Knowledge, attitudes, practices and perceived barriers of emergency health care providers regarding sepsis and septic shock in a tertiary care centre: A cross-sectional study

This study aimed to assess knowledge, attitudes, practices, and perceived barriers of emergency healthcare providers regarding the management of sepsis and septic shock. This cross-sectional study was conducted in the Emergency Department of Aga Khan University Hospital, Karachi, Pakistan from August to October 2017. A total of 53 healthcare providers participated in the study. Overall, 42(79%) of the participants demonstrated correct knowledge of the sepsis bundle. The most common barrier reported in the compliance of the sepsis bundle was a shortage of staff (62%), followed by delayed presentation of patients (58%) and overcrowding (42%). Furthermore, better staffing was perceived by the participants (60%) to improve the care of septic patients, followed by sepsis awareness sessions (23%) and reduction in ED crowding (11%). Staff shortage, delayed presentation of patients, and ED overcrowding were considered the most common barriers in the management of sepsis in this setting

Effectiveness of high-fidelity simulation in training emergency medicine physicians in point of care ultrasonography in Pakistan: A quasi-experimental study

Background: Point-of-care ultrasound (PoCUS) is frequently utilized in emergency medicine (EM), with an extended-focused assessment with sonography in trauma (e-FAST) being the most widely used PoCUS modality. This modality is not only time- and cost-efficient, but it is highly accurate in the diagnosis and management of surgical patients in the emergency department, as well as being highly predictive of patient outcomes. Targeted training is essential to ensure a learner\u27s confidence in image acquisition, interpretation, and translation of knowledge to making clinical decisions. High-fidelity simulation offers a uniquely safe and mistake-forgiving environment to teach and train medical professionals. The present study evaluated the effectiveness of a high-fidelity simulator to train EM physicians in e-FAST at a tertiary care teaching hospital in a lower-middle-income country.Methods: This quasi-experimental study was performed at a state-of-the-art simulation center of a multidisciplinary university hospital in Karachi, Pakistan. Subjects were included if they were EM physicians who volunteered to participate and were available for the entire training and testing period. The educational intervention included lectures and hands-on practice on a high-fidelity simulator (SonoSim, Santa Monica, CA).Knowledge and image interpretation on e-FAST were evaluated using a questionnaire, administered before and after the training course. Each participant\u27s ability to acquire and interpret satisfactory images was assessed by experienced EM physicians and recorded. Participants were also administered a needs assessment survey and a course evaluation. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). All the tests were two-sided, and p-values ≤0.05 were considered significant. Baseline characteristics and outcome variables were recorded and compared by Wilcoxon signed-rank tests.Results: A total of 31 EM physicians, 12 (38.7%) men and 19 (61.3%) women, were enrolled in the study, with 24 (77.3%) having one to three years of EM experience. Mean and percentage group performance improved from 6 and 40% before the intervention to 14.5 and 96.6% after the intervention (Z=4.867, p≤0.05). Most improvement in image acquisition on high-fidelity simulation was observed in the upper right quadrant of the suprapubic window (29/31; 93.5%), followed by the upper left quadrant (27/31; 87%) and the subxiphoid window (21/31; 67%). All 31 participants reported improvements in comfort and confidence level with PoCUS after attending the workshop.Conclusions: EM physicians who attended a brief workshop incorporating simulation demonstrated improvements in knowledge and image acquisition skills in all domains tested. High-fidelity simulation training is an effective modality for training EM physicians in e-FAST

Medical perspective of cupping therapy (Ḥijama): a review

Traditional and alternative medicine practitioners have used cupping therapy for centuries.Growing data suggests that it may help treat disorders that are associated to pain in recentyears. An overview of the use of cupping therapy is provided in this article. One of themost effective treatments for Ilaj bil Tadbeer is hijama. A vacuum is created to eitherrelease blood from beneath the skin's surface or merely suction the area without allowingany blood out in this unique therapeutic method, which involves positioning cup-shapedveins on the body's surface. However, the effects in certain clinical trials were really strong.It is suggested that medical professionals or researchers in order to ascertain the efficacyof hijama in the treatment of various illnesses

A review of medicinal herbs in the management of male infertility

Male infertility can be caused by a variety of factors, including neurohormonal imbalances, reproductive tissue disturbances, and qualitative and quantitative degradation of semen. There is a global decline in male reproductive health, and modern therapeutic options to tackle male infertility are expensive, less accessible and have extended treatment durations and adverse effects. When it comes to male reproductive health, herbal therapies are in a much better position to provide more holistic approaches. As aphrodisiacs, a unique class of herbs defined in herbal pharmacology, nourish and stimulate the body's sexual tissues. A careful evaluation of the current information on drugs and their probable functions in treating male infertility is the purpose of this paper

Thermal Analysis of Staggered Pin Fin Heat Sink for Central Processing Unit

The advancement of microelectronics technology in producing high clock speed and power density’s central processor unit (CPU) indirectly related to thermal management issue. This is a major challenge to the manufacturers, designers and researchers to find the optimum design of the cooling system. If the problem is not being tackled, it will become a major setback to the development of electronic components and devices in the next five to ten years. The most popular technique used in the electronic devices is a metal heat sink with high heat transfer rate. The choice and suitable for the optimal heat sink design are needed in order to control and increase the heat dissipation. In this paper, 3D simulation staggered pin fin heat sink is designed and analyzed using COMSOL Multiphysics software. The finding of this study then is used to propose an optimal staggered pin fin arrangement of heat sink design that could give better thermal performance

Structural, electromagnetic and microwave properties of magnetite extracted from mill scale waste via conventional ball milling and mechanical alloying techniques

This study presents the utilization of mill scale waste, which has attracted much attention due to its high content of magnetite (Fe3 O4 ). This work focuses on the extraction of Fe3 O4 from mill scale waste via magnetic separation, and ball milling was used to fabricate a microwave absorber. The extracted magnetic powder was ground-milled using two different techniques: (i) a conventional milling technique (CM) and (ii) mechanical alloying (MM) process. The Fe3 O4 /CM samples were prepared by a conventional milling process using steel pot ball milling, while the Fe3 O4 /MM samples were prepared using a high-energy ball milling (HEBM) method. The effect of milling time on the structural, phase composition, and electromagnetic properties were examined using X-ray diffraction (XRD) and a vector network analyzer (VNA). XRD confirmed the formation of magnetite after both the magnetic separation and milling processes. The results revealed that Fe3 O4 exhibited excellent microwave absorption properties because of the synergistic characteristics of its dielectric and magnetic loss. The results showed that the Fe3 O4 /CM particle powder had a greater absorption power (reflection loss: <−10 dB) with 99.9% absorption, a minimum reflection loss of −30.83 dB, and an effective bandwidth of 2.30 GHz for 2 mm thick samples. The results revealed the Fe3 O4 /MM powders had higher absorption properties, including a higher RL of −20.59 dB and a broader bandwidth of 2.43 GHz at a matching thickness of only 1 mm. The higher microwave absorption performance was attributed to the better impedance matching property caused by the porous microstructure. Furthermore, the magnetite, Fe3 O4 showed superior microwave absorption characteristics because of the lower value of permittivity, which resulted in better impedance matching. This study presents a low-cost approach method by reutilizing mill scale waste to fabricate a high purity crystalline Fe3 O4 with the best potential for designing magnetic nano-sized based microwave absorbers

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat