaz J, Jachmann A, Keitel K, Brandenberger J. Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study. BMJ Open 2024; 14:e077716. [PMID: 38216184 PMCID: PMC10806666 DOI: 10.1136/bmjopen-2023-077716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/14/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy. DESIGN A mixed-methods study. SETTING Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland. PARTICIPANTS AND METHODS Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted. RESULTS The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy. CONCLUSION The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well-positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.
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Affiliation(s)
- Myriam Gmünder
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Noemi Gessler
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Sina Buser
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Ursula Feuz
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jabeen Fayyaz
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Jachmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristina Keitel
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Julia Brandenberger
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Mahant S, Ling SC, Williams S, Shah P, Fayyaz J, Lim-Shue C, Irwin MS, Huang A. Developing a Faculty Awards Strategy in an Academic Department: Recognizing Faculty and Promoting the Department. J Pediatr 2024:113899. [PMID: 38181977 DOI: 10.1016/j.jpeds.2024.113899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 12/28/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Sanjay Mahant
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada.
| | - Simon C Ling
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Suzan Williams
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Prakesh Shah
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Mount Sinai Hospital, Toronto, Canada
| | - Jabeen Fayyaz
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Catherine Lim-Shue
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Meredith S Irwin
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
| | - Annie Huang
- Department of Paediatrics, University of Toronto Temerty Faculty of Medicine, Toronto, Canada; Department of Paediatrics, Hospital for Sick Children, Toronto, Canada
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Fayyaz J, Jaeger M, Takundwa P, Iqbal AU, Khatri A, Ali S, Mukhtar S, Saleem SG, Whitfill T, Ali I, Duff JP, Kardong‐Edgren S(S, Gross IT. Exploring cultural sensitivity during distance simulations in pediatric emergency medicine. AEM Educ Train 2023; 7:e10908. [PMID: 37997591 PMCID: PMC10664395 DOI: 10.1002/aet2.10908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 11/25/2023]
Abstract
Background Cultural sensitivity (CS) training is vital to pediatric emergency medicine (PEM) curricula. This study aimed to explore CS in Yale PEM fellows and emergency medicine (EM) residents at Indus Hospital and Health Network (IHHN) in Pakistan through distance simulation activities. Methods This mixed-methods analysis of an educational intervention was conducted at Yale University in collaboration with IHHN. We approached seven U.S. PEM fellows and 22 Pakistani EM residents. We performed a baseline CS assessment using the Clinical Cultural Competency Questionnaire (CCCQ). Afterward, the U.S. PEM fellows facilitated the Pakistani EM residents through six distance simulation sessions. Qualitative data were collected through online focus groups. The CCCQ was analyzed using descriptive statistics, and content analysis was used to analyze the data from the focus groups. Results Seven U.S. PEM fellows and 18 of 22 Pakistani EM residents responded to the CCCQ at the beginning of the module. The mean (±SD) CCCQ domain scores for the U.S. PEM fellows versus the Pakistani EM residents were 2.56 (±0.37) versus 2.87 (±0.72) for knowledge, 3.02 (±0.41) versus 3.33 (±0.71) for skill, 2.86 (±0.32) versus 3.17 (±0.73) for encounter/situation, and 3.80 (±0.30) versus 3.47 (±0.47) for attitude (each out of 5 points). Our qualitative data analysis showed that intercultural interactions were valuable. There is a common language of medicine among the U.S. PEM fellows and Pakistani EM residents. The data also highlighted a power distance between the facilitators and learners, as the United States was seen as the standard of "how to practice PEM." The challenges identified were time differences, cultural practices such as prayer times, the internet, and technology. The use of local language during debriefing was perceived to enhance engagement. Conclusion The distance simulation involving U.S. PEM fellows and Pakistani EM residents was an effective approach in assessing various aspects of intercultural education, such as language barriers, technical challenges, and religious considerations.
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Affiliation(s)
- Jabeen Fayyaz
- University of TorontoTorontoOntarioCanada
- The Hospital for Sick ChildrenTorontoOntarioCanada
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
- Department of Pediatrics, Division of Pediatric Critical Care (PICU), Faculty of Medicine & DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Margret Jaeger
- Research DepartmentEducation Centre of Social Fund ViennaViennaAustria
| | - Prisca Takundwa
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Ammarah U. Iqbal
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Adeel Khatri
- Emergency MedicineIndus Hospital and Health NetworkKarachiPakistan
| | - Saima Ali
- Emergency MedicineIndus Hospital and Health NetworkKarachiPakistan
| | - Sama Mukhtar
- Emergency MedicineIndus Hospital and Health NetworkKarachiPakistan
| | | | - Travis Whitfill
- Pediatric Emergency MedicineYale School of MedicineNew HavenConnecticutUSA
| | - Inayat Ali
- Department of Public Health and Allied Sciences, Department of AnthropologyFatima Jinnah Women's UniversityRawalpindiPakistan
| | - Jonathan P. Duff
- Department of Pediatrics, Division of Pediatric Critical Care (PICU), Faculty of Medicine & DentistryUniversity of AlbertaEdmontonAlbertaCanada
| | - Suzan (Suzie) Kardong‐Edgren
- Health Professions Education Program, Center for Interprofessional Studies and InnovationMGH Institute of Health ProfessionBostonMassachusettsUSA
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Thakur N, Mahajan P, Misra S, Fayyaz J. Pediatric Trauma Training in India- Need of the Hour. Indian Pediatr 2023; 60:800-803. [PMID: 37209056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Pediatric trauma is preventable yet every year the number of road accident victims continues to rise. India is facing another epidemic in the form of pediatric trauma. Children less than 14 years account for 11% of accident-related deaths in India. Road traffic injury have multipronged effects on child's mental and physical development. Injury during developing phase can have both long-term and short-term consequences. Currently, India has only 5 Level 1 trauma centers where trauma care providers have mostly undergone training in Adult Trauma Life Support. It is well established that the outcome of pediatric trauma victims is largely dependent on the management received in the golden hour. Yet no standardized pediatric trauma training programme exists in India, and there is a need to address this gap.
