Journal of the Asian Medical Students Association
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The Role of SBAR Communication Tools Implementation for Clinical Handover Among Medical Personnel in Emergency Department: A Systematic Review and Meta-analysis of Hospital Setting Studies
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Patient handover in Emergency Department (ED) plays important role in the impact of patient safety. To overcome this, the SBAR instrument, a communication checklist, is required to relay information in critical circumstances.Significance
This study aimed at summarizing and evaluating the outcome of SBAR tools implementation on patient handover in the ED.
Methods
This meta-analysis was reported based on criteria from Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Different electronic sources were used for the literature search. Mean Difference (MD) and Standard Deviation (SD) with 95% of the confidence interval (CI) were used to evaluate the association between SBAR tool implementation and the increase of total handover quality score. Results Twenty studies were included in the qualitative synthesis and six studies were admitted into quantitative meta-analysis. The current study showed that the implementation of SBAR communication tool for clinical handover was very beneficial (Pooled MD=1.79, 95% CI (1.59-2.00), p<0.00001, I2=57%). It could also reduce the duration of clinical handover (Pooled MD=1.74,95% CI (-2.27, -0.67), p=0.0003, I2=92%). Conclusion: This study provides valuable evidence suggesting the implementation of SBAR communication tool as a potential strategy for increasing the total handover quality
Knowledge, attitude and practice regarding basic life support among employees of tertiary care hospital of central India
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Introduction: Cardiovascular diseases cause more deaths than any other mode, including cancers. The most important out of these is the cardiac arrest, which is defined as the sudden cessation of pumping of heart secondary to arrhythmia. Most of the events are OHCA(Out of Hospital Cardiac Arrest). It becomes necessary for the bystanders to perform a cardiopulmonary resuscitation (CPR) until ambulance or an advanced help arrives.
Objective:
1)To determine effectiveness of Basic Life Support training to general population.
2)To assess the efficacy of the BLS training for general population, if any
Methodology: Study type: Cross sectional type of observational study. Study sample: 906. We conducted a questionnaire based study among the employees of a tertiary care hospital of central India. The questionnaire was distributed before and after a session of basic life support, and their scores were compared.
Results: Out of the total of 906 responses to questionnaire, 8040(88.4%) average was the post test score and 1309 (14.48%) was pretest score. The absolute gain was 0.96. It was concluded that the basic life support training is effective for learning to provide a high quality CPR and basic life support
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Conclusion:
It can be clearly seen that the hands on training of BLS was a useful method to spread awareness, knowledge and to learn about emegency cardiac conditions.
The BLS training was able to inculcate the readiness and quick decision making abilities in the population.
 
Repetitive Trans-Cranial Magnetic Stimulation (rTMS) for Cognitive Enhancement in Traumatic Brain Injury (TBI) patients: A Systematic Review and Meta-analysis.
Get PDFIntroduction: Earlier, Cognitive Rehabilitation Therapy (CRT) focussed on restorative or compensatory approach. It is only recently that repetitive Transcranial Magnetic Stimulation (rTMS) approach of CRT has been shown to stimulate cognitive networks to produce long lasting cognitive enhancement in Traumatic Brain Injury (TBI) patients.
Objective: To determine the effectiveness of low frequency rTMS for cognitive enhancement in TBI patients.
Method: PubMed (n=2), Trip Medical Database (n=6), ClinicalTrials.Gov (n=8) were searched for ‘rTMS’, ‘TBI’ & ‘cognition’. Studies identified from inception were imported to EndNote X9 Library and duplicates removed post which RCTs conducted with TBI patients (>=18 year) having undergone rTMS for Cognitive Enhancement compared against Sham controlled placebo groups were screened using Title and Abstract (n=9) and full text (n=9). Trail Making (TMT) Test Part-B & Montreal Cognitive Assessment (MoCA) Data could be extracted from 6 studies, and their meta-analysis was done in Review Manager 5.4.
Result: Due to considerable heterogeneity (Chi2 = 257.44, p<0.000001, I2 = 82%), inverse variance random effect meta-analysis was done. Cognitive enhancement scores of 154 patients from 6 studies revealed a pooled Standardized Mean Difference of 0.07 [95% CI, -0.81, 0.94]. Test for overall effect Z = 0.15 (P = 0.88) indicates that there is no significant difference in cognitive outcomes between Sham controlled and rTMS patients. Overall cognitive enhancement reached statistical significance (Z = 20.53 (P < 0.00001)) in sham control favouring sub-group (fixed effect meta-analysis (I2 = 0%)) as well as in rTMS favouring sub-group (Z = 2.79 (P = 0.005)) (random effect meta-analysis (I2 = 71%))
Conclusion: The pooled evidence suggests that both interventions significantly improved cognitive outcomes among TBI patients and rTMS does not have any significant benefit over Sham controlled groups for cognitive enhancement. The meta analysis from our study shall guide treatment and future researchers
Depression in Patients With Traumatic Amputation of the Upper and Lower Limb
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Introduction
The process of amputation is defined as the surgical removal of part of the body, such as an arm or leg. Traumatic amputations may be done when a limb cannot be salvaged after an accident or injury. Rehabilitation succeeding the operation is a crucial part of the entire recovery process, but assessing the patients’ mental health, such as anxiety and depression, is also extremely important. In traumatic amputations, patients grieve for a huge and sudden loss. Such a degree of abrupt disturbance may pose the patient at a higher risk of depression. Results from studies using the Hospital Anxiety and Depression Scale (HADS) were included.
Objective
To determine and compare the prevalence of depression between patients with upper and lower traumatic limb amputations.
Method
A literature search of electronic databases including PubMed, Medline, Embase, Cochrane Library and CINAHL was performed. Searches were included from January 2000 using the terms ‘amputation’, ‘depression’ and ‘HADS’.
Results
Data from 889 participants was used and the mean age for all participants was 49.4 years. It was shown that HADS depression and anxiety scores are higher in traumatic upper limb amputations than in lower limb amputations. In upper limb amputations, the mean depression and anxiety scores were 5.30 ± 1.24 and 7.46 ± 1.30, respectively. In lower limb amputations, the mean depression and anxiety scores were 4.50 ± 0.28 and 5.73 ± 0.93, respectively.
Conclusion
Data shows slightly higher HADS depression and anxiety scores in traumatic upper limb amputations compared to lower limb amputations. However, factors such as the ratio of males to females in the study, socio-economic background of the participants, etc., should be taken into consideration as well. Nevertheless, psychological support is a crucial part of rehabilitation for post-traumatic amputees
Media Reporting of Suicides and its Impact on the General Population: A Scoping Review
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Suicide is one of the leading causes of death among individuals worldwide. Numerous factors contribute to suicide ideation and recent studies are suggesting that the media’s presentation of suicide seems to contribute considerably to suicide ideation and attempt among their audience.
Significance
This current study aims to evaluate the extent of the literature on media reporting in the context of suicide ideation. It attempts to answer the questions, what potential factors and phenomena in media reporting are relevant to suicide ideation, what are the current solutions to improve media reporting, and what are the implications of the factors and solutions on media reporting regarding suicide ideation and attempt?
Methods
PubMed, Google Scholar, CMAJ, PNAS, Research Gate, Science Direct, and Sage Pub were used to retrieve journals of interest; 516 relevant journals were then collected. After which, the PRISMA Extension for Scoping Reviews was employed to screen for eligibility that resulted to the final 61 journals that were included in the present study.
Results
Enough evidence supports that media reporting methods are a crucial contributor to the prevention of suicide ideation and attempt. Thereby, the application of positive changes in these methods warrants suicide prevention instead of mediation.
Conclusion
Our study strongly suggests that emphasis is needed on guideline adherence, construction, improvement, and implementation of media reporting methods. These methods must be proactively addressed and established with a holistic approach and constant collaboration among mental health experts and media professionals
The Impact of Technology-Based Interventions on Informal Caregivers of Persons with Dementia: A Systematic Review
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Poised to revolutionize healthcare, ‘telemedicine’ is the new buzzword disrupting the global healthcare industry. Increasingly, telehealth services are being integrated into our everyday care. Yet, there is a lack of consensus regarding the efficacy of telehealth interventions in improving the wellbeing of caregivers of patients with dementia (PwD).
Significance
To systematically review current literature on the efficacy of telehealth interventions in improving caregiver well-being and to explore possible interventions that would improve its efficacy.
Methods
The review was conducted in accordance with the PRISMA guidelines. All studies that reported on the outcomes of telemedicine interventions targeted at the informal caregivers of PwD were included.
Results
A total of 4176 participants across 32 RCTs were included in our analysis, with 2243 participants in the intervention arm. Overall, a statistically significant improvement in caregiver self-efficacy and caregiver gain was observed together with a significant reduction in anxiety. Telemedicine was also noted to have modest but non-significant effects on improving caregiver stress, QoL and social support. No consensus was reached with respect to caregiver burden and depression. Additionally, telehealth interventions were not found to have an effect on emotional well-being and psychosocial distress.
Conclusion
Telehealth is not a panacea for the concerns of caregivers. A non-specific, ‘one-size-fits-all’ approach is neither sustainable nor effective in improving caregiver well-being. Given how the efficacy of telehealth interventions as well as the recommended approach remains unclear, further large-scale longitudinal studies involving novel telehealth interventions are recommended to delineate the most effective intervention, or combination of interventions that promotes caregiver well-being
CSF BIOMARKERS TO PREDICT INJURY SEVERITY AND NEUROLOGICAL RECOVERY IN TRAUMATIC SPINAL CORD INJURY: A SYSTEMATIC REVIEW
Get PDFIntroduction: Spinal cord injury (SCI) is a catastrophic condition that can reduce the quality of life of a patient. Every SCI patient has their own severity which can be assessed by a standardized method. The examination requires acute SCI patients to be conscious and cooperative. However, many such patients cannot be examined reliably upon arrival in the emergency room because of concomitant injuries or pharmacological sedation. Recent biomolecular studies of cerebrospinal fluid (CSF) components have led us to the findings of substances that are seen as a potential indicator of patients’ prognosis.Objective: This systematic review aims to study the usage of CSF biomarkers as a potential tool in predicting injury severity and future neurological recovery of SCI patients.
Methods: To identify the relevant studies, the authors used five databases: PubMed, Scopus, Science Direct, PLOS ONE, and Proquest. The database search identified 438 articles from the five sources mentioned and other sources; 24 articles matched the title and abstract, yet only 7 articles met the inclusion criteria to be further reviewed. Included articles were assessed with CEBM Level of Evidence.
Results: Seven studies were reviewed with a total sample of 280 patients. Studies showed an overall increase of CSF inflammatory protein concentrations in the acute phase of injury with various concentrations in each AIS or Frankle grade. We found that biomarkers’ concentrations were negatively correlated with improvement in AIS grade. The high concentrations of biomarkers are known to be associated with more severe injury and lesser chance of neurological recovery.
Conclusion: CSF biomarkers can be a useful tool to classify patients’ severity and predict neurological recovery. This leads to a more comprehensive approach in the evaluation and treatment of spinal cord injury cases
Tackling Workplace Violence and Improving Wellbeing of Healthcare Professionals in the Emergency Department: A Rapid Review of intervention strategies and policies
Get PDFBackground: Workplace violence in the emergency department has detrimental effects on healthcare professional work satisfaction, social, and emotional health. With persisting high prevalence in many countries, this study aims to review and propose key intervention strategies and policies.
Methods: PubMed, Embase, and Scopus were searched from inception to April 2021 for studies on intervention strategies for tackling workplace violence or improving wellbeing of the healthcare professionals in the emergency department. Titles, abstracts, and main texts of the citations that met the eligibility criteria were determined by two independent reviewers. The extracted data were analyzed through thematic synthesis, and possible intervention strategies and policies were defined and recommended.
Results: A total of 27 papers were included in the study, including 50 intervention strategies. Based on joint ILO and WHO guidelines, Geneva 2002, 50 intervention strategies were categorized into 5 areas: 17 individual focused, 6 post-incident, 15 pre-incident, 6 organizational, and 6 environmental strategies. For pre-incident intervention, policy and risk assessment are commonly suggested (22%), while staff distribution (11%) is the most common organizational intervention. Additionally, environmental intervention focuses on ED design (22%), and violence incident management training along with self-care approaches (19%) are the most prevalent individual-focused intervention. Lastly, user-friendly reporting systems (15%) is the highlighted post-incident intervention.
Conclusions: Intervention strategies for tackling violence and improving mental and physical wellbeing of healthcare professionals have been consistently developed worldwide. However, hospitals face challenges in implementation since governments and employers still overlook the issue of occupational violence, making it impossible for guidelines specific to the cultural context of a hospital to be developed. The initiatives in pre-incident strategies including all-level personnel education, effective risk assessment tools, and environmental redesign are recommended, while staff follow-up systems and department protocol developments are suggested as post-incident strategies.
Keywords: Workplace violence, Wellbeing, Emergency Department, Policy Developmen
Comparison of Colorectal cancer prognosis between developed and developing countries: A literature review.: Colorectal cancer prognosis
No full textBackground: The cancer is caused when cells start dividing abnormally in the body. Age, genetics and lifestyle are major risk factors in developing cancer. The World Cancer Research Fund states that colorectal cancer incidence is globally ranked third in men and second in women. This highlights the need for effective screening and management of colorectal cancer to achieve better prognosis to prevent mortality and morbidity. Screening and management are not uniform all over the world, and it is affected by the economy of individual countries. In this context, we aimed to explore the prognosis of colorectal cancer in developed and developing countries and also to look for the factors affecting the prognosis.Material and Methods: A systematic search of the peer-reviewed journals from databases at Perdana University library which includes British Medical Journal, Up To Date, The Lancet, and Pubmed was done to answer the research questions. Results: We found that developed countries were in the west having a predominantly Caucasian population. The 5-year survival of patients with colorectal cancer (2008-13) was found to be least in Poland and the highest in Australia. In the developing countries it was found to have a broad representation from different ethnicities. The 5-year survival of colorectal cancer fwas ound to be least in Ghana and highest in Turkey.Conclusion: Looking at the results, the range of prognosis among developed countries is narrower than those in developing countries. This may be due to standardized screening and treatment practice in developed countries
Prevention of Nosocomial Pneumonia After Trauma
Get PDFIntroduction : Mortality is an important criterion for assessing trauma patients. Nosocomial infection is known to increase the risk of death. Increased morbidity of Ventilation associated Pneumonia(VAP) in trauma patients implies the need for prevention of VAP.
Objective : Our goal is to review the validness of those strategies on 2021 and for trauma patients.
Method : Six people conducted a literature survey(2021.04.14-18) and the inclusion criteria were; nosocomial infection after trauma, prevention risk factor, epidemiology, prevention, treatment. The theme was narrowed down to ‘VAP’. The keywords were selected from a review research from Keyt H et al.(2014) Considering how each keyword affects ‘VAP’, we put together our classified literature.
Result : Non-invasive positive pressure ventilation (NIPPV) is useful for severe thoracic trauma patients to lower the risk of VAP. Early tracheostomy is recommendable since it’s benefits for Spinal Cord Injury(SCI) patients with prolonged mechanical ventilation.
Subglottic suctioning endotracheal tubes(ETTs) are an effective method to prevent VAP on trauma patients. It reduces probability, delays occurrence, and lowers the sensitivity of pneumonia after trauma. Strictly ‘complied’ Ventilator Bundle (including Head of Bed Elevation) is an effective method for VAP prevention in trauma patients.
Selective Digestive Tract Decontamination(SDD) is a standardized treatment to reduce VAP and appears to contain mortality of trauma patients.
Re-intubation, antibacterial coated ETTs, oral decontamination and probiotic administration lower VAP incidence for ICU patients, not specifically for trauma patients.
Conclusion : To prevent VAP in trauma patients, we recommend choosing from: Non-invasive positive pressure ventilation, Re-intubation, Early tracheostomy, Head of Bed elevation, Subglottic suctioning endotracheal tubes, Selective digestive tract decontamination