Factors Predicting Successful Suicide Among Adolescents:Multiple Attempts And Index Methods, A Retrospective Cohort Study

Background: While suicide among adolescents has emerged as a significant social problem, few studies have examined the relationship between changes in suicide methods and suicide success following multiple attempts. This study aimed to investigate the relationship between changing suicide methods and successful suicide among adolescents after repeated attempts.Methods: This retrospective study analyzed the psychiatric history of patients (n=227) between 10 and 18 years of age who visited a pediatric emergency center between January 2007 and February 2021 for suicide attempts. Results: Out of a total of 227 patients, 80 achieved successful suicide attempts, including emergency hospitalization or death. A significant association was observed between successful suicide in patients with multiple attempts who chose drug intoxication (DI) as the index method (p=0.010) and patients with multiple attempts who chose DI as a suicide method (p=0.001). No statistically significant outcomes for changing methods and number of suicide attempts were evident.Conclusions: This study emphasizes the importance of identifying index methods as well as suicide methods among adolescent patients with multiple suicide attempts. This study identified predictors affecting the successful suicide of adolescents. Identifying the index method and the changed method among adolescent patients with multiple suicide attempts are significant predictors of successful suicide. Identifying the index method and changed method of suicide is expected to help in interviewing adolescents with multiple suicide attempts.

Effect of Professional Ethics Workshop on the Moral Intelligence of Prehospital Emergency Personnel in East Azerbaijan, Iran

Background: Moral intelligence is one of the several types of human intelligence. It is the ability to understand right from wrong and behave based on the value which is believed to be right. Objectives: This study was conducted to evaluate the effect of a professional ethics workshop on the moral intelligence of prehospital emergency technicians in East Azerbaijan Province, Iran, and consequently the improvement of their performance and increase in their work efficiency. Methods: In this before- and after-interventional study conducted in Tabriz University Prehospital Emergency Center, Iran, in 2020, a total of 234 participants were evaluated. The sample was collected using the Lennick and Kiel’s Moral Intelligence Questionnaire and full census method. Before the workshop, the questionnaire was completed by the participants. After the workshop, the same questionnaire was completed again. Results: The pretest and posttest scores for moral intelligence were 83.02 ± 7.33 and 83.49 ± 8.40, respectively, which showed a statistically significant difference (P < 0.05). In the three components of moral intelligence, namely consistent behaviors based on principles, values, and beliefs, persistence for the right, and responsibility for personal decisions, there were statistically significant differences (P < 0.05) before and after the workshop. Conclusions: According to the results, holding a professional ethics workshop was effective in increasing the overall level of moral intelligence, particularly in the three aforementioned components of moral intelligence. It is recommended to continue holding such workshops and improve the conditions and methods of training to increase their efficiency as much as possible.

Fasting Has Limited Impacts on the Result of Penicillin Allergy Skin Test: An Observation Study

Objective Penicillin allergy skin test is a common procedure in nursing care. Many patients can only do an allergy skin test on fasting due to the disease condition. However, whether or not the fasting state has any effects on the skin testing results remains unclear. Therefore, this study aimed to determine the effects of fasting on the results of penicillin allergy skin tests. Methods This observational cohort study analyzed the clinical data of 200 patients undergoing a penicillin skin test in the emergency center of The Seventh Affiliated Hospital of Sun Yat-sen University from August 1, 2020, to December 31, 2020, of which 100 cases were fasting patients and 100 were non-fasting patients. The information including gender, age, allergy, skin test results, dizziness, and gastrointestinal symptoms were collected and compared. Result Among the 200 patients, five patients (2.5%) tested positive for the penicillin-allergy skin tests. Three patients (3%) tested positive in the fasting group, while two patients (2%) in the non-fasting group tested positive (Relative Risk: 1.5; 95% Confidence Interval: 0.3055 to 7.397; P=0.65). Conclusion These data suggest that fasting may have limited impacts on the results of penicillin allergy skin tests.

Improving the safety of outpatient parenteral antimicrobial therapy for patients with solid tumors

Background and objectives Outpatient parenteral antimicrobial therapy (OPAT) for infections has been in use for nearly 40 years, and although it has been found safe and efficacious, its use has been studied primarily among otherwise healthy patients. We aimed to develop and evaluate an OPAT program for patients with cancer, particularly solid tumors. Methods We implemented multiple quality improvement interventions between June 2018 and January 2020. We retrospectively and prospectively collected data on demographics, the completeness of infectious diseases (ID) physician consultation notes, rates of laboratory test result monitoring, ID clinic follow-up, and 30-day outcomes, including unplanned OPAT-related readmissions, OPAT-related emergency center visits, and deaths. Results Completeness of ID provider notes improved from a baseline of 77 to 100% (p < .0001) for antimicrobial recommendations, 75 to 97% (p < .0001) for follow-up recommendations, and 19 to 98% (p < .0001) for laboratory test result monitoring recommendations. Completion of laboratory tests increased from a baseline rate of 24 to 56% (p = .027). Thirty-day unplanned OPAT-related readmission, ID clinic follow-up, 30-day emergency center visit, and death rates improved without reaching statistical significance. Conclusions Sustained efforts, multiple interventions, and multidisciplinary engagement can improve laboratory test result monitoring among solid tumor patients discharged with OPAT. Although demonstrating a decrease in unplanned readmissions through institution of a formal OPAT program among patients with solid malignancies may be more difficult compared with the general population, the program may still result in improved safety.

Drinking and Night-Time Driving May Increase the Risk of Severe Health Outcomes: A 5-Year Retrospective Study of Traffic Injuries among International Travelers at a University Hospital Emergency Center in Thailand

Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers’ demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41–4.55) and night-time driving (AOR 2.54, 95% CI 1.36–4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17–0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers’ safety practices and proper preparation for road accidents should be explored further.

Research on the Setting of Australian Mountain Fire Emergency Center Based on K-Means Algorithm

The Australian wildfires in 2019–2020 have brought suffering to the Australian people. It is essential to use models to help the Victorian government monitor and predict the occurrence and development of fires to the greatest extent possible under the principles of safety and economy to facilitate rapid response. Through the idea of K -means algorithm and greedy algorithm, we, respectively, analyzed cities and rural areas at different altitudes and combined the altitude with the obtained clusters; the analysis from the established model shows that, for cities, cluster areas with smaller clusters with an altitude of less than 1600 meters and areas with smaller clusters with an altitude of greater than or equal to 1800 meters are covered by an EOC; for areas with larger clusters less than or equal to 600 meters above the sea level and areas with larger clusters greater than or equal to 1000 meters above the sea level, we use two EOCs for coverage; for rural areas, all areas with smaller clusters are covered by one EOC, while for areas with larger clusters where the altitude is less than or equal to 1000 meters and the altitude is greater than or equal to 1600 meters, we use two EOCs for coverage; also, obtained through greedy algorithm analysis, one EOC corresponds to 14 SSA UAVs and 8 repeater UAVs, and two EOCs correspond to 12 repeater UAVs and 26 SSA UAVs. We have a reason to believe that, through our mathematical model and the leaps in drone technology, it will have a long-term and profound impact on Australia’s wildfire control.

Effective response to a regional outbreak of COVID-19 – Experience of a tertiary emergency center

Objective: This study evaluates the usefulness, safety, and outcomes of operating a pretriage screening clinic and an expanded preemptive quarantine area in the ED during a regional COVID-19 outbreak. Methods: A descriptive cross-sectional, retrospective study conducted in a single institution. General patient demographic data, initial vital sign, symptoms, and patient outcome was collected from January to March of 2020. Data were compared according to the implementation of a new protocol involving pretriage screening and risk stratification. Outcome was also analyzed according to quarantine areas, including conventional, negative pressured, cohort, or preemptive quarantine area. Results: The pretriage clinic lowered the volume of low severity patients entering emergency department. Preemptive and cohort quarantine area provided more care to febrile patients compared to conventional quarantine area with longer length of hospital stay and lower mortality. After implementing the new protocol, emergency department in the study hospital was not closed again. Conclusions: In a regional outbreak of an epidemic, pretriage clinic safely screened infectious patients from entering ED. Expanded preemptive quarantine area increased surge capacity on quarantine area. An infectious disease protocol implementing two treatment area may contribute to preserve and maintain ED function.

Populatiemanagement binnen de Dringende hulpverlening: transport van patiënten met een Covid-19-infectie

The role of population management for the Emergency Assistance: transport of patients with a Covid-19 infection In Belgium, it is obvious for citizens that an ambulance service provides immediate assistance after calling the 112 emergency center. The National Council for Emergency Assistance (NRDGH), which is composed of various stakeholders involved, has drawn up a Service Level Agreement (SLA) for this purpose. The SLA states that in 90% of cases, a care recipient or someone in his or her environment who requests urgent assistance via a 112 call should receive that help within 15 minutes after the call. To guarantee this, there is a whole set of legislation and health professionals who maintain the system and pursue it in the pre-hospital phase. The entire healthcare system was put under a lot of pressure in 2020 due to the rapid spread of the SARS-CoV-2 virus. On the one hand, the demand for care increased and on the other hand, the pressure on the available capacity escalated. That was also the case for the Emergency Assistance. The number of calls in the emergency centers increased enormously. The health inspectorate feared a shortage of resources. At that time, it was important for the Emergency Assistance Service to organize itself so that the principle of immediate access to Emergency Assistance after a 112 call could be guaranteed. This was done through the triage of incoming calls and the allocation of 'dedicated ambulances', which were specifically used for the transport of patients with a Covid-19 infection.