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Affiliation(s)
- Neha Thakur
- Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, Uttar Pradesh, India. Correspondence to: Dr Neha Thakur, Associate Professor, Department of Paediatrics, Dr Ram Manohar Lohia Institute of Medical Sciences Lucknow 226010, Uttar Pradesh.
| | - Prashant Mahajan
- Chief, Section of Pediatric Emergency Medicine, CS Mott Children's Hospital University of Michigan Ann Arbor, Michigan, United States of America
| | - Samir Misra
- Department of Trauma Surgery, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Jabeen Fayyaz
- University of Toronto PEM Staff Physician, The Hospital for Sick Children, Toronto, Canada
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5
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Pirie J, Fayyaz J, Prinicipi T, Kempinska A, Gharib M, Simone L, Glanfield C, Walsh C. Impact and effectiveness of a mandatory competency-based simulation program for pediatric emergency medicine faculty. AEM Educ Train 2023; 7:e10856. [PMID: 36970557 PMCID: PMC10033845 DOI: 10.1002/aet2.10856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/19/2023] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
Introduction Pediatric emergency medicine physicians struggle to maintain their critical procedural and resuscitation skills. Continuing professional development programs incorporating simulation and competency-based standards may help ensure skill maintenance. Using a logic model framework, we sought to evaluate the effectiveness of a mandatory annual competency-based medical education (CBME) simulation program. Methods The CBME program, evaluated from 2016 to 2018, targeted procedural, point-of-care ultrasound (POCUS) and resuscitation skills. Delivery of educational content included a flipped-classroom website, deliberate practice, mastery-based learning, and stop-pause debriefing. Participants' competence was assessed using a 5-point global rating scale (GRS; 3 = competent, 5 = mastery). Statistical process control charts were used to measure the effect of the CBME program on team performance during in situ simulations (ISS), measured using the Team Emergency Assessment Measure (TEAM) scale. Faculty completed an online program evaluation survey. Results Forty physicians and 48 registered nurses completed at least one course over 3 years (physician mean ± SD 2.2 ± 0.92). Physicians achieved competence on 430 of 442 stations (97.3%). Mean ± SD GRS scores for procedural, POCUS, and resuscitation stations were 4.34 ± 0.43, 3.96 ± 0.35, and 4.17 ± 0.27, respectively. ISS TEAM scores for "followed standards and guidelines" improved significantly. No signals of special cause variation emerged for the other 11 TEAM items, indicating skills maintenance. Physicians rated CBME training as highly valuable (mean question scores 4.15-4.85/5). Time commitment and scheduling were identified as barriers to participation. Conclusions Our mandatory simulation-based CBME program had high completion rates and very low station failures. The program was highly rated and faculty improved or maintained their ISS performance across TEAM scale domains.
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Affiliation(s)
- Jonathan Pirie
- Division of Pediatric Emergency MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Jabeen Fayyaz
- Division of Pediatric Emergency MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Tania Prinicipi
- Division of Pediatric Emergency MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Anna Kempinska
- Division of Pediatric Emergency Medicine, London Health Sciences CentreChildren's Hospital of Western OntarioLondonOntarioCanada
| | - Mireille Gharib
- Division of Pediatric Emergency MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Laura Simone
- Division of Pediatric Emergency MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Carrie Glanfield
- Division of Pediatric Emergency MedicineThe Hospital for Sick ChildrenTorontoOntarioCanada
| | - Catharine Walsh
- Division of Gastroenterology, Hepatology and Nutrition and the Research and Learning InstitutesThe Hospital for Sick ChildrenTorontoOntarioCanada
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6
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Gross IT, Clapper TC, Ramachandra G, Thomas A, Ades A, Walsh B, Kreuzer F, Elkin R, Wagner M, Whitfill T, Chang TP, Duff JP, Deutsch ES, Loellgen RM, Palaganas JC, Fayyaz J, Kessler D, Calhoun AW. Setting an Agenda: Results of a Consensus Process on Research Directions in Distance Simulation. Simul Healthc 2023; 18:100-107. [PMID: 36989108 DOI: 10.1097/sih.0000000000000663] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The COVID-19 pandemic forced rapid implementation and refinement of distance simulation methodologies in which participants and/or facilitators are not physically colocated. A review of the distance simulation literature showed that heterogeneity in many areas (including nomenclature, methodology, and outcomes) limited the ability to identify best practice. In April 2020, the Healthcare Distance Simulation Collaboration was formed with the goal of addressing these issues. The aim of this study was to identify future research priorities in the field of distance simulation using data derived from this summit. METHODS This study analyzed textual data gathered during the consensus process conducted at the inaugural Healthcare Distance Simulation Summit to explore participant perceptions of the most pressing research questions regarding distance simulation. Participants discussed education and patient safety standards, simulation facilitators and barriers, and research priorities. Data were qualitatively analyzed using an explicitly constructivist thematic analysis approach, resulting in the creation of a theoretical framework. RESULTS Our sample included 302 participants who represented 29 countries. We identified 42 codes clustered within 4 themes concerning key areas in which further research into distance simulation is needed: (1) safety and acceptability, (2) educational/foundational considerations, (3) impact, and (4) areas of ongoing exploration. Within each theme, pertinent research questions were identified and categorized. CONCLUSIONS Distance simulation presents several challenges and opportunities. Research around best practices, including educational foundation and psychological safety, are especially important as is the need to determine outcomes and long-term effects of this emerging field.
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Affiliation(s)
- Isabel T Gross
- From the Department of Pediatrics (I.T.G., T.W.), Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT; Weill Cornell Medicine NewYork-Presbyterian Simulation Center (T.C.C.), Weill Cornell Medical College, New York, NY; Department of Pediatric Intensive Care (G.R.), Krishna Institute of Medical Science, Secunderabad, India; Division of Pediatric Emergency Medicine (A.T.), Department of Pediatrics, Seattle Children's Hospital, Seattle, WA; Division of Neonatology (A.A.), Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA; Division of Pediatric Emergency Medicine (B.W.), Department of Pediatrics, Boston University School of Medicine, Boston, MA; Faculty of Medicine (F.K.), Ludwig-Maximilians-University Munich, Munich, Germany; Department of Emergency Medicine (R.E., D.K.), Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian Hospital, New York, NY; Division of Neonatology (M.W.), Pediatric Intensive Care and Neuropediatrics, Department of Pediatrics, Comprehensive Center for Pediatrics, Medical University of Vienna, Vienna, Austria; Department of Emergency Medicine (T.W.), Yale University School of Medicine, New Haven, CT; Division of Emergency Medicine (T.P.C.), Department of Medical Education, Children's Hospital Los Angeles & Keck School of Medicine at University of Southern California, Los Angeles, CA; Division of Pediatric Critical Care Medicine (J.P.D.), Department of Pediatrics, University of Alberta, Edmonton, Canada; Department of Anesthesiology and Critical Care Medicine (E.S.D.), Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatric Emergency Medicine (R.M.L.), Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden; Department of Anesthesia, Critical Care, and Pain Medicine (J.C.P.), Harvard Medical School, Boston, MA; Department of Pediatric Emergency Medicine (J.F.), The Hospital for Sick Children, Toronto, Canada; and Department of Pediatrics (A.W.C.), University of Louisville and Norton Children's Hospital, Louisville, KY
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7
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Alfaheed M, Campos S, Gupta J, Fayyaz J, Litwin S. Stick a Needle in My Eye: A Case Report of Penetrating Needlefish Injury Causing Cavernous Sinus Thrombosis and Carotid Cavernous Fistula. Cureus 2023; 15:e34453. [PMID: 36874751 PMCID: PMC9981213 DOI: 10.7759/cureus.34453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
While swimming in the ocean on vacation in Cuba, a previously healthy 17-year-old female was unexpectedly stabbed through her orbit and into her brain by a needlefish. This is a unique case of a penetrating injury causing orbital cellulitis, retro-orbital abscess, cerebral venous sinus thrombosis and carotid cavernous fistula. After initial management at a local emergency department, she was transferred to a tertiary care trauma centre where she was treated by a team of emergency, neurosurgery, stroke neurology, ophthalmology, neuroradiology and infectious disease physicians. The patient faced a significant risk of a thrombotic event. There was careful consideration from the multidisciplinary team about the utility of thrombolysis or an interventional neuroradiology procedure. Ultimately, the patient was treated conservatively with intravenous antibiotics, low molecular weight heparin and observation. The patient continued to show clinical improvement several months later, which supported the challenging decision to opt for conservative management. There are very few cases to guide the treatment of this type of contaminated penetrating orbital and brain injury.
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Affiliation(s)
| | - Sarah Campos
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN
| | - Joel Gupta
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN
| | - Jabeen Fayyaz
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN.,Faculty of Medicine, University of Toronto, Toronto, CAN
| | - Sasha Litwin
- Emergency Medicine, The Hospital for Sick Children, Toronto, CAN.,Faculty of Medicine, University of Toronto, Toronto, CAN
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Buser S, Gessler N, Gmuender M, Feuz U, Jachmann A, Fayyaz J, Keitel K, Brandenberger J. Correction: The use of intercultural interpreter services at a pediatric emergency department in Switzerland. BMC Health Serv Res 2022; 22:1550. [PMID: 36536349 PMCID: PMC9764506 DOI: 10.1186/s12913-022-08964-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Sina Buser
- grid.411656.10000 0004 0479 0855Division of Pediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Noemi Gessler
- grid.411656.10000 0004 0479 0855Division of Pediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Myriam Gmuender
- grid.411656.10000 0004 0479 0855Division of Pediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Ursula Feuz
- grid.411656.10000 0004 0479 0855Division of Pediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Jachmann
- grid.411656.10000 0004 0479 0855Emergency Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jabeen Fayyaz
- grid.42327.300000 0004 0473 9646Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario Canada
| | - Kristina Keitel
- grid.411656.10000 0004 0479 0855Division of Pediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia Brandenberger
- grid.411656.10000 0004 0479 0855Division of Pediatric Emergency Medicine, Department of Paediatrics, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland ,grid.42327.300000 0004 0473 9646Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario Canada ,grid.17063.330000 0001 2157 2938Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, ON Canada
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Thomas AA, Montgomery EE, Abulebda K, Whitfill T, Chapman J, Leung J, Fayyaz J, Auerbach M. The feasibility of a pediatric distance learning curriculum for emergency department nurses during the COVID-19 pandemic: An Improving Pediatric Acute Care Through Simulation (ImPACTS) collaboration. J Emerg Nurs 2022. [PMCID: PMC9458703 DOI: 10.1016/j.jen.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction To develop and evaluate the feasibility and effectiveness of a longitudinal pediatric distance learning curriculum for general emergency nurses, facilitated by nurse educators, with central support through the Improving Acute Care Through Simulation collaborative. Methods Kern’s 6-step curriculum development framework was used with pediatric status epilepticus aimed at maintaining physical distancing, resulting in a 12-week curriculum bookended by 1-hour telesimulations, with weekly 30-minute online asynchronous distance learning. Recruited nurse educators recruited a minimum of 2 local nurses. Nurse educators facilitated the intervention, completed implementation surveys, and engaged with other educators with the Improving Pediatric Acute Care through Simulation project coordinator. Feasibility data included nurse educator project engagement and curriculum engagement by nurses with each activity. Efficacy data were collected through satisfaction surveys, pre-post knowledge surveys, and pre-post telesimulation performance checklists. Results Thirteen of 17 pediatric nurse educators recruited staff to complete both telesimulations, and 38 of 110 enrolled nurses completed pre-post knowledge surveys. Knowledge scores improved from a median of 70 of 100 (interquartile range: 66-78) to 88 (interquartile range: 79-94) (P = .018), and telesimulation performance improved from a median of 60 of 100 (interquartile range: 45-60) to 100 (interquartile range: 85-100) (P = .016). Feedback included a shortened intervention and including physician participants. Discussion A longitudinal pediatric distance learning curriculum for emergency nurses collaboratively developed and implemented by nurse educators and Improving Pediatric Acute Care through Simulation was feasible for nurse educators to implement, led to modest engagement in all activities by nurses, and resulted in improvement in nurses’ knowledge and skills. Future directions include shortening intervention time and broadening interprofessional scope.
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Chang TP, Elkin R, Boyle TP, Nishisaki A, Walsh B, Benary D, Auerbach M, Camacho C, Calhoun A, Stapleton SN, Whitfill T, Wood T, Fayyaz J, Gross IT, Thomas AA. Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation. Simul Healthc 2022. [DOI: 10.54531/drkq7209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.
We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.
Small groups (n = 121) and survey ranking (n = 54) were used with
This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of
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Affiliation(s)
- Todd P Chang
- 1Division of Emergency Medicine & Transport, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Elkin
- 2Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children’s Hospital-Columbia University Irving Medical Center/Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tehnaz P Boyle
- 3Division of Pediatric Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Akira Nishisaki
- 4Division of Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Walsh
- 5Division of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, MA, USA
| | - Doreen Benary
- 6Division of Pediatric Emergency Medicine, NYU Langone Medical Center, New York University, New York, NY, USA
| | - Marc Auerbach
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Camacho
- 8Simulation and Outreach Education, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron Calhoun
- 9Division of Critical Care, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Stephanie N Stapleton
- 10Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Travis Whitfill
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Trish Wood
- 11Starship Child Health, Auckland, New Zealand
| | - Jabeen Fayyaz
- 12Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Isabel T Gross
- 13Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anita A Thomas
- 14Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
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Chang TP, Elkin R, Boyle TP, Nishisaki A, Walsh B, Benary D, Auerbach M, Camacho C, Calhoun A, Stapleton SN, Whitfill T, Wood T, Fayyaz J, Gross IT, Thomas AA. Characterizing preferred terms for geographically distant simulations: distance, remote and telesimulation. Simul Healthc 2022; 1:55-65. [DOI: 10.54531/dwti2869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulationists lack standard terms to describe new practices accommodating pandemic restrictions. A standard language around these new simulation practices allows ease of communication among simulationists in various settings.
We explored consensus terminology for simulation accommodating geographic separation of participants, facilitators or equipment. We used an iterative process with participants of two simulation conferences, with small groups and survey ranking.
Small groups (n = 121) and survey ranking (n = 54) were used with
This research has deepened our understanding of how simulationists interpret this terminology, including the derived themes: (1) physical distance/separation, (2) overarching nature of the term and (3) implications from existing terms. We further deepen the conceptual discussion on healthcare simulation aligned with the search of the terminologies. We propose there are nuances that prevent an early consensus recommendation. A taxonomy of descriptors specifying the conduct of
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Affiliation(s)
- Todd P Chang
- 1Division of Emergency Medicine & Transport, Children’s Hospital Los Angeles/Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Rachel Elkin
- 2Division of Pediatric Emergency Medicine, New York-Presbyterian Morgan Stanley Children’s Hospital-Columbia University Irving Medical Center/Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Tehnaz P Boyle
- 3Division of Pediatric Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston University, Boston, MA, USA
| | - Akira Nishisaki
- 4Division of Pediatric Critical Care, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Barbara Walsh
- 5Division of Emergency Medicine, Boston Children’s Hospital, Harvard University, Boston, MA, USA
| | - Doreen Benary
- 6Division of Pediatric Emergency Medicine, NYU Langone Medical Center, New York University, New York, NY, USA
| | - Marc Auerbach
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Cheryl Camacho
- 8Simulation and Outreach Education, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Aaron Calhoun
- 9Division of Critical Care, Norton Children’s Hospital, University of Louisville, Louisville, KY, USA
| | - Stephanie N Stapleton
- 10Department of Emergency Medicine, Boston Medical Center/Boston University School of Medicine, Boston, MA, USA
| | - Travis Whitfill
- 7Departments of Pediatrics and Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Trish Wood
- 11Starship Child Health, Auckland, New Zealand
| | - Jabeen Fayyaz
- 12Division of Emergency Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Isabel T Gross
- 13Division of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA
| | - Anita A Thomas
- 14Department of Pediatrics, Division of Emergency Medicine, University of Washington School of Medicine, Seattle Children’s Hospital, Seattle, WA, USA
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Pirie J, Fayyaz J, Gharib M, Simone L, Glanfield C, Kempinska A. Development and implementation of a novel, mandatory competency-based medical education simulation program for pediatric emergency medicine faculty. Adv Simul (Lond) 2021; 6:17. [PMID: 33957994 PMCID: PMC8101101 DOI: 10.1186/s41077-021-00170-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background Maintaining acute care physician competence is critically important. Current maintenance of certification (MOC) programs has started to incorporate simulation-based education (SBE). However, competency expectations have not been defined. This article describes the development of a mandatory annual SBE, competency-based simulation program for technical and resuscitation skills for pediatric emergency medicine (PEM) physicians. Methods The competency-based medical education (CBME) program was introduced in 2016. Procedural skill requirements were based on a needs assessment derived from Royal College PEM training guidelines. Resuscitation scenarios were modified versions of pre-existing in-situ mock codes or critical incident cases. All full-time faculty were required to participate annually in both sessions. Delivery of educational content included a flipped classroom website, deliberate practice, and stop-pause debriefing. All stations required competency checklists and global rating scales. Results Between 2016 and 2018, 40 physicians and 48 registered nurses attended these courses. Overall course evaluations in 2018 were 4.92/5 and 4.93/5. Barriers to implementation include the need for many simulation education experts, time commitment, and clinical scheduling during course events. Conclusion We have developed a mandatory simulation-based, technical, and resuscitation CBME program for PEM faculty. This simulation-based CBME program could be adapted to other acute care disciplines. Further research is required to determine if these skills are enhanced both in a simulated and real environment and if there is an impact on patient outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s41077-021-00170-4.
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Affiliation(s)
- Jonathan Pirie
- Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada. .,PEM Simulation Program, Toronto, Canada. .,University of Toronto, Toronto, Canada.
| | - Jabeen Fayyaz
- Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,PEM Simulation Program, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Mireille Gharib
- Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,PEM Simulation Program, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Laura Simone
- Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,PEM Simulation Program, Toronto, Canada.,University of Toronto, Toronto, Canada
| | - Carrie Glanfield
- Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,PEM Simulation Program, Toronto, Canada
| | - Anna Kempinska
- Division of Emergency Medicine, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.,PEM Simulation Program, Toronto, Canada.,University of Toronto, Toronto, Canada
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Nihan K, Makda A, Salat H, Khursheed M, Fayyaz J, Khan UR. Assessment of knowledge, attitude, and practice of child abuse amongst health care professionals working in tertiary care hospitals of Karachi, Pakistan. J Family Med Prim Care 2021; 10:1364-1368. [PMID: 34041180 PMCID: PMC8140284 DOI: 10.4103/jfmpc.jfmpc_1691_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/27/2020] [Accepted: 01/05/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: UNICEF report (2004) states that a significant percentage of total child population under the age of 5 years suffered malnutrition. Child sexual abuse remains undiscussed across Pakistan. Health care professionals (HCPs) are usually the first notifiers of child abuse and are ethically obliged to manage and report it. Objective: This study was conducted to assess HCPs' response in dealing with patients of child abuse. With a better understanding, we can have a better outcome for the victims. Methods: A total of 101 participants filled out a structured questionnaire by HCPs working in three tertiary hospitals of Karachi i.e., Aga Khan University, National Institute of Child Health (NICH), and Civil Hospital. Data were entered into SPSS 19.0. Results: HCPs believed that young male relatives were thought to be most likely the offender, and that every child regardless of class is prone to get abused triggered by financial stressors and the absence of parents. Proper physical exams helped identify cases. A proper system of reporting was required in hospitals, but HCPs were reluctant to report the cases to authorities. There was a significant difference noted between public and private hospitals. Conclusion: Our findings indicate that HCPs have limited knowledge in defining various types of abuse and most were unaware of any reporting facility in hospitals. Senior HCPs as consultants have a better understanding of child abuse than nurses or interns. Mandatory reporting should be implicated so that prompt action could be taken. There could be a more successful outcome of managing a child abuse victim with proper training.
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Affiliation(s)
- Khuld Nihan
- Jinnah Sindh Medical University, Karachi, Pakistan
| | - Aamir Makda
- Jinnah Sindh Medical University, Karachi, Pakistan
| | | | | | - Jabeen Fayyaz
- Sick Children Hospital, University of Toronto, Canada
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Hamid MA, Siddiqui S, Fayyaz J, Chandna A, Ariz A, Butchey J, Ambalavanar E, Mistry N, Azad AM, Bhatti JA, Scolnik D. Paediatric-appropriate facilities in emergency departments of community hospitals in Ontario: A cross-sectional study. World J Emerg Med 2017; 8:264-268. [PMID: 29123603 DOI: 10.5847/wjem.j.1920-8642.2017.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND We assessed whether the paediatric-appropriate facilities were available at Emergency Departments (ED) in community hospitals in a Canadian province. METHODS We conducted a cross-sectional survey of EDs in community hospitals in Ontario, Canada that had inpatient paediatric facilities and a neonatal intensive care unit. Key informants were ED chiefs, clinical educators, or managers. The survey included questions about paediatric facilities related to environment, triage, training, and staff in EDs. RESULTS Of 52 hospitals, 69% (n=36) responded to our survey. Of them, 14% EDs (n=5) had some separated spaces available for paediatric patients. About 53% (n=19) of EDs lacked children activities, e.g., toys. Only 11% (n=4) EDs were using paediatric triage scales and 42% (n=15) had a designated paediatric resuscitation bay. Only half of the ED (n=18) required from their staff to update paediatric life support training. Only 31% (n=11) had a designated liaison paediatrician for the ED. Paediatric social worker was present in only 8% (n=3) of EDs in community hospitals. CONCLUSION Most of the Ontario community hospital EDs included in this survey had inadequate facilities for paediatric patients such as specific waiting and treatment areas.
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Affiliation(s)
- Muhammad Akhter Hamid
- Scarborough and Rouge Hospital, Toronto, Canada.,University of Toronto, Department of Paediatrics, Toronto, Canada
| | | | | | | | - Aliya Ariz
- Hamilton Health Sciences Centre, Hamilton, Canada
| | - Joe Butchey
- Scarborough and Rouge Hospital, Toronto, Canada
| | | | | | | | | | - Dennis Scolnik
- University of Toronto, Department of Paediatrics, Toronto, Canada
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15
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Khan NU, Khan UR, Feroze A, Khan SA, Ali N, Ejaz K, Khan AR, Nooruddin S, Fayyaz J. Trends of acute poisoning: 22 years experience from a tertiary care hospital in Karachi, Pakistan. J PAK MED ASSOC 2016; 66:1237-1242. [PMID: 27686296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the trends of acute poisoning in terms of frequency, nature of poisoning agent, clinical presentation and its outcome. METHODS The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who presented with poisoning between January 1989 and December 2010.The patients were randomly selected , and demographic, chemical information, clinical feature, treatment and outcome were analysed using SPSS 16. RESULTS Of the total hospital admissions during the period, 3,189(0.3%) were cases of poisoning. Of them, medical records of 705(22%) cases were reviewed; 462(65.5%) adult and 243(34.5%) paediatric cases below 16 years of age. The overall median age was 21 years (interquartile range: 4-32 years)Moreover, 544(87%) were critical at the time of presentation. In 647(92%) cases, the poisoning occurred at home. Psychiatric drugs were found involved in 205(29%) cases, followed by prescription drugs 172(24.4%), pesticides 108(15.3%), hydrocarbons 71(10%), analgesics 59(8.7%), household toxins 59(8.7%), alcohol and drug abuse 21(2.97%) and others 47(6.67%). CONCLUSIONS Poisoning was a serious cause of morbidity in children and young adults. Medications were the leading cause and home was the most common place of incident.
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Affiliation(s)
| | - Uzma Rahim Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi
| | - Asher Feroze
- Department of Emergency Medicine, The Aga Khan University, Karachi
| | - Sajjad Ali Khan
- Department of Emergency Medicine, The Aga Khan University, Karachi
| | - Najia Ali
- Department of Emergency Medicine, The Aga Khan University, Karachi
| | - Kiran Ejaz
- Department of Emergency Medicine, The Aga Khan University, Karachi
| | | | | | - Jabeen Fayyaz
- Department of Emergency Medicine, The Aga Khan University, Karachi
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16
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Hamid MA, Chandna A, Siddiqui S, Fayyaz J. Pulse oximetry: A reliable and cost effective screening tool in children with pneumonia for developing countries. J PAK MED ASSOC 2016; 66:1015-1018. [PMID: 27524539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The infant mortality rates are high in developing countries and, according to World Health Organisation (WHO), statistics show that the main contributors are acute respiratory infections and pneumonia. In children hypoxaemia is an ominous sign associated with respiratory tract infections. Hypoxia can be detected easily with pulse oximetry. It is a non-invasive, readily available and cost-effective way to identify hypoxaemia. If we identify hypoxaemia at the primary care level, especially in a low-income setting, we can make early referral to tertiary care settings. This will subsequently have a positive impact in saving lives. A detailed search of Medline database was conducted through PubMed from 1990 to date, to review the literature on the usefulness of pulse oximetry at primary care centres in developing countries. Such information will become vital in formulating guidelines for income-poor countries in order to stratify high-risk children with hypoxaemia.
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Affiliation(s)
| | - Ayesha Chandna
- Research Assistant, Dada Medical Professionals, Scarborough, ON, Canada
| | - Sohaib Siddiqui
- Pediatric Research, Rouge Valley Health System, Centenary Hospital, University of Toronto, Canada
| | - Jabeen Fayyaz
- Emergency Department, Aga Khan University, Karachi, Pakistan
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Atiq H, Siddiqui E, Bano S, Feroze A, Kazi G, Fayyaz J, Gupta S, Razzak JA, Hyder AA, Mian AI. The pediatric disease spectrum in emergency departments across Pakistan: data from a pilot surveillance system. BMC Emerg Med 2015; 15 Suppl 2:S11. [PMID: 26691052 PMCID: PMC4682388 DOI: 10.1186/1471-227x-15-s2-s11] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system. METHODS Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of over one million ED encounters. RESULTS Of 25,052 children registered in Pak-NEDS (10% of all patients seen): 61% were male, 13% under 5 years, while almost 65% were between 10 to < 16 years. The majority (90%) were seen in public hospital EDs. About half the patients were discharged from the EDs, 9% admitted to hospitals and only 1.3% died in the EDs. Injury (39%) was the most common presenting complaint, followed by fever/malaise (19%) and gastrointestinal symptoms (18%). Injury was more likely in males vs. females (43% vs. 33%; p < 0.001), with a peak presentation in the 5-12 year age group (45%). CONCLUSIONS Pediatric patients constitute a smaller proportion among general ED users in Pakistan. Injury is the most common presenting complaint for children seen in the ED. These data will help in resource allocation for cost effective pediatric ED service delivery systems. Prospective longer duration surveillance is needed in more representative pediatric EDs across Pakistan.
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Khursheed M, Fayyaz J, Jamil A. SETTING UP TRIAGE SERVICES IN THE EMERGENCY DEPARTMENT: EXPERIENCE FROM A TERTIARY CARE INSTITUTE OF PAKISTAN. A JOURNEY TOWARD EXCELLENCE. J Ayub Med Coll Abbottabad 2015; 27:737-740. [PMID: 26721057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing the ED overcrowding. The history of triage at AKUH-ED dated back in 2000. In the beginning physicians and nurse both were assigned to triage desk where they use to sort out the patient according to presenting complaints. At that time the documentation was manual with locally developed triage priorities. With the expansion of ED in 2008, responsibility of triage was shifted to nursing services. Triage policy was established and implemented. Specific triage protocols were developed for guidance and uniformity of care. Manual recording system was replaced by computerized triage data entry software. Enabling the department to monitor patient quality care indicators like total number of patients triaged, triage category, lag time reports and left without being seen by physicians.
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Khursheed M, Fayyaz J, Feroze A, Shakeel N, Bhatti JA. Time to treatment in patients of suspected acute coronary syndrome in Pakistan: a clinical audit. Heart Lung 2014; 44:63-7. [PMID: 25281530 DOI: 10.1016/j.hrtlng.2014.08.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 08/24/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Evaluate time to treatment (TT) in suspected acute coronary syndrome (ACS) patients in the Emergency Department (ED) in Pakistan. METHODS In this clinical audit, medical records of adult patients with suspicion of ACS visiting the ED of a tertiary care facility in Karachi from January to March of 2012 were reviewed and evaluated according to benchmarks from American College of Cardiology/American Heart Association guidelines. RESULTS Study included 230 patients, of which 62.6% were males (n = 144). Physicians saw most patients (74.1%) in ≤10 min (min) of ED triage. ECG was performed in ≤10 min in 93 (47.7%) patients. Of the 207 patients being prescribed Aspirin, 41.9% received it in ≤10 min. Of 155 patients who were prescribed anti-coagulants (e.g., heparin), 32.9% received them in 10 min. Half of the patients requiring primary coronary intervention underwent the procedure within 90 min. CONCLUSION Findings warrant exploring interventions to improve TT for ACS care in resource-limited settings.
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Affiliation(s)
- Munawar Khursheed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Jabeen Fayyaz
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Asher Feroze
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Nishi Shakeel
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Junaid A Bhatti
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan; Sunnybrook Health Sciences Centre Research Institute, Toronto, Canada
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Fayyaz J, Rehman A, Hamid A, Khursheed M, Zia N, Feroze A, Khan UR. CT scan in children with acute bacterial meningitis: experience from emergency department of a tertiary-care hospital in Karachi, Pakistan. J PAK MED ASSOC 2014; 64:419-422. [PMID: 24864636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the role of computed tomography scan in children presenting to emergency department with symptoms and signs of suspected acute bacterial meningitis. METHODS The retrospective analysis was done on children who were admitted through the Emergency Department at Aga Khan University Hospital, Karachi, from September 2009 to September 2011 with the diagnosis of acute bacterial meningitis. Information related to age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients was gathered from the medical records. SPSS 19 was used for statistical analysis. RESULTS A total of 192 patients were admitted with the relevant diagnosis. The male-female ratio was 2.3:1. Computed tomography scan was done in 114 (59.4%) patients. The scan was reported normal in 90 (78.94%) patients. However, cerebral oedema was found in 16 (14.03%) patients, cerebral infarct in 6(5.26%) and hydrocephalus in 2 (1.75%) patients. Overall, there were 6 (3.1%) deaths. CONCLUSION Comuted tomography scan may have a beneficial role in children with acute bacterial meningitis. However, further studies are required to use the scan as a routine investigation for such a diagnosis.
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Fayyaz J, Rehman A, Hamid A, Khursheed M, Zia N, Feroze A. Age related clinical manifestation of acute bacterial meningitis in children presenting to emergency department of a tertiary care hospital. J PAK MED ASSOC 2014; 64:296-299. [PMID: 24864603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To determine the signs and symptoms of acute bacterial meningitis (ABM) in different age grops of a paediatric population. METHODS The retrospective study comprised patients who had been admitted through the Emergency Department of Aga Khan University Hospital, Karachi with the relevant diagnosis from September 2009 to September 2011. Case record forms were used to collect data from patient files. Data was collected using variables such as age, gender, presenting complaints, clinical signs and symptoms, computed tomography scan findings and final outcome of patients. There was a minimal risk of breach in patient confidentiality. SPSS 19 was used for data analysis. RESULTS A total of 192 patietns were enrolled. The presenting complaint in 165 (86%) patients was fever; vomiting in 93 (48.43%); and 49 (52.68%) of them were more than 5 years old. Irritability was present in 54 (28.12%) children, of whom 27 (50%) were less than one year. Fits were present in 47 (24.47%) cases out of which 21 (44.68%) were less than one year. Neck stiffness and signs of meningeal irritation, Kerning's sign and Brudzincski's sign, were present in 53 (27.60%) patients; 26 (13.54%); and 18 (9.3%) respectively. These signs were more common in children over 5 years of age, reflected by 29 (54.7%), 16 (61.5%) and 11 (61.11%) patients respectively. On presentation, headache was found in 77 (40.10%) children among whom 56 (72.72%) were over 5 years. Besides, 151 (78.6%) patients required admission to the ward, while 40 (20.8%) were admitted in High Dependancy Unit/critical care units Adverse outcome was observed in 6 (3.12%) patients. CONCLUSION Younger children with acute bacterial meningitis presented with non-specific signs and symptoms. Headache and signs of meningeal irritation were common findings in children over 5 years.
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Khan NU, Fayyaz J, Khan UR, Feroze A. Importance of clinical toxicology teaching and its impact in improving knowledge: sharing experience from a workshop. J PAK MED ASSOC 2013; 63:1379-1382. [PMID: 24392523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To assess the impact of a one-day clinical toxicology workshop in improving knowledge. METHODS A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data. RESULT There were 22 participants in the course. The pre-test mean score was 31.6 +/- 15.1% (95% CI; 24-40; n = 19) compared to the post-test the mean score of 56.0 +/- 10.8% (95% CI; 47- 61; n = 17). The positive difference was also statistically significant (p < 0.001). The overall workshop was evaluated as excellent by 08 (47.46%) and very good by 10 (52.63%) participants. CONCLUSION Short training in clinical toxicology improved knowledge of the participants.
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Affiliation(s)
- Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi
| | - Jabeen Fayyaz
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi
| | - Asher Feroze
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi
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Fayyaz J, Khursheed M, Umer Mir M, Khan U. Pattern of emergency department visits by elderly patients: study from a tertiary care hospital, Karachi. BMC Geriatr 2013; 13:83. [PMID: 23937518 PMCID: PMC3751048 DOI: 10.1186/1471-2318-13-83] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/31/2013] [Indexed: 11/25/2022] Open
Abstract
Background Worldwide the proportion of elderly people in the population is increasing. Currently in Pakistan 7.3 million people (5.6% of total population) are more than 60 years old. This age shift has emerged as an important health issue and is associated with an increased utilization of emergency services by the elderly. We carried out this study to assess the pattern of elderly patients (>60 years) who visit emergency departments in comparison to young adults (18–60 years). Methods Data was collected retrospectively of patients aged 18 years or more who visited the Emergency Department (ED) of Aga Khan University Hospital, Karachi (AKUH) during September, 2009 to September, 2011. The data collection sheet included patient’s demographic information, triage category, reason for visit, clinical presentation, ED length of stay, day and time of presentation and their disposition. Data was entered and analyzed using SPSS version 19.0. Descriptive statistics were used to describe patient’s demographics. Chi-square (χ2) test was used as a test of significance to compare differences between groups for categorical data and t-test for continuous data. Multiple logistic regression analysis was done to find out the association between the patient characteristics and outcomes (admission and expiry). Results Almost 24% (n = 13014) of all adults (n = 54588) presenting to the ED were over the age of 60 years. More than 57% of elderly patients belonged to the high priority triage category compared to 35% in younger patients. Most of the elderly patients ( 27%) presented with nonspecific complaints followed by shortness of breath (13%) and fever (9%). The median length of stay (LOS) in the ED for elderly was 379 minutes (252 min in under-60 yrs patients) and they were more likely to get admitted to in-patient departments compared to younger patients (OR 1.7 95% CI 1.6-1.8). A high proportion of those admitted (20%) required intensive or special care. Mortality in elderly patients was 2.3% as compared to 0.7% in young adults. This was accompanied by a higher mortality risk in the elderly with an odds ratio of 2.3 (CI 2–2.5). Conclusion Elderly ED users differ significantly from younger adults in terms of criticality on presentation, ED LOS and final disposition.
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Affiliation(s)
- Jabeen Fayyaz
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan.
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Khursheed M, Khan UR, Ejaz K, Fayyaz J, Qamar I, Razzak JA. A comparison of WHO guidelines issued in 1997 and 2009 for dengue fever - single centre experience. J PAK MED ASSOC 2013; 63:670-674. [PMID: 23901662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To compare the original (1997) and revised (2009) versions of World Health Organization guidelines for dengue patients METHODS Adult patients with a positive dengue Immunoglobulin M serology, and a diagnosis of dengue were included in the study at Aga Khan University Hospital during a three-year period from January 2005 to December 2007. Data related to these dengue patients was collected from their medical records. Guidelines were then applied by the research assistant and correlation among these guidelines was computed. SPSS 19 was used for statistical analysis. RESULTS A total of 612 patients were found with a diagnosis of dengue, but only 439 (71.73%) had a positive IgM. The median age of these 439 patients was 28 (interquartile range: 18) years and majority of them were males, 295 (67%). According to the 1997 guidelines, 383 (87%) patients were classified as having dengue, while according to the 2009 guidelines, all the 439 (100%) patients were classified with a dengue infection. Under WHO 1997, 21 (5.5%) cases were classified as dengue shock syndrome, while 2009 guidelines labelled 88 (20%) cases as severe dengue. There was a consensus on only 11 severe cases by both the guidelines, showing different results between the two. CONCLUSION By using 2009 guidelines, a physician would classify more dengue patients as having severe disease.
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Affiliation(s)
- Munawar Khursheed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
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Fayyaz J, Khursheed M, Mir MU, Mehmood A. Missing the boat: odds for the patients who leave ED without being seen. BMC Emerg Med 2013; 13:1. [PMID: 23324162 PMCID: PMC3571890 DOI: 10.1186/1471-227x-13-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Accepted: 09/23/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A patient left without being seen is a well-recognized indicator of Emergency Department overcrowding. The aim of this study was to define the characteristics of LWBS patients, their rates and associated factors from a tertiary care hospital of Pakistan. METHODS A retrospective patient record review was undertaken. All patients presenting to the Aga Khan University Hospital, Karachi, between April and December of the year 2010, were included in the study. Information was collected on age, sex, presenting complaints, ED capacity, month, time, shift, day of the week, and waiting times in the ED. A basic descriptive analysis was made and the rates of LWBS patients were determined among the patient subgroups. Logistic regression analysis was used to assess the risk factors associated with a patient not being seen in the ED. RESULTS A total of 38,762 patients visited ED during the study period. Among them 5,086 (13%) patients left without being seen. Percentage of leaving was highest in the night shift (20%). The percentage was twice as high when the ED was on diversion (19.8%) compared to regular periods of operation (9.8%). Mean waiting time before leaving the ED in pediatric patients was 154 minutes while for adults it was 171 minutes. More than 32% of patients had waited for more than 180 minutes before they left without being seen, compared to the patients who were seen in ED. Important predictors for LWBS included; Triage category P4 i.e. walk -in-patients had an OR of 13.62(8.72-21.3), Diversion status, OR 1.49(1.26-1.76), night shift , OR 2.44(1.95-3.05) and Pediatric age, OR 0.57(0.48-0.66). CONCLUSIONS Our study elucidates the LWBS population characteristics and identifies the risk factors for this phenomenon. Targeted interventions should be planned and implemented to decrease the waiting time and alternate services should be provided for high-risk patients (for LWBS) to minimize their number.
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Affiliation(s)
- Jabeen Fayyaz
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Munawar Khursheed
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammed Umer Mir
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Amber Mehmood
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Arif F, Fayyaz J, Hamid A. Awareness among parents of children with thalassemia major. J PAK MED ASSOC 2008; 58:621-624. [PMID: 19024134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the awareness among parents of children with thalassaemia major (TM) regarding the disease. METHODS This (cross sectional) study was conducted at Paediatric OPD of Civil Hospital Karachi from May 2007 to October 2007. Parents of thalassaemic children presenting to out patient department, receiving blood transfusion from Patient Welfare Association (PWA) were interviewed using a pre designed questionnaire. Informed verbal consent was taken from the parents. Questions regarding duration of illness, awareness regarding screening of blood, mode of transmission of disease, prevention and treatment were asked. RESULTS A total of 120 care takers were questioned. Majority was of low socioeconomic class and 66.7% were illiterate. Although nearly 100% of the patients were receiving blood transfusions either from PWA or Hussaini blood bank or both, only 15.8% knew the importance of blood screening. Knowledge regarding desferrol was present in 55% of the patient's parents but only 10.9% were receiving it adequately. Only 15% knew that thalassaemia is an inherited disorder and family screening of the siblings and antenatal diagnosis in subsequent pregnancies was done in 5.8% and 5% respectively. CONCLUSION Awareness of parents regarding the disease was inadequate. General public and parents of thalassemic children should be sensitized in this regard.
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Affiliation(s)
- Fehmina Arif
- Paediatric Unit 1, Dow University of Health Sciences, Civil Hospital, Karachi, Pakistan
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Fayyaz J. Ponderal index. J PAK MED ASSOC 2005; 55:228-9. [PMID: 16045088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
